Lung Metastasis From Uterine Leiomyosarcoma: An Asymptomatic Presentation for a Rare Tumor.

Uterine leiomyosarcoma (ULC) is an uncommon neoplasm characterized by poor prognosis, it can predispose to distant metastasis, causing various symptomatic presentations. We present a unique case of a large heterogeneous mass in the lung cavity arising from a ULC, with complete absence of pulmonary symptoms and with concurrent coronavirus disease 2019 (COVID-19) infection. A high degree of clinical suspicion is required for ULC with accompanying metastasis.

Neurosurgery Lectures Benefit from a Flipped Class Approach.

BACKGROUND: In a flipped classroom, students learn lecture material before class and then participate in active learning during in-person sessions. This study examines preferences for flipped classroom activities during a neurosurgery presentation on traumatic brain injury. METHODS: Two hundred twenty-five third- and fourth-year medical students on their core neurology rotation watched an online podcast about traumatic brain injury before meeting for in-person, active learning activities with a neurological surgeon. Before and after the class, students were given rank-based surveys with an optional section for comments. The initial survey assessed preference for specific active learning activities, and the final survey assessed satisfaction with the experience. The students also answered an online 20-question postlecture test as part of the standard neurology class assessment. RESULTS: Every student scored over 90% on the postlecture test. Of the 81 students who answered the first survey, most students (83.95%) strongly preferred or preferred case scenarios with group discussion. The average Likert score for case scenario preference (4.37/5) was significantly higher than the score for all other activities (P < 0.05). Of the 207 students who answered the second survey, 80.19% of students reported that they would probably or definitely like to see more flipped classroom activities. CONCLUSIONS: Medical students highly preferred case scenarios because according to their comments, this method was relevant to real-life situations and led to higher information retention. This information suggests that the flipped classroom model for neurosurgical-based lectures is preferred, is beneficial, and should incorporate case scenarios. This methodology may also apply to neurosurgical residency training.

Automated Segmentation and Connectivity Analysis for Normal Pressure Hydrocephalus.

Objective and Impact Statement. We propose an automated method of predicting Normal Pressure Hydrocephalus (NPH) from CT scans. A deep convolutional network segments regions of interest from the scans. These regions are then combined with MRI information to predict NPH. To our knowledge, this is the first method which automatically predicts NPH from CT scans and incorporates diffusion tractography information for prediction. Introduction. Due to their low cost and high versatility, CT scans are often used in NPH diagnosis. No well-defined and effective protocol currently exists for analysis of CT scans for NPH. Evans' index, an approximation of the ventricle to brain volume using one 2D image slice, has been proposed but is not robust. The proposed approach is an effective way to quantify regions of interest and offers a computational method for predicting NPH. Methods. We propose a novel method to predict NPH by combining regions of interest segmented from CT scans with connectome data to compute features which capture the impact of enlarged ventricles by excluding fiber tracts passing through these regions. The segmentation and network features are used to train a model for NPH prediction. Results. Our method outperforms the current state-of-the-art by 9 precision points and 29 recall points. Our segmentation model outperforms the current state-of-the-art in segmenting the ventricle, gray-white matter, and subarachnoid space in CT scans. Conclusion. Our experimental results demonstrate that fast and accurate volumetric segmentation of CT brain scans can help improve the NPH diagnosis process, and network properties can increase NPH prediction accuracy.

Comparison of liver biopsies before and after direct-acting antiviral therapy for hepatitis C and correlation with clinical outcome.

Direct-acting antivirals (DAA) have replaced interferon (IFN)-based therapies for hepatitis C virus. In this retrospective clinical study, we examined differences in histopathologic features in paired liver biopsies collected from the same patient before and after DAA and correlated these findings with clinical outcome. Biopsies (n = 19) were evaluated by quantitative imaging analysis to measure steatosis and fibrosis. Most patients had decreased steatosis in their post-treatment, follow-up biopsies. However, one patient had a striking increase in steatosis (from 0.86 to 6.32%) and later developed decompensated cirrhosis and hepatocellular carcinoma (HCC). This patient had a marked increase in fibrosis between biopsies, with a CPA of 6.74 to 32.02. Another patient, who already had bridging fibrosis at the time of her pre-treatment biopsy, developed cholangiocarcinoma after DAA. Even though the overall inflammatory activity in the post-treatment biopsies significantly decreased after treatment, 60% of patients had persistent portal lymphocytic inflammation. In summary, DAAs decreased steatosis and hepatic inflammation in most patients, although some may have persistence of lymphocytic portal inflammation. Patients known to have advanced fibrosis at treatment initiation and who have other risk factors for ongoing liver injury, such as steatosis, should be followed closely for the development of adverse outcomes, such as portal hypertension and primary liver cancers.

Establishment and Benefits of a Normal Pressure Hydrocephalus Support Group on Patient Education and Experience.

INTRODUCTION: Normal pressure hydrocephalus (NPH) is a debilitating, neurological condition that can lead to mental deterioration. With the diagnosis and treatment of NPH constantly evolving and its symptoms worsening with age, education for patients and their families is crucial. In this study, we aim to explore the potential educational benefits of a physician-led NPH support group. METHODS: Between December 2015 and November 2018, six semiannual NPH support group meetings were held for patients and their families. Attendees, ages 20-90, completed a Likert scale-based survey designed to assess the support group's educational benefits using the following primary outcome variables: (1) subjective knowledge, (2) perceived utility/efficacy, and (3) patient satisfaction. RESULTS: Our survey data suggests that patients and their family members agree on the efficacy of the support group in learning about NPH. They felt that the support group served its purpose and improved their comfort/knowledge regarding NPH. There was consensus about sustaining and maintaining the support group for the future. Of 65 survey responses, the composite average score of questions pertaining to subjective knowledge, perceived utility/efficacy, and patient satisfaction was 4.5 out of 5.0. CONCLUSION: We demonstrated that support groups are effective in educating the adult NPH population and their family/friends about NPH onset and treatment. Enhanced educational awareness for patients and families can help patients cope with their neurological condition and improve patient adherence to follow-up and physician recommendations.

Action-Oriented Population Nutrition Research: High Demand but Limited Supply.

BACKGROUND: The relatively rapid ascendancy of nutrition and health on policy agendas, along with greater emphasis on accountability and results, has stimulated interest in new forms of research to guide the development and implementation of effective policies, programs, and interventions-what we refer to as action-oriented research. To date, action-oriented research in the nutrition field is thought to be the exception rather than the rule, but empirical evidence to support this claim is lacking. METHODS: We conducted a survey of selected journals in nutrition and public health to assess the extent and nature of population nutrition research published in 2012 that embodied 5 defined characteristics of action-oriented research in relation to: (1) topic(s) of study, (2) processes/influences, (3) actors, (4) methods, and (5) approaches. We identified 762 articles from the 6 selected nutrition journals and 77 nutrition-related articles from the 4 selected public health journals that met our search criteria. RESULTS: Only 7% of the 762 papers in nutrition journals had at least 1 of the 5 action-oriented research characteristics, compared with 36% of the 77 nutrition-related papers in the public health journals. Of all 80 articles that had at least 1 action-oriented research characteristic, only 5 articles (6.25%) embodied all 5 characteristics. Articles with action-oriented research covered a broad range of topics and processes/influences, including policy, workforce development, and schools, as well as actors, such as program staff, store owners, parents, and school staff. In addition, various research methods were used, such as stakeholder analysis, ethnographic narrative, iterative action research, and decision tree modeling, as well as different approaches, including participant-observer and community-based participatory research. CONCLUSIONS: Action-oriented research represents a small fraction of articles published in nutrition journals, especially compared with public health journals. This reinforces recent calls to expand population nutrition research agendas to more effectively inform and guide the initiation, development, implementation, and governance of policies, programs, and interventions to address the varied forms of nutrition-related problems. With heightened attention to the magnitude and importance of nutrition problems worldwide, there are substantial reasons and opportunities to incentivize and support such expansion.