Penetrate wound of the urinary bladder and rectum

U uvodu je dat prikaz incidencije, mehanizma povrede, patološkog supstrata, simptomatologije, kao i prikaz dijagnostičkih metoda i terapeutskih postupaka kod perforativnih povreda mokraćnog mjehura. Govori se također o prognozi i kasnim posljedicama. Na odjelu za urologiju u Vinkovcima, u proteklih 15 godina, operirano je 11 zatvorenih povreda mokraćnog mjehura i 1 prostrijelna povreda mokraćnog mjehura i rektuma. Prikazan je bolesnik sa strijelnom povredom mokraćnog mjehura i rektuma kao raritet u mirnodopskim uvjetima. Istaknuta je uspješna suradnja kirurškog i urološkog operativnog tima u zbrinjavanju povrede mokraćnog mjehura i rektuma. Opisan je suprapubični pristup radi zbrinjavanja prednje i stažnje stijenke mokraćnog mjehura i prednje stijenke rektuma, kao i sakralni pristup sa ekstirpacijom trtične kost i radi evakuacije stranog tijela (metak) i zbrinjavanja stražnje stijenke rektuma. Šest mjeseci nakon opsežnog operativnog zahvata, rezultirala je litijaza mokraćnog mjehura kao kasna komplikacija. U kasnijem toku bolesnik nije imao mikcionih i drugih tegoba.A review of frequency, matter of traumatism, pathologic substrats and a review of diagnostic and therapeutic procedures in perforative lesions of the urinary bladder are given. The prognosis and further complications are also discussed. A patient with a gunshot wound of the urinary bladder and rectum is presented as a rare case in the peace-time situations. The good correlation within surgical and urologic teams in sanation of the perforative lesion of the urinary bladder and rectum is stressed. Suprapubic exposure for the operative procedure on the bladder and the anteror wall of the rectum is presented as well as the sacral view with excision of the coccygis for the posterior rectum wall and the extirpation of the metall foreign body. Six months after the major surgery has been performed a calculosis of the urinary bladder is diagnosed as a late complication. After sanation of this lesi on the patient has been quite well

A nationwide registry for recurrent urolithiasis in the upper urinary tract – The RECUR study protocol

Background Urinary stone disease is a widespread disease with tremendous impact on those affected and on societies around the globe. Nevertheless, clinical and health care research in this area seem to lag far behind cardiovascular diseases or cancer. This may be due to the lack of an immediate deadly threat from the disease and therefore less public and professional interest. However, the patients suffer from recurring, sometimes intense pain and often must be treated in hospital. Long-term morbidity includes doubled rates of chronic kidney disease and arterial hypertension after at least one stone-related event. Observational studies, more specifically, registries and other electronic data sets have been proposed as a means of filling critical gaps in evidence. We propose a nationwide digital and fully automated registry as part of the German Ministry for Education and Research (BMBF) call for the establishment of model registries”. Methods RECUR builds on the technical infrastructure of Germany’s Medical Informatics Initiative. Local data integration centres (DIC) of participating medical universities will collect pseudonymized and harmonized data from respective hospital information systems. In addition to their clinical data, participants will provide patient reported outcomes using a mobile patient app. Scientific data exploration includes queries and analysis of federated data from DICs of eleven participating sites. All primary patient data will remain at the participating sites at all times. With comprehensive data from this longitudinal registry, we will be able to describe the disease burden, to determine and validate risk factors, and to evaluate treatments. Implementation and operation of the RECUR registry will be funded by the BMBF for five years. Subsequently, the registry is to be continued by the German Society of Urology without significant costs for study personnel. Discussion The proposed registry will substantially improve the structural and procedural framework for patients with recurrent urolithiasis. This includes advanced diagnostic algorithms and treatment pathways. The registry will help us identify those patients who will most benefit from specific interventions to prevent recurrences. The RECUR study protocol and the registry’s technical architecture including full digitalization and automation of almost all registry-associated proceedings can be transferred to future registries

An Adaptive P300-Based Control System

An adaptive P300 brain-computer interface (BCI) using a 12 × 7 matrix explored new paradigms to improve bit rate and accuracy. During online use, the system adaptively selects the number of flashes to average. Five different flash patterns were tested. The 19-flash paradigm represents the typical row/column presentation (i.e. 12 columns and 7 rows). The 9- and 14-flash A and B paradigms present all items of the 12 × 7 matrix three times using either 9 or 14 flashes (instead of 19), decreasing the amount of time to present stimuli. Compared to 9-flash A, 9-flash B decreased the likelihood that neighboring items would flash when the target was not flashing, thereby reducing the interference from items adjacent to targets. 14-flash A also reduced the adjacent item interference and 14-flash B additionally eliminated successive (double) flashes of the same item. Results showed that the accuracy and bit rate of the adaptive system were higher than those of the non-adaptive system. In addition, 9- and 14-flash B produced significantly higher performance than their respective A conditions. The results also show the trend that the 14-flash B paradigm was better than the 19-flash pattern for naive users

Optimized Stimulus Presentation Patterns for an Event-Related Potential EEG-Based Brain-Computer Interface

P300 brain-computer interface (BCI) systems typically use a row/column (RC) approach. This article presents a P300 BCI based on a 12 × 7 matrix and new paradigmatic approaches to flashing characters designed to decrease the number of flashes needed to identify a target character. Using an RC presentation, a 12 × 7 matrix requires 19 flashes to present all items twice (12 columns and seven rows) per trial. A 12 × 7 matrix contains 84 elements (characters). To identify a target character in 12 × 7 matrix using the RC pattern, 19 flashes (sub-trials) are necessary. In each flash, the selected characters (one column or one row in the RC pattern) are flashing. We present four new paradigms and compare the performance to the RC paradigm. These paradigms present quasi-random groups of characters using 9, 12, 14 and 16 flashes per trial to identify a target character. The 12-, 14- and 16-flash patterns were optimized so that the same character never flashed twice in succession. We assessed the practical bit rate and classification accuracy of the 9-, 12-, 14-, 16- and RC (19-flash) pattern conditions in an online experiment and with offline simulations. The results indicate that 16-flash pattern is better than other patterns and performance of an online P300 BCI can be significantly improved by selecting the best presentation paradigm for each subject

Brain-computer interfaces for assessment and communication in disorders of consciousness

Many patients with Disorders of Consciousness (DOC) are misdiagnosed for a variety of reasons. These patients typically cannot communicate. Because such patients are not provided with the needed tools, one of their basic human needs remains unsatisfied, leaving them truly locked in to their bodies. This chapter first reviews current methods and problems of diagnoses and assistive technology for communication, supporting the view that advances in both respects are needed for patients with DOC. The authors also discuss possible solutions to these problems and introduce emerging developments based on EEG (Electroencephalography), fMRI (Functional Magnetic Resonance Imaging), and fNIRS (Functional Near-Infrared Spectroscopy) that have been validated with patients and healthy volunteers

International Comparisons of Harmonized Laboratory Value Trajectories to Predict Severe COVID-19: Leveraging the 4CE Collaborative Across 342 Hospitals and 6 Countries: A Retrospective Cohort Study

To perform an international comparison of the trajectory of laboratory values among hospitalized patients with COVID-19 who develop severe disease and identify optimal timing of laboratory value collection to predict severity across hospitals and regions. Retrospective cohort study. The Consortium for Clinical Characterization of COVID-19 by EHR (4CE), an international multi-site data-sharing collaborative of 342 hospitals in the US and in Europe. Patients hospitalized with COVID-19, admitted before or after PCR-confirmed result for SARS-CoV-2. Primary and secondary outcome measures: Patients were categorized as ″ever-severe″ or ″never-severe″ using the validated 4CE severity criteria. Eighteen laboratory tests associated with poor COVID-19-related outcomes were evaluated for predictive accuracy by area under the curve (AUC), compared between the severity categories. Subgroup analysis was performed to validate a subset of laboratory values as predictive of severity against a published algorithm. A subset of laboratory values (CRP, albumin, LDH, neutrophil count, D-dimer, and procalcitonin) was compared between North American and European sites for severity prediction. Of 36,447 patients with COVID-19, 19,953 (43.7%) were categorized as ever-severe. Most patients (78.7%) were 50 years of age or older and male (60.5%). Longitudinal trajectories of CRP, albumin, LDH, neutrophil count, D-dimer, and procalcitonin showed association with disease severity. Significant differences of laboratory values at admission were found between the two groups. With the exception of D-dimer, predictive discrimination of laboratory values did not improve after admission. Sub-group analysis using age, D-dimer, CRP, and lymphocyte count as predictive of severity at admission showed similar discrimination to a published algorithm (AUC=0.88 and 0.91, respectively). Both models deteriorated in predictive accuracy as the disease progressed. On average, no difference in severity prediction was found between North American and European sites. Laboratory test values at admission can be used to predict severity in patients with COVID-19. Prediction models show consistency across international sites highlighting the potential generalizability of these models

Evolving phenotypes of non-hospitalized patients that indicate long COVID

International audienceAbstract Background For some SARS-CoV-2 survivors, recovery from the acute phase of the infection has been grueling with lingering effects. Many of the symptoms characterized as the post-acute sequelae of COVID-19 (PASC) could have multiple causes or are similarly seen in non-COVID patients. Accurate identification of PASC phenotypes will be important to guide future research and help the healthcare system focus its efforts and resources on adequately controlled age- and gender-specific sequelae of a COVID-19 infection. Methods In this retrospective electronic health record (EHR) cohort study, we applied a computational framework for knowledge discovery from clinical data, MLHO, to identify phenotypes that positively associate with a past positive reverse transcription-polymerase chain reaction (RT-PCR) test for COVID-19. We evaluated the post-test phenotypes in two temporal windows at 3–6 and 6–9 months after the test and by age and gender. Data from longitudinal diagnosis records stored in EHRs from Mass General Brigham in the Boston Metropolitan Area was used for the analyses. Statistical analyses were performed on data from March 2020 to June 2021. Study participants included over 96 thousand patients who had tested positive or negative for COVID-19 and were not hospitalized. Results We identified 33 phenotypes among different age/gender cohorts or time windows that were positively associated with past SARS-CoV-2 infection. All identified phenotypes were newly recorded in patients’ medical records 2 months or longer after a COVID-19 RT-PCR test in non-hospitalized patients regardless of the test result. Among these phenotypes, a new diagnosis record for anosmia and dysgeusia (OR 2.60, 95% CI [1.94–3.46]), alopecia (OR 3.09, 95% CI [2.53–3.76]), chest pain (OR 1.27, 95% CI [1.09–1.48]), chronic fatigue syndrome (OR 2.60, 95% CI [1.22–2.10]), shortness of breath (OR 1.41, 95% CI [1.22–1.64]), pneumonia (OR 1.66, 95% CI [1.28–2.16]), and type 2 diabetes mellitus (OR 1.41, 95% CI [1.22–1.64]) is one of the most significant indicators of a past COVID-19 infection. Additionally, more new phenotypes were found with increased confidence among the cohorts who were younger than 65. Conclusions The findings of this study confirm many of the post-COVID-19 symptoms and suggest that a variety of new diagnoses, including new diabetes mellitus and neurological disorder diagnoses, are more common among those with a history of COVID-19 than those without the infection. Additionally, more than 63% of PASC phenotypes were observed in patients under 65 years of age, pointing out the importance of vaccination to minimize the risk of debilitating post-acute sequelae of COVID-19 among younger adults

International Analysis of Electronic Health Records of Children and Youth Hospitalized With COVID-19 Infection in 6 Countries

International audienceAdditional sources of pediatric epidemiological and clinical data are needed to efficiently study COVID-19 in children and youth and inform infection prevention and clinical treatment of pediatric patients