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关键词： Collagen matrix graft   DuraGen   Dural reconstruction   Microvascular decompression   Surgical technique  

摘要： Background Watertight dural closure is a crucial step in preventing postoperative cerebrospinal fluid (CSF) leak and subsequent infection in posterior fossa surgery. The aim of this study is to assess an alternative use of collagen matrix double grafting in microvascular decompression (MVD). Methods Dural closure using double collagen matrix grafts was retrospectively compared with autologous fascial grafting in 120 patients who underwent MVD. Double collagen matrix grafting technique, a combination use of inlay and onlay grafting (DuraGen(R), Integra Lifesciences, Plainsboro, NJ, USA, $700-800 for an MVD craniotomy size), was applied in 60 patients (the collagen matrix group). In the remaining 60 patients, an autologous fascial graft was sutured in a watertight fashion to the dural defect (the fascia group). Postoperative wound complications, such as CSF leak and infection, were retrospectively compared between the two groups. Results CSF leaks were observed in 3 patients (5.0%) in the fascia group and in 2 patients (3.3%) in the collagen matrix group. All cases of CSF leakage presented with pseudomeningoceles except one patient who developed an incisional CSF leak. A repair surgery for CSF leak was required in this one patient in the fascia group. Subcutaneous abscesses were noted in 2 patients (3.3%) in the fascia group. There was no patient who developed a subcutaneous abscess in the collagen matrix group. One patient in each group developed aseptic meningitis. Statistical analyses revealed that the collagen matrix group showed non-inferior outcomes to the fascia group in CSF leaks and infectious complications. Conclusions Double grafting technique with a combination of inlay and onlay collagen sheets is a safe and secure alternative for watertight dural closure despite a cost limitation.

关键词： deep learning   imaging-guided biopsy   magnetic resonance imaging   ultrasonography  

摘要： Purpose: Targeted biopsy improves prostate cancer diagnosis. Accurate prostate segmentation on magnetic resonance imaging (MRI) is critical for accurate biopsy. Manual gland segmentation is tedious and time-consuming. We sought to develop a deep learning model to rapidly and accurately segment the prostate on MRI and to implement it as part of routine magnetic resonance-ultrasound fusion biopsy in the *** and Methods: A total of 905 subjects underwent multiparametric MRI at 29 institutions, followed by magnetic resonance-ultrasound fusion biopsy at 1 institution. A urologic oncology expert segmented the prostate on axial T2-weighted MRI scans. We trained a deep learning model, ProGNet, on 805 cases. We retrospectively tested ProGNet on 100 independent internal and 56 external cases. We prospectively implemented ProGNet as part of the fusion biopsy procedure for 11 patients. We compared ProGNet performance to 2 deep learning networks (U-Net and holistically-nested edge detector) and radiology technicians. The Dice similarity coefficient (DSC) was used to measure overlap with expert segmentations. DSCs were compared using paired ***: ProGNet (DSC=0.92) outperformed U-Net (DSC=0.85, p <0.0001), holistically-nested edge detector (DSC=0.80, p <0.0001), and radiology technicians (DSC=0.89, p <0.0001) in the retrospective internal test set. In the prospective cohort, ProGNet (DSC=0.93) outperformed radiology technicians (DSC=0.90, p <0.0001). ProGNet took just 35 seconds per case (vs 10 minutes for radiology technicians) to yield a clinically utilizable segmentation ***: This is the first study to employ a deep learning model for prostate gland segmentation for targeted biopsy in routine urological clinical practice, while reporting results and releasing the code online. Prospective and retrospective evaluations revealed increased speed and accuracy.(C) 2021 by the American Urological Association, Inc.

关键词： Alternative therapies   Art Therapy   Disease X   Covid-19  

摘要： Identify and review alternative (home-based) therapies for prolonged lockdowns. Interdisciplinary study using multi-method approach - case study, action research, grounded theory. Only secondary data has been used in this study. Epistemological framework based on a set of digital humanities tools. The set of tools are based on publicly available, open access technological solutions, enabling generalisability of the findings. Alternative therapies can be integrated in healthcare systems as home-based solutions operating on low-cost technologies.

摘要： In wheat head blight fungus Fusarium graminearum, A-to-I RNA editing occurs specifically during sexual reproduction. Among the genes with premature stop codons (PSCs) that require RNA editing to encode full-length proteins, FgBUD14 also had alternative splicing events in perithecia. In this study, we characterized the functions of FgBUD14 and its post-transcriptional modifications during sexual reproduction. The Fgbud14 deletion mutant was slightly reduced in growth, conidiation and virulence. Although deletion of FgBUD14 had no effect on perithecium morphology, the Fgbud14 mutant was defective in crozier formation and ascus development. The FgBud14-GFP localized to the apex of ascogenous hyphae and croziers, which may be related to its functions during early sexual development. During vegetative growth and asexual reproduction, FgBud14-GFP localized to hyphal tips and both ends of conidia. Furthermore, mutations blocking the splicing of intron 2 that has the PSC site had no effect on the function of FgBUD14 during sexual reproduction but caused a similar defect in growth with Fgbud14 mutant. Expression of the non-editable FgBUD14(Intron2-TAA) mutant allele also failed to complement the Fgbud14 mutant. Taken together, FgBUD14 plays important roles in ascus development, and both alternative splicing and RNA editing occur specifically to its transcripts during sexual reproduction in F. graminearum.

关键词： polyhydroxyalkanoates   microwave-assisted extraction   mixed microbial cultures   bacterial biopolymer   biopolymer extraction  

摘要： BACKGROUND: Polyhydroxyalkanoates (PHAs) are a class of biodegradable biopolymers produced and accumulated by microorganisms. PHAs are recovered from microbial biomass through the stages of pretreatment, extraction and purification. An alternative recovery method is microwave-assisted extraction (MAE), which involves the supply of energy through an electromagnetic field, generating high temperatures in reduced times. A study to evaluate the recovery of PHAs from mixed microbial cultures was conducted using MAE. This method was evaluated through a four-factorial experimental design, with the efficiency as the evaluated response. PHAs were also recovered using conventional heat extraction as control. RESULTS: It was found that the highest efficiency achieved using MAE was 68 +/- 1.2% (w/w), which was close to the 66 +/- 5.3% (w/w) obtained using conventional heat extraction. The following combination of factors corresponded to the optimum conditions of experimental design: extraction time of 1 min, temperature of 130 degrees C, chloroform-to-methanol ratio of 1:1 and solvent-to-biomass ratio of 20 volumes. The efficiency increased substantially when the solvent-to-biomass ratio and chloroform-to-methanol ratio increased, although the temperature was the least significant factor. Functional groups, decomposition temperatures (263-309 degrees C) and melting point (158 degrees C) of MAE-recovered PHAs were similar to those measured for commercial poly[(3-hydroxybutyrate)-co-(3-hydroxyvalerate)]. CONCLUSIONS: MAE is a never-before-reported useful method for recovering PHAs from mixed microbial cultures, which provides for a high extraction efficiency and quality of the recovered biopolymers. (c) 2021 Society of Chemical Industry (SCI).

关键词： suburethral sling   urinary incontinence, stress   dyspareunia  

摘要： Purpose: Limited data exist regarding sexual function after single incision sling (SIS) surgery. We compared sexual function 36 months postoperatively between patients undergoing SIS and transobturator sling (TMUS) for treatment of stress urinary incontinence. Materials and Methods: Assessment of sexual function was a planned secondary objective of this prospective, multi-center study that enrolled women to Solyx SIS or Obtryx II TMUS. The primary study aim was to compare efficacy and safety using non-inferiority design at 36 months. Patient-reported outcomes of sexual function were assessed at baseline and 6, 12, 18, 24 and 36 months using Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Changes in sexual function were analyzed within and between groups. Outcomes for patients requiring surgical retreatment were determined. Results: Baseline characteristics were balanced using propensity score stratification (N=141 SIS, N=140 TMUS). Groups were similar in age, body mass index and concomitant surgery performed. Average length of followup was 30 months. Baseline sexual activity was similar (123/141 SIS, 114/140 TMUS, p=0.18). Severity of urinary incontinence did not correlate with baseline sexual activity. Mean PISQ-12 scores increased significantly from baseline to 36 months for both groups, indicating better sexual function at each visit. There were no significant differences in PISQ-12 scores between groups except at 36 months, where the difference was small (-2.5, 95% CI [-4.7, 0.2]). Among patients undergoing surgical retreatment (9/281, 3%), improvement in sexual function was maintained. De novo dyspareunia was rare following both treatments (SIS 1/141, TMUS 0/140, p=1.00). Conclusions: Patients have significant improvement in sexual function after SIS and TMUS. De novo sexual pain is low after sling surgery.