Reflex Anuria: A Complication of Hyperthermic Intraperitoneal Chemotherapy

Reflex anuria (RA) is a rare cause of abrupt reduction of urine output following trauma, irritation, or painful stimuli to the kidneys, ureters, or surrounding organs. The mechanism of RA is a reflex spasm of both ureters and/or renal arterioles. It is a well-documented complication of colorectal surgeries and gynecological surgeries which involve placement of a ureteric stent for ureteric identification and prevention of injury. RA and post-renal obstruction can both be complications of intraperitoneal hyperthermic chemotherapy (HIPEC) in patients who are undergoing surgery for colorectal cancer and peritoneal carcinomatosis. HIPEC procedure can lead to inflammation of the entire abdomen, including the ureters. This inflammation can result in hematuria that can form clots along the urinary tract and cause post-renal obstruction. The inflammation can also result in RA. It is essential to maintain high urine output during the early postoperative period to prevent clots and the ensuing post renal obstruction. It is also important to identify RA and maintain a low threshold to treat it by placing ureteric stents even in the absence of overt bilateral hydronephrosis

Patients’ Compliance to Active Surveillance (AS) Protocol in Low-risk Prostate Cancer

Aim/Introduction Active surveillance (AS) is currently the preferred initial option for patients with low risk prostate cancer (PC). AS requires patients to undergo regular office visits with periodic testing. We measured patient compliance to NCCN guidelines for AS through review of medical record abstractions. Methods White and Black patients (n=221) with newly diagnosed low-risk PC on AS identified through a population-based cancer registry were surveyed at baseline (4 months after diagnosis) and at 2 year follow-up. 186 medical records reviewed and confirmed the AS protocol and compliance. Patient self-reported data were then compared with medical records data. Results Of the 186 patients who initially on AS, 151 remained on AS at 2 year follow-up. Overall, 55.2% (n=90) were guideline-concordant of having at least three PSA tests and one prostate biopsy during 2 year follow-up. Patients more likely guideline-concordant for PSA testing than guideline-concordant with prostate biopsy (76.7% vs. 66.9 %, respectively). Discussion Majority of patients on AS in this sample follow practice guidelines, but there is significant variation in the proportion of men on AS that meet guideline recommendations for follow-up PSA testing and repeat biopsy. These data highlight the need for further patients and providers education that emphasize the need of repeated testing including prostate biopsies to ensure safety of AS

Synergistic remineralization of enamel white spot lesions using mesoporous bioactive glasses loaded with amorphous calcium phosphate

Objectives: The purpose of this study was to create a new delivery system that can synergistically remineralize enamel white spot lesions (WSLs).Materials and methods: The delivery system (PAA-ACP@aMBG) was prepared by using aminated mesoporous bioactive glasses (aMBG) as the carrier loaded with polyacrylic-stabilized amorphous calcium phosphate (PAA-ACP). The materials were characterized by transmission electron microscopy (TEM), X-ray powder diffraction (XRD), inductively coupled plasma–optical emission spectrometry (ICP–OES), and so on. Forty-eight artificial WSLs enamel samples were randomized to four groups: artificial saliva (negative control, NC), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), PAA-ACP@aMBG, and MBG. The effects of demineralization and remineralization of the enamel surface were compared by means of surface microhardness (SMH) measurements, surface color change measurements, fluorescence microscopy (FM), X-ray diffraction (XRD) analysis and scanning electron microscopy (SEM).Results: There was no significant difference in the surface microhardness recovery rate (SMHRR) or color recovery rate (CRR) among the CPP-ACP group, PAA-ACP@aMBG group and MBG group (P>0.05), but these values were significantly higher than those in the NC group (p < 0.01). FM demonstrated that the remineralization depth in the PAA-ACP@aMBG group was significantly greater than that of the remaining three groups (p < 0.01). SEM analysis indicated that the enamel demineralization marks in the PAA-ACP@aMBG group, CPP-ACP group, and MBG group were obscured by mineral deposition.Conclusions: PAA-ACP@aMBG showed good mineralization properties, implying its great potential for clinical application

Diverse genome structures of Salmonella paratyphi C

<p>Abstract</p> <p>Background</p> <p><it>Salmonella paratyphi </it>C, like <it>S. typhi</it>, is adapted to humans and causes typhoid fever. Previously we reported different genome structures between two strains of <it>S. paratyphi </it>C, which suggests that <it>S. paratyphi </it>C might have a plastic genome (large DNA segments being organized in different orders or orientations on the genome). As many but not all host-adapted <it>Salmonella </it>pathogens have large genomic insertions as well as the supposedly resultant genomic rearrangements, bacterial genome plasticity presents an extraordinary evolutionary phenomenon. Events contributing to genomic plasticity, especially large insertions, may be associated with the formation of particular <it>Salmonella </it>pathogens.</p> <p>Results</p> <p>We constructed a high resolution genome map in <it>S. paratyphi </it>C strain RKS4594 and located four insertions totaling 176 kb (including the 90 kb SPI7) and seven deletions totaling 165 kb relative to <it>S. typhimurium </it>LT2. Two rearrangements were revealed, including an inversion of 1602 kb covering the <it>ter </it>region and the translocation of the 43 kb I-CeuI F fragment. The 23 wild type strains analyzed in this study exhibited diverse genome structures, mostly as a result of recombination between <it>rrn </it>genes. In at least two cases, the rearrangements involved recombination between genomic sites other than the <it>rrn </it>genes, possibly homologous genes in prophages. Two strains had a 20 kb deletion between <it>rrlA </it>and <it>rrlB</it>, which is a highly conservative region and no deletion has been reported in this region in any other <it>Salmonella </it>lineages.</p> <p>Conclusion</p> <p><it>S. paratyphi </it>C has diverse genome structures among different isolates, possibly as a result of large genomic insertions, e.g., SPI7. Although the <it>Salmonella </it>typhoid agents may not be more closely related among them than each of them to other <it>Salmonella </it>lineages, they may have evolved in similar ways, i.e., acquiring typhoid-associated genes followed by genome structure rearrangements. Comparison of multiple <it>Salmonella </it>typhoid agents at both single sequenced genome and population levels will facilitate the studies on the evolutionary process of typhoid pathogenesis, especially the identification of typhoid-associated genes.</p

Individualized prevention of proton pump inhibitor related adverse events by risk stratification

Proton pump inhibitors (PPIs) are commonly used for gastric acid-related disorders, but their safety profile and risk stratification for high-burden diseases need further investigation. Analyzing over 2 million participants from five prospective cohorts from the US, the UK, and China, we found that PPI use correlated with increased risk of 15 leading global diseases, such as ischemic heart disease, diabetes, respiratory infections, and chronic kidney disease. These associations showed dose-response relationships and consistency across different PPI types. PPI-related absolute risks increased with baseline risks, with approximately 82% of cases occurring in those at the upper 40% of the baseline predicted risk, and only 11.5% of cases occurring in individuals at the lower 50% of the baseline risk. While statistical association does not necessarily imply causation, its potential safety concerns suggest that personalized use of PPIs through risk stratification might guide appropriate decision-making for patients, clinicians, and the public

Intracytoplasmic sperm injection (ICSI) versus conventional in vitro fertilisation (IVF) in couples with non-severe male infertility (NSMI-ICSI) : protocol for a multicentre randomised controlled trial

Funding This study was supported by National Key Research and Development Program of China (2016YFC1000201; 2018YFC1002104) and the National Science Foundation of China (81730038). The study funders had no rule in the study design, implementation, analysis, manuscript, preparation or decision to submit this article for publication.Peer reviewedPublisher PD

The prognostic value of deep earlobe creases in patients with acute ischemic stroke

Background and purposeData on earlobe crease (ELC) among patients with acute ischemic stroke (AIS) are limited. Here, we determined the frequency and characteristics of ELC and the prognostic effect of ELC among AIS patients.MethodsA total of 936 patients with acute AIS were enrolled during the period between December 2018 and December 2019. The patients were divided into those without and with ELC, unilateral and bilateral ELC, and shallow and deep ELC, according to the photographs taken of the bilateral ears. Logistic regression models were used to estimate the effect of ELC, bilateral ELC, and deep ELC on poor functional outcomes at 90 days (a modified Rankin Scale score ≥2) in AIS patients.ResultsAmong the 936 AIS patients, there were 746 (79.7%) patients with ELC. Among patients with ELC, there were 156 (20.9%) patients with unilateral ELC and 590 (79.1%) with bilateral ELC and 476 (63.8%) patients with shallow ELC and 270 (36.2%) with deep ELC. After adjusting for age, sex, baseline NIHSS score, and other potential covariates, patients with deep ELC were associated with a 1.87-fold [odds ratio (OR) 1.87; 95% confidence interval (CI), 1.13–3.09] and 1.63-fold (OR 1.63; 95%CI, 1.14–2.34) increase in the risk of poor functional outcome at 90 days in comparison with those without ELC or shallow ELC.ConclusionELC was a common phenomenon, and eight out of ten AIS patients had ELC. Most patients had bilateral ELC, and more than one-third had deep ELC. Deep ELC was independently associated with an increased risk of poor functional outcome at 90 days

Gold Nanoparticles Prepared with Cyclodextrin Applied to Rapid Vertical Flow Technology for the Detection of Brucellosis

Currently, brucellosis seriously threatens the health of humans and animals and hinders the development of animal husbandry. However, the diagnostic methods for brucellosis have some disadvantages, such as low sensitivity, long detection time, professional operation, and high cost. This study aims to establish a convenient, fast, effective, and inexpensive detection method for brucellosis. Gold nanoparticles with β-cyclodextrin as a reducing agent were prepared and optimized, applied to rapid vertical flow technology (RVFT), and used to establish a kit for the detection of brucellosis. In this study, gold nanoparticles prepared from β-cyclodextrin were applied to RVFT for the first time, and on this basis, silver staining amplification technology was introduced, which further improved the sensitivity and reduced the detection limit of this method. Standard Brucella-Positive Serum (containing Brucella antibody at 4000 IU/mL) could be detected in this system even for a dilution factor of 1 × 10−3. The detection limit was 4 IU/mL. RVFT is simple to operate, has a short reaction time, and is 5–6 min visible to the naked eye, without any equipment