Acute Chorioamnionitis at Term Caused by the Oral Pathogen Fusobacterium Nucleatum

Fusobacterium nucleatum is an oral pathogen associated with preterm birth. Presented is a case of acute chorioamnionitis that progressed to maternal sepsis in a term patient with intact membranes. In addition to its role in periodontal disease and preterm birth, our case demonstrates that intrauterine infection with Fusobacterium nucleatum can result in severe disease at term.     

Commissioning of a grid-based Boltzmann solver for cervical cancer brachytherapy treatment planning with shielded colpostats

PurposeWe sought to commission a gynecologic shielded colpostat analytic model provided from a treatment planning system (TPS) library. We have reported retrospectively the dosimetric impact of this applicator model in a cohort of patients.Methods and MaterialsA commercial TPS with a grid-based Boltzmann solver (GBBS) was commissioned for ¹⁹²Ir high-dose-rate (HDR) brachytherapy for cervical cancer with stainless steel–shielded colpostats. Verification of the colpostat analytic model was verified using a radiograph and vendor schematics. MCNPX v2.6 Monte Carlo simulations were performed to compare dose distributions around the applicator in water with the TPS GBBS dose predictions. Retrospectively, the dosimetric impact was assessed over 24 cervical cancer patients’ HDR plans.ResultsApplicator (TPS ID #AL13122005) shield dimensions were within 0.4 mm of the independent shield dimensions verification. GBBS profiles in planes bisecting the cap around the applicator agreed with Monte Carlo simulations within 2% at most locations; differing screw representations resulted in differences of up to 9%. For the retrospective study, the GBBS doses differed from TG-43 as follows (mean value ± standard deviation [min, max]): International Commission on Radiation units [ICRU]rectum (?8.4 ± 2.5% [?14.1, ?4.1%]), ICRUbladder (?7.2 ± 3.6% [?15.7, ?2.1%]), D_2cc-rectum (?6.2 ± 2.6% [?11.9, ?0.8%]), D_2cc-sigmoid (?5.6 ± 2.6% [?9.3, ?2.0%]), and D_2cc-bladder (?3.4 ± 1.9% [?7.2, ?1.1%]).ConclusionsAs brachytherapy TPSs implement advanced model-based dose calculations, the analytic applicator models stored in TPSs should be independently validated before clinical use. For this cohort, clinically meaningful differences (>5%) from TG-43 were observed. Accurate dosimetric modeling of shielded applicators may help to refine organ toxicity studies.     

Atypical performance patterns on Delis–Kaplan Executive Functioning System Color–Word Interference Test: Cognitive switching and learning ability in older adults

Introduction: Cognitive set shifting requires flexible application of lower level processes. The Delis–Kaplan Executive Functioning System (DKEFS) Color–Word Interference Test (CWIT) is commonly used to clinically assess cognitive set shifting. An atypical pattern of performance has been observed on the CWIT; a subset of individuals perform faster, with equal or fewer errors, on the more difficult inhibition/switching than the inhibition trial. This study seeks to explore the cognitive underpinnings of this atypical pattern. It is hypothesized that atypical patterns on CWIT will be associated with better performance on underlying cognitive measures of attention, working memory, and learning when compared to typical CWIT patterns. Method: Records from 239 clinical referrals (age: M = 68.09 years, SD = 10.62; education: M = 14.87 years, SD = 2.73) seen for a neuropsychological evaluation as part of diagnostic work up in an outpatient dementia and movement disorders clinic were sampled. The standard battery of tests included measures of attention, learning, fluency, executive functioning, and working memory. Analyses of variance (ANOVAs) were conducted to compare the cognitive performance of those with typical versus atypical CWIT patterns. Results: An atypical pattern of performance was confirmed in 23% of our sample. Analyses revealed a significant group difference in acquisition of information on both nonverbal (Brief Visuospatial Memory Test–Revised, BVMT–R total recall), F(1, 213) = 16.61, p < .001, and verbal (Hopkins Verbal Learning Test–Revised, HVLT–R total recall) learning tasks, F(1, 181) = 6.43, p < .01, and semantic fluency (Animal Naming), F(1, 232) = 7.57, p = .006, with the atypical group performing better on each task. Effect sizes were larger for nonverbal (Cohen’s d = 0.66) than verbal learning (Cohen’s d = 0.47) and semantic fluency (Cohen’s d = 0.43). Conclusions: Individuals demonstrating an atypical pattern of performance on the CWIT inhibition/switching trial also demonstrated relative strengths in semantic fluency and learning.