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STUDY DESIGN Retrospective Cohort. OBJECTIVE Identify patient variables, injury characteristics, and costs associated with operative and non-operative treatment following inter-facility transfer of patients with isolated cervical spine fractures. SUMMARY OF BACKGROUND DATA Patients with isolated cervical spine fractures are subject to inter-facility transfer for surgical assessment, yet are often treated non-operatively. The American College of Surgeons' benchmark rate of "secondary over-triage" is < 50%. Identifying patient and injury characteristics as well as costs associated with treatment following transfer of patients with isolated cervical spine fractures may help reduce rates of secondary over-triage and healthcare expenditures. METHODS Patients transferred to a Level-1 trauma center with isolated cervical spine fractures between January 2015 and September 2020 were identified. Patient demographics, comorbidities, insurance data, injury characteristics, imaging workup, treatment, and financial data were collected for all patients. Multivariable logistic regression models were constructed to identify patient and injury characteristics associated with surgical treatment. RESULTS Nearly 75% of patients were treated non-operatively. Over 97% of transfers were accepted by the general surgery trauma service. Multivariable modeling found that higher BMI, presence of any neurologic deficit including spinal cord or isolated spinal nerve root injuries, current smoking status, or cervical spine MRI obtained post-transfer, were associated with surgical treatment for isolated cervical spine fractures. Among patients with type II dens fractures, increased fracture displacement was associated with surgical treatment. Median charges to patients treated operatively and non-operatively were $380,890 and $90,734, respectively. Median hospital expenditures for patients treated operatively and non-operatively were $55,115 and $12,131, respectively. CONCLUSION A large proportion of patients with isolated cervical spine fractures are subject to over-triage. Injury characteristics are important for determining need for surgical treatment, and therefore inter-facility transfer. Improving communication with spine surgeons when deciding to transfer patients may significantly reduce healthcare costs and resource use.Level of Evidence: 4.

Purpose: There are primarily two techniques for affixing the scleral buckle (SB) to the sclera in the repair of rhegmatogenous retinal detachment (RRD): scleral tunnels or scleral sutures. Methods: This retrospective study examined all patients with primary RRD who were treated with primary SB or SB combined with vitrectomy from January 1, 2015 through December 31, 2015 across six sites. Two cohorts were examined: SB affixed using scleral sutures versus scleral tunnels. Pre- and postoperative variables were evaluated including visual acuity, anatomic success, and postoperative strabismus. Results: The mean preoperative logMAR VA for the belt loop cohort was 1.05 ± 1.06 (Snellen 20/224) and for the scleral suture cohort was 1.03 ± 1.04 (Snellen 20/214, p = 0.846). The respective mean postoperative logMAR VAs were 0.45 ± 0.55 (Snellen 20/56) and 0.46 ± 0.59 (Snellen 20/58, p = 0.574). The single surgery success rate for the tunnel cohort was 87.3% versus 88.6% for the suture cohort (p = 0.601). Three patients (1.0%) in the scleral tunnel cohort developed postoperative strabismus, but only one patient (0.1%) in the suture cohort (p = 0.04, multivariate p = 0.76). All cases of strabismus occurred in eyes that underwent SB combined with PPV (p = 0.02). There were no differences in vision, anatomic success, or strabismus between scleral tunnels versus scleral sutures in eyes that underwent primary SB. Conclusion: Scleral tunnels and scleral sutures had similar postoperative outcomes. Combined PPV/SB in eyes with scleral tunnels might be a risk for strabismus post retinal detachment surgery.

Purpose To describe a case of ciliochoroidal melanoma with massive spontaneous hemorrhagic retinal and choroidal detachment that presented a diagnostic challenge because of poor fundus visualization and atypical imaging features. Methods Case report. Results A 71-year-old white man on apixaban for atrial fibrillation presented with sudden onset of pain and vision loss in the left eye. The patient was found to have total hemorrhagic retinal detachment and was referred for our opinion. On examination, visual acuity was 20/25 in the right eye and light perception in the left eye. Intraocular pressures were 10 mmHg in the right eye and 21 mmHg in the left eye. The unaffected right eye demonstrated only macular retinal pigment epithelial alterations. Evaluation of the left eye revealed dilated episcleral sentinel vessels superonasally, shallow anterior chamber, and total hemorrhagic retinal and choroidal detachment to the back of the crystalline lens. There was no view of the choroid. Transillumination demonstrated diffuse blockage of light from blood and no specific shadow. B-scan ultrasonography revealed total retinal and choroidal detachment with dense echoes of blood under the retina and in the suprachoroidal space with elevation of 12 mm and no definite mass or spontaneous vascular pulsations. Magnetic resonance imaging revealed diffuse high signals within the globe on T1-weighted images with no specific mass. On gadolinium enhancement, a localized enhancing area temporally of 12-mm thickness and a localized nonenhanced area nasally of 11-mm thickness was noted. Both areas showed low signal on T2-weighted images. Despite atypical features, suspicion for underlying ciliochoroidal melanoma and poor visual prognosis lead to enucleation. Histopathology confirmed an extensively necrotic, mushroom-shaped ciliochoroidal melanoma with total hemorrhagic retinal and choroidal detachment. Conclusion Diagnosis of necrotic posterior uveal melanoma can be challenging, because these tumors can be camouflaged by overlying hemorrhagic retinal and choroidal detachment and can present with atypical features on ultrasonography and magnetic resonance imaging. Patients with spontaneous hemorrhagic retinal and choroidal detachment should be evaluated for possible underlying malignancy.

Background Regional body compositions are differentially associated with cardiometabolic risk factors. Simultaneous inclusion of both upper and lower body composition predictors in models is not often done, and studies which do include both measures (1) tend to exclude some tissue(s) of potential metabolic relevance, and (2) have used study populations with underrepresentation of individuals with African ancestries. Further, most body composition analyses do not employ compositional data analytic approaches, which may result in spurious associations. Objective The objective of this analysis was to assess associations of abdominal and thigh adipose (AT) and muscle tissues with hypertension and type 2 diabetes using compositional data analytic methods. Research Design and Methods This cross‐sectional analysis included 610 African Caribbean men (median age: 62 years; mean BMI: 27.8 kg/m2). Abdominal (three components: subcutaneous [ASAT] and visceral [VAT] AT, ‘other’ abdominal tissue) and mid‐thigh (four components: subcutaneous and intermuscular AT, muscle, bone) compositions were measured by computed tomography; additive log ratio transformations were applied to each composition. Regression models were used to simultaneously assess associations of abdominal and thigh component ratios with continuous risk factors (blood pressures, fasting glucose and insulin, HOMA‐IR) and disease categories. Results A two‐fold increase in ASAT:‘Other’ ratio was associated with higher continuous risk factors and with odds of being in a higher hypertension (OR: 1.77, 95%CI: 1.10–2.84) or diabetes (OR: 1.81, 95%CI: 1.06–3.10) category. A two‐fold increased VAT ratio was only associated with higher log‐insulin and log‐HOMA‐IR (β = 0.10, p

Summary Background There is a paucity of evidence to support safe and effective management of patients with acute severe ulcerative colitis during the COVID-19 pandemic. We sought to identify alterations to established conventional evidence-based management of acute severe ulcerative colitis during the early COVID-19 pandemic, the effect on outcomes, and any associations with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe COVID-19 outcomes. Methods The PROTECT-ASUC study was a multicentre, observational, case-control study in 60 acute secondary care hospitals throughout the UK. We included adults (≥18 years) with either ulcerative colitis or inflammatory bowel disease unclassified, who presented with acute severe ulcerative colitis and fulfilled the Truelove and Witts criteria. Cases and controls were identified as either admitted or managed in emergency ambulatory care settings between March 1, 2020, and June 30, 2020 (COVID-19 pandemic period cohort), or between Jan 1, 2019, and June 30, 2019 (historical control cohort), respectively. The primary outcome was the proportion of patients with acute severe ulcerative colitis receiving rescue therapy (including primary induction) or colectomy. The study is registered with ClinicalTrials.gov , NCT04411784 . Findings We included 782 patients (398 in the pandemic period cohort and 384 in the historical control cohort) who met the Truelove and Witts criteria for acute severe ulcerative colitis. The proportion of patients receiving rescue therapy (including primary induction) or surgery was higher during the pandemic period than in the historical period (217 [55%] of 393 patients vs 159 [42%] of 380 patients; p=0·00024) and the time to rescue therapy was shorter in the pandemic cohort than in the historical cohort (p=0·0026). This difference was driven by a greater use of rescue and primary induction therapies with biologicals, ciclosporin, or tofacitinib in the COVID-19 pandemic period cohort than in the historical control period cohort (177 [46%] of 387 patients in the COVID-19 cohort vs 134 [36%] of 373 patients in the historical cohort; p=0·0064). During the pandemic, more patients received ambulatory (outpatient) intravenous steroids (51 [13%] of 385 patients vs 19 [5%] of 360 patients; p=0·00023). Fewer patients received thiopurines (29 [7%] of 398 patients vs 46 [12%] of 384; p=0·029) and 5-aminosalicylic acids (67 [17%] of 398 patients vs 98 [26%] of 384; p=0·0037) during the pandemic than in the historical control period. Colectomy rates were similar between the pandemic and historical control groups (64 [16%] of 389 vs 50 [13%] of 375; p=0·26); however, laparoscopic surgery was less frequently performed during the pandemic period (34 [53%] of 64] vs 38 [76%] of 50; p=0·018). Five (2%) of 253 patients tested positive for SARS-CoV-2 during hospital treatment. Two (2%) of 103 patients re-tested for SARS-CoV-2 during the 3-month follow-up were positive 5 days and 12 days, respectively, after discharge from index admission. Both recovered without serious outcomes. Interpretation The COVID-19 pandemic altered practice patterns of gastroenterologists and colorectal surgeons in the management of acute severe ulcerative colitis but was associated with similar outcomes to a historical cohort. Despite continued use of high-dose corticosteroids and biologicals, the incidence of COVID-19 within 3 months was low and not associated with adverse COVID-19 outcomes. Funding None.

BACKGROUNDThe function of the gestational sac (GS) and the placenta in the closely related processes of embryogenesis and teratogenicity in the first trimester has been minimally described. The prevailing assumption is that direct teratogenic effects are mediated by the critical extraembryonic organ, the placenta, which either blocks or transfers exposures to the foetus. Placental transfer is a dominant mechanism, but there are other paradigms by which the placenta can mediate teratogenic effects. Knowledge of these paradigms and first trimester human developmental biology can be useful to the epidemiologist in the conduct of biomarker-based studies of both maternal and child health.OBJECTIVE AND RATIONALEOur aim is to provide a causal framework for modelling the teratogenic effects of first trimester exposures on child health outcomes mediated by the GS and placenta using biomarker data collected in the first trimester. We initially present first trimester human developmental biology for the sake of informing and strengthening epidemiologic approaches. We then propose analytic approaches of modelling placental mechanisms by way of causal diagrams using classical non-embryolethal teratogens (diethylstilboestrol [DES], folic acid deficiency and cytomegalovirus [CMV]) as illustrative examples. We extend this framework to two chronic exposures of particular current interest, phthalates and maternal adiposity.SEARCH METHODSInformation on teratogens was identified by a non-systematic, narrative review. For each teratogen, we included papers that answered the five following questions: (i) why were these exposures declared teratogens? (ii) is there a consensus on biologic mechanism? (iii) is there reported evidence of a placental mechanism? (iv) can we construct a theoretical model of a placental mechanism? and (v) can this knowledge inform future work on measurement and modelling of placental-foetal teratogenesis? We prioritized literature specific to human development, the organogenesis window in the first trimester and non-embryolethal mechanisms.OUTCOMESAs a result of our review of the literature on five exposures considered harmful in the first trimester, we developed four analytic strategies to address first trimester placental mechanisms in birth cohort studies: placental transfer and direct effects on the foetus (DES and maternal adiposity), indirect effects through targeted placental molecular pathways (DES and phthalates), pre-placental effects through disruptions in embryonic and extraembryonic tissue layer differentiation (folic acid deficiency), and multi-step mechanisms that involve maternal, placental and foetal immune function and inflammation (DES and CMV).WIDER IMPLICATIONSThe significance of this review is to offer a causal approach to classify the large number of potentially harmful exposures in pregnancy when the exposure occurs in the first trimester. Our review will facilitate future research by advancing knowledge of the first trimester mechanisms necessary for researchers to effectively associate environmental exposures with child health outcomes.

PURPOSE OF REVIEW: In this review, we provide essential background knowledge and an analytical framework for the application of placental-fetal molecular biomarkers in fetal origins chronic disease epidemiology. The widely available and highly quantitative placental hormone human chorionic gonadotropin (hCG) is used as an example. hCG is currently used for diagnosing fetal genetic disorders; yet it can and should be expanded to understanding the fetal origins of chronic diseases. We provide justification and methods to do this. RECENT FINDINGS: Ten papers published in the last 5 years were identified with supportive findings relevant to the application of biomarkers of hCG in epidemiologic studies on the developmental origins of health and disease (DOHaD). SUMMARY: There is increasing and consistent evidence that placental-fetal biomarkers may be highly informative in observational studies, as exemplified by hCG, with the correct approaches for measurement and data analysis.

This case report is mainly about neurological symptoms in relationship to hypoglycemia. Some of the symptoms of neuroglycopenic are cognitive impairment, behavioral changes, psychomotor abnormalities, weakness, seizures, and coma. Normally coma is the dominating neurological symptom in hypoglycemia and seizures are rare manifestations. So it may be overlooked when the patient admitted due to seizures by the hypoglycemia. Seizures may be associated due to hyperglycemia or hypoglycemia because abnormal blood glucose is seen in daily clinical practice.

Purpose We report our single-institution stereotactic body radiation therapy (SBRT) experience on stage I renal cancer with prospectively collected toxicity and efficacy data. Methods and Materials A total of 21 patients with solitary renal tumors, including 14 surgical candidates who refused surgery (66%), were treated with SBRT. Histologic confirmation was obtained on all patients before treatment; 2 had transitional cell carcinoma and 19 had renal cell carcinoma. The median age was 71 years (range, 58-88). Nearly all patients received 48 Gy in 3 fractions. Results The median follow-up was 78 months (range, 5-107). At 5 years post treatment, the local tumor control rate was 100%. Tumor size decreased by a median value of 5.3% at 1 year post treatment, 15.6% at 2 years post treatment, and 15.4% at 5 years post treatment. Glomerular filtration rate had decreased by a median value of 1.5% at 1 year post treatment, 7.0% at 2 years post treatment, and 14.2% at 5 years post treatment. Three patients experienced grade 1 toxicity; no other treatment-related adverse effects were reported. Conclusions SBRT is a promising noninvasive treatment in the management of primary renal cell carcinoma, with evolving clinical evidence demonstrating encouraging results with respect to local control and toxicity.

OBJECTIVES Although inadequate health literacy has been shown to impact health outcomes in other cancers, little is known about its impact in head and neck cancer (HNC). This study aimed to determine the prevalence and predictors of inadequate health literacy and evaluate the association between health literacy and quality of life (QOL) in HNC survivors. METHODS We conducted a retrospective analysis of HNC survivors evaluated in a multidisciplinary HNC survivorship clinic. Survivors had to be ≥1-year postcompletion of treatment to be included in the analysis. Health literacy was assessed via self-report with the Brief Health Literacy Screen (score

PURPOSE Oral mucositis (OM) remains a common, debilitating toxicity of radiation therapy (RT) for head and neck cancer. The goal of this phase IIb, multi-institutional, randomized, double-blind trial was to compare the efficacy and safety of GC4419, a superoxide dismutase mimetic, with placebo to reduce the duration, incidence, and severity of severe OM (SOM). PATIENTS AND METHODS A total of 223 patients (from 44 institutions) with locally advanced oral cavity or oropharynx cancer planned to be treated with definitive or postoperative intensity-modulated RT (IMRT; 60 to 72 Gy [≥ 50 Gy to two or more oral sites]) plus cisplatin (weekly or every 3 weeks) were randomly assigned to receive 30 mg (n = 73) or 90 mg (n = 76) of GC4419 or to receive placebo (n = 74) by 60-minute intravenous administration before each IMRT fraction. WHO grade of OM was assessed biweekly during IMRT and then weekly for up to 8 weeks after IMRT. The primary endpoint was duration of SOM tested for each active dose level versus placebo (intent-to-treat population, two-sided α of .05). The National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03, was used for adverse event grading. RESULTS Baseline patient and tumor characteristics as well as treatment delivery were balanced. With 90 mg GC4419 versus placebo, SOM duration was significantly reduced ( P = .024; median, 1.5 v 19 days). SOM incidence (43% v 65%; P = .009) and severity (grade 4 incidence, 16% v 30%; P = .045) also were improved. Intermediate improvements were seen with the 30-mg dose. Safety was comparable across arms, with no significant GC4419-specific toxicity nor increase of known toxicities of IMRT plus cisplatin. The 2-year follow-up for tumor outcomes is ongoing. CONCLUSION GC4419 at a dose of 90 mg produced a significant, clinically meaningful reduction of SOM duration, incidence, and severity with acceptable safety. A phase III trial (ROMAN; ClinicalTrials.gov identifier: NCT03689712 ) has begun.

OBJECTIVE. Although neck impairment has been described following surgical resection, limited studies have investigated its prevalence in nonsurgical treatment. The purpose of this study is to determine the prevalence and predictors of neck disability following head and neck cancer (HNC) treatment and to explore its association with quality of life (QOL). STUDY DESIGN. Cross-sectional study. SETTING. HNC survivorship clinic. SUBJECTS AND METHODS. We identified 214 survivors who completed treatment ≥1 year prior to evaluation in the clinic. Self-reported neck impairment was measured using the Neck Disability Index. QOL was measured using the University of Washington QOL Questionnaire, with physical and social subscale scores calculated. Regression analysis and trend tests were employed to explore associations. RESULTS. Over half of survivors (54.2%) reported neck disability. The odds of neck disability in survivors who received nonsurgical treatment and those who received surgery plus adjuvant treatment were 3.46 and 4.98 times higher compared to surgery alone (P = .008, P = .004). Survivors who underwent surgery only had higher physical and social QOL than those who received nonsurgical treatment (physical QOL: P < .001, social QOL: P = .023) and those who received surgery plus adjuvant treatment (physical QOL: P

Adequate maternal thyroid hormone (TH) is necessary for fetal brain development. The role of placental human chorionic gonadotropin (hCG) in ensuring the production of TH is less well understood. The objective of the study was to evaluate 1) associations of placental hCG and its subunits, and maternal TH in the second trimester, and 2) the single and joint effects of TH and placental hormones on cognitive development and communication at ages 1 and 3 years. Fifty individuals (5%) were selected from the CANDLE (Conditions Affecting Neurocognitive Development and Early Learning) pregnancy cohort in Memphis, Tennessee, with recruitment from 2006 to 2011, to equally represent male and female fetuses. Participants were 68% Black and 32% White. Hormones measured were maternal thyroid (thyrotropin [TSH] and free thyroxine [FT4]) and placental hormones (hCG, its hyperglycosylated form [hCG-h], and free α- [hCGα] and β-subunits [hCGβ]) in maternal serum (17-28 weeks). The primary outcome measurement was the Bayley Scales of Infant and Toddler Development. All forms of hCG were negatively associated with FT4 and not associated with TSH. hCGα was associated with cognitive development at age 1 year and jointly interacted with TSH to predict cognitive development at age 3 years. This pilot study added insight into the thyrotropic actions of hCG in the second trimester, and into the significance of this mechanism for brain development. More research is warranted to elucidate differences between hCGα, hCGβ, and hCG-h in relation to TH regulation and child brain function.

Background and objectives The prevalence of substance use disorders (SUD), particularly involving opiates and benzodiazepines, has increased to the detriment of public health and the economy. Here, we evaluate relapse factors among the high-risk demographic of patients with SUD and comorbid affective disorders. Methods A retrospective chart review of 76 patients discharged after detoxification and simultaneous psychiatric care for concomitant affective disorders and SUDs. Relapse was assessed by two independent evaluators via postdischarge chart review, which included state-wide healthcare utilization, by patient, through healthcare information exchange systems. A Cox Hazards analysis was performed to characterize relapse risk factors. Results Benzodiazepine use, admission through the emergency department (ED) rather than direct admission, frequent ED use in the preceding year, and history of prior attendance at multiple detoxification programs were risk factors for shortened time-to-relapse. Polysubstance use and intravenous drug use prolonged time to relapse. Discussion and conclusions Notable findings include the significant relapse risk associated with benzodiazepine abuse and frequent prior ED utilization. These risk factors could reflect a number of underlying mediators for relapse, including anxiety, disease burden, and malingering. Additionally, this study recapitulates the observation in other patient populations that the majority of health resource utilization is attributed to a small population of patients. Scientific significance This study is the first to identify relapse predictors among dual-diagnosis affective disorder and SUD patients in survival analysis, and replicates the alarming and largely unknown effect that benzodiazepines have on increasing relapse risk.

OBJECTIVE Patients undergoing spine surgery often inaccurately estimate their pain tolerance and postoperative analgesic requirement. We sought to identify an association between patients' self-perceived pain tolerance and postoperative opioid consumption (POC). METHODS We included adult patients undergoing elective lumbar spine decompression and fusion between 2014 and 2018. Patients with cognitive delay, psychiatric comorbidities, and perioperative complications were excluded. Demographic data, mean daily postoperative morphine milligram equivalents (MME), and pain tolerance scores were recorded. RESULTS Eighty-four patients met inclusion criteria. The median pain tolerance score was 8, which was used to defined a cutoff for high (≥8) and low (

BACKGROUND Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or as described in terms of such damage. Regional anesthetic procedure is a need for local anesthetic with desirable properties like longer duration of sensory blockade and lesser duration of motor paralysis. We wanted to evaluate the efficacy of Inj. Dexmedetomidine (1.5 µg/kg) with 0.75% Ropivacaine by epidural route compared to Inj. Clonidine (2 µg/kg) with 0.75% Ropivacaine by epidural route in patients undergoing lower abdominal surgeries. MATERIALS AND METHODS In this study, 50 patients belonging to ASA grade I and II undergoing elective lower abdominal surgeries were randomly divided into two groups by lottery method. Group RC (Control): The control group comprises of patients in whom 19 ml of 0.75% Ropivacaine with Inj. clonidine 2 µg/Kg (made to 1 ml) administered epidurally. Group RD (Study group): Consists of patients in whom 19 ml of 0.75% Ropivacaine with inj. Dexmedetomidine – 1.5 μg/Kg (made to 1 ml) was administered epidurally. RESULTS The mean time of onset of sensory blockade, 2 segment regression time in Dexmedetomidine group is significantly less than Clonidine group. The mean duration of sensory blockade was significantly higher with Dexmedetomidine group than Clonidine group. The mean time of onset and duration of motor blockade was significantly less in Dexmedetomidine group than Clonidine group and control group. The duration of analgesia was significantly prolonged and highest in the Dexmedetomidine group compared to Clonidine group. CONCLUSION We conclude that dexmedetomidine is a better adjuvant than clonidine in epidural anesthesia as far as patient comfort, stable cardio-respiratory parameters, intra-operative and post-operative analgesia are concerned.

Plaque brachytherapy is a well-accepted modality to manage selected cases of ocular melanoma. Although this modality provides validated oncologic and quality of life benefits, severe complications and adverse events can occur. This article reviews complications and adverse events of plaque brachytherapy, including scleral necrosis, strabismus, cataract, glaucoma, and retinopathies as well as management of these conditions. For practicing oncologists and ophthalmologists, these complications are important to understand, identify, and treat. Additionally, an understanding of common complications of brachytherapy should influence the decision of pursuing it as a treatment option.

Background In the context of COVID‐19, cancer survivors represent a particularly vulnerable population that may be “doubly hit” by both costs of cancer treatment and financial strain imposed by the pandemic. Methods We performed a review of the literature pertaining to cancer, financial toxicity, and economic challenges. Results Multiple societies have put forth recommendations to modify delivery of cancer care in order to minimize patient exposure to the virus. Cancer survivors, especially patients with head and neck cancer, have been disproportionately affected by rising unemployment levels and economic recessions in the past, both of which are linked to higher cancer mortality. Patients who rely on employer‐provided insurance and do not qualify for Medicaid may lose access to life‐saving treatments. Conclusions It is essential to implement interventions and policy changes in order to mitigate the effects of this pandemic but also to ensure this becomes a nonissue during the next one.

Purpose Stereotactic body radiation therapy (SBRT) is an emerging option for localized prostate cancer. However, there are no standard dosimetric guidelines, and normal tissue tolerances for extreme hypofractionation are not well defined. We analyzed dosimetric correlations with patient-reported urinary and bowel quality of life (QOL) on a prospective trial. Methods and Materials Patients with low- or intermediate-risk prostate cancer from 18 institutions were enrolled on a phase 2 trial from 2007 to 2012 and treated using robotic SBRT to 38 Gy in 4 fractions on consecutive days. No androgen deprivation was used. Patients received simulation with Foley catheter for urethral delineation. The clinical target volume was prostate (low-risk patients) or prostate plus 1 cm of proximal seminal vesicles (intermediate-risk patients). Multiple dosimetric measures for urethra, bladder, and rectum were prospectively recorded. QOL using the Expanded Prostate Cancer Index Composite was assessed before and after treatment at protocol-specific time points. Linear regression was used to assess factors associated with QOL at 1 month and 2 years. Results A total of 259 patients were enrolled. QOL data were available for 98%, 96%, and 84% at baseline, 1 month, and 2 years, respectively. Median age was 69 years. Prior transurethral resection of the prostate and clinical target volume size were associated with 2-year urinary incontinence. There was a trend toward worse 2-year obstruction/irritation in older patients on multivariable analysis. Bladder and urethral doses were not associated with either 1-month or 2-year urinary QOL. In contrast, rectum maximum dose was associated with both 1-month and 2-year bowel QOL. At 2 years, the proportion with moderate or big overall bowel problems (as defined by Expanded Prostate Cancer Index Composite-26) was significantly higher in patients with rectum maximum dose greater than versus less than the median 37.4 Gy (11% vs 2%, Fisher's exact test P = .008). Conclusions These results provide novel data that contribute to a better understanding of patient and dosimetric factors associated with adverse QOL effects from prostate SBRT.

Background Stereotactic body radiation therapy is an emerging treatment for prostate cancer (PC), with potential biological and oncologic advantages. A well-established radiation dosing schedule (38Gy in 4 fractions) has shown excellent long-term efficacy in high-dose-rate (HDR) brachytherapy. Objective To report 5-yr efficacy, toxicity, and quality-of-life (QOL) outcomes of a novel 4-d SBRT regimen. Design, setting, and participants This was a single-arm prospective phase 2 trial involving 259 patients with low- or intermediate-risk PC treated at 18 US centers from December 2007 to February 2012. The median follow-up was 5yr (interquartile range 37–85mo). Intervention SBRT with 38Gy in four fractions; radiation plans mimicked HDR brachytherapy dosimetry. Outcome measurements and statistical analysis We measured freedom from biochemical recurrence (BCR) and assessed toxicities using the Common Terminology Criteria for Adverse Events v3.0 and QOL using the Expanded Prostate Cancer Index Composite. Results and limitations The 5-yr BCR-free rates were 100% and 88.5% for patients with low- and intermediate-risk PC, respectively. The cumulative 5-yr grade 2, 3, and 4 toxicity rates were 12.4%, 1.9%, and 0.4% for urinary, and 3.4%, 0%, and 0% for gastrointestinal toxicities, respectively. The median baseline prostate-specific antigen (PSA) level of 5.12ng/ml decreased to 0.1ng/ml by ≥42mo. QOL scores decreased at 1mo but returned to baseline by 6mo, with a later decline (≥24mo) in the urinary continence domain (pad use was 2% at baseline and 10% at 5yr), and lower sexual potency over time. Comparative outcomes versus other types of radiotherapy are difficult because the trial was not randomized. Conclusions This regimen yields a high rate of BCR-free survival, with a very low median PSA nadir suggesting prostate ablation. For properly selected patients with low- or intermediate-risk PC who choose SBRT, this treatment regimen is effective. Patient summary This potent four-treatment stereotactic body radiotherapy regimen appears to be effective for patients with early prostate cancer.

82 soil samples were collected randomly at different land use/cover locations, which includes agriculture, forest, built up area, scrubland and plantation at a depth of 0–30 cm, analyzed for soil pH, electrical conductivity (EC) and presence of nitrogen (N), phosphorous (P) and potassium (K). Inverse Distance Weightage method (IDW) was employed for analyzing the spatial distribution of soil fertility through geospatial techniques for sustainable agriculture. It is observed that soil pH varies between 4.8 and 7.5; showing nearly 83% of the study area is acidic in nature. The EC varies from 0.04 to 0.87 ds/m with a mean of 0.21 ds/m and non saline in condition. Out of 435 km2 of total study area, 99% of area is less in nitrogen followed by potassium (70%) and phosphorus (42%) respectively. Keywords: Soil fertility, Spatial distribution, Inverse Distance method, Sustainable agriculture

Background Stereotactic body radiotherapy (SBRT) is an emerging treatment option for liver metastases in patients unsuitable for surgery. We investigated factors associated with clinical outcomes for liver metastases treated with SBRT from a multi-center, international patient registry. Methods Patients with liver metastases treated with SBRT were identified in the RSSearch® Patient Registry. Patient, tumor and treatment characteristics associated with treatment outcomes were assessed. Dose fractionations were normalized to BED10. Overall survival (OS) and local control (LC) were evaluated using Kaplan Meier analysis and log-rank test. Results The study included 427 patients with 568 liver metastases from 25 academic and community-based centers. Median age was 67 years (31–91 years). Colorectal adenocarcinoma (CRC) was the most common primary cancer. 73% of patients received prior chemotherapy. Median tumor volume was 40 cm3 (1.6–877 cm3), median SBRT dose was 45 Gy (12–60 Gy) delivered in a median of 3 fractions [1–5]. At a median follow-up of 14 months (1–91 months) the median overall survival (OS) was 22 months. Median OS was greater for patients with CRC (27 mo), breast (21 mo) and gynecological (25 mo) metastases compared to lung (10 mo), other gastro-intestinal (GI) (18 mo) and pancreatic (6 mo) primaries (p

False alarms are in terms of fire safety engineering – fire alarms in absence of areal fire condition. They are related to the exchange of information and occur as a side effect of system technologies and the alerting process. Fires often are associated with considerable damages. Because time is a critical factor, detection is often accomplished by installed Spatio Wildfire Prediction and Monitoring System (SWPMS). The highly sensitive sensors in fire detectors make the identification of fires in a nearly stage possible, but this also makes SWPMS susceptible to false alarms. So far there is no reliable evidence on the ratio of false alarms to installed fire detection and fire alarm systems in SWPMS. The studies, which are described in the present paper, close this gap for Visakhapatnam on the basis of an empirical analysis of data from fire brigades. It is difficult to describe the ratio in one single value, because a great number of conditions and influencing factors are relevant. To reduce the false alarm ratio, we need a common understanding of false alarms and a consistent use of terms and categories.

BACKGROUND Previous studies have shown that children with isolated linear skull fractures have excellent clinical outcomes and low risk of surgery. We wish to identify other injury patterns within the spectrum of paediatric mild head injury, which need only conservative management. Children with low risk of evolving neurosurgical lesions could be safely managed in primary hospitals. METHODS We retrospectively analysed all children with mild head injury (i.e. admission Glasgow coma score 13-15) and skull fracture or haematoma on a head computed tomography scan admitted to Westmead Children's Hospital, Sydney over the years 2009-2014. Data were collected regarding demographics, clinical findings, mechanism of injury, head computed tomography scan findings, neurosurgical intervention, outcome and length of admission. Wilcoxon paired test was used with P value

BACKGROUND AND OBJECTIVE: Non-causal macular holes (MHs) can occur concurrently with rhegmatogenous retinal detachments (RRDs). The visual outcomes and surgical approach for these eyes are variable. PATIENTS AND METHODS: This was a multi-institutional, retrospective review of all primary retinal detachment surgeries from January 1, 2015, through December 31, 2015. Pre-, intra-, and postoperative metrics were recorded. RESULTS: There were 2,242 eyes that had pars plana vitrectomy for primary RRD, 43 (1.9%) of which had a MH at the time of surgery. The mean postoperative logMAR visual acuity (VA) for the MH cohort was 0.87 ± 0.64 (20/148) and for eyes without a MH was 0.47 ± 0.63 (20/59; P < .0001). The single-surgery re-attachment rate for the MH cohort and no MH cohort was 86.1% and 84.9%, respectively ( P = 1.0000). CONCLUSIONS: Patients with noncausal MHs and RRD had significantly worse VA than patients without a MH. Preoperative counseling is imperative in patients with both RRD and MH. [ Ophthalmic Surg Lasers Imaging Retina . 2020;51:500–505.]

Background: Adipose tissue (AT) distribution, which differs by race/ethnicity, can differentially impact risk for cardiometabolic disease. Traditional analyses using AT volumes tend to place all ATs in a regression model, estimating an increase in one AT volume while “holding other volumes constant”; however, the compositional nature of the data suggests the other ATs cannot remain constant. Compositional data analysis (CODA) methods eliminate this concern by comparing logratios of components. CODA was designed for analyses of data like those of body composition , but has yet to be used in this field. We demonstrate the use of CODA for the comparison of visceral AT (VAT) and subcutaneous AT of the abdomen (ASAT) and thigh (TSAT) with prevalence of cardiometabolic diseases. Methods: This cross-sectional analysis used 615 African Caribbean men from Tobago aged 50-91 years (mean age 63.6 years, mean BMI 27.7 kg/m 2 ). AT volumes were obtained from CT scans of the abdomen (VAT and ASAT) and of the mid-thigh (TSAT). An additive log2 ratio transformation was applied to the ATs to generate the VAT, ASAT, and TSAT component effects relative to the other tissues captured in the respective CT scan. Ordinal logistic regression analyses were performed for increasing hypertension or glucose impairment categories (defined in Table) after adjustment for age, disease status, and lifestyle factors. Results: After full adjustment (Table), a 2-fold higher ASAT volume (relative to other abdominal tissues) was associated with higher odds, and a 2-fold higher TSAT volume (relative to other thigh tissues) was associated with lower odds, of being in a higher hypertension category. After BMI adjustment, no AT was associated with glucose impairment category. VAT was not a significant predictor for either outcome in African Ancestry men. Conclusion: CODA methods, which avoid problematic assumptions made in traditional analyses, found significant and opposing associations of TSAT and ASAT with hypertension categories in African Ancestry men.

Background/aimsVitrectomy to repair retinal detachment is often performed with either non-contact wide-angle viewing systems or wide-angle contact viewing systems. The purpose of this study is to assess whether the viewing system used is associated with any differences in surgical outcomes of vitrectomy for primary non-complex retinal detachment repair.MethodsThis is a multicenter, interventional, retrospective, comparative study. Eyes that underwent non-complex primary retinal detachment repair by either pars plana vitrectomy (PPV) alone or in combination with scleral buckle/PPV in 2015 were evaluated. The viewing system at the time of the retinal detachment repair was identified and preoperative patient characteristics, intraoperative findings and postoperative outcomes were recorded.ResultsA total of 2256 eyes were included in our analysis. Of those, 1893 surgeries used a non-contact viewing system, while 363 used a contact lens system. There was no statistically significant difference in single surgery anatomic success at 3 months (p=0.72), or final anatomic success (p=0.40). Average postoperative visual acuity for the contact-based cases was logMAR 0.345 (20/44 Snellen equivalent) compared with 0.475 (20/60 Snellen equivalent) for non-contact (p=0.001). After controlling for numerous confounding variables in multivariable analysis, viewing system choice was no longer statistically significant (p=0.097).ConclusionThere was no statistically significant difference in anatomic success achieved for primary retinal detachment repair when comparing non-contact viewing systems to contact lens systems. Postoperative visual acuity was better in the contact-based group but this was not statistically significant when confounding factors were controlled for.

(1) Describe financial toxicity (FT) in head and neck cancer (HNC) survivors and assess its association with personal/health characteristics and health-related quality of life (HRQOL); (2) examine financial coping mechanisms (savings/loans); (3) assess relationship between COmprehensive Score for financial Toxicity (COST) and Financial Distress Questionnaire (FDQ).Cross-sectional survey from January - April 2018 of insured patients at a tertiary multidisciplinary HNC survivorship clinic who completed primary treatment for squamous cell carcinoma of the oral cavity, oropharynx, or larynx/hypopharynx.Of 104 survivors, 30 (40.5%) demonstrated high FT. Patients with worse FT were more likely (1) not married (COST, 25.33 ± 1.87 vs. 30.61 ± 1.34, p = 0.008); (2) of lower education levels (COST, 26.12 ± 1.47 vs. 34.14 ± 1.47, p 0.001); and (3) with larynx/hypopharynx primaries (COST, 22.86 ± 2.28 vs. 30.27 ± 1.50 vs. 32.72 ± 1.98, p = 0.005). Younger age (4.23, 95%CI 2.20 to 6.26, p 0.001), lower earnings at diagnosis (1.17, 95%CI 0.76 to 1.58, p 0.001), and loss in earnings (-1.80, 95%CI -2.43 to -1.16, p 0.001) were associated with worse FT. COST was associated with HRQOL (0.08, p = 0.03). Most survivors (63/102, 60%) reported using savings and/or loans. Worse FT was associated with increased likelihood of using more mechanisms (COST, OR1.06, 95%CI 1.02 to 1.10, p = 0.004). Similar results were found with FDQ.We found differences in FT by primary site, with worst FT in larynx/hypopharynx patients. This finding illuminates potential site-specific factors, e.g. workplace discrimination or inability to return to work, that may contribute to increased risk. FDQ correlates strongly with COST, encouraging further exploration as a clinically-meaningful screening tool.

It is widely agreed that adequate maternal thyroid hormone is necessary for proper brain development. The role of the fetal placenta in ensuring the production and delivery of thyroid hormone during fetal brain development is less well understood. We hypothesized that the placenta ‘hijacks’ the maternal thyroid in early pregnancy to ensure adequate thyroid hormone, and either or both endocrine systems are vulnerable to perturbation by phthalate exposure. We did a pilot study to examine this theory. 50 subjects were recruited in Memphis, TN into the CANDLE birth cohort study, and were were: 68% African-American, 32% White, 50% female babies, mean maternal age of 27.5 years, 28% nulliparous, 50% had greater than a high school education. Blood and urine samples were collected between 17-28 wks gestation. Infant cognition was measured by the Bayley’s Scales at 1 and 3 years of age, and combined into one measure. hCG-alpha, hCG-beta, hyperglycosylated hCG, intact hCG, thyroid stimulating hormone and free thyroxine were analyzed in maternal serum by immunofluorometric assays. Phthalate metabolites were measured in maternal urine by HPLC tandem mass spectrometry. Linear regression models, with quadratic terms, were used to estimate sex-specific associations, and then decomposed to evaluate direct vs. indirect effects of phthalates on infant cognition: phthalates > placental hormone > thyroid hormone > infant cognition. Consistent with previous knowledge, TSH was negatively associated with FT4 (-0.23 pmol/l per log TSH, 95% CI -0.4, -0.1) and both hormones were related to infant cognition, but without statistical significance. hCG-alpha was significantly associated with infant cognition (u-shaped), positively associated with TSH (0.38 log units TSH, 95% CI -0.1, 0.8), negatively associated with FT4 in females (-0.84 pmol/l FT4, 95% CI -1.8, 0.1). Of the phthalates, only mono-n-butyl phthalate (MnBP) was associated with lower hCG-alpha (-0.14 log units, 95% CI -0.3, 0.1), higher FT4 (1.11 pmol/l, 95% CI 0.5, 1.8) in females, and infant cognition to year 3 (-0.11 log units in females, 95% CI -0.2, 0.0). The MnBP indirect effect on cognition, through the hormones, was null. Pilot data were underpowered to generate robust findings, but provided insights: 1) hCG-alpha has a distinct correlation structure, different from the other forms of hCG, in relation to MnBP, thyroid hormone, and infant cognition; 2) these data offer support for the theory that hCG-alpha supplants TSH during this critical period of brain development. Endocrine pathways in pregnancy are related to fetal brain development and vulnerable to phthalate exposure. These types of effects can be studied by the measurement of relevant hormones. Funding was provided by The Department of Epidemiology at the University of Pittsburgh, NIEHS, Vanderbuilt University CTSA, and the Urban Child Institute.

The Indian spice turmeric, in which the active and dominant biomolecule is curcumin, has been demonstrated to have significant medicinal properties, including anti-inflammatory and anti-neoplastic effects. This promise is potentially very applicable to musculoskeletal disorders, which are common causes of physician visits worldwide. Research at the laboratory, translational and clinical levels that supports the use of curcumin for various musculoskeletal disorders, such as osteoarthritis, osteoporosis, musculocartilaginous disorders, and sarcoma is here in comprehensively summarized. Though more phase I-III trials are clearly needed, thus far the existing data show that curcumin can indeed potentially be useful in treatment of the hundreds of millions worldwide who are afflicted by these musculoskeletal disorders.

BACKGROUND CONTEXT Alterations in spinopelvic motion and position following spinopelvic fusion may lead to impingement, increased wear, and dislocation in total hip arthroplasty (THA). Pelvic morphometry is critical in determining appropriate spinal alignment and acetabular position. PURPOSE Understanding the relationship between pelvic and acetabular morphometry and changes in postoperative position may enable more synergy between cup placement and spinal fusion. STUDY DESIGN/SETTING Single center, retrospective, case series. PATIENT SAMPLE Consecutive sample of patients from a single institution. OUTCOME MEASURES Radiographic spinopelvic parameters. METHODS This was a retrospective study of adult patients following spinopelvic fusion between 2012 and 2020. Patients with neuromuscular disease, active infections, trauma or tumors were excluded. Demographic data and operative details were recorded. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), acetabular ante-inclination (AI) and sacro-acetabular angle (SAA) were measured. Similar to PI, SAA is a fixed morphometric parameter. Measurements were made on preoperative and most recent postoperative standing sagittal spine radiographs. Analysis was performed with paired t-test and linear regression. RESULTS A total of 124 patients met inclusion criteria with mean follow-up time 17.6 months. PI-LL mismatch improved postoperatively from 19.6° to 5.7° (P CONCLUSIONS Radiographic morphometric measurements of the acetabulum and pelvis are closely related. Changes in pelvic tilt and lumbar lordosis to restore sagittal spine balance following spinopelvic fusion appear to be linked to changes in acetabular position. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

In many applications researchers are typically interested in testing for inequality constraints in the context of linear fixed effects and mixed effects models. Although there exists a large body of literature for performing statistical inference under inequality constraints, user friendly statistical software implementing such methods is lacking, especially in the context of linear fixed and mixed effects models. In this article we introduce CLME, a package in the R language that can be used for testing a broad collection of inequality constraints. It uses residual bootstrap based methodology which is reasonably robust to non-normality as well as heteroscedasticity. The package is illustrated using two data sets. The package also contains a graphical user interface built using the shiny package.

Retinal degeneration due to chronic ambient light exposure is a common spontaneous age-related finding in albino rats, but it can also be related to exposures associated with environmental chemicals and drugs. Typically, light induced retinal degeneration has a central/hemispherical localization where as chemical induced retinal degeneration has a diffuse localization. This study was conducted to identify National Toxicology Program (NTP) rodent bioassays with treatment-related retinal degeneration, and to characterize the retinal lesions related to these retinal toxicities. A total of 3 chronic bioassays in F344/N rats were identified that had treatment-related increases in retinal degeneration (kava kava extract, acrylamide, and leucomalachite green). A retrospective light-microscopic evaluation of the retinas from rats in these three studies showed a dose-related increase in the frequencies of retinal degeneration, beginning with the loss of photoreceptor cells, followed by the inner nuclear layer cells. These dose-related increased frequencies of degenerative retinal lesions localized within the central/hemispherical region are suggestive of exacerbation of light-induced retinal degeneration.

Corporate entities engage in business with a profit motive, but host communities suffer displacement, loss of livelihood, workplace hazards, environmental pollution, resources depletion and other such risks. These would be acceptable, if there is an overall betterment of life of local communities with an equitable distribution of wealth. The medieval practices of exploitation unmindful of consequences are out of place in modern capitalism. There is a growing realization that sustainable growth and success can be achieved by businesses only by recognizing social responsibilities and contributing to socioeconomic progress of host society and country. There is a paradigm shift in corporate accountability from ‘shareholders only’ to ‘all stakeholders’ with its evolution from philanthropy, charity, trusteeship, transparency, social accountability and sustainable business strategy to a responsibility. The concept and implementation of corporate social responsibility (CSR) differ much between developed countries and developing nations of Asia, Africa and South America. The diamond mining has deservingly earned a great deal of notoriety from looting, stealing, and reckless exploitation and ruining of host communities and countries. Terms like ‘blood diamonds‘ and’conflict diamonds‘ are the examples. This chapter attempts to explore, if cooperation, accountability, fair play and social values are incorporated in Zimbabwe’s Marange diamond fields, comparison of its record with that of other mining countries, examine the applicability of CSR of developed countries to developing nations, and drawing relevant conclusions and suggestions to enable developing countries bridge gaps in their CSR practices. It has been concluded that even the best endowed country in natural resources might remain poor with bad CSR practices, if resources are not properly managed.

The proposed mechanism of Terson’s syndrome is increased intracranial pressure that leads to dilation of the retrobulbar optic nerve and compression of the central retinal vein. Terson’s syndrome has been associated with many conditions that increase intracranial pressure such as venous sinus thrombosis, Moyamoya disease, leukemia, direct head trauma, and intraocular hemorrhage related to shaken baby syndrome. We present a novel case of a patient with recent viral prodrome found to have papilledema and multilayered retinal hemorrhages consistent with Terson syndrome. Computed tomography and magnetic resonance venography of the brain did not reveal any subdural, subarachnoid, or intracranial hemorrhages. However, cerebrospinal fluid analyses were significant for increased opening pressure and elevated protein levels, which were suggestive of viral meningoencephalitis. We describe this case as a Terson-like syndrome because the etiology of intraocular hemorrhage is increased intracranial pressure. However, this case does not fit the traditional presentation of Terson’s syndrome as the intracranial pressure is secondary to meningeal inflammation instead of subdural, subarachnoid, or intracranial hemorrhage. We strongly feel that it is important for physicians to be aware of the link between viral meningoencephalitis and retinal conditions such as Terson-like syndrome because it can facilitate rapid diagnosis and treatment.

The retina is continually exposed to free radicals from its rich blood supply, numerous mitochondria, and photons of light which strike its surface. Most pathological processes that take place in the retina, such as inflammation, cell apoptosis, or angiogenesis, can hence involve free radicals directly or indirectly. Since inflammatory and oxidative stress pathways underlie retinal pathology, compounds that address these factors are therefore natural choices for treatment. This review article summarizes and provides commentary on curcumin's therapeutic potential use in ophthalmology with principal focus on retinal dosorders. Curcumin (diferuloylmethane) is a compound of the Indian spice turmeric (Curcuma longa) that has been found to be efficacious in preventing and treating a number of inflammatory diseases and neoplastic processes. Curcumin exerts anti-inflammatory, anti-tumor, antioxidant, and VEGF inhibition properties through modulation of numerous biochemical mediators. This makes curcumin particularly effective in retinal disorders. Curcumin has found a role in slowing, and in some cases even reversing, age-related macular degeneration, diabetic retinopathy, retinitis pigmentosa, proliferative vitreoretinopathy, and retinal cancers. However, studies on curcumin’s efficacy have been limited mostly to animal studies. Moreover, the biomedical potential of curcumin is not easy to use, given its low solubility and oral bioavailability—more attention therefore has been given to nanoparticles and liposomes.

Data derived from microarray technologies are generally subject to various sources of noise and accordingly the raw data are pre-processed before formally analysed. Data normalization is a key pre-processing step when dealing with microarray experiments, such as circadian gene-expressions, since it removes systematic variations across arrays. A wide variety of normalization methods are available in the literature. However, from our experience in the study of rhythmic expression patterns in oscillatory systems (e.g. cell-cycle, circadian clock), the choice of the normalization method may substantially impair the identification of rhythmic genes. Hence, the identification of a gene as rhythmic could be just as an artefact of how the data were normalized. Yet, gene rhythmicity detection is crucial in modern toxicological and pharmacological studies, thus a procedure to truly identify rhythmic genes that are robust to the choice of a normalization method is required.To perform the task of detecting rhythmic features, we propose a rhythmicity measure based on bootstrap methodology to robustly identify rhythmic genes in oscillatory systems. Although our methodology can be extended to any high-throughput experiment, in this chapter, we illustrate how to apply it to a publicly available circadian clock microarray gene-expression data and give full details (both statistical and computational) so that the methodology can be used in an easy way. We will show that the choice of normalization method has very little effect on the proposed methodology since the results derived from the bootstrap-based rhythmicity measure are highly rank correlated for any pair of normalization methods considered. This suggests, on the one hand, that the rhythmicity measure proposed is robust to the choice of the normalization method, and on the other hand, that gene rhythmicity detected using this measure is potentially not a mere artefact of the normalization method used. In this way the researcher using this methodology will be protected against the possible effect of different normalizations, as the conclusions obtained will not depend so strongly on them. Additionally, the described bootstrap methodology can also be employed as a tool to simulate gene-expression participating in an oscillatory system from a reference data set.

Diagnosing culture-proven endophthalmitis is complicated by the insufficient yield of intraocular samples and the variety of etiologies which mimic true endophthalmitis. In cases of impending vision loss where vitreous biopsy cannot provide a definitive diagnosis, transvitreal retinochoroidal biopsy can be an effective next step. Our case is a 48-year-old male with B-cell acute lymphoblastic leukemia that presented with counting fingers vision, redness, and tearing of the left eye. Exam showed cell and flare with hypopyon as well as dense vitritis. The patient underwent diagnostic pars plana vitrectomy and vitreous culture was negative at the time. Flow cytometry demonstrated no malignant cells. However, the patient’s vision and mental status continued to clinically decline despite being started on intravitreal and systemic antibiotic and antifungal therapy. Neuroimaging revealed rim-enhancing brain lesions. Transvitreal retinochoroidal biopsy was performed in an elevated area of the retina. The biopsy helped rule out malignancy and showed acute-angle, septate, branching hyphae characteristic ofAspergillus fumigatus. Ultimately, the vitreous biopsy, cultures, and a biopsy from the left frontal lobe brain abscess all confirmed this diagnosis as well. Transvitreal retinochoroidal biopsy can play a role in the diagnosis of a case of posterior uveitis and can be particularly effective in diagnosing a fungal endophthalmitis.

Internet of Things has been successful in achieving the goal to build a connected future. Everything around us can communicate mutually and exchange data to work smart, thanks to IoT. In a world where health problems decelerate human harmony, that rise due to the lack of detailed information and misleading advertisements about the food that they consume, the water that they drink, the air that they breathe; a concept like IoT could serve the purpose of enabling communication between all the ’things’ that matter a lot as far as human health is concerned and human beings themselves, in order to make health-friendly choices about food and water, with greater precision. Water-a ‘thing’ that can be a serious threat to human life, even if it is consumed slightly untreated requires constant monitoring. This paper focuses on drinking water quality monitoring and employs IoT for the same and stands apart from conventional ideas in being people-centric. The water in a packaged drinking water plant is monitored for its TDS-the total dissolved solids which at higher values can imply adverse long-term effects on human beings. The TDS values measured using a TDS sensor interfaced with a ESP8266 ESP12-E board, is sent to an open IoT platform like Thingspeak, where data is efficiently visualized. The path specific URL that houses these data is embedded onto a QR code that is attached to the bottle containing the water from which the data has been extracted. People are provided with a smartphone app that can be used to scan this QR code, which would take the users to the URL where the data regarding the water that they have purchased/yet to purchase is stored. The app also has text bodies that explain what a TDS value would mean to a particular user. This project uses the ESP8266 ESP12-E (NodeMCU) microcontroller to achieve the purpose. All data transactions between the microcontroller and the cloud platform is achieved using the MQTT protocol which is extremely light weight and is thus popular among IoT applications.

Objective Cancer caregivers are at increased risk for cardiovascular disease (CVD) and mortality. The aims of this study were to examine psychosocial and behavioral predictors of metabolic syndrome, an intermediate endpoint of CVD. Methods Cancer caregivers were administered a battery of questionnaires assessing sociodemographic characteristics, depressive symptoms, perceived stress, caregiver quality of life, sleep, physical activity, alcohol and tobacco use, social support, relationship quality, and loneliness. Metabolic syndrome was defined using the American Heart Association guidelines and the National Cholesterol Education Program's Adult Treatment Panel (ATP) III, which includes the presence of at least three of the following abnormalities: blood pressure, glucose, abdominal girth, high-density lipoprotein (HDL), and triglycerides. Results Of the 104 caregivers, 77% were female, 94% were Caucasian, and the mean age was 59.5 (SD = 12.8). Of the 104 caregivers, 35.6% reported depressive symptoms in the clinical range of the Center for Epidemiologic Studies-Depression (CES-D) and 69.2% reported Perceived Stress Scale scores at least one standard deviation above the general population norms. A total of 16.3% of caregivers currently used tobacco, 28.8% consumed alcohol, and 26.7% were overweight (BMI = 25-29.9) and 48.5% were obese (BMI ≥ 30). Forty-nine percent of the caregivers met the criteria for metabolic syndrome. After age, gender, and race were adjusted, the following remained as significant predictors of metabolic syndrome: low levels of caregiver quality of life (Odds Ratio (OR) = 1.067; 95% CI, 1.019-1.117; P = .006), high levels of hostility (OR = 1.142; 95% CI, 1.030-1.267; P = .012), and current alcohol use (OR = 4.193; 95% CI, 1.174-14.978; P = .027). Conclusion Development of interventions to reduce the risk of metabolic syndrome in cancer caregivers is recommended.

Background: Lung health might be influenced by oral bacteria through micro-aspiration and transfer of inflammatory mediators from the oral mucosa. Aim: To describe the association between oral bacteria and lung function in a healthy population from Bergen, Norway. Methods: Samples of gingival fluid were collected concurrently with spirometry in 288 adults (52% males, median age 28 years) from the RHINESSA study, Bergen centre. Bacterial DNA from the 16S rRNA gene were isolated from gingival fluid, sequenced by Illumina® and assigned bacterial taxonomy by the Human Oral Microbiome Database. Differential abundance in the gingival microbiome by FEV1 and FVC percent predicted was evaluated by the Analysis of Composition of Microbiomes methodology with 5% False Discovery Rate, adjusting for weight, education, smoking and asthma medication. Results: We identified 148 bacteria genera in the gingival fluid samples. 12 genera, accounting for 4.5% of the total gingiva microbiota, showed increased relative abundance with lower FEV1. The main contributors were Rothia spp. (2.4%) and Enterococcus spp. (1.2%). Among the 12 genera associated with FEV1, 6 genera (0.8% of the gingiva bacterial community) were also associated with lower FVC, with Propionibacterium spp. (0.6%) as the main contributor. Additionally 6 genera were associated with lower FVC; these contributed to Conclusion: High levels of Rothia, Propionibacterium and Enterococcus genera were associated with lower lung function, FEV1 in particular. Rothia species are implicated in lung disease and with periodontitis, while Propionibacterium and Enterococcus include known cariogenic pathogens. Thus, the main contributors to lower lung function are known oral or lung pathogens.