CT-Guided vs. Navigational Bronchoscopic Biopsies for Solitary Pulmonary Nodules: A Single-Institution Retrospective Comparison.

OBJECTIVE: Lung cancer is the second most common cause of death by cancer. Multiple modalities can be used to obtain a tissue sample from a pulmonary nodule. We aimed to compare the yield and adverse events related to transthoracic needle aspiration (TTNA) and Electromagnetic Navigation Biopsy (ENB) at our institution. METHODS: This was a single-center retrospective study in which all patients referred for evaluation of a pulmonary lesion over 5 years (1 January 2013 to 31 December 2018) were identified. Our primary outcome was to compare the accuracy of TTNA to that of ENB in establishing the diagnosis of pulmonary lesions. Secondary outcomes included the evaluation of the adverse events and the sensitivity, specificity, positive, and negative predictive value of each modality. RESULTS: A total of 1006 patients were analyzed. The mean age of patients in the TTNA and the ENB group was 67.2 ± 11.2 years and 68.3 ± 9.2 years respectively. Local anesthesia was predominantly used for TTNA and moderate sedation was more commonly used in the ENB group. We found ENB to have an accuracy of 57.1%, with a sensitivity of 40.0%, a specificity of 100.0%, a positive predictive value of 100.0%, and a negative predictive value of 40.0%. As for the TTNA, the accuracy was 75.9%, with a sensitivity of 77.5%, a specificity of 61.5%, a positive predictive value of 95.0%, and a negative predictive value of 22.5%. The rate of clinically significant complications was higher in the TTNA group (8.2%) as compared to the ENB group (4.7%) with a p-value < 0.001. CONCLUSION: TTNA was superior to ENB-guided biopsy for the diagnostic evaluation of lung nodules. However, the complication rate was much higher in the TTNA group as compared to the ENB group.

Acute Respiratory Distress Syndrome; A Review of Recent Updates and a Glance into the Future.

Acute respiratory distress syndrome (ARDS) is a rapidly progressive form of respiratory failure that accounts for 10% of admissions to the ICU and is associated with approximately 40% mortality in severe cases. Despite significant mortality and healthcare burden, the mainstay of management remains supportive care. The recent pandemic of SARS-CoV-2 has re-ignited a worldwide interest in exploring the pathophysiology of ARDS, looking for innovative ideas to treat this disease. Recently, many trials have been published utilizing different pharmacotherapy targets; however, the long-term benefits of these agents remain unknown. Metabolomics profiling and stem cell transplantation offer strong enthusiasm and may completely change the outlook of ARDS management in the near future.

DAXI (DaxibotulinumtoxinA) - An Innovative Approach for Frown Lines.

Glabellar frown lines, also known as worry lines, are a common sign of aging. The current treatment option for glabellar lines is subjective and ranges from economical anti-wrinkle creams and skin resurfacing techniques such as microdermabrasion and fillers to highly expensive facelifts. Botox® has been the mainstream treatment for decades, but the suggested time between treatments for most toxins is 12-16 weeks, and evidence shows that patients being treated for glabellar lines want longer-lasting results. Recently, on September 16th, the US Food and Drug Administration (FDA) approved the development of daxibotulinumtoxinA (DAXI) for injection based on clinical trials (SAKURA 1, 2, and 3). These encouraging findings followed by FDA approval mean that the need for repeated treatments to sustain the desired outcome has decreased. DAXI could be a reliable and secure choice for reducing the appearance of wrinkles on the face caused by muscle activity, and its long duration has the potential to enhance the treatment of both therapeutic and cosmetic disorders.

Using Facial Micro-Expressions in Combination With EEG and Physiological Signals for Emotion Recognition.

Emotions are multimodal processes that play a crucial role in our everyday lives. Recognizing emotions is becoming more critical in a wide range of application domains such as healthcare, education, human-computer interaction, Virtual Reality, intelligent agents, entertainment, and more. Facial macro-expressions or intense facial expressions are the most common modalities in recognizing emotional states. However, since facial expressions can be voluntarily controlled, they may not accurately represent emotional states. Earlier studies have shown that facial micro-expressions are more reliable than facial macro-expressions for revealing emotions. They are subtle, involuntary movements responding to external stimuli that cannot be controlled. This paper proposes using facial micro-expressions combined with brain and physiological signals to more reliably detect underlying emotions. We describe our models for measuring arousal and valence levels from a combination of facial micro-expressions, Electroencephalography (EEG) signals, galvanic skin responses (GSR), and Photoplethysmography (PPG) signals. We then evaluate our model using the DEAP dataset and our own dataset based on a subject-independent approach. Lastly, we discuss our results, the limitations of our work, and how these limitations could be overcome. We also discuss future directions for using facial micro-expressions and physiological signals in emotion recognition.

Novel Mouse Models of Bladder Cancer Identify a Prognostic Signature Associated with Risk of Disease Progression.

To study the progression of bladder cancer from non-muscle-invasive to muscle-invasive disease, we have developed a novel toolkit that uses complementary approaches to achieve gene recombination in specific cell populations in the bladder urothelium in vivo, thereby allowing us to generate a new series of genetically engineered mouse models (GEMM) of bladder cancer. One method is based on the delivery of adenoviruses that express Cre recombinase in selected cell types in the urothelium, and a second uses transgenic drivers in which activation of inducible Cre alleles can be limited to the bladder urothelium by intravesicular delivery of tamoxifen. Using both approaches, targeted deletion of the Pten and p53 tumor suppressor genes specifically in basal urothelial cells gave rise to muscle-invasive bladder tumors. Furthermore, preinvasive lesions arising in basal cells displayed upregulation of molecular pathways related to bladder tumorigenesis, including proinflammatory pathways. Cross-species analyses comparing a mouse gene signature of early bladder cancer with a human signature of bladder cancer progression identified a conserved 28-gene signature of early bladder cancer that is associated with poor prognosis for human bladder cancer and that outperforms comparable gene signatures. These findings demonstrate the relevance of these GEMMs for studying the biology of human bladder cancer and introduce a prognostic gene signature that may help to stratify patients at risk for progression to potentially lethal muscle-invasive disease. SIGNIFICANCE: Analyses of bladder cancer progression in a new series of genetically engineered mouse models has identified a gene signature of poor prognosis in human bladder cancer.

Forensic psychiatry in Kuwait - characterization of forensic psychiatry patients evaluated over year duration in the only available forensic psychiatry unit.

INTRODUCTION: The offending behavior arising from a mental disorder invokes criminal responsibility doctrines or insanity defenses and calls for legislative framework ensuring availability of care and treatment for the patient and protection of the public from harm from the offender. The conviction of mentally disordered offenders varies depending upon the local legislation and its socio-cultural context, so do the principles, procedures and guidelines for forensic assessments between different countries. The criminal Act of Kuwait, which governs the work of forensic psychiatrists remain unchanged, from a psychiatric point of view, since it was enacted in the early 1960's. OBJECTIVES: To shed some light on the forensic psychiatry services running in Kuwait and describe forensic psychiatry patients evaluated in the only-available forensic psychiatry unit. METHODS: Retrospective chart review of all cases referred for criminal forensic psychiatric assessments during the period from January 1st, 2016 to May 31st, 2017. The demographics, types of offences, psychiatric diagnoses, and details of psychiatric evaluations were retrieved and characterized. RESULTS: A total of 95 case-notes were reviewed. Most of them were males (90%), Kuwaiti nationals (77%), primary or intermediate school education (74%), and were aged 20-39 (69%). Almost all (97%) of the referrals required ascertainment of 'responsibility' for the alleged offence. Eighty-six percent (N = 81) of the offenders were referred from the police or the public prosecutor office. Eighty-three percent (N = 79) of the offenders were found to have a mental disorder while 55% (N = 52) were found to be criminally responsible. The males (57%) outnumbered the females (33%) as criminally responsible. CONCLUSIONS: The number of mentally ill offenders referred for criminal responsibility and fitness to stand trial is very small compared to western countries. One reason behind this could be that a substantial number of the mentally disordered offenders pass undetected through the legal system. It is then incumbent that psychiatrists and forensic mental health workers might need to provide better awareness and education about mental health to legal authorities in Kuwait.

Radiotherapy-induced reactivation of neurotrophic human herpes viruses: Overview and management.

PURPOSE: Infection by Human Herpes Viruses (HHV) types 1-3, are prevalent throughout the world. It is known that radiotherapy can reactivate HHVs, but it is unclear how and to what extent reactivations can interact with or affect radiotherapeutic efficacy, patient outcomes and mortality risk. Herein, we aim to summarize what is known about Herpes Simplex Virus (HSV)-1,2 and Varicella Zoster Virus (VZV) pathophysiology as it relates to tumor biology, radiotherapy, chemo-radiotherapy, diagnosis and management so as to optimize cancer treatment in the setting of active HHV infection. Our secondary aim is to emphasize the need for further research to elucidate the potential adverse effects of active HHV infection in irradiated tumor tissue and to design optimal management strategies to incorporate into cancer management guidelines. MATERIALS AND METHODS: The literature regarding herpetic infection, herpetic reactivation, and recurrence occurring during radiotherapy and that regarding treatment guidelines for herpetic infections are reviewed. We aim to provide the oncologist with a reference for the infectious dangers of herpetic reactivation in patients under their care and well established methods for prevention, diagnosis, and treatment of such infections. Pain management is also considered. CONCLUSIONS: In the radiotherapeutic setting, serologic assays for HSV-1 and HSV-2 are feasible and can alert the clinician to patients at risk for viral reactivation. RT-PCR is specific in identifying the exact viral culprit and is the preferred diagnostic method to measure interventional efficacy. It can also differentiate between herpetic infection and radionecrosis. The MicroTrak® HSV1/HSV2/VZV staining kit has high sensitivity and specificity in acute lesions, is also the most rapid means to confirm diagnosis. Herpetic reactivation and recurrences during radiotherapy can cause interruptions, cessations, or prolongations of the radiotherapeutic course, thus decreasing the biologically effective dose, to sub-therapeutic levels. Active HHV infection within the treatment volume results in increased tumor radio-resistance and potentially sub-therapeutic care if left untreated. Visceral reactivations may result in fatality and therefore, a high index of suspicion is important to identify these active infections. The fact that such infections may be mistaken for acute and/or late radiation effects, leading to less than optimal treatment decisions, makes knowledge of this problem even more relevant. To minimize the risk of these sequelae, prompt anti-viral therapy is recommended, lasting the course of radiotherapy.