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Introduction Service members and veterans applying to medical schools can be a challenging experience. Often, the applicants have difficulty providing descriptions of their experiences. Additionally, their pathway to medical school is significantly different compared to traditional applicants. We sought to determine if there were statistically significant factors within a cohort of U.S. military medical school applications to a U.S.-based allopathic medical school to provide recommendations on how to best advise military applicants. Methods Data about social, academic, and military factors were collected and analyzed from the American College Application Service (AMCAS) applications to the West Virginia University School of Medicine (WVU SoM) from the 2017 to 2021 cycles. Eligibility criteria included the applications that indicated that the applicant listed any type of military experience. Results In the 5-year study period, there were 25,514 applicants to the WVU SoM, and 1.6% (n = 414) self-identified as military applicants. Of the military applicants, 28 (7%) were accepted to the WVU SoM. Statistically significant differences were found in several factors, including but not limited to academic performance, number of total experiences (14.5 vs. 12, P = .01), and number of military experiences (4 vs. 2, P = .003) listed on the AMCAS applications. In the accepted group, 88% of the applications included information about military experiences, which was understandable to the nonmilitary researchers compared to 79% in the nonaccepted group (P = .24). Conclusions Premedical advisors can share statistically significant findings with military applicants, so they are informed about the academic and experiential factors associated with medical school acceptance. Applicants should also be advised to provide clear explanations of any military lexicon used in their applications. Although not statistically significant, there were a higher percentage of applications that contained descriptions of military language that was understandable to the civilian researchers in the accepted group vs. the nonaccepted group.

Point of care pre-procedure neuraxial ultrasound imaging of the lower lumbar vertebrae is becoming the gold standard in labor and delivery neuraxial analgesia and anesthesia. Pre-procedure ultrasound imaging can be used to facilitate successful neuraxial placement by determining the optimal vertebral interspace, identification of the midline, locating the optimal insertion point as well as the best angle for needle insertion, and to provide an accurate measurement depth for needle advancement to the epidural or intrathecal space. Neuraxial ultrasound can enhance the parturient’s overall comfort, experience, and satisfaction by reducing the risk for failed or traumatic lumbar punctures and epidural catheterizations, the number of insertion attempts, and needle redirections. Furthermore, neuraxial ultrasound imaging can be of particular benefit in parturients with difficult anatomy or landmarks.

Background: Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, single-group cohort study that evaluated andexanet alfa in patients with acute major bleeding. The results of the final analyses are presented. Methods: Patients with acute major bleeding within 18 hours of FXa inhibitor administration were enrolled. Co-primary end points were anti-FXa activity change from baseline during andexanet alfa treatment and excellent or good hemostatic efficacy, defined by a scale used in previous reversal studies, at 12 hours. The efficacy population included patients with baseline anti-FXa activity levels above predefined thresholds (≥75 ng/mL for apixaban and rivaroxaban, ≥40 ng/mL for edoxaban, and ≥0.25 IU/mL for enoxaparin; reported in the same units used for calibrators) who were adjudicated as meeting major bleeding criteria (modified International Society on Thrombosis and Haemostasis definition). The safety population included all patients. Major bleeding criteria, hemostatic efficacy, thrombotic events (stratified by occurring before or after restart of either prophylactic [ie, a lower dose, for prevention rather than treatment] or full-dose oral anticoagulation), and deaths were assessed by an independent adjudication committee. Median endogenous thrombin potential at baseline and across the follow-up period was a secondary outcome. Results: There were 479 patients enrolled (mean age, 78 years; 54% male; 86% White); 81% were anticoagulated for atrial fibrillation, and the median time was 11.4 hours since last dose, with 245 (51%) on apixaban, 176 (37%) on rivaroxaban, 36 (8%) on edoxaban, and 22 (5%) on enoxaparin. Bleeding was predominantly intracranial (n=331 [69%]) or gastrointestinal (n=109 [23%]). In evaluable apixaban patients (n=172), median anti-FXa activity decreased from 146.9 ng/mL to 10.0 ng/mL (reduction, 93% [95% CI, 94–93]); in rivaroxaban patients (n=132), it decreased from 214.6 ng/mL to 10.8 ng/mL (94% [95% CI, 95–93]); in edoxaban patients (n=28), it decreased from 121.1 ng/mL to 24.4 ng/mL (71% [95% CI, 82–65); and in enoxaparin patients (n=17), it decreased from 0.48 IU/mL to 0.11 IU/mL (75% [95% CI, 79–67]). Excellent or good hemostasis occurred in 274 of 342 evaluable patients (80% [95% CI, 75–84]). In the safety population, thrombotic events occurred in 50 (10%) patients; in 16 patients, these occurred during treatment with prophylactic anticoagulation that began after the bleeding event. No thrombotic episodes occurred after oral anticoagulation restart. Specific to certain populations, reduction of anti-FXa activity from baseline to nadir significantly predicted hemostatic efficacy in patients with intracranial hemorrhage (area under the receiver operating characteristic curve, 0.62 [95% CI, 0.54–0.70]) and correlated with lower mortality in patients P =0.022; unadjusted P =0.003). Median endogenous thrombin potential was within the normal range by the end of andexanet alfa bolus through 24 hours for all FXa inhibitors. Conclusions: In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02329327.

Due to the coronavirus pandemic, virtual interviews became a mainstay of graduate dental and medical education selection processes. To gain a handle on how to navigate lingering uncertainties about how interviews should be conducted in the future, this study examined the benefits and pitfalls of the virtual interview process (VIP) and assessed program plans to implement in the next interview cycle.An anonymous online survey, for completion by one program representative (director or associate director), was sent to graduate medical education (GME) and advanced dental education programs at West Virginia University (N = 74).Fifty-two (52) of the programs (70%) completed the survey. Zoom was the most frequently used interview platform (78.8%). Approximately two thirds (65.4%) of the interviewers thought VIP allowed the program to promote the university, the school, and their program and also reported experiencing video-conferencing fatigue. About six in 10 perceive VIP can introduce bias in selecting applicants (59.6%) and potentially disadvantage some applicants (67.3%). Compared to the previous in-person cycle, 67.4% of programs invited more applicants, and 73.1% interviewed more applicants. Regarding the 2021-2022 interview cycle, 55.8% of programs plan to offer either an in-person or VIP, while 7.7% plan to keep their process completely virtual.Graduate programs in this study demonstrated the indispensability of technology in transitioning from in-person to virtual interviews during COVID-19 pandemic. VIP has several advantages and disadvantages; this style of interview is forecasted to have a presence in applicant selection in the future.

OBJECTIVES: A paucity of information exists to advise medical school applicants who have had to retake the Medical College Admission Test (MCAT) to achieve a competitive score. To better advise repeat test takers from West Virginia and other Appalachian and southern areas, MCAT data from West Virginia applicants were analyzed and compared with national data. METHODS: In the application cycles of 2017–2020, the following factors were analyzed in relation to medical school acceptance in West Virginia applicants: MCAT scores, the number of test-taking attempts, biology-chemistry-physics-math grade point average, time between test-taking attempts, and academic major. MCAT data from medical school applicants from West Virginia who took the test more than once also were compared with national data. RESULTS: Of the total repeat test takers from West Virginia (N = 285) in the study timeframe, 57 (20%) were ultimately accepted into medical school. Factors associated with medical school acceptance were as follows: first MCAT test score (odds ratio [OR] 1.3, 95% confidence level [CL] 1.2–1.4, P < 0.001), change in MCAT test score (OR 1.2, 95% CL 1.1–1.3, P = 0.0015), and biology-chemistry-physics-math grade point average (OR 15.1, 95% CL 4.2–54.8, P < 0.0001). The highest benefit for improved scores occurred between the first and second attempts. The highest point gain occurred when the first MCAT score was in the range of 477 to 487 (

Robert Shapiro,1,2 Alec Sunyecz,3 Stanley Zaslau,1,2 Manuel C Vallejo,1,4 Tyler Trump,2 Omar Dueñas-Garcia1 1Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA; 2Department of Urology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA; 3West Virginia University School of Medicine, Morgantown, WV, 26506, USA; 4Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, WV, 26506, USACorrespondence: Robert ShapiroHealth Science Center North, West Virginia University, PO Box 9001A, Morgantown, WV, 26506, USATel +1 304-293-5631Fax +1 304-293-5160Email rshapiro@hsc.wvu.eduBackground: In this study, we aim to compare outcomes after cystotomy repair between standard sutures (910 polyglactin, poliglecaprone) versus barbed (V-LocTM 90) suture. As a secondary outcome, we analyzed factors for suture preference between the two groups.Methods: A retrospective chart review was undertaken for surgeries complicated by cystotomy, identified by ICD-9/10 codes from 2016 to 2019 at West Virginia University (WVU) Hospital. Comparisons were made between cystotomy repair using barbed suture versus standard braided suture. Injuries were categorized by procedure, surgical route, type of suture used in repair, and subsequent complications related to repair. Primary endpoints were examined by Pearson’s Chi-square test and interval data by t-test. A p < 0.05 was significant.Results: Sixty-eight patients were identified with iatrogenic cystotomy at WVU. Barbed suture was used for cystotomy repair in 11/68 (16.2%) patients. No significant difference was seen in postoperative outcomes between patients repaired with barbed suture versus standard braided suture. Barbed suture was significantly more likely to be used for cystotomy repair in minimally invasive surgery (p = 0.001). It was most often utilized in a robotic approach 7/11 (63.6%) followed by laparoscopic 3/11 (27.3%). Body mass index (BMI) was significantly higher in patients receiving a barbed suture repair (p = 0.005).Conclusion: Barbed suture may be comparable to standard braided suture for cystotomy repair. Barbed suture may offer a practical alternative to facilitate cystotomy repair in minimally invasive surgery, especially in patients with a high BMI.Keywords: barbed suture, cystotomy, minimally invasive surgery, obesity

Protoplanetary discs are complex dynamical systems where several processes may lead to the formation of ring-like structures and planets. These discs are flared following a profile where the vertical scale height increases with radius. In this work, we investigate the role of this disc flaring geometry on the formation of rings and holes. We combine a flattening law change with X-ray and FUV photoevaporative winds. We have used a semi-analytical 1D viscous α approach, presenting the evolution of the disc mass and mass rate in a grid of representative systems. Our results show that changing the profile of the flared disc may favour the formation of ring-like features resembling those observed in real systems at the proper evolutionary times, with proper disc masses and accretion rate values. However, these features seem to be short-lived and further enhancements are still needed for better matching all the features seen in real systems.

Extracellular vesicles (EVs) play important roles in cell-to-cell communication and are potential biomarkers as they carry markers of their derived tissues and disease signatures. However, obtaining pure EV preparations from biofluids is challenging due to contaminants with similar physicochemical properties. Here, we performed a meta-analysis of plasma EV proteomics data deposited in public repositories to refine the protein composition of EVs and investigate potential roles in type 1 diabetes development. With the concept that each purification method yields different proportions of distinct contaminants, we grouped proteins into clusters based on their abundance profiles. This allowed us to separate clusters with classical EV markers, such as CD9, CD40, C63 and CD81, from clusters of well-known contaminants, such as serum albumin, apolipoproteins and components of the complement and coagulation pathways. Two clusters containing a total of 1720 proteins combined were enriched with EV markers and depleted in common contaminants; therefore, they were considered to contain bona fide EV components. As possible origins of plasma EVs, these clusters had markers of tissues such as spleen, liver, brain, lungs, pancreas, and blood/immune cells. These clusters were also enriched in cell surface markers CD antigens, and proteins from cell-to-cell communication and signaling pathways, such as chemokine signaling and antigen presentation. We also show that the EV component and type 1 diabetes biomarker, platelet basic protein (PPBP/CXCL7) regulates apoptosis in both beta and macrophage cell lines. Overall, our meta-analysis refined the composition of plasma EVs, reinforcing a primary function as messengers for cell-to-cell communication and signaling. Furthermore, this analysis identifies optimal avenues to target EVs for development of disease biomarkers.

Gender-related healthcare disparities persist. We sought to determine gender-related differences in rural healthcare. Quality control assurance analysis utilizing an electronic medical record was used to determine gender-related differences in rural healthcare over a 3-year period (n = 78,814). Compared to men, women tended to be older (69.4 ± 13.6 years vs 67.9 ± 12.5 years, p

The dynamical characterization of the Millisecond Pulsar (MSP) parameters is a key issue in understanding these systems. We present an analytical analysis of the orbital parameters of binary MSPs with long periods (Porb > 2 d) and circular (e < 0.1) orbits, produced by an asymmetric kick model imparted during the Accretion Induced Collapse (AIC) of white dwarfs process. It turns out that the distribution of orbits peaks up to P_orb;f < 90 d with strong circularization. Considering the different assumptions about the distribution of companions He stars 3M< Mcom < 5M, the binary will affect the setups of the balance condition of minimum energy. Our analytical approach is just the first approach to the more complete models required for describing all binary parameters after an asymmetric kick. Therefore, we have also run some numerical simulations in order to compare their results with the analytical studies. We aim to initiate the first exploration of the full complexity of the problem, when combining a variable kick time and a variable kick vector direction. Indeed, the numerical simulations show patterns resembling the complex behavior found in chaotic scattering problems. Although we deal with a deterministic problem and bounded orbits, the regular characteristic orbits are found in more realistic phases during the AIC process. In addition, the overall process can show complex behaviors strongly associated with the internal kick mechanisms. This would lead us to identify the nature of regular orbits and their orbital morphology., In press (Journal of High Energy Astrophysics)

Robert Shapiro,1,2 Omar Felipe Dueñas-Garcia,1 Manuel Vallejo,1 Tyler Trump,2 Makenzy Sufficool,3 Stanley Zaslau1,2 1Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA; 2Department of Urology, West Virginia University School of Medicine, Morgantown, WV 26506, USA; 3West Virginia University School of Medicine, Morgantown, WV 26506, USACorrespondence: Robert ShapiroDepartment of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USAEmail rshapiro@hsc.wvu.eduIntroduction: Patients may develop recurrent urinary tract infections, pain syndromes, dyspareunia, and voiding difficulty after mid-urethral sling placement that can be treated by partial sling excision.Objective: The primary objective of this study was to evaluate the incidence of de novo incontinence and voiding difficulty after partial sling excision. A secondary objective was to assess risk factors associated with future incontinence surgery in this subset of patients.Methods: From 2009 to 2017, 95 female patients with subjective complaints of pelvic pain, dyspareunia, or voiding difficulty following synthetic mid-urethral sling placement for stress urinary incontinence underwent partial sling excision at a single institution. The incidence of urinary incontinence was assessed 6 months after partial sling excision. Patients were also assessed for resolution of voiding difficulty and future incontinence surgery. Primary endpoints were examined by Pearson’s Chi-square test and interval data by t-test. A p < 0.05 was significant.Results: About 72% of patients were more likely to be continent after partial sling excision irrespective of initial symptoms prior to surgery. No difference was seen in voiding difficulty between the continent and incontinent patients after partial sling excision (p=0.09). Patients with a retropubic mid-urethral sling were more likely to be continent after partial sling excision (p=0.03). Preoperative maximum flow rate > 16 mL/sec was associated as an independent variable to develop incontinence surgery after partial sling excision (p=0.009).Conclusion: In conclusion, partial sling excision poses a low risk for de novo urinary incontinence regardless of preoperative symptoms. Stress urinary incontinence may be less likely to reoccur in those patients having a retropubic approach. A preoperative maximum flow rate of > 16 mL/sec is a risk factor for future incontinence surgery after partial sling excision and should be taken into consideration when formulating a treatment plan.Keywords: sling excision, mesh, incontinence, mid-urethral sing

Background In women undergoing cesarean delivery under spinal anesthesia with intrathecal morphine, transversus abdominis plane (TAP) block with bupivacaine hydrochloride (HCl) may not improve postsurgical analgesia. This lack of benefit could be related to the short duration of action of bupivacaine HCl. A retrospective study reported that TAP block with long-acting liposomal bupivacaine (LB) reduced opioid consumption and improved analgesia following cesarean delivery. Therefore, we performed a prospective multicenter, randomized, double-blind trial examining efficacy and safety of TAP block with LB plus bupivacaine HCl versus bupivacaine HCl alone. Methods Women (n = 186) with term pregnancies undergoing elective cesarean delivery under spinal anesthesia were randomized (1:1) to TAP block with LB 266 mg plus bupivacaine HCl 50 mg or bupivacaine HCl 50 mg alone. Efficacy was evaluated in a protocol-compliant analysis (PCA) set that was defined a priori. The primary end point was total postsurgical opioid consumption (oral morphine equivalent dosing [MED]) through 72 hours. Pain intensity was measured using a visual analog scale. Adverse events (AEs) after treatment were recorded through day 14. Results Total opioid consumption through 72 hours was reduced with LB plus bupivacaine HCl versus bupivacaine HCl alone (least squares mean [LSM] [standard error (SE)] MED, 15.5 mg [6.67 mg] vs 32.0 mg [6.25 mg]). This corresponded to an LSM treatment difference of -16.5 mg (95% confidence interval [CI], -30.8 to -2.2 mg; P = .012). The area under the curve of imputed pain intensity scores through 72 hours supported noninferiority of LB plus bupivacaine HCl versus bupivacaine HCl alone (LSM [SE], 147.9 [21.13] vs 178.5 [19.78]; LSM treatment difference, -30.6; 95% CI, -75.9 to 14.7), with a prespecified noninferiority margin of 36 (P = .002). In an analysis of all treated patients, including those not meeting criteria for inclusion in the PCA, there was no difference in postsurgical opioid consumption between groups. In the LB plus bupivacaine HCl group, 63.6% of patients experienced an AE after treatment versus 56.2% in the bupivacaine HCl-alone group. Serious AEs after treatment were rare (≈3% in both groups). Conclusions TAP block using LB plus bupivacaine HCl as part of a multimodal analgesia protocol incorporating intrathecal morphine resulted in reduced opioid consumption after cesarean delivery in the PCA set. Results suggest that with correct TAP block placement and adherence to a multimodal postsurgical analgesic regimen, there is an opioid-reducing benefit of adding LB to bupivacaine TAP blocks after cesarean delivery (ClinicalTrials.gov identifier: NCT03176459).

A dopamine-modified, bioinspired gellan gum hydrogel (STM-148B) with improved physicochemical and biological characteristics, suitable for minimally invasive cell delivery and retention in the context of cartilage repair, is herein presented. STM-148B's putative game-changing design characteristics include a highly biocompatible, animal-free and chemically defined composition, reproducibility of manufacture and ease of formulation. STM-148B undergoes rapid ionic crossinking by physiologically relevant mono and divalent cations to form stable 3D hydrogels that possess excellent tissue adhesiveness, such that additional fixation aids are rendered superfluous. STM-148B hydrogels maintain viability of mammalian cells and further promote up-regulation of the expression of healthy chondrogenic extracellular matrix markers upon stimulation. STM-148B is currently undergoing pre-clinical safety and efficacy assessment as a medical device for cell delivery and retention focussing on regeneration of hyaline-like cartilage and may represent a valuable addition to the armamentarium of tissue-engineering therapies for treatment of focal cartilage lesions.

Epidural analgesia, commonly used to alleviate labor pain, is not without complication. The most common complication associated with labor epidural analgesia (LEA) is Unintentional Dural Puncture (UDP), where many professionals go on to develop a Post Dural Puncture Headache (PDPH). Spinal anesthesia can also result in PDPH. Other complications of dural puncture necessitating further treatment include hospital readmission, persistent headache, persistent backache, cerebral venous thrombosis, subdural hematoma, postpartum depression, post-traumatic stress disorder, and decreased maternal breastfeeding. In this article, we will define and discuss the definition and diagnosis for PDPH, the pathophysiology of PDPH, PDPH treatment options including conservative therapy, pharmacologic therapy, and invasive procedural measures including the therapeutic epidural blood patch, prophylactic epidural blood patch, intrathecal catheter placement after UDP, and potential new therapies.

The rise of deep molecular characterization with omics data as a standard in biological sciences has highlighted a need for expanded instruction in bioinformatics curricula. Many large biology data sets are publicly available and offer an incredible opportunity for educators to help students explore biological phenomena with computational tools, including data manipulation, visualization, and statistical assessment. However, logistical barriers to data access and integration often complicate their use in undergraduate education. Here, we present a cancer bioinformatics module that is designed to overcome these barriers through six exercises containing authentic, biologically motivated computational exercises that demonstrate how modern omics data are used in precision oncology. Upper-division undergraduate students develop advanced Python programming and data analysis skills with real-world oncology data which integrates proteomics and genomics. The module is publicly available and open source at https://paynelab.github.io/biograder/bio462. These hands-on activities include explanatory text, code demonstrations, and practice problems and are ready to implement in bioinformatics courses.

Made available in DSpace on 2021-07-14T10:39:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-25. Added 1 bitstream(s) on 2021-07-14T11:35:04Z : No. of bitstreams: 1 S1808-16572009000300359.pdf: 207365 bytes, checksum: d330d676117626f910695f8bc882f790 (MD5) Seis linhagens de Penicillium foram isoladas do solo, na profundidade de 0 15 cm, na Estação Ecológica de Juréia-Itatins (EEJI), Estado de São Paulo, Brasil. Elas foram analisadas quanto a produção de xilanase sob diferentes temperaturas e fontes de carbono e de nitrogênio. Foi utilizado meio contendo água de torneira com 2% de carboidrato e/ou 1% de fonte de nitrogênio. A melhor fonte de carbono e temperatura foram obtidas no sistema automatizado de crescimento tipo Bioscreen C. Posteriormente, Penicillium citrinum, P. fellutanum, P. rugulosum e P. decumbens foram cultivadas em frascos agitados em 150 rpm, contendo meio líquido contendo água de torneira com uma única fonte de carbono 2% e/ou 1% de fonte de nitrogênio, pH 5.0, a 25o C, por 72 horas. Estas mesmas linhagens, exceto P. decumbens, e P. purpurogenum foram cultivadas em substrato sólido contendo farelo de trigo sob as mesmas condições ambientais anteriores de cultivo. Maior atividade de xilanase foi observada em culturas contendo farelo de trigo, sem adição de qualquer outra fonte de carbono, usando inoculo com 1.107 esporos mL-1 (25o C, pH 5.0, 72 h). Pode ser concluído que P. fellutanum e P. citrinum são bons produtores de xilanase a 28º C. Os resultados da atividade da xilanase foram 54% menores a 28º C em cultura líquida em relação aos resultados observados em substrato sólido. Six Penicillium strains were isolated from soil at a depth of 0 15 cm in the Juréia-Itatins Ecology Station (JIES), in the São Paulo State, Brazil. They were evaluated for xylanase production under different temperatures and carbon sources. The best carbon source and temperature were first determined in an automated Bioscreen C system, verifying the growth of microorganisms. Liquid media containing tap water with 2% carbohydrate and/or 1% nitrogen sources were used. Afterwards, Penicillium citrinum, P. fellutanum, P. rugulosum and P. decumbens were cultivated in 250 mL Erlenmeyer flasks with 50 mL of culture medium containing tap water sole 2% carbon source (fructose, glucose, mannitol, sucrose or xylose) and 1% yeast extract as a nitrogen source at pH 5.0 and 28o C, with agitation of 150 rpm for 72 hours. These same strains, except P. decumbens, and P. purpurogenum were cultivated in solid substrate with wheat bran under the same environmental conditions to study the potential of xylanase activity. Maximum xylanase activity was observed in cultures with wheat bran, without the addition of any other carbon source, using inocula containing 1 x 107 spores.mL-1 (28o C, pH 5.0, 72 h). It can be concluded that P. fellutanum and P. citrinumare a good xylanase producers under the conditions of 28º C. The results of xylanase activity were 54% less at 28º C in liquid cultures media cultures than in solid substrate. Universidade Estadual Paulista, Centro de Estudos Ambientais Universidade Estadual Paulista, Centro de Estudos Ambientais

Background In this study, we aim to compare outcomes after cystotomy repair between standard sutures (910 polyglactin, poliglecaprone) versus barbed (V-Loc™ 90) suture. As a secondary outcome, we analyzed risk factors for suture preference between the two groups. Methods A retrospective chart review was undertaken for surgeries complicated by cystotomy, identified by ICD-9/10 codes from 2016 to 2019 at West Virginia University (WVU) Hospital. Comparisons were made between cystotomy repair using barbed suture versus standard braided suture. Injuries were categorized by procedure, surgeon specialty, surgical route, type of suture used in repair, and subsequent complications related to repair. Primary endpoints were examined by Pearson’s Chi-square test and interval data by t-test. A p

Teeth are present in most clades of vertebrates but have been lost completely several times in actinopterygian fishes and amniotes. Using phenotypic data collected from over 500 genera via micro-computed tomography, we provide the first rigorous assessment of the evolutionary history of dentition across all major lineages of amphibians. We demonstrate that dentition is invariably present in caecilians and salamanders, but teeth have been lost completely more than 20 times in frogs, a much higher occurrence of edentulism than in any other vertebrate group. The repeated loss of teeth in anurans is associated with a specialized diet of small invertebrate prey as well as shortening of the lower jaw, but it is not correlated with a reduction in body size. Frogs provide an unparalleled opportunity for investigating the molecular and developmental mechanisms of convergent tooth loss on a large phylogenetic scale.

This Pro-Con debate will provide the practitioner with an evidence-based knowledge approach to assist the clinician in determining whether to employ (Pro) or not to employ (Con) this technique in the obstetrical suite for labor analgesia. Nitrous oxide has been used safely in dentistry and medicine for many centuries. However, accumulating preclinical and clinical evidence increasingly suggests previously unrecognized adverse maternal and fetal effects of nitrous oxide, which warrants reconsideration of its use in pregnant women and a more detailed informed consent. Nitrous oxide is associated with metabolic, oxidative, genotoxic, and transgenerational epigenetic effects in animals and humans that may warrant limiting its usefulness in labor. This debate will discuss and review the clinical uses, advantages, and disadvantages of nitrous oxide on occupational effects of nitrous oxide exposure, neuroapoptosis, FDA warning on inhalational anesthetics and the developing brain, research limitations, occupational exposure safety limits, effects on global warming, and potential for diversion.

Purpose: Members of the transgender community face significant health disparities within our society, especially within the state of West Virginia, which is primarily rural. We sought to examine and compare existing attitudes and knowledge of resident and faculty physician medical professionals at our institution about treating transgender individuals within a rural tertiary care center. Methods: The Medical Practitioner Attitudes Towards Transgender Patients (MP-ATTS) survey and the Medical Practitioner Beliefs and Knowledge about Treating Transgender Patients (MP-BKTTP) survey were sent to all faculty and resident physicians at West Virginia University Hospitals. Demographics included information about gender, rurality of hometown, race, and description of medical practitioner status (i.e., years out of residency, residency status). Findings: In general, there were positive attitudes and reception of the survey among residents and faculty physicians. 76.45% of providers assumed that their patients were not transgender. More than 40% of respondents believed that they would need further education about transgender patients to provide appropriate health care. Male health care providers had significantly higher negative perceptions of the transgender community (N=85, M=4.46, standard deviation [SD]=0.55, p

To investigate efficacy and safety of liposomal bupivacaine (LB) transversus abdominis plane (TAP) block with or without intrathecal morphine (ITM) compared with ITM alone for postsurgical analgesia after cesarean delivery (CD).Multicenter, open-label, randomized trial (NCT03853694).Operating room.Women with term pregnancy of 37 to 42 weeks scheduled for elective CD under spinal anesthesia.Patients were randomized 1:1:1 to LB 266 mg TAP block alone (LB group), ITM 50 μg followed by LB 266 mg TAP block (LB + ITM group), or ITM 150 μg alone (ITM group). All groups received the same postsurgical multimodal analgesic regimen.The LB and LB + ITM groups were compared with the ITM group for all efficacy outcomes. Postsurgical opioid consumption in morphine milligram equivalents (MMEs) through 72 h was compared by assessing noninferiority before testing superiority. Postsurgical pruritus severity was assessed on an 11-point numerical rating scale.Between March 4, 2019, and January 10, 2020, 153 patients (LB, n = 52; LB + ITM, n = 48; ITM, n = 53) were enrolled. Baseline characteristics were comparable across groups. The LB group had statistically noninferior postsurgical opioid consumption through 72 h compared with the ITM group (least squares mean [LSM], 19.2 vs 16.4 MMEs; LSM treatment ratio, 1.17 [95% confidence interval (CI), 0.74-1.86]; noninferiority P 0.0034) as did the LB + ITM group (LSM, 14.6 vs 16.4 MMEs; LSM treatment ratio, 0.89 [95% CI, 0.55-1.44]; noninferiority P 0.0001). The LB and LB + ITM groups had significantly reduced pruritus severity scores through 12, 24, 48, and 72 h compared with the ITM group (P ≤ 0.0121). Adverse events occurred in 58%, 85%, and 81% of the LB, LB + ITM, and ITM groups, respectively.LB TAP block with or without ITM resulted in statistically noninferior postsurgical opioid consumption through 72 h, reduced pruritus, and favorable safety compared with ITM in women undergoing CD.

Teeth have been broadly maintained across most clades of vertebrates but have been lost completely at least once in actinopterygian fishes and several times in amniotes. Using phenotypic data collected from over 500 genera via micro-computed tomography, we provide the first rigorous assessment of the evolutionary history of dentition across all major lineages of amphibians. We demonstrate that dentition is invariably present in caecilians and salamanders, but teeth have been lost completely more than 20 times in frogs, a much higher occurrence of edentulism than in any other vertebrate group. The repeated loss of teeth in anurans is associated with a specialized diet of small invertebrate prey as well as shortening of the lower jaw, but it is not correlated with a reduction in body size. Frogs provide an unparalleled opportunity for investigating the molecular and developmental mechanisms of convergent tooth loss on a large phylogenetic scale.

Purpose/objective(s) Stereotactic body radiotherapy (SBRT) has become the standard of care for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) and for patients who refuse surgery. The aim of this study was to evaluate the effectiveness and safety of primary SBRT in patients with early-stage NSCLC. Materials/methods Retrospective multicenter study of 397 patients (416 primary lung tumours) treated with SBRT at 18 centres in Spain. 83.2% were men. The median age was 74.4 years. In 94.4% of cases, the tumour was inoperable. The pathological report was available in 54.6% of cases. SPSS vs 22.0. was used to perform all statistical analyses. Results Complete response was obtained in 53.6% of cases. Significant prognostic factors were standard CT planning (p = 0.014) and 4D cone beam CT (p = 0.000). Acute and chronic toxicity >= grade 3 was observed in 1.2% of cases. At a median follow-up of 30 months, local relapse was 9.6%, lymph node relapse 12.8%, distant metastasis 16.6%, and another lung tumour 11.5%. Complete response was the only significant prognostic factor for local relapse (p = 0.012) and distant metastasis (p = 0.001). The local relapse-free survival was 88.7%. The overall survival was 75.7%. The cancer-specific survival was 92.7%. The disease-free survival was 78.7%. Conclusion SBRT is an effective and well-tolerated treatment option for patients with early-stage lung cancer who are not suitable for surgery. The most important prognostic factor for local and distant recurrence was complete response, which in our sample depended on the type of CT planning and the IGRT technique.