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The American College of Obstetricians and Gynecologists recommends that women exercise throughout pregnancy unless they have a condition-related contraindication. This study’s purpose was to determine if pregnant women perceive receiving exercise counseling by their providers with details of frequency, intensity, type, and time (FITT principle). Women in 2 postpartum care units of a large health care system were invited to complete a voluntary, anonymous survey regarding whether they received exercise counseling during their prenatal care. Survey results were descriptively reported, stratified by demographic variables, and analyzed using Fisher’s exact tests. Of 224 postpartum women surveyed, 130 (58.0%) perceived receiving exercise counseling during pregnancy; 119 (91.5%) did not recall receiving counseling on exercise frequency. Though 165 (73.6%) exercised before becoming pregnant, 64 (38.8%) ceased exercise during pregnancy. Eighty-eight (39.3%) received advice from other sources/non–health care professionals. Privately insured women reported receiving exercise counseling at a higher rate (70.1%) than those on Medicaid (44.8%) or uninsured (40.0%; P = .004). A disproportionate number of pregnant women perceived not receiving adequate prenatal exercise counseling or received incomplete counseling. Women at a socioeconomic disadvantage may be vulnerable. As social determinants of health, structural barriers, and socioeconomic status likely contribute, women may benefit from more targeted inclusive and equitable messaging.

Background Melanoma is attributable to predisposing phenotypical factors, such as skin that easily sunburns and unprotected exposure to carcinogenic UV radiation. Reducing the proportion of young adults who get sunburned may reduce the incidence of melanoma, a deadly form of skin cancer. Advances in technology have enabled the delivery of real-time UV light exposure and content-relevant health interventions. Objective This study aims to examine the feasibility of young adults performing the following tasks daily: wearing a UV dosimeter, receiving text messages and real-time UV-B doses on their smartphone, and responding to daily web-based surveys about sunburn and sun protection. Methods Young adults aged 18-39 years (n=42) were recruited in the United States in June 2020 via social media. Participants received the UV Guard sun protection system, which consisted of a UV dosimeter and a smartphone app. During 3 consecutive periods, intervention intensity increased as follows: real-time UV-B dose; UV-B dose and daily behavioral facilitation text messages; and UV-B dose, goal setting, and daily text messages to support self-efficacy and self-regulation. Data were self-reported through daily web-based surveys for 28 days, and UV-B doses were transmitted to cloud-based storage. Results Patients’ median age was 22 years (IQR 20, 29), and all patients had sun-sensitive skin. Sunburns were experienced during the study by fewer subjects (n=18) than those in the preceding 28 days (n=30). In July and August, the face was the most commonly sunburned area among 13 body locations; 52% (22/42) of sunburns occurred before the study and 45% (19/42) occurred during the study. The mean daily UV-B dose decreased during the 3 periods; however, this was not statistically significant. Young adults were most often exercising outdoors from 2 to 6 PM, walking from 10 AM to 6 PM, and relaxing from noon to 2 PM. Sunburn was most often experienced during exercise (odds ratio [OR] 5.65, 95% CI 1.60-6.10) and relaxation (OR 3.69, 95% CI 1.03-4.67) relative to those that did not exercise or relax in each category. The self-reported exit survey indicated that participants felt that they spent less time outdoors this summer compared to the last summer because of the COVID-19 pandemic and work. In addition, 38% (16/42) of the participants changed their use of sun protection based on their app-reported UV exposure, and 48% (20/42) shifted the time they went outside to periods with less-intense UV exposure. A total of 79% (33/42) of the participants were willing to continue using the UV Guard system outside of a research setting. Conclusions In this proof-of-concept research, young adults demonstrated that they used the UV Guard system; however, optimization was needed. Although some sun protection behaviors changed, sunburn was not prevented in all participants, especially during outdoor exercise. Trial Registration ClinicalTrials.gov NCT03344796; http://clinicaltrials.gov/ct2/show/NCT03344796

Nano-formulations that are responsive to tumour-related and externally-applied stimuli can offer improved, site-specific antitumor effects, and can improve the efficacy of conventional therapeutic agents. Here, we describe the performance of a novel stimulus-responsive nanoparticulate platform for the targeted treatment of prostate cancer using sonodynamic therapy (SDT). The nanoparticles were prepared by self-assembly of poly(L-glutamic acid-L-tyrosine) co-polymer with hematoporphyrin. The nanoparticulate formulation was characterized with respect to particle size, morphology, surface charge and singlet oxygen production during ultrasound exposure. The response of the formulation to the presence of cathepsin B, a proteolytic enzyme that is overexpressed and secreted in the tumour microenvironment of many solid tumours, was assessed. Our results showed that digestion with cathepsin B led to nanoparticle size reduction. In the absence of ultrasound, the formulation exhibited greater toxicity at acidic pH than at physiological pH, using the human prostate cells lines LNCaP and PC3 as targets. Nanoparticle cellular uptake was enhanced at acidic pH – a condition that was also associated with greater cathepsin B production. Nanoparticles exhibited enhanced ultrasound-induced cytotoxicity against both prostate cancer cell lines. Subsequent proof-of-concept in vivo studies demonstrated that, when ectopic human xenograft LNCaP tumours in SCID mice were treated with SDT using the systemically-administered nanoparticulate formulation at a single dose, tumour volumes decreased by up to 64% within 24 h. No adverse effects were observed in the nanoparticle-treated mice and their body weight remained stable. The potential of this novel formulation to deliver safe and effective treatment of prostate cancer is discussed., Graphical abstract Unlabelled Image, Highlights • Digestion by cathepsin B leads to nanoparticle size reduction. • The acidic pH facilitates improved cellular uptake of the nanoparticles. • Ultrasound–induced cytotoxic effects were elicited only for the nanoparticle-treated prostate cancer cells. • Sonodynamic treatment resulted in an average of 36% reduction in prostate tumour volume, within 24 h.

Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical countries. However, different modalities of treatment of liver abscess are conservative (medical management), percutaneous needle aspiration, percutaneous catheter drainage, surgical drainage and endoscopic drainage. The aim of the study is to evaluate the clinical presentation and the different management done for liver abscess. This is an observational prospective study for presentation of liver abscess and its management done in the department of general surgery, simmer hospital, Surat, Gujarat, India from 1st January 2018 to 31st December 2018. In this study, 35patients (23 males and 12 females; age range, 2-72 years; average age, 35 years) with liver abscesses (amebic 08; pyogenic 27) underwent either percutaneous needle aspiration, percutaneous catheter drainage, or surgical intervention along with appropriate antimicrobial therapy. In patients assigned to the needle aspiration group, an 18-gauge spinal needle under local anaesthesia was used to aspirate the abscess cavity. For catheter drainage, 8- to 12-French catheters were introduced into the abscess cavity using the Seldinger technique. Patients were followed up to assess the outcome of the treatment, length of hospital stay, and development of any complications. Sonography was performed every third day during hospitalization in cases of percutaneous needle aspiration and percutaneous catheter drainage. After discharge of the patient, periodic clinical and sonographic examinations were done until total resolution of abscesses was achieved. Improvement in clinical features, liver function tests, ultrasonic evidence of decrease in the size of abscess cavity was considered as criteria for successful treatment.

Background: The current coronavirus disease 2019 (COVID-19) pandemic has disrupted the spectrum of health care, including delaying diagnoses and treatment, particularly for complex health conditions, such as pediatric patients with congenital heart disease (CHD). Objectives: The objective of this study is to assess the impact of COVID-19 crisis and lockdown on families of children with CHD and to study knowledge, attitude, and practices (KAP) regarding COVID-19 among them. Methodology: The purposive sampling was used, all patients (173) who consulted in the cardiology outpatient department during the study period and 190 CHD patients whose the date of surgery was previously scheduled during April and May 2020, but delayed due to the national lockdown were included in this study. Hence, the sample size of the study was 363. Phone calls were made to all patients' families. This study design was used due to current COVID-19 crisis to minimize contact with patients, in line with safety precautions mandated by the government. Results: 54.2% were male patients, 43.3% in the age group of 1–5 years, predominant diagnosis (37.3%) was ventricular septal defect. Majority of parents of CHD patients (78.2%) answered that primary source of information about COVID-19 was social media. Twelve percent patients had worsening of symptoms related to existing heart condition during this period. Parents of 26 patients (8.3%) faced difficulty in getting medicines due to lockdown. The KAP assessment found that a high proportion of parents possessed basic knowledge about the disease at the early stage of the pandemic. The average KAP score was 10.2 (Range 2–16). Conclusion: This is the first study to investigate the impact of COVID-19 on children with CHD during the pandemic. This group had faced considerable difficulty like the general population. KAP assessment showed that they had good knowledge about the pandemic; they were following precautionary measures, especially because of the child's condition, to ensure the child's safety.

INTRODUCTION AND OBJECTIVES: Pathologic upgrading from biopsy to prostatectomy occurs in approximately 30% of prostate cancer cases. PSA, a nonspecific protein, has previously been the primary serum marker for prostate cancer. Markers that more accurately assess risk of aggressiveprostate cancer at the timeof screening are critical for the future management of this disease. The aim of this study was to identify a panel of microRNA (miRNA) from serum that could differentiate patients with low-risk (Gleason 6) prostate cancer on TRUS biopsy specimenswho were either the same grade or upgraded at the time of prostatectomy. METHODS: Total RNA was isolated from serum of patients who had Gleason Sum (GS) 6 prostate cancer at the time of TRUS guided prostate biopsy. These patients were divided into groups with GS 6 that remained GS 6 (same grade) at prostatectomy and those who were upgraded to GS7 (upgrade) at the time of prostatectomy. For the discovery phase, sample pools from each group were profiled via miRNA PCR array (Exiqon). Validation of miRNA expression levels was performed on 29 same and 31 upgrade samples by qRT-PCR. RESULTS: Array analysis of 751miRNA identified34miRNAwith 2-fold differential expression between patients who had Gleason upgrading between biopsies and prostatectomy compared to patients who were same grade. Of these, 20 miRNA were down-regulated and 14 were up-regulated in theupgradedgroup.Additionally, 3miRNAwereexpressed in the upgrade groupwhich were not detected in the same grade group. 17 miRNA were further validated by qRT-PCR on individual samples. miR425-5pandmiR-146-5pwere found tobesignificantlydifferent between the same grade and upgraded groups. ROC curve of logistic regression analysis of theses two showed an area under the curve of 0.691. CONCLUSIONS: Serum samples demonstrated different miRNA expression levels between samples that were same grade or upgraded from Gleason 6 at prostatectomy. This minimally invasive assay could provide an adjunct to PSA and prostate biopsies to better counsel patients on management of low-risk prostate cancer and monitor patients on active surveillance.

INTRODUCTION AND OBJECTIVES: Neoadjuvant chemotherapy prior to radical cystectomy has been shown to confer a survival advantage in patients with muscle-invasive bladder cancer. When combined with maximal endoscopic resection of visible tumor, 38% of patients can be rendered pathologic stage 0 (pT0) at the time of cystectomy. Previous studies have shown differential expression of microRNA (miRNA) in the cell-free urine of patients with muscle invasive and non-muscle invasive bladder cancer. We aimed to identify miRNA in the urine of patients with a history of invasive bladder cancer and differentiating patients with a complete response to therapy from those with persistent disease. METHODS: Total RNA was isolated from cell-free urine of patients undergoing cystectomy for muscle-invasive cancer (pT0, pT1, and >pT2), cT0 patients on active surveillance with a history of muscle invasive disease, as well as healthy control samples (HC) from patients with no history of cancer. Patient samples were divided into four groups: HC (n1⁄413), pT0/cT0 (n1⁄417), pT1 (n1⁄49) and pT2 (n1⁄423), consistent with the pathologic tumor stage of the specimen at the time of TURBT or surgery. Pooled RNA isolates from each group were profiled via PCR array of 751 miRNA (Exiqon). MiRNA expression levels were validated on individual samples by qRT-PCR. RESULTS: The number of miRNA detected within each group correlated with the severity of disease where 391 miRNAs were detected in the pT2 group, 137 in the pT1 group, 124 in the pT0/cT0 group, and 73 among the HCs. Hierarchical cluster analysis revealed two main branches; one consisting of the HC and pT0/cT0 pools and the other comprised of the pT1 and pT2 pools. Additionally, 32 miRNA were expressed in the pT1 and pT2 pools, and not detected in the pT0/ cT0 and HC pools. qRT-PCR confirmed differential expression of several miRNA distinguishing the two clustered groups (p

Case reports of the implantation of penile nodules indicate that this uncommon phenomenon should be recognized despite having few reported complications. Although the diagnosis of an artificial penile nodule is straightforward, it must be differentiated from other conditions such as subcutaneous angiitis, cysts, or calcification of the penis. Often, there are no serious side effects but there are reports of infection and hematoma. Long-term complications may include scar tissue formation, pain, and erectile dysfunction. CONCLUSIONS: The practice of genital modification by genital pearling is an uncommon phenomenon generally practiced to produce enhanced sexual pleasure.

Introduction: In this video, we demonstrate both the anterior and the posterior bladder neck dissection with tension stitch. Placing a suture in the posterior bladder neck is a common approach in patients with median lobes, whereby the median lobe is retracted with a figure-of-eight suture. Materials and Methods: The 30-degree down lens is utilized for the most optimal view of this dissection. Results: Multiple visual cues are utilized to determine the location of the bladder neck, including the limits of the anterior prostatic fat pad, excursions of the Foley balloon, and tissue response to pinching maneuvers. The initial dissection focuses primarily in the midline, aiming to get down to vertical fibers, which appear just before the catheter is exposed. If the lateral contours of the prostate are readily apparent, this tissue may be taken down as well, bearing in mind that bleeding is often encountered laterally as shown. Once the catheter is exposed, some lateral progression will help define th...

Permanent tattoos are formed through the injection of ink solids through the epidermis into the dermis and can cause multiple adverse reactions. We report a 38-year-old man who presented to our Dermatologic Surgery Unit with a diagnosis of a superficially invasive squamous cell carcinoma (SCC), keratoacanthoma (KA) type, of the left forearm in a 1-month-old tattoo. Since his initial biopsy, he developed four more similar lesions on his left forearm within his tattoo. On physical examination, the patient had a large, multicolor tattoo on his left forearm, a well-healed surgical biopsy site and four erythematous hyperkeratotic papules within differently pigmented areas of the patient's tattoo. Histopathological examination showed KA and tattoo pigment. Based on the eruptive nature of these lesions, their clinical presentation and the histopathological changes, we report this as the first case of eruptive KA arising in a multicolor tattoo.