Testicular mapping-guided sperm retrieval upfront microTESE in non-obstructive azoospermia: a comparison of sperm retrieval, pregnancy and live-birth rates.

Background: Sperm extraction by Microscopic Testicular Sperm Extraction (microTESE) has become the standard of care for sperm retrieval (SR) in men with non-obstructive azoospermia (NOA) but is costly and has a 40-50% chance of failure. Fine needle aspiration mapping (FNAM) can be performed prior to microTESE as a predictor of success to reduce the likelihood of failure to retrieve sperm but there is limited evidence that directly compares these methods. The objective of this study was to compare success rate of SR, pregnancy, and live birth rates in men who underwent upfront microTESE versus FNAM.

Electroconvulsive Therapy in a Left Ventricular Assist Device Recipient With Treatment-Resistant Depression.

Depression and heart failure are highly comorbid, with up to 35% of heart failure patients suffering from comorbid depression. Left ventricular assist devices (LVADs) serve as a major lifeline for patients with heart failure; however, despite the drastic improvement in cardiac function following LVAD implantation, up to 24% of LVAD recipients suffer from depression. Depression management in LVAD recipients is often complicated by the recipient's increased risk for antidepressant side effects, adverse drug reactions, and inability to safely receive certain interventional psychiatry therapies, as the LVAD is either a relative or absolute contraindication.

Transformative Therapies for Depression: Postpartum Depression, Major Depressive Disorder, and Treatment-Resistant Depression.

Depressive disorders present an enormous global public health burden. A notable treatment gap exists between the prevalence of depression and our ability to provide rapid-acting, effective treatment that achieves remission. Brexanolone and zuranolone, the first US Food and Drug Administration-approved drugs for postpartum depression, signify a critical advancement in addressing the unmet needs of a vulnerable patient population.

Assessing the Pharmacotherapy and Clinical Outcomes After Deep Brain Stimulation for Treatment-Refractory Obsessive-Compulsive Disorder: A Case-Cohort Study.

In the search for effective treatments for refractive obsessive-compulsive disorder (OCD), deep brain stimulation (DBS) serves as an alternative option for those with minimal response to pharmacotherapy. The rarity of reports regarding DBS use for OCD is attributed to the invasive nature of the procedure: placement of electrodes within targeted areas of the brain to provide neuromodulation. This treatment of last resort may decrease functional impairment and pharmacologic complications for a debilitating mental illness.

Cardiac surgery elicits pericardial inflammatory responses that are distinct compared with postcardiopulmonary bypass systemic inflammation.

Objectives: Cardiac surgery using cardiopulmonary bypass contributes to a robust systemic inflammatory process. Local intrapericardial postsurgical inflammation is believed to trigger important clinical implications, such as postoperative atrial fibrillation and postsurgical intrathoracic adhesions. Immune mediators in the pericardial space may underlie such complications.

Comprehensive characterization of the postoperative pericardial inflammatory response: Potential implications for clinical outcomes.

Objective: There is a paucity of data on the inflammatory response that takes place in the pericardial space after cardiac surgery. This study provides a comprehensive assessment of the local postoperative inflammatory response.

Methods: Forty-three patients underwent cardiotomy, where native pericardial fluid was aspirated and compared with postoperative pericardial effluent collected at 4, 24, and 48 hours' postcardiopulmonary bypass.

Gender harmony: improved standards to support affirmative care of gender-marginalized people through inclusive gender and sex representation.

Objective: Accurate representation of clinical sex and gender identity in interoperable clinical systems is a major challenge for organizations intent on improving outcomes for sex- and gender-marginalized people. Improved data collection has been hindered by the historical approach that presumed a single, often binary, datum was sufficient. We describe the Health Level Seven International (HL7) Gender Harmony logical model that proposes an improved approach.

Making science computable: Developing code systems for statistics, study design, and risk of bias.

The COVID-19 crisis led a group of scientific and informatics experts to accelerate development of an infrastructure for electronic data exchange for the identification, processing, and reporting of scientific findings. The Fast Healthcare Interoperability Resources (FHIR®) standard which is overcoming the interoperability problems in health information exchange was extended to evidence-based medicine (EBM) knowledge with the EBMonFHIR project. A 13-step Code System Development Protocol was created in September 2020 to support global development of terminologies for exchange of scientific evidence.

Carcinoid tumours of the appendix: an analysis of emergency appendicectomies over a 24-year period and outcomes of laparoscopic versus open resection.

Background: Carcinoid tumours of the appendix are the most common primary malignant lesion of the appendix. However, the overall incidence remains low; found in as few as 0.3-0.

Igniting Harmonized Digital Clinical Quality Measurement through Terminology, CQL, and FHIR.

Background: Electronic clinical quality measures (eCQMs) seek to quantify the adherence of health care to evidence-based standards. This requires a high level of consistency to reduce the effort of data collection and ensure comparisons are valid. Yet, there is considerable variability in local data capture, in the use of data standards and in implemented documentation processes, so organizations struggle to implement quality measures and extract data reliably for comparison across patients, providers, and systems.

Clinical Concept Value Sets and Interoperability in Health Data Analytics.

This paper focuses on as an essential component in the health analytics ecosystem. We discuss shared repositories of reusable value sets and offer recommendations for their further development and adoption. In order to motivate these contributions, we explain how value sets fit into specific analytic tasks and the health analytics landscape more broadly; their growing importance and ubiquity with the advent of Common Data Models, Distributed Research Networks, and the availability of higher order, reusable analytic resources like electronic phenotypes and electronic clinical quality measures; the formidable barriers to value set reuse; and our introduction of a concept-agnostic orientation to vocabulary collections.

Variables Associated With Cardiac Surgical Waitlist Mortality From a Population-Based Cohort.

Background: Cardiac surgery waitlist recommendations, which were developed based on expert opinion, poorly predict preoperative mortality. Studies reporting risk factors for waitlist mortality have not evaluated the risks including nonadherence to waitlist benchmarks.

Methods: In patients who underwent cardiac surgery or died on the waitlist between 2005 and 2015, we used a Fine and Gray competing risk model to identify independent predictors of waitlist mortality in 12,106 patients scheduled for urgent, semiurgent, or nonurgent surgery.

ETS1 induces transforming growth factor β signaling and promotes epithelial-to-mesenchymal transition in prostate cancer cells.

Expression of the transcriptional regulator, E26 transformation-specific 1 (ETS1), is elevated in human prostate cancers, and this is associated with more aggressive tumor behavior and a rapid progression to castrate-resistant disease. Multiple ETS1 isoforms with distinct biological activities have been characterized and in 44 matched nonmalignant and malignant human prostate specimens, messenger RNAs for two ETS1 isoforms, ETS1p51 and ETS1p42, were detected, with ETS1p51 levels significantly lower in prostate tumor compared to matched nonmalignant prostate tissues. In contrast, ETS1p51 protein, the only ETS1 isoform detected, was expressed at significantly higher levels in malignant prostate.

Sarcoid-resembling granulomatous lung disease secondary to occupational magnetite iron dust exposure.

Non-caseating granulomatous pulmonary conditions resembling sarcoidosis secondary to industrial/occupation exposure to magnetite iron ore dusts have been rarely documented in the literature. This is a case report of a 58-year-old blast crew member involved in iron ore/magnetite mining who presented with a 12-month history of chronic dry cough. High-resolution computed tomography revealed bilateral interstitial opacities.

Merkel cell polyomavirus and p63 status in Merkel cell carcinoma by immunohistochemistry: Merkel cell polyomavirus positivity is inversely correlated with sun damage, but neither is correlated with outcome.

The aim of this study was to determine the frequency of Merkel cell polyomavirus (MPyV) and p63 positivity by immunohistochemistry in a large cohort of primary Merkel cell carcinoma (MCC) from a region with high rates of actinic damage. We also aimed to determine whether there is any relationship between these markers and histological correlates of chronic sun exposure and to identify whether these markers have prognostic significance in our population. Ninety-five cases of primary cutaneous MCC were identified and stained with immunohistochemical markers for MPyV and p63.

Localized differences in caudate and hippocampal shape are associated with schizophrenia but not antipsychotic type.

Unlabelled: Caudate and hippocampal volume differences in patients with schizophrenia are associated with disease and antipsychotic treatment, but local shape alterations have not been thoroughly examined. Schizophrenia patients randomly assigned to haloperidol and olanzapine treatment underwent magnetic resonance imaging (MRI) at 3, 6, and 12 months. The caudate and hippocampus were represented as medial representations (M-reps); mesh structures derived from automatic segmentations of high resolution MRIs.

Absence of regional brain volume change in schizophrenia associated with short-term atypical antipsychotic treatment.

The first aim of this pilot study was to determine if longitudinal change in caudate volume could be detected in chronic schizophrenic patients after 12 weeks of atypical antipsychotic treatment. A sub-aim of the first aim was to determine if similar results could be obtained from an operator-assisted segmentation tool for volumetric imaging (ITK-SNAP) and voxel-based morphometry (VBM) methods in the caudate. The second aim was to determine if frontal and temporal lobe grey matter, white matter, ventricular and sulcal cerebrospinal fluid volume change could be detected after 12 weeks of atypical antipsychotic treatment with VBM.

Creating interoperable guidelines: requirements of vocabulary standards in immunization decision support.

Interoperable support of electronic health records and clinical decision support technology are central to the vision of sustainable information infrastructure. Efforts to implement interoperable clinical guidelines for immunization practice have been sparse. We used the SAGE knowledge workbench to develop a knowledge base to provide immunization decision support in primary care.

Contesting the dominance of emotional labour in professional nursing.

Purpose: The main intension of this paper is to challenge the dominance of emotional labour in professional nursing.

Design/methodology/approach: The article begins by evaluating the central conceptual and definitional aspects of emotional labour, emotion work and emotional work. The purpose of this discussion is to argue against the false public and private dichotomy that has plagued emotional labour and emotion work.

The SAGE Guideline Model: achievements and overview.

The SAGE (Standards-Based Active Guideline Environment) project was formed to create a methodology and infrastructure required to demonstrate integration of decision-support technology for guideline-based care in commercial clinical information systems. This paper describes the development and innovative features of the SAGE Guideline Model and reports our experience encoding four guidelines. Innovations include methods for integrating guideline-based decision support with clinical workflow and employment of enterprise order sets.

Use of declarative statements in creating and maintaining computer-interpretable knowledge bases for guideline-based care.

Developing computer-interpretable clinical practice guidelines (CPGs) to provide decision support for guideline-based care is an extremely labor-intensive task. In the EON/ATHENA and SAGE projects, we formulated substantial portions of CPGs as computable statements that express declarative relationships between patient conditions and possible interventions. We developed query and expression languages that allow a decision-support system (DSS) to evaluate these statements in specific patient situations.