Barriers with Valve Mechanisms Are Predicted to Protect Crops from Slug Carriers of Rat Lungworm Disease.

Angiostrongyliasis (Rat Lungworm disease) is an emerging parasitic disease caused by the ingestion of gastropods infected with the neurotropic nematode Angiostrongylus cantonensis. The reduction of crop infestation with infected slug carriers may vary widely by protection method. We explored the application of barriers with valve mechanisms, whereby selective directional forces caused a greater number of slugs to exit than enter the protected plot, leading to decreased slug population densities at a steady state. Using field data, we constructed predictive models to estimate slug population densities at a steady state in protected plots with (1) no valve effect, (2) a valve effect, (3) no valve effect with a single breach of the barrier, (4) a valve effect with a single breach of the barrier, (5) a valve effect with a constant breach of the barrier, and (6) a repelling effect. For all scenarios, plots protected using a barrier with a valve effect had consistently lower slug densities at a steady state. Our findings support the use of barriers with valve mechanisms under different conditions, and potentially in combination with other interventions to reduce the contamination of crops by slug carriers of A. cantonensis. Improving barriers extends beyond disease mitigation to economic and cultural impacts on the local farmer and consumer communities.

Introduction of an academic medical center's point-of-care ultrasound curriculum to internal medicine residents at a community-based teaching hospital.

BACKGROUND: Despite its proven utility, integration of point-of-care ultrasound (POCUS) into internal medicine (IM) residency training has been inconsistent. Due to their unique constraints, community-based teaching hospitals may face particular challenges in providing POCUS training to IM residents. OBJECTIVES: To evaluate short-term educational outcomes of an academic center's POCUS curriculum following its adaptation and delivery to IM residents at a community-based teaching hospital. METHODS: A needs assessment (NA) regarding POCUS training was distributed to PGY-2 and PGY-3 IM residents at a community-based teaching hospital in 2017. Based on the NA results, a POCUS curriculum from an academic center was modified and a revised course was offered to the same residents. Participants completed cognitive assessments before and after three of the four didactic sessions. Observed placement of an ultrasound-guided peripheral IV before and after the training program comprised the skills assessment. RESULTS: 17 of 28 (61%) residents completed the NA; eleven participated in the course. Of 33 possible quiz pairs, 15 (45%) were completed. Average quiz scores rose after the first and third sessions. Skills assessment scores increased after course completion. CONCLUSION: Adaptation of POCUS curricula from academic centers may be a feasible instructional strategy for community-based IM residency programs.

Prevalence and Risk Factors for Human Cystic Echinococcosis in the Cusco Region of the Peruvian Highlands Diagnosed Using Focused Abdominal Ultrasound.

AbstractLatin America is among the highly endemic regions for cystic echinococcosis (CE). In Peru, an estimated 1,139 disability-adjusted life years are lost annually from surgical treatment of CE. This is comparable with the combined total for Argentina, Brazil, Uruguay, and Chile. The prevalence of human infection has been investigated in the central Peruvian Andes, but there are no community-based screening data from other regions of Peru. We carried out a population survey in January 2015 using abdominal ultrasound to estimate the prevalence of abdominal CE in the Canas and Canchis provinces, in the Cusco region of Peru. Among 1,351 subjects screened, 41 (3%) had CE. There was significant variation between communities with similar socioeconomic features in a small geographical area. A history of CE was reported by 4.1% of the screened subjects, among whom 30.3% still had CE on ultrasound. Among patients reporting previous CE treatment, 14.9% had CE in active stages. Limited education, community of residence, and knowing people with CE in the community were associated with CE. These results demonstrate a significant burden of CE in the region and suggest the need for further investigations, control activities, and optimization of clinical management for CE in this area.

Normal anatomic relationships in prepubescent female external genitalia.

OBJECTIVE: Female congenital abnormalities and concomitant ambiguous genitalia constitute the primary reason for female genital reconstruction, however, objective data describing normal female anatomy is lacking. The aim of this study is to describe the normal anatomical relationships and size of the external genital structures in prepubescent females. MATERIALS AND METHODS: Data were collected prospectively from consecutive Tanner stage 1 females undergoing surgery unrelated to the genitalia. Recorded measurements included: clitoris length and width, length from clitoris to anus, clitoris to urethra, clitoris to posterior labia majora, mucosa behind vagina or posterior fourchette, and radius to labia minora at vagina. Patients were stratified by age into four age groups: <2 years, 2-5 years, 5-11 years and >11 years. RESULTS: Fifty-six patients met inclusion criteria. Clitoral width was similar in all age groups. The regression plots for the remaining measurements modeled on age all show a significant linear growth distribution. CONCLUSIONS: The average clitoral width was 3.8 mm, which remained constant between age groups. Clitoral length, length from clitoris to anus, clitoris to posterior labia majora, clitoris to urethra and posterior fourchette length increased across age groups. This study provides insight into the dimensions of normal external genitalia in tanner stage 1 females.

Partial bladder outlet obstruction in mice may cause E-cadherin repression through hypoxia induced pathway.

PURPOSE: Posterior urethral valves are the most common cause of partial bladder outlet obstruction in the pediatric population. Posterior urethral valves is a devastating clinical problem that ultimately results in urinary incontinence, neurogenic bladder and renal impairment. Despite improvements in medical and surgical management at least a third of patients with this condition progress to end stage renal disease and half will have problems with urinary incontinence. To achieve better understanding of the mechanism associated with clinical events we generated partial bladder outlet obstruction in male mice. In this model we investigated pathological consequences and underlying molecular mechanisms secondary to partial bladder outlet obstruction. MATERIALS AND METHODS: Five to 8-week-old male C57BL/6 mice were divided into a surgical obstruction group and a sham operated group that served as controls. Bladders and kidneys were harvested from each group 1, 2, 3, 5 and 7 days postoperatively, respectively. We examined histological and biochemical alterations, and further investigated our hypothesis that partial bladder outlet obstruction induces hypoxia activated profibrotic signaling and changes in gene expression in the bladder. RESULTS: Mice with partial bladder outlet obstruction demonstrated significant increases in bladder mass and urinary retention compared to sham operated mice. Obstruction caused fibrosis in the bladder and induced up-regulation of profibrotic genes, hypoxia-inducible factors and epithelial-mesenchymal transition-inducing transcription factors, resulting in E-cadherin down-regulation. CONCLUSIONS: Obstruction induced significant histological and molecular alterations, including activation of the hypoxia-inducible factors pathway in the mouse bladder. Activation of epithelial-mesenchymal transition-inducing transcription factors by hypoxia-inducible factors might have an important role in the pathogenesis of partial bladder outlet obstruction.

The effect of short-term dutasteride intake in early-stage prostate cancer: analysis of 148 patients who underwent three-dimensional prostate mapping biopsy.

OBJECTIVES: The effect of dutasteride on existing prostate cancer volume is largely unknown. In this study, we assessed the impact of dutasteride on tumor burden and Gleason score. METHODS: A retrospective review of patients from our institution was performed, examining men interested in surveillance for prostate cancer, who underwent transperineal three-dimensional mapping (TP-3DM) biopsy within 3-6 months after their initial cancer diagnosis. The criteria to qualify for TP-3DM biopsy included prostate-specific antigen < 10 ng/mL, Gleason score ≤ 7, ≤ 2 positive cores out of 12. There were 2 cohorts of men--those who took dutasteride daily before the TP-3DM biopsy and those who did not receive any 5ARIs. Upstaging of prostate cancer diagnosis was defined as an increase in one or more positive cores or a change from unilateral to bilateral disease. RESULTS: From 2006-2008, a cohort of 148 men underwent TP-3DM biopsy of the prostate. Ninety-one men received a treatment regime of dutasteride at least 3 months before TP-3DM biopsy. Fifty-seven men did not receive dutasteride or any other 5ARI. Approximately 74% of men who did not take dutasteride were upstaged and/or upgraded compared with 49.4% of men who received dutasteride (P = .0038). CONCLUSIONS: We observed a 24.3% decrease in the proportion of upstaging and/or upgrading of prostate cancer in men who received dutasteride at least 3 months before 3D prostate TP-3DM biopsy. Thus, the effect of dutasteride on prostate cancer may have implications for its potential use as a secondary chemoprevention agent.

The role of LHRH antagonists in the treatment of prostate cancer.

For patients with advanced prostate cancer, luteinizing hormone-releasing hormone (LHRH) agonists have provided successful androgen deprivation therapy (ADT) for some 25 years. However, the benefits of LHRH agonists are limited in that these agents are agonists, not antagonists. The search for and development of an effective LHRH antagonist have proven difficult. Nevertheless, antagonists offer subtle advantages, including more rapid reduction in testosterone levels, reduction in testosterone-induced flare, and maintenance of castrate levels of testosterone. Accordingly, LHRH antagonists appear to provide a viable alternative to LHRH agonist therapy. Degarelix, a recently approved LHRH antagonist, has been shown to work more quickly in lowering serum testosterone levels, with an acceptable safety profile and a mechanism of action that obviates the testosterone surges associated with LHRH agonist use. Presently, degarelix is the only LHRH antagonist approved for the treatment of advanced prostate cancer.

Targeted focal therapy for prostate cancer: a review.

PURPOSE OF REVIEW: Prostate cancer screening has shifted the diagnosis of prostate cancer to lower grade, organ confined disease. Radical prostatectomy or radiation therapy has been shown to be overtreatment in 30% of patients. In this review, we will discuss targeted focal therapy (TFT) using the modalities of cryotherapy or high intensity focused ultrasound as an alternate treatment for low-risk prostate cancers. RECENT FINDINGS: TFT uses 3-D mapping biopsies to guide treatment so lesions of interest are ablated whereas sparing surrounding healthy tissues, avoiding the side-effects associated with more invasive treatments. In recent years, improvements in cryotherapy and HIFU have increased efficacy whereas decreasing complications. Prostate cancer control reported following TFT is promising. SUMMARY: With data demonstrating effective treatment in select patients, physicians can better inform their patients of the options available to eradicate their prostate cancer. TFT provides an alternative to active surveillance and more aggressive treatments for patients with low-risk tumors. As studies mature, more information regarding long-term survival and benefit will become more evident.