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1.
Integr Comp Biol ; 2024 Apr 23.
Article in English | MEDLINE | ID: mdl-38653716

ABSTRACT

Instances of convergent or parallel evolution provide a potent model system for exploring contingency and determinism in evolutionary biology. Likewise, the multiple, independent habitat transitions from saltwater to freshwater biomes offer opportunity for studying convergent evolution within and among different vertebrate lineages. For example, stingrays have invaded freshwater habitats multiple times across different continents, sometimes even several times within the same clade (e.g., Dasyatidae). We evaluated the frequency of saltwater-freshwater invasions in stingrays, compared ecological and phenotypic diversification among freshwater and saltwater lineages, and assessed the degree of convergence among freshwater species. Despite not being morphologically distinct from saltwater stingrays, freshwater stingrays do expand the margins of stingray morphological diversity. According to our data, trophic specialists occupied non-overlapping regions of morphospace, with piscivores and molluscivores being distinct from other diet guilds. Freshwater stingrays as a group did not strongly converge morphologically, neither did freshwater rays from different lineages which shared similar niches. These findings could be explained by there not being enough time for convergence to occur among more ancient and more recent freshwater lineages. Alternatively, the different ancestral bauplans of various freshwater ray lineages and weak selection on optimal phenotypes could promote contingency in the form of evolution along paths of least resistance.

2.
Toxicol Sci ; 2024 Apr 24.
Article in English | MEDLINE | ID: mdl-38656946

ABSTRACT

Absolute (ALW) and relative (RLW) liver weight changes are sensitive endpoints in repeat-dose rodent toxicity studies, and their changes are often used for quantitative assessment of health effects induced by hepatotoxic chemicals using the benchmark dose-response modeling (BMD) approach. To find biologically relevant liver weight changes to chemical exposures, we evaluated all data available for liver weight changes and associated liver histopathologic findings from the Toxicity Reference Database (ToxRefDB). Our analysis of 389 subchronic mouse and rat studies for 273 chemicals found significant differences in treatment-related ALW and RLW changes between dose groups with and without liver histopathologic changes. In addition, we demonstrate that chemical treatment-induced ALW and RLW changes can predict the presence of histopathologic findings and inform the selection of biologically relevant liver weight changes for BMD modeling and derivation of toxicity values.

5.
Rev Sci Instrum ; 94(8)2023 Aug 01.
Article in English | MEDLINE | ID: mdl-38065160

ABSTRACT

The National Diagnostic Working Group (NDWG) has led the effort to fully exploit the major inertial confinement fusion/high-energy density facilities in the US with the best available diagnostics. These diagnostics provide key data used to falsify early theories for ignition and suggest new theories, recently leading to an experiment that exceeds the Lawson condition required for ignition. The factors contributing to the success of the NDWG, collaboration and scope evolution, and the methods of accomplishment of the NDWG are discussed in this Review. Examples of collaborations in neutron and gamma spectroscopy, x-ray and neutron imaging, x-ray spectroscopy, and deep-ultraviolet Thomson scattering are given. An abbreviated history of the multi-decade collaborations and the present semiformal management framework is given together with the latest National Diagnostic Plan.

6.
Shap Mem Superelasticity ; 9: 50-73, 2023 Jan 18.
Article in English | MEDLINE | ID: mdl-37261068

ABSTRACT

Nitinol implants, especially those used in cardiovascular applications, are typically expected to remain durable beyond 108 cycles, yet literature on ultra-high cycle fatigue of nitinol remains relatively scarce and its mechanisms not well understood. To investigate nitinol fatigue behavior in this domain, we conducted a multifaceted evaluation of nitinol wire subjected to rotary bend fatigue that included detailed material characterization and finite element analysis as well as post hoc analyses of the resulting fatigue life data. Below approximately 105 cycles, cyclic phase transformation, as predicted by computational simulations, was associated with fatigue failure. Between 105 and 108 cycles, fractures were relatively infrequent. Beyond 108 cycles, fatigue fractures were relatively common depending on the load level and other factors including the size of non-metallic inclusions present and the number of loading cycles. Given observations of both low cycle and ultra-high cycle fatigue fractures, a two-failure model may be more appropriate than the standard Coffin-Manson equation for characterizing nitinol fatigue life beyond 108 cycles. This work provides the first documented fatigue study of medical grade nitinol to 109 cycles, and the observations and insights described will be of value as design engineers seek to improve durability for future nitinol implants.

7.
J Pediatr Urol ; 19(5): 565.e1-565.e5, 2023 10.
Article in English | MEDLINE | ID: mdl-37355344

ABSTRACT

INTRODUCTION: Detrusor contraction in bladder exstrophy (BE) patients following reconstruction is poorly understood as there are few published studies assessing urodynamic findings in this population. Understanding the ability of the detrusor to contract in BE patients early after closure may be able to inform the longer-term management and potential for the development of future continence in this population. OBJECTIVE: We sought to evaluate early detrusor contraction using urodynamic studies (UDS) in children who had previously undergone complete primary repair of bladder exstrophy (CPRE). We hypothesized that a majority of children with BE would display the presence of normal detrusor contractile function after CPRE. STUDY DESIGN: A retrospective review of our prospectively collected database was performed for all patients with a diagnosis of classic BE who underwent primary CPRE between 2013 and 2017. From this cohort we identified patients with at least one post-operative UDS at 3 years of age or older who had undergone an initial CPRE. Our primary outcome was the presence of a detrusor contraction demonstrated on UDS. RESULTS: There were 50 children (31 male, 19 female) with CBE who underwent CPRE between 2013 and 2017.There were 26 (13 male, 13 female) who met inclusion criteria. Median age was 3.5 (IQR: 3.2-4.7) years at the time of UDS Sixteen of the 26 (61.5%) generated a sustained detrusor contraction generating a void, with a median peak voiding pressure of 38 cm H20 (IQR: 28-51). The median bladder capacity reached was 48 ml, which represented a median of 30% of expected bladder capacity. The median post void residual (PVR) for the entire cohort was 26 ml (IQR: 9, 47) or 51% (IQR: 20%-98%) of their actual bladder capacity, while the median PVR for those children with a sustained detrusor contraction was 18 ml (IQR: 5, 46) or 33% (IQR: 27%, 98%) of their actual bladder capacity. Intraoperative bladder width and bladder dome to bladder neck length did not correlate with the presence of voiding via a detrusor contraction (p = 0.64). DISCUSSION: We present the first study assessing early UDS finding of detrusor contraction in BE patients after CPRE. In our cohort, 61.5% of patients were able to generate a sustained detrusor contraction on UDS which is a higher percentage than has been reported in previous series. A difference in initial surgical management may account for these findings. CONCLUSION: At short term follow up, the majority of children in our cohort were able to produce sustained detrusor contractions sufficient to generate a void per urethra with a modest post void residual volume. Long-term follow-up and repeated UDS will be needed to track detrusor contractility rates, bladder capacities, compliance, post void residuals and ultimately continence rates over time.


Subject(s)
Bladder Exstrophy , Child , Humans , Male , Female , Child, Preschool , Bladder Exstrophy/surgery , Urodynamics , Urinary Bladder/surgery , Urination , Retrospective Studies
8.
J Pediatr Urol ; 19(5): 514.e1-514.e7, 2023 10.
Article in English | MEDLINE | ID: mdl-36775719

ABSTRACT

INTRODUCTION: Antenatal hydronephrosis (ANH) is one of the most common anomalies identified on prenatal ultrasound, found in up to 4.5% of all pregnancies. Children with ANH are surveilled with repeated renal ultrasound and when there is high suspicion for a ureteropelvic junction obstruction on renal ultrasound, a mercaptuacetyltriglycerine (MAG3) Lasix renal scan is performed to evaluate for obstruction. However, the challenging interpretation of MAG3 renal scans places patients at risk of misdiagnosis. OBJECTIVE: Our objective was to analyze MAG3 renal scans using machine learning to predict renal complications. We hypothesized that our deep learning model would extract features from MAG3 renal scans that can predict renal complications in children with ANH. STUDY DESIGN: We performed a case-control study of MAG3 studies drawn from a population of children with ANH concerning for ureteropelvic junction obstruction evaluated at our institution from January 2009 until June of 2021. The outcome was renal complications that occur ≥6 months after an equivocal MAG-3 renal scan. We created two machine learning models: a deep learning model using the radiotracer concentration versus time data from the kidney of interest and a random forest model created using clinical data. The performance of the models was assessed using measures of diagnostic accuracy. RESULTS: We identified 152 eligible patients with available images of which 62 were cases and 90 were controls. The deep learning model predicted future renal complications with an overall accuracy of 73% (95% confidence inteveral [CI] 68-76%) and an AUC of 0.78 (95% CI 0.7, 0.84). The random forest model had an accuracy of 62% (95% CI 60-66%) and an AUC of 0.67 (95% CI. 0 64, 0.72) DISCUSSION: Our deep learning model predicted patients at high risk of developing renal complications following an equivocal renal scan and discriminate those at low risk with moderately high accuracy (73%). The deep learning model outperformed the clinical model built from clinical features classically used by urologists for surgical decision making. CONCLUSION: Our models have the potential to influence clinical decision making by providing supplemental analytical data from MAG3 scans that would not otherwise be available to urologists. Future multi-institutional retrospective and prospective trials are needed to validate our model.


Subject(s)
Deep Learning , Hydronephrosis , Ureteral Obstruction , Humans , Child , Female , Pregnancy , Retrospective Studies , Prospective Studies , Case-Control Studies , Hydronephrosis/diagnostic imaging , Hydronephrosis/etiology , Hydronephrosis/surgery , Ureteral Obstruction/etiology , Ureteral Obstruction/complications
9.
Int J Fatigue ; 1552022 Feb.
Article in English | MEDLINE | ID: mdl-36276843

ABSTRACT

To better understand the complex interplay of speed and environment on metals commonly used in implants, rotary bend fatigue tests were conducted on stainless steel and nitinol wires. A range of alternating strains was tested to create ε-N curves at two speeds (physiologic and accelerated) and in three environments (deionized water at body temperature, phosphate buffered saline at body temperature, and laboratory air at ambient room temperature). Results indicate that speed and environment can affect the observed fatigue life in nuanced ways. An electropotential monitoring technique was demonstrated to characterize fatigue crack growth which may be useful in future investigations.

10.
J Pediatr Urol ; 18(4): 493-498, 2022 08.
Article in English | MEDLINE | ID: mdl-35817657

ABSTRACT

In this focused narrative review we set out to review the current literature addressing the utilization of UDS in patients with spina bifida (SB). We specifically analyzed 6 urodynamic parameters and their roles as predictors of upper tract deterioration in pediatric SB patients. The material available did not allow a systematic analysis or the usage of metanalysis methodology, due to the predominance of small retrospective cohorts, and high heterogeneity. We identified 10 retrospective chart reviews that met our study criteria. The results of each of these papers, as well as other studies deemed relevant to the discussion, are included in our narrative review of the literature. We summarize the current literature, offer explanations for divergences in opinion, and identify future research directions and emerging solutions with a focus on machine learning.


Subject(s)
Spinal Dysraphism , Urinary Bladder, Neurogenic , Child , Humans , Urodynamics , Urologists , Retrospective Studies , Spinal Dysraphism/complications , Spinal Dysraphism/diagnosis
11.
Integr Comp Biol ; 62(2): 424-440, 2022 08 25.
Article in English | MEDLINE | ID: mdl-35482600

ABSTRACT

Habitat transitions are key potential explanations for why some lineages have diversified and others have not-from Anolis lizards to Darwin's finches. The ecological ramifications of marine-to-freshwater transitions for fishes suggest evolutionary contingency: some lineages maintain their ancestral niches in novel habitats (niche conservatism), whereas others alter their ecological role. However, few studies have considered phenotypic, ecological, and lineage diversification concurrently to explore this issue. Here, we investigated the macroevolutionary history of the taxonomically and ecologically diverse Neotropical freshwater river rays (subfamily Potamotrygoninae), which invaded and diversified in the Amazon and other South American rivers during the late Oligocene to early Miocene. We generated a time-calibrated, multi-gene phylogeny for Potamotrygoninae and reconstructed evolutionary patterns of diet specialization. We measured functional morphological traits relevant for feeding and used comparative phylogenetic methods to examine how feeding morphology diversified over time. Potamotrygonine trophic and phenotypic diversity are evenly partitioned (non-overlapping) among internal clades for most of their history, until 20-16 mya, when more recent diversification suggests increasing overlap among phenotypes. Specialized piscivores (Heliotrygon and Paratrygon) evolved early in the history of freshwater stingrays, while later trophic specialization (molluscivory, insectivory, and crustacivory) evolved in the genus Potamotrygon. Potamotrygonins demonstrate ecological niche lability in diets and feeding apparatus; however, diversification has mostly been a gradual process through time. We suggest that competition is unlikely to have limited the potamotrygonine invasion and diversification in South America.


Subject(s)
Lizards , Skates, Fish , Animals , Fresh Water , Lizards/genetics , Phenotype , Phylogeny
12.
Avian Dis ; 65(2): 219-226, 2021 06.
Article in English | MEDLINE | ID: mdl-34412451

ABSTRACT

Movement and land application of manure is a known risk factor for secondary spread of avian influenza viruses. During an outbreak of highly pathogenic avian influenza (HPAI), movement of untreated (i.e., fresh) manure from premises known to be infected is prohibited. However, moving manure from apparently healthy (i.e., clinically normal) flocks may be critical, because some egg-layer facilities have limited on-site storage capacity. The objective of this analysis was to evaluate targeted dead-bird active surveillance real-time reverse transcriptase polymerase chain reaction (rRT-PCR) testing protocols that could be used for the managed movement of manure from apparently healthy egg-layer flocks located in an HPAI control area. We also evaluated sequestration, which is the removal of manure from any contact with chickens, or with manure from other flocks, for a period of time, while the flock of origin is actively monitored for the presence of HPAI virus. We used stochastic simulation models to predict the chances of moving a load of contaminated manure, and the quantity of HPAI virus in an 8 metric ton (8000 kg) load of manure moved, before HPAI infection could be detected in the flock. We show that the likelihood of moving contaminated manure decreases as the length of the sequestration period increases from 3 to 10 days (e.g., for a typical contact rate, with a sample pool size of 11 swabs, the likelihood decreased from 48% to <1%). The total quantity of feces from HPAI-infectious birds in a manure load moved also decreases. Results also indicate that active surveillance protocols using 11 swabs per pool result in a lower likelihood of moving contaminated manure relative to protocols using five swabs per pool. Simulation model results from this study are useful to inform further risk evaluation of HPAI spread through pathways associated with manure movement and further evaluation of biosecurity measures intended to reduce those risks.


Artículo regular­Estrategias de vigilancia y aislamiento para reducir la probabilidad de transportar gallinaza de aves de postura contaminada con virus de influenza aviar altamente patógeno. El movimiento y la aplicación de gallinaza a la tierra es un factor de riesgo conocido para la propagación secundaria de los virus de la influenza aviar (IA). Durante un brote de influenza aviar altamente patógena (IAAP), se prohíbe el movimiento de gallinaza sin tratar (es decir, fresco) de las instalaciones que se conoce que están infectadas. Sin embargo, el traslado de gallinaza de parvadas aparentemente sanas (es decir, clínicamente normales) puede ser fundamental, porque algunas instalaciones de producción de huevo tienen una capacidad limitada de almacenamiento en el lugar. El objetivo de este análisis estaba evaluar los protocolos de la prueba de transcriptasa reversa y reacción en cadena de la polimerasa en tiempo real (rRT-PCR) utilizados en la vigilancia activa dirigida a aves muertas, que podrían usarse para el movimiento controlado de gallinaza de parvadas de postura aparentemente sanas ubicadas en un área de control para influenza aviar de alta patogenicidad. También se evaluó el aislamiento, que es la remoción de gallinaza y prevenir cualquier contacto con pollos, o con gallinaza de otras parvadas, durante un período de tiempo, mientras que la parvada de origen es monitoreada activamente para detectar la presencia del virus de la influenza aviar altamente patógeno. Se utilizaron modelos de simulación estocástica para predecir las posibilidades de trasladar una carga de estiércol contaminado y la cantidad de virus de la influenza aviar altamente patógeno en una carga de ocho toneladas métricas (8000 kg) de gallinaza trasladada, antes de que se pudiera detectar la infección por influenza aviar altamente patógena en la parvada. Se demostró que la probabilidad de mover gallinaza contaminada disminuye a medida que la duración del período de aislamiento aumenta de tres a diez días (por ejemplo, para una tasa de contacto típica, con un tamaño de muestra de 11 hisopos, la probabilidad disminuyó de 48% a <1 %). La cantidad total de heces de aves infectadas por la influenza aviar altamente patógena en una carga de gallinaza transportada también disminuye. Los resultados también indican que los protocolos de vigilancia activa que utilizan 11 hisopos como muestra agrupada dan como resultado una menor probabilidad de mover gallinaza contaminada en comparación con los protocolos que utilizan cinco hisopos por muestra agrupada. Los resultados del modelo de simulación de este estudio son útiles para una evaluación adicional del riesgo de la propagación de la influenza aviar altamente patógena a través de vías asociadas con el movimiento de gallinaza y una evaluación adicional de las medidas de bioseguridad destinadas a reducir esos riesgos.


Subject(s)
Chickens/virology , Influenza A virus/pathogenicity , Influenza in Birds/transmission , Manure/virology , Medical Waste Disposal/methods , Animals , Computer Simulation , Influenza A virus/isolation & purification , Influenza in Birds/prevention & control , Medical Waste Disposal/standards , Real-Time Polymerase Chain Reaction/veterinary , Reverse Transcriptase Polymerase Chain Reaction/veterinary , Stochastic Processes
14.
Avian Dis ; 2021 Mar 01.
Article in English | MEDLINE | ID: mdl-33647945

ABSTRACT

Movement and land application of manure is a known risk factor for secondary spread of avian influenza (AI) viruses. During an outbreak of highly pathogenic avian influenza (HPAI), movement of untreated (i.e., fresh) manure from premises known to be infected would be prohibited. However, moving manure from apparently healthy (i.e., clinically normal) flocks may become critical, because some egg-layer facilities have limited on-site storage capacity. The objective of this analysis was to evaluate targeted dead-bird active surveillance rRT-PCR (real-time reverse transcriptase polymerase chain reaction) testing protocols that could be used for the managed movement of manure from apparently healthy egg-layer flocks located in a HPAI Control Area. We also evaluated sequestration, which is the removal of manure from any contact with chickens, or with manure from other flocks, for a period of time, while the flock of origin is actively monitored for the presence of HPAI virus. We used stochastic simulation models to predict the chances of moving a load of contaminated manure, and the quantity of HPAI virus in an 8 metric ton (8000 kg) load of manure moved, before HPAI infection would be detected in the flock. We show that the likelihood of moving contaminated manure would decrease as the length of the sequestration period increased from 3 to 10 days (e.g., for a typical contact rate, with a sample pool size of 11 swabs, the likelihood decreased from 48% to <1%). The total quantity of feces from HPAI infectious birds in a manure load moved would also decrease. Results also indicate that active surveillance protocols using 11 swabs per-pool result in a lower likelihood of moving contaminated manure relative to protocols using 5 swabs per pool. Simulation model results from this study are useful to inform further risk evaluation of HPAI spread through pathways associated with the manure movement, and further evaluation of biosecurity measures intended to reduce those risks.

16.
ESMO Open ; 6(1): 100005, 2021 02.
Article in English | MEDLINE | ID: mdl-33399072

ABSTRACT

BACKGROUND: Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome. PATIENTS AND METHODS: Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann-Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method. RESULTS: In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission. CONCLUSION: Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.


Subject(s)
COVID-19/prevention & control , Neoplasms/therapy , Outcome Assessment, Health Care/statistics & numerical data , SARS-CoV-2/isolation & purification , Adult , Aged , Aged, 80 and over , C-Reactive Protein/analysis , COVID-19/virology , Female , Humans , L-Lactate Dehydrogenase/metabolism , Logistic Models , Longitudinal Studies , Lymphocyte Count , Lymphocytes/metabolism , Male , Middle Aged , Neoplasms/blood , Neoplasms/metabolism , Neutrophils/metabolism , Outcome Assessment, Health Care/methods , Platelet Count , SARS-CoV-2/physiology , United Kingdom , Young Adult
17.
Ann Oncol ; 32(4): 522-532, 2021 04.
Article in English | MEDLINE | ID: mdl-33359547

ABSTRACT

BACKGROUND: The incidence of esophageal adenocarcinoma (EAC) is rapidly rising and has a 5-year survival rate of <20%. Beyond TNM (tumor-node-metastasis) staging, no reliable risk stratification tools exist and no large-scale studies have profiled circulating tumor DNA (ctDNA) at relapse in EAC. Here we analyze the prognostic potential of ctDNA dynamics in EAC, taking into account clonal hematopoiesis with indeterminate potential (CHIP). PATIENTS AND METHODS: A total of 245 samples from 97 patients treated with neoadjuvant chemotherapy and surgery were identified from the prospective national UK Oesophageal Cancer Clinical and Molecular Stratification (OCCAMS) consortium data set. A pan-cancer ctDNA panel comprising 77 genes was used. Plasma and peripheral blood cell samples were sequenced to a mean depth of 7082× (range 2196-28 524) and ctDNA results correlated with survival. RESULTS: Characteristics of the 97 patients identified were as follows: 83/97 (86%) male, median age 68 years (SD 9.5 years), 100% cT3/T4, 75% cN+. EAC-specific drivers had higher variant allele fractions than passenger mutations. Using stringent quality criteria 16/79 (20%) were ctDNA positive following resection; recurrence was observed in 12/16 (75%) of these. As much as 78/97 (80%) had CHIP analyses that enabled filtering for CHIP variants, which were found in 18/78 (23%) of cases. When CHIP was excluded, 10/63 (16%) patients were ctDNA positive and 9/10 of these (90%) recurred. With correction for CHIP, median cancer-specific survival for ctDNA-positive patients was 10.0 months versus 29.9 months for ctDNA-negative patients (hazard ratio 5.55, 95% confidence interval 2.42-12.71; P = 0.0003). Similar outcomes were observed for disease-free survival. CONCLUSIONS: We demonstrate in a large, national, prospectively collected data set that ctDNA in plasma following surgery for EAC is prognostic for relapse. Inclusion of peripheral blood cell samples can reduce or eliminate false positives from CHIP. In future, post-operative ctDNA could be used to risk stratify patients into high- and low-risk groups for intensification or de-escalation of adjuvant chemotherapy.


Subject(s)
Adenocarcinoma , Esophageal Neoplasms , Adenocarcinoma/drug therapy , Adenocarcinoma/genetics , Aged , Biomarkers, Tumor , Esophageal Neoplasms/genetics , Humans , Liquid Biopsy , Male , Neoplasm Recurrence, Local/genetics , Prospective Studies
18.
J Pediatr Urol ; 17(2): 235.e1-235.e7, 2021 04.
Article in English | MEDLINE | ID: mdl-33342678

ABSTRACT

INTRODUCTION: Patients with neurogenic bladder (NGB) and urinary incontinence (UI) due to low bladder outlet resistance may require bladder neck procedures (BNPs) to achieve continence. These patients may also have reduced bladder capacity and or elevated detrusor storage pressures that require augmentation cystoplasty (AC). AC is not without complications that include risks for bladder rupture, urolithiasis, urinary tract infections and metabolic issues. Avoidance of AC would be helpful in patients with neurogenic urinary incontinence that have safe bladder parameters in the setting of low bladder outlet resistance. OBJECTIVE: To determine if pre-operative urodynamics could select children with NGBs and UI for isolated BNPs without AC. Additionally we sought to determine the safety of BNPs without AC and future need of AC with long-term follow-up. STUDY DESIGN: This is an IRB-approved retrospective analysis of all patients undergoing BNPs for management of neurogenic UI over a 17-year period. We separated these BNP patients into two groups: No AC + BNP (Group 1) vs. AC + BNP (Group 2). Our primary analyses focused on postoperative outcomes for patients in Group 1. Outcomes assessed included additional surgical procedures, urodynamic changes, development of CKD, new hydronephrosis (HDN) and vesicoureteral reflux (VUR). Secondary analysis included the timeline for the development of any bladder deterioration that necessitated AC in Group 1. RESULTS: 93 patients underwent BNP at a mean age of 10.8 years. Thirty did not have AC at the time of surgery (Group 1). These children had larger (p < 0.001) and more compliant (p < 0.001) bladders than Group 2 having simultaneous augmentation. At 6 years mean follow-up in Group 1 patients, three developed new reflux and three had new hydronephrosis. Nine (30%) had additional continence procedures. Twelve required (40%) AC at a mean of 23 months after the initial BNP. No patients had AC after 5 years. Detrusor end filling pressure increased 14.8 cm H2O (p = 0.028) and expected bladder capacity decreased 26.1% (p = 0.005) after isolated BNP. DISCUSSION: We found that from our cohort of patients who had normal bladder compliance and normal/near normal expected capacity preoperatively 40% required subsequent AC. We were unable to find pre-operative clinical parameters which predicted failure or conversion to AC. We found that 43.3% of our BNP without AC patients had no subsequent invasive procedures with mean 6-year follow-up. We found that none of our patients developed any degree of CKD. Finally, we found that the majority of patients that converted to AC after their BNP did so within the first 2 years after their initial BNP and no patients required augmentation 5 years post their initial BNP. This data validates that these patients require very strict follow up, particularly in the first 5 years after surgery. CONCLUSIONS: BNP without AC is safe in only a few selected patients with NGB. Despite preoperative selection, there are significant changes in bladder dynamics and 40% required subsequent augmentation. Bladder deterioration occurs early and generally in the first 2 years. Since there are no apparent reliable pre-operative variables predicting the need for subsequent AC, parents should be counseled regarding vigilant post-operative follow-up.


Subject(s)
Urinary Bladder, Neurogenic , Urinary Incontinence , Child , Follow-Up Studies , Humans , Retrospective Studies , Urinary Bladder, Neurogenic/etiology , Urinary Bladder, Neurogenic/surgery , Urodynamics
19.
Philos Trans A Math Phys Eng Sci ; 378(2184): 20200031, 2020 Nov 13.
Article in English | MEDLINE | ID: mdl-33040651

ABSTRACT

Argon fluoride (ArF) is currently the shortest wavelength laser that can credibly scale to the energy and power required for high gain inertial fusion. ArF's deep ultraviolet light and capability to provide much wider bandwidth than other contemporary inertial confinement fusion (ICF) laser drivers would drastically improve the laser target coupling efficiency and enable substantially higher pressures to drive an implosion. Our radiation hydrodynamics simulations indicate gains greater than 100 are feasible with a sub-megajoule ArF driver. Our laser kinetics simulations indicate that the electron beam-pumped ArF laser can have intrinsic efficiencies of more than 16%, versus about 12% for the next most efficient krypton fluoride excimer laser. We expect at least 10% 'wall plug' efficiency for delivering ArF light to target should be achievable using solid-state pulsed power and efficient electron beam transport to the laser gas that was demonstrated with the U.S. Naval Research Laboratory's Electra facility. These advantages could enable the development of modest size and lower cost fusion power plant modules. This would drastically change the present view on inertial fusion energy as being too expensive and the power plant size too large. This article is part of a discussion meeting issue 'Prospects for high gain inertial fusion energy (part 1)'.

20.
J Phys Chem Lett ; 11(17): 7184-7189, 2020 Sep 03.
Article in English | MEDLINE | ID: mdl-32787312

ABSTRACT

High-resolution X-ray photoelectron spectroscopy (XPS) and density functional theory (DFT) were used to characterize IrO2(110) films on Ir(100) with stoichiometric as well as OH-rich terminations. Core-level Ir 4f and O 1s peaks were identified for the undercoordinated Ir and O atoms and bridging and on-top OH groups at the IrO2(110) surfaces. Peak assignments were validated by comparison of the core-level shifts determined experimentally with those computed using DFT, quantitative analysis of the concentrations of surface species, and the measured variation of the Ir 4f peak intensities with photoelectron kinetic energy. We show that exposure of the IrO2(110) surface to O2 near room temperature produces a large quantity of on-top OH groups because of reaction of background H2 with the surface. The peak assignments made in this study can serve as a foundation for future experiments designed to utilize XPS to uncover atomic-level details of the surface chemistry of IrO2(110).

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