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BACKGROUND Multiple societal guidelines recommend medical optimization and exercise therapy for patients with claudication prior to lower extremity revascularization (LER). However, the application of those guidelines in practice remains unknown. Our hypothesis is that vascular surgeons (VS) are more adherent to guidelines compared to non-vascular surgeons treating claudication. METHODS The records of patients undergoing LER for claudication in a single center were reviewed, and adherence to guidelines prior to LER was assessed. Patients received conservative therapy if the impact of claudication on quality of life (QOL) was documented, ankle brachial index (ABI) was obtained, and patients were treated with at least 3 months of walking exercise and smoking cessation when indicated. RESULTS There were 187 patients treated for claudication (VS=65, non-vascular surgeons=122). There were 161 patients who underwent endovascular intervention, 19 patients had an open revascularization, and 7 patients had a hybrid prin the medical management of vascular claudication prior to LER was higher among VS compared with non-vascular surgeons, overall rates of adherence were low. Stricter institutional protocols and oversight across specialties are needed to reinforce the application of the established standards of care. R-848 supplier OBJECTIVES The use of unfractionated heparin in hypovolemic shock, aortic clamping and visceral reperfusion is still not established, despite evidence of inhibition of early cell damage. This study investigated the potential protective effect of unfractionated heparin on hepatic and renal apoptosis in a porcine ischemia and reperfusion model. METHODS Twenty-one male swine (Sus scrofa) were divided into three groups sham (n = 5), heparin (n = 8) and non-heparin (n = 8). The heparin and non-heparin groups underwent hypovolemic shock for 30 min, supraceliac aortic clamping for 1 h and reperfusion for 3 h. Unfractionated heparin 200 mg/kg was administered to the heparin group during aortic clamping. Hemodynamic and laboratory parameters were monitored, including aminotransferase and serum urea. Histological lesion scores were applied to hematoxylin & eosin-stained liver and kidney sections. Apoptosis quantification was performed by caspase-3 immunohistochemistry. RESULTS The proposed model caused a severe cardiocirculatory disturbance in the heparin and non-heparin groups, observed by the carotid-femoral pressure gradient and lactic acidosis. There was no significant difference in hemodynamic and laboratory parameters between these two groups. The mean values of liver and renal histological lesion scores did not present any significant differences. Caspase-3 immunoexpression was lower in the heparin than the non-heparin group for both liver and kidney. CONCLUSIONS Attenuation of liver and kidney cell apoptosis in pigs undergoing systemic heparinization suggests a potential use for heparin in modulating cell death under critical hemodynamic conditions. OBJECTIVES To compare the clinical characteristics and the dynamics of viral load between the imported and non-imported patients with COVID-19. DESIGN AND METHODS Data from 51 laboratory-confirmed patients were retrospectively analyzed. RESULTS The incubation period in the tertiary group was longer than that in the imported and secondary groups (both P  0.05). For the tertiary group, the viral load was undetectable for half of the patients (52.63%) on day 7, and all patients on day 14. For 1/3rd of the patients in the imported and secondary groups, the viral load remained positive on day 14 after the admission. CONCLUSIONS COVID-19 can present as pneumonia with less onset of symptoms, and the infectivity of SARS-CoV2 may gradually decrease in the tertiary patients. OBJECTIVES The performance of the investigational-use-only version of the BioFire® FilmArray® Pneumonia Panel (FA-Pneumo), a high-order nested multiplex PCR, was evaluated for detection of typical respiratory bacterial pathogens and antibiotic resistance genes in sputa and endotracheal aspirate (ETA) specimens. METHODS Thirty-one sputa and 69 ETA specimens were analyzed. The diagnostic performance of FA-Pneumo was assessed using routine microbiological methods as the reference standard. RESULTS Overall sensitivity and specificity for organism detection using FA-Pneumo were 98.5% and 76.5%, respectively. The sensitivities for each pathogen were 100%, except for Klebsiella aerogenes, and the range of specificity was 83.3 – 99.0%. FA-Pneumo detected antimicrobial resistance genes in 17 out of 18 specimens (94.4%) that were resistant by antimicrobial susceptibility testing. FA-Pneumo additionally detected 25 resistance genes in 22 specimens, and sequencing for the presence of resistance genes confirmed the majority of these results (20/25, 80%). Semi-quantitative analysis of bacterial nucleic acid amounts by FA-Pneumo revealed that 88.2% of the identified bacteria (67/76) with ≥ 106 copies/mL also gave culture-positive results with significant amounts of bacteria. CONCLUSION FA-Pneumo is a rapid test with high sensitivity for detection of bacteria and antimicrobial resistance genes from sputum and ETA specimens and could aid in determining antibiotic therapy. BACKGROUND We assessed the cost-effectiveness of Camino Verde, a community-based mobilization strategy to prevent and control dengue and other mosquito-borne diseases. A cluster-randomized controlled trial in Managua, Nicaragua, and in three coastal regions in Guerrero, Mexico (75 intervention and 75 control clusters), Camino Verde used non-governmental community health workers, called brigadistas, to support community mobilization. This donor-funded trial demonstrated reductions of 29·5% (95% confidence interval, CI 3·8%-55·3%) on dengue infections and 24·7% (CI 1·8%-51·2%) on self-reported cases. METHODS We estimated program costs through a micro-costing approach and semi-structured questionnaires. We show results as incremental cost-effectiveness ratios (ICER) for costs per disability-adjusted life-year (DALYs) averted and conducted probabilistic sensitivity analyses. FINDINGS The Camino Verde trial spent $16·72 in Mexico and $7·47 in Nicaragua per person annually. We found an average of 910 (CI 487-1 353) and 500 (CI 250-760) dengue cases averted annually per million population in Mexico and Nicaragua, respectively, compared to control communities.