12 ng/dl for the SSST (sensitivity 73.5%, specificity 79.5%). No patients experienced adverse events during the SSST. Conclusions The SSST was safe and convenient for PA diagnosis. The accuracy of the SSST for a confirmatory diagnosis of PA was better than that of the RSST. The SSST is a reliable alternative for PA confirmation in Chinese individuals.Estrogen appears to play a role in minimizing skeletal muscle damage as well as regulating the expression of the protective heat shock proteins (HSPs). To clarify the relationship between estrogen, muscle HSP content, and muscle damage, tibialis anterior (TA) muscles from ovary-intact (OVI; n = 12) and ovariectomized (OVX; 3 weeks, n = 12) female Sprague-Dawley rats were subjected to either 20 or 40 lengthening contractions (LCs). Twenty-four hours after stimulation, TA muscles were removed, processed, and assessed for HSP25 and HSP72 content as well as muscle (damage) morphology. No differences in muscle contractile properties were observed in TA muscles between OVI and OVX animals for peak torque during the LCs. In unstressed TA muscles, the basal expression of HSP72 expression was decreased in OVX animals (P less then 0.05) while HSP25 content remained unchanged. Following 20 LCs, HSP25 content was elevated (P less then 0.05) in TA muscles from OVX animals but unchanged in muscles from OVI animals. Following 40 LCs, HSP25 content was elevated (P less then 0.01) in TA muscles from both OVI and OVX animals while HSP72 content was elevated only in TA muscles from OVI animals (P less then 0.05). Taken together, these data suggest the loss of ovarian hormones, such as estrogen, may impair the skeletal muscle cellular stress response thereby rendering muscles more susceptible to certain types of contraction induced damage. Novelty Ovariectomy alters muscle HSP72 content. Muscle contractile measures are maintained following ovariectomy.The COVID-19 pandemic has strained global health care systems in ways that simply could not have been imagined just several months ago. learn more Writing from the heart of New York City - the unfortunate new epicenter of this pandemic - we have been confronted with this new reality head-on. As directors of two major academic cardiac catheterization laboratories in the city, we both have had to operationalize logistical planning of physician and staff redeployments as well as modification of our respective hospital units including conversion of large portions of the catheterization laboratory into COVID-19 intensive care units in order to deal with the surge of COVID-19 patients within the hospital.Introduction Assessment of intraocular pressure (IOP) is a core diagnostic tool in management of glaucoma. All established ways to measure IOP use indirect approaches through ocular tissues, mainly the cornea or the sclera. Telemetric IOP measurement with an implantable device could eliminate bias caused by indirect techniques and could allow continuous monitoring. A favorable safety profile, high efficacy and good tolerability are key requirements.Areas covered The Eyemate-IO™ system (Implandata Ophthalmic Products GmbH, Hannover, Germany) is a novel CE-marked implantable medical device for direct measurement of IOP. It consists of an intraocular sensor ring and an external reading device. This review presents the mechanism of telemetric IOP measurement and summarizes the available clinical data. Twelve months follow-up data of two clinical trials provide support for the efficacy and safety of this device.Expert opinion The implantable Eyemate-IO™ in keratoprosthesis was well tolerated; recorded adverse events were known complications of standalone surgery. The system had a good agreement with other IOP measuring modalities, including intraoperative manometry. In glaucoma patients, the Eyemate-IO™ could be implanted safely and showed a favorable efficacy and safety profile in the first twelve months postoperatively. The potential to achieve IOP monitoring with the Eyemate-IO™ seems promising.Root cause analyses were intended to search for system vulnerabilities rather than individual errors, using a human factors engineering approach. In practice, root cause analyses done in the NHS may generally fail to identify components where there are organisational failures, as there may be an inherent desire to protect institutional reputation. A human factors approach to root cause analysis looks at system vulnerabilities, considering the entirety of the environment in which an individual works and taking into account factors such as the physical environment and individual mental characteristics. Other human factors include group dynamics, task complexity and concurrent tasks. It is time that the growing evidence of the potential shortcomings of root cause analysis, especially as frequently applied within the NHS, is heeded. At present, rather than assisting learning it may be an impediment to patient safety. The authors propose that root cause analyses should be performed by a group of people who are not managing the service. External organisations such as the General Medical Council, Nursing and Midwifery Council, Care Quality Commission and Practitioner Performance Assessment are heavily reliant on this tool when concerns are raised. If the flaws in root cause analysis can be eliminated, drawing on the available evidence, cases such as those of Dr Hadiza Bawa-Garba and Mr David Sellu might be avoided.Shared decision making is a collaborative process between clinicians and patients, which aims to select the most suitable management option based on both best available evidence and patient preferences. This article looks at the role of shared decision making in perioperative medicine.Desflurane has a carbon equivalence 20 times greater than sevoflurane. This article discusses alternative anaesthetic techniques, including sevoflurane, xenon, total intravenous anaesthesia and regional techniques, and methods of reducing venting of gases, which might lower the environmental impact of anaesthesia.Metastatic spinal cord compression is compression of the spinal cord or cauda equina as a result of metastatic deposits in the spinal column. It affects approximately 4000 cases per year in England and Wales. Prompt identification and treatment of metastatic spinal cord compression is necessary to prevent irreversible neurological injury, treat pain and maintain patients' mobility, function and independence. Survival of patients with common malignancies has improved significantly with the ongoing development of radiotherapy and chemotherapy, as well as improved surgical treatment of resectable primary tumours. This article outlines the clinical approach to presentation, pathophysiology, diagnosis and management.