An electronic registry to improve adherence to active surveillance monitoring among men with prostate cancer at a safety-net hospital: protocol for a pilot study.

BackgroundThe evidence-based practice of active surveillance to monitor men with favorable-risk prostate cancer in lieu of initial definitive treatment is becoming more common. However, there are barriers to effective implementation, particularly in low-resource settings. Our goal is to assess the efficacy and feasibility of a health information technology registry for men on active surveillance at a safety-net hospital to ensure patients receive guideline-recommended care.MethodsWe developed an electronic registry for urology clinic staff to monitor men on active surveillance. The health information technology tool was developed using the Systems Engineering Initiative for Patient Safety model and iteratively tailored to the needs of the clinic by engaging providers in a co-design process. We will enroll all men at Zuckerberg San Francisco General Hospital and Trauma Center who choose active surveillance as a treatment strategy. The primary outcomes to be assessed during this non-randomized, pragmatic evaluation are number of days delayed beyond recommended date of follow-up testing, the proportion of men who are lost to follow-up, the cancer stage at active treatment, and the feasibility and acceptability of the clinic-wide intervention with clinic staff. Secondary outcomes include appointment adherence within 30 days of the scheduled date.DiscussionUse of a customized electronic approach for monitoring men on active surveillance could improve patient outcomes. It may help reduce the number of men lost to follow-up and improve adherence to timely follow-up testing. Evaluating the adoption and efficacy of a customized registry in a safety-net setting may also demonstrate feasibility for implementation in diverse clinical contexts.Trial registrationClinicalTrials.gov identifier NCT03553732, An Electronic Registry to Improve Adherence to Active Surveillance Monitoring at a Safety-net Hospital. Registered 11 June 2018

Sugar Alcohols Have a Key Role in Pathogenesis of Chronic Liver Disease and Hepatocellular Carcinoma in Whole Blood and Liver Tissues.

The major risk factors for hepatocellular carcinoma (HCC) are hepatitis C and B viral infections that proceed to Chronic Liver Disease (CLD). Yet, the early diagnosis and treatment of HCC are challenging because the pathogenesis of HCC is not fully defined. To better understand the onset and development of HCC, untargeted GC-TOF MS metabolomics data were acquired from resected human HCC tissues and their paired non-tumor hepatic tissues (n = 46). Blood samples of the same HCC subjects (n = 23) were compared to CLD (n = 15) and healthy control (n = 15) blood samples. The participants were recruited from the National Liver Institute in Egypt. The GC-TOF MS data yielded 194 structurally annotated compounds. The most strikingly significant alteration was found for the class of sugar alcohols that were up-regulated in blood of HCC patients compared to CLD subjects (p < 2.4 × 10-12) and CLD compared to healthy controls (p = 4.1 × 10-7). In HCC tissues, sugar alcohols were the most significant (p < 1 × 10-6) class differentiating resected HCC tissues from non-malignant hepatic tissues for all HCC patients. Alteration of sugar alcohol levels in liver tissues also defined early-stage HCC from their paired non-malignant hepatic tissues (p = 2.7 × 10-6). In blood, sugar alcohols differentiated HCC from CLD subjects with an ROC-curve of 0.875 compared to 0.685 for the classic HCC biomarker alpha-fetoprotein. Blood sugar alcohol levels steadily increased from healthy controls to CLD to early stages of HCC and finally, to late-stage HCC patients. The increase in sugar alcohol levels indicates a role of aldo-keto reductases in the pathogenesis of HCC, possibly opening novel diagnostic and therapeutic options after in-depth validation

Management of rare side effects of peginterferon and ribavirin therapy during hepatitis C treatment: a case report

Cardiac arrhythmias and syncope are rare consequence of therapy with pegylated interferon. We report a 55-year-old Egyptian woman who developed palpitation and syncopal attacks twice within 3 months after starting therapy with pegylated interferon α2b and ribavirin for the treatment of chronic hepatitis C virus. Hepatitis C virus-RNA was undetectable after 12 week. The electrocardiogram holter revealed ventricular extra-systoles on top of sinus tachycardia. pegylated interferon α2b therapy was continued but with a reduced dose. Close follow up revealed neither palpitation nor syncope and hepatitis C virus-RNA was undetectable at 24 and 48 weeks of treatment. In conclusion, our study suggests readjustment of the dose of pegylated interferon α2b therapy to avoid these serious side effects

Polyploidy in chronic lymphocytic leukemia with p53 deletion detected by fish: a case report

We report a case of chronic lymphocytic leukemia with a characteristic cytogenetics finding detected by fluorescent in situ hybridization. This case has deletion in p53 gene in 50% of interphase nuclei studied in the peripheral blood and polyploidy in 30% of cells. To our knowledge polyploidy is not commonly reported with chronic lymphocytic leukemia patients

Innovative Techniques for 60-GHz On-Chip Antennas on CMOS Substrate

The 60-GHz band has a 7-GHz of bandwidth enabling high data rate wireless communication. Also, it has a short wavelength allowing for passive devices integration into a chip, that is, fully integrated system-on-chip (SOC) is possible. This chapter features the design, implementation, and measurements of 60-GHz on-chip antennas (OCAs) on complementary-metal-oxide-semiconductor (CMOS) technology. OCAs are the primary barrier for the SOC solution due to their limited performance. This degraded performance comes from the low resistivity and the high permittivity of the CMOS substrate. We present here two innovative techniques to improve the CMOS OCAs’ performance. The first method utilizes artificial magnetic conductors to shield the OCA electromagnetically from the CMOS substrate. The second methodology employs the PN-junction properties to create a high resistivity layer. Both approaches target the mitigation of the losses of the CMOS substrate; hence, the radiation performance characteristics of the OCAs are enhanced

Fully symbolic-based technique for solving complex state-space control systems

Despite the superiority of symbolic approaches over the purely numerical approaches in many aspects, it does not receive the proper attention due to its significant complexity, high resources requirement and long drawn time which even grows significantly with the increase of model dimensions. However, its merits deserve every attempt to overcome the difficulties being faced. In this paper, a fully generic symbolic-based technique is proposed to deal with complex state space control problems. In this technique, depending on the model dimension if exceeds a predefined limit, the state space is solved using the partitioned matrices theory and block wise inversion formula. Experimental results demonstrate that the proposed technique overcomes all the previously mentioned barriers and gives the same results when compared to numerical methods (Simulink). Moreover, it can be used to gain useful information about the system itself, provides an indication of which parameters are more important and reveals the sensitivity of system model to single parameter variations

Sleep Quality, and Fatigue As Predictive Factors For Mechanical Neck Pain

Aims: The purpose of our study was to investigate the relationship between mechanical neck pain and sleep disorders, mental and physical fatigue, and the rising expectations of people in modern societies regarding their work, families, and social lives. Mechanical neck pain is a common problem that can result in disability. Methods: We included 230 patients with mechanical neck discomfort, with a mean age of 25.62 ± 9.25years, in our study. The Neck Disability Index, Chalder Fatigue Scale, and Pitssburg Sleep Quality Index was applied to all participant.   Results: Multiple linear regression analysis revealed that the overall model explained 22% of the variance of NDI score. Both sleep quality scale and fatigue scale were significantly associated and can predict NDI score (p < 001). Conclusion: sleep quality and fatigue were found among the independent determinants of neck disability. Therefore, physiotherapists who treat patients with mechanical neck pain should advise them to get enough sleep and teach them relaxation techniques to help them feel less stressed and exhausted, which will lower their neck discomfor

Parametric tolerance study of Trojan Horse plasma wakefield acceleration scheme

A promising scheme for plasma wakefield acceleration is the hybrid plasma acceleration mechanism, which is experimentally connected to world-wide programs at various accelerator facilities. This scheme may lead to extremely high quality electron bunches, which can be used to drive ultrabright light sources such as free electron lasers. The big challenge for plasma acceleration is to produce electron bunches with high quality in terms of low emittance, energy spread and high brightness. To overcome this challenge, the Trojan Horse scheme [1,2,3,4,5] is used for production of designer electron beams. This work explores the Trojan Horse mechanism in a parametric study by variation of the injector laser pulse by intensity a0, spot size w0 and relative spatiotemporal synchronization and alignment. These parameters define output electron witness beam parameters and its quality. This sensitivity study shows a high robustness of the scheme, which is promising for a wider key prospect of the approach, namely the development of compact plasma accelerators to produce electron beams with unprecedented emittance and brightness in order to power free-electron lasers