Low skeletal muscle mass assessed directly from the 3rd cervical vertebra can predict pharyngocutaneous fistula risk after total laryngectomy in the male population.

PURPOSE: Skeletal muscle mass (SMM) loss and sarcopenia have been identified as risk factors for postoperative complications. The aim of this study was to investigate the relationship between pharyngocutaneous fistula (PCF) formation after total laryngectomy (TL) and SMM assessed from a computed tomography image of the 3rd cervical vertebra (C3). METHODS: Retrospective study of 86 male patients who underwent TL between 2013 and 2019 in a single institution. We excluded women from the analysis due to our limited sample. SMM was determined from cross-sectional muscle area (CSMA) measurement at C3 using the ImageJ software. Results were compared with those for the skeletal muscle mass index (SMMI) calculated from the estimated measure at 3rd lumbar vertebra (L3). RESULTS: PCF formation occurred in 21/86 patients. According to the CSMA at a C3 cut-off of 35.5cm2, of 18 patients (20.9%) with low SMM, 9 developed PCFs (50.0%). Among patients with normal SMM (n = 68, 79.1%), 12 developed PCFs (17.6%). The CSMA at C3 was the only variable significantly associated with PCF risk, which was 4.7 times greater in patients with low SMM (p = 0.007). Sarcopenia was more frequent in underweight patients (p = 0.0001), patients undergoing extended surgeries (p = 0.003), or presenting preoperative anaemia (p = 0.009) or hypoalbuminemia (p = 0.027). CONCLUSION: Measuring the CSMA at C3 obtained results equivalent to those obtained by calculating the SMMI at L3, suggesting that direct SMM assessment from C3 is a useful approach to evaluating PCF formation risk after TL.

Diagnostic accuracy of three computer-aided detection systems for detecting pulmonary tuberculosis on chest radiography when used for screening: Analysis of an international, multicenter migrants screening study.

The aim of this study was to independently evaluate the diagnostic accuracy of three artificial intelligence (AI)-based computer aided detection (CAD) systems for detecting pulmonary tuberculosis (TB) on global migrants screening chest x-ray (CXR) cases when compared against both microbiological and radiological reference standards (MRS and RadRS, respectively). Retrospective clinical data and CXR images were collected from the International Organization for Migration (IOM) pre-migration health assessment TB screening global database for US-bound migrants. A total of 2,812 participants were included in the dataset used for analysis against RadRS, of which 1,769 (62.9%) had accompanying microbiological test results and were included against MRS. All CXRs were interpreted by three CAD systems (CAD4TB v6, Lunit INSIGHT v4.9.0, and qXR v2) in offline setting, and re-interpreted by two expert radiologists in a blinded fashion. The performance was evaluated using receiver operating characteristics curve (ROC), estimates of sensitivity and specificity at different CAD thresholds against both microbiological and radiological reference standards (MRS and RadRS, respectively), and was compared with that of the expert radiologists. The area under the curve against MRS was highest for Lunit (0.85; 95% CI 0.83-0.87), followed by qXR (0.75; 95% CI 0.72-0.77) and then CAD4TB (0.71; 95% CI 0.68-0.73). At a set specificity of 70%, Lunit had the highest sensitivity (81.4%; 95% CI 77.9-84.6); at a set sensitivity of 90%, specificity was also highest for Lunit (54.5%; 95% CI 51.7-57.3). The CAD systems performed comparable to the sensitivity (98.3%), and except CAD4TB, to specificity (13.7%) of the expert radiologists. Similar trends were observed when using RadRS. Area under the curve against RadRS was highest for CAD4TB (0.87; 95% CI 0.86-0.89) and Lunit (0.87; 95% CI 0.85-0.88) followed by qXR (0.81; 95% CI 0.80-0.83). At a set specificity of 70%, CAD4TB had highest sensitivity (84.1%; 95% CI 82.3-85.8) followed by Lunit (80.9%; 95% CI 78.9-82.7); and at a set sensitivity of 90%, specificity was also highest for CAD4TB (54.6%; 95% CI 51.3-57.8). In conclusion, the study demonstrated that the three CAD systems had broadly similar diagnostic accuracy with regard to TB screening and comparable accuracy to an expert radiologist against MRS. Compared with different reference standards, Lunit performed better than both qXR and CAD4TB against MRS, and CAD4TB and Lunit better than qXR against RadRS. Moreover, the performance of the CADs can be impacted by characteristics of subgroup of population. The main limitation was that our study relied on retrospective data and MRS was not routinely done in individuals with a low suspicion of TB and a normal CXR. Our findings suggest that CAD systems could be a useful tool for TB screening programs in remote, high TB prevalent places where access to expert radiologists may be limited. However, further large-scale prospective studies are needed to address outstanding questions around the operational performance and technical requirements of the CAD systems.

A major role for Nrf2 transcription factors in cell transformation by KSHV encoded oncogenes.

Kaposi's sarcoma (KS) is the most common tumor in AIDS patients. The highly vascularized patient's skin lesions are composed of cells derived from the endothelial tissue transformed by the KSHV virus. Heme oxygenase-1 (HO-1) is an enzyme upregulated by the Kaposi´s sarcoma-associated herpesvirus (KSHV) and highly expressed in human Kaposi Sarcoma (KS) lesions. The oncogenic G protein-coupled receptor (KSHV-GPCR or vGPCR) is expressed by the viral genome in infected cells. It is involved in KS development, HO-1 expression, and vascular endothelial growth factor (VEGF) expression. vGPCR induces HO-1 expression and HO-1 dependent transformation through the Ga13 subunit of heterotrimeric G proteins and the small GTPase RhoA. We have found several lines of evidence supporting a role for Nrf2 transcription factors and family members in the vGPCR-Ga13-RhoA signaling pathway that converges on the HO-1 gene promoter. Our current information assigns a major role to ERK1/2MAPK pathways as intermediates in signaling from vGPCR to Nrf2, influencing Nrf2 translocation to the cell nucleus, Nrf2 transactivation activity, and consequently HO-1 expression. Experiments in nude mice show that the tumorigenic effect of vGPCR is dependent on Nrf2. In the context of a complete KSHV genome, we show that the lack of vGPCR increased cytoplasmic localization of Nrf2 correlated with a downregulation of HO-1 expression. Moreover, we also found an increase in phospho-Nrf2 nuclear localization in mouse KS-like KSHV (positive) tumors compared to KSHV (negative) mouse KS-like tumors. Our data highlights the fundamental role of Nrf2 linking vGPCR signaling to the HO-1 promoter, acting upon not only HO-1 gene expression regulation but also in the tumorigenesis induced by vGPCR. Overall, these data pinpoint this transcription factor or its associated proteins as putative pharmacological or therapeutic targets in KS.

Cancer incidence and survival in Metro Manila and Rizal province, Philippines.

The database of two population-based cancer registries (Philippine Cancer Society-Manila Cancer Registry and Department of Health-Rizal Cancer Registry) was used to generate age-standardized incidence rates of cancer during 1980-2002. Five-year relative survival rates were obtained for incident cases from 1993 to 2002 using a period analysis method. Overall incidence had increased in both males and females. Among males, lung cancer was the leading cancer and reached a peak in 1988-92. Colorectal and prostate cancers showed rising trends and became more common than liver cancer, with stable incidence over time. Stomach cancer incidence fell steeply. Among females, there was a steady increase in incidence of breast cancer. There was a slight decrease in the incidence of the second common cancer, cervical cancer, and colorectal cancer became equally common. Lung cancer incidence in females also reached a peak by 1998-2002 and then slightly decreased. Oral cavity cancer decreased strongly in the last period. In general, survival rates among Philippine residents were one-third lower than among Filipino-Americans and Whites in the USA especially in cancer sites wherein effective early detection methods may be available such as breast, cervix, colorectal and thyroid cancers. Survival was also lower in Philippine leukemia cases, a disease wherein effective treatment is proven in some types but is quite expensive. Lifestyle factors such as smoking, unhealthy diet, physical inactivity, and human papillomavirus and hepatitis B virus infections were associated with some incidence patterns. Late stage at diagnosis was largely responsible for low survival.

Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke.

BACKGROUND AND PURPOSE: Different definitions have been proposed to define the ischemic penumbra from perfusion-CT (PCT) data, based on parameters and thresholds tested only in small pilot studies. The purpose of this study was to perform a systematic evaluation of all PCT parameters (cerebral blood flow, volume [CBV], mean transit time [MTT], time-to-peak) in a large series of acute stroke patients, to determine which (combination of) parameters most accurately predicts infarct and penumbra. METHODS: One hundred and thirty patients with symptoms suggesting hemispheric stroke < or =12 hours from onset were enrolled in a prospective multicenter trial. They all underwent admission PCT and follow-up diffusion-weighted imaging/fluid-attenuated inversion recovery (DWI/FLAIR); 25 patients also underwent admission DWI/FLAIR. PCT maps were assessed for absolute and relative reduced CBV, reduced cerebral blood flow, increased MTT, and increased time-to-peak. Receiver-operating characteristic curve analysis was performed to determine the most accurate PCT parameter, and the optimal threshold for each parameter, using DWI/FLAIR as the gold standard. RESULTS: The PCT parameter that most accurately describes the tissue at risk of infarction in case of persistent arterial occlusion is the relative MTT (area under the curve=0.962), with an optimal threshold of 145%. The PCT parameter that most accurately describes the infarct core on admission is the absolute CBV (area under the curve=0.927), with an optimal threshold at 2.0 ml x 100 g(-1). CONCLUSIONS: In a large series of 130 patients, the optimal approach to define the infarct and the penumbra is a combined approach using 2 PCT parameters: relative MTT and absolute CBV, with dedicated thresholds.

The labial-coronal effect revisited: Japanese adults say pata, but hear tapa.

The labial-coronal effect has originally been described as a bias to initiate a word with a labial consonant-vowel-coronal consonant (LC) sequence. This bias has been explained with constraints on the human speech production system, and its perceptual correlates have motivated the suggestion of a perception-production link. However, previous studies exclusively considered languages in which LC sequences are globally more frequent than their counterpart. The current study examined the LC bias in speakers of Japanese, a language that has been claimed to possess more CL than LC sequences. We first conducted an analysis of Japanese corpora that qualified this claim, and identified a subgroup of consonants (plosives) exhibiting a CL bias. Second, focusing on this subgroup of consonants, we found diverging results for production and perception such that Japanese speakers exhibited an articulatory LC bias, but a perceptual CL bias. The CL perceptual bias, however, was modulated by language of presentation, and was only present for stimuli recorded by a Japanese, but not a French, speaker. A further experiment with native speakers of French showed the opposite effect, with an LC bias for French stimuli only. Overall, we find support for a universal, articulatory motivated LC bias in production, supporting a motor explanation of the LC effect, while perceptual biases are influenced by distributional frequencies of the native language.

Obstetric and perinatal outcome in women with twin pregnancy and gestational diabetes.

OBJECTIVE: The aim of this study was to evaluate pregnancy complications and obstetric and perinatal outcomes in women with twin pregnancy and GDM. STUD DESIGN: An observational multicentre retrospective study was performed and 534 pregnant woman and 1068 twins infants allocated into two groups, 257 with GDM and 277 controls, were studied. MAIN OUTCOME MEASURES: Pregnant women characteristics, hypertensive complications, preterm delivery rate, mode of delivery and birthweight were analysed. RESULTS: Pregnant women with GDM were older (p < 0.001) and had higher body mass index (p < 0.001) than controls. GDM was associated with higher risk of prematurity in twin pregnancy (odds ratio 1.64, 95% confidence interval [1.14-2.32], p = 0.005). This association was based on the association with other pregnancy complications. Birthweight Z-scores were significantly higher in the GDM group (p = 0.02). The rate of macrosomia was higher in the GDM group (p = 0.002) and small for gestational age (SGA) babies were significantly less frequent (p = 0.03). GDM was an independent predictor of macrosomia (p = 0.006). CONCLUSION: The presence of GDM in twin pregnancy was associated with a higher risk of hypertensive complications, prematurity and macrosomia, but significantly reduces the risk of SGA infants. Prematurity was related to the presence of other associated pregnancy complications.

Comunicación y coordinación en enfermería en una institución de salud de alta complejidad en Cartagena / Communication and coordination of nursing in a high complexity health institution in Cartagena

Objetivo: Evaluar la comunicación y coordinación de enfermería en una Institución Prestadora de Servicios (IPS) de alta complejidad en Cartagena, Colombia. Metodología: Estudio descriptivo transversal, de tipo cuantitativo. La población estuvo constituida por cien enfermeras4 que participaron voluntariamente. La información fue recolectada mediante la aplicación de las escalas del instrumento Cuestionario de práctica colaborativa UCI médico-enfermera, de Shortell et al., versión en español, validada en el contexto colombiano con un Alfa de Cronbach de 0,92 para Comunicación -según la definición de Irvine et al. (1)- y de 0,82 para Coordinación -según la definición de Shortell et al (2). Resultados: El promedio de los puntajes de la dimensión Comunicación a nivel individual para todas las enfermeras de una misma unidad fue de 3,8 en las Unidades de Urgencias, Cirugía y Hospitalización; y 3,7 en la Unidad de Cuidados Intensivos y Programas Especiales. En cuanto a Coordinación, el promedio fue de 3,9 para las Unidades de Cirugía y Hospitalización; de 3,3 para Unidad de Cuidados Intensivos; y 3,8 para Urgencias. Conclusión: La mayor parte de los factores que conforman las dimensiones Comunicación y Coordinación entre las enfermeras y con el equipo de salud fueron evaluados positivamente al hallarse resultados similares en las unidades en las puntuaciones y promedio a nivel individual para todas las enfermeras de una misma unidad. Esto facilita que la enfermería asuma de manera óptima la continuidad de los cuidados en el rol interdependiente.

Objetivo: Avaliar a comunicação e coordenação de enfermagem em uma Instituição Prestadora de Serviços (IPS) de alta complexidade em Cartagena, Colômbia. Metodologia: Estudo descritivo transversal, de tipo quantitativo. A população constou de uma centena de enfermeiros que participaram voluntariamente. As informações foram coletadas através da aplicação das escalas do instrumento Questionário de prática colaborativa UCI médico-enfermeira, de Shortell et al. versão em espanhol, validada no contexto da Colômbia, com Alfa de Cronbach de 0,92 para Comunicação -segundo a definição de Irvine et al. (1)- e 0,82 para a Coordenação -segundo a definição de Shortell et al (2). Resultados: Os resultados médios das pontuações da dimensão Comunicação a nível individual para todos os enfermeiros da mesma unidade foi de 3,8 nas Unidades de Emergência, Cirurgia e Hospitalização; e 3,7 na Unidade de Terapia Intensiva e Programas Especiais. Em relação à Coordenação, a média foi de 3,9 para Unidades a Cirurgia e Hospitalização; de 3,3 para a Unidade de Cuidados Intensivos; e 3,8 para Urgências. Conclusão: A maioria dos fatores que compõem as dimensões Comunicação e Coordenação entre os enfermeiros e a equipe de saúde foram avaliados positivamente, ao encontrar-se resultados semelhantes nas unidades em dezenas e dezenas, da média nas pontuações a nível individual para todos os enfermeiros da mesma unidade. Isso facilita que a enfermagem assuma da melhor maneira a continuidade dos cuidados no que tem a ver com o papel interdependente.

Objective: To evaluate communication and coordination of nursing in a highly complex institution (IPS) in Cartagena, Colombia. Methodology: A cross-sectional descriptive study was made. The population involved one hundred nurses who participated voluntarily. Information was collected by applying the Shortell' et al. scales from Physician collaborative practice icu nurse questionnaire, validated for Colombian context with a Cronbach's Alpha of 0.92 for Communication -according to the definition of Irvine et al. (1)- and 0.82 for Coordination -according to the definition of Shortell et al (2). Results: The average scores of Communication dimension individually for all nurses of the same unit was 3.8 in the Emergency, Surgery, and Hospitalization Units; and 3.7, in the Intensive Care Unit and Special Programs. In respect of Coordination dimension, the average was of 3.9 in the surgery and hospital units; of 3.3 in Intensive Care Unit; and 3.8 in Emergency Room. Conclusion: Most of factors that make both Communication and Coordination dimensions among nurses and the health team were evaluated positively, with similar results in the units and average scores of individual-level scores for all nurses of the same unit. This facilitates that nursing optimally assume continuity of care regarding the interdependent role.