Assessment of diagnostic accuracy for cryptorchidism and risk factors for delayed orchidopexy.

OBJECTIVES: Cryptorchidism (CO) diagnosis by palpation is challenging. Patients with suspected CO are primarily referred to pediatric urologists by general pediatricians and urologists. Currently, surgical treatment for CO is recommended earlier than in previous guidelines. In this study, we evaluated factors that lead to diagnosis discordance and delayed orchidopexy in patients referred with suspected CO in addition to timing of initial screening. METHODS: In total, 731 patients (1052 testes) with suspected CO were included. Risk factors for diagnostic discrepancy in CO diagnosis by pediatric urologists and risk of delayed orchiopexy were evaluated. RESULTS: Herein, 659 (90%) patients were diagnosed during routine public health checkups for infants and young children, and 419 (57%) patients were referred by pediatric practitioners. Of 1052 testes, 374 (36%) were diagnosed with CO by pediatric urologists. In multivariate analysis, risk factors of diagnostic discrepancy for CO diagnosis by pediatric urologists were bilateral testis (odds ratio [OR] = 9.17, p < 0.0001), >6 months old at initial diagnosis (OR = 1.036, p < 0.0001), and pediatric referral (OR = 4.60, p < 0.0001). In total, 296 patients underwent orchiopexy for CO. In multivariate analysis, risk factors for delayed orchiopexy were presence of comorbidities (OR = 3.43, p = 0.003) and >10 months old at referral (OR = 12.62, p < 0.0001). CONCLUSIONS: Pediatric referral is a risk factor for discordant CO diagnostics, and late age at referral brings a risk of delayed orchiopexy. It is necessary to enlighten pediatricians, who are mainly responsible for routine health checkups, in teaching CO diagnostic techniques to ensure early referral.

Long-term follow-up of congenital hydronephrosis in a single-center study.

OBJECTIVES: Many congenital hydronephroses spontaneously resolve. This study evaluated a long-term follow-up of more than 4 years of patients with congenital hydronephrosis at a single center. METHODS: In total, 215 patients (286 kidneys) with congenital hydronephrosis were included. Hydronephrosis outcomes (resolution, improvement, and persistence) and time-to-outcome were evaluated. RESULTS: Fourteen patients underwent early surgical intervention until the age of 2 years. A total of 189 congenital hydronephrosis cases (66%) showed resolution at a median of 16 months (interquartile range: 7-21 months) and 169 (80%) of 210 kidneys with grade I to II hydronephrosis showed resolution at a median of 14 months (interquartile range: 6-23 months). Of 76 kidneys with grade III to IV hydronephrosis, 24 (32%) showed resolution at a median of 29 months (interquartile range: 24-41 months), and 56 (74%) showed improvement to grade II or less at a median of 12 months (interquartile range: 5-23 months). Of the 76 kidneys with grade III to IV hydronephrosis, five required delayed pyeloplasty at a median of 66 months (interquartile range: 42-89 months). One patient was asymptomatic, with a marked worsening of hydronephrosis and decreased renal function 6 years after the resolution of hydronephrosis. CONCLUSIONS: None of the patients with grade I to II hydronephrosis required surgical treatment, and a shorter follow-up may be sufficient. Grade III to IV severe hydronephrosis should be considered for a longer and more careful follow-up, given the possibility of asymptomatic exacerbation of hydronephrosis.

Email me back: Examining provider biases through email return and responsiveness.

The majority of research on accessing and utilizing mental health services has focused on patient barriers to care. Few studies have explored possible provider biases that may impact client access at point of entry. Using the audit method, we conducted an email-based field experiment to investigate the responsiveness of psychotherapy providers to inquiries from simulated patients with different backgrounds (i.e., race, gender, diagnosis, and ability to pay). A total of 725 therapists (176 men, 549 women) practicing in Chicago, Illinois were identified from an online therapist directory and randomized to receive emails requesting therapy appointments. Overall, 21.7% of providers did not return prospective client email inquiries; 32.5% of providers were somewhat responsive in that they returned an email despite not being able to take on the client; and 45.7% were highly responsive in that they returned an email and offered an appointment or the opportunity to discuss the matter further. Male providers were less responsive to African American and Latinx simulated clients and most responsive to White clients, whereas female providers were more likely to respond similarly to all simulated clients. Moreover, regardless of the providers' gender, they were more responsive to simulated patients with depression than to simulated patients with schizophrenia or borderline personality disorder (BPD). Finally, providers were more responsive to those who could pay the full fee than to those who requested a sliding scale. Educating providers on these possible biases is important because it could help reduce biased behaviors and improve access to care for vulnerable populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Use of otolith for detecting strontium-90 in fish from the harbor of Fukushima Dai-ichi Nuclear Power Plant.

To clarify the level of contamination with radioactive cesium (radiocesium) discharged from Fukushima Dai-ichi Nuclear Power Plant (FDNPP), three fish species caught in the main harbor of FDNPP were subjected to γ-ray analysis. The concentration of radiocesium in muscle differed among individual fish, even those of similar size of the same species, and showed little relation to the standard length of fish. The maximum concentration of radiocesium (202 kBq/kg wet) was detected from fat greenling samples. A comparison to data from outside the port indicated that the level of radiocesium contamination inside the port was higher than that outside. We found that ß-rays were emitted from otoliths of fishes caught in the port of FDNPP. ß-ray intensities were correlated with the concentrations of radiocesium in muscles of the three fish species. In Japanese rockfish, the ß-ray count rates from otoliths were significantly correlated with the concentration of radiocesium and (90)Sr in the whole body without internal organs of Japanese rockfish. However, no ß-rays were detected from brown hakeling samples collected around FDNPP, suggesting that the detection of ß-rays from otoliths may indicate living in the main harbor of FDNPP.

[Case of xanthogranulomatous pyelonephritis complicated by simultaneous septic pulmonary embolism].

A 57-year-old man with fever-up and multiple nodules in the peripheral area of the lungs on the chest CT was referred to the department of respiratory medicine of our hospital for further examination. The whole body CT disclosed a space-occupying lesion in the left frontal lobe of his brain, an irregular mass in the left kidney, and swelling of paraaortic lymph nodes. A pathological diagnosis could not be made from the results of the bronchoscopic examination and percutaneous needle biopsy for the renal mass. Left nephrectomy and lymph node dissection were carried out because of possible renal malignancy with distant metastases. The renal lesion was diagnosed as xanthogranulomatous pyelonephritis histopathologically. After the nephrectomy, the multiple lung nodules disappeared spontaneously leaving scars in some lesions. Septic pulmonary embolism was highly suspected on the basis of the clinical course. The brain nodule also decreased in size significantly and is currently under careful surveillance.

Southwest intrusion of 134Cs and 137Cs derived from the Fukushima Dai-ichi nuclear power plant accident in the Western North Pacific.

Enormous quantities of radionuclides were released into the ocean via both atmospheric deposition and direct release as a result of the Fukushima Dai-ichi Nuclear Power Plant (FNPP) accident. This study discusses the southward dispersion of FNPP-derived radioactive cesium (Cs) in subsurface waters. The southernmost point where we found the FNPP-derived (134)Cs (1.5-6.8 Bq m(-3)) was 18 °N, 135 °E, in September 2012. The potential density at the subsurface peaks of (134)Cs (100-500 m) and the increased water column inventories of (137)Cs between 0 and 500 m after the winter of 2011-2012 suggested that the main water mass containing FNPP-derived radioactive Cs was the North Pacific Subtropical Mode Water (NPSTMW), formed as a result of winter convection. We estimated the amount of (134)Cs in core waters of the western part of the NPSTMW to be 0.99 PBq (decay-corrected on 11 March 2011). This accounts for 9.0% of the (134)Cs released from the FNPP, with our estimation revealing that a considerable amount of FNPP-derived radioactive Cs has been transported to the subtropical region by the formation and circulation of the mode water.

[A case of testicular tumor presenting with acute scrotum].

A 37-year-old man visited our hospital with a chief complaint of sudden onset of right scrotal pain. Because spermatic cord torsion was suspected, an exploratory incision was made. There was no spermatic cord torsion, but an induration was palpated in a part of the right testis. Because a testicular tumor was strongly suspected, right high orchiectomy was performed. The histopathological diagnosis was a pT1 seminoma. Our experience with this case suggests that testicular tumor should be considered in the differential diagnoses of acute scrotum.

[A case of giant bladder stone in a young man with neither lower urinary tract dysfunction nor foreign body in the bladder].

A 38-year-old man visited our hospital complaining of lower urinary tract symptoms. He had undergone extracorporeal shockwave lithotripsy to remove a right renal stone two times when he was 24 years old. Since examinations revealed right staghorn calculi and a giant bladder stone, vesicolithotomy was carried out. The removed stone measured 95 × 75 × 55 mm and weighed 250 g. We hypothesized that a fragment of the upper urinary tract stone had reached the bladder which could not be discharged spontaneously, and grew in the bladder. After the operation, uroflowmetry and voiding cystourethrography were performed and the results indicated no abnormalities in the lower urinary tract function.

The Accuracy of Bayesian Model Fit Indices in Selecting Among Multidimensional Item Response Theory Models.

Item response theory (IRT) models are often compared with respect to predictive performance to determine the dimensionality of rating scale data. However, such model comparisons could be biased toward nested-dimensionality IRT models (e.g., the bifactor model) when comparing those models with non-nested-dimensionality IRT models (e.g., a unidimensional or a between-item-dimensionality model). The reason is that, compared with non-nested-dimensionality models, nested-dimensionality models could have a greater propensity to fit data that do not represent a specific dimensional structure. However, it is unclear as to what degree model comparison results are biased toward nested-dimensionality IRT models when the data represent specific dimensional structures and when Bayesian estimation and model comparison indices are used. We conducted a simulation study to add clarity to this issue. We examined the accuracy of four Bayesian predictive performance indices at differentiating among non-nested- and nested-dimensionality IRT models. The deviance information criterion (DIC), a commonly used index to compare Bayesian models, was extremely biased toward nested-dimensionality IRT models, favoring them even when non-nested-dimensionality models were the correct models. The Pareto-smoothed importance sampling approximation of the leave-one-out cross-validation was the least biased, with the Watanabe information criterion and the log-predicted marginal likelihood closely following. The findings demonstrate that nested-dimensionality IRT models are not automatically favored when the data represent specific dimensional structures as long as an appropriate predictive performance index is used.

Classification of Hippocampal Ripples: Convolutional Neural Network Learns Episode-Specific Changes.

The hippocampus is known to play an important role in memory by processing spatiotemporal information of episodic experiences. By recording synchronized multiple-unit firing events (ripple firings with 300 Hz-10 kHz) of hippocampal CA1 neurons in freely moving rats, we previously found an episode-dependent diversity in the waveform of ripple firings. In the present study, we hypothesized that changes in the diversity would depend on the type of episode experienced. If this hypothesis holds, we can identify the ripple waveforms associated with each episode. Thus, we first attempted to classify the ripple firings measured from rats into five categories: those experiencing any of the four episodes and those before experiencing any of the four episodes. In this paper, we construct a convolutional neural network (CNN) to classify the current stocks of ripple firings into these five categories and demonstrate that the CNN can successfully classify the ripple firings. We subsequently indicate partial ripple waveforms that the CNN focuses on for classification by applying gradient-weighted class activation mapping (Grad-CAM) to the CNN. The method of t-distributed stochastic neighbor embedding (t-SNE) maps ripple waveforms into a two-dimensional feature space. Analyzing the distribution of partial waveforms extracted by Grad-CAM in a t-SNE feature space suggests that the partial waveforms may be representative of each category.

New evidence on the validity of the Arnett Caregiver Interaction Scale: Results from the Early Childhood Longitudinal Study-Birth Cohort.

The Arnett Caregiver Interaction Scale (CIS) has been widely used in research studies to measure the quality of caregiver-child interactions. The scale was modeled on a well-established theory of parenting, but there are few psychometric studies of its validity. We applied factor analyses and item response theory methods to assess the psychometric properties of the Arnett CIS in a national sample of toddlers in home-based care and preschoolers in center-based care from the Early Childhood Longitudinal Study-Birth Cohort. We found that a bifactor structure (one common factor and a second set of specific factors) best fits the data. In the Arnett CIS, the bifactor model distinguishes a common substantive dimension from two methodological dimensions (for positively and negatively oriented items). Despite the good fit of this model, the items are skewed (most teachers/caregivers display positive interactions with children) and, as a result, the Arnett CIS is not well suited to distinguish between caregivers who are "highly" versus "moderately" positive in their interactions with children, according to the items on the scale. Regression-adjusted associations between the Arnett CIS and child outcomes are small, especially for preschoolers in centers. We encourage future scale development work on measures of child care quality by early childhood scholars.

[Brain metastasis which appeared during complete response of lung metastatic lesion by sunitinib treatment in a patient with renal cell carcinoma].

A 59-year-old man underwent radical nephrectomy for left renal cell carcinoma with multiple lung metastases (cT3bN0M1) in May 2010. Pathological diagnosis was clear cell carcinoma, G2 and pT3b. After sunitinib treatment for 7 months computed tomography (CT) revealed complete response of lung lesions and the treatment was continued. After 10 months, the patient complained of right hemiplegia. Brain magnetic resonance imaging (MRI) revealed a 3 cm tumor in his frontal lobe of cerebrum. He underwent surgical resection of the tumor and pathological diagnosis was metastatic renal cell carcinoma. He has been well without local recurrence or distant metastasis for 18 months.

[Chronic urinary retention in women caused by primary bladder neck obstruction : report of two cases treated successfully with transurethral resection of bladder neck].

A 60-year-old female was referred to our hospital for the treatment of chronic urinary retention which had compelled her to continue clean intermittent self catheterization (CIC) for several years. After further examination including physical examinations, urodynamic study, cystography, and urethrocystoscopy, she was diagnosed with primary bladder neck obstruction (PBNO). Transurethral resection of the bladder neck (TURBN) was performed to relieve the bladder outlet obstruction and she was free from CIC thereafter. Another 61-year-old female on CIC was also referred to our hospital and diagnosed with PBNO through detailed examinations including urodynamics. She was also successfully relieved of CIC after TURBN. Primary bladder neck obstruction is a condition which can be effectively treated by a less-invasive procedure when properly diagnosed by urodynamic examination. Urologists must keep this rare condition in mind as a possible cause of chronic urinary retention in women.

Molecular cloning and catalytic mechanism of a novel glycosphingolipid-degrading beta-N-acetylgalactosaminidase from Paenibacillus sp. TS12.

We report here the molecular cloning, characterization, and catalytic mechanism of a novel glycosphingolipid-degrading ß-N-acetylgalactosaminidase (ß-NGA) from Paenibacillus sp. TS12 (NgaP). Consisting of 1034 putative amino acid residues, NgaP shares no sequence similarity with known proteins. Recombinant NgaP, expressed in Escherichia coli, cleaved the nonreducing terminal ß-GalNAc residues of gangliotriaosylceramide and globotetraosylceramide. The enzyme hydrolyzed para-nitrophenyl-ß-N-acetylgalactosaminide ∼100 times faster than para-nitrophenyl-ß-N-acetylglucosaminide. GalNAc thiazoline, an analog of the oxazolinium intermediate and potent inhibitor for enzymes adopting substrate-assisted catalysis, competitively inhibited the enzyme. The K(i) of the enzyme for GalNAc thiazoline was 1.3 nM, whereas that for GlcNAc thiazoline was 46.8 µM. Comparison of the secondary structure with those of known enzymes exhibiting substrate-assisted catalysis and point mutation analysis indicated that NgaP adopts substrate-assisted catalysis in which Glu-608 and Asp-607 could function as a proton donor and a stabilizer of the 2-acetamide group of the ß-GalNAc at the active site, respectively. These results clearly indicate that NgaP is a ß-NGA showing substrate-assisted catalysis. This is the first report describing the molecular cloning of a ß-NGA adopting substrate-assisted catalysis.

[Tubercular prostatic abscess following intravesical Bacillus Calmette-Guerin therapy].

We report a case of tubercular prostatic abscess in a male patient who had undergone intravesical Bacillus Calmette-Guerin therapy for bladder carcinoma in situ. The abscess was successfully treated with transurethral resection of the prostate for drainage and subsequent antituberculous regime of chemotherapy.

[Functional Movement Disorders That Do Not Improve after Explaining the Diagnosis: Do Not Treat the Disease, Treat the Patient].

The most important factor in the treatment of functional movement disorders is the initial discussion between the doctor and the patient, wherein the doctor must inform the patient regarding their diagnosis and obtain their consent. To obtain consent, explanations must be tailored to the patient's knowledge. To do so, it is important to know the patient. In this process, psychological factors may be speculated. The rationale for the diagnosis, including test results, should be presented to the patient. Although the choice of future treatment should be left to the patient, the doctor must assure the patient of their continued support until they recover.

An Empirical Identification Issue of the Bifactor Item Response Theory Model.

Using the bifactor item response theory model to analyze data arising from educational and psychological studies has gained popularity over the years. Unfortunately, using this model in practice comes with challenges. One such challenge is an empirical identification issue that is seldom discussed in the literature, and its impact on the estimates of the bifactor model's parameters has not been demonstrated. This issue occurs when an item's discriminations on the general and specific dimensions are approximately equal (i.e., the within-item discriminations are similar in strength), leading to difficulties in obtaining unique estimates for those discriminations. We conducted three simulation studies to demonstrate that within-item discriminations being similar in strength creates problems in estimation stability. The results suggest that a large sample could alleviate but not resolve the problems, at least when considering sample sizes up to 4,000. When the discriminations within items were made clearly different, the estimates of these discriminations were more consistent across the data replicates than that observed when the discriminations within the items were similar. The results also show that the similarity of an item's discriminatory magnitudes on different dimensions has direct implications on the sample size needed in order to consistently obtain accurate parameter estimates. Although our goal was to provide evidence of the empirical identification issue, the study further reveals that the extent of similarity of within-item discriminations, the magnitude of discriminations, and how well the items are targeted to the respondents also play factors in the estimation of the bifactor model's parameters.

Dual-Arm Visuo-Haptic Optical Tweezers for Bimanual Cooperative Micromanipulation of Nonspherical Objects.

Cooperative manipulation through dual-arm robots is widely implemented to perform precise and dexterous tasks to ensure automation; however, the implementation of cooperative micromanipulation through dual-arm optical tweezers is relatively rare in biomedical laboratories. To enable the bimanual and dexterous cooperative handling of a nonspherical object in microscopic workspaces, we present a dual-arm visuo-haptic optical tweezer system with two trapped microspheres, which are commercially available end-effectors, to realize indirect micromanipulation. By combining the precise correction technique of distortions in scanning optical tweezers and computer vision techniques, our dual-arm system allows a user to perceive the real contact forces during the cooperative manipulation of an object. The system enhances the dexterity of bimanual micromanipulation by employing the real-time representation of the forces and their directions. As a proof of concept, we demonstrate the cooperative indirect micromanipulation of single nonspherical objects, specifically, a glass fragment and a large diatom. Moreover, the precise correction method of the scanning optical tweezers is described. The unique capabilities offered by the proposed dual-arm visuo-haptic system can facilitate research on biomedical materials and single-cells under an optical microscope.

A Mixed Method Study of Teachers' Appraisals of Student Wellness Services and Supports During COVID-19.

BACKGROUND: Understanding teachers' appraisals of student wellness services and supports during COVID-19 is essential to strengthening services and improving student health outcomes. This mixed-method study aimed to examine US PK-12 teachers' appraisals of student wellness services and supports during COVID-19. METHODS: This study focuses on qualitative data from 291 teachers' open-ended responses to the question: "What do you wish your school leaders knew about this (wellness support) aspect of your work?" and whose responses described wellness services and supports. A qualitative content analysis was conducted by an interdisciplinary research team using open- and axial coding. RESULTS: Three main themes emerged. (1) insufficient access to mental health professionals and programming at schools, (2) concern about the quality of available services, and (3) a need for teacher professional development and support on student wellness. Statistically significant differences in teacher appraisals of insufficient access to mental health professionals and programming were found based on grade level taught and percentage of immigrant students in the school. CONCLUSION: With amplified student wellness needs, school personnel, including school leaders, must consider ways to allocate additional resources/staffing, assess the quality of services and supports, and design professional development opportunities to support teachers' involvement in supporting student wellness needs.

Organ-Specific and Mixed Responses to Pembrolizumab in Patients with Unresectable or Metastatic Urothelial Carcinoma: A Multicenter Retrospective Study.

To investigate the organ-specific response and clinical outcomes of mixed responses (MRs) to immune checkpoint inhibitors (ICIs) for unresectable or metastatic urothelial carcinoma (ur/mUC), we retrospectively analyzed 136 patients who received pembrolizumab. The total objective response rate (ORR) and organ-specific ORR were determined for each lesion according to the Response Evaluation Criteria in Solid Tumors version 1.1 as follows: (i) complete response (CR), (ii) partial response (PR), (iii) stable disease (SD), and (iv) progressive disease (PD). Most of the organ-specific ORR was 30−40%, but bone metastasis was only 5%. There was a significant difference in overall survival (OS) between responders and non-responders with locally advanced lesions and lymph node, lung, or liver metastases (HR 9.02 (3.63−22.4) p < 0.0001; HR 3.63 (1.97−6.69), p < 0.0001; HR 2.75 (1.35−5.59), p = 0.0053; and HR 3.17 (1.00−10.0), p = 0.049, respectively). MR was defined as occurring when PD happened in one lesion plus either CR or PR occurred in another lesion simultaneously, and 12 cases were applicable. MR was significantly associated with a poorer prognosis than that of the responder group (CR or PR; HR 0.09 (0.02−0.35), p = 0.004). Patients with bone metastases benefitted less. Care may be needed to treat patients with MR as well as patients with pure PD. Further studies should be conducted in the future.