Computed tomographic appearance of urachal adenocarcinomas: review of 25 cases

Twenty-five cases of surgically proven urachal carcinomas were retrospectively reviewed. The radiological archives at the Armed Forces Institute of Pathology were searched for cases of surgically proven urachal carcinomas that had a computed tomographic (CT) scan as a part of their radiologic evaluation. CT images from all cases were evaluated to determine tumor morphology, presence and localization of calcification, extent of bladder invasion and metastases. Tumor size at presentation averaged 6cm. Twenty-one of 25 (84%) were mixed cystic solid lesions and 4/25 (16%) were completely solid. Calcifications were present in 18/25 (72%), with 11 peripherally located, 3 central only and 4 both. Bladder wall invasion was present in 23/25 (92%), but was seen as an intraluminal mass in only 13/25 (52%). The bulk of the mass was extravesicular in 22/25 (88%). Metastases were present in 12/25 (48%). Our series supports observations from other smaller series that a midline, calcified, supravesicular mass is highly suspicious, if not pathognomonic, for urachal carcinom

Urocortin 2 inhibits human aortic smooth muscle cell proliferation via corticotrophin releasing hormone receptor-2 in abdominal aortic aneurysm

Introduction: A key feature of abdominal aortic aneurysm is the loss of proliferation and paucity of vascular smooth muscle cells, the major cells within the aortic tunica media. It has been suggested that urocortin 2 (UCN2), a selective ligand for corticotrophin releasing factor receptor 2 (CRFR2) may play a beneficial role in various cardiovascular diseases. However, the role of this peptide in abdominal aortic aneurysm has not been studied in detail. Here we assessed the hypothesis that urocortin 2 promotes an aneurysm phenotype in human aortic smooth muscles in vitro via CRFR2. Experimental Procedure: We assessed the release of UCN2 from explants of human tissue biopsies in vitro (Aortic aneurysm thrombus, n = 14; aortic aneurysm body, n = 11; femoral atheroma control, n = 6) using ELISA. We investigated the effect of incubating human aortic smooth muscle cells with recombinant UCN2 or aneurysm thrombus explants secretions at a UCN2 dose of 0, 10 and 100 nM for 24 and 48 hours (n = 6 per group x 3 experiments). Cell proliferation was determined by the alamarBlue® cell viability reagent. Results were analyzed and presented as mean ± SEM relative to the control. We also investigated the impact of blocking CRFR2 on UCN2 induced changes on these cells. Results: Secretion of UCN2 was significantly higher from aneurysm thrombus (n = 14, p = 0.0020) and aneurysm body (n = 11, p = 0.0104) compared to femoral atheroma. Human aortic smooth muscle cells proliferation was dose dependently inhibited by recombinant UCN2 (p = 0.0172) and aortic aneurysm thrombus conditioned medium (p = 0.0273) after 24 hours. This effect of recombinant UCN2 was abrogated significantly by prior incubation with the CRFR2 blocker Astressin-2B (p = 0.0043). Similar effects were seen on incubating cells for 48 hours. Conclusion: UCN2 is released in high concentrations by aortic aneurysm thrombus. UCN2 inhibits aortic vascular smooth muscle cell proliferation in vitro via CRFR2. This effect may be relevant to the pathogenesis of abdominal aortic aneurysm

Urocortin 2 inhibits human aortic smooth muscle cell proliferation via corticotrophin releasing hormone receptor-2 in abdominal aortic aneurysm

Introduction: A key feature of abdominal aortic aneurysm is the loss of proliferation and paucity of vascular smooth muscle cells, the major cells within the aortic tunica media. It has been suggested that urocortin 2 (UCN2), a selective ligand for corticotrophin releasing factor receptor 2 (CRFR2) may play a beneficial role in various cardiovascular diseases. However, the role of this peptide in abdominal aortic aneurysm has not been studied in detail. Here we assessed the hypothesis that urocortin 2 promotes an aneurysm phenotype in human aortic smooth muscles in vitro via CRFR2. Experimental Procedure: We assessed the release of UCN2 from explants of human tissue biopsies in vitro (Aortic aneurysm thrombus, n = 14; aortic aneurysm body, n = 11; femoral atheroma control, n = 6) using ELISA. We investigated the effect of incubating human aortic smooth muscle cells with recombinant UCN2 or aneurysm thrombus explants secretions at a UCN2 dose of 0, 10 and 100 nM for 24 and 48 hours (n = 6 per group x 3 experiments). Cell proliferation was determined by the alamarBlue® cell viability reagent. Results were analyzed and presented as mean ± SEM relative to the control. We also investigated the impact of blocking CRFR2 on UCN2 induced changes on these cells. Results: Secretion of UCN2 was significantly higher from aneurysm thrombus (n = 14, p = 0.0020) and aneurysm body (n = 11, p = 0.0104) compared to femoral atheroma. Human aortic smooth muscle cells proliferation was dose dependently inhibited by recombinant UCN2 (p = 0.0172) and aortic aneurysm thrombus conditioned medium (p = 0.0273) after 24 hours. This effect of recombinant UCN2 was abrogated significantly by prior incubation with the CRFR2 blocker Astressin-2B (p = 0.0043). Similar effects were seen on incubating cells for 48 hours. Conclusion: UCN2 is released in high concentrations by aortic aneurysm thrombus. UCN2 inhibits aortic vascular smooth muscle cell proliferation in vitro via CRFR2. This effect may be relevant to the pathogenesis of abdominal aortic aneurysm

Eye Care Providers' Attitudes Towards Tele-ophthalmology

Background: The rapid rise of e-health and remote care systems will likely change the practice patterns of ophthalmologists. Although telemedicine practices are thriving in many specialties of medicine, telemedicine for ophthalmology has been limited primarily to asynchronous care for diabetic retinopathy. The goal of this research was to evaluate perspectives on and familiarity with telemedicine among eye care providers at a large tertiary-care medical center via an anonymous, descriptive survey. Results: In total, 58 eye care physicians completed surveys (response rates of 86% for physicians-in-training and 49% for faculty physicians, respectively). Although a majority of both faculty and physicians-in-training were willing to participate in telemedicine services, trainees were more likely to be willing to interpret photographs than faculty (p=0.04). Most respondents (71%) indicated that they did not use telemedicine. Over half had received photographs (via phone or e-mail) for interpretation from referring physicians (54%) or patients (56%) within the past 3 months. A majority of providers (82%) would be willing to participate in telemedicine for consultations and for interpreting photographs, but a majority (59%) had low confidence in remote care for providing an opinion on patient care. Conclusions: Most eye care providers viewed telemedicine as part of the future of eye care but were concerned about the use of telemedicine. Although most providers did not practice telemedicine, over half of them were comfortable managing eye care consultations (including patients' photographs) via the Internet.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140282/1/tmj.2014.0115.pd

Cluster-randomized, crossover trial of head positioning in acute stroke

The role of supine positioning after acute stroke in improving cerebral blood flow and the countervailing risk of aspiration pneumonia have led to variation in head positioning in clinical practice. We wanted to determine whether outcomes in patients with acute ischemic stroke could be improved by positioning the patient to be lying flat (i.e., fully supine with the back horizontal and the face upwards) during treatment to increase cerebral perfusion. METHODS In a pragmatic, cluster-randomized, crossover trial conducted in nine countries, we assigned 11,093 patients with acute stroke (85% of the strokes were ischemic) to receive care in either a lying-flat position or a sitting-up position with the head elevated to at least 30 degrees, according to the randomization assignment of the hospital to which they were admitted; the designated position was initiated soon after hospital admission and was maintained for 24 hours. The primary outcome was degree of disability at 90 days, as assessed with the use of the modified Rankin scale (scores range from 0 to 6, with higher scores indicating greater disability and a score of 6 indicating death). RESULTS The median interval between the onset of stroke symptoms and the initiation of the assigned position was 14 hours (interquartile range, 5 to 35). Patients in the lying-flat group were less likely than patients in the sitting-up group to maintain the position for 24 hours (87% vs. 95%, P\u3c0.001). In a proportional-odds model, there was no significant shift in the distribution of 90-day disability outcomes on the global modified Rankin scale between patients in the lying-flat group and patients in the sitting-up group (unadjusted odds ratio for a difference in the distribution of scores on the modified Rankin scale in the lying-flat group, 1.01; 95% confidence interval, 0.92 to 1.10; P = 0.84). Mortality within 90 days was 7.3% among the patients in the lying-flat group and 7.4% among the patients in the sitting-up group (P = 0.83). There were no significant betweengroup differences in the rates of serious adverse events, including pneumonia. CONCLUSIONS Disability outcomes after acute stroke did not differ significantly between patients assigned to a lying-flat position for 24 hours and patients assigned to a sitting-up position with the head elevated to at least 30 degrees for 24 hours

Loss to follow-up barriers in care for Cornea Ulcers and Glaucoma: A Scoping Review Protocol

To cite data: Saylor, K., Hicks, PM., Kang, L., Stagg, BC. Newman-Casey, PA., Woodward, MA., Literature search files for Loss to follow-up barriers in care for Cornea Ulcers and Glaucoma: A Scoping Review [Data set]. University of Michigan - Deep Blue.In this scoping review, we sought to understand the barriers, both financial and nonfinancial, to accessing care for treatment of glaucoma and corneal ulcers utilizing Penchansky and Thomas’ five dimensions associated with access to care as a framework. We have chosen both an acute and chronic eye condition to determine if there are barrier differences or similarities between the two conditions. Understanding these barriers can have implications to address these barriers so patients may avoid outcomes of vision-loss and blindness.National Eye Institute (R01EY031033 [MAW]), Research to Prevent Blindness, Career Advancement Award (MAW).The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.http://deepblue.lib.umich.edu/bitstream/2027.42/168393/1/LTFCG_Protocol_20210716.pdfDescription of LTFCG_Protocol_20210716.pdf : ProtocolSEL

Carotid sinus denervation (CSD) ameliorates renovascular hypertension in adult Wistar rats

The peripheral chemoreflex is known to be hyper-responsive in both spontaneously hypertensive (SHR) and Goldblatt hypertensive (2 kidney 1 clip; 2K1C) rats. We have previously shown that carotid sinus nerve denervation (CSD) reduces arterial blood pressure (ABP) in SHR. Here, we show that CSD ameliorates 2K1C hypertension and reveal potential underlying mechanisms. Adult Wistar rats were instrumented to record ABP via telemetry, then underwent CSD (n = 9) or sham CSD (n = 9) five weeks after renal artery clipping, versus normal Wistar (n = 5). After 21 days renal function was assessed, and tissue collected to assess sympathetic postganglionic intracellular calcium transients ([Ca(2+) ]i ) and immune cell infiltrates. Hypertensive 2K1C rats showed a profound elevation in ABP (Wistar: 98 ± 4 mmHg vs. 2K1C: 147 ± 8 mmHg; P < 0.001), coupled with impairments in renal function and baroreflex sensitivity, increased neuro-inflammatory markers and enhanced [Ca(2+) ]I in stellate neurons (P < 0.05). CSD reduced ABP in 2K1C+CSD rats and prevented the further progressive increase in ABP seen in 2K1C+sham CSD rats, with a between-group difference of 14 ± 2 mmHg by Week 3 (P < 0.01), accompanied by improvements in both baroreflex control and spectral indicators of cardiac sympatho-vagal balance. Furthermore, CSD improved protein and albuminuria, decreased [Ca(2+) ]i evoked responses from stellate neurons, and reduced indicators of brainstem inflammation. In summary, CSD in 2K1C rats reduces the hypertensive burden and improves renal function. This may be mediated by improvements in autonomic balance, functional remodelling of post-ganglionic neurones and reduced inflammation. Our results suggest that the peripheral chemoreflex may be considered as a potential therapeutic target for controlling renovascular hypertension

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019 a pooled analysis of 1201 population-representative studies with 104 million participants

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO.Fil: Zhou, Bin. Imperial College London; Reino UnidoFil: Carrillo Larco, Rodrigo M.. Imperial College London; Reino UnidoFil: Danaei, Goodarz. Harvard Medical School; Estados UnidosFil: Riley, Leanne M.. WHO; SuizaFil: Paciorek, Christopher J.. University of California; Estados UnidosFil: Stevens, Gretchen A.. Imperial College London; Reino UnidoFil: Gregg, Edward W.. Imperial College London; Reino UnidoFil: Bennett, James E.. Imperial College London; Reino UnidoFil: Solomon, Bethlehem. Imperial College London; Reino UnidoFil: Singleton, Rosie K.. Imperial College London; Reino UnidoFil: Sophiea, Marisa K.. Imperial College London; Reino UnidoFil: Iurilli, Maria LC. Imperial College London; Reino UnidoFil: Lhoste, Victor PF. Imperial College London; Reino UnidoFil: Cowan, Melanie J.. WHO; SuizaFil: Savin, Stefan. WHO; SuizaFil: Woodward, Mark. Imperial College London; Reino Unido. University of New South Wales; AustraliaFil: Balanova, Yulia. National Medical Research Centre for Therapy and Preventive Medicine; RusiaFil: Cifkova, Renata. Karlova Univerzita; República ChecaFil: Damasceno, Albertino. Eduardo Mondlane University; MozambiqueFil: Elliott, Paul. Imperial College London; Reino UnidoFil: Farzadfar, Farshad. Non-Communicable Diseases Research Center; IránFil: He, Jiang. University of Tulane; Estados UnidosFil: Ikeda, Nayu. National Institutes of Biomedical Innovation, Health and Nutrition; JapónFil: Kengne, Andre P.. South African Medical Research Council; SudáfricaFil: Khang, Young Ho. Seoul National University College of Medicine; Corea del SurFil: Chang Kim, Hyeon. Yonsei University College of Medicine; Corea del SurFil: Laxmaiah, Avula. National Institute of Nutrition; IndiaFil: Lin, Hsien Ho. National Taiwan University; ChinaFil: Margozzini Maira, Paula. Pontificia Universidad Católica de Chile; ChileFil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Impacts of predicted climate change on recruitment at the geographical limits of Scots pine

Ongoing changes in global climate are having a significant impact on the distribution of plant species, with effects particularly evident at range limits. We assessed the capacity of Pinus sylvestris L. populations at northernmost and southernmost limits of the distribution to cope with projected changes in climate. We investigated responses including seed germination and early seedling growth and survival, using seeds from northernmost (Kevo, Finland) and southernmost (Granada, Spain) populations. Seeds were grown under current climate conditions in each area and under temperatures increased by 5 &deg;C, with changes in precipitation of +30% or -30% with reference to current values at northern and southern limits, respectively, in a fully factorial controlled-conditions experimental design. Increased temperatures reduced germination time and enhanced biomass gain at both range edges but reduced survival at the southern range edge. Higher precipitation also increased survival and biomass but only under a southern climate. Seeds from the southern origin emerged faster, produced bigger seedlings, allocated higher biomass to roots, and survived better than northern ones. These results indicate that recruitment will be reduced at the southernmost range of the species, whereas it will be enhanced at the northern limit, and that the southern seed sources are better adapted to survive under drier conditions. However, future climate will impose a trade-off between seedling growth and survival probabilities. At the southern range edge, higher growth may render individuals more susceptible to mortality where greater aboveground biomass results in greater water loss through evapotranspiration