Online partner seeking and high-risk behaviour in men who have sex with men and male-to-female transgendered people in Mumbai, India: Implications for prevention strategies.

BACKGROUND: It is important to understand the current internet-related sexual behaviours of high-risk groups such as men who have sex with men (MSM). We designed the present study to understand the types of online/mobile apps used by MSM and male-to-female transgendered people/hijras [TGH] in Mumbai, India. We also compared the internet-related 'partner seeking' and 'sexual behaviours' in MSM and TGH in Mumbai, India. METHODS: This is a cross-sectional analysis of secondary data collected (April to June 2020) from 8582 MSM and 4163 TGH from five targeted intervention programmes each in Mumbai, Maharashtra, India. Data on demographics, years of association with the intervention, number and type of online/mobile apps used, sexual behaviours including partners from virtual space and non-virtual (physical) space, group sex, attending parties, mobility for sexual partners, and HIV status were collected. RESULTS: MSM were more likely to have mobile phone (88% vs 51%, p < 0.001) and internet access over the phone (78% vs 27%; p < 0.001) compared with TGH. The common apps used by MSM were Grindr (48%), Facebook (42%), and Blued (36%). MSM were more likely to have partners from virtual space (91% vs 67%; p < 0.001). A higher proportion of MSM had attended parties (28% vs 2%; p < 0.001), had group sex (16% vs 6%; p < 0.001), and were mobile for sex (25% vs 4%). MSM and TGH who had partners from virtual space were significantly more likely to report 'missed a condom at least once during penetrative sex in the past one week' (17% vs 12%; p<0.001). In HIV positive MSM, group sex, parties, and mobility for sex, were only in those who reported partners from the virtual space. CONCLUSIONS: Internet-based interventions for MSM should be incorporated in the existing targeted intervention programme and outreach workers should be trained in virtual outreach services. Among TGH, given the low reach and use of smartphones and apps, internet-based interventions may not be such a useful option, and the existing physical targeted intervention programmes should be strengthened.

Synthesis of Fused Tetracyclic Compounds via Oxidative Annulation: Access to Copper-Catalyzed Indolo[1,2-a]quinolines and to Ruthenium-Catalyzed Isoquinolin-1[2H]-ones.

A facile double oxidative annulation of (en-3-yn-1-yl)phenylbenzamides was developed allowing us to synthetize fused tetracyclic compounds. Under copper catalysis, the reaction proceeds with high efficiency and leads to new indolo[1,2-a]quinolines via a decarbonylative double oxidative annulation. On the other hand, under ruthenium catalysis, new isoquinolin-1[2H]-ones were obtained via a double oxidative annulation.

Algorithmic analysis for dental caries detection using an adaptive neural network architecture.

OBJECTIVES: AI techniques have lifelong impact in biomedics and widely accepted outcomes. The sole objective of the study is to evaluate accurate detection of caries using feature extraction and classification of the dental images along with amalgamation Adaptive Dragonfly algorithm (DA) algorithm and Neural Network (NN) classifier. MATERIALS AND METHODS: Here proposed caries detection model is designed for detecting the tooth cavities in an accurate manner. This methodology has two main phases; feature extraction and classification. In all total 120 images database is split into three sets, randomly for evaluating the performance. Further, this categorization of the test cases aids in ensuring the enhancement of the performance. In each of the test cases, there are 40 caries images the investigation in the performance of the proposed caries detection model was done in terms of accuracy, sensitivity, specificity, and precision, FPR, FNR, NPV, FDR, F1Score and MCC. RESULTS: Here MPCA with Nonlinear Programming and Adaptive DA, the proposed model is termed as MNP-ADA. The performance of the proposed MPCA-ADA model is evaluated by comparing it over the other existing feature extraction models. MPCA-ADA over the conventional classifier models like PCA-ADA, LDA-ADA and ICA-ADA in terms of performance parameters and MCC for all the test types and have superior results than the existing ones. CONCLUSION: The research work emphasizes the prospective efficacy of IP and NN algorithms for the detection and diagnosis of dental caries. A novel and improved model shows substantially worthy performance in distinguishing dental caries using image processing techniques.

Molecular genotyping of clinically important blood group antigens in patients with thalassaemia.

BACKGROUND & OBJECTIVES: In multitransfused thalassaemic patients, haemagglutination fails to phenotype the patient's blood group antigens due to the presence of donor-derived erythrocytes. DNA-based methods can overcome the limitations of haemagglutination and can be used to determine the correct antigen profile of these patients. This will facilitate the procurement of antigen-matched blood for transfusion to multitransfused patients. Thus, the aim of this study was to compare the serological phenotyping of common and clinically important antigens of Rh, Duffy, Kell, Kidd and MNS blood group systems with molecular genotyping amongst multitransfused thalassaemic patients. METHODS: Blood samples from 200 patients with thalassaemia and 100 'O' group regular blood donors were tested using standard serological techniques and polymerase chain reaction-based methods for common antigens/alleles (C, c, D, E, e, Fya, Fyb, Jka, Jkb, K, k, M, N, S, s). RESULTS: Genotyping and phenotyping results were discordant in 77 per cent of thalassaemic patients for five pairs of antithetical antigens of Rh, Duffy, Kell and Kidd blood group systems. In the MNS blood group system, 59.1 per cent of patients showed discrepancy. The rate of alloimmunization among thalassaemics was 7.5 per cent. INTERPRETATION & CONCLUSIONS: Molecular genotyping enabled the determination of the actual antigen profile in multitransfused thalassaemia patients. This would help reduce the problem of alloimmunization in such patients and would also aid in the better management of transfusion therapy.

Radio-anatomic measurements and statistical generation of a safe surgical corridor to enter the ventricular trigone while avoiding injury to the optic radiations.

OBJECTIVE: To find a safe operative corridor to the ventricular trigone avoiding injury to the optic radiations (ORs). METHODS: In 24 adult hemispheres, dimensions of the atrium, height of the OR, and the cortex-to-atrium distance were measured. Superior parietal lobule (SPL), parieto-occipital sulcus (POS), and middle temporal gyrus (MTG) traced approaches were used to measure maximum safe angles to enter the atrium without traversing the OR. A statistical algorithm was generated using these measurements to predict the height of the OR and safe angles from measurements from MR imaging of five test hemispheres. Statistically calculated angles were compared with measured angles from dissection. RESULTS: Mean length and height of atrium, height of OR, and cortico-atrium distances were 2.07 cm, 3.36 cm, 2.53 cm, and 4.11 cm, respectively. The height of the atrium influenced the height of the OR significantly (p < 0.0001). The height of the dilated and small atrium was > 4.5 cm (> 95th percentile) and < 2 cm (< 5th percentile), respectively. For the SPL approach, the mean sagittal angle was 15.75 to 41.04 degrees; the mean coronal angle was - 17.08 to 14.92 degrees. For the POS approach, the mean sagittal angle was 51.29 to 70.1 degrees; the mean coronal angle was -8.63 to 17.22 degrees. Mean calculated height (statistically) of the OR was 0.29 mm above the mean observed height (dissection). The calculated angles and observed angles were very similar when tested for a variability of ± 2 degrees. CONCLUSION: The height of the normal atrium was 2.58 cm (height of atrium to height of OR ratio was 1:0.76). An operative corridor to the atrium without damaging the OR can be calculated from MR imaging of the brain.

Fatal intracranial hemorrhage as the initial presentation of acute lymphocytic leukemia: a case report.

Hemorrhagic complications of acute leukemia are well described and are a common cause of mortality in these patients. However, to our knowledge, fatal intracerebral hemorrhage (ICH) as an initial presentation of acute lymphocytic leukemia (ALL) has only been reported once. We report a case of previously undiagnosed ALL presenting with ICH. Our patient is a 17-year old male who was found unresponsive several hours after complaining of headache. Initial emergency room evaluation found the patient to have anisocoria with a fixed and dilated right pupil and demonstrated evidence of decorticate posturing. Imaging revealed a large right-sided intraparenchymal hemorrhage, intraventricular hemorrhage, midline shift, and uncal herniation. Laboratory evaluation showed marked leukocytosis with blastic predominance and evidence of disseminated intravascular coagulopathy. Emergent surgical intervention was performed. However, despite evacuation of the hematoma, the patient eventually progressed to clinical brain death. Usually, ICH is seen in ALL patients after the diagnosis has been made. We report a unique case of fatal intracranial hemorrhage as the initial presentation of ALL and discuss the possible management dilemmas to treat such entities. ALL should be kept in the broad differential diagnosis of spontaneous ICH, especially in a young patient with evidence of severe coagulopathy.

Low-level amplification of oncogenes correlates inversely with age for patients with nontypical meningiomas.

BACKGROUND: This study sought to identify genes in nontypical meningiomas with gains in copy number (CN) that correlate with earlier age of onset, an indicator of aggressiveness. METHODS: Among 94 adult patients, 91 had 105 meningiomas that were histologically confirmed. World Health Organization grades I (typical), II (atypical), and III (anaplastic) were assigned to tumors in 76, 14, and 1 patient, respectively. Brain invasion indicated that two World Health Organization grade I meningiomas were biologically atypical. DNA from 15 invasive/atypical/anaplastic meningiomas and commercial normal DNA were analyzed with multiplex ligation dependent probe amplification. The CN ratios (fold differences from normal) for 78 genes were determined. The CN ratio was defined as [tumor CN]/[normal CN] for each gene to normalize results. RESULTS: Characteristic gene losses (CN ratio < 0.75) occurred in >50% of the invasive/atypical/anaplastic meningiomas at 22q11, 1p34.2, and 1p22.1 loci. Gains (CN ratio ≥ 2.0) occurred in each tumor for 2 or more of 19 genes. Each of the 19 genes' CN ratio was ≥ 2.0 in multiple tumors, and their collective sums (up to 49.1) correlated inversely with age (r = -0.72), minus an outlier. In patients ≤ 55 versus >55 years, 5 genes (BIRC2, BRAF, MET, NRAS, and PIK3CA) individually exhibited significantly higher CN ratios (P < 0.05) or a trend for them (P < 0.09), with corrections for multiple comparisons, and their sums correlated inversely with age (r = -0.74). CONCLUSIONS: Low levels of amplification for selected oncogenes in invasive/atypical/anaplastic meningiomas were higher in younger adults, with the CN gains potentially underlying biological aggressiveness associated with early tumor development.

Evaluation of interspinous process distraction device (X-STOP) in a representative patient cohort.

OBJECTIVE: To test the hypothesis that the level of clinical efficacy reported in the investigational device exemption (IDE) study of the X-STOP device that led to its approval by the U.S. Food and Drug Administration could also be achieved in patients who are representative of the population approved for treatment, irrespective of whether they met all the stringent requirements of the IDE study. METHODS: A retrospective analysis was conducted of a consecutive series of 31 patients who received the X-STOP interspinous process distraction device as treatment for neurogenic intermittent claudication. Outcome was assessed at an average of 2 years after surgery by use of the Zurich Claudication Questionnaire (ZCQ), which used the definition of clinical success used in the IDE study. RESULTS: On the basis of the ZCQ, clinically significant improvement occurred in 38% of the evaluable patients (21 patients), compared with 48.4% in the IDE study; at the sites other than those of the device's inventors, the improvement level was 37%. Four patients needed additional surgery, which was a rate comparable with that reported in the IDE study. CONCLUSIONS: The success level in the controlled IDE study that established the safety and efficacy of the X-STOP device was achieved in a representative patient cohort that did not necessarily meet all the strict requirements of the IDE plan. Nevertheless, the overall results were not good, suggesting that the ZCQ definition of success might not have captured the true outcome of surgical treatment with the X-STOP device.

Rapid detection of high-level oncogene amplifications in ultrasonic surgical aspirations of brain tumors.

BACKGROUND: Genomic tumor information, such as identification of amplified oncogenes, can be used to plan treatment. The two sources of a brain tumor that are commonly available include formalin-fixed, paraffin-embedded (FFPE) sections from the small diagnostic biopsy and the ultrasonic surgical aspiration that contains the bulk of the tumor. In research centers, frozen tissue of a brain tumor may also be available. This study compared ultrasonic surgical aspiration and FFPE specimens from the same brain tumors for retrieval of DNA and molecular assessment of amplified oncogenes. METHODS: Surgical aspirations were centrifuged to separate erythrocytes from the tumor cells that predominantly formed large, overlying buffy coats. These were sampled to harvest nuclear pellets for DNA purification. Four glioblastomas, 2 lung carcinoma metastases, and an ependymoma were tested. An inexpensive PCR technique, multiplex ligation-dependent probe amplification (MLPA), quantified 79 oncogenes using 3 kits. Copy number (CN) results were normalized to DNA from non-neoplastic brain (NB) in calculated ratios, [tumor DNA]/[NB DNA]. Bland-Altman and Spearman rank correlative comparisons were determined. Regression analysis identified outliers. RESULTS: Purification of DNA from ultrasonic surgical aspirations was rapid (<3 days) versus FFPE (weeks) and yielded greater amounts in 6 of 7 tumors. Gene amplifications up to 15-fold corresponded closely between ultrasonic aspiration and FFPE assays in Bland-Altman analysis. Correlation coefficients ranged from 0.71 to 0.99 using 3 kit assays per tumor. Although normalized CN ratios greater than 2.0 were more numerous in FFPE specimens, some were found only in the ultrasonic surgical aspirations, consistent with tumor heterogeneity. Additionally, CN ratios revealed 9 high-level (≥ 6.0) gene amplifications in FFPE of which 8 were also detected in the ultrasonic aspirations at increased levels. The ultrasonic aspiration levels of these amplified genes were also greater than 6.0 CN ratio, except in one case (3.53 CN ratio). Ten of 17 mid-level (≥3.0 & <6.0 CN ratio) amplifications detected in FFPE were also detected as being increased (≥ 2.0 CN ratio) in the aspirations. CONCLUSIONS: Buffy coats of centrifuged ultrasonic aspirations contained abundant tumor cells whose DNA permitted rapid, multiplex detection of high-level oncogene amplifications that were confirmed in FFPE. VIRTUAL SLIDES: http://www.diagnosticpathology.diagnomx.eu/vs/1883718801686466.

A novel method of identifying the internal acoustic canal in the middle fossa approach in a cadaveric study-the rule of 2s.

Objective Multiple landmarks and anatomic relationships exist to identify internal acoustic canal (IAC) in middle fossa approach for removing intracanalicular schwannomas. We attempted to identify a reproducible, practical method to quickly identify the IAC that would be applicable when an expanded middle fossa approach is required. Design Middle fossa approach was performed on 10 cadavers (21 dissections). In the first head, temporal and suboccipital craniotomies were performed to identify landmarks and formulate a hypothesis. Porous acusticus (PA) was identified and IAC was circumferentially skeletonized into middle fossa. Orientation of IAC in the middle fossa was evaluated in relation to foramen spinosum (FS), foramen ovale (FO), petrous ridge, and petrous apex. Consistency of this relationship was tested in the remaining heads. Results The opening of PA (point A) was consistently found at a mean of 2.38 cm posterolateral to the petrous apex along the petrous ridge (range 2.1 to 2.8). A line was drawn from the FO to FS and extrapolated posteriorly. The IAC (point B) was found a mean distance of 2.39 cm from FS along the FS-FO line (range 2.1 to 2.8). The course of IAC was consistently found by connecting point A to point B. Conclusion A novel, practical, and reproducible method is described to identify the IAC via the expanded middle fossa approach.

The use of bioabsorbable screws to fix Type II odontoid fractures: a biomechanical study.

OBJECT: Anterior screw fixation of the Type II odontoid fracture stabilizes the odontoid without restricting the motion of the cervical spine. The metal screw may limit bone remodeling because of stress shielding (if not placed properly) and limit imaging of the fracture. The use of bioabsorbable screws can overcome such shortcomings of the metal screws. The purpose of this study was to compare the strength of a 5-mm bioabsorbable screw with single 4-mm metal and double 3.5-mm lag screw fixation for Type II fractures of the odontoid process. METHODS: Three different modalities of anterior screw fixation were used in 19 C-2 vertebrae. These fixation methods consisted of a single 5-mm cannulated bioabsorbable lag screw (Group A), a single 4-mm cannulated titanium lag screw (Group B), and two 3.5-mm cannulated titanium lag screws (Group C). Anteroposterior (AP) stiffness and rotational stiffness were evaluated in all constructs. RESULTS: There was no statistical difference among the ages of the cadavers in each group (p = 0.52). The AP bending stiffness in Groups A, B, and C was 117 ± 86, 66 ± 43, and 305 ± 130 Nm/mm, respectively. The AP bending stiffness in Group C was significantly higher than that in Groups A and B (p = 0.01 and p = 0.001, respectively). The difference in AP bending stiffness values of bioabsorbable and 4-mm metal screws was not statistically significant (p = 0.23). The rotational stiffness of the double 3.5-mm metal screws was significantly greater than that of the 5-mm bioabsorbable and the 4-mm titanium screws. CONCLUSIONS: Double screw fixation with 3.5-mm screws provides the stiffest construct in Type II odontoid fractures. Bioabsorbable lag screws (5 mm) have the same AP bending and rotational stiffness as the single titanium lag screw (4 mm) in odontoid fractures.

Metastatic prostate cancer mimicking chronic subdural hematoma: a case report and review of the literature.

Cancer of the prostate is extremely common and is well known to metastasize to the pelvic lymph nodes and axial skeleton (vertebral column, pelvis, cranium, and proximal femur). However, reports of intracranial metastasis are rare and commonly discovered postmortem. Moreover, metastatic lesions mimicking subdural hematoma are extremely rare and are uncommonly reported in the literature. We found only three such cases in the literature. We present a unique case of metastatic prostate cancer presenting with headaches after head trauma with classic radiologic findings of subdural hematoma. The diagnosis may have been made sooner with preoperative magnetic resonance imaging.

Comparison of allograft bone and titanium cages for vertebral body replacement in the thoracolumbar spine: a biomechanical study.

BACKGROUND: When an anterior approach to repair a burst fracture is indicated, several devices can be used to restore spinal stability (eg, bone graft, free-standing titanium cage, and expandable titanium cage). OBJECTIVE: We compare the biomechanical stability and prices of each of these systems. MATERIALS AND METHODS: Eight fresh human cadaver T11 through L3 vertebral specimens were harvested and cleaned of soft tissues. T11-T12 and L2-L3 were fixed by screws. The fixed ends were then set in automotive body filler (Bondo). The prepared specimens were tested in the Biaxial Instron tester (8874, Norwood, MA) after a sequence of the following: intact, after the creation of an anterior corpectomy at L1, and after insertion of both of the 2 different titanium cages and the fibular graft. A titanium screw-and-plate anterolateral system was used to secure the construct (VANTAGE, Medtronic Sofamor Danek, Memphis, TN). The conditions of displacement testing were as follows: rotation (+/- 3.5 degrees ), flexion and extension, and left and right bending (+/- 3.5 mm). For each mode of testing, the stiffness was calculated. RESULTS: The stiffness data, when statistically analyzed by repeated-measures analysis of variance (at P = .05 and power > 0.9), indicated no significant differences among these devices. CONCLUSION: On the basis of this biomechanical study, the stiffness of the fibular graft was similar to that of the other metallic devices in this cadaver model.

International and specialty trends in the use of prophylactic antibiotics to prevent infectious complications after insertion of external ventricular drainage devices.

BACKGROUND: External ventricular drains (EVD) are used as a method of diverting cerebral spinal fluid out of the cranium. After placement of these drains, it has been customary to initiate antibiotics to prevent drain-related infections. Prophylactic regimes include peri-operative and prolonged administration of antibiotics. Little evidence exists to support either regime. To determine current practices or to determine if an unintended consensus has developed, a survey was taken concerning antibiotic prophylaxis with EVD insertion. METHODS: E-mail survey from a membership database of the Neurocritical Care Society, a database of neurosurgeons maintained by the LSU Department of Neurosurgery and infectious diseases practitioners from a Department of Medicine database. RESULTS: There was an approximate 781 responses. Of the responders, 77% (599) were neurosurgeons, 10.5% (82) neurocritical care, 5.0% (41) intensivists, 6.5% (50) infectious diseases specialist, and 1% (9) others. The majority of responders (64%) have been in practice > 10 years. Most respondents from outside Europe recommended use of prophylactic antibiotics. Of those that did use antibiotics prophylaxis, the majority (56%) recommend use for the duration the catheter is in place. The exception is European responders used peri-operative prophylaxis most frequently. The majority of responders (78%) support a prospective trial to address this issue. CONCLUSION: The use of antibiotics prophylaxis after EVD placement is disparate among specialties that deal with EVD placement and complications. There is no consistent practice pattern based on specialty, locale, and years of practice. The majority of all responders felt a prospective trial was warranted.

Management of acute ischemic stroke: current status of pharmacological and mechanical endovascular methods.

OBJECTIVE: To provide the current strategies of acute stroke management using pharmacological and interventional endovascular modalities. METHODS: Review of the literature for publications in English language literature on endovascular pharmacological and mechanical thrombolysis and clot retrieval. RESULTS: Aggressive management protocols have yielded therapeutic windows for effective reperfusion of ischemic brain in acute cerebral hypoperfusion/stroke. Starting with intravenous infusion of thrombolytics, which still remains to be the best feasible treatment for acute stroke management, recent advances in neuron imaging made it possible to utilize emergency cerebral angiographic evaluation of intracranial vessels followed by therapeutic measure that could be pharmacological or mechanical intervention. Intra-arterial clot lysis under image guidance combined with intravenous administration of thrombolytic is rapidly evolving with encouraging results. Microcatheters and endovascular appliances tested very positively, yielding better outcomes in acute stroke. MERCI trial, Multi MERCI trial and Stroke trials [emergency management of stroke (EMS) and interventional management of stroke (IMS)] have shown that early recanalization and reperfusion constitute good prognostic indicators by reducing mortality and improving neurological outcomes. Further trials are expected to yield better evidence to form guidelines for aggressive management of acute cerebral ischemia. DISCUSSION: Intravenous fibrinolysis is, to date, the best possible intervention in acute stroke and has been shown to be a better alternative to aspirin, the only known effective, pharmacological treatment. Endovascular interventions have shown very promising results with intra-arterial administration of thrombolytics as well as mechanical clot retrieving methods.

A noncontiguous 2-level spinal injury in a young female driver due to a 3-point seat belt restraint.

OBJECTIVES: The purpose of this case is to describe noncontiguous fracture and dislocations of the thoracolumbosacral spine in a 23-year-old female driver with a 3-point seat belt restraint. CLINICAL FEATURES: A 23-year-old woman presented to us after a motor vehicle accident while driving with a 3-point seat belt restraint. She was neurologically intact except for loss of motor function in the distribution of the L5 nerve root in the right lower limb. Computed tomography and magnetic resonance imaging showed fracture and dislocation of T3 with considerable retrolisthesis and complete anterolisthesis of L5 over the sacrum. INTERVENTION AND OUTCOME: Both fractures were reduced and fixed with bone graft and instrumentation. She was discharged a month later without any further neurologic deterioration. CONCLUSIONS: To our knowledge, this case is the first report in the literature of a seat belt safety restraint causing 2 noncontiguous fracture dislocations of the spine. Although the consensus is that seat belts can prevent most spine injuries, this case shows that the seat belt can be a contributor to spine injury. It shows that the shoulder-lap restraint can act as 2 fulcrums at the upper and lower bands causing 2 separate fracture dislocations. A thorough radiologic evaluation of the spine with respect to the clinical findings is mandatory in seat belt-restrained road traffic accidents cases.