Utility of ultrasound-based scoring system in post-pyeloplasty recovery.

BACKGROUND/OBJECTIVE: Differentiation of uretero-pelvic junction obstruction (UPJO) from non-obstructive dilatation (NOD) is a major challenge. The aim of this retrospective study is to determine whether pyeloplasty prediction score (PPS) could predict the need for surgery and resolution after surgery. METHODS: Among patients with antenatally diagnosed hydronephrosis, those who were stable during post-natal follow-up were considered NOD. The UPJO group were the ones who worsened and underwent pyeloplasty based on conventional indications. All patients with UPJO underwent laparoscopic dismembered pyeloplasty. PPS was determined based on three ultrasound parameters obtained retrospectively: Society of Fetal Urology (SFU) grade of hydronephrosis, transverse anteroposterior (APD), and the absolute percentage difference of ipsilateral and contralateral renal lengths. RESULTS: Among 137 patients included (R:L = 59:73; M:F 102:35), 96 were conservatively managed (NOD), while 41 patients (29%) needed pyeloplasty (UPJO). Mean PPS was 4.2 (1.2) in the NOD group and it was significantly higher at 10.8 (1.63) in the UPJO group (p = 0.001). All patients with PPS > 8 needed a pyeloplasty, while two patients with PPS of 7 needed pyeloplasty due to drop in renal function. PPS cutoff value of >8 had a sensitivity 95%, specificity 100% and a likelihood ratio of 20. Post-pyeloplasty PPS resolution was proportional to the duration of follow-up. CONCLUSIONS: A PPS cutoff value of 8 or above is associated with the presence of significant UPJO. PPS is also useful in the assessment of hydronephrosis recovery post-pyeloplasty. The limitation of PPS: it can only be applied in the presence of contralateral normal kidney.

Heat and health of occupational workers: a short summary of literature.

Globally, occupational workers suffer various health impacts due to extreme heat. In this short review, we examine the literature discussing health impacts of heat on occupational workers, and then discuss certain individual and institutional measures needed to address the problem. Though the available literature in the recent decade discusses health impacts of heat on workers as various heat-related illnesses, we found very few studies examining how occupational workers suffer from issues concerning cardiovascular health, neurological health, respiratory health, and mental health. In this regard, we highlight the need for more studies to examine how occupational workers exposed to extreme heat conditions suffer from fatal health issues like cardiovascular attack, brain stroke, and other ailments impacting vital organs of the body. Occupational workers across the world should be made aware of measures to protect themselves from extreme heat. Further, countries should develop occupational heat safety guidelines with statutory effect.

High-entropy engineering of the crystal and electronic structures in a Dirac material.

Dirac and Weyl semimetals are a central topic of contemporary condensed matter physics, and the discovery of new compounds with Dirac/Weyl electronic states is crucial to the advancement of topological materials and quantum technologies. Here we show a widely applicable strategy that uses high configuration entropy to engineer relativistic electronic states. We take the AMnSb2 (A = Ba, Sr, Ca, Eu, and Yb) Dirac material family as an example and demonstrate that mixing of Ba, Sr, Ca, Eu and Yb at the A site generates the compound (Ba0.38Sr0.14Ca0.16Eu0.16Yb0.16)MnSb2 (denoted as A5MnSb2), giving access to a polar structure with a space group that is not present in any of the parent compounds. A5MnSb2 is an entropy-stabilized phase that preserves its linear band dispersion despite considerable lattice disorder. Although both A5MnSb2 and AMnSb2 have quasi-two-dimensional crystal structures, the two-dimensional Dirac states in the pristine AMnSb2 evolve into a highly anisotropic quasi-three-dimensional Dirac state triggered by local structure distortions in the high-entropy phase, which is revealed by Shubnikov-de Haas oscillations measurements.

Transfusions with laboratory-grown red blood cells: a new development in science.

It is inevitable to anticipate the development of laboratory abilities and their involvement in clinical research in a fast-paced world. The RESTORE study is one such incident that has drawn the interest of various specialists. Red blood cells (RBCs) that have been generated in a laboratory have been transfused into a volunteer in this trial. To our knowledge, this procedure was the first to deliver laboratory-grown cells to another individual through a blood transfusion, which is an advancement in laboratory innovations. The purpose of the research was to determine how long a mini-transfusion of up to two teaspoons or 10 mL of laboratory-grown RBCs will persist in the body in comparison with an equivalent quantity of regular cells from the same donor. Assuming the process can be scaled up to a standard transfusion, this approach is advantageous because it can address the shortage of donors for those with rare blood types. Laboratory-grown blood cells are anticipated to last longer and perform better, which is another benefit to be noticed. This study represents a tremendous advancement in scientific innovation and teamwork while providing high-quality care to those who need it the most, although additional trials are required before clinical usage.

Stationary states in two-lane traffic: Insights from kinetic theory.

Kinetics of dilute heterogeneous traffic on a two-lane road is formulated in the framework of Ben-Naim-Krapivsky model and stationary state properties are analytically derived in the asymptotic limit. The heterogeneity is introduced into the model as a quenched disorder in desired speeds of vehicles. The two-lane model assumes that each vehicle or platoon in a lane moves ballistically until it approaches a slow-moving vehicle or platoon and then joins it. Vehicles in a platoon are assumed to escape the platoon at a constant rate by changing lanes after which they continue to move at their desired speeds. Each lane is assumed to have a different escape rate. As the stationary state is approached, the platoon densities in the two lanes become equal, whereas the vehicle densities and fluxes are higher in the lane with lower escape rate. A majority of the vehicles enjoy a free flow if the harmonic mean of the escape rates of the lanes is comparable to average initial flux on the road. The average platoon size is close to unity in the free-flow regime. If the harmonic mean is lower than the average initial flux, then vehicles with desired speeds lower than a characteristic speed v^{*} still enjoy free flow while those vehicles with desired speeds that are greater than v^{*} experience congestion and form platoons behind the slower vehicles. The characteristic speed depends on the mean of escape times [R=(R_{1}+R_{-1})/2] of the two lanes (represented by 1 and -1) as v^{*}∼R^{-1/µ+2}, where µ is the exponent of the quenched disorder distribution for desired speed in the small speed limit. The average platoon size in a lane, when v^{*}≪1, is proportional to R^{µ+1/µ+2} plus a lane-dependent correction. Equations for the kinetics of platoon size distribution for two-lane traffic are also studied. It is shown that a stationary state with platoons as large as road length can occur only if the mean escape rate is independent of platoon size.

Bladder height width ratio on voiding cystourethrogram as a predictor of future valve bladder in children with posterior urethral valve.

BACKGROUND/AIMS: Prompt and early treatment of valve bladder is known to improve renal outcome in patients with PUV. We hypothesized that bladder height width ratio (HWR) measurement on voiding cystourethrogram (VCUG) could predict development of valve bladder. METHODS: All patients who underwent primary PUV ablation and evaluated later with urodynamics were included. Valve bladder was suspected when there were daytime wetting, persistent hydroureteronephrosis, and elevated detrusor pressures on urodynamics. VCUGs were analysed for HWR: maximum height/width of bladder. ROC curve analysis was performed to identify HWR that could predict development of urodynamic abnormality. RESULTS: Between 2012 and 2017, 102 patients were studied: median age at valve ablation 25 days (3-125 days); follow-up 5 years (3-7 years). The ROC curve comparing post-ablation HWR with occurrence of valve bladder showed a cut-off of 1.45 (AUC 0.93). HWR cut-off of 1.45 had a sensitivity of 89% and specificity of 84% in predicting future valve bladder. Detrusor overactivity was noticed on urodynamics in 41/55 (74%) of those with HWR > 1.45 compared 5/47 (11%) in those with HWR < 1.45 (p = 0.001). CONCLUSION: Bladder height width ratio on VCUG is a useful parameter to predict development of future valve bladder in children with PUV.

A paper-based colorimetric molecular test for SARS-CoV-2 in saliva.

Herein, we describe the development of a paper-based device to detect nucleic acids of pathogens of interest in complex samples using loop-mediated isothermal amplification (LAMP) by producing a colorimetric response visible to the human eye. To demonstrate the utility of this device in emerging public health emergencies, we developed and optimized our device to detect SARS-CoV-2 in human saliva without preprocessing. The resulting device was capable of detecting the virus within 60 min and had an analytical sensitivity of 97% and a specificity of 100% with a limit of detection of 200 genomic copies/µL of patient saliva using image analysis. The device consists of a configurable number of reaction zones constructed of Grade 222 chromatography paper separated by 20 mil polystyrene spacers attached to a Melinex® backing via an ARclean® double-sided adhesive. The resulting device is easily configurable to detect multiple targets and has the potential to detect a variety of pathogens simply by changing the LAMP primer sets.

Utility of ultrasound elastography in postoperative follow-up of children with unilateral ureteropelvic junction obstruction.

INTRODUCTION: We aimed to determine whether shear wave velocity (SWV) on ultrasound elastography is useful in follow-up of children with ureteropelvic junction obstruction (UPJO) following pyeloplasty. METHODS: Consecutive children with unilateral UPJO who were co-operative for elastography (n = 31) were included. SWV of normal kidney was used as control, and it was compared with that of the affected kidney (UPJO) in the same patient. They were followed up with elastography at 3 months and elastography + renogram at 6 months postoperatively. In patients with a static renogram at 6 months, the study was repeated at 1 year. Patient outcomes were classified as improved at 6 months, static at 6 months, and worsened at 1 year based on ultrasound and renogram findings. The SWV was compared between the different outcomes. RESULTS: Thirty-one children with a median age of 8.5 years were studied (m:f = 29:2; L:R = 22:9). The mean SWV was significantly higher (3.21 m/s) in UPJO kidney compared to the SWV (2.72 m/s) found in normal kidney (P = 0.011). The mean SWV was significantly less at 3 months (2.73 m/s) and 6 months (2.57 m/s) postoperative follow-up (P = 0.018 and P= 0.001). Among the patients who improved, the mean SWV was 2.65 m/s. This SWV was significantly raised (3.57 m/s) in patients whose condition remained static (P = 0.006) and even higher (4.36 m/s) in those who worsened (P = 0.001). CONCLUSIONS: SWV was significantly higher in UPJO compared to normal kidneys in children. It is useful in assessing postoperative resolution, and a rising velocity can be useful as an early marker of recurrence in UPJO.

Comparison of different pathological markers in predicting pyeloplasty outcomes in children.

PURPOSE: To compare the efficacy of pathological markers like Interstitial cells of Cajal (ICC), neurons and Collagen to Muscle ratio (CM ratio), in predicting pyeloplasty outcomes. METHODS: Histological sections from 31 patients with UPJO were analyzed for ICC & neurons on immuno-histochemistry and CM ratio on Masson's trichrome staining. Post-operative outcomes were analyzed at 1-year follow up; expressed as excellent, moderate or mild improvement, static and deterioration based on the three factors: ultrasound grade, differential renal function and renogram drainage pattern. The pathological findings were correlated with clinical outcomes. RESULTS: The study group (n = 31) had a mean age 2.9 (0.6) years (M: F = 22:9). UPJ segment had significantly less ICC/neurons and more collagen compared to normal ureter (p = 0.001). Pathological parameters at the anastomosed end of ureter had a better correlation than those at UPJ with clinical outcome. CM ratio with a stronger correlation (r = - 0.94; p = 0.001) was a better predictor of prognosis than ICC (r = 0.76; p = 0.01) or neuron (r = 0.83; p = 0.01) density. ICC >10/HPF, neurons >6/HPF and CM ratio <1.2 at ureteric end anastomosed were predictors of success. CONCLUSIONS: CM ratio analysis at anastomosed ureter is a superior marker for predicting pyeloplasty outcomes. LEVEL OF EVIDENCE: Type 2: Development of diagnostic criteria in a consecutive series of patients.

A Rapid Special Staining Technique for Identification of Normal Ureter by Frozen Section in Children With Ureteropelvic Junction Obstruction.

BACKGROUND: The exact etiology of ureteropelvic junction obstruction (UPJO) is unknown, and inadequate excision of the narrow segment has been proposed as a cause of failure in 5% to 7% of cases of pyeloplasty. AIMS: To study whether frozen section can be useful to detect normal ureter distal to UPJO during pyeloplasty. METHODS: Histological sections from 31 patients with UPJO were analyzed for collagen to muscle ratio (CMR) on conventional (formalin) and rapid (frozen section) Masson's trichrome staining. Pathological findings were correlated with postoperative outcomes analyzed at 1-year follow-up and expressed as excellent, moderate, or mild improvement, static and deterioration based on ultrasound grade, differential renal function, and renogram drainage pattern. RESULTS: There was a very strong positive correlation (r = .94; P = .001) between CMR by conventional and rapid frozen Masson's trichrome staining. There was a very strong negative correlation between pyeloplasty outcomes and CMR on conventional staining (r = -.94; P = .001) or rapid frozen Masson's trichrome staining (r = -.91; P = .001). Regression analysis revealed that a CMR of 1.2 or less (95% confidence interval: 1.9-0.7) was associated with a successful outcome. CONCLUSIONS: It is feasible to intraoperatively identify normal ureter distal to UPJO using CMR analysis on the novel rapid frozen section technique reported.

Correlation between Ultrasound-based TIRADS and Bethesda System for Reporting Thyroid-cytopathology: 2-year Experience at a Tertiary Care Center in India.

BACKGROUND: In recent times, high-resolution ultrasound thyroid imaging has paved the way for significant transformation in clinical approach to thyroid nodule. There are several risk stratification systems in thyroid imaging, developed with an aim, not only to reduce the inter-observer variability but also to establish effective communication system. Thyroid image reporting and data system (TIRADS) classification system, which is similar to breast imaging reporting and data system for breast lesion, is the most useful of all. To our knowledge, there is just a handful published research articles available based on Indian population in this regard. In this article, we study the thyroid nodules using high-resolution ultrasound in Indian population and we try to correlate the TIRADS and Bethesda system for reporting thyroid cytopathology. MATERIALS AND METHODS: This prospective study includes 184 patients studied over a period of 2 years (April 2015-April 2017). Patients having thyroid nodule in B-mode ultrasound and are scheduled to get a fine-needle aspiration cytology (FNAC) done. Bethesda classification of these nodules is tabulated in follow-up period simultaneously. By comparing these data, efficacy of TIRADS in differentiating benign from malignant nodules are assessed finally using accuracy, positive predictive value (PPV), cross-tabulation, and Chi-square tests. RESULTS: Out of the 117 TIRADS 2 nodules, none turned out to be Bethesda IV or higher, which means none of these nodules turned out to be malignant. The risk of malignancy for TIRADS 2, TIRADS 3, TIRADS 4, and TIRADS 5 was 0, 2.2, 38.5, and 77.8%, respectively. The risk of malignancy percentage in our study is similar to those values obtained in other prominent studies. CONCLUSION: The probability of a particular nodule being malignant can be effectively inferred from the ultrasound-based TIRADS system with a certain level of confidence. Considering our results and other literature reviews, it be can be safely assumed that FNAC can be at least deferred in patients having TIRADS 2 nodules, which contribute to majority of newly detected cases. In our experience, there is a remarkable correlation exists between TIRADS ultrasound classification and Bethesda cytology, especially for benign nodules.

Evaluating Neonates With Antenatal Hyderonephrosis Using a Standard Protocol: An Audit of Hospital Records.

AIMS: To audit the extent of evaluation of neonates with antenatal hydronephrosis. METHODS: Records of all neonates with antenatal hydronephrosis between January 2013 and December 2016 were audited to look for patient factors and investigation results. RESULTS: 290 records were evaluated, 93 (32%) of which had abnormalities detected on voiding cystourethrogram. In the presence of hydroureter, 65% had an abnormality while in the absence only 11% were abnormal. In the presence of pelvis ≥20 mm, 93% had abnormal diuretic renogram, while with pelvis <20 mm, only 1.5% were abnormal (P=0.001). Numbers needed to harm calculation revealed 1 in 2 patients would receive an unnecessary voiding cystourethrogram in the absence of hydroureter, and unnecessary diuretic renogram when pelvis <20 mm. CONCLUSIONS: While evaluating neonates with antenatal hydronephrosis invasive tests can be limited, if evaluation is guided by ultrasonographic criteria.

Orphan disease: Cherubism, optic atrophy, and short stature.

A 12-year-old female presented with complaints of progressive visual impairment in both her eyes. On clinical examination, she was short for her age and her ophthalmoscopic examination revealed bilateral optic atrophy. Computed tomography of the patient revealed multiple expansile lytic lesions of mandible suggesting cherubism. The optic atrophy was confirmed on magnetic resonance imaging, which additionally revealed bilateral retrocerebellar arachnoid cysts. This association of cherubism with optic atrophy and short stature was grouped as orphan disease by National Institutes of Health and only one case was reported in the literature so far.