Value of DermaCheckup as a novel dedicated digital health solution for teledermatology.

Daily healthcare is becoming increasingly costly and resource-intensive, requiring vast human and financial resources. The primary aim of the present study was to present the initial findings regarding the diagnostic accuracy of a novel telemedicine platform, DermaCheckup, when compared with face-to-face clinical appointments. The secondary aim was to assess whether patient management plans produced via this telemedicine platform differ from those decided upon following a face-to-face dermatological consultation. The difference in time to diagnosis between the tele-dermatology platform and standard care was also assessed. The DermaCheckup teledermatology service was implemented in March, 2020 as the COVID-19 pandemic emerged in the UK. The present study assessed patients who underwent a face-to-face clinical consultation, who, prior to visiting the clinic, used the teledermatology platform; thus, the diagnosis made via teledermatology was able to be compared to that made following standard care. Comparisons were made between diagnosis, process of diagnosis and the time to diagnosis. A total of 29 consecutive patients entering one UK dermatology clinic were included in the study. The COVID-19 pandemic resulted in face-to-face visits being challenging, owing to the risk of transmission of SARS-CoV-2. This limited the number of patients recruited into the study. The DermaCheckup application exhibited a very good level of agreement in terms of diagnosis with traditional face-to-face appointments. In the present study cohort, 93% of the patients could have been managed safely or referred immediately for a biopsy, thus avoiding a visit to the hospital. A substantial important improvement was also observed in the efficiencies that can be potentially achieved; the time to manage a patient decreased between 46-22-fold without considering the waiting time required between the time of organizing an appointment to the actual appointment.

Clinical and Patient-reported Outcome Measures in Men Referred for Consideration of Surgery to Treat Lower Urinary Tract Symptoms: Baseline Results and Diagnostic Findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM).

BACKGROUND: Clinical evaluation of male lower urinary tract symptoms (MLUTS) in secondary care uses a range of assessments. It is unknown how MLUTS evaluation influences outcome of therapy recommendations and choice, notably urodynamics (UDS; filling cystometry and pressure flow studies). OBJECTIVE: To report participants' sociodemographic and clinical characteristics, and initial diagnostic findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). UPSTREAM is a randomised controlled trial evaluating whether symptoms are noninferior and surgery rates are lower if UDS is included. DESIGN, SETTING, AND PARTICIPANTS: A total of 820 men (≥18 yr of age) seeking treatment for bothersome LUTS were recruited from 26 National Health Service hospital urology departments. INTERVENTION: Care pathway based on routine, noninvasive tests (control) or routine care plus UDS (intervention arm). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome is International Prostate Symptom Score (IPSS) and the key secondary outcome is surgery rates 18 mo after randomisation. International Consultation on Incontinence Questionnaires were captured for MLUTS, sexual function, and UDS satisfaction. Baseline clinical and patient-reported outcome measures (PROMs), and UDS findings were informally compared between arms. Trends across age groups for urinary and sexual PROMs were evaluated with a Cuzick's test, and questionnaire items were compared using Pearson's correlation coefficient. RESULTS AND LIMITATIONS: Storage LUTS, notably nocturia, and impaired sexual function are prominent in men being assessed for surgery. Sociodemographic and clinical evaluations were similar between arms. Overall mean IPSS and quality of life scores were 18.94 and 4.13, respectively. Trends were found across age groups, with older men suffering from higher rates of incontinence, nocturia, and erectile dysfunction, and younger men suffering from increased daytime frequency and voiding symptoms. Men undergoing UDS testing expressed high satisfaction with the procedure. CONCLUSIONS: Men being considered for surgery have additional clinical features that may affect treatment decision making and outcomes, notably storage LUTS and impaired sexual function. PATIENT SUMMARY: We describe initial assessment findings from a large clinical study of the treatment pathway for men suffering with bothersome urinary symptoms who were referred to hospital for further treatment, potentially including surgery. We report the patient characteristics and diagnostic test results, including symptom questionnaires, bladder diaries, flow rate tests, and urodynamics.

Neural dynamics in reconfigurable silicon.

A neuromorphic analog chip is presented that is capable of implementing massively parallel neural computations while retaining the programmability of digital systems. We show measurements from neurons with Hopf bifurcations and integrate and fire neurons, excitatory and inhibitory synapses, passive dendrite cables, coupled spiking neurons, and central pattern generators implemented on the chip. This chip provides a platform for not only simulating detailed neuron dynamics but also uses the same to interface with actual cells in applications such as a dynamic clamp. There are 28 computational analog blocks (CAB), each consisting of ion channels with tunable parameters, synapses, winner-take-all elements, current sources, transconductance amplifiers, and capacitors. There are four other CABs which have programmable bias generators. The programmability is achieved using floating gate transistors with on-chip programming control. The switch matrix for interconnecting the components in CABs also consists of floating-gate transistors. Emphasis is placed on replicating the detailed dynamics of computational neural models. Massive computational area efficiency is obtained by using the reconfigurable interconnect as synaptic weights, resulting in more than 50 000 possible 9-b accurate synapses in 9 mm(2).

Abelès method revisited.

The Abelès method is a classical method for determining the refractive index of dielectric thin films. In this paper we examine the main features of the method in a formal manner, using closed-form equations, and we show that the method is ambiguous in certain yet unreported situations.

Cyclin D1 binding to the androgen receptor (AR) NH2-terminal domain inhibits activation function 2 association and reveals dual roles for AR corepression.

The androgen receptor (AR) is a member of the nuclear receptor superfamily, the activity of which is critical for the development and progression of prostate cancer. We and others have previously demonstrated that cyclin D1 is a potent corepressor of the AR. Although cyclin D1 is suspected to recruit histone deacetylases to the AR complex, previous studies have demonstrated that this activity alone is insufficient for cyclin D1 function. Here, we uncover a novel, secondary means of cyclin D1-mediated repression, through modulation of AR amino-carboxy terminal interactions. We show that cyclin D1 predominantly binds the N-terminal domain of the AR, dependent on the AR 23FxxLF27 motif. Through this motif, cyclin D1 abrogates the ability of the AR N-terminal domain to interact with the C terminus. Secondary amino-terminal domain sites capable of fostering interaction with the C terminus were refractory to cyclin D1 action, indicating that the ability of cyclin D1 to modulate AR amino-carboxy terminal interactions is specific to 23FxxLF27. Deletion of the N-terminal cyclin D1 binding site severely compromised AR activity (due to loss of FxxLF) but unmasked a repressor action through interaction with the AR C terminus. In summary, these data reveal novel, unexpected mechanisms of cyclin D1 activity and demonstrate that this function of cyclin D1 is critical for AR modulation.

Sensitivity analysis of grating parameter estimation.

An optimization method for the sensitivity of diffraction efficiency measurements is presented. I define the sensitivity as the estimation precision of the grating parameters. The optimization method called sensitivity analysis for fitting scans all the possible measurement configurations and selects the configuration that yields the best sensitivity. The scan is made over the domain of the experimental parameters of the arrangement, such as the azimuth angle of the grating and the orientation angles of the analyzer and the polarizer. These parameters can be freely varied, and among the multitude of possible combinations there is one configuration that provides optimum sensitivity. Comparison with experimental results reveals a qualitative agreement between theory and practice.

Phase-modulation scatterometry.

Phase-modulation scatterometry is a metrology technique for determining, by means of a phase modulator as a key device, the parameters of gratings. The main source of error to be dealt with are the fluctuations of the phase-modulation amplitude. The grating zeroth-order reflectance modulated by the phase modulator is converted into a signal by the photodetector. The measurables are the direct term and the first two harmonics of the signal. For experimental data fitting, we used the ratio of the harmonics over the direct term because it significantly improves the accuracy. A sensitivity analysis was performed for two samples, one real and one theoretical, to find the measurement configuration that insures optimum determination precision for the grating parameters. For the real sample, comparison of the theoretical predictions for sensitivity with the actual values showed a good agreement. For both samples the sensitivity analysis indicated subnanometric precision for the critical dimension (grating linewidth).

Uso del estimulador vagal, en la epilepsia refractaria: una alternativa terapéutica / Vagus nerve stimulation in the management of intractable epilepsy

La utilización del estimulador vagal constituye una alternativa válida de tratamiento paliativo en aquellas epilepsias refractarias que no pueden ser tratadas mediante técnicas quirúrgicas a cielo abierto (lobectomias, lesionectomías, desconexiones). Se describen fundamentos del procedimiento, indicaciones del mismo, técnica quirúrgica y experiencia de los autores.

Uso del estimulador vagal, en la epilepsia refractaria: una alternativa terapéutica / Vagus nerve stimulation in the management of intractable epilepsy

La utilización del estimulador vagal constituye una alternativa válida de tratamiento paliativo en aquellas epilepsias refractarias que no pueden ser tratadas mediante técnicas quirúrgicas a cielo abierto (lobectomias, lesionectomías, desconexiones). Se describen fundamentos del procedimiento, indicaciones del mismo, técnica quirúrgica y experiencia de los autores. (AU)

Focal liver lesions: evaluation of the efficacy of gadobenate dimeglumine in MR imaging--a multicenter phase III clinical study.

PURPOSE: To evaluate gadobenate dimeglumine (Gd-BOPTA) for dynamic and delayed magnetic resonance (MR) imaging of focal liver lesions. MATERIALS AND METHODS: In 126 of 214 patients, MR imaging was performed before Gd-BOPTA administration, immediately after bolus administration of a 0.05- mmol/kg dose of Gd-BOPTA, and 60-120 minutes after an additional intravenously infused 0.05-mmol/kg dose. In 88 patients, imaging was performed before and 60-120 minutes after a single, intravenously infused 0.1-mmol/kg dose. T1- and T2-weighted spin-echo and T1-weighted gradient-echo images were acquired. On-site and blinded off-site reviewers prospectively evaluated all images. Intraoperative ultrasonography, computed tomography (CT) during arterial portography, and/or CT with iodized oil served as the reference methods in 110 patients. RESULTS: Significantly more lesions were detected on combined pre- and postcontrast images compared with on precontrast images alone (P <. 01). All reviewers reported a decreased mean size of the smallest detected lesion and improved lesion conspicuity on postcontrast images. All on-site reviewers and two off-site reviewers reported increased overall diagnostic confidence (P <.01). Additional lesion characterization information was provided on up to 109 (59%) of 184 delayed images and for up to 50 (42%) of 118 patients in whom dynamic images were assessed. Gd-BOPTA would have helped change the diagnosis in 99 (47%) of 209 cases and affected patient treatment in 408 (23%) of 209 cases. CONCLUSION: Gd-BOPTA increases liver lesion conspicuity and detectability and aids in the characterization of lesions.

Appendicitis after appendectomy: CT diagnosis.

This article presents a case of appendicitis 7 years after open appendectomy. Together with the apparent CT findings we discuss the current literature of this issue.

Extratemporal epilepsy in children: candidate selection and surgical treatment.

From June 1988 to June 1998, 60 children with extratemporal epilepsies (EE), most of whom were symptomatic, underwent surgery. All patients were studied by means of CT scanning, MRI and scalp EEG. Video-telemetry was used in 40 cases. Intracranial electrodes were placed in 10. Intraoperative ECoG was used in the 35 children who underwent resective procedures and in the 25 in whom disconnection was performed. Surgical procedures were as follows: 24 lesionectomies, 25 disconnecting procedures, 7 polectomies and/or lobectomies, 3 corticectomies and 1 anatomical hemispherectomy. After at least 1 year's follow-up in 48 children, to date 38 are in Engel class I, 7 in class II, 1 in class III and 2 in class IV. That is to say, in 46 of the 48, surgical outcomes ranges from very good to at least worthwhile, as reflected in their classification in Engel class III.