Average Ban DSS and subsequently updated score system results were 4.6 ± 1.5 points (range 2-6) for both scores. Conclusions Difficulties were encountered in applying the score when simultaneous multiple wedge resections were performed. The laparoscopic DSS is applicable to robotic LRs with some limitations due to the peculiarity of the two different minimally invasive approaches. A specific robotic difficulty rating score could be necessary to include these elements.Introduction Thoracoscopic repair of esophageal atresia and tracheo-esophageal fistula (EA/TEF) is challenging. We addressed this by designing a fully synthetic simulator of the procedure and described the design process and how its content validity was assessed. Methods An iterative design and assessment of content validity was undertaken in three stages. Data were collected from participants who trialed the model and completed a survey of their experience (adapted from Barsness et al.). Results The model was trialed by participants of varying experience. Each design refinement improved the model’s fidelity and validity. For the last iteration of the simulator, the observed averages (out of a maximum of 5) were value as a training tool 4.8, relevance 4.6, physical attributes 4.5, realism of material 4.25, realism experience 4.17, and ability to perform tasks 3.77. Conclusion An iterative design process based on end-user feedback has led to a synthetic simulator that has achieved a high level of content validity. This model has advantages over other EA/TEF simulators in that it is relatively inexpensive and does not use animal tissue, thus removing ethical and procurement issues. It was rated highly for its value and relevance to training.A probiotic is considered a live microbial feed supplement that has beneficial effects on the host. In this study, the probiotic property by which strain HS-08 increased intestinal acetate levels and enhanced IgA secretion, which may result in strengthening of the mucosal immune system.BACKGROUND Liraglutide was administered to patients with type 2 diabetes, and its effects on estimated glomerular filtration rate (eGFR) slopes and albuminuria were retrospectively evaluated. METHODS This study included 568 patients with type 2 diabetes who received liraglutide therapy (up to 0.9 mg/day) >1 year and were followed-up for a maximum of 2 years before and 7 years after treatment. find more The decline in renal function was estimated as the slope of the individual linear regression line of eGFR over the follow-up time. Spot urine samples were collected to measure albuminuria, which were calculated using creatinine levels. In addition, HbA1c, body weight, blood pressure, and heart rate were monitored. RESULTS The mean liraglutide treatment period was 3.1 ± 2.0 years. The mean baseline eGFR slope (mL/min/1.73m2/year) was -2.75 ± 6.04. After liraglutide treatment, the mean eGFR slope significantly improved (-1.42 ± 4.30, P less then 0.01). This effect appeared more pronounced for baseline eGFRs less then 45 mL/min/1.73 m2. Albuminuria, HbA1c, body weight, and systolic blood pressure levels were significantly reduced after treatment with liraglutide for 1 year, whereas diastolic blood pressure and heart rates were increased. CONCLUSIONS Patients treated with liraglutide experienced a significantly slower annual decline in kidney function. The benefit appeared more pronounced in patients with the development and progression of diabetic kidney disease. These results suggest that the benefits of liraglutide on kidney function identified in clinical trials appear to be well generalizable to clinical practice.RATIONALE Patients who receive invasive mechanical ventilation (IMV) are usually exposed to opioids as part of their sedation regimen. The rates of post-hospital prescribing of opioids are unknown. OBJECTIVES Determine the frequency of persistent post-hospital opioid use among patients who received IMV. METHODS We assessed opioid-naïve adults who were admitted to an intensive care unit (ICU), received IMV and survived at least 7d after hospital discharge in Ontario, Canada over a 26 month period; February, 2013 through March, 2015. The primary outcome was new persistent opioid use during the year following discharge. We assessed factors associated with persistent use using multivariable logistic regression. Patients receiving IMV were also compared with matched hospitalized patients who did not receive intensive care (non-ICU). MEASUREMENTS AND MAIN RESULTS Among 25,085 opioid-naive IMV patients, 5,007 (20.0%,95%CI 19.5-20.5) filled a prescription for opioids in the 7d following hospital discharge. During the year following, 648 (2.6%,95%CI 2.4-2.8) of the IMV cohort met criteria for new persistent opioid use. The patient characteristic most strongly associated with persistent use in the IMV cohort was being a surgical (vs medical) patient aOR 3.29,95%CI 2.72-3.97. The rate of persistent use was slightly higher than for matched non-ICU patients ((2.6% vs 1.5%) aOR 1.37,95%CI 1.19-1.58). CONCLUSIONS Twenty percentage of IMV patients received a prescription for opioids after hospital discharge; 2.6% met criteria for persistent use, an average of 300 new persistent users per year in a population of 14 million. Receipt of surgery was the factor most strongly associated with persistent use.BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by SARS-coronavirus 2 (SARS-CoV-2). Angiotensin converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) mediate viral infection of host cells. We reasoned that differences in ACE2 or TMPRSS2 gene expression in sputum cells among asthma patients may identify subgroups at risk for COVID19 morbidity. METHODS We analyzed gene expression for ACE2 and TMPRSS2, and for intercellular adhesion molecule 1 (ICAM-1)(rhinovirus receptor as a comparator), in sputum cells from 330 participants in the Severe Asthma Research Program-3 and 79 healthy controls. RESULTS Gene expression of ACE2 was lower than TMPRSS2, and expression levels of both genes was similar in asthma and health. Among asthma patients, male gender, African Americans race, and history of diabetes mellitus, was associated with higher expression of ACE2 and TMPRSS2. Use of inhaled corticosteroids (ICS) was associated with lower expression of ACE2 and TMPRSS2, but treatment with triamcinolone acetonide (TA) did not decrease expression of either gene.