27-year trends in incidence rates for testis cancer across a large statewide registry.

PURPOSE: To review 27-years of testicular cancer (TC) incidence data (1990-2017) within the state of Pennsylvania to better define incidence, geographic distribution, and trends over time. METHODS: The Pennsylvania Cancer Registry was reviewed for statewide and component county age-adjusted TC incidence rates and stage distribution. We reported annual percent changes (APCs) in age-adjusted rates. Maps plotting county-level incidence rates across the state in five-year time intervals were created. RESULTS: In Pennsylvania, 9,933 TC cases were recorded between 1990-2017. Over two-thirds of patients were < 40 years of age and 95% were White. Approximately 89% presented as local and regional disease. Age-adjusted annual rates of total TC increased from 4.80 to 7.20 patients per 100,000 with an APC of 0.94 (95% Confidence Interval (CI) = (0.59, 1.29), P < 0.01) over the study interval. Annual rates of local disease increased from 3.20 to 5.00 patients per 100,000 with an APC of 1.07 (95% CI = (0.67, 1.46), P < 0.01). Annual rates of distant disease were stable and ranged from 0.50 to 0.80 patients per 100,000 with an APC of 0.69 (95% CI = (-0.02, 1.40), P = 0.06). Geospatial investigation noted increased incidence in urban centers. CONCLUSIONS: Although TC is rare, incidence is rising. Rates of TC in Pennsylvania almost doubled over the past two decades. Fortunately, this rising trend is primarily attributed to increases in local and regional disease. Counties with higher incidence rates cluster in urban centers which may reflect exposure risk, access to care, or reporting bias.

Loose scrotal wound edge approximation in the setting of pyoderma gangrenosum after COVID-19 infection.

Pyoderma gangrenosum (PG) is a rare autoinflammatory skin disease characterized by recurrent ulcers. It is a diagnosis of exclusion and treatment can be challenging due to limited evidence-based therapies. While surgical management is typically avoided due to the risk of pathergy, it can be warranted in specific cases. Here, we have illustrated a unique case of genital PG that began after COVID-19 infection and which resulted in scrotal prolapse with testicular exposure. Loose closure with a horizontal mattress suture while the patient was on immunosuppression allowed for complete wound healing.

Hospital Readmission in Alcohol Use Disorder Patients: The Role of Anti-Craving Medications and Discharge Disposition.

Background: Alcohol use disorder (AUD) results in frequent hospital readmissions. Although the literature has shown the efficacy of anti-craving medications (ACM), they are infrequently prescribed upon discharge. The outcomes of discharge to substance use treatment facilities (STF) have also not been fully explored. This study seeks to determine the impact of ACM as well as discharge to STF on readmissions for people with AUD. Methods: This retrospective case-control study analyzed encounters made within HCA Healthcare hospitals across the United States from 2016 to 2018 for adults with AUD. The case definition was the presence of ACM defined as acamprosate or naltrexone upon discharge as well as discharge disposition (STF vs. all others). The main outcomes were the likelihood of 30- and 90-day readmission and blood alcohol concentration (BAC) on 30-day readmission in cases versus adults with AUD declining/not referred to an STF or not using ACM. The controlled variables included age, sex, race, and insurance status. Results: A total of 14 691 patients were identified for the study. Of these, 3308 patients were prescribed ACM and 1125 patients were discharged to an STF. Patients without ACM were 1.18 times more likely to be readmitted within 30 days (95% CI, 1.07-1.30; P = .0005). Patients discharged to an STF were 1.57 times more likely to be readmitted within 30 days (95% CI, 1.37-1.79; P < .0001), but these patients had a BAC that was 26.74 units lower on 30-day readmission than those who were not discharged to an STF. Conclusion: The prescription of ACM on discharge was associated with decreased 30-day readmission rates. The lower BAC of those who were readmitted within 30 days suggests discharge to STF may be beneficial for the treatment of AUD in the longer term. Practitioners are encouraged to prescribe ACM for people admitted with AUD to reduce the likelihood of 30-day readmission.

Culturally Sensitive Health Education in the Caribbean Diaspora: A Scoping Review.

CONTEXT: The Caribbean diaspora in the United States is a diverse community that is afflicted with high morbidity and mortality due to preventable chronic diseases. OBJECTIVE: Our goal is to determine which culturally sensitive health and nutrition educational modalities have the highest efficacy for improving general health in the Caribbean diaspora. METHODS: A scoping literature review was performed on the MEDLINE, CINAHL, and Web of Science databases using terms related to health and nutrition in the Caribbean population. Original, peer-reviewed research published from 2010 to 2020, which took place in the U.S. and Caribbean countries, were included in our review. RESULTS: We identified a total of nine articles that met our inclusion criteria. Rate differences for individual education program features were calculated to assess the likelihood of a positive impact on diet, physical activity, and diabetes. CONCLUSION: Our review helps to identify key educational modalities targeting diabetes, diet, and physical activity levels that can be used to meet the health and nutritional needs of the Caribbean diaspora population.

Reconstruction of 1,000 Projection Neurons Reveals New Cell Types and Organization of Long-Range Connectivity in the Mouse Brain.

Neuronal cell types are the nodes of neural circuits that determine the flow of information within the brain. Neuronal morphology, especially the shape of the axonal arbor, provides an essential descriptor of cell type and reveals how individual neurons route their output across the brain. Despite the importance of morphology, few projection neurons in the mouse brain have been reconstructed in their entirety. Here we present a robust and efficient platform for imaging and reconstructing complete neuronal morphologies, including axonal arbors that span substantial portions of the brain. We used this platform to reconstruct more than 1,000 projection neurons in the motor cortex, thalamus, subiculum, and hypothalamus. Together, the reconstructed neurons constitute more than 85 meters of axonal length and are available in a searchable online database. Axonal shapes revealed previously unknown subtypes of projection neurons and suggest organizational principles of long-range connectivity.