One scrotalincision orchidopexy regarding palpable undescended testis in children

BACKGROUND An anti-reflux anastomosis "double-flap technique" was recently used to resolve severe reflux esophagitis after intrathoracic esophagogastrostomy performed following proximal gastrectomy and lower esophagectomy, for esophagogastric junction (EGJ) cancer. We describe thoracoscopic reconstruction procedure performed by using the "double-flap" technique, which involves the creation of seromuscular flap under direct vision. This case report aimed to report the usefulness of this intrathoracic anastomosis procedure, as it may be difficult to perform double-flap technique with intraperitoneal manipulation in EGJ cancer cases. PRESENTATION OF CASE A 58-year-old man was diagnosed with Siewert type II EGJ cancer. We performed laparoscopic proximal gastrectomy, lower esophagectomy, and thoracoscopic esophagogastrostomy using the anti-reflux double-flap technique in the prone position. This was achieved after careful dissection in the plane between the muscular and submucosal layers prior to replacing the remnant stomach into the abdominal cavity. The postoperative course was uneventful, with no symptoms of esophageal reflux after 21 months of surgery, even without medications. DISCUSSION This procedure offers the advantage of minimal invasiveness and ensures adequate surgical margins when lower esophageal incisions are required. This minimally invasive procedure achieves anastomosis using the complete hand-sewn method to prevent reflux, under a good surgical field of view for dissection of the lower esophagus and mediastinal lymph nodes. CONCLUSIONS This procedure is very useful due to its minimal invasiveness, ease of thoracic procedure, and prevention of reflux in patients with EGJ cancer. To our knowledge, this is the first report of thoracoscopic esophagogastrostomy performed using the double-flap technique for EGJ cancer. Methylmalonic acidemia and homocystinuria, cblC type is a rare autosomal recessive inheritance disease. Its clinical phenotype involves multiple systems with varying degrees of severity. The disease is caused by the mutations in the MMACHC gene located on chromosome 1p34.1. Here we report the generation of an iPSC line from the PBMCs of a patient with compound heterozygous mutations in the MMACHC gene. This new iPSC line will allow a better understanding of the MMA disease. BACKGROUND Approximately 50% of patients do not achieve seizure control with antiepileptic drug (AED) monotherapy, and polytherapy, with more than one AED, is often required. To date, no evidence-based criteria on how to combine AEDs exist. OBJECTIVE This narrative review aimed to provide critical findings of the available literature about the role of pharmacodynamic AEDs' interactions in patients whose epilepsies were treated with polytherapy. METHODS Electronic databases, Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica dataBASE (EMBASE), were systematically searched to identify relevant studies on pharmacodynamic AEDs' interactions in patients with epilepsy. RESULTS AND CONCLUSION Most data on AED combinations are coming from animal models and preclinical studies. Combining AEDs with different mechanisms of actions seems to have greater effectiveness and lower risk of adverse event development. Conversely, the combination of AEDs may cause pharmacodynamic synergistic efefully ascertain the role of pharmacokinetic interactions and variations of AEDs' levels in the blood are needed. Clinical factors associated with daytime sleepiness and insomnia in persons with epilepsy (PWE) were examined in this cross-sectional study of 126 participants (men, 50.8%). Excessive daytime sleepiness (EDS; score of ≥11 on the Epworth Sleepiness Scale (ESS)) was noted in 17.5% of participants (mean score, 6.1 ± 4.2), and moderate-to-severe insomnia (Insomnia Severity Index (ISI) scores of ≥15) was noted in 20.6% (mean score, 7.8 ± 6.4). Linear regression analyses revealed that ESS scores were independently associated with obstructive sleep apnea (OSA; snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and gender (STOP-Bang) score of ≥3), an antiepileptic drug (AED) load of >3, depression (Patient Health Questionnaire-9 (PHQ-9) score of ≥10), female sex, and nocturnal seizures. Insomnia Severity Indices were independently associated with depression and anxiety (Generalized Anxiety Disorder-7 (GAD-7) score of ≥7). Notably, significant sex differences were found. Epworth Sleepiness Scale scores were associated with OSA in men but were associated with depression in women. In addition, anxiety was associated with insomnia in women only. Overall, OSA and depression were the most important significant clinical factors associated with daytime sleepiness and insomnia, respectively. However, there were sex differences for the associations between individual factors and sleep disturbances. INTRODUCTION Scaling up the involvement of primary care providers in epilepsy management in low- and middle-income countries (LMICs) requires an understanding of their epilepsy knowledge, attitudes, and practices (KAP). AIM The aim of the study was to document levels of knowledge about, attitudes towards, and practices regarding epilepsy among different ranks of primary healthcare providers in a North-Western Indian district. METHODS The survey included government medical officers (MOs), auxiliary nurse midwives (ANMs), and accredited social health activists (ASHAs). They were administered a specially designed KAP questionnaire. Responses were analyzed according to rank. RESULTS The survey showed that nearly 10% of ANMs and almost a fifth of ASHAs had never heard about epilepsy. A quarter of MOs and over two-thirds of ANMs and ASHAs had never provided care to someone with epilepsy. find more There were significant differences in the levels of knowledge between the three groups of workers. CONCLUSIONS Closing the huge gaps in KAP by educating primary care and community health workers about epilepsy should be a priority before engaging them in the epilepsy care delivery. The assessment of microbiome biodiversity is the most common application of metagenomics. While 16S sequencing remains standard procedure for taxonomic profiling of metagenomic data, a growing number of studies have clearly demonstrated biases associated with this method. By using Whole Genome Shotgun sequencing (WGS) metagenomics, most of the known restrictions associated with 16S data are alleviated. However, due to the computationally intensive data analyses and higher sequencing costs, WGS based metagenomics remains a less popular option. Selecting the experiment type that provides a comprehensive, yet manageable amount of information is a challenge encountered in many metagenomics studies. In this work, we created a series of artificial bacterial mixes, each with a different distribution of skin-associated microbial species. These mixes were used to estimate the resolution of two different metagenomic experiments - 16S and WGS - and to evaluate several different bioinformatics approaches for taxonomic read classification.