493 research outputs found
Open Partial Nephrectomy for Pediatric Renovascular Hypertension
Pediatric renovascular hypertension is typically managed with revascularization, angioplasty, or radical nephrectomy. We describe the case of a 13-year-old boy with medically refractory renovascular hypertension who presented to our institution after a failed arterial bypass. Subsequent angiography and renin sampling of the segmental renal veins suggested that the lower pole of the kidney was affected exclusively by the relative hypoperfusion. We proceeded with an open partial nephrectomy in order to excise the affected region of the kidney, while preserving maximum renal function. The patient was normotensive off all antihypertensive medication and without complications 8 months postoperatively. We believe that partial nephrectomy is a reasonable treatment for children with renovascular hypertension secondary to segmental hypoperfusion, and it should be considered as alternative therapy
Distilling Information Reliability and Source Trustworthiness from Digital Traces
Online knowledge repositories typically rely on their users or dedicated
editors to evaluate the reliability of their content. These evaluations can be
viewed as noisy measurements of both information reliability and information
source trustworthiness. Can we leverage these noisy evaluations, often biased,
to distill a robust, unbiased and interpretable measure of both notions?
In this paper, we argue that the temporal traces left by these noisy
evaluations give cues on the reliability of the information and the
trustworthiness of the sources. Then, we propose a temporal point process
modeling framework that links these temporal traces to robust, unbiased and
interpretable notions of information reliability and source trustworthiness.
Furthermore, we develop an efficient convex optimization procedure to learn the
parameters of the model from historical traces. Experiments on real-world data
gathered from Wikipedia and Stack Overflow show that our modeling framework
accurately predicts evaluation events, provides an interpretable measure of
information reliability and source trustworthiness, and yields interesting
insights about real-world events.Comment: Accepted at 26th World Wide Web conference (WWW-17
Residual Energy Based Cluster-head Selection in WSNs for IoT Application
Wireless sensor networks (WSN) groups specialized transducers that provide
sensing services to Internet of Things (IoT) devices with limited energy and
storage resources. Since replacement or recharging of batteries in sensor nodes
is almost impossible, power consumption becomes one of the crucial design
issues in WSN. Clustering algorithm plays an important role in power
conservation for the energy constrained network. Choosing a cluster head can
appropriately balance the load in the network thereby reducing energy
consumption and enhancing lifetime. The paper focuses on an efficient cluster
head election scheme that rotates the cluster head position among the nodes
with higher energy level as compared to other. The algorithm considers initial
energy, residual energy and an optimum value of cluster heads to elect the next
group of cluster heads for the network that suits for IoT applications such as
environmental monitoring, smart cities, and systems. Simulation analysis shows
the modified version performs better than the LEACH protocol by enhancing the
throughput by 60%, lifetime by 66%, and residual energy by 64%
Classroom Management through Teacher Candidatesâ Lenses: Transforming Learning Communities Through a Community of Practice
To better prepare teacher candidates for classroom management through attention to learning communities that affirm and support diverse students, including those effected by trauma, four instructors redesigned a required, undergraduate course. This study describes findings from three teacher candidate co-authors who were enrolled in that course. One semester after completing a course on classroom management and building community, candidates were asked to review their course products and other artifacts to consider what they learned and build upon their prior knowledge. Candidates used stimulated recall to respond to prompts on community building and relationships, gender and racial inclusivity, trauma sensitive practices, and the school to prison pipeline. Their perspectives contribute to understandings about how candidates engage in sense-making regarding classroom communities and classroom management
Giant secreting adrenal myelolipoma in a man: a case report
<p>Abstract</p> <p>Introduction</p> <p>Adrenal myelolipoma is a rare, benign neoplasm that is usually asymptomatic, unilateral and nonsecreting. It develops within the adrenal gland and is composed of mature adipose tissue with elements of the hematopoietic series. We describe the case of what is, to the best of our knowledge, one of the largest secreting adrenal myelolipomas reported in the literature.</p> <p>Case presentation</p> <p>A 52-year-old Caucasian man of medium build who had had moderate hypertension for three years presented to our hospital. He had no other significant symptoms. His hypertension was pharmacologically treated. He came to our hospital to undergo abdominal ultrasonography during a clinical checkup. The ultrasound scan showed the presence of a voluminous hyperechoic mass interposed between the spleen and the left kidney. It was reported as a myelolipoma of the left kidney on the basis of its structural characteristics and position. Computed tomography confirmed our diagnosis. All preoperative biochemical tests were normal, with the exception of high serum cortisol, which was being overproduced by the lesion and was probably responsible for the patient's hypertension. He underwent successful surgery, and his postoperative course was uneventful. The pathologic examination of the lesion confirmed the diagnosis of adrenal myelolipoma. The patient's blood pressure returned to within the normal range.</p> <p>Conclusions</p> <p>The "incidental" discovery of an adrenal mass requires careful diagnostic study to plan adequate therapeutic management. Both of the primary investigations at our disposal, ultrasound and blood tests (adrenal hormones), helped in rendering the diagnosis and allowed us to move toward the most appropriate treatment, taking into account the size of the tumor and its probable hormonal production.</p
Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy
© Springer-Verlag GmbH Germany, part of Springer Nature 2018Background: Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy. Patients and methods: Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes. Results: Of 1213 patients included in the analysis, 21.8% had concomitant CIS. Baseline clinical and pathologic characteristics of the âCISâ versus âno-CISâ groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9% with CIS vs 21.9% without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or †pT1N0 (42.8% with CIS vs 37.8% without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95% CI 0.63â1.18; p = 0.35). The presence of LVI (HR 1.41, 95% CI 1.01â1.96; p = 0.04), hydronephrosis (HR 1.63, 95% CI 1.23â2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95% CI 0.34â0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95% CI 0.82â1.35; p = 0.70). Conclusion: In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.Peer reviewedFinal Accepted Versio
Case report â ancient schwannoma of the scrotum
BACKGROUND: Scrotal schwannoma is a rare neoplasm and poses a diagnostic challenge to urologists. This article describes a rare case of ancient scrotal schwannoma and reviews the current modality of investigation and treatment of this tumour. CASE REPORT: A 28 year old man presented with a 3-month history of an asymptomatic scrotal swelling. Ultrasonography and computer topography revealed an intra-scrotal and extra-testicular mass without local invasion. Surgical excision was undertaken and histology was an ancient schwannoma of the scrotum. CONCLUSION: Schwannoma is a benign encapsulating neoplasm with an overall low incidence, occurring mostly in the head and neck region and seldom in the scrotum. Histology shows two distinctive patterns, Antoni type A and B areas. Variations of schwannoma such as cellular, ancient, glandular and epithelioid are observed based on the appearances. Ancient schwannoma exhibits pleomorphism without mitosis as the result of cellular degeneration, which can lead to an erroneous diagnosis of malignancy. Imaging modalities are non-specific for schwannomas, but can define tumour size, site and extension. The mainstay treatment is complete excision, although local recurrence may occur in large and incompletely excised lesions. Malignant change is exceedingly rare
On the Use of Special Functions for Analyzing the Steady State Creep in Short Fiber Composites Semi-theoretically
Impact of perioperative chemotherapy on survival in patients with advanced primary urethral cancer: results of the international collaboration on primary urethral carcinoma
This is the first series that suggests a prognostic benefit of neoadjuvant treatment in a consecutive series of patients who underwent perioperative chemotherapy plus surgery for advanced primary urethral carcinoma. Further studies should yield a better understanding of how perioperative chemotherapy exerts a positive effect on survival in order to selectively advocate its use in advanced primary urethral carcinom
Integrated Expression of Circulating miR375 and miR371 to Identify Teratoma and Active Germ Cell Malignancy Components in Malignant Germ Cell Tumors
Active germ cell malignancies express high levels of specific circulating micro-RNAs (miRNAs), including miR-371a-3p (miR371), which is undetectable in teratoma. Teratoma markers are urgently needed for theselection of patients and treatments because of the risk of malignant transformation and growing teratoma syndrome. To assess the accuracy of plasma miR375 alone or in combination with miR371 in detecting teratoma, 100 germ cell tumor patients, divided into two cohorts, were enrolled in a prospective multi-institutional study. In the discovery cohort, patients with pure teratoma and with no/low risk of harboring teratoma were compared; the validation cohort included patients with confirmed teratoma, active germ cell malignancy, or complete response after chemotherapy. The area under the receiver operating characteristic curve values for miR375, miR371, and miR371-miR375 were, respectively, 0.93 (95% confidence interval [CI]: 0.87-0.99), 0.59 (95% CI: 0.44-0.73), and 0.95 (95% CI: 0.90-0.99) in the discovery cohort and 0.55 (95% CI: 0.36-0.74), 0.74 (95% CI: 0.58-0.91), and 0.77 (95% CI: 0.62-0.93) in the validation cohort. Our study demonstrated that the plasma miR371-miR375 integrated evaluation is highly accurate to detect teratoma. PATIENT SUMMARY: The evaluation of two micro-RNAs (miR375-miR371) in the blood of patients with germ cell tumors is promising to predict teratoma. This test could be particularly relevant to the identification of teratoma in patients with postchemotherapy residual disease.info:eu-repo/semantics/publishedVersio
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