In order to study the integration of reticuloendotheliosis virus (REV) in pigeonpox virus (PPV), we collected suspected pigeonpox disease material, amplified the 4b core protein gene of PPV, the gp90 gene of REV, and the integrated sequence fragments from the end of the ORF201 segment of PPV to the beginning of the LTR of REV, and sequenced these genes. The results showed that a 4b core protein fragment of 332 bp was amplified and identified as pigeonpox virus, which was named SX/TY/LTR 01/2023. Sequence analysis showed that the pigeonpox virus isolate belonged to genotype A2, which was the closest to the domestic CVL strain, with a identity of 99.4%. A band of 1191 bp was amplified from the gp90 gene of REV, named SX/TY/PPV-REV01/2023, and sequence analysis indicated that REV belonged to genotype III. The sequence analysis showed that REV belonged to genotype III, and belonged to the same large branch as the domestic isolates JSRD0701 and LNR0801, with 99.3% identity. The integrated sequence fragment was amplified to a band of 637 bp, which determined that the REV sequence was integrated in the PPV rather than a mixed infection of the two viruses. This indicates that REV was integrated in this isolation of PPV, suggesting that pigeon farms need to prevent reticuloendotheliosis at the same time when preventing pigeonpox.

OBJECTIVE: The use of goal-directed fluid therapy (GDFT) has been shown to reduce complications and improve prognosis in high-risk abdominal surgery patients. However, the utilization of pulse pressure variation (PPV) guided GDFT in laparoscopic surgery remains a subject of debate. We hypothesized that utilizing PPV guidance for GDFT would optimize short-term prognosis in elderly patients undergoing laparoscopic radical resection for colorectal cancer compared to conventional fluid therapy.
METHODS: Elderly patients undergoing laparoscopic radical resection of colorectal cancer were randomized to receive either PPV guided GDFT or conventional fluid therapy and explore whether PPV guided GDFT can optimize the short-term prognosis of elderly patients undergoing laparoscopic radical resection of colorectal cancer compared with conventional fluid therapy.
RESULTS: The incidence of complications was significantly lower in the PPV group compared to the control group (32.8% vs. 57.1%, P = .009). Additionally, the PPV group had a lower occurrence of gastrointestinal dysfunction (19.0% vs. 39.3%, P = .017) and postoperative pneumonia (8.6% vs. 23.2%, P = .033) than the control group.
CONCLUSIONS: Utilizing PPV as a monitoring index for GDFT can improve short-term prognosis in elderly patients undergoing laparoscopic radical resection of colorectal cancer.
BACKGROUND: ChiCTR2300067361; date of registration: January 5, 2023.

UNASSIGNED: This study aimed to develop a deep learning system to identify and differentiate the metastatic cervical lymph nodes (CLNs) of thyroid cancer.
UNASSIGNED: From January 2014 to December 2020, 3059 consecutive patients with suspected with metastatic CLNs of thyroid cancer were retrospectively enrolled in this study. All CLNs were confirmed by fine needle aspiration. The patients were randomly divided into the training (1228 benign and 1284 metastatic CLNs) and test (307 benign and 240 metastatic CLNs) groups. Grayscale ultrasonic images were used to develop and test the performance of the Y-Net deep learning model. We used the Y-Net network model to segment and differentiate the lymph nodes. The Dice coefficient was used to evaluate the segmentation efficiency. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were used to evaluate the classification efficiency.
UNASSIGNED: In the test set, the median Dice coefficient was 0.832. The sensitivity, specificity, accuracy, PPV, and NPV were 57.25%, 87.08%, 72.03%, 81.87%, and 66.67%, respectively. We also used the Y-Net classified branch to evaluate the classification efficiency of the LNs ultrasonic images. The classification branch model had sensitivity, specificity, accuracy, PPV, and NPV of 84.78%, 80.23%, 82.45%, 79.35%, and 85.61%, respectively. For the original ultrasonic reports, the sensitivity, specificity, accuracy, PPV, and NPV were 95.14%, 34.3%, 64.66%, 59.02%, 87.71%, respectively. The Y-Net model yielded better accuracy than the original ultrasonic reports.
UNASSIGNED: The Y-Net model can be useful in assisting sonographers to improve the accuracy of the classification of ultrasound images of metastatic CLNs.

UNASSIGNED: The elastic scattering spectroscopy (ESS) device (DermaSensor Inc., Miami, FL) is a noninvasive, painless, adjunctive tool for skin cancer detection.
UNASSIGNED: To investigate the performance of the ESS device in the detection of melanoma.
UNASSIGNED: A prospective, investigator-blinded, multicenter study was conducted at 8 United States (US) and 2 Australian sites. All eligible skin lesions were clinically concerning for melanoma, examined with the ESS device, subsequently biopsied according to dermatologists\' standard of care, and evaluated with histopathology. A total of 311 participants with 440 lesions were enrolled, including 44 melanomas (63.6% in situ and 36.4% invasive) and 44 severely dysplastic nevi.
UNASSIGNED: The observed sensitivity of the ESS device for melanoma detection was 95.5% (95% CI, 84.5% to 98.8%, 42 of 44 melanomas), and the observed specificity was 32.5% (95% CI, 27.2% to 38.3%). The positive and negative predictive values were 16.0% and 98.1%, respectively.
UNASSIGNED: The device was tested in a high-risk population with lesions selected for biopsy based on clinical and dermoscopic assessments of board-certified dermatologists. Most enrolled lesions were pigmented.
UNASSIGNED: The ESS device\'s high sensitivity and NPV for the detection of melanoma suggest the device may be a useful adjunctive, point-of-care tool for melanoma detection.

The capnodynamic method, based on Volumetric capnography and differential Fick mathematics, assess cardiac output in mechanically ventilated subjects. Capnodynamic and established hemodynamic monitoring parameters\' capability to depict alterations in blood volume were investigated in a model of standardized hemorrhage, followed by crystalloid and blood transfusion.
Ten anesthetized piglets were subjected to controlled hemorrhage (450 mL), followed by isovolemic crystalloid bolus and blood re-transfusion. Intravascular blood volume, and all hemodynamic variables, were determined twice after each intervention. The investigated hemodynamic variables were: cardiac output and stroke volume for capnodynamics and pulse contour analysis, respectively, pulse pressure and stroke volume variability and mean arterial pressure. One-way ANOVA and Tukey\'s test for multiple comparisons were used to identify significant changes. Trending was assessed by correlation and concordance.
Concordance against intravascular volume changes for capnodynamic cardiac output and stroke volume were 96 and 94%, with correlations r = .78 and .68, (p < .0001) with significant changes for 6 and 5 of the 6 measuring points, respectively. Mean arterial pressure and pulse pressure variation had a concordance of 85% and 87%, r = .67 (p < .0001) and r = -.45 (p < .0001), respectively, and both changed significantly for 3 of 6 measuring points. Pulse contour stroke volume variation, stroke volume and cardiac output, showed concordance and correlation of 76%, r = -.18 (p = .11), 63%, r = .28 (p = .01) and 50%, r = .31 (p = .007), respectively and significant change for 1, 1 and 0 of the measuring points, respectively.
Capnodynamic cardiac output and stroke volume did best depict the changes in intravascular blood volume. Pulse contour parameters did not follow volume changes in a reliable way.

BACKGROUND: Methods of sclerotomy closure following a vitrectomy, including the use of sutures, have been associated with complications such as inflammation, foreign body sensation, and infection. Here, we test an innovative approach to scleral wound closure following pars plana vitrectomy that involves plugging the wound. We investigated several materials with the intent of using products that were either already approved by the FDA for other types of procedures or were biocompatible patient-derived materials.
METHODS: We examined whether scleral wounds could be sealed by a clot or internal \"plug\" rather than a suture or an external adhesive. We tested patient-derived materials (platelet-rich plasma (PRP) and whole blood) as well as polyethylene glycol (PEG) sealant. Whole blood and PRP were prevented from clotting prematurely using sodium citrate, and were clotted for the study with thrombin. Polyethylene glycol (PEG) sealant was prepared according to manufacturer\'s recommendations. We used fresh-frozen cadaveric porcine eyes. We tested several methods to form plugs using the above materials, as well as various methods to deliver the plugs into the sclerotomy incisions. We used a novel technique of manual vitrectomy. Successfully generated and implanted clots were tested for efficacy with the Seidel test.
RESULTS: Polyethylene glycol (PEG) sealant fractured during our attempts at molding and inserting the plug. In contrast, both whole blood and PRP yielded successful plugs for insertion. We molded a whole blood clot plug by allowing it to clot inside a 20-gauge angiocath catheter and we successfully delivered it through a 23G trocar. At baseline, no wound leakage was apparent. However, the whole blood clot dislodged during the Seidel test. We successfully molded and delivered a PRP clot plug using a tapered 2-20 μl pipette tip, using MAXGrip Forceps to push it through into the wound. No scleral wound leakage was noted at our baseline physiologic infusion pressure. Furthermore, the PRP clot plug prevented scleral wound leakage up to a pressure of 60 mmHg and was confirmed with the Seidel test.
CONCLUSIONS: Our findings suggest that insertion of a clot plug made from either whole blood or PRP may be an effective strategy for scleral wound closure following pars plana vitrectomy. Further testing in preclinical models is warranted to further refine the materials and methods, since this appears to have the potential to improve the closure of the scleral wounds after pars plana vitrectomy.

BACKGROUND: Less than 50% of stroke patients in Norway reach hospital within 4 h of symptom onset. Early prehospital identification of stroke and triage to the right level of care may result in more patients receiving acute treatment. Quality of communication between paramedics and the stroke centre directly affects prehospital on-scene time, emphasising this as a key factor to reduce prehospital delay. Prehospital stroke scales are developed for quick and easy identification of stroke, but have poor sensitivity and specificity compared to an in-hospital assessment with the National Institutes of Health Stroke Scale (NIHSS). The aim of the Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) is to assess whether a structured learning program, prehospital NIHSS and a mobile application facilitating communication with the stroke physician may improve triage of acute stroke patients.
METHODS: A stepped wedge cluster randomised controlled intervention design will be used in this trial in Oslo, Norway. Paramedics at five ambulance stations will enrol adult patients with suspected stroke within 24 h of symptom onset. All paramedics will begin in a control phase with standard procedures. Through an e-learning program and practical training, a random and sequential switch to the intervention phase takes place. A mobile application for NIHSS scoring, including vital patient information for treatment decisions, transferring data from paramedics to the on-call stroke physician at the Stroke Unit at Oslo University Hospital, will be provided for the intervention. The primary outcome measure is positive predictive value (PPV) for prehospital identification of patients with acute stroke defined as the proportion of patients accepted for stroke evaluation and discharged with a final stroke diagnosis. One thousand three hundred patients provide a 50% surplus to the 808 patients needed for 80% power to detect a 10% increase in PPV.
CONCLUSIONS: Structured and digital communication using a common scale like NIHSS may result in increased probability for better identification of stroke patients and less stroke mimics delivered to a stroke team for acute diagnostics and treatment in our population.
BACKGROUND: ClinicalTrials.gov NCT04137874 . Registered on October 24, 2019.

OBJECTIVE: Implementation of quality control measures ensures acceptable performance by a laboratory. This study aims to assess the quality of cervical cytopathology reporting using quality metrics like ASCUS/SIL ratio, cytohistological correlation (CHC) and positive predictive value (PPV) of Pap smears for squamous lesions of cervix.
METHODS: Retrospective study of Pap smears from 2015 to 2020 was done. Quality metrics analyzed include: a) ASCUS/SIL ratio, b) CHC and c) PPV. Cases with cervical biopsies/hysterectomy were included for CHC, and discrepancy defined as two category variations in CHC.
RESULTS: A total of 22,695 cervical cytology smears were reported. Unsatisfactory smears(n=290) were excluded. Squamous lesions reported in 233 smears and Bethesda nomenclature was followed. Definitive diagnosis (SILs and SCC) was given in 74% cases. ASCUS and ASC-H were reported in 47 and 14 cases. Most common lesion on Pap smear was HSIL(n=92), followed by LSIL(n=64), and 2 were ungradable SIL. SCC was reported in 14 smears. The ASCUS/SIL ratio was 0.38. CHC(n=139) was 100% for ASC-H ,LSIL, SCC and 84.7% for HSIL. A review of discrepant cases suggested sampling and interpretational discrepancy in 5 and 1 cases respectively. The PPV of Pap smear for squamous lesions was 96.4%.
CONCLUSIONS: It is essential to have good quality cytopathology reports for early identification permitting accurate management.Most commonly used quality indicator for cytopathology is ASCUS/SIL ratio. This study suggests inclusion of CHC and PPV of pap smear as quality metrics, since these are easily measurable and serve as a good indicator of quality in cervical cytopathology reporting.

An iris-claw intraocular lens (IOL) has been widely used as a secondary implant in aphakic patients. The study presents the results of implanting the anterior chamber iris-claw Artisan IOL in cases of where an appropriate posterior capsular support is lacking. The study included 132 patients subjected to primary IOL implantation during complicated cataract surgery with damage to the posterior capsule (I), secondary implantation in aphakia (II), secondary implantation during penetrating keratoplasty (III), and secondary implantation during pars plana vitrectomy with luxated IOL extraction (IV). We analyzed the records of best-corrected visual acuity (BCVA), spherical equivalent (SE), intraocular pressure (IOP), and corneal endothelial cell count (cECC), taken before and 1, 2, 3, and 4 years after the surgery. BCVA depended on the time after IOL implantation and the primary indication. Four years post-surgery, the SE values were the lowest in group III. IOP was the same in all groups both before and after the surgery, but 4 years after the surgery IOP values in group IV were higher than in group III. The cECC decreased every year after the surgery in all groups, but four years after the IOL implantation, the lowest cECC values were observed in group IV. At the same time, all groups of patients showed improved BCVA, stable refraction, and a low percentage of postoperative complications.

Diagnosis of Cytomegalovirus (CMV) primary infection during pregnancy or in immunocompetent patients relies on serology with detection of specific CMV-IgG and IgM. In case of positive CMV-IgM in pregnant women, CMV-IgG avidity is now widely recommended, but in general population it is not currently performed.
In this study, we aimed to determine CMV-IgM positive predictive values (PPV) in different clinical settings.
We conducted a retrospective study on positive CMV-IgM in our virology laboratory from 2013 to 2019, in three clinical groups: screening in non-symptomatic pregnant women (group 1), pregnant women with ultrasound (US) abnormalities (group 2) and patients (general population) with clinical signs suggestive of CMV primary infection (group 3). CMV-IgG avidity had been performed in all cases allowing to evaluate PPV of positive CMV-IgM to diagnose CMV primary-infection in each group.
Between 2013 and 2019, 6859 serum samples were found positive for CMV-IgM and had been tested for CMV-IgG avidity, with 6560 sera for group 1, 30 for group 2 and 269 for group 3. Overall, low avidity confirming primary infection was observed respectively in 16.4 % for group 1, 36.7 % for group 2, and 35.3 % for group 3. CMV-IgM PPV was significantly lower in group 1 compared to groups 2 (p = 0.01) and 3 (p < 0.001).
Our observations highlight the major importance of including CMV-IgG avidity in the diagnostic algorithm, whatever the clinical situation (for immunocompetent patients), to confirm or exclude a recent CMV primary infection in case of positive CMV-IgM.