Excision of recurrent penile schwannoma with neurovascular bundle sparing: A novel surgical approach

Penile schwannomas are rare, often painless lesions usually growing on the dorsum of the penis. A young and otherwise healthy male with recurrent painful penile schwannomas and decreased libido was successfully treated with surgical excision. Through fine dissection of the nerve fascicles leading to the primary schwannoma, the lesion was successfully removed without compromising erectile or ejaculatory function. This novel approach allowed for significant symptomatic relief and improved quality of life.

Evolutionary analysis of cellular reduction and anaerobicity in the hyper-prevalent gut microbe Blastocystis

Blastocystis is the most prevalent microbial eukaryote in the human and animal gut, yet its role as commensal or parasite is still under debate. Blastocystis has clearly undergone evolutionary adaptation to the gut environment and possesses minimal cellular compartmentalization, reduced anaerobic mitochondria, no flagella, and no reported peroxisomes. To address this poorly understood evolutionary transition, we have taken a multi-disciplinary approach to characterize Proteromonas lacertae, the closest canonical stramenopile relative of Blastocystis. Genomic data reveal an abundance of unique genes in P. lacertae but also reductive evolution of the genomic complement in Blastocystis. Comparative genomic analysis sheds light on flagellar evolution, including 37 new candidate components implicated with mastigonemes, the stramenopile morphological hallmark. The P. lacertae membrane-trafficking system (MTS) complement is only slightly more canonical than that of Blastocystis, but notably, we identified that both organisms encode the complete enigmatic endocytic TSET complex, a first for the entire stramenopile lineage. Investigation also details the modulation of mitochondrial composition and metabolism in both P. lacertae and Blastocystis. Unexpectedly, we identify in P. lacertae the most reduced peroxisome-derived organelle reported to date, which leads us to speculate on a mechanism of constraint guiding the dynamics of peroxisome-mitochondrion reductive evolution on the path to anaerobiosis. Overall, these analyses provide a launching point to investigate organellar evolution and reveal in detail the evolutionary path that Blastocystis has taken from a canonical flagellated protist to the hyper-divergent and hyper-prevalent animal and human gut microbe.

Evaluation of a revised AERMOD treatment of plume dispersion in the daytime elevated stable layer

Advanced dispersion models such as AERMOD specifically address the portion of a plume emitted in convective conditions that is sufficiently buoyant to rise into the stable layer above the elevated inversion. This portion of the plume mass is often referred to as the "penetrated plume" because that plume component breaks through the elevated inversion and penetrates into the stable layer aloft. A premature mixing of the penetrated plume to the ground has been identified in the current formulation of AERMOD, which is the U.S. EPA-preferred short-range dispersion model and used in several other countries. This behavior has been observed based on data from field studies where the model is found to overpredict ground-level concentration events due to the penetrated plume component, with the timing of these peak predictions too early in the day. A proposed update to AERMOD to address the penetrated plume issue (referred to as "HBP" for modifications particularly important for "highly buoyant plume") is documented and evaluated in this manuscript. The revised approach involves a check on the convective mixing height for the current hour as well as the next hour to determine how much of the penetrated plume has been captured by the convective boundary layer by the end of the current hour. The amount of the penetrated plume mass that is allowed to mix to the ground in the HBP modifications depends upon the result of this calculation. The HBP modification has been evaluated as an update to AERMOD for three databases along with a sensitivity analysis of the effects of the HBP changes on a variety of stack heights and buoyancy fluxes. The findings of the evaluation indicate that the HBP changes to AERMOD result in reduced overprediction tendencies.Implications: A proposed enhancement to AERMOD to address a premature mixing of penetrated plume material to the ground has been performed by implemented and evaluated by the authors. The enhancement, referred to as the highly buoyant plume (HBP) is based on work developed by Jeffrey Weil. HBP is designed to better characterize the penetrated plume behavior in the model such that it aligns more closely with observations based on data from field studies.

Highly pathogenic avian influenza virus H5N6 (clade 2.3.4.4b) has a preferable host tropism for waterfowl reflected in its inefficient transmission to terrestrial poultry

Highly-pathogenic avian influenza virus (HPAIV) H5N6 (clade 2.3.4.4b) incurred into Europe in late 2017 and was predominantly detected in wild birds, with very few terrestrial poultry cases. Pekin ducks directly-infected with a UK virus (H5N6-2017) were donors of infection to investigate contact transmission to three recipient species: Ducks, chickens and turkeys. H5N6-2017 transmission to ducks was 100% efficient, but transmission to in-contact galliforme species was infrequent and unpredictable, thereby reflecting the European 2017-2018 H5N6 epidemiology. Although only two of 28 (7%) infected ducks died, the six turkeys and one chicken which became infected all died and displayed systemic H5N6-2017 dissemination, while pathogenesis in ducks was generally milder. Analysis of H5N6-2017 progeny in the contacts revealed no emergent polymorphisms in an infected duck, but the galliforme species included changes in the polymerase (PB2 A199T, PA D347A), matrix (M1 T218A) and neuraminidase genes (T88I). H5N6-2017 environmental contamination was associated with duck shedding.

YouTube as a Patient Education Resource for Male Hypogonadism and Testosterone Therapy

Introduction

YouTube is an unregulated platform that patients are using to learn about treatment options.

Aim

To assess the reliability of YouTube videos (YTVs) related to male hypogonadism and testosterone therapy.

Methods

Searching on YouTube by relevance and view count, we analyzed the top 10 videos (80 videos total) for the following search terms: low testosterone, testosterone replacement therapy, AndroGel, and hypogonadism.

Main Outcome Measure

We recorded the number of views for each video, evaluated videos using the DISCERN score (DS) criterion, and compared the DS for videos including board-certified physicians and videos without. A second comparison was made between videos with board-certified physicians in urology, endocrinology, other MD, and those without any physician.

Results

The YTVs analyzed received a total of 38,549,090 views, a median of 25,201 and 17.30 views/day. Videos that featured physicians had significantly fewer views/day than videos that did not (39.48 CI 9,72 vs 1,731 CI 330, 3,132; P = .019). Most YTVs studied were unreliable. The median DS across all videos was 2. However, most videos created by physicians were found to be reliable with a median DS of 4. In addition, YTVs that did not feature a physician were found to be significantly less reliable than videos that featured a physician (3.22 CI 3.06, 4.09 vs 1.87 CI 1.56, 2.18; P < .001). There was no significant difference in the reliability or viewership of YTVs stratified by physician type.

Conclusion

Most YTVs related to male hypogonadism/testosterone therapy were unreliable, but there are reliable YTVs available. Reliable videos usually feature a physician and receive fewer views than unreliable YTVs. Physicians and academic societies should work to provide verified videos to provide patients with reliable information about male hypogonadism and testosterone therapy.

CJ Warren, J Wisener, B Ward, et al. YouTube as a Patient Education Resource for Male Hypogonadism and Testosterone Therapy. Sex Med 2021;9:100324.

YouTube and Men's Health: A Review of the Current Literature

INTRODUCTION

YouTube is the most used social media website, and there is a growing body of literature examining the reliability of healthcare information on this platform. Patients seeking men's health information may be more likely to use YouTube owing to the sensitivity of these issues.

OBJECTIVES

The objective of this study is to review the literature for studies related to the reliability of YouTube videos about men's health topics.

METHODS

A literature review was conducted using PubMed and Google Scholar for publications related to the reliability of YouTube videos about men's health as of July 1, 2020.

RESULTS

There were 17 studies related to YouTube and Men's Health. Most videos were found to be unreliable, and videos uploaded by physicians or healthcare organizations were usually more reliable. However, there were no studies in which more reliable videos had higher metrics of user engagement (views, likes, comments) than unreliable videos and there were several studies where unreliable videos had higher metrics of user engagement. In addition, the methods used to evaluate YouTube videos are not uniform across studies including the way that terms are searched (filtering by relevance vs view count) and the way in which reliability is assessed. For example, some studies create custom evaluation forms based on clinical guidelines, whereas others use validated questionnaires. The only validated questionnaire used across multiple studies was the DISCERN score criterion.

CONCLUSIONS

Most information on YouTube about men's health is unreliable. Videos created by physicians and healthcare organizations are more reliable, and videos that are advertisements are less reliable. Physicians and healthcare systems should continue to upload educational YouTube videos but work to increase their views and user engagement. It may benefit patients if physician organizations could work with YouTube to create verified videos disseminating healthcare information that are favored in the search algorithm. Warren CJ, Sawhney R, Shah T, et al. YouTube and Men's Health: A Review of the Current Literature. Sex Med Rev 2021;9:280-288.

Vulnerable Immigrant Populations in the New York Metropolitan Area and COVID-19: Lessons Learned in the Epicenter of the Crisis

The epicenter of the COVID-19 crisis since March 17, 2020-the New York metropolitan area-is home to some of the largest Latino immigrant communities in the nation. These communities have long faced barriers to health care access, challenges due to immigration status, and financial and labor instability. The COVID-19 pandemic has aggravated these existing issues in a vulnerable, often forgotten, immigrant community. It has been challenging for this population to access public information regarding COVID-19 testing, treatment, and assistance programs because this information has seldom been disseminated in Spanish and even less frequently in Portuguese. While long-term solutions will require time and changes to policy, some short-term measures can mitigate the current situation. The authors share their experience from Newark, New Jersey, where partnerships of public and private community-based organizations (CBOs) have been successful in establishing trust between the health care system and a fearful Latino community. The Ironbound Initiative, a student group at Rutgers New Jersey Medical School in Newark, New Jersey, has partnered with Mantena Global Care, a Brazilian CBO in Newark, to facilitate dissemination of COVID-19-relevant information. Medical student volunteers, removed from their clinical duties, serve as virtual patient navigators, using social media to reach community members with the goals of improving awareness of precautions to take during the pandemic and of increasing access to needed medical care. These students have collaborated with colleagues in other disciplines to provide necessary legal guidance to community members fearful of seeking care because of their immigration status. The authors urge other academic institutions across the country to recruit multidisciplinary teams of medical, health professions, and law students invested in their local communities and to empower students to partner with CBOs, immigrant community leaders, faith-based organizations, hospitals, and local authorities to support these vulnerable communities during this crisis.

Reporting of Research by Matched Otolaryngology Residency Applicants

OBJECTIVES

Matching to an otolaryngology residency program is a competitive process for medical students, and research performed by students is considered as a factor for granting interviews by program directors. Because abstracts, presentations and publications are all reported in combination by the National Resident Matching Program's "Charting Outcomes in the Match" (ChOM) and may be weighted differently by PDs, we specifically investigated the number of publications by past applicants accepted to top otolaryngology residency programs.

METHODS

The top 25 otolaryngology residency programs were identified using Doximity, sorting by reputation. Current residents were determined from the programs' websites. Using PubMed, each resident's number of publications, authorship status, and journal type were recorded.

RESULTS

A total of 24 programs were included in the final analysis and the average number of manuscripts was 2.76 ± 4.01. The mean number of publications in otolaryngology journals was 1.03 ± 1.91.

CONCLUSIONS

The difference between the investigated average number of publications (2.76) and those published by ChOM (10.4) represent a discrepancy due to the lack of delineation between abstracts, presentations and publications. The reported numbers for research may lead medical students to pursue alternate measures to increase their own research. Some options, such as adding a research year are not universally accessible. A clearer and more detailed approach to reporting research statistics would be beneficial to both applicants and PDs for otolaryngology programs.

Fall and fracture rates following a change from carpet to vinyl floor coverings in a geriatric rehabilitation hospital. A longitudinal, observational study

Objective:

To investigate whether changing from 5 mm thick carpet tiles to vinyl on a concrete subfloor would alter fall or fracture rates.

Design:

Longitudinal, observational study.

Setting:

Six wards (129 beds) of a geriatric rehabilitation hospital.

Subjects:

All inpatients during this time.

Interventions:

The floor covering was changed from 5 mm carpet tiles to vinyl on these wards when they were closed for other maintenance. This occurred in stages from November 2007 to December 2009.

Measures:

Falls are routinely reported using a quality improvement event reporting form. Fall and fracture rates were calculated in the 12 months prior to and following the change in floor covering on each ward.

Results:

There were 854 falls on the carpet tiles in the 12 months prior to the flooring change and 878 falls on the vinyl in the 12 months after (19.5 and 19.6 falls/1000 bed days, respectively, [ P = 0.95] NS. Fifteen fractures occurred on carpet and 11 fractures on vinyl, [ P = 0.39] NS. Using run charts there were no detectable trends in either the fall or fracture rates following the change in flooring surface.

Conclusion:

There may be no difference in fall rates or fractures on carpet or vinyl floor covering of similar thickness and subfloor type.

Influence of file handle attachments on tactile discrimination: an evaluation by dental students

This study used a simulator to determine the effectiveness of two file-handle sleeves that are claimed to improve tactile discrimination and the ease of manipulation of endodontic hand instruments. Thirty final-year dental undergraduates inserted files into instrument setting rods until a putty resistance was felt, following which depth of penetration into the material was measured with a microscope. Results were analysed statistically. Despite favourable comments from participants in the trial, the devices failed to deliver enhanced tactile discrimination.

Amiodarone pulmonary toxicity: cytopathology, ultrastructure, and immunocytochemistry

One hundred ninety cardiac patients were prospectively enrolled in an amiodarone protocol. Over a 10-year period, 16 patients developed new or progressive respiratory symptoms while taking amiodarone. These symptoms included dyspnea associated with abnormal chest radiographs or new or worsening abnormalities on pulmonary function testing. Specimens for microscopic examination were obtained by fiberoptic bronchoscopy with transbronchial lung biopsy (TBB), bronchoalveolar lavage (BAL), open lung biopsy (OLB), or autopsy. Large foamy macrophages with characteristic lamellated cytoplasmic inclusions were noted in all specimens, regardless of other evidence of pulmonary toxicity, suggesting that foamy macrophages represent a routine drug effect. Foamy macrophages were not present in BAL specimens from 53 normal controls and were rarely seen in specimens from 27 patients who had other interstitial lung diseases. When present, the foamy macrophages were less prominent than those seen in specimens from patients receiving amiodarone. Fibrosis was noted in 11 of 16 histological specimens, whereas type II-cell-hyperplasia was observed in 7 of the 16 specimens. Four of the 16 patients with respiratory symptoms died, and their autopsy revealed a combination of foamy macrophages with fibrosis and type II cell hyperplasia reflective of amiodarone pulmonary toxicity. Hyperplastic type II cells were not found in the absence of fibrosis. Immunocytochemistry allowed differentiation between foamy macrophages and type II cells and represents a useful tool for future investigations of the pathogenesis of amiodarone-induced pulmonary disease.

Coping resources of women with premenstrual syndrome

The purpose of this study was to determine what coping resources are used by women who suffer from premenstrual syndrome (PMS), and to compare the coping resources used with those of a normative population. Two hundred forty-four women volunteered to be in the study. After screening and a 3-month lapse time required for diary completion, 54 subjects remained in the study. A history developed by the researchers, menstrual diaries, and the Coping Resources Inventory (CRIS) were used in data collection. The findings indicate a statistically significant relationship between the dependent variable, severity of PMS, and the independent variables, self-disclosure, stress monitoring, social support, and structure. There was a positive relationship between self-disclosure and stress monitoring with severity of PMS, and an inverse relationship between social support and structuring and severity of PMS.

Detection of IL-2 at mRNA and protein levels in synovial infiltrates from inflammatory arthropathies using biotinylated oligonucleotide probes in situ

A non-radioactive in situ hybridization method for IL-2 mRNA detection based on the use of four biotinylated oligonucleotide probes, plus appropriate positive and negative control probes was developed and applied to synovial surgical and needle biopsies from rheumatoid arthritis (RA), spondyloarthropathy (SpA), psoriatic arthritis (PsA) and juvenile chronic arthritis (JCA) patients. In eight surgical biopsies (six RA, one SpA, one PsA) this non-radioactive system showed similar sensitivity to that of a previously described 32P-labelled probe system, and in addition detected IL-2 mRNA in five out of seven biopsies from SpA and PsA patients and in two out of two JCA needle biopsies. IL-2 mRNA was found in the absence of IL-2 protein in RA biopsies (six surgical, 12 needle), but variable amounts of IL-2 protein were detected in six out of seven needle biopsies from SpA, PsA and JCA patients, where CD3+ lymphoid infiltrates were present. These data suggest differences in IL-2 regulation and expression in RA and non-RA inflammatory arthropathies.

An investigation of T-cell subset phenotype and function in the rheumatoid synovium using in situ hybridization for IL-2 mRNA

Cryostat sections of synovial biopsy tissue from patients with active rheumatoid arthritis (RA), spondyloarthritis (SpA) and osteoarthritis (OA) have been investigated for interleukin-2 (IL-2) mRNA and protein production. In situ hybridization using 32P-labelled oligonucleotide probes based on IL-2 gene sequences coded by exon 1 and exon 3 of the IL-2 gene revealed IL-2 mRNA over lymphoid aggregates in RA and SpA tissue. No IL-2 mRNA was detected in OA tissue and reflected the absence of lymphoid infiltrates in these tissues. Total mRNA, as detected by a 32P oligo dT probe, was found in all tissue examined. IL-2 protein product was detected by monoclonal antibody staining in SpA but not in RA or OA tissue. This is the first report of in situ studies of lymphoid function in the microenvironment of the RA synovium. Whether these data reflect the function of normal CD3+ CD4+ CD45RO+ T-cell subsets in the diseased joint remains to be resolved.

Adenoid cystic carcinoma metastasizing before detection of the primary lesion

Although adenoid cystic carcinomas are occasionally manifested in atypical ways, metastatic disease preceding detection of the primary tumor has not been previously reported. We have described a patient in whom multiple pulmonary metastatic nodules were found one year before identification of primary adenoid cystic carcinoma of the maxilla. This case illustrates the need to include adenoid cystic carcinoma in the differential diagnosis of patients with metastatic disease and an unknown primary lesion. The use of special stains and electron microscopy can be helpful in confirming a diagnosis of adenoid cystic carcinoma.

Effects of some antibiotics on the growth of human diploid skin fibroblasts in cell culture

During serial subcultures 50 micrograms per ml gentamicin and penicillin (100 U per ml)-streptomycin (100 micrograms per ml) depressed cell growth signficantly 2 weeks after the addition of the antibiotics; gentamicin, but not penicillin-streptomycin, stimulated cell growth before it became inhibitory. Removal of the antibiotics resulted in the cell yield returning to normal. The results show that these antibiotics can be harmful to cells even at concentrations thought to be safe.