In the second stage, more samples were used to verify the two SNPs. After comprehensive data analysis in the two stages, the frequency of rs28383797 G allele and rs653778 T allele in AS with uveitis was significantly higher than that in AS without uveitis (

=1.9×10

, OR=2.161, 95%CI=1.609-2.902 and

=1.5×10

, OR=2.028, 95%CI=1.610-2.554) and healthy controls.

Rs653778 (T allele) of IFNA13 and rs28383797 (G allele) of IFNA1 were associated with AS concomitant uveitis, and may act as the susceptibility genes of AS with uveitis in the Chinese population.

Rs653778 (T allele) of IFNA13 and rs28383797 (G allele) of IFNA1 were associated with AS concomitant uveitis, and may act as the susceptibility genes of AS with uveitis in the Chinese population.The pineal gland, one of the three equivalent avian biological clock structures, is also the site of intensive neurosteroid synthesis (7α-hydroxypregnenolone and allopregnanolone). Pineal neurosteroid biosynthesis involves six enzymes cytochrome P450 side-chain cleavage – Cyp11a1 encoded, cytochrome P4507α – Cyp7b1, 3β-hydroxysteroid dehydrogenase – Hsd3b2, 5α-reductase – Srd5a1, 3α-hydroxysteroid dehydrogenase – Akr1d1, and 5β-reductase – Srd5a3. Regulation of neurosteroid biosynthesis is not fully understood; although it is known that the E4BP4 transcription factor induces activation of biosynthetic cholesterol genes, which are the targets for SREBP (element-binding protein transcription factor). SREBP principal activity in the pineal gland is suppression and inhibition of the Period2 canonical clock gene, suggesting our hypothesis that genes encoding enzymes involved in neurosteroidogenesis are under circadian clock control and are the Clock Control Genes (CCGs). Therefore, through investigation of daily changes in Cyp11a1, Cyp7b1, Hsd3b2, Akr1d1, Srd5a1, and Srd5a3, pineal genes were tested in vivo and in vitro, in cultured pinealocytes. Experiments were carried out on pineal glands taken from 16-day-old chickens in vivo or using in vitro cultures of pinealocytes collected from 16-day-old animals. Both the birds in the in vivo experiments and the pinealocytes were kept under controlled light conditions (LD 1212) or in constant darkness (DD). Subsequently, materials were prepared for RT-qPCR analysis. Results revealed that three of the six tested genes Cyp11a1, Cyp7b1, and Srd5a3 demonstrated significant 24-hour variation in in vivo and in vitro. Findings of this study confirm that these genes could be under clock control and satisfy many of the requirements to be identified as CCGs.

Worldwide, children who acquired human immunodeficiency virus (HIV) at an early age, either perinatally or through blood transfusion, are reaching adolescence and adulthood due to successful antiretroviral treatment (ART). While many are thriving, a significant proportion face unprecedented multilevel challenges that can affect their long-term outcomes. Specifically, longstanding and poorly controlled HIV resulting from inadequate early regimens and nonadherence, along with the toxicities of some ART agents, can predispose them to sequelae including HIV-associated complications and other comorbidities.

This paper reviews and summarizes the unique issues facing adolescents and young adults with early acquired HIV (AYA-EAHIV), including ART challenges, emerging comorbidities, and complications, including mental health comorbidities, secondary prevention, and transition from pediatric/adolescent to adult care.

AYA-EAHIV are a special population that have lived their entire lives with the physical and psychological toll of HIV mandating targeted and purposeful approaches to optimize their management and outcomes. Multifaceted inclusive and context-specific approaches focusing on heightened research, risk reduction interventions, and 'outside the box’ thinking will be required to optimize treatment and reduce morbidity and mortality.

AYA-EAHIV are a special population that have lived their entire lives with the physical and psychological toll of HIV mandating targeted and purposeful approaches to optimize their management and outcomes. Multifaceted inclusive and context-specific approaches focusing on heightened research, risk reduction interventions, and 'outside the box’ thinking will be required to optimize treatment and reduce morbidity and mortality.

Medulloblastoma (MB) is a heterogeneous tumor of the cerebellum that is divided into four main subgroups with distinct molecular and clinical features. Sonic Hedgehog MB (SHH-MB) is the most genetically understood and occurs predominantly in childhood. Current therapies consist of aggressive and non-targeted multimodal approaches that are often ineffective and cause long-term complications. These problems intensify the need to develop molecularly targeted therapies to improve outcome and reduce treatment-related morbidities. In this scenario, Hedgehog (HH) signaling, a developmental pathway whose deregulation is involved in the pathogenesis of several malignancies, has emerged as an attractive druggable pathway for SHH-MB therapy.

This review provides an overview of the advancements in the HH antagonist research field. We place an emphasis on Smoothened (SMO) and glioma-associated oncogene homolog (GLI) inhibitors and immunotherapy approaches that are validated in preclinical SHH-MB models and that have therapeutic potential for MB patients. Literature from Pubmed and data reported on ClinicalTrial.gov up to August 2020 were considered.

Extensive-omics analysis has enhanced our knowledge and has transformed the way that MB is studied and managed. The clinical use of SMO antagonists has yet to be determined, however, future GLI inhibitors and multitargeting approaches are promising.

Extensive-omics analysis has enhanced our knowledge and has transformed the way that MB is studied and managed. The clinical use of SMO antagonists has yet to be determined, however, future GLI inhibitors and multitargeting approaches are promising.

Inflammatory bowel disease (IBD) patients in apparent clinical remission who present with irritable bowel syndrome (IBS)-like symptoms pose a diagnostic and therapeutic dilemma that is called post-IBD IBS. When associated with a diarrheal IBS presentation, this clinical syndrome is known as post-IBD IBS-D.

We review and describe the literature regarding the clinical overlap of IBD and IBS. We discuss prevalent theories regarding the pathophysiology of post-IBD IBS-D and whether this presentation represents coincident inherent IBS-D, IBS-D triggered by IBD, or an even more subtle level of IBD activity that is unrecognized by available laboratory modalities. We also discuss observations that post-IBD IBS-D patients harbor significantly increased colon mucosal eosinophils and appear to respond to a GI-hypoallergenic diet and budesonide therapy.

The symptoms overlap between IBD and IBS complicates diagnosis and subsequent management of patients with post-IBD IBS-D. In addition to current theories regarding the pathophysiology of this condition such as alterations in mucosal inflammation, the microbiota, mucosal permeability, and gut-brain interactions. This new avenue of eosinophilic colopathy and therapy directed toward food-derived immune response in patients with post-IBD IBS-D deserves additional investigation.

The symptoms overlap between IBD and IBS complicates diagnosis and subsequent management of patients with post-IBD IBS-D. In addition to current theories regarding the pathophysiology of this condition such as alterations in mucosal inflammation, the microbiota, mucosal permeability, and gut-brain interactions. This new avenue of eosinophilic colopathy and therapy directed toward food-derived immune response in patients with post-IBD IBS-D deserves additional investigation.Cardio-oncology is the care of cancer patients with cardiovascular disease. The need for a dedicated subspecialty emerged to address heart failure caused by drugs such as anthracyclines and anti-human epidermal growth factor receptor 2 (HER2) therapies, but over time has expanded into an exciting subspecialty with widening horizons. While still dealing with a lot of commonly recognised toxicities, such as heart failure, hypertension and coronary disease, new and revolutionary cancer therapies have been associated with challenging cardiovascular complications, requiring specialist input to manage effectively. Echocardiography is a key investigation, with advanced techniques such as three-dimensional and strain assessment allowing more accurate diagnosis and earlier detection of subtle changes. Cardiac magnetic resonance and biomarkers are useful adjuncts to aid diagnosis and management. With increasing cancer incidence and improved cancer survival rates, it is important that general cardiologists and physicians are aware of cardiac complications associated with cancer and how to manage them.Predictive analytics refers to technology that uses patterns in large datasets to predict future events and inform decisions. This article considers the challenges of this technology and how these should be considered, before incorporating this technology into healthcare settings.Guidance from the British Geriatrics Society provides practical advice to support healthcare professionals who are involved in caring for frail, older people in the last phase of life.Guidance regarding appropriate use of personal protective equipment in hospitals is in constant flux as research into SARS-COV-2 transmission continues to develop our understanding of the virus. The risk associated with procedures classed as 'aerosol generating’ is under constant debate. Current guidance is largely based on pragmatic and cautious logic, as there is little scientific evidence of aerosolization and transmission of respiratory viruses associated with procedures. The physical properties of aerosol particles which may contain viable virus have implications for the safe use of personal protective equipment and infection control protocols. As elective work in the NHS is reinstated, it is important that the implications of the possibility of airborne transmission of the virus in hospitals are more widely understood. This will facilitate appropriate use of personal protective equipment and help direct further research into the true risks of aerosolization during these procedures to allow safe streamlining of services for staff and patients.Malnutrition is the disturbance of normal form or function, arising from the deficiency of one or more nutrients, and is a significant issue in the older adult population. Despite their reduced energy requirements, older patients need the same protein intake and micronutrients as younger patients, but age-related changes may impact the ability to meet these requirements. The cause of malnutrition in individuals is likely to be multifactorial and can therefore be complex to manage. Adequate nutrition is important for both community dwelling patients and inpatients, as malnutrition increases the risk of complications and the likelihood of needing residential or nursing home care on discharge. This article discusses the risk factors for the development of malnutrition in older patients and the different nutritional assessment tools available. Management strategies for optimising nutrition can be divided into systems and supplementation. With an ageing population, most doctors will inevitably become increasingly involved with treating older patients and this article highlights the need to consider a patient’s nutritional status. Nutrition should be considered during every ward round and the multidisciplinary team as a whole should maintain an awareness and responsibility for managing malnutrition.Assessing the quality of care for patients receiving long-term ventilation is complex given the diversity of this population (0-24 years in this case) and their differing requirements for treatment. This article details how and why such reviews are necessary.Most readers will be familiar with the term 'Wallerian degeneration’ – the degenerative changes that take place in nerve fibres distal to the site of their division. Few, I would respectfully suggest, would know very much about the discoverer of this phenomenon, Augustus Waller. This year marks the 200th anniversary of his death.The British Orthopaedic Association’s Standards for Trauma and Orthopaedics outline the essential clinical standards for spinal clearance and management of spinal cord injury in the acute trauma patient. From initial presentation in the hospital setting to long-term rehabilitation, the recommendations for clinical assessment, imaging, treatment priorities and the role of trauma networks are summarised.There has been a significant rise in the incidence of contrast-associated nephropathy caused by administration of contrast media during cardiac interventions. This is one of the major complications of percutaneous coronary interventions, which may proceed to acute renal failure. Risk factors, including pre-existing renal dysfunction, older age and use of high osmolar contrast media, predispose patients to the development of contrast-associated nephropathy. Different risk-reduction strategies have been used to prevent contrast-associated nephropathy, including use of low osmolar contrast media, N-acetylcysteine, alkalisation of tubular fluid with intravenous sodium bicarbonate, and oral and intravenous hydration with isotonic solution. Hydration using intravenous saline is one of the main treatments used to prevent the development of nephropathy in patients receiving contrast media during cardiac interventions. Prehydration, before administering contrast media, seems to be crucial. The results of studies of the relative efficacy of sodium bicarbonate and/or N-acetylcysteine in reducing the development of contrast-associated nephropathy are not consistent and any beneficial effects may depend on the pre-existing state of the kidney. This review discusses hydration of patients who are at risk of developing contrast-associated nephropathy using intravenous fluid.Ulnar tunnel syndrome is compression of the ulnar nerve at the level of the wrist within Guyon’s canal. It is most commonly caused by a ganglion cyst but may also be secondary to fractures, inflammatory conditions, neoplasm, vascular anomalies, aberrant musculature or a combination of these. Assessment should include a detailed history focusing on duration, site and progression of symptoms. The level of compression can be estimated clinically on examination by assessing motor and sensory changes in the hand. Investigations are used to confirm diagnosis or to clarify the underlying cause. X-rays and computed tomography can be used to exclude fractures. Ultrasound is used to diagnose ganglion cysts and vascular anomalies, and can localise the level of compression. Nerve conduction studies can be used to support the diagnosis and look for proximal compression. Mild symptoms can be managed non-operatively. Surgical exploration and decompression is the gold standard treatment for neuro-compressive causes with largely good outcomes.Sepsis requiring cardiovascular support is a common reason for critical care admission. The threshold for mean arterial pressure in septic shock has been set at a population-wide threshold of 65 mmHg by a European consensus statement, but should the threshold be higher?This article summarises radiological imaging of the small bowel, with an emphasis on Crohn’s disease. Different imaging techniques are discussed, including the advantages and disadvantages of each modality, and radiological findings for common small bowel pathologies are described, supplemented with pictorial examples.Hands-on wet lab simulation training is a vital part of modern surgical training. Since 2010, surgical 'boot camps’ have been run by many UK deaneries to teach core surgical trainees basic entry level skills. Training in advanced skills often requires attendance at national fee-paying courses. In the Wessex Deanery, multiple, free of charge, core surgical 'field camps’ were developed to provide more advanced level teaching in the particular specialty preference of each core surgical trainee. After the COVID-19 pandemic, national hands-on courses will be challenging to provide and deanery-based advanced skills training may be the way forward for craft-based specialties. The experiences over 2 years of delivering the Wessex core surgical field camps are shared, giving a guide and advice for other trainers on how to run a field camp.Acute-on-chronic liver failure is used to describe an acute decline in liver function in a patient with existing liver disease combined with other organ failure. Acute-on-chronic liver failure is associated with high short-term mortality, and the greater the number and severity of organ failures, the higher the mortality. The most commonly identified precipitants of acute-on-chronic liver failure include bacterial infection, gastrointestinal haemorrhage, viral hepatitis and recent excessive alcohol intake. Since some of these aetiologies are treatable, organ failure may return to pre-decompensation levels in up to 55% of patients. As a result, a trial of critical care treatment may be appropriate for many of these patients. Clinical scoring tools may help clinicians recognise futility, allowing timely withdrawal of organ support and shifting the focus of care toward palliation.Research interest in ingestible Wireless Capsule Endoscopy (WCE) studies in humans showed better results than conventional invasive probe endoscopy methods. Because of the structure and the position of the small intestine, proper scanning cannot be done in the area using traditional endoscopic methods. For patient comfort, continuous developments have been suggested in capsule endoscopy designs in terms of the quality of images transmitted, capsule orientation, positioning of the capsule from outside the body, link budget analysis, impedance matching and capsule miniaturization. To improve the image quality, transmission efficiency of the antenna has to be improved. This has led to the development of many antenna structures in an ingestible capsule system. Literatures have identified Med Radio and ISM (Industrial, Scientific and Medical) band as operation bands for the WCE systems. This review aims to highlight (1) design considerations for various antenna types, (2) miniaturization techniques, (3) operating bands, specifications and various design challenges and (4) research gap, advanced design technologies and targets of ingestible antenna system. The main aim of this paper is to tutorial the up-to-date information on the recent antenna designing techniques and challenges for ingestible system.

The aims of the study were to explore women’s experiences of an immediate postpartum intrauterine contraception (PPIUC) service recently introduced in a UK maternity setting, to identify areas for improvement and inform service provision.

Qualitative research was carried out in hospital and community maternity services in Lothian, UK. In-depth interviews were conducted with 35 women who had received PPIUC at vaginal or caesarean delivery. The interview data were analysed thematically to explore the women’s experiences of PPIUC service provision.

Women’s decisions to choose PPIUC were influenced by their perception of intrauterine contraception (IUC) as a suitable and effective method and the convenience of immediate postpartum insertion. Most women were satisfied with their experience of PPIUC. Women delivering vaginally sometimes reported concerns about delays to insertion, particularly where they perceived a lack of communication from staff about when and where insertion would occur. PPIUC informationplementation challenges in order to enhance women’s experience of the service. These include ensuring that clear and appropriate PPIUC information and support are provided antenatally; women are able to access PPIUC immediately after delivery; robust clinical pathways are in place to support post-insertion IUC care; and both staff and women are familiar with the clinical pathways.

Technical and logical breakthroughs have provided new opportunities in medicine to use knowledge bases and large-scale clinical data (real-world) at point-of-care as part of a learning healthcare system to diminish the knowledge-practice gap.

The article is based on presentations, discussions and recommendations from an international scientific workshop. Value, research needs and funding avenues of knowledge bases and access to real-world data as well as transparency and incorporation of patient perspectives are discussed.

Evidence-based, publicly funded, well-structured and curated knowledge bases are of global importance. They ought to be considered as a public responsibility requiring transparency and handling of conflicts of interest. Information has to be made accessible for clinical decision support systems (CDSS) for healthcare staff and patients. Access to rich and real-world data is essential for a learning health care ecosystem and can be augmented by data on patient-reported outcomes and preforld data.

This research aimed to investigate the major user behavior patterns of noise sources in healthcare environments and summarize such information as evidence that can inform the design of maternity wards for indoor noise control and patients’ well-being.

Field investigations were conducted to identify users’ behaviors as the major contributors of noises in the maternity wards of a typical hospital. A control experiment was set to test the feasibility of a noise control system that consisted of smart bracelets, mobile terminals, and monitors. Comparative studies were designed for statistical analysis of patients’ sleep quality and satisfaction. Finally, a follow-up interview was conducted among the experts who were from the fields of healthcare environment design, medical treatments, and hospital administration to shed an insight into their concerns on the findings.

The enclosed waiting areas, instead of open ones that were often seen in hospitals, around the entrances of operation rooms, were considered as the appropriate design strategy for maternity wards in China. Such a design could keep patients from being exposed to the excessive noises generated by visitors during nighttime, although it would occupy the floor area of wards and lead to a reduction of beds. Moreover, the statistical information of patients’ behaviors could be used to moderate visitors’ behaviors.

It was necessary to include user behavior information in building information management and then make a good trade-off between the proportions of wards and enclosed waiting rooms in order to achieve a balance of medical efficiency and environmental satisfaction.

It was necessary to include user behavior information in building information management and then make a good trade-off between the proportions of wards and enclosed waiting rooms in order to achieve a balance of medical efficiency and environmental satisfaction.

Glucose-regulated protein 78 (GRP78) is a stress-inducible molecular chaperone expressed within the endoplasmic reticulum where it acts as a master regulator of the unfolded protein response (UPR) pathway. At times of ER stress, activation of the UPR, a multimolecular pathway, limits proteotoxicity induced by misfolded proteins. In malignancies, including multiple myeloma which is characterized by an accumulation of misfolded immunoglobulins, GRP78 expression is increased, with notable translocation of GRP78 to the cell surface. Studies suggest cell-surface GRP78 (csGRP78) to be of prognostic significance with emerging evidence that it interacts with a myriad of co-ligands to activate signaling pathways promoting cell proliferation and survival or apoptosis.

This review focuses on the role of ER and csGRP78 in physiology and oncogenesis in multiple myeloma, addressing factors that shift the balance in GRP78 signaling from survival to apoptosis. The role of GRP78 as a potential prognostic biomarker is explored and current therapeutics in development aimed at targeting csGRP78 are addressed. We conducted a PubMed literature search using the keywords 'GRP78,’ 'multiple myeloma’ reviewing studies prior to 2020.

Cell-surface GRP78 expression is a potential novel prognostic biomarker in myeloma and targeting of csGRP78 is promising and requires further investigation.

Cell-surface GRP78 expression is a potential novel prognostic biomarker in myeloma and targeting of csGRP78 is promising and requires further investigation.

Onychomycosis is the most common nail disease seen in clinical practice. Treatment options include systemic and topical therapies, as well as devices. Following clinical and mycologic diagnosis, treatment must be individualized, accounting for disease severity, infecting organism(s), comorbidities, patient characteristics and drug/device efficacy. Safety is the most important consideration in choosing the most appropriate therapeutic modality.

This review covers currently available treatments for onychomycosis, with an emphasis on safety and tolerability. Medications and devices were analyzed for side effects, drug-drug interactions, and safety during pregnancy and breastfeeding.

Systemic antifungals offer greater efficacy for onychomycosis treatment but are limited by risks of systemic toxicity and drug-drug interactions. The risk of terbinafine-induced hepatotoxicity is negligible in healthy patients. Systemic therapies, especially azole antifungals, are associated with numerous drug-drug interactionside effects. Systemic and topical onychomycosis treatments should not be prescribed during pregnancy and breastfeeding. Laser therapy is likely less effective than systemic and topical therapies, but may be safely used during pregnancy and breastfeeding.

Somatostatin receptor ligands including octreotide LAR are first-line therapy in locally advanced or metastatic NETs that are nonresectable and well differentiated and are recommended as first-line therapy in functioning and in G1/low G2 nonfunctioning NETs. However, several questions remain that are not adequately addressed in current guidelines regarding its use in clinical scenarios in which the tumor progresses. These include use of nonconventional doses or schedules of octreotide LAR in tumors with hormonal symptoms or showing clinical-radiological progression, administration in combination with everolimus, peptide receptor radionuclide therapy, and chemotherapy, following first-line treatment with octreotide LAR.

An expert panel was gathered to obtain consensus using Delphi methodology on a series of statements regarding further administration of octreotide LAR after its use in first-line therapy in these settings in patients who experience disease progression.

Consensus was reached for 8 of the 10 statements proposed in the above clinical scenarios; consensus was not achieved for two statements.

The present statements aim to fill current gaps in treatment guidelines by providing recommendations based on expert consensus in clinical settings in which patients progress following first-line therapy with octreotide LAR.

The present statements aim to fill current gaps in treatment guidelines by providing recommendations based on expert consensus in clinical settings in which patients progress following first-line therapy with octreotide LAR.Conversation Analysis was used to explore how teachers, personal care assistants, and students organized inclusive multiparty classroom interaction when one of the students in the classroom used an eye-gaze accessed speech-generating device (SGD). Scaffolding and collaborative practices that created a response space for the construction of the eye-gaze accessed SGD-mediated turn were identified and analyzed. The participants were two adolescent students with severe cerebral palsy and intellectual disability who relied on eye-gaze accessed SGDs, and their teachers, personal care assistants, and classmates with intellectual disabilities. The data consisted of 2 hr and 40 min of video recordings collected in the participants’ classrooms. Three practices were identified (a) the practice of explicit turn allocation organization and the use of display questions, (b) the practice of locally contingent on-screen scaffolding activities, and (c) the practice of dealing with turn competition by classmates. Teacher and assistant practices differed with regard to the student’s access to the vocabulary relevant to answering the teacher’s question. The practices were found to create a response space for students using SGDs accessed via eye gaze, thereby ensuring their educational inclusion in the classroom.Statistical modeling with sparsity has become an active research topic in the fields of statistics and machine learning. Because the true sparsity pattern of a model is generally unknown aforehand, it is often explored by a sparse estimation procedure, like least absolute shrinkage and selection operator (lasso). In this study, a penalized least squares (PLS) method for structural equation modeling (SEM) with ordinal data is developed. PLS describes data generation by an underlying response approach, and uses a least squares (LS) fitting function to construct a penalized estimation criterion. A numerical simulation was used to compare PLS with existing penalized likelihood (PL) in terms of averaged mean square error, absolute bias, and the correctness of the model. Based on these empirical findings, a hybrid PLS was also proposed to improve both PL and PLS. The hybrid PLS first chooses an optimal sparsity pattern by PL, then estimates model parameters by an unpenalized LS under the model selected by PL. We also extended PLS to cases of mixed type data and multi-group analysis. All proposed methods could be realized in the R package lslx.

The purpose of this study was to examine the effects of exposure to imatinib in the prenatal period on testis development in rats.

Although all the study groups received intraperitoneal imatinib on prenatal days 1-8, no pregnancy occurred in the Imatinib-80 group. Immunohistochemical analysis, TUNEL, c-kit and PDGF staining revealed no difference between the groups in terms of positivity scoring.

A significant decrease was detected in total sperm counts in the Imatinib-20 group compared to the control group, but the sperm count was higher in the Imatinib-60 group than in the Imatinib-20 group. At biochemical measurements, the drug increased oxidative stress in the testis and serum in the Imatinib-20 group, but caused a decrease in tissue in the Imatinib-60 group. Thiol measurements revealed a decrease in the testis and serum in the Imatinib-60 group, while an increase in serum measurements was observed in the Imatinib-40 group. Analysis revealed no difference between the groups in terms of protamine and histone gene expression levels in testis tissue exposed to imatinib.

Our findings show that prenatal exposure to imatinib can lead to histopathological and biochemical changes in testis tissue, but that no adverse effect occurs in nuclear maturation of germ cells during spermiogenesis.

Our findings show that prenatal exposure to imatinib can lead to histopathological and biochemical changes in testis tissue, but that no adverse effect occurs in nuclear maturation of germ cells during spermiogenesis.

Resection of insular tumours utilising modern neurosurgical techniques has become commonplace since its safety and reduced morbidity was first established. Interest has grown in the cognitive consequences of insula neurosurgery and studies have largely shown postoperative stability or minor decline. Major or widespread improvements in cognitive functioning following resection of insular tumours have not previously been reported.

A 34-year-old, left-handed man with a right insular low-grade glioma (LGG) presented with seizures, nausea, altered sensation, poor balance and extensive cognitive decline. Comprehensive neuropsychological assessment highlighted a striking left hemispatial neglect and impairments in attention, working memory, verbal learning and fluency. During an awake craniotomy with functional cortical mapping, he reported intraoperative improvements in hand function and processing speed. Resolution of the neglect and significant improvements in cognition, mood and functioning were observed at follow-up and sustained over several years.

This case highlights that right insular LGGs can cause significant cognitive and functional deficits and that neurosurgery has the potential to alleviate these difficulties to an extent beyond those documented in the extant literature.

This case highlights that right insular LGGs can cause significant cognitive and functional deficits and that neurosurgery has the potential to alleviate these difficulties to an extent beyond those documented in the extant literature.

The purpose of this study was to identify assessments used to evaluate the homes of people with disabilities in terms of accessibility, usability, activities, comfort/satisfaction, and aesthetics.

The home is increasingly becoming an environment for healthcare as more people desire to age in place. Research indicates home environmental modifications to be beneficial to promote a better person-environment fit, especially when using a standardized assessment approach. There is not a comprehensive list of assessments that address home modifications, adaptations, or interior designs for people with disabilities.

Researchers conducted a rapid review of articles, with data collection scales, instruments, and procedures for home modifications published between 2000 and 2017.

A total of 26 articles met the inclusion criteria, resulting in the identification of 33 distinct assessments, including 18 assessments evaluating the accessibility of home modifications, 3 assessments examining usability, 15 assessments addressing activities of daily living or functional activities, and 5 assessments addressing comfort and/or satisfaction. No assessments for aesthetics were located.

Researchers developed a list of assessments that could be used for research or practice. Further research is needed to address the lack of assessments focusing on the aesthetics or attractiveness of home modifications, as well as more assessments tailored to specific diagnoses and population groups.

Researchers developed a list of assessments that could be used for research or practice. Further research is needed to address the lack of assessments focusing on the aesthetics or attractiveness of home modifications, as well as more assessments tailored to specific diagnoses and population groups.

The aim of this study was to investigate the developmental tendencies and distribution of ocular biometric parameters in premature infants without retinopathy of prematurity (ROP). Axial length (AL), anterior chamber depth (ACD), lens thickness (LT) and vitreous length (VL) were measured, and their relationships with birth weight (BW) and postmenstrual age (PMA) were analyzed during their earliest weeks of life.

This cross-sectional cohort study included 633 premature infants. They were divided into nine groups according to their PMA 32weeks, 33weeks, 34weeks, and onward to 40weeks. All participants underwent portable slit-lamp examination, RetCam3 and A-scan ultrasound biometry. The following ocular biometric parameters were recorded AL, ACD, LT and VL. The t-test, one-way analysis of variance, and the multiple regression analysis model were used to analyze the data.

The increases in AL, ACD, LT and VL were 0.14 mm, 0.028 mm, 0.0025 mm and 0.11 mm per week, respectively. AL, ACD, LT and VL were positively correlated with BW (β=0.000337, 4.234E-5, 2.697E-5, 0.000278, respectively) and PMA (β=0.142, 0.026, 0.011, 0.103, respectively).

With maturation, AL and VL increased and ACD deepened, but there was no significant change in LT. The ocular growth parameters were positively correlated with BW and PMA however the correlations were not strong.

With maturation, AL and VL increased and ACD deepened, but there was no significant change in LT. The ocular growth parameters were positively correlated with BW and PMA however the correlations were not strong.Vaginal dryness is common during and after menopause due to declining estrogen. It is one of the symptoms of vulvovaginal atrophy (VVA), which is part of the genitourinary syndrome of menopause. This can be distressing for women and cause pain, discomfort, and dyspareunia. Vaginal dryness affects over 50% of postmenopausal women but is under-reported and thus under-treated due to barriers to seeking help. Estrogen replacement can resolve symptoms, but may be contraindicated or not desired by all women. Over-the-counter vaginal moisturizers and lubricants can ease the symptoms of VVA. However, their chemical composition varies enormously and some are known to cause detrimental effects due to unphysiological pH, osmolality, and additives. The primary purpose of this review is to assess both their efficacy and safety. Women should be directed toward products that are as 'body-similar’ as possible to vaginal secretions in terms of pH and osmolality. Products with potentially harmful ingredients should be avoided. Lubricants can be trialed for sexual activity and moisturizers for symptom control, even if topical or systemic menopause hormone therapy is being used.

There are several surgical techniques for unilateral cleft lip repair. In most of these techniques, the points where the postoperative scars cross the vermilion border are on the peak of the Cupid’s bow. These scars make the shape of Cupid’s bow indistinct. To maintain the natural shape of the Cupid’s bow, we modified the surgical technique.

We modified the modified Millard’s surgical technique (Onizuka’s surgical technique). The main point of this modification was as follows we combined a small triangular flap and a vermilion triangular flap (described by Noordhoff). We maintained the projection point on the lateral side of cleft lip which was coordinated to the peak of the Cupid’s bow.

We could preserve the shape and symmetry of the peak of the Cupid’s bow.

To keep the projection point on the affected side of cleft lip and the surrounding vermilion border as one curve structure is important in maintaining the natural shape of the Cupid’s bow.

To keep the projection point on the affected side of cleft lip and the surrounding vermilion border as one curve structure is important in maintaining the natural shape of the Cupid’s bow.

The objective of this study was to examine practices regarding cleft lip and palate (CLP) among medical professionals and caregivers of children with CLP and to identify barriers and facilitators to comprehensive CLP care at a hospital in West Africa.

Qualitative methods used consisted of individual semistructured interviews with caregivers of children with CLP and one focus group with CLP team members.

A majority of the interviews took place in the hospital, with some occurring during home visits. The focus group was conducted in the same hospital.

Forty-five caregivers of children with CLP and 1 adult with CLP completed an interview. Additionally, 2 of the caregivers had CLP and completed an interview from their perspective. The focus group consisted of 13 CLP team members from a comprehensive CLP team in Ghana.

Interviews consisted of semistructured, open-ended questions, and the focus group relied on a discussion guide. Line-by-line coding was used to identify common themes regarding barriers and facilitators to CLP care.

Barriers to CLP care that were consistent across caregiver interviews and the focus group were lack of knowledge regarding CLP, stigma and cultural beliefs surrounding CLP, transportation, financial, and feeding/nutrition issues. Barriers to care identified in the interviews and focus group were similar; however, facilitators to care varied greatly between the 2.

Two different qualitative methods provided unique perspectives on barriers and facilitators to CLP care. However, patients and caregivers continue to face substantial barriers to obtaining care.

Two different qualitative methods provided unique perspectives on barriers and facilitators to CLP care. However, patients and caregivers continue to face substantial barriers to obtaining care.

Stress urinary incontinence (SUI) is a common benign disease causing a markedly negative impact on quality of life. Vaginal laser is a minimally invasive treatment and no major complications of this technique have been published to date. The purpose of the article is to present the first major adverse event related to this treatment.

We present the case of a 48-year-old woman with an important complication after vaginal laser for SUI.

The patient presented a transverse vaginal septum and shortening of vaginal length after two sessions of vaginal erbiumyttrium aluminum garnet laser treatment. She required two surgical interventions, local injections, and pelvic floor physiotherapy, although currently the patient has not experienced complete resolution of symptoms.

Vaginal laser use can lead to serious adverse events. Selection of patients and treatment must be carried out with caution.

Vaginal laser use can lead to serious adverse events. Selection of patients and treatment must be carried out with caution.

To describe the cumulative incidences of adverse drug reactions (ADRs) associated with disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients from real-world data (RWD), using the DREAM-RA registry, and to compare these with incidence frequencies mentioned in the Summary of Product Characteristics (SmPC).

All ADRs in patients with recorded use of adalimumab, etanercept, hydroxychloroquine, leflunomide, oral and subcutaneous methotrexate, and sulfasalazine from a single center participating in the DREAM-RA registry (n=1,098 patients) that were directly sent to the Netherlands Pharmacovigilance Center Lareb were assessed. Cumulative incidences were calculated, described and compared to the most recently revised SmPCs.

In total, 14 ADRs (≥5 case reports) associated with the use of one of the included DMARDs were reported with a higher estimated cumulative incidence compared to the SmPC. For hydroxychloroquine and sulfasalazine, 5 ADRs (≥5 case reports) mentioned with an 'unknown’ incidence in the SmPC were reported as 'common’ in this study.

Although ADR data in the DREAM-RA registry were partly comparable with data in the SmPCs, RWD from this patient registry provided an added value to the currently available information on the incidences of ADRs associated with DMARDs in RA patients as described in SmPCs.

Although ADR data in the DREAM-RA registry were partly comparable with data in the SmPCs, RWD from this patient registry provided an added value to the currently available information on the incidences of ADRs associated with DMARDs in RA patients as described in SmPCs.The objective of this study was to analyze the effectiveness and cost of patient incentives, together with patient navigation and patient reminders, to increase fecal immunochemical test (FIT) kit return rates and colorectal cancer screening uptake in one federally qualified health center (FQHC) in Appalachia. This FQHC is a designated homeless clinic, as 79.7% of its patient population are homeless. We collected process, outcome, and cost data from the FQHC for two time periods usual care (September 2016-August 2017) and implementation (September 2017-September 2018). We reported the FIT kit return rate, the increase in return rate, and the additional number of individual screens. We also calculated the incremental cost per additional screen. The patient incentive program, with patient navigation and patient reminders, increased the number of FIT kits returned from the usual care period to the implementation period. The return rate increased by 25.9 percentage points (from 21.7% to 47.6%) with an additional 91 people screened at an incremental cost of $134.61 per screen. A patient incentive program, together with the assistance of patient navigators and supplemented with patient reminders, can help improve CRC screening uptake among vulnerable and homeless populations.The purpose of this study is to evaluate the effectiveness of the West Virginia Program to Increase Colorectal Cancer Screening in implementing patient reminders to increase fecal immunochemical test (FIT) kit return rates in nine federally qualified health centers (FQHCs). Using process measures and cost data collected, the authors examined the differences in the intensity of the phone calls across FQHCs and compared them with the return rates achieved. They also reported the cost per kit successfully returned as a result of the intervention. Across all FQHCs, 5,041 FIT kits were ordered, and the initial return rate (without a reminder) was 41.1%. A total of 2,201 patients received reminder phone calls; on average, patients received 1.61 reminder calls each. The reminder interventions increased the average FIT kit return rate to 60.7%. The average total cost per FIT kit returned across all FQHCs was $60.18, and the average cost of only the reminders was $11.20 per FIT kit returned. FQHCs achieved an average increase of 19.6 percentage points in FIT kit return rates, and costs across clinics varied. Clinics with high-quality health information systems that enabled tracking of patients with minimal effort were able to implement lower cost reminder interventions.Background There is a lack of research regarding whether prolonged use of cocaine would lead to increase of coronary plaque burden. Objectives To study the effects of cocaine use on the coronary artery plaque volume. We hypothesize the longer the cocaine use, the greater the plaque burden. Methods We used coronary computed tomography angiography to evaluate plaque volumes. The study included chronic (N = 33 with 27 HIV+) and non-cocaine users (N = 15 with 12 HIV+). Chronic cocaine use was defined as use by any route for at least 6 months, administered at least 4 times/month. The Student’s t-test was used to compare the plaque volumes between chronic and non-cocaine users. Multivariable regression analysis adjusted for age, sex, body mass index, HIV status, cigarette smoking, diabetes, and total cholesterol was performed to determine the relationship between years of cocaine use and plaque volumes. Results The total plaque volumes between groups showed no difference (p = .065). However, the total left anterior descending artery (LAD) plaque volume in the chronic cocaine group was significantly higher than that in the non-cocaine group (p = .047). For each year increase in cocaine use, total plaque volume and total LAD plaque volume increased by 7.23 mm3 (p = .013) and 4.56 mm3 (p = .001), respectively. In the multivariable analyses, both total plaque volume and total LAD plaque volume were significantly associated with years of cocaine use (p = .039 and 0.013, respectively). Conclusion Prolonged cocaine use accelerates the development of sub-clinical atherosclerosis.As an awardee of the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program, the California Department of Public Health partnered with Neighborhood Healthcare to implement evidence-based interventions and provider incentives (incentives offered to support staff, e.g., medical assistants, phlebotomists, front office staff, lab technicians) to improve colorectal cancer screening uptake. The objective of this study was to evaluate the effectiveness and cost of the provider incentive intervention implemented by Neighborhood Healthcare to increase colorectal cancer screening uptake. We collected and analyzed process and cost data to assess fecal immunochemical test (FIT) kit return rates to the health centers and the number of completed FIT kits. We estimated the costs of the preexisting interventions and the new interventions. Analyses were conducted for two time periods preimplementation and implementation. Most Neighborhood Healthcare health centers experienced an increase in the percentage of FIT kit returns (average of 3.6 percentage points) and individuals screened (an average increase of 111 FIT kits per month) from the baseline period through the implementation period. The cost of the incentive intervention for each additional screen was $66.79. In conclusion, the results indicate that incentive programs can have an overall positive impact on both the percentage of FIT kits returned and the number of individuals screened.

Retrospective cohort study.

Analysis of postoperative sagittal alignment of the unfused spine is lacking in patients with adult spinal deformity (ASD). The present study aims to evaluate the efficacy of the whole spine full-flexion lateral radiograph to predict the reciprocal change of the unfused spine after correction surgery. We hypothesized that the novel parameter (T1-UIV angle angle between the upper vertebral endplate of the T1 and the upper vertebral endplate of the upper instrumented vertebra) of the preoperative whole spine full-flexion lateral radiograph is similar to that of the postoperative lateral radiograph if the patient has the ideal sagittal alignment.

Twenty-six ASD patients who underwent correction surgery with a minimum 2-year follow-up were enrolled and separated into the Ideal and Non-Ideal groups according to the Scoliosis Research Society (SRS)-Schwab classification of the final follow-up radiograph. Radiographic parameters, including T1-UIV of the preoperative whole spine full-flexion lateral radiograph, were obtained.

Thirteen patients were included in the Ideal group and 13 were in Non-Ideal group. Preoperative T1-UIV of the whole spine full-flexion lateral radiograph exhibited significant correlations with the T1-UIV angles of the postoperative and final follow-up radiographs (

= 0.64,

< .01,

= 0.800

+ 8.012, and

= 0.69,

< .01,

= 0.857

+ 2.960, respectively). Interestingly, this correlation was stronger for the Ideal group (

= 0.77,

< .01,

= 1.207

– 1.517, and

= 0.89,

< .01,

= 0.986

+ 0.694, respectively).

A novel radiographic strategy (T1-UIV of preoperative the whole spine full-flexion lateral radiograph) could estimate the postoperative alignment of the unfused spine correctly.

A novel radiographic strategy (T1-UIV of preoperative the whole spine full-flexion lateral radiograph) could estimate the postoperative alignment of the unfused spine correctly.

Surgery of single cerebral metastases is standard but frequently fails to achieve local tumour control. Reliable predictors for local tumour progression and overall survival are unknown. MRI-based apparent diffusion coefficients (ADC) correlate with tumour cellularity and invasion. The present study analysed a potential relation between the MRI based apparent diffusion coefficients local recurrence and outcome in patients with brain metastases.

A retrospective analysis was performed for patients with cerebral metastases and complete surgical resection evaluated by an early postoperative MRI < 72h. Minimal ADC and mean ADC were assessed in preoperative 1,5T-MRI scans by placing regions of interests in the tumour and the peritumoural tissue.

Analysis of the relation between ADC values, local progression and outcome was performed in 86 patients with a mean age of 59 years (range 33-83 years). Primary site was NSCLC in 37.2% of all cases. Despite complete resection 33.7% of all patients suffered from local in-brain-progression.