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Using an Anti-Racist Research Framework to Design Studies of Oral Human Papillomavirus and Oropharyngeal Cancer in San Francisco: Rationale and Protocol for the Health Equity and Oral Health in People Living with HIV (HEOHP) Qualitative Study
No full textSynergies and Dis-Synergies Between Universal Health Coverage and Global Health Security: A Case Study of Cambodia
No full textAssessing the Impact of the COVID-19 Pandemic on the Mental Health of Female Entertainment Workers in Cambodia: A Group Model Building Approach
No full textThe Alabama Embryo Decision - the Politics and Reality of Recognizing Extrauterine Children
No full textType 1C Choledochal Cyst With Recurrent CBD Dilation After Roux-en-Y Hepaticojejunostomy
No full textIntroduction: Choledochal cysts are rare, with an incidence of 1 in 150,000 individuals, most common in Asia. Due to very high risk of malignant transformation, they require early total surgical resection of the biliary structures, with either Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy. In this case report we describe a young female with a rare, large 4.2 cm remnant CBD dilatation with fluid collection 2 years after open choledochal cyst resection and Roux-en-Y hepaticojejunostomy, managed with fine-needle aspiration, and biliary stent placement. Case Description/Methods: A 22-year-old woman with history of type 1c choledochal cyst s/p biliary stenting and subsequent open cholecystectomy, choledochal cyst resection and Roux-en-Y hepaticojejunostomy 2 years prior presented with severe RUQ abdominal pain without fevers, with nausea and vomiting. Patient had leukocytosis of 17,900, imaging revealed a dramatic 4.2 cm CBD dilation. Repeat ERCP revealed a dilated CBD remnant with fluid collection and stenotic major papilla. Patient underwent ventral pancreatic duct sphincterotomy and stent placement, CBD remnant stent placement, and fine-needle aspiration of fluid collection without acute complication. Her symptoms resolved and she was discharged home. Discussion: The reported risk of malignancy in type 1 choledochal cyst ranges from 2.5-2.8% and guidelines are to perform early resection and hepaticojejunostomy as in our patient. Post hepaticojejunostomy related complications are poorly described in literature and here we describe a large CBD dilation 2 years post-operation of 4.2 cm. The etiology of this massive dilation appears unclear, possible causes include post-op stricture, malignancy, biloma, abscess, or retained segment of primary choledochal cyst due to incomplete resection. Here, dilation was complicated by fluid collection, which was aspirated and ruled out malignancy based on cytologic studies. In this case, symptomatic relief was achieved with biliary stents and bile flow was appreciated without evidence of obstruction. Sufficient guidelines do not exist to guide decisions on timing and frequency of endoscopic follow-up, patient symptoms and expert opinion are the guiding factor in this decision. Surgical consult should be obtained to assess the need for revision procedure (see Figure 1)
The OHStat Guidelines for Reporting Observational Studies and Clinical Trials in Oral Health Research: Manuscript Checklist
No full textSingle-Cell Multi-Ome and Immune Profiles of the Inspiration4 Crew Reveal Conserved, Cell-Type, and Sex-Specific Responses to Spaceflight
No full textSpaceflight induces an immune response in astronauts. To better characterize this effect, we generated single-cell, multi-ome, cell-free RNA (cfRNA), biochemical, and hematology data for the SpaceX Inspiration4 (I4) mission crew. We found that 18 cytokines/chemokines related to inflammation, aging, and muscle homeostasis changed after spaceflight. In I4 single-cell multi-omics data, we identified a “spaceflight signature” of gene expression characterized by enrichment in oxidative phosphorylation, UV response, immune function, and TCF21 pathways. We confirmed the presence of this signature in independent datasets, including the NASA Twins Study, the I4 skin spatial transcriptomics, and 817 NASA GeneLab mouse transcriptomes. Finally, we observed that (1) T cells showed an up-regulation of FOXP3, (2) MHC class I genes exhibited long-term suppression, and (3) infection-related immune pathways were associated with microbiome shifts. In summary, this study reveals conserved and distinct immune disruptions occurring and details a roadmap for potential countermeasures to preserve astronaut health
Electron Beam Response Corrections for an Ultra-High-Dose-Rate Capable Diode Dosimeter
No full textBackground: Ultra-high-dose-rate (UHDR) electron beams have been commonly utilized in FLASH studies and the translation of FLASH Radiotherapy (RT) to the clinic. The EDGE diode detector has potential use for UHDR dosimetry albeit with a beam energy dependency observed. Purpose: The purpose is to present the electron beam response for an EDGE detector in dependence on beam energy, to characterize the EDGE detector\u27s response under UHDR conditions, and to validate correction factors derived from the first detailed Monte Carlo model of the EDGE diode against measurements, particularly under UHDR conditions. Methods: Percentage depth doses (PDDs) for the UHDR Mobetron were measured with both EDGE detectors and films. A detailed Monte Carlo (MC) model of the EDGE detector has been configured according to the blueprint provided by the manufacturer under an NDA agreement. Water/silicon dose ratios of EDGE detector for a series of mono-energetic electron beams have been calculated. The dependence of the water/silicon dose ratio on depth for a FLASH relevant electron beam was also studied. An analytical approach for the correction of PDD measured with EDGE detectors was established. Results: Water/silicon dose ratio decreased with decreasing electron beam energy. For the Mobetron 9 MeV UHDR electron beam, the ratio decreased from 1.09 to 1.03 in the build-up region, maintained in range of 0.98–1.02 at the fall-off region and raised to a plateau in value of 1.08 at the tail. By applying the corrections, good agreement between the PDDs measured by the EDGE detector and those measured with film was achieved. Conclusions: Electron beam response of an UHDR capable EDGE detector was derived from first principles utilizing a sophisticated MC model. An analytical approach was validated for the PDDs of UHDR electron beams. The results demonstrated the capability of EDGE detector in measuring PDDs of UHDR electron beams
Socioeconomic Differences Between Medically and Surgically Treated Prolactinomas: A Retrospective Review of 598 Patients
No full textOBJECTIVE Socioeconomic status (SES) is known to affect presentations and outcomes in pituitary neuroendocrine tumor resections, but there is a paucity of literature examining its impact specifically on patients with prolactinomas, who may be treated medically or surgically. The authors sought to determine whether SES was associated with differences in treatment choice or outcomes for prolactinoma patients. METHODS The authors retrospectively reviewed patient records at a high-volume academic pituitary center for prolactinoma diagnoses. Patients were split into medically and surgically treated cohorts. Race, ethnicity, insurance status, primary care physician (PCP) status, and zip code–based income data were collected and examined as socioeconomic covariates. Outcomes of interest included pretreatment likelihood of surgical cure, medical versus surgical treatment allocation, and posttreatment remission rates. RESULTS The authors analyzed 568 prolactinoma patients (351 medically treated and 217 surgically treated). Patients receiving surgery were more likely to have Medicaid or private insurance (p \u3c 0.001) and have lower incomes (p \u3c 0.001) than medically treated patients. Lower-income surgical patients were more likely to require surgical intervention for an indication such as tumor decompression than higher-income patients (p = 0.023). Surgical patients with a PCP had a higher estimated likelihood of surgical cure (p = 0.008), while no SES-based differences in surgical remission likelihood existed in the medical cohort. After surgery, surgical patients who achieved remission had significantly higher income than those who did not (p \u3c 0.001). Other SES factors were not associated with surgical remission, and among medically treated patients, remission rates were not affected by any SES factor. Income was inversely related to prolactinoma size in both cohorts (surgical, p \u3c 0.001; medical, p = 0.005) but was associated more prominently in surgical patients (surgical, −0.65 mm per 10,000). CONCLUSIONS While surgical prolactinoma patients were prone to income and PCP-related disparities, no SES disparities were found among medically treated patients. Income had a more pronounced association with tumor size in the surgical cohort and likely contributed to the increased need for surgical intervention seen in low-income surgical patients. Addressing socioeconomic healthcare disparities is needed among surgical prolactinoma patients to increase rates of early presentation and improve the outcomes of low-SES populations
