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Modifications in Brain Dopamine Extracellular Attention right after Ethanol Supervision; Rat Microdialysis Reports.
PURPOSE The urinary microbiota in women with type 2 diabetes (T2DM) can have bacterial uropathogens which are more virulent. The primary objective was to describe and compare the characteristics of the microbiota in voided urine of women with and without T2DM. METHODS Two cohorts of women those with T2DM (n = 87) and those without T2DM (n = 49) were studied. Demographic data, hemoglobin A1c (HbA1c), fasting serum glucose, and voided urine were collected. To determine the characteristics of the microbiota in the urine, 16S rRNA gene sequencing was used. RESULTS The genus Lactobacillus was more often present in women with T2DM (75.9%, n = 66) than in the controls (59.2%, n = 30) (p = 0.042), as was the family Enterobacteriaceae (12.6% T2DM versus 2.0% control, p = 0.055). There was evidence of an association between HbA1c and the relative abundance of the various bacteria in the total cohort. The relative abundance of Lactobacillus was positively associated (ρ = 0.19, 95% CI 0.02, 0.34), while Corynebacterium (ρ = -0.26, 95% CI -0.41, -0.10) and Prevotella (ρ = -0.23, 95% CI -0.38, -0.06) were inversely associated with HbA1c. CONCLUSIONS Enterobacteriaceae (e.g. E. coli) predispose women to urinary tract infections and since T2DM increases this risk, further study is needed. The species of Lactobacillus and its impact needs exploration. BACKGROUND Some Medicaid enrollees frequently utilize the emergency department (ED) due to barriers accessing health care services in other settings. OBJECTIVES To determine whether an ED-initiated Patient Navigation program (ED-PN) designed to improve health care access for Medicaid-insured frequent ED users could decrease ED visits, hospitalizations, and costs. METHODS We conducted a prospective, randomized controlled trial comparing ED-PN with usual care (UC) among 100 Medicaid-enrolled frequent ED users (defined as 4-18 ED visits in the prior year), assessing ED utilization during the 12 months pre- and post-enrollment. Secondary outcomes included hospitalizations, outpatient utilization, hospital costs, and Medicaid costs. We also compared characteristics between ED-PN patients with and without reduced ED utilization. RESULTS Of 214 eligible patients approached, 100 (47%) consented to participate. Forty-nine were randomized to ED-PN and 51 to UC. Sociodemographic characteristics and prior utilization were similar between groups. ED-PN participants had a significant reduction in ED visits and hospitalizations during the 12-month evaluation period compared with UC, averaging 1.4 fewer ED visits per patient (p = 0.01) and 1.0 fewer hospitalizations per patient (p = 0.001). Both groups increased outpatient utilization. ED-PN patients showed a trend toward reduced per-patient hospital costs (-$10,201, p = 0.10); Medicaid costs were unchanged (-$5,765, p = 0.26). Patients who demonstrated a reduction in ED usage were older (mean age 42 vs. 33 years, p = 0.03) and had lower health literacy (78% low health literacy vs. 40%, p = 0.02). CONCLUSION An ED-PN program targeting Medicaid-insured high ED utilizers demonstrated significant reductions in ED visits and hospitalizations in the 12 months after enrollment. OBJECTIVE Cepstral measures are sensitive to slightest deviance in voice quality. Vocal fatigue is an initial symptom of a voice disorder. This study aimed (1) to assess the correlation of vocal fatigue and cepstral measures and (2) to identify a measure for analyzing voice change due to vocal fatigue in individuals with hyperfunctional voice disorders. STUDY DESIGN Cross-sectional. METHODS A total of 100 subjects participated in the study, that is Group I (50 cases) and Group II (50 controls). Vocal Fatigue Index (VFI-T) in Tamil was administered to identify the presence of fatigue. Voice samples (sustained vowel and conversational speech) were recorded using the Computerized Speech Lab (Model 4150). Mic to mouth distance was maintained at 10 cm. Extraction of cepstral peak prominence (CPP) and smoothened cepstral peak prominence (CPPS) for a vowel (v) and connected speech (cs) was done using Praat software (version 6.0.39, Boersma & Weenink, 2018). RESULTS Independent t test was used to compare the cepstral measures between cases and controls. Individuals with vocal fatigue (cases) showed significantly lower cepstral values and higher VFI scores compared to the controls. Spearman's rho revealed moderate to strong negative correlation between factors of VFI and cepstral measures. On stepwise multiple linear regression, CPPcs was retained as a sensitive measure to analyze vocal fatigue in individuals with hyperfunctional voice disorder. CONCLUSION Cepstral measures can be applied to analyze vocal fatigue. There is a paucity of data relating to histological margins of cutaneous squamous cell carcinoma (cSCC) and local recurrence. Retrospective data were collected for 721 patients with cSCC treated at Queen Victoria Hospital, UK, and followed up for five years. The local recurrence rate was 6.1%, the mean time to recurrence was 12.61 months and 93% of recurrences occurred within two years. Sixty-six per cent of recurrences had a deep margin of 2.5 mm or less (p 0.041). The Pearson's correlation coefficient showed a strong correlation with tumour grade (r=0.82, p, 0.05), lymphovascular invasion (r=0.73. p less then 0.05), medium correlation with deep histological margin(r= -0.55, p less then 0.05), a weak correlation with male sex (r= 0.31, p less then 0.05) and the anatomical site of head and neck (r=0.31, p less then 0.05).The multiple regression analysis model using the 5 variables generated an r value of 0.71 and adjusted r square of 0.7. In conclusion, our findings are consistent with previously mentioned prognostic indicators and also demonstrate that deep histological margin is a significant predictor of local recurrence of cSCC. We recommend larger multi-institutional studies to confirm the above results to subsequently guide the specialist skin multidisciplinary teams' recommendations. PURPOSE In the future, it is expected that treatment of Dupuytren disease (DD) may shift toward control of early disease. Ultrasound might be an accurate method to measure the outcome of such treatment. The aim of this study was to assess the reliability of sonographic measurement of palmar nodules. METHODS Fifty patients with nodules characteristic for early disease were assessed with ultrasound by 2 observers. Four different aspects of DD nodules were measured in the transversal and sagittal planes, width, depth, circumference, and area. The intra- and interobserver reliabilities were calculated using the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the smallest detectable change (SDC) were also calculated for each aspect. RESULTS The intraobserver reliability was good (ICC, 0.724 [0.562-0.833] to 0.886 [0.808-0.934]), except for width in the sagittal direction (ICC, 0.671 [0.484-0.799]). The interobserver reliability was moderate (ICC, 0.385 [0.126-0.596] to 0.757 [0.538-0.869]). The intraobserver ICCs of area were highest (transverse, 0.847 [0.744-0.893]; sagittal, 0.886 [0.808-0.934]). The SEM and SDC of area were 6.1 and 16.9 mm2 in the transverse and 8.0 and 22.2 mm2 in the sagittal plane. MSAB CONCLUSIONS The intraobserver reliability of sonographic assessment of DD nodules is good. The measurement of area is the most reliable and is, therefore, recommended for future studies. However, even single-observer measurements have a clear dispersion, and a change beyond 16.9 (61%) and 22.2 mm2 (79%) has to be observed in the transverse and sagittal planes, respectively, before it can be considered as regression or progression. CLINICAL RELEVANCE Repeated ultrasonographic measurements in DD should ideally be done by a single observer, using area of the nodule in the sagittal plane. Change beyond 16.9 (transverse) and 22.2 (sagittal) mm2 can be considered as a real change in nodule size. INTRODUCTION For lung cancer screening, the available data are often derived from patients enrolled prospectively in clinical trials. We, therefore, investigated lung cancer screening patterns among individuals eligible for, but not enrolled in, a screening trial. PATIENTS AND METHODS From February 2017 through February 2019, we enrolled subjects in a trial examining telephone-based navigation during low-dose computed tomography (LDCT) for lung cancer screening. We identified patients for whom LDCT was ordered and who were approached, but not enrolled, in the trial. We categorized nonenrollment as the patient had declined or could not be reached. We compared the characteristics and LDCT completion rates among these groups and the enrolled population using the 2-sample t test and χ2 test. RESULTS Of 900 individuals approached for participation (mean age, 62 years; 45% women, 53% black), 447 were enrolled in the screening clinical trial. No significant demographic differences were found between the enrolled and nonenrolled cohorts. Of the 453 individuals not enrolled, 251 (55%) had declined participation and 202 (45%) could not be reached, despite up to 6 attempts. LDCT completion was significantly associated with enrollment status 81% of enrolled individuals, 73% of individuals who declined participation, and 49% of those who could not be reached (P less then .001). CONCLUSIONS In the present single-center study, demographic factors did not predict for participation in a lung cancer screening trial. Lung cancer screening adherence rates were substantially lower for those not enrolled in a screening trial, especially for those who could not be contacted. These findings may inform the broader implementation of screening programs. When there is a varus knee deformity, the ankle and foot compensate. However, the association between pain and angular change in the compensatory mechanism is not well understood. Therefore, we investigated the relationship between pain and angular change of the lower extremity in genu varus patients. Standing whole-lower-leg plain radiographs of 127 legs (77 patients) with >4° of genu varum were evaluated. Pain was assessed separately at the ankle, forefoot, and hindfoot. Knee, ankle, and subtalar joint angles were measured. Patients were divided into 3 groups according to the degree of lower leg angular imbalance (group 1, mild; group 2, moderate; group 3, severe). The presence of multiple pain locations differed significantly between groups and was significantly higher in group 3 than group 1 (p = .0061). Likewise, the subtalar angle was significantly more varus in group 3 than group 1 (p = .012). In conclusion, an unbalanced lower extremity with genu varum was associated with multiple foot and ankle pain, and the subtalar joint played a primary role in compensation for genu varum deformity. Radius-Maumenee syndrome (SRM) or idiopathic episcleral venous hypertension (HVEI) is an uncommon disorder that occurs with a dilation of the episcleral vessels and an increase in intraocular pressure (IOP). It is a syndrome that constitutes a diagnostic and therapeutic challenge for the ophthalmologist. A case is presented in which, despite making an early diagnosis and trying to plan a treatment aimed at avoiding choroidal effusion, its appearance was unavoidable, having to treat it twice with good functional results so far.
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