Case Of Sp Research Articles

Can xenobiotics support the growth of Mn(II)-oxidizing bacteria (MnOB)? A case of phenol-utilizing bacteria Pseudomonas sp. AN-1

Biogenic manganese oxides (BioMnOx) produced by Mn(II)-oxidizing bacteria (MnOB) have garnered considerable attention for their exceptional adsorption and oxidation capabilities. However, previous studies have predominantly focused on the role of BioMnOx, neglecting substantial investigation into MnOB themselves. Meanwhile, whether the xenobiotics could support the growth of MnOB as the sole carbon source remains uncertain. In this study, we isolated a strain termed Pseudomonas sp. AN-1, capable of utilizing phenol as the sole carbon source. The degradation of phenol took precedence over the accumulation of BioMnOx. In the presence of 100 mg L−1 phenol and 100 µM Mn(II), phenol was entirely degraded within 20 h, while Mn(II) was completely oxidized within 30 h. However, at the higher phenol concentration (500 mg L−1), phenol degradation reduced to 32% and Mn(II) oxidation did not appear to occur. TOC determination confirmed the ability of strain AN-1 to mineralize phenol. Based on the genomic and proteomics studies, the Mn(II) oxidation and phenol mineralization mechanism of strain AN-1 was further confirmed. Proteome analysis revealed down-regulation of proteins associated with Mn(II) oxidation, including MnxG and McoA, with increasing phenol concentration. Notably, this study observed for the first time that the expression of Mn(II) oxidation proteins is modulated by the concentration of carbon sources. This work provides new insight into the interaction between xenobiotics and MnOB, thus revealing the complexity of biogeochemical cycles of Mn and C.

A210 ESOPHAGEAL SQUAMOUS PAPILLOMATOSIS AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION

Abstract Background Squamous papillomatosis is a rare benign epithelial finding, generally found incidentally in the distal esophagus. The pathophysiology is not well understood but felt to be secondary to reflux and chemical irritation leading to leukoplakia and verrucous hyperplasia of the epithelium and papilloma formation. Aims To present a case of esophageal squamous papillomatosis after endoscopic submucosal dissection (ESD) and radiofrequency ablation (RFA) of Barrett’s esophagus (BE) and early esophageal cancer. Methods Case report and review of the literature Results A 78-year-old male with C3M3 BE and previous band mucosectomy for nodular dysplasia was referred for ESD of an early esophageal cancer. ESD was successfully performed, with histopathology identifying a low-risk well-differentiated intramucosal adenocarcinoma without lymphovascular invasion and negative margins. Radiofrequency ablation was performed 3-months post-resection for residual BE. Subsequent surveillance gastroscopy 6 months post-resection identified extensive fleshy pink granulation tissue at the ESD scar, histopathology revealing SP. This was confirmed on subsequent repeat gastroscopy and biopsy. Compliance with double dose proton pump inhibitor therapy was confirmed. Conclusions To our knowledge, this is the first reported case of SP developing post-ESD and RFA; further expanding our knowledge of potential Barrett’s endotherapy-related adverse events. Funding Agencies None

Invariant differential operators for noncompact Lie groups: The Sp(n,1) case

In this paper, we continue the project of systematic construction of invariant differential operators (IDOs) on the example of the noncompact algebras [Formula: see text]. Our choice of these algebras is motivated by the fact that they belong to a narrow class of algebras, which are of split rank one, of which class the other cases were studied, some long time ago. We concentrate on the case [Formula: see text]. We give the main multiplets and the main reduced multiplets of indecomposable elementary representations (ER) for, including the necessary data for all relevant invariant differential operators. We also present explicit expressions for the singular vectors and the intertwining differential operators.

Enhancement on migration and biodegradation of Diaphorobacter sp. LW2 mediated by Pythium ultimum in soil with different particle sizes.

The composition and structure of natural soil are very complex, leading to the difficult contact between hydrophobic organic compounds and degrading-bacteria in contaminated soil, making pollutants hard to be removed from the soil. Several researches have reported the bacterial migration in unsaturated soil mediated by fungal hyphae, but bacterial movement in soil of different particle sizes or in heterogeneous soil was unclear. The remediation of contaminated soil enhanced by hyphae still needs further research. In this case, the migration and biodegradation of Diaphorobacter sp. LW2 in soil was investigated in presence of Pythium ultimum. Hyphae could promote the growth and migration of LW2 in culture medium. It was also confirmed that LW2 was able to migrate in the growth direction and against the growth direction along hyphae. Mediated by hyphae, motile strain LW2 translocated over 3 cm in soil with different particle size (CS1, 1.0-2.0 mm; CS2, 0.5-1.0mm; MS, 0.25-0.5 mm and FS, <0.25 mm), and it need shorter time in bigger particle soils. In inhomogeneous soil, hyphae participated in the distribution of introduced bacteria, and the total number of bacteria increased. Pythium ultimum enhanced the migration and survival of LW2 in soil, improving the bioremediation of polluted soil. The results of this study indicate that the mobilization of degrading bacteria mediated by Pythium ultimum in soil has great potential for application in bioremediation of contaminated soil.

Clinician approaches to new spine pain cases in primary care: Balance of opioid prescribing and early linkage to exercise therapy and spinal manipulation.

Spine pain (SP) is common and often disabling. Clinical practice guidelines discourage opioid treatment and outline the value of varied nonpharmacologic therapies (NPTs). This study elucidates the amount of variability in primary-care clinicians' (PCPs') prescribing of opioids and in their cases' receipt of the two most common NPTs (exercise therapy and spinal manipulation). The design was a retrospective cohort study examining variation in the treatment of PCPs' new SP cases, classified by receipt of (a) prescription of an opioid at the initial visit; (b) exercise therapy and/or spinal manipulation within 30 days of initial visit. The study was set in the primary care clinics at military treatment facilities of the US Military Health System in the period between October 2011 and September 2016. The majority of cases did not receive a study treatment (66.3%); 19.6% of cases received only NPT within 30 days of initial visit; 11.5% were prescribed only an opioid at the initial visit with receipt of both NPT and opioid during early treatment rare (2.6%). Exercise therapy within 30 days exhibited more than a twofold difference in interquartile percentile rates (IQR) (median provision 15.8%, IQR 9.8%-22.1%). The other treatments exhibited even greater variation; specifically, spinal manipulation (median 8.5%, IQR 3.3%-15.8%), and opioid at initial visit (median 10.3%, IQR 4.4%-18.2%). The availability of physical therapists and doctors of chiropractic had significant association with several clinical provision rates. Among providers of spine care for a sample of Army soldiers, there was substantial variation in the early provision of exercise therapy, spinal manipulation, and opioid prescriptions. The magnitude of the case-mix adjusted variation and its association with facility availability of providers suggests that quality of care initiatives may help reduce this variation.

DERMATITIS DUE TO SARCOPTES SCABIEI AND RHIPICEPHALUS SANGUINEUS ACCOMPANIED BY ANAPLASMOSIS IN SHIH-TZU MIXED DOG

Dermatitis is a skin disorder that can be caused by a variety of things, including ectoparasites such as mites and ticks. A tick infestation is often accompanied by a bacterial infection in the blood. The case dog is a Shih-Tsu cross dog named Pico, female, 3 years old. The case animal had complaints of itching for 12 weeks and had previously experienced tick infestation. Physical examination, the hair looked dirty and dull, the animal's skin showed erythema, hyperpigmentation, crusting, scale and Rhipicephalus sanguineus ticks were found. Examination of skin scrapings found Sarcoptes scabiei mites. Complete haematological examination showed normochromic microcytic anemia and thrombocytopenia. The results of the blood smear showed the presence of Anaplasma sp in the erythrocytes. Examination of the test kit showed that the dog was a positive case of Anaplasma sp. Based on the results of the examination of case dogs, they were diagnosed with dermatitis due to Sarcoptes scabiei and Rhipicephalus sanguineus accompanied by anaplasmosis. Case dogs were treated with ivermectin 300 mcg/kg BW subcutaneously at intervals of 14 days, topical therapy with sulfur soap and bathed twice a week, doxycycline 5mg/kg BW once a day orally for 28 days. Symptomatic therapy, diphenhydramine HCl 1 mg/kg BW intramuscularly and chlorpheniramine maleate 2 mg twice daily orally for 14 days. For supportive therapy, 1 ml of B-complex vitamins intramuscularly and vitamins B12 and Fe orally once a day for 28 days. After 21 days of therapy, the dog's condition improved, the frequency of pruritus decreased, the lesions decreased, the hair started growing, no ticks were found and the hematology results showed an increase in RBC, Hb and platelets from the initial condition. Pet owners recommend disinfecting the environment to break the life cycle of ticks and keeping dogs in cages to prevent transmission to healthy animals.

The Plancherel formula of Fourier integral operators: The case of Sp(1,1)

In this paper, we consider the Plancherel formula for Fourier integral operator on the space [Formula: see text], where [Formula: see text] is the quaternion skew field. By using the metaplectic representations of a noncompact classical dual pair [Formula: see text] and combining with the Plancherel formula of Poisson transform, we obtain the direct integral decomposition of all irreducible unitary representations of Fourier integral operator.

The Impact of Prior Mammograms on the Diagnostic Performance of Radiologists in Early Breast Cancer Detection: A Focus on Breast Density, Lesion Features and Vendors Using Wholly Digital Screening Cases.

This study aims to investigate the diagnostic efficacy of radiologists when reading screening mammograms in the absence of previous images, and with the presence of prior images from the same and different vendors. 612 radiologists' readings across 9 test sets, consisting of 540 screening mammograms (361-normal and 179-cancer) with 245 cases having prior images obtained from same vendor as current images, 129 from a different vendor and 166 cases having no prior images, were retrospectively analysed. True positive (sensitivity), true negative (specificity) and area under ROC curve (AUC) values of radiologists were calculated for three groups of cases (without prior images (NP), with prior images from same vendor (SP), and with prior images from different vendor (DP)). Logistic regression was used to estimate the odds ratio (OR) of true positive, true negative and true cancer localization among case groups with different levels of breast density and lesion characteristics. Radiologists obtained 12.8% and 10.3% higher sensitivity in NP and DP than SP (0.803-and-0.785 vs. 0.712; p < 0.0001). Specificity in NP and DP cases were 4.8% and 2.0% lower than SP cases (0.749 and 0.771 vs. 0.787). The AUC values for NP and DP were significantly higher than SP cases across different levels of breast density (0.814-and-0.820 vs. 0.782; p < 0.0001). The odds ratio (OR) of true positive for NP relative to SP was 1.6 (p < 0.0001) and DP relative to SP was 1.5 (p < 0.0001). Radiologists were more like to detect architectural distortion in DP than SP cases (OR = 3.2; p < 0.0001), whilst the OR for abnormal calcifications was 2.85 (p < 0.0001). Cases without previous mammograms or with prior mammograms obtained from different vendors were more likely to benefit radiologists in cancer detection, whilst prior mammograms undertaken from the same vendor were more useful for radiologists in evaluating normal cases.

Análise da tendência nas taxas de detecção de sífilis em gestantes e de incidência de sífilis congênita no Ceará no período de 2015 a 2021

ABSTRACT Objective: To analyze the trend in the detection rate of Syphilis in Pregnant Women (SP) and in the incidence rate of Congenital Syphilis (CS) in the state of Ceará. Methods: This is an ecological study that used the technique of interrupted time series to analyze monthly data on cases of SP and CS obtained from the Department of Informatics of the Brazilian Unified Health System (DATASUS) from January 2015 to July 2021. The Kernel test and the Lincoln-Petersen estimate were used to analyze the statistical significance. Results: In 2015, a monthly detection rate of SP was estimated at 5.4 and a CS incidence rate of 8.2 per one thousand live births (LB). The implementation of the ordinance that changed the criteria for defining cases of SP and CS resulted in an increase of 4.9 (p&lt;0.0001; 95%CI; 3.33; 6.61) in the detection rate of SP and a decrease of 0.1 on the incidence of CS (p&lt;0.001; 95%CI -0.2; -0.1). The COVID-19 pandemic did not impact the monthly detection rate of SP (p=0.558; 95%CI 5.92; 3.22), nor its trend (p=0.7397; 95%CI 0.28; 0.3), but there was an increase of 0.19 in CS (p&lt;0.001; 95%CI 0.1; -0.31). Conclusion: Between 2015 and June 2021, the trend in the detection rate of SP and in the incidence rate of CS was impacted by changes in the criteria for defining cases of these diseases proposed by the Brazilian Ministry of Health and the COVID-19 pandemic.

Gestational and congenital syphilis across the international border in Brazil.

Brazil lacks data from syphilis in its border areas. We aimed to describe the spatial and temporal distribution of acquired syphilis (AS), in pregnancy (SP) and congenital syphilis (CS) in Brazilian municipalities in the arches border contexts. An ecological, cross-sectional study was conducted from 2010 to 2020. The study was based on the cases of syphilis available in the Notifiable Diseases Information System (SINAN), and on the Primary Health Care Information System. The detection rates of AS and SP, and the incidence of CS were estimated, and the time series was analyzed. Data between the border arches were compared. In 2020, data showed 7,603 cases of AS (detection rate 64.8/100,000 inhabitants), 3,960 cases of SP (detection rate of 21.6/1,000 live births) and 836 cases of CS (incidence of 4.6/1,000 live births) in the border region. Between 2010 and 2020, the mean annual increase of detection rate of SP was 53.4% in Brazil, 48.0% in the border region, 59.6% in the North Arch, 28.8% in the Central and 67.2% in the South. Annual variation on the incidence of CS for the same period was 31.0% in Brazil 38.4% at the border, in the North and South Arcs 18.3% and 65.7% respectively. The Central Arch showed an increase only between 2010 and 2018 (62.7%). A total of 427 (72.6%) municipalities has primary health care coverage ≥ 95% of the population. In 2019, 538 (91.8%) municipalities reported using rapid tests for syphilis, which decreased to 492 (84%) in 2020. In 2019, 441 (75.3%) municipalities reported administering penicillin, and 422 (72%) in 2020. Our data show syphilis reman problem at the Brazilian border, rates in pregnant are high. It was observed a reduction in the detection rates, SP and the incidence of CS between 2018 and 2020. Syphilis should be included on the agenda of all management levels, aiming at expanding access and quality care.

The Missouri Osteochondral Preservation System Is Associated With Better Short-Term Outcomes Than Standard Preservation Methods When Performing Osteochondral Allograft Transplantation Using Shell Grafts for Patellofemoral Lesions

To compare outcomes after whole-surface osteochondral allograft (OCA) transplantation using shell grafts for treatment of patellofemoral joint lesions with respect to surfaces treated and OCA preservation method. With institutional review board approval and informed consent, patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. Patients who received patellofemoral shell OCA to treat the entire articular surface of the patella, trochlea, or both, and with a minimum of 2-year follow-up data, including patient-reported outcome measures (PROMs), failures, and complications, were included. Functional graft survival was determined based on patients returning to functional activities without need for OCA revision or arthroplasty surgery and calculated using the formula: 100% - (%revision+ %failure). Minimum clinically important differences were determined based on previously validated data. Outcomes were compared based on differences in graft preservation methodology (Missouri Osteochondral Preservation System [MOPS] or standard preservation [SP]) and based on surfaces treated (patella, trochlea, or both). Fifty-eight patients met inclusion criteria. Mean age was 36.7 years (range 15-60 years) and mean body mass index was 28.9 (range 18-42). OCAs stored using SP methods were transplanted in 12 patients, mean follow-up was (66.1 months; range 54-70 months): OCAs stored using MOPS methods were transplanted in 46 patients, mean follow-up was (44.8 months; range 24-60 months). Graft survival rate at final follow-up was significantly greater (P= .025) for MOPS OCAs (98%) compared with SP OCAs (75%), whereas 2-year functional graft survival rates (MOPS 98% vs SP 83%; P= .1) were not. Reoperation rate was significantly greater (P= .0014) for SP cases compared with MOPS cases. PROMs showed statistically significant and clinically meaningful improvements through 4 years after unipolar patella, unipolar trochlea, and bipolar patellofemoral OCA transplantation using MOPS grafts. Unipolar patella OCA transplantations were associated with significantly more reduction in pain and significantly better PROMs at 1-year compared with unipolar trochlea and bipolar patellofemoral OCAs. OCA transplantation using MOPS shell grafts for unipolar and bipolar patellofemoral resurfacing was associated with statistically significant and clinically meaningful improvements from preoperative levels of pain and function. The 2-year functional graft survival rate was 83% in the SP group and 98% in the MOPS group, such that MOPS was associated with better short-term outcomes than SP methods when performing OCA transplantation using shell grafts for patellofemoral lesions. Patients who received unipolar patella allografts reported the best outcomes in terms of pain and function. Level III, retrospective analysis of registry data.

Optimizing Clinical Reasoning Assessments With Analytic and Holistic Ratings: Examining the Validity, Reliability, and Cost of a Simplified Patient Note Scoring Procedure.

Post-standardized patient (SP) encounter patient notes used to assess students' clinical reasoning represent a significant time burden for faculty who traditionally score them. To reduce this burden, the authors previously reported a complex faculty-developed scoring method to assess patient notes rated by nonclinicians. The current study explored whether a simplified scoring procedure for nonclinician raters could further optimize patient note assessments by reducing time, cost, and creating additional opportunities for formative feedback. Ten nonclinician raters scored patient notes of 141 students across 5 SP cases by identifying case-specific patient note checklist items. The authors identified the bottom quintile of students using the proportion of correct items identified in the note (percent-scores) and case-specific faculty-generated scoring formulas (formula-scores). Five faculty raters scored a subset of notes from low, borderline, and high-performing students (n = 30 students) using a global rating scale. The authors performed analyses to gather validity evidence for percent-scores (i.e., relationship to other variables), investigate its reliability (i.e., generalizability study), and evaluate its costs (i.e., faculty time). Nonclinician percent- and formula-scores were highly correlated ( r = .88) and identified similar lists of low-performing students. Both methods demonstrated good agreement for pass-fail determinations with each other (Kappa = .68) and with faculty global ratings (Kappa percent =.61; Kappa formula =.66). The G-coefficient of percent-scores was .52, with 38% of variability attributed to checklist items nested in cases. Using percent-scores saved an estimated $746 per SP case (including 6 hours of faculty time) in development costs over formula-scores. Nonclinician percent-scores reliably identified low-performing students without the need for complex faculty-developed scoring formulas. Combining nonclinician analytic and faculty holistic ratings can reduce the time and cost of patient note scoring and afford faculty more time to coach at-risk students and provide targeted assessment input for high-stakes summative exams.

A clinical study of risk factors,aetiology and management ofspontaneous pneumothorax

Materials &amp; Methods: A hospital based prospective study of 50 consecutive cases presenting to MGM Medical College, Hospital diagnosed as Spontaneous Pneumothorax from the time period of 2014 December to 2016 November who met the inclusion and exclusion criteria. Results: In the total of 50 cases of SP studied, 35 (70% of total cases) of them were found to have under lying lung pathology and diagnosed as SSP while only 15(30%of total cases) had no demonstrable lung pathology and diagnosed as PSP. Among the total cases of 50 studied the highest number of cases were in the age group of 50-60 years (28% of total cases), followed by the age group of 20-30 years (22% of total cases). Males were more commonly affected comprising 40 of the total 50 cases studies (82% of total cases) while females comprised of the rest 9 cases (18% of total cases). Male: Female Ratio for SP was5:1, for PSP9:1and for SSP 4. 5:1. COPD was found to be the leading cause of SSP responsible for 21 of the 35 cases of SSP (60% of the total cases), followed by TB accounting for only 10 cases (28. 57% of the total cases).

A rare case report of dominant paediatric sinus pericranii: food for thought!

BackgroundSinus pericranii (SP) is a rare venous anomaly abnormally connecting the intracranial dural sinuses with the epicranial venous channels. Various authors have attempted to classify this entity to decide management for this potentially life-threatening condition. With approximately 200 cases reported in world literature till date, no definitive guidelines for management have emerged.Case presentationA female child aged 7 years presented to us with complaints of occipital swelling since birth. This swelling was gradually increasing in size as reported by the parents. On examination, the swelling was located in the right parieto-occipital region, size 10 cm diameter in lying position, soft, non-tender, fluid-like diffuse swelling with underlying areas of palpable bony defects, partially reducible in sitting up position, and cough impulse was present. On evaluation, a case of dominant SP was established.ConclusionTraditionally, SP has been reported mostly in paediatric population and managed surgically or endovascularly for selected cases, while the remaining cases have been observed. Profuse haemorrhage has been a major deterrent to manage these lesions surgically. Long-term complications like trauma, haemorrhage, infection and thrombosis have been reported in conservatively managed cases. The neurosurgical community has thus been left searching for the optimal management of SP. The authors report this case attempting to classify this case according to the available classification systems and hence decide the best possible management.

Clinical Outcomes of Rose Bengal Mediated Photodynamic Antimicrobial Therapy on Fungal Keratitis with Their Microbiological and Pathological Correlation

Purpose To report the clinical outcome of Photodynamic Antimicrobial Therapy (PDAT) with Rose Bengal (RB) used as an early adjuvant therapy in patients with fungal keratitis and their microbiological and pathological correlation. Methods Patients with microbiologically confirmed fungal keratitis underwent PDAT-RB along with topical natamycin 5% drops hourly and oral ketoconazole 200 mg twice a day. This was performed by applying rose bengal (0.1%) to the de-epithelialized cornea for 30 minutes, followed by irradiation with a 6 mW/cm2 custom-made green LED source for 15 minutes (5.4 J/cm2). The corresponding fungal isolates were tested in vitro using PDAT-RB and corneal buttons were evaluated for correlation. Results Following informed consent, seven patients (male-5, female-2, mean age 47.7 years) with fungal keratitis were recruited. There were 3 cases each of Fusarium and Aspergillus flavus and 1 case of Acremonium sp. The average vertical and horizontal diameters of the corneal infiltrate were 4.12 ± 0.55 and 3.99 ± 1.19 mm, respectively. The average depth of corneal involvement was 283 ± 75.27µ as measured by anterior segment OCT. The clinical resolution was achieved in the cases with Fusarium keratitis with an average time of 39 days. Three cases of A. flavus and a single patient with Acremonium keratitis worsened and needed therapeutic keratoplasty (TPK) for resolution. Post-TPK, the corneal tissues grew A. flavus in one out of three cases and Acremonium sp. in one case. In vitro PDAT-RB experiment was performed on the corresponding fungal isolates grown from the corneal scraping. PDAT-RB produced clear inhibition of Fusarium and Acremonium sp. with no effect on the growth of A. flavus. Histopathologically, 2 out of 4 (50%) corneal buttons showed fungal filaments. Conclusions While the in vitro and in vivo results of PDAT-RB matched for Fusarium sp. and Aspergillus flavus keratitis being favourable in the former and non-favourable in the latter, these results were discrepant in Acremonium sp.

Bird fancier's lung serodiagnosis by automated r-IgLL1 ELISA

ContextBird fancier's lung (BFL) is the most prevalent form of hypersensitivity pneumonitis (HP) worldwide. The current techniques used for the serological diagnosis of BFL all use crude extracts from feathers, droppings, and blooms as test antigens, which is associated with a lack of standardization and variability of the results. An antigenic protein, immunoglobulin lambda-like polypeptide-1 (IgLL1), isolated from pigeon droppings, was recently identified to be associated with BFL. We used genetic engineering to produce IgLL1 as a recombinant antigen. AimWe aimed to prospectively validate the use of an automated ELISA based on recombinant IgLL1 protein (r-IgLL1) as the test antigen for the serological diagnosis of BFL. MethodsImmunoprecipitation (IP) techniques (immunodiffusion (ID), immunoelectrophoresis (IEP)) and ELISA using r-IgLL1 were performed concomitantly over 10 months on 634 sera from patients with a BFL serodiagnosis request. Questionnaires were sent to obtain details on the avian exposure, clinical data, and final diagnosis. Concordance, sensitivity (Se), and specificity (Sp) of the two techniques were compared. ResultsIn total, 72 completed questionnaires were returned with 18 cases of BFL diagnosed and 54 of non-BFL. The concordance between the ELISA and ID+IEP precipitation techniques was 71%. The combination of immunoprecipitation techniques showed a Se of 78% and a Sp of 67%. The ELISA using r-IgLL1 showed a Se of 89% and a Sp of 91%. The automated r-IgLL1 ELISA test is sufficiently efficient to be used alone for the diagnosis of patients exposed solely to Columbidae.In cases of other avian exposure, the Se and Sp of the r-IgLL1 ELISA used for screening combined with the immunodiffusion test for confirmation were 89% and 93%, respectively. ConclusionsThe automated ELISA using r-IgLL1 is a promising tool for BFL serodiagnosis. Replacing immunodiffusion by the automated ELISA using r-IgLL1 as a screening technique will be the basis of our future strategy for BFL serodiagnosis.

PD35-09 SINGLE PORT ROBOTIC UPPER URINARY TRACT RECONSTRUCTION – RESULTS FROM A SINGLE CENTER CASE SERIES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (PD35)1 Sep 2021PD35-09 SINGLE PORT ROBOTIC UPPER URINARY TRACT RECONSTRUCTION – RESULTS FROM A SINGLE CENTER CASE SERIES Graham Hale, Luca Morgantini, and Simone Crivellaro Graham HaleGraham Hale More articles by this author , Luca MorgantiniLuca Morgantini More articles by this author , and Simone CrivellaroSimone Crivellaro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002039.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reconstruction of the upper urinary tract can be challenging and complex. The introduction of minimally invasive surgical techniques has helped decrease the morbidity of these procedures. This case series seeks to assess the safety and feasibility, and report initial outcomes of a single port robotic platform (SP) for reconstruction of the upper urinary tract (RUT). METHODS: Between February 2019 and March 2021, data were collected retrospectively on all cases of SP for RUT for key outcome including patient demographic, pre, peri, and post-operative data. RESULTS: 36 surgeries on 31 patients were performed (Table 1) with mean follow up of 204 days. 8 procedures were performed to salvage previous RUT. Intra and perioperative data are summarized in Table 2. Average length of stay was 2.11 days, with 5/36 (14%) same day discharges and 12/36 (33%) on POD1.1 patient was lost to follow-up.24/30 (80%) patients were stent and symptoms free. 2 patients are awaiting stent removal. One intraoperative complication (1/36, 2.8%) was recorded (repaired sigmoid laceration : no additional intervention) and 2 patients (2/36, 5.6%) had urine leaks necessitating PCNs perioperatively. 6/35 (17.1%) surgeries failed and required reoperation: 2 received salvage ureteroplasty (with success), 2 chose stent dependent, and 2 nephrectomies for atrophic kidney, poor renal function prior on renal scan. All results summarized Table 3. CONCLUSIONS: Single port robotic reconstruction of the upper urinary tract is safe and feasible. The functional outcomes and length of stay in our short term follow up period are encouraging. Comparison studies to other robotics platforms are ongoing to assess the role of single port robotic platforms for upper urinary tract reconstruction. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e592-e593 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Graham Hale More articles by this author Luca Morgantini More articles by this author Simone Crivellaro More articles by this author Expand All Advertisement Loading ...

Strong coupling expansion of free energy and BPS Wilson loop in mathcal{N} = 2 superconformal models with fundamental hypermultiplets

As a continuation of the study (in arXiv:2102.07696 and arXiv:2104.12625) of strong-coupling expansion of non-planar corrections in mathcal{N} = 2 4d superconformal models we consider two special theories with gauge groups SU(N) and Sp(2N). They contain N-independent numbers of hypermultiplets in rank 2 antisymmetric and fundamental representations and are planar-equivalent to the corresponding mathcal{N} = 4 SYM theories. These mathcal{N} = 2 theories can be realised on a system of N D3-branes with a finite number of D7-branes and O7-plane; the dual string theories should be particular orientifolds of AdS5 × S5 superstring. Starting with the localization matrix model representation for the mathcal{N} = 2 partition function on S4 we find exact differential relations between the 1/N terms in the corresponding free energy F and the frac{1}{2} -BPS Wilson loop expectation value leftlangle mathcal{W}rightrangle and also compute their large ’t Hooft coupling (λ » 1) expansions. The structure of these expansions is different from the previously studied models without fundamental hypermultiplets. In the more tractable Sp(2N) case we find an exact resummed expression for the leading strong coupling terms at each order in the 1/N expansion. We also determine the exponentially suppressed at large λ contributions to the non-planar corrections to F and leftlangle mathcal{W}rightrangle and comment on their resurgence properties. We discuss dual string theory interpretation of these strong coupling expansions.

Evaluation of beta-2 microglobulin, erythropoietin and tobacco use in polycythemic cases.

In the 2016 WHO classification, hemoglobin and hematocrit thresholds for diagnosing polycythemia vera (PV) have been lowered, increasing the number of consultations for polycythemia investigations. In PV, beta-2 microglobulin (B2m) levels are reportedly increased, whereas erythropoietin (EPO) levels are usually low. Most secondary polycythemia cases (SP) are caused by tobacco use. We decided to analyze the relevance of these three parameters in all patients seen for polycythemia investigations to help differentiate PV from SP cases. A cohort of 257 patients (123 PV; 134 SP) was identified. The median B2m level was higher for PV patients (3.16 vs 1.98mg/l, p < 0.0001). Increased B2m levels were observed in 83.7% of PV patients (11.9% in SP). The median EPO level was lower in PV patients (4.4 vs 12.3 UI/l, p < 0.0001). Tobacco was used by 42.8% of SP patients (8% in PV, p < 0.0001). Increased B2m, low EPO and no tobacco exposure was predictive of PV (specificity and positive predictive value = 100%). Normal B2m, normal EPO and tobacco exposure was predictive of SP (positive predictive value = 100%). These simple and inexpensive parameters could be used to rapidly differentiate PV from SP cases, before prescribing time-consuming JAK2 V617F mutation analysis by specialists.

First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity.

PurposePatients identifying as sexual and gender minorities (SGMs) face healthcare barriers. This problem is partly due to medical training.1 We evaluated first year medical student experiences during a novel four-hour seminar, in which students answered discussion questions, participated in peer role-plays, and interviewed two standardized patientsMethodA constructivist qualitative design employed audio-recorded and transcribed student focus groups. Using generic content analysis, transcripts were iteratively coded, emergent categories identified, sensitizing concepts applied, and a thematic framework created.ResultsThirty-five students (71% female) participated in five focus groups. Two themes were developed: SGM bias (faculty, standardized patients [SPs], students, curriculum), and Adaptive Expertise in Clinical Skills (case complexity, learner support, skill development). SPs identifying as SGM brought authenticity and lived experience to their roles. Preceptor variability impacted student learning. Students were concerned when a lack of faculty SGM knowledge accompanied negative biases. Complex SP cases promoted cognitive integration and preparation for clinical work.ConclusionsThese students placed importance on the lived experiences of SGM community members. Persistent prejudices amongst faculty negatively influenced student learning. Complex SP cases can promote student adaptive expertise, but risk unproductive learning failures. The lessons learned have implications for clinical skills teaching, learning about minority populations, and medical and health professions education in general.