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Investigate outcomes for patients undergoing minimally invasive hysterectomies (MIHs) performed for endometrial cancer at ambulatory surgery centers (ASCs). Our study aimed to explore the feasibility and discharge outcomes for MIHs for endometrial cancer in an ASC setting by using same-day discharge data. The prevalence of MIH for endometrial cancer between 2016 and 2019 was estimated from the Nationwide Ambulatory Surgery Sample. Patients who underwent MIHs for endometrial cancer at an ASC were included. N/A Weighted estimates of prevalence and association between discharge status and sociodemographic factors were explored. Same-day discharge was defined as discharge on the day of surgery, and delayed discharge was defined as discharge after the day of surgery. An estimated 95 041 MIHs for endometrial cancer were performed at ASCs between 2016 and 2019. Notably, 91.9% (n = 87 372) resulted in same-day discharge, 1.2% (n = 1121) had delayed discharge, and 6.9% (n = 6548) had missing discharge information; 78.7% procedures (n = 68 812) were performed at public hospitals. The proportion of delayed discharges were lower in private, not-for profit ASCs (0.8%, p =.03) than public hospitals. Patients who had delayed discharges on average were older (69.7 vs 62.4 years, p <.001), more likely to have comorbid conditions including diabetes (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.25–1.75) and overweight or obese body mass indices (aOR 1.18, 95% CI 1.01–1.39), and more likely to have public insurance (aOR 1.78, 95% CI 1.40–2.25). MIHs for endometrial cancer are feasible in an ASC. Optimal candidates for receipt of MIHs for endometrial cancer at an ASC are patients who are younger and have less comorbidities, lower body mass index, and private insurance. [ABSTRACT FROM AUTHOR]

• Adjuvant human papillomavirus vaccination among patients with history of dysplasia are low. • Physician counseling rates regarding vaccination among this population have not been studied. • Vaccination rates and physician counseling regarding vaccination in this cohort remain low. We describe provider documented counseling patterns and perception regarding HPV vaccination among patients with a history of cervical dysplasia. All patients ages 21–45 who underwent colposcopy at a single academic medical center from 2018 to 2020 were sent a self-administered survey through the electronic medical record patient portal to assess their attitudes regarding human papillomavirus (HPV) vaccination. Demographic information, HPV vaccination history, and documented obstetrics and gynecology provider counseling at the time of colposcopy were examined. Of 1465 patients, 434 (29.6 %) reported or had documented receipt of at least one dose of the human papillomavirus vaccine. The remainder reported they were not vaccinated or had no documentation of vaccination. Proportion of vaccinated patients was higher among White compared to Black and Asian patients (P = 0.02). On multivariate analysis, private insurance (aOR 2.2, 95 % CI 1.4–3.7) was associated with vaccinated status while Asian race (aOR 0.4, 95 % CI 0.2–0.7) and hypertension (aOR 0.2, 95 % CI 0.08–0.7) were less likely to be associated with vaccination status. Among patients with unvaccinated or unknown vaccination status, 112 (10.8 %) received documented counseling regarding catch-up human papillomavirus vaccination at a gynecologic visit. Patients seen by a sub-specialist obstetrics and gynecologic provider were more likely to have documented provider counseling regarding vaccination compared to those seen by a generalist obstetric/gynecologist provider (26 % vs 9.8 %, p < 0.001). Patients cited lack of physician discussion (53.7 %) and the belief that they were too old to receive the HPV vaccine (48.8 %) as the main reasons for remaining unvaccinated. HPV vaccination and the rate of obstetric and gynecologic provider counseling regarding HPV vaccination among patients undergoing colposcopy remains low. When surveyed, many patients with a history of colposcopy cited provider recommendation as a factor in their decision to undergo adjuvant HPV vaccination, demonstrating the importance of provider counseling in this group. [ABSTRACT FROM AUTHOR]

Design failure modes, effects, and criticality analysis (d-FMECA) 2 2 The term FMEA and FMECA are used interchangeably throughout this paper. The user has the option in the interface to choose either FMEA or FMECA based on their desired application. is a bottom-up, semi-quantitative risk assessment approach that is used by reliability engineers across all industries (nuclear, chemical, environmental, pharmaceuticals, aerospace, etc.) for identifying the effects of postulated components failure modes such as solenoid-operated valves (SOV), motor-operated valves (MOV), controllers, pumps, sensors of various types, printed circuit boards (PCBs). This research aims to develop a novel AI-augmented tool that guides, in real-time, the risk-analyst to a host of potential failure modes and their effects for each component contained in a bigger system. Through a user-friendly graphical interface and a robust statistical modeling backend, the AI-driven tool streamlines the risk assessment process by prompting the risk analyst to input a system's name and subsequently generate an extensive array of failure modes and associated effects for each constituent component within the system. This AI-augmented tool allows the user to select either a simplified d-FMEA or a detailed d-FMECA for the system under investigation. This novel AI-driven tool offers significant effort and time savings in conducting d-FMECA, which is known to be a labor-intensive engineering task. In addition, this tool can be used for training risk and reliability professionals. • Developed a novel AI-augmented tool to replace conventional d-FMEA approach. • Designed a user-friendly graphical interface & robust statistical modeling backend. • This AI-driven tool offers significant effort & time savings in conducting d-FMECA. • Help train junior reliability engineers to effectively conduct d-FMEA. [ABSTRACT FROM AUTHOR]

Adnexal mass and torsion are relatively uncommon, but potentially emergent complaints among pediatric and adolescent patients in the emergency department (ED) and surgical intervention is sometimes indicated. There is little national data evaluating surgical prevalence and outcomes within this population. This is a retrospective cross-sectional study utilizing the Nationwide Emergency Department Sample (NEDS) of hospital owned EDs throughout the United States from 2016 to 2018. Inclusion criteria included female sex, younger than 20 years old, and a diagnosis of adnexal mass or ovarian/tubal torsion by ICD-10 (International Classification of Diseases) codes. Other variables included age, ED disposition, type of hospital, region of the country, and teaching hospital status. Surgery status (binomial) was determined utilizing the ICD-10 PCS (Procedure Coding System) and included all ICD-10 CPS related to surgery on the adnexa. Descriptive and bivariate analyses were conducted to assess demographic findings and rates of admission and surgical intervention. Funded by the NASPAG Young Investigator Grant for 2021-2022. N=2,269 pediatric and adolescent patients presented to the emergency department from 2016-2018 with a diagnosis of either adnexal mass or ovarian/tubal torsion. 33.1% (n=751) of patients were admitted to the hospital and 15.1% (n=342) underwent adnexal surgery. Mean age of presentation was 15.3 years old. 63% (n=1,437) were 15 years or older and 35.7% (n=811) were 10 to 14 years old. Most of the expected payors were Medicaid (45.4%, n=1,028) and private insurance (45.5%, n=1,031). 38% of the patients presented to a hospital in the south and 25% in the northeast. 77% presented to a metropolitan, teaching hospitals, 16% metropolitan, non-teaching, and 6.3% non-metropolitan, non-teaching hospitals. There were no differences in patients who received surgery versus no surgery by insurance type, region, or urban-rural hospital distinction. There were higher odds of receiving surgery if at a teaching hospital compared to a non-teaching, metropolitan hospital (OR 1.83, 95% CI 1.2-2.7). Approximately one-third of patients with an adnexal mass or torsion diagnosis were admitted to the hospital and half of those patients ultimately received surgery. This is the first known study to date evaluating prevalence of surgical intervention within this population. Surgery was more likely at teaching hospitals; however, this study does not account for differences in acuity. Further analysis will focus on differentiation between adnexal mass and torsion, type of surgery (oophorectomy versus cystectomy), and mode of surgery (open versus laparoscopy). [ABSTRACT FROM AUTHOR]

When beginning a phototherapy regimen for a patient, consideration of compliance rates is important. Compliance to phototherapy can be affected by several factors, including the grade of discomfort and side effects from therapy, failure of previous therapies, accessibility and convenience to reach the phototherapy center, grade of improvement during phototherapy, patient relief due to light therapy, and rapport with staff. Understanding how these factors can affect patient adherence can allow for phototherapy regimens to be tailored in a manner that optimizes health outcomes and allows for proper patient selection. [ABSTRACT FROM AUTHOR]

Light therapy has been incorporated into the art of healing and cosmesis for thousands of years and currently has found utility in many areas of medicine. Various modalities of cosmetic phototherapy are detailed, as well as the indications and mechanism of action for each modality. These modalities can be used to treat many common cosmetic conditions, including acne vulgaris, solar lentigo, and melasma. Phototherapy is considered a safe and effective option in the treatment of many of these disorders. [ABSTRACT FROM AUTHOR]

Pulmonary alveolar proteinosis (PAP) is a rare pulmonary syndrome that is characterized by the accumulation of excess surfactant in the alveolar space, leading to impaired gas exchange. Sirolimus-induced PAP is an extremely rare entity that has only been described in the literature in a small number of case reports. We present a case of a 39-year-old female with acute lymphocytic leukemia who underwent stem cell transplant, complicated by graft-versus-host-disease (GVHD) involving the skin for which she was treated with steroids, photopheresis, sirolimus, and ruxolitinib. She was admitted to the intensive care unit (ICU) for acute on chronic hypoxic respiratory failure requiring intermittent mechanical ventilation. Computed tomography (CT) of the chest showed thickened inter- and intralobular septa with ground glass opacities and consolidation with a limited geographic pattern. Bronchoalveolar lavage fluid was stained with Periodic acid-Schiff (PAS), which was positive for extracellular proteinaceous material. Autoimmune studies including antibody levels for primary autoimmune pulmonary alveolar proteinosis (PAP) were negative. The patient was diagnosed with sirolimus-induced secondary PAP, and sirolimus was discontinued. A year later, she no longer required supplemental oxygen, and repeat CT imaging showed only faint residual disease. This is the only documented case of sirolimus-induced PAP in a stem cell transplant recipient and the first case reported in which the patient developed severe hypoxic respiratory failure requiring mechanical ventilation. In the right clinical context, PAP can be diagnosed with characteristic high resolution computed tomography (HRCT) findings, serum GM-CSF antibody levels, and bronchoscopy with bronchoalveolar lavage. [ABSTRACT FROM AUTHOR]

Abstract: Background: Brain ischemia is the underlying cause of neuron death during stroke and brain trauma. Neural cells exposed to ischemia can undergo apoptosis. Adrenomedullin (AM) in combination with its enhancing binding protein, AMBP-1, has been shown to reduce tissue damage in inflammation. Methods: To evaluate a beneficial effect of AM/AMBP-1 administration in brain ischemia, we employed an in vitro model of neuronal hypoxia using differentiated human neuroblastoma SH-SY5Y cells. Results: After exposure to 1% O2 for 20 h, neural cells were injured with decreased ATP levels and increased LDH release. Pre-administration of AM/AMBP-1 significantly reduced hypoxia-induced cell injury. Moreover, AM/AMBP-1 treatment reduced the number of TUNEL-positive cells and activation of caspase-3, compared to cells exposed to hypoxia alone. AM/AMBP-1 prevented a reduction of cAMP levels and protein kinase A (PKA) activity in neural cells after hypoxia exposure. Correspondingly, an elevation of cAMP levels by forskolin protected neural cells from hypoxia-induced injury. Inhibition of PKA by KT5720 abolished the protective effect of AM/AMBP-1 on hypoxia-induced apoptosis. Conclusions: AM/AMBP-1 elevates cAMP levels, followed by activating PKA, to protect neural cells from the injury caused by hypoxia. General significance: AM/AMBP-1 may be used as therapeutic agents to prevent neuron damage from brain ischemia. [Copyright &y& Elsevier]

Summary: Protein inhibitors of proteolytic enzymes regulate proteolysis and prevent the pathological effects of excess endogenous or exogenous proteases. Cysteine proteases are a large family of enzymes found throughout the plant and animal kingdoms. Disturbance of the equilibrium between cysteine proteases and natural inhibitors is a key event in the pathogenesis of cancer, rheumatoid arthritis, osteoporosis, and emphysema. A family (I42) of cysteine protease inhibitors (http://merops.sanger.ac.uk) was discovered in protozoan parasites and recently found widely distributed in prokaryotes and eukaryotes. We report the 2.2 Å crystal structure of the signature member of the I42 family, chagasin, in complex with a cysteine protease. Chagasin has a unique variant of the immunoglobulin fold with homology to human CD8α. Interactions of chagasin with a target protease are reminiscent of the cystatin family inhibitors. Protein inhibitors of cysteine proteases may have evolved more than once on nonhomologous scaffolds. [Copyright &y& Elsevier]

Aortic insufficiency (AI) following left ventricular assist device (LVAD) placement is a serious, well established complication. Transcatheter aortic valve replacement (TAVR) has been successfully used in LVAD patients developing AI. However, femoral/iliac arterial access required for TAVR is not always possible due to arterial calcifications and small arterial size. Transcaval approach is a novel alternative percutaneous catheter route from the IVC, through the retroperitoneal space, into the abdominal aorta. Transcaval TAVR in LVAD patients with severe AI has not been described. Patient is a 28 year old female with history of postpartum STEMI secondary to spontaneous LAD/LCX dissection requiring CABG with subsequent cardiogenic shock requiring emergent LVAD (HeartMate 3) placement. One month following LVAD implantation, she presents with intractable nausea and vomiting. Physical exam illustrates a cachectic female who was hypotensive, tachycardic, with cool extremities. Laboratory evaluation reveals elevated lactate, transaminases and creatinine. Abdominal CTA shows a prior dissection in the infrarenal abdominal aorta, occlusion of the right external iliac artery and stenosis in the left external iliac artery. On echocardiography, there is severe, continuous, aortic regurgitation increased in severity compared to baseline. Right heart catheterization illustrates right atrial pressure 18 mmHg, pulmonary artery pressure 53/25 mmHg, pulmonary wedge pressure 24 mmHg, and cardiac index 1.3 L/min/m2. Patient is referred for urgent TAVR via transcaval access due to her stenotic and small sized iliac arteries. A pigtail was inserted in the left femoral artery and advanced to the abdominal aorta and another pigtail was inserted in the right femoral vein and advanced to the IVC to align with the aorta one. From the IVC, an astato wire was crossed into the aorta using wats to electrify the wire. A Sapien 3 valve was deployed. The caval aortic fistula was closed with a covered aortic stent. Final angiography showed complete occlusion of the fistula. Post intervention, patient experienced immediate improvement with resolution of cardiogenic shock. At three months, she remained asymptomatic and echocardiogram showed a well seated valve with no AI. We present an urgent transcaval TAVR performed for a LVAD patient presenting with cardiogenic shock due to AI. Transcaval TAVR is a promising intervention that can be successfully used in LVAD patients developing AI with challenging iliofemoral arterial access. [ABSTRACT FROM AUTHOR]

Highlights • PBMCs from caregivers have increased proinflammatory gene expression levels when stimulated in vitro compared to controls. • These genes include NF-κB and many of its cytokine and chemokine targets. • PBMCs from caregivers showed increased Th17 differentiation and increased expression of COX-2 signaling pathway. • Inflammatory gene expression is associated with shorter telomere length prospectively. Abstract The chronic psychological stress of caregiving leads to higher risks for many diseases. One of the mechanisms through which caregiving is associated with disease risk is chronic inflammation. Chronic inflammation may accelerate cellular aging via telomere dysfunction and cell senescence, although this has not been examined in human cells from healthy people. We examined peripheral blood mononuclear cells (PBMCs) from 20 healthy mothers of children with autism (caregivers) and 19 mothers of neurotypical children (controls) in an in vitro culture system where PBMCs were stimulated with phytohaemagglutinin (PHA). We measured RNA expression levels of a panel of immune function genes before and after PHA stimulation, as well as telomere length from PBMCs collected from the participants at baseline and 15 months later. Caregivers and controls had similar gene expression profiles in unstimulated PBMCs, but after PHA stimulation, caregivers had increased RNA levels of the master inflammatory regulator NF-κB and its proinflammatory cytokine targets IL-1β, IL-6 and its receptor IL-6R as well as inflammatory chemokines IL-8, CXCL1 and CXCL2. Gene expression analysis suggested caregivers have increased Treg and Th17 T cell differentiation. Additionally, key signaling molecules involved in the upregulation of COX-2, a critical enzyme in the synthesis of the inflammatory mediator prostaglandin, were elevated. When both groups were examined together, higher expression levels of proinflammatory genes were associated with shorter telomere length in PBMCs from blood drawn 15 months later, independent of baseline telomere length. Taken together, these results suggest that chronic stress is associated with an exaggerated inflammatory response in PBMCs, which in turn is associated with shorter telomere length measured from PBMCs collected 15 months later. To our knowledge, this is the first human study that shows increased proinflammatory expression predicts future telomere shortening. [ABSTRACT FROM AUTHOR]

Porous brittle solids evidence complex mechanical behavior, where localized failure patterns originate from mechanical processes on the microstructural level. In order to investigate the failure mechanics of porous brittle solids, we outline a general stochastic and numerical microstructure-based approach. To this end, we generate random porous microstructures by level-cutting Gaussian random fields, and conduct numerical simulations using the material point method. This allows investigating both small and large deformation characteristics of irregular porous media where a segmentation into grains and bonds is ambiguous. We demonstrate the versatility of our approach by examining elasticity and failure as a function of a wide range of porosities, from 20% to 80%. Observing that onset of failure can be well described through the second order work, we show that the stress at failure follows a power law similar to that of the elastic modulus. Moreover, we propose that the failure envelope can be approximated by a simple quadratic fitting curve, and that plastic deformation appears to be governed by an associative plastic flow rule. Finally, large deformation simulations reveal a transition in the mode of localization of the deformation, from compaction bands for highly porous samples to shear bands for denser ones. [ABSTRACT FROM AUTHOR]

This study described sleep in a heterogeneous sample of breast cancer patients using the Pittsburgh Sleep Quality Index (PSQI) and examined the relation between sleep disturbance and health-related quality of life as measured by the Rand 36-Item Health Survey. Chemotherapy and radiation therapy were explored as predictors of sleep disturbance in breast cancer patients, and the sleep characteristics of breast cancer patients were compared to the sleep characteristics of a sample of medical patients with general medical conditions. Results showed that 61% of breast cancer patients had significant sleep problems. Sleep was characterized by reduced total sleep time with sleep frequently being disturbed by pain, nocturia, feeling too hot, and coughing or snoring loudly. Despite the frequency of significant sleep disturbance, pharmacological and cognitive–behavioral treatments of sleep problems were observed to be inadequate. Limited evidence was found for the role of chemotherapy and radiation therapy in the sleep disturbance of breast cancer patients, and the general pattern of sleep disturbance in breast cancer patients was not significantly different than that observed in medical patients with general medical conditions. Breast cancer patients having significant sleep problems had greater deficits in many areas of health-related quality of life. The implications of the findings and study limitations are discussed. [Copyright &y& Elsevier]

Pathogen transmission by mosquitoes is tightly linked to blood feeding which, in turn, is required for egg development. Studies of these processes would greatly benefit from genetic methods, such as the binary Gal4/UAS system. The latter has been well established for model organisms, but its availability is limited for mosquitoes. The objective of this study was to develop the blood-meal-activated, gut-specific Gal4/UAS system for the yellow-fever mosquito Aedes aegypti and utilize it to investigate the regulation of gut-specific gene expression. A 1.1-kb, 5 ′ upstream region of the carboxypeptidase A ( CP ) gene was used to genetically engineer the CP-Gal4 driver mosquito line. The CP-Gal4 specifically activated the Enhanced Green Fluorescent Protein (EGFP) reporter only after blood feeding in the gut of the CP-Gal4 > UAS-EGFP female Ae. aegypti . We used this system to study the regulation of CP gene expression. In vitro treatments with either amino acids (AAs) or insulin stimulated expression of the CP-Gal4 > UAS-EGFP transgene; no effect was observed with 20-hydroxyecdysone (20E) treatments. The transgene activation by AAs and insulin was blocked by rapamycin, the inhibitor of the Target-of-Rapamycin (TOR) kinase. RNA interference (RNAi) silence of the insulin receptor (IR) reduced the expression of the CP-Gal4 > UAS-EGFP transgene. Thus, in vitro and in vivo experiments have revealed that insulin and TOR pathways control expression of the digestive enzyme CP. In contrast, 20E, the major regulator of post-blood-meal vitellogenic events in female mosquitoes, has no role in regulating the expression of this gene. This novel CP-Gal4/UAS system permits functional testing of midgut-specific genes that are involved in blood digestion and interaction with pathogens in Ae. aegypti mosquitoes. [ABSTRACT FROM AUTHOR]