Search

Objective: The risk of hydrocephalus following hemispherectomy for drug resistant epilepsy (DRE) remains high. Patients with pre-existing hydrocephalus pose a postoperative challenge, as maintaining existing shunt patency is necessary but lacks a clearly defined strategy. This study examines the incidence and predictors of shunt failure in pediatric hemispherectomy patients with pre-existing ventricular shunts. Methods: We performed a retrospective chart review at our center to identify pediatric patients diagnosed with DRE who were treated with ventricular shunt prior to their first hemispherectomy surgery. Demographic and perioperative data were obtained including shunt history, hydrocephalus etiology, epilepsy duration, surgical technique, and postoperative outcomes. Univariate analysis was performed using Fisher's exact test and Pearson correlation, with Bonferroni correction to a = 0.00625 and a = 0.01, respectively. Results: Five of nineteen (26.3%) patients identified with ventriculoperitoneal shunting prior to hemispherectomy experienced postoperative shunt malfunction. All 5 of these patients underwent at least 1 shunt revision prior to hemispherectomy, with a significant association between pre- and post-hemispherectomy shunt revisions. There was no significant association between post-hemispherectomy shunt failure and valve type, intraoperative shunt alteration, postoperative external ventricular drain placement, hemispherectomy revision, lateralization of shunt relative to resection, postoperative complications, or postoperative aseptic meningitis. There was no significant correlation between number of post-hemispherectomy shunt revisions and age at shunt placement, age at hemispherectomy, epilepsy duration, or shunt duration prior to hemispherectomy. Conclusions: Earlier shunt revision surgery may portend a subsequent need for shunt revision following hemispherectomy. These findings may guide neurosurgeons in counseling patients with pre-existing ventricular shunts prior to hemispherectomy surgery. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Few studies among gay, bisexual and other men who have sex with men (GBMSM) have examined facilitators and barriers to self-collecting specimens for extragenital STI screening, and none have evaluated attitudes towards self-collecting hair samples that can be utilized for PrEP drug level testing to assess adherence. To address this gap, we interviewed 25 sexually active GBMSM who were offered a choice to self-collect and return finger-stick blood samples (for actual HIV testing), pharyngeal swabs, rectal swabs and urine specimens (for actual gonorrhea and chlamydia testing), and hair samples (to visually determine their adequacy for PrEP drug level testing): 11 who returned all, 4 who returned some, and 10 who did not return any. Participants found self-collecting finger-stick blood samples and rectal swabs more challenging than other specimens. Frequently discussed facilitators of return included an opportunity to confirm one's HIV or STI status, limited access to a healthcare provider and a desire to advance research focusing on home-based testing. Commonly cited barriers to return included low self-efficacy pertaining to self-collection and apprehension around the possibility of delay or loss of specimens during transit. Offering additional support such as real-time video conferencing may prove helpful in future field-based research with GBMSM. [ABSTRACT FROM AUTHOR]

Introduction Chronic kidney disease (CKD) patients face multiple complications. One of them is involvement of the auditory system and it deserves more attention than is paid by the current approaches as hearing loss has major repercussions on the quality of life. Early detection can prevent further deterioration of hearing and improve the quality of life of patients suffering from CKD. Material and methods The high frequency (8–18 kHz) audiometry with pure tones was performed in 82 patients with CKD and compared with age and sexes matched healthy control group of 90 patients. Individual ear were used for statistical calculations. Results This study clearly observed that the hearing thresholds for frequencies 8–18 kHz increased in CKD patients when compared to sex and aged matched healthy control group, the thresholds significantly increased in CKD with diabetes mellitus as compared to nondiabetic with CKD. The high frequency thresholds significantly increased in patients on hemodialysis, and were significantly correlated with age, stage of CKD and duration of CKD. Conclusion This study highlights the presence of high frequency (8–18 kHz) hearing loss in patients of CKD. The severity is significantly correlated with age, stage and duration of CKD. [ABSTRACT FROM AUTHOR]

As the number of childhood cancer survivors increases, a heightened awareness and recognition of therapy-related late effects is becoming more important. Pulmonary complications are the third leading cause of late mortality in cancer survivors. Diagnosis of these complications on chest imaging helps facilitate prompt treatment to mitigate adverse outcomes. In this review, we summarize the imaging of late pulmonary complications of cancer therapy in children and highlight characteristic findings that should be recognized by radiologists. [ABSTRACT FROM AUTHOR]

In this review, we summarize early pulmonary complications related to cancer therapy in children and highlight characteristic findings on imaging that should be familiar to a radiologist reviewing imaging from pediatric cancer patients. [ABSTRACT FROM AUTHOR]

Food safety and foodborne diseases are significant global public health concerns. Meat and poultry carcasses can be contaminated by pathogens like E. coli and salmonella, by contact with animal fecal matter and ingesta during slaughter and processing. Since fecal matter and ingesta can host these pathogens, detection, and excision of contaminated regions on meat surfaces is crucial. Fluorescence imaging has proven its potential for the detection of fecal residue but requires expertise to interpret. In order to be used by meat cutters without special training, automated detection is needed. This study used fluorescence imaging and deep learning algorithms to automatically detect and segment areas of fecal matter in carcass images using EfficientNet-B0 to determine which meat surface images showed fecal contamination and then U-Net to precisely segment the areas of contamination. The EfficientNet-B0 model achieved a 97.32% accuracy (precision 97.66%, recall 97.06%, specificity 97.59%, F-score 97.35%) for discriminating clean and contaminated areas on carcasses. U-Net segmented areas with fecal residue with an intersection over union (IoU) score of 89.34% (precision 92.95%, recall 95.84%, specificity 99.79%, F-score 94.37%, and AUC 99.54%). These results demonstrate that the combination of deep learning and fluorescence imaging techniques can improve food safety assurance by allowing the industry to use CSI-D fluorescence imaging to train employees in trimming carcasses as part of their Hazard Analysis Critical Control Point zero-tolerance plan. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is caused by a mutation in the β-globin gene HBB1. We used a custom adenine base editor (ABE8e-NRCH)2,3 to convert the SCD allele (HBBS) into Makassar β-globin (HBBG), a non-pathogenic variant4,5. Ex vivo delivery of mRNA encoding the base editor with a targeting guide RNA into haematopoietic stem and progenitor cells (HSPCs) from patients with SCD resulted in 80% conversion of HBBS to HBBG. Sixteen weeks after transplantation of edited human HSPCs into immunodeficient mice, the frequency of HBBG was 68% and hypoxia-induced sickling of bone marrow reticulocytes had decreased fivefold, indicating durable gene editing. To assess the physiological effects of HBBS base editing, we delivered ABE8e-NRCH and guide RNA into HSPCs from a humanized SCD mouse6 and then transplanted these cells into irradiated mice. After sixteen weeks, Makassar β-globin represented 79% of β-globin protein in blood, and hypoxia-induced sickling was reduced threefold. Mice that received base-edited HSPCs showed near-normal haematological parameters and reduced splenic pathology compared to mice that received unedited cells. Secondary transplantation of edited bone marrow confirmed that the gene editing was durable in long-term haematopoietic stem cells and showed that HBBS-to-HBBG editing of 20% or more is sufficient for phenotypic rescue. Base editing of human HSPCs avoided the p53 activation and larger deletions that have been observed following Cas9 nuclease treatment. These findings point towards a one-time autologous treatment for SCD that eliminates pathogenic HBBS, generates benign HBBG, and minimizes the undesired consequences of double-strand DNA breaks.A custom adenine base editor can edit the variant of the β-globin gene that causes sickle cell disease into a non-pathogenic variant in human and mouse cells, and transplantation of the edited cells rescues sickle cell disease in mice. [ABSTRACT FROM AUTHOR]

Transcription factor CCAAT/enhancer-binding protein-alpha (C/EBPα) regulates myelopoiesis by coupling growth arrest with differentiation of myeloid progenitors. Mutations in one or both alleles are observed in 10-14% AML cases that render C/EBPα functionally inactive. Besides, antagonistic protein-protein interactions also impair C/EBPα expression and function. In recent independent studies, we showed that CDK2 and SKP2 downregulated C/EBPα expression in an ubiquitin-dependent proteasome degradation manner leading to differentiation block in AML. Here, we demonstrate that CDK2-instigated C/EBPα downregulation is actually mediated by SKP2. Mechanistically, we show that CDK2 stabilizes SKP2 by phosphorylating it at Ser64 and thereby potentiates C/EBPα ubiquitination and subsequent degradation in AML cells. Immunoblot experiments showed that CDK2 inhibition downregulated SKP2 levels and concomitantly enhanced C/EBPα levels in myeloid cells. We further show that while CDK2 promoted C/EBPα ubiquitination and inhibited its protein levels, negatively affected its transactivation potential and DNA binding ability, simultaneous SKP2 depletion abrogated CDK2-promoted ubiquitination and restored C/EBPα expression and function. Taken together, these findings consolidate that CDK2 potentiates SKP2-mediated C/EBPα degradation in AML and targeting CDK2-SKP2 axis can be harnessed for therapeutic benefit in AML. Hypothetical model depicts that SKP2-mediated C/EBPα proteasomal degradation is reinforced by CDK2. CDK2 phopshorylates SKP2 leading to its enhanced stabilization which in turn exaggerates C/EBPα degradation leading to differentiation arrest in AML. [ABSTRACT FROM AUTHOR]

Prior research with male couples has focused on how sexual agreements can influence relationship dynamics, sexual risk taking, and health promoting behaviors. Little is known about the association between sexual agreements and the experience or perpetration of intimate partner violence (IPV) in this population. Our study sought to evaluate these associations using dyadic data from a sample of 386 male couples residing in the U.S. Both partners independently reported on their relationship characteristics, sexual agreements, and specific acts reflecting physical, emotional, controlling, and monitoring IPV in separate surveys. Participants were more likely to have experienced IPV in the past year if they were in a relationship for ≥ 3 years versus < 3 years (aOR = 1.62, 95% CI = 1.03–2.53). Among 278 couples who had formulated sexual agreements, men who concurred with their partners on being in an "open" relationship were less likely to have experienced IPV versus those in a "closed" relationship (aOR = 0.47, 95% CI = 0.25–0.89). However, participants were more likely to have experienced IPV if their partners believed they had previously broken their sexual agreement (aOR = 2.79, 95% CI = 1.03–7.52). The verbal explicitness and duration of sexual agreements were not associated with either experiencing or perpetrating IPV in the past year. However, increasing levels of depressive symptomatology were associated with a greater likelihood of both experiencing and perpetrating IPV. Our findings highlight the need to prioritize dyadic interventions for male couples that focus on skills building around enhancing mutual communication and negotiating sexual agreements to reduce IPV. [ABSTRACT FROM AUTHOR]

Use of Pre-exposure prophylaxis (PrEP) for HIV prevention by men who have sex with men (MSM) may be impacted by relationship dynamics. We assessed perceived partner support of PrEP use and benefit of PrEP by relationship characteristics among male couples. Baseline data from a randomized control trial of video-based HIV counseling and testing among male couples in the U.S. were used in adjusted multilevel regression models to assess individual and dyadic characteristics. Among 659 participants, 73.3% thought their partner would be supportive of their PrEP use; 26.7% reported their partner would not support PrEP use, which was significantly associated with intimate partner violence (IPV) (p = 0.008). Most (57.7%) did not believe PrEP would be beneficial to them or their partner. Couples with a sexual agreement allowing outside partners were significantly associated with higher perceived support of partners for PrEP (p < 0.001) and benefit of PrEP use (p < 0.001). Perceived partner support of PrEP was high but perceived benefit of PrEP was low, both shaped by relationship dynamics that highlight the need for tailored dyadic interventions. The association between perceived PrEP support and IPV points to the need to integrate relationship contexts in HIV prevention programs. [ABSTRACT FROM AUTHOR]

Transgender youth have low rates of engagement in HIV prevention, shaped in part by experiences of transphobia and lack of access to culturally competent care. Project Moxie tested the feasibility of an intervention that provides home-based HIV self-testing coupled with video-chat counseling. A diverse sample of 202 binary and nonbinary transgender youth (TY) were recruited online, and randomized 2:1 to receive the intervention or a control condition of only home-based HIV self-testing. TY were willing to order HIV self-testing kits and report their results. Half of those in the intervention arm opted to use the video-chat counseling and, among those who did, levels of satisfaction were high. Project Moxie demonstrates the ability to recruit TY online and provide them with access to home HIV testing. Further work is required to develop online interventions for youth who do not wish to receive counseling through video-chat formats. [ABSTRACT FROM AUTHOR]

Purpose: To date, there are conflicting reports with no consensus on the influence of bisphosphonates on lumbar fusion. The goal of this study was to compare the radiographic and functional outcomes of patients that had lumbar fusion with and without bisphosphonates.Methods: A systematic search of multiple medical reference databases was conducted for studies comparing bisphosphonate use to controls following spinal fusion. Meta-analysis was performed using the random-effects model for heterogeneity. Radiographic outcome measures included fusion rates and risk of screw loosening, cage subsidence and vertebral fracture. Functional outcomes measures included Oswestry Disability Index and visual analog scale score for back and leg pain.Results: Bisphosphonate use was statistically suggestive of a higher fusion rate compared to controls (OR 2.2, 95% CI 0.87-5.56, p = 0.09). There was no difference in screw loosening rates between the bisphosphonate group and controls (OR 0.45, 95% CI 0.14-1.48, p = 0.19). However, bisphosphonate use was associated with decreased odds of cage subsidence and vertebral fractures compared to controls (cage subsidence: OR 0.29, 95% CI 0.11-0.75, p = 0.01; vertebral fracture: OR 0.18, 95% CI 0.07-0.48, p = 0.0007).Conclusion: Bisphosphonate use does not appear to impair successful lumbar fusion compared to controls. Additionally, bisphosphonate use was associated with decreased odds of cage subsidence and vertebral fractures compared to controls that had lumbar fusion. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

There is growing evidence that sexual behaviors among male couples are strongly shaped by emotional and quality characteristics of the relationship, and that the labels that men attach to their relationships may indicate how men perceive and engage in risk taking. There has been a lack of attention to how male couples label their relationships, and how discordant understandings of relationship labels may shape HIV risk behavior. Using data from a sample of 804 partnered men who have sex with men, this analysis examines associations between discordant relationship labeling and participation in HIV testing and sexual behavior. Men who labeled their relationship differently from their partners were less likely to have been recently tested for HIV and more likely to engage in sexual risk. The results underscore the need to develop interventions that provide spaces and skills for men to learn how to effectively navigate HIV risks in their relationships. [ABSTRACT FROM AUTHOR]

Partnered men who have sex with men are not immune to the risk of HIV. Analyzing dyadic data from 360 male couples recruited from April 2016 to June 2017, we examined how relationship characteristics might influence HIV testing behavior and perceptions of partners' HIV testing. Increasing levels of mutual trust were associated with lower odds of both partners (versus neither) having been tested in the past year (aOR = 0.91, 95% CI 0.83–0.99), but increasing levels of communal coping were associated with higher odds (aOR = 1.06, 95% CI 1.02–1.10). Only one partner was more likely to be correct about whether or not his partner had been tested in the past year (versus both) if someone had broken their sexual agreement (aOR = 2.60, 95% CI 1.17–5.76). Increasing differences in trust (aOR = 1.10, 95% CI 1.01–1.20) were also associated with higher odds of only one partner being correct. Dyadic HIV prevention efforts should incorporate skills building around negotiating sexual agreements and constructive communication. [ABSTRACT FROM AUTHOR]

In this article, we study a discounted stochastic game to model resource optimal intrusion detection in wireless sensor networks. To address the problem of uncertainties in various network parameters, we propose a globalized robust game-theoretic framework for discounted robust stochastic games. A robust solution to the considered problem is an optimal point that is feasible for all realizations of data from a given uncertainty set. To allow a controlled violation of the constraints when the parameters move out of the uncertainty set, the concept of globalized robust framework comes into view. In this article, we formulate a globalized robust counterpart for the discounted stochastic game under consideration. With the help of globalized robust optimization, a concept of globalized robust Markov perfect equilibrium is introduced. The existence of such an equilibrium is shown for a discounted stochastic game when the number of actions of the players is finite. The contraction mapping theorem, Kakutani fixed point theorem and the concept of equicontinuity are used to prove the existence result. To compute a globalized robust Markov perfect equilibrium for the considered discounted stochastic game, a tractable representation of the proposed globalized robust counterpart is also provided. Using the derived tractable representation, we formulate a globalized robust intrusion detection system for wireless sensor networks. [ABSTRACT FROM AUTHOR]

Male couples often formulate sexual agreements, but little is known about the extent to which partners concur about their exact terms. Disagreements, particularly with respect to sex outside the relationship, may induce stress and potentially increase the risk of HIV and other sexually transmitted infections. Our study sought to describe concordance between male partners on several aspects of their sexual agreements, overall, as well as stratified by dyadic HIV serostatus and relationship duration. Between July 2014 and May 2016, we collected bidirectional data from 160 male couples residing in Atlanta, Boston, and Chicago. Overall, we observed weak concordance for whether or not couples had a mutual agreement about sex with outside partners. Even among 110 couples in which both partners reported having an agreement, there was weak-to-moderate concordance for general rules that might apply to having sex outside the relationship (e.g., forming emotional relationships is not allowed, outside sexual activities must be disclosed), and for specific sexual behaviors allowed or disallowed (e.g., topping without a condom, bottoming without a condom). Concordance for the type of sexual agreement was higher within HIV seroconcordant negative partnerships compared to HIV serodiscordant partnerships, and lower within relationships ≥ 5 years and 1 to < 5 years compared to those < 1 year. Dyadic interventions for male couples (e.g., couples HIV testing and counseling, relationship education programs) can offer unique opportunities for skills building around negotiating sexual agreements and might especially benefit HIV serodiscordant partnerships, and those in the formative stages of their relationships. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Although adolescent sexual minority males (ASMM) are at increased risk for human immunodeficiency virus (HIV) in the United States (US), studies that estimate sexual risk behaviors that contribute to HIV risk in ASMM are limited. We completed a systematic review and meta-analysis to compile available data and estimate the prevalence of risk behaviors in this population. We searched four databases for key terms related to ASMM, defined as males aged 14 through 19 who identified as gay or bisexual, reported sex with a male in their lifetime, and/or were considered sexual minority by the study. Articles eligible for inclusion were in English, from US studies, and reported quantitative data on sexual risk behaviors among ASMM. We extracted data from eligible articles and meta-analyzed outcomes reported in three or more articles using random effects. Of 3864 articles identified, 21 were eligible for data extraction. We meta-analyzed nine outcomes. Sixty-two percent of adolescent males self-identifying as gay or bisexual ever had sex with a male, and 67% of participants from ASMM studies recently had sex. Among ASMM who had sex in the last 6 months or were described as sexually active, 44% had condomless anal intercourse in the past 6 months, 50% did not use a condom at last sex, and 32% used alcohol or drugs at their last sexual experience. Available data indicate that sexual risk behaviors are prevalent among ASMM. We need more data to obtain estimates with better precision and generalizability. Understanding HIV risk in ASMM will assist in intervention development and evaluation, and inform behavioral mathematical models. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The role of extracorporeal support in form of extracorporeal membrane oxygenation (ECMO) has been well established in cases of acute cardiopulmonary failure. The initial enthusiasm dampened, and there was no new development in this field before the recent H1N1 pandemic. Encouraging results in H1N1 patients saw a revised interest in use of ECMO. Gradually, the scope of ECMO widened and is now being used for various indications both in pediatric and adult patients. One of the newly added roles of ECMO is to provide interval support for organ retrieval in cases of donation after cardiac death (DCD). In this article, we will try to elaborate the concept and outcomes of the use of ECMO in donation after cardiac death. [ABSTRACT FROM AUTHOR]

Lead perforation is a rare complication of implantable cardiac devices. Late lead perforation is defined as the one occurring after 30 days of implantation. Majority of these cases of lead perforation occurs within 1 year of implantation. We report a case of lead perforation which was managed by percutaneous transvenous removal in the operating room with a cardiac surgery team kept on standby and present a detailed review of existing literature on this rare but interesting problem. [ABSTRACT FROM AUTHOR]

Objective: With progressive aging of population in developing nations, cardiac surgeons increasingly face elderly patients. These patients are usually symptomatic, yet at high risk for intervention. This study aims to review our experience in elderly Indian patients. Methods: We reviewed the records of 128 elderly patients (mean age 74.6 years; range 70-84) operated at our institution from 2005 to 2009. Postoperatively, patients were followed-up in the out-patient-department. Results: Surgery was performed on 10 as an emergency and 41 on an urgent (on the day of referral or the following day) basis. Mean left ventricular ejection fraction was 44% ± 9.5. Early mortality (during current admission or within 30 days of discharge from the hospital) was 12 (9.3%). Mean New York Heart Association functional class was improved from 3.0 ± 0.8 preoperatively to 1.5 ± 0.7 postoperatively. Median Intensive Care Unit and in-hospital stay was 4 days (range 1-17) and 12 days (range 4-37), respectively. Postoperative complications included pneumonia (6.3%), stroke (5.5%), reoperation for bleeding (4.6%) and intra-aortic balloon pump requirement (4.6%). Emergency surgery was significantly associated ( P < 0.05) with an increased risk of early mortality- operative procedure and cardiopulmonary bypass time were not. Conclusion: We conclude that cardiac surgery can be performed in elderly population with an acceptable early mortality. Postoperatively, patients attain an improved quality of life. Operative procedures and cardiopulmonary bypass times are not risk factors for increased mortality. Emergency surgery in this group of patients is less rewarding. [ABSTRACT FROM AUTHOR]

Toxic myocarditis is a less explored indication of extracorporeal life support (ECLS) in our country. We present a case of use of ECLS in severe left ventricular dysfunction induced by aluminum phosphide (ALP) poisoning. As refractory arrhythmias and myocardial failure have been established as the primary cause of death in ALP poisoning, ECLS can prove to be a useful adjunct to the supportive management. [ABSTRACT FROM AUTHOR]

An H-type rectourethal fistula was seen in a male child. The anus and anterior urethra were normal. The embryology and surgical management of this rare anomaly are discussed. [ABSTRACT FROM AUTHOR]

The diagnosis of right-sided diaphragmatic rupture (RDR) due to blunt abdominal trauma is often missed in the acute setting, especially in the absence of other thoracoabdominal injuries. We describe two such children. The problems associated with the diagnosis and management of RDR are discussed to emphasize the need to have a high index of suspicion for this entity. [ABSTRACT FROM AUTHOR]

Choledochal cyst in an uncommon congenital anomaly with classic presentation triad of abdominal pain, jaundice and right upper abdominal mass. Presentation due to biliary peritonitis following cyst rupture is extremely rare. One such case which was successfully treated is being reported. [ABSTRACT FROM AUTHOR]