Diversity of the midstream urine microbiome in adults with chronic kidney disease

Purpose

To examine the characteristics of the midstream urine microbiome in adults with stage 3–5 non-dialysis-dependent chronic kidney disease (CKD).

Methods

Patients with non-dialysis-dependent CKD (estimated glomerular filtration rate [eGFR]?<?60 ml/min/1.73 m²) and diuretic use were recruited from outpatient nephrology clinics. Midstream voided urine specimens were collected using the clean-catch method. The bacterial composition was determined by sequencing the hypervariable (V4) region of the bacterial 16S ribosomal RNA gene. Extraction negative controls (no urine) were included to assess the contribution of extraneous DNA from possible sources of contamination. Midstream urine microbiome diversity was assessed with the inverse Simpson, Chao and Shannon indices. The diversity measures were further examined by demographic characteristics and by comorbidities.

Results

The cohort of 41 women and 36 men with detectable bacterial DNA in their urine samples had a mean age of 71.5 years (standard deviation [SD] 7.9) years (range 60–91 years). The majority were white (68.0%) and a substantial minority were African-American (29.3%) The mean eGFR was 27.2 (SD 13.6) ml/min/1.73 m². Most men (72.2%) were circumcised and 16.6% reported a remote history of prostate cancer. Many midstream voided urine specimens were dominated (>?50% reads) by the genera Corynebacterium (n?=?11), Staphylococcus (n?=?9), Streptococcus (n?=?7), Lactobacillus (n?=?7), Gardnerella (n?=?7), Prevotella (n?=?4), Escherichia_Shigella (n?=?3), and Enterobacteriaceae (n?=?2); the rest lacked a dominant genus. The samples had high levels of diversity, as measured by the inverse Simpson [7.24 (95% CI 6.76, 7.81)], Chao [558.24 (95% CI 381.70, 879.35)], and Shannon indices [2.60 (95% CI 2.51, 2.69)]. Diversity measures were generally higher in participants with urgency urinary incontinence and higher estimated glomerular filtration rate (eGFR). After controlling for demographics and diabetes status, microbiome diversity was significantly associated with estimated eGFR (P?<?0.05).

Conclusions

The midstream voided urine microbiome of older adults with stage 3–5 non-dialysis-dependent CKD is diverse. Greater microbiome diversity is associated with higher eGFR.

     

Defects in processing and trafficking of the AE1 Cl<Superscript>−</Superscript>/HCO3<Superscript>−</Superscript> exchanger associated with inherited distal renal tubular acidosis

Distal renal tubular acidosis (dRTA) results from impaired urinary acidification by the renal collecting duct. Acquired dRTA can be secondary to diverse pathological processes, including diabetic, ischemic, fibrosing, or immunological processes; less frequently it presents as a familial disorder with either an autosomal recessive or dominant pattern of transmission. Mutations in the SLC4A1/AE1/band 3 Cl^?/HCO₃ ^? exchanger gene have been identified as causes for both dominant and recessive forms of dRTA. These mutations comprise a group almost entirely distinct from the SLC4A1 mutations that underlie the familial hemolytic anemia of hereditary spherocytosis. Why does one group of mutations express almost exclusively an isolated erythroid phenotype, whereas the second group of mutations expresses almost exclusively a phenotype explicable entirely by defective function of renal collecting duct type A intercalated cells? This review summarizes current research addressing this central question in the pathobiology of inherited dRTA associated with mutations in the SLC4A1 gene. Studying dRTA-associated mutant AE1 polypeptides can provide novel insights into the biology of the intercalated cell and the collecting duct as well as more generally into mechanisms by which epithelial cells generate and maintain functional polarity.     

Risk factors for predicting increased surgical drain output in patients after anterior cervical corpectomy and fusion

Background

Although measures to reduce and treat the postoperative surgical drain output are discussed, along with the increased interest in causative factors related to the prevention and treatment reported by many studies, these are still controversial.

Methods

A retrospective study was conducted on a consecutive series of 217 patients who had underwent ACCF between January 2016 and March 2017. Patients were categorized based on normal or increased total drain output. These two groups were compared for demographic distribution and clinical data to investigate the predictive factors of increased drain output by multivariate analysis.

Results

The overall incidence rate of increased drain output after ACCF was 16.6%. There are no significant differences in sex, BMI, history of taking aspirin, and ASA classification between the two groups (P?>?0.05). Of the patients with increased drain output, a significantly higher proportion of patients have OPLL in the surgical level, 18 (50.0%) versus 33 (18.2%) (P?=?0.000). The mean age was 60.67?±?8.18 years versus 54.41?±?10.05 years (P?=?0.001). Number of discs involved was 2.42?±?0.50 versus 2.02?±?0.65 (P?=?0.001). Operation time was 112.22?±?16.49 min versus 105.21?±?17.89 min (P?=?0.031). Intraoperative blood loss was 109.86?±?62.02 mL versus 87.83?±?56.40 mL (P?=?0.036). Logistic regression analysis showed that age (OR, 1.075; p?=?0.003), history of smoking (OR, 2.792; p?=?0.021), OPLL in surgical level (OR, 2.107; p?=?0.001), and number of discs involved (OR, 2.764; p?=?0.003) maintained its significance in predicting likelihood of increased surgical drain output.

Conclusions

The occurrence of increased drain output after ACCF is most likely multifactorial and is related to age, history of smoking, OPLL in surgical level, and number of discs involved.

     

Sagittal abdominal diameter and Framingham risk score in non-dialysis chronic kidney disease patients

Background

Chronic kidney disease (CKD) is very common now and is associated with high overall and cardiovascular mortality. Numerous studies have reported that abdominal obesity is a risk factor for cardiovascular mortality. We investigated the link between sagittal abdominal diameter (SAD) and Framingham risk score in non-dialysis CKD patients.

Methods

In a cross-sectional study, we enrolled 307 prevalent non-dialysis CKD patients (175 males, aged 50.7?±?17.04 years). SAD and Framingham risk score were measured.

Results

Framingham cardiovascular disease risk score was independently predicted by SAD (P?<?0.01), GFR (P?<?0.01) and diabetic history (P?<?0.05). Adjusted R² of the model was 0.178. SAD could be independently predicted by BMI (P?<?0.01), diabetic history (P?<?0.01), GFR (P?<?0.01) and age (P?<?0.01). Adjusted R² of the model was 0.409. Using receiver operating characteristic (ROC) curve, a cutoff SAD value of 16.55 cm was determined with sensitivity of 63.7%, specificity of 58.3%.

Conclusion

Elevated SAD is significantly associated with increased Framingham risk score in non-dialysis CKD patients. SAD can be predicted by patients’ BMI, diabetic history, renal function and age. Further investigation is needed to explore the potential benefits of central obesity lowering therapy in this patient group.

     

Evaluation of the theoretical optimal angle of the tibial tunnel in transtibial anatomic posterior cruciate ligament reconstruction by computed tomography

Background

“Killer turn” effect is a critical explanation for the recurrent posterior laxity following transtibial posterior cruciate ligament (PCL) reconstruction, which affected by the angle of the tibial tunnel. Meanwhile, excessive tunnel angle would have an adverse impact on the healing of tendon to bone. The purpose was to evaluate the theoretical optimal angle of the tibial tunnel in transtibial anatomic PCL reconstruction.

Methods

The measurements were performed on CT sagittal plane, including the thickness of cancellous bone (L1), the theoretical optimal angle of the tibial tunnel (TOA, which was measured between tibial plateau and the extension cord connecting the center of PCL insertion site with a point 5?mm superior from marrow cavity vertex), L2 - the distance from anterior tunnel aperture to anterior end of tibial plateau, L3 - the distance from anterior tunnel aperture to tibial tuberosity (lowest edge of patellar ligament attachment).

Results

The value of TOA and L3 were 35.4?±?7.9 ° and 26.8?±?11.4?mm, respectively. L1 and L2 were higher in males than females (L1, P?= 0.002; L2, P?= 0.046). Regarding age, L1, TOA, L2 and L3 were higher in the 46–60?years group than 31–45?years group (P =?0.02, P =?0.001, P =?0.038, P =?0.032, respectively). With regard to height, L1 was lower in group I - <?1.66?m than group II - 1.66 to 1.75?m and group III -?>?1.75?m (I v II, P =?0.015, I v III, P =?0.026). L2 was also lower in group I than group II and group III (I v II, P =?0.026, I v III, P =?0.006). TOA and L3 showed no significant differences among sex and height groups (P?>?0.05).

Conclusions

TOA (35.4 °?±?7.9 °) and L3 (26.8?±?11.4?mm) could be used as a reference for ideal tibial tunnel placement in transtibial anatomic PCL reconstruction, so as to prevent recurrent PCL laxity and ensure good graft healing. However, further clinical validation is needed.

     

Low-intensity red and infrared lasers affect mRNA expression of DNA nucleotide excision repair in skin and muscle tissue

Lasers emit light beams with specific characteristics, in which wavelength, frequency, power, fluence, and emission mode properties determine the photophysical, photochemical, and photobiological responses. Low-intensity lasers could induce free radical generation in biological tissues and cause alterations in macromolecules, such as DNA. Thus, the aim of this work was to evaluate excision repair cross-complementing group 1 (ERCC1) and excision repair cross-complementing group 2 (ERCC2) messenger RNA (mRNA) expression in biological tissues exposed to low-intensity lasers. Wistar rat (n?=?28, 4 for each group) skin and muscle were exposed to low-intensity red (660 nm) and near-infrared (880 nm) lasers at different fluences (25, 50, and 100 J/cm²), and samples of these tissues were withdrawn for RNA extraction, cDNA synthesis, and gene expression evaluation by quantitative polymerase chain reaction. Laser exposure was in continuous wave and power of 100 mW. Data show that ERCC1 and ERCC2 mRNA expressions decrease in skin (p?<?0.001) exposed to near-infrared laser, but increase in muscle tissue (p?<?0.001). ERCC1 mRNA expression does not alter (p?>?0.05), but ERCC2 mRNA expression decreases in skin (p?<?0.001) and increases in muscle tissue (p?<?0.001) exposed to red laser. Our results show that ERCC1 and ERCC2 mRNA expression is differently altered in skin and muscle tissue exposed to low-intensity lasers depending on wavelengths and fluences used in therapeutic protocols.     

Acute septic arthritis of shoulder joint caused by <Emphasis Type="Italic">Aeromonas veronii biotype sobria</Emphasis>

We present the case of a 91-year-old woman who presented with a 2?day history of progressive pain and immobility of the right shoulder joint after fever of unknown etiology. Aeromonas sobria was isolated from a culture of purulent synovial fluid. The clinical condition gradually improved with the application of appropriate antibiotics and no surgical intervention was necessary. This report indicates that acute septic arthritis may result from Aeromonas veronii biotype sobria infections in healthy people. This case is contrary to the previous reports due to the absence of obvious risk factors.     

A retrospective comparison of two vaginal mesh kits in the management of anterior and apical vaginal prolapse: long-term results for apical fixation and quality of life

Introduction and hypothesis

To compare apical correction in stage ≥3 cystocele between two mesh kits.

Methods

This was a retrospective, nonrandomized study that compared two groups matched on anterior/apical POP-Q stage: 84 received Elevate Ant? single-incision mesh (Elevate Ant group) and 42 Perigee? transvaginal mesh (Perigee group). Follow-up at 1 and 2 years comprised objective (POP-Q) and subjective (PFDI-20, PFIQ-7, PISQ-12) assessments. The primary endpoint was objective success: 2-year apical POP-Q stage ≤1. Secondary endpoints were anterior POP-Q stage, subjective results and complications.

Results

Groups were comparable in terms of age (66.6 and 64.7 years, respectively; p?=?0.19), BMI (both 25.4 kg/m²; p?=?0.93), and history of hysterectomy (7.2 % and 14.3 %; p?=?0.21) or prolapse surgery (12 % and 14.3 %; p?=?0.72). Operative time was shorter in the Elevate Ant group (54.1 vs. 62.5 min; p?=?0.048), and the 2-year objective apical success rate was higher (92.9 % vs. 66.7 %; p?<?0.0001), with better point C correction (?5 vs. ?3.8; p?=?0.006). Function improved in both groups, with significantly better PFIQ-7 (p?=?0.03) and PFDI-20 (p?=?0.02) scores in the Elevate Ant group at 2 years. Vaginal exposure was not seen in the Elevate Ant group but occurred in two patients in the Perigee group (p?=?0.33). Factors associated with success were age >65 years (OR 7.16, 95 % CI 1.83?–?27.97) and treatment with Elevate Ant mesh (OR 10.16, 95 % CI 2.78?–?37.14). Postoperative stress urinary incontinence rate was greater with the Elevate Ant group (29.8 % and 16.7 %; p?=?0.11).

Conclusions

The use of the Elevate Ant mesh was associated with significantly better apical correction at 2 years. Function improved in both groups, but with a significantly better PFDI-20 score in the Elevate Ant group at 1 and 2 years. The postoperative stress urinary incontinence rate, however, tended to be greater in the Elevate Ant group. The results need confirming with longer follow-up of these cohorts and in randomized studies.

     

Influence of Age on the Clinical Outcome of Breast Cancer for Men and the Development of Second Primary Cancers

Background

Low incidence of breast cancer in men (BCM) (<?1% of all breast cancers) has led to a paucity of outcome data. This study evaluated the impact of age on BCM outcomes.

Methods

For this study, BCM patients treated between 2000 and 2011 were stratified by age (≤?65 or?>?65 years). Kaplan–Meier methods were used to compare overall survival (OS) and breast cancer-specific survival (BCSS). Competing-risk methods analyzed time to second primary cancers (SPCs), with any-cause death treated as a competing risk.

Results

The study identified 152 BCM patients with a median age of 64 years (range 19–96 years). The median body mass index (BMI) was 28 kg/m². Men age 65 years or younger (n?=?78, 51%) were more overweight/obese than men older than 65 years (n?=?74, 49%) (89% vs 74%, respectively; P?=?0.008). Both groups had similar nodal metastases rates (P?=?0.4), estrogen receptor positivity (P?=?1), and human epidermal growth factor receptor 2 (HER2)neu overexpression (P?=?0.6). Men 65 years of age or younger were more likely to receive chemotherapy (P?=?0.002). The median follow-up period was 5.8 years (range 0.1–14.4 years). The 5-year OS was 86% (95% confidence interval [CI] 80–93%), whereas the 5-year BCSS was 95% (95% CI 91–99%). The BCM patients 65 years of age and younger had better OS (P?=?0.003) but not BCSS (P?=?0.8). The 5-year cumulative incidence of SPC was 8.4% (95% CI 3.4–13.4%). The prior SPC rate was higher for men older than 65 years (n?=?20, 31%) than for those age 65 years or younger (n?=?7, 11%) (P?=?0.008). This did not account for differences in life years at risk. No difference was observed in SPC cumulative incidence stratified by age (P?=?0.3).

Conclusions

Men 65 years of age or younger received more chemotherapy and had improved OS, but not BCSS, compared with men older than 65 years. For all BCM, SPC is a risk, and appropriate screening may be warranted.

     

Evidence for the polyphyly of <Emphasis Type="Italic">Encoelia</Emphasis> and <Emphasis Type="Italic">Encoelioideae</Emphasis> with reconsideration of respective families in Leotiomycetes

This study focuses on the genus Encoelia and the subfamily Encoelioideae in the morphologically and ecologically diverse Helotiales. The 28S and 18S rDNA as well as tef1, rpb1 and rpb2 were sequenced for 70 species. Phylogenetic analyses revealed Encoelia and Encoelioideae to be highly polyphyletic, with species distributed among eight major lineages. Encoelia fascicularis and E. pruinosa belonged to Sclerotiniaceae and were combined in a new genus, Sclerencoelia. Rutstroemiaceae comprised E. tiliacea and Dencoeliopsis johnstonii, both accepted in Rutstroemia. The type of Encoelia, E. furfuracea, was closely related to species of Velutarina, Cenangiopsis and Crumenulopsis. These species together with members of Hemiphacidiaceae formed a clade conforming to the emended concept of Cenangiaceae, introduced here. Another resurrected family, Cordieritidaceae, comprised E. fimbriata, E. heteromera and species of Ameghiniella, Cordierites, Diplocarpa and Ionomidotis, characterised by inamyloid asci and a positive ionomidotic reaction. Encoelia glauca showed closest affinities with Chlorociboria species in Chlorociboriaceae. A new genus, Xeropilidium, with sporodochial and pycnidial synanamorphs, was described for the distinct encoelioid member of the Chaetomellaceae, previously known as E. fuckelii. Morphological and ecological synapomorphies were distinguished from convergent characters to delimit monophyletic taxa including encoelioid fungi. Incorporation of public sequences from various biological samples in ITS rDNA analyses allowed identification of sequenced organisms at species, genus, or family level and added information on the ecology of seversal taxa. Members of Cenangiaceae appeared to be widespread as endophytes. Inclusion of encoelioid genera in Chaetomellaceae and Sclerotiniaceae added xylicolous saprotrophs to these families.     

Comparison of Vela and holmium laser enucleation of the prostate: a retrospective clinical trial with a 12-month follow-up

Purpose

This study aimed to estimate the validity and applicability of Vela laser enucleation of the prostate (VoLEP) in the management of benign prostatic hyperplasia (BPH).

Methods

A retrospective chart review of 112 patients with BPH who underwent VoLEP (n?=?60) or holmium laser enucleation of the prostate (HoLEP) (n?=?56) was conducted at our institution from January 2015 to June 2015. The general and perioperative characteristics of the patients were collected. The 12-month follow-up data, including the lower urinary tract symptom (LUTS) indexes (International Prostate Symptom Score [I-PSS], quality-of-life [QoL] score and maximum flow rate [Qmax]), as well as rates of perioperative and late complications, were analyzed.

Results

No significant differences were observed in pre- and perioperative parameters, including operation time (58.05?±?10.14 vs. 60.14?±?12.30 min, P?=?0.44), serum sodium decrease (3.49?±?0.83 vs. 3.48?±?0.84 mmol/L, P?=?0.97), hemoglobin decrease (1.28?±?0.38 vs. 1.24?±?0.77 g/dL, P?=?0.71), catheterization time (3.63?±?1.10 vs. 3.89?±?1.11 days, P?=?0.21) and hospital stay (4.57?±?1.25 vs. 4.68?±?1.18 days, P?=?0.63) between the two groups of patients. Compared with the HoLEP group, the noise during operation was lower in VoLEP group (47.22?±?10.31 vs. 59.45?±?9.65 db, P?<?0.05). During 1, 6 and 12 months of follow-up visits, the LUTS indexes (I-PSS, QoL score and Qmax) were remarkably improved in both groups when comparing with the baseline values. Furthermore, LUTS indexes were comparable in both groups (P?>?0.05).

Conclusion

Similarly as the holmium laser, the Vela laser is a potent, safe, efficient durable and surgical treatment option for minimally invasive surgery in patients with BPH-induced LUTS.

     

Application of three-dimensional computerised tomography reconstruction and image processing technology in individual operation design of developmental dysplasia of the hip patients

Purpose

Acetabular coverage deficiency displays individual difference among patients with developmental dysplasia of the hip (DDH). Therefore, the correct direction and degree of the acetabular fragment is patient-specific during Bernese periacetabular osteotomy (PAO). This paper introduces a feasible method using 3D computed tomography (CT) and computer image processing technology for customised surgical planning.

Methods

CT data of 96 hips in 60 DDH patients (male 15, female 45; average age/range 30?±?8/14–49 years) and 53 normal hips (male 13, female 37; average age/range 52?±?13/16–69 years) were reconstructed using commercially available software Mimics and Imageware. Geometric parameters of each hip were measured in relation to the anterior pelvic plane after correcting for pelvic tilt and rotation. Deficiency types and degrees of acetabular dysplasia in patients with DDH were determined by comparison with normal hips, and improvement in femoral-head coverage was analysed again after virtual PAO. A customised surgery programme for each DDH patient was designed and provided the reference for the actual operation.

Results

We produced a 3D pelvic model using image processing software, doing precise measurement and with close approximation to the actual PAO. Lateral centre-edge angle (LCEA), anterior centre-edge angle (ACEA), acetabular anteversion angle (AAVA), anterior acetabular sector angle (AASA) and posterior acetabular sector angle (PASA) of normal hips in the control group were 35.128?±?6.337, 57.052?±?6.853, 19.215?±?5.504, 61.537?±?7.291 and 99.434?±?8.372°, respectively. Angles of hips with DDH before surgery were 11.46?±?11.19, 35.79?±?13.75, 22.77?±?6.13, 43.58?±?9.15 and 88.46?±?8.24, which were corrected to 33.81?±?2.36, 55.38?±?2.09, 20.16?±?2.18, 58.29?±?7.60, and 4.71?±?7.75°, respectively, after surgery. After virtual Bernese PAO, LCEA, ACEA, AAVA, AASA and PASA were corrected significantly (p?<?0.01). There was no statistically significant differences between LCEA, ACEA and AAVA after virtual Bernese PAO and normal hips (p?=?0.06, p?=?0.23, p?=?0.06°, respectively). AASA improved significantly (p?=?0.002) post-operatively at the cost of reducing posterior coverage represented by PASA, which is significantly smaller than in normal and pre-operative hips of DDH patients (p?<?0.01).

Conclusions

The geometric feature of the pelvis for patients with DDH can be assessed comprehensively by using 3D-CT reconstruction and image processing technology. Based on this method, surgeons can design individualised treatment scheme and improve the effect of PAO.

     

Neutrophil activation,protein oxidation and ceruloplasmin levels in children with Henoch-Schönlein purpura

The aim of this study was to investigate the role of neutrophil activation, protein oxidation and ceruloplasmin (CLP) in the pathogenesis of Henoch-Schönlein purpura (HSP), which has not been investigated previously. Serum activities of myeloperoxidase (MPO) and arylesterase (ARYL) and levels of free thiol groups, CLP and total oxidant status (TOS) were measured in 29 children with HSP at the onset of the disease and during remission in comparison with 30 healthy subjects. Patients at active stage had significantly higher MPO activity (391?±?277 vs. 155?±?154 U/l, P? P?2O₂/l, P?3?±?39?×?10³ vs. 187?×?10³?±?46?×?10³ U/l, P? P?r?=?0.437, P?=?0.018) and TOS and CLP (r?=?0.409, P?=?0.028) at disease onset, whereas a negative correlation was found between MPO and thiol (r?=??0.597, P?=?0.001) during remission. In conclusion, protein oxidation and neutrophil activation may play important roles in the pathogenesis of HSP. Further research is required to understand the potential linkage between oxidant stress and complications and to develop therapeutic strategies in HSP.     

Impact of COVID-19 and containment measures on burn care: A qualitative exploratory study

BackgroundBurn care in India is limited by multiple constraints. The COVID-19 pandemic and the containment measures restricted access to non-COVID emergency conditions, including burns. The aim of this study was to explore the impact of the pandemic on burn care in India.MethodsUsing the qualitative exploratory methods, we conducted in-depth interviews (IDI) with plastic and general surgeons representing burn units from across India. Participants were selected purposively to ensure representation and diversity and the sample size was guided by thematic saturation. Thematic analysis was undertaken adopting an inductive coding using NVivo 12 Pro.Results19 participants from diverse geographic locations and provider types were interviewed. Three major emerging themes were, change in patient and burn injury characteristics; health system barriers, adaptation, and challenges; and lessons and emerging recommendations for policy and practice. There was change in patient load, risk factors, and distribution of burns. The emergency services were intermittently disrupted, the routine and surgical services were rationally curtailed, follow-up and rehabilitation services were most affected. Measures like telemedicine and decentralising burn services emerged as the most important lesson.ConclusionsThe ongoing pandemic has compounded the challenges for burns care in India. Urgent action is required to prioritise targeted prevention, emergency transport, decentralise service delivery, and harnessing technology for ensuring resilience in burns services.     

Impaired bone mineral density as a predictor of graft subsidence following minimally invasive transpsoas lateral lumbar interbody fusion

Purpose

The LLIF procedure is a useful stand-alone and adjunct surgical approach for many spinal conditions. One complication of LLIF is subsidence of the interbody graft into the vertebral bodies, resulting in severe pain, impaired arthrodesis and potentially fracture of the body. Low bone density, as measured by T score on DEXA scanning, has also been postulated to increase the risk of subsidence.

Methods

A retrospective review of prospectively collected data was performed on all patients who underwent LLIF at this institution consisting of 712 levels in 335 patients. Patients with subsidence following LLIF were recorded. We utilized the T score obtained from the femoral neck DEXA scans, which is used to determine overall fracture risk. The T score of patients with subsidence was compared to those without subsidence.

Results

20 of 57 (35 %) patients without subsidence had a DEXA T score between ?1.0 and ?2.4 consistent osteopenia, one patient (1.8 %) exhibited a T score less than ?2.5, consistent with osteoporosis. 13 patients of 23 (57 %) with subsidence exhibited a T score between ?1.0 and ?2.4, consistent with osteopenia, five (22 %) exhibited a T score of ?2.5 or less, consistent with osteoporosis. The mean DEXA T score in patients with subsidence was ?1.65 (SD 1.04) compared to ?0.45 (SD 0.97) in patients without subsidence (p < 0.01). The area under the receiver operating characteristic curve for patients with a T score of ?1.0 or less was 80.1 %.

Conclusions

Patients with DEXA T scores less than ?1.0 who undergo stand-alone LLIF are at a much higher risk of developing graft subsidence. Further, they are at an increased risk of requiring additional surgery. In patients with poor bone quality, consideration could be made to supplement the LLIF cage with posterior instrumentation.

     

Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project

Purpose

To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa).

Methods

A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated.

Results

Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text.

Conclusion

Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.

     

The family Amanitaceae: molecular phylogeny,higher-rank taxonomy and the species in China

Mushrooms in the basidiomycete family Amanitaceae are very important both economically and ecologically. However, the delimitation of the family is still controversial, in part due to limited taxon sampling and in part because of insufficient gene fragment employed for molecular phylogenetic analyses. Furthermore, species diversity in the family is likely to have been largely underestimated, due to morphological similarity between taxa and phenotypic plasticity. In this study, we examined 1190 collections, including 1008 Chinese and 182 external ones, and performed the first comprehensive phylogenetic analyses of Amanitaceae using multi-locus sequence data. To test the monophyly of the Amanitaceae, a concatenated (nrLSU, rpb1, and rpb2) dataset of 200 taxa of the order Agaricales was analyzed. To infer the phylogeny of Amanitaceae, a concatenated nrLSU, tef1-α, rpb2 and β-tubulin dataset (3010 sequences from ca. 890 samples with 2309 newly generated sequences) was used. In this dataset, 252 sequences from the types of 77 species were provided. Our results indicate that Amanitaceae is a monophyletic group, and consists of five genera, namely Amanita, Catatrama, Limacella, Limacellopsis and Myxoderma. It is clear that Catatrama is closely related to Limacella, however, the phylogenetic relationships among these genera remain largely unresolved. Amanita contains 95% of the species in the family, and is here divided into three subgenera and eleven sections (subgen. Amanita, containing: sect. Amanita, sect. Amarrendiae, sect. Caesareae and sect. Vaginatae; subgen. Amanitina, containing: sect. Amidella, sect. Arenariae, sect. Phalloideae, sect. Roanokenses, sect. Strobiliformes and sect. Validae; and subgen. Lepidella, containing sect. Lepidella). Subgen. Lepidella occupies the basal position in the genus. One-hundred and sixty-two species of Amanitaceae known from China are treated in this study, including 50 novel species and 112 known taxa. Amanita gleocystidiosa, A. pyriformis, A. atrofusca, A. subjunquillea var. alba and A. areolata are treated as synonyms of A. sychnopyramis f. subannulata, A. orientigemmata, A. umbrinolutea, A. subjunquillea and A. zangii, respectively. 26 extralimital taxa including a novel species, namely Catatrama indica, were included in our study to allow us to make comparisons between these and the Chinese taxa. DNA sequence data for all the species of Amanitaceae in China and keys for identification of the species are provided.     

Validation of the International Consultation on Incontinence Questionnaire–Vaginal Symptoms (ICIQ-VS) in two south- Asian languages

Introduction

The multifaceted nature of pelvic floor disorders means that a systematic evaluation is required for optimal treatment outcome. It is also generally acknowledged that a valid tool is necessary to objectively assess symptoms reported by affected women.

Methods

The International Consultation on Incontinence Questionnaire—Vaginal Symptoms (ICIQ-VS) questionnaire was translated to Sinhala and Tamil and a validation study carried out among women attending gynecology clinics at North Colombo Teaching Hospital, Ragama, and the district general hospitals Mannar and Vavuniya.

Results

Content validity was assessed by the level of missing answers, which was < 4% and 2% for each item in Sinhala and Tamil, respectively. Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. Both differentiated patients from controls on vaginal symptoms score (VSS) (p?<?0.001), sexual symptoms score (SSS) (p?<?0.01), and quality of life (QoL) (p?<?0.001). There was a strong positive correlation between Pelvic Organ Prolapse Quantification (POP-Q) scores and VSS (Sinhala r _s ?=?0.64, p?<?0.001, Tamil r _s ?=?0.65, p?<?0.001), and QoL (Sinhala r _s ?=?0.49, p?<?0.001, Tamil r _s ?=?0.60, p?<?0.001). Internal consistency as assessed using Cronbach’s coefficient alpha: 0.78 (0.76–0.78) and 0.83 (0.80–0.84) in Sinhala and Tamil, respectively. Test–retest reliability was assessed by weighted kappa scores (Sinhala 0.58–0.88 and Tamil 0.76–0.90). Both questionnaires were sensitive to change and showed that VSS and QoL improved following surgery (Wilcoxon matched-pairs signed-rank test p?<?0.001).

Conclusion

The validated Sinhala and Tamil translations of ICIQ-VS will be useful for assessing vaginal and sexual symptoms among women speaking Sinhala and Tamil.

     

Differences in Characteristics and Outcome of Patients with Penetrating Injuries in the USA and the Netherlands: A Multi-institutional Comparison

Introduction

The incidence and nature of penetrating injuries differ between countries. The aim of this study was to analyze characteristics and clinical outcomes of patients with penetrating injuries treated at urban Level-1 trauma centers in the USA (USTC) and the Netherlands (NLTC).

Methods

In this retrospective cohort study, 1331 adult patients (470 from five NLTC and 861 from three USTC) with truncal penetrating injuries admitted between July 2011 and December 2014 were included. In-hospital mortality was the primary outcome. Outcome comparisons were adjusted for differences in population characteristics in multivariable analyses.

Results

In USTC, gunshot wound injuries (36.1 vs. 17.4%, p?<?0.001) and assaults were more frequent (91.2 vs. 77.7%, p?<?0.001). ISS was higher in USTC, but the Revised Trauma Score (RTS) was comparable. In-hospital mortality was similar (5.0 vs. 3.6% in NLTC, p?=?0.25). The adjusted odds ratio for mortality in USTC compared to NLTC was 0.95 (95% confidence interval 0.35–2.54). Hospital stay length of stay was shorter in USTC (difference 0.17 days, 95% CI ?0.29 to ?0.05, p?=?0.005), ICU admission rate was comparable (OR 0.96, 95% CI 0.71–1.31, p?=?0.80), and ICU length of stay was longer in USTC (difference of 0.39 days, 95% CI 0.18–0.60, p?<?0.0001). More USTC patients were discharged to home (86.9 vs. 80.6%, p?<?0.001). Readmission rates were similar (5.6 vs. 3.8%, p?=?0.17).

Conclusion

Despite the higher incidence of penetrating trauma, particularly firearm-related injuries, and higher hospital volumes in the USTC compared to the NLTC, the in-hospital mortality was similar. In this study, outcome of care was not significantly influenced by differences in incidence of firearm-related injuries.