Subclinical Hypothyroidism and Low-Normal Thyroid Function are Associated with Nonalcoholic Steatohepatitis and Fibrosis

Variations in level of thyroid-stimulating hormone (TSH) within the reference range of thyroid hormone could have negative health effects. We evaluated the effect of plasma TSH levels within the euthyroid range on the severity of histological damage associated with nonalcoholic fatty liver disease (NAFLD).

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Thoracic Epidural Anesthesia Reversed Myocardial Fibrosis in Patients With Heart Failure Caused by Dilated Cardiomyopathy

To verify that high thoracic epidural anesthesia (TEA) could reverse myocardial fibrosis in heart failure caused by dilated cardiomyopathy (DCM).

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2016 American College of Cardiology/American Heart Association Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Perioperative Implications

LOWER EXTREMITY peripheral artery disease (PAD) is a common manifestation of atherosclerotic cardiovascular disease, estimated to affect approximately 8.5 million Americans older than age 40 and more than 200 million people worldwide.1 PAD portends a poor prognosis both because of its detrimental effect on physical functioning and its association with atherosclerotic cardiovascular disease in other regions, namely the coronary, cerebrovascular, and renovascular systems.2–4 In the Reduction of Atherothrombosis for Continued Health registry, a large international registry of more than 65,000 patients spanning more than 40 countries across 6 major regions (Latin America, North America, Europe, Asia, the Middle East, and Australia), approximately 1 in 6 patients with atherosclerotic cardiovascular disease had evidence of symptomatic polyvascular disease, including the majority of patients with PAD.

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Uncommon Causes of Cerebral Microbleeds

Cerebral microbleeds (CMBs) are small and round perivascular hemosiderin depositions detectable by gradient echo sequences or susceptibility-weighted imaging. Cerebral microbleeds are common among patients with hypertension, cerebral ischemia, or cerebral amyloid angiopathy. In this article, we describe uncommon causes of CMBs.

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Comparison of Rates of Growth between Unruptured and Ruptured Aneurysms Using Magnetic Resonance Angiography

Growth is a key risk factor for rupture of unruptured cerebral aneurysms. There are few reports of investigations into the actual growth of ruptured intracranial aneurysms. The aim of the present study was to ascertain the risk of rupture of aneurysms based on the growth of unruptured and ruptured aneurysms.

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Successful Resection of a Growing Distal Medial Lenticulostriate Artery Pseudoaneurysm Presenting with Isolated Intraventricular Hemorrhage

Distal medial lenticulostriate artery (LSA) aneurysms associated with isolated intraventricular hemorrhage (IVH) are extremely rare. We report a very rare case of the isolated IVH due to the rupture of the distal medial LSA pseudoaneurysm that was not visible at the initial angiography but later emerged and grew.

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Prediction of Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke: The Symptomatic Intracranial Hemorrhage Score

Symptomatic intracranial hemorrhage (sICH) is common after intravenous thrombolysis in acute ischemic strokes (AISs). Available predictive scoring systems were derived mostly in the Western countries.

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Hypoxia promotes the skewed differentiation of umbilical cord mesenchymal stem cells toward type II alveolar epithelial cells by regulating microRNA-145

Publication date: 30 September 2017
Source:Gene, Volume 630
Author(s): Yang Li, Xu Shi, Liming Yang, Yan Mou, Yingbo Li, Rongjing Dang, Changyuan Li
Mesenchymal stem cells (MSCs) are well recognized for their ability to differentiate into type II alveolar epithelial (ATII) cells in damaged lungs, which is critical for reepithelization and recovery in acute lung injury (ALI). However, the high level of transforming growth factor-β (TGF-β) commonly seen in injured lung tissues is also able to induce MSCs to differentiate into fibroblast-like cells. In this study, we found that hypoxia could promote umbilical cord mesenchymal stem cells (UCMSCs) differentiation into ATII cells rather than into fibroblast-like cells, and this effect was mainly mediated by microRNA-145 (miR-145), which could induce the inhibition of TGF-β signaling by targeting TGF-β receptor II (TGFβRII). Clarifying the function of hypoxia in the fate determination of MSCs is important for improving stem cell-based therapies for ALI.



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Rural emergency care 360{degrees}: mobilising healthcare professionals, decision-makers, patients and citizens to improve rural emergency care in the province of Quebec, Canada: a qualitative study protocol

Introduction

Emergency departments (EDs) are an important safety net for rural populations. Results of our earlier studies suggest that rural Canadian hospitals have limited access to advanced imaging services and intensive care units and that patients are transferred over large distances. They also revealed significant geographical variations in rural services. In the absence of national standards, our studies raise questions about inequities in rural access to emergency services and the risks for citizens. Our goal is to build recommendations for improving services by mobilising stakeholders interested in rural emergency care. With help and full engagement of stakeholders, we will (1) identify solutions for improving quality and performance in rural EDs; (2) formulate and prioritise recommendations; (3) transfer knowledge of the recommendations to rural EDs and support operationalisation and (4) assess knowledge transfer and explore further impacts of this participatory action research project.

Methodology

We will use a participatory action research approach. We will plan for a governance structure that includes all stakeholdersâ™ representatives, so throughout this project, stakeholders are fully engaged at every step. Our sample will be 26 EDs in rural Quebec. We will conduct semistructured individual and focus group interviews with relevant and representative participants, including patients and citizens (estimated n=200). Interviews will be thematically analysed to extract potential solutions and other qualitative information.

An expert panel (±15) will use an analysis grid to develop consensus recommendations from solutions suggested and will evaluate feasibility, impacts, costs, conditions for implementation and establish monitoring indicators. Recommendations will be transferred to stakeholders using tailored knowledge translation strategies (web platform, meetings and so on).

Discussion and expected results

This study will result in a comprehensive consensus list of feasible and high-priority recommendations enabling decision-makers in emergency care to implement improvements in rural emergency care in Quebec.

Ethics and dissemination

This protocol has been approved by the CSSS Alphonse-Desjardins research ethics committee (Project number: MP 2017-009). The qualitative material will be kept confidential and the data will be presented in a way that respects confidentiality. The dissemination plan for the study includes publications in scientific and professional journals. We will also use social media to disseminate our findings and activities such as communications in public conferences.

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New factors in mammalian DNA repair—the chromatin connection

New factors in mammalian DNA repair—the chromatin connection

Oncogene 36, 4673 (17 August 2017). doi:10.1038/onc.2017.60

Authors: G Raschellà, G Melino & M Malewicz

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PARP inhibitors enhance replication stress and cause mitotic catastrophe in MYCN-dependent neuroblastoma

PARP inhibitors enhance replication stress and cause mitotic catastrophe in MYCN-dependent neuroblastoma

Oncogene 36, 4682 (17 August 2017). doi:10.1038/onc.2017.40

Authors: V Colicchia, M Petroni, G Guarguaglini, F Sardina, M Sahún-Roncero, M Carbonari, B Ricci, C Heil, C Capalbo, F Belardinilli, A Coppa, G Peruzzi, I Screpanti, P Lavia, A Gulino & G Giannini

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DUB3 and USP7 de-ubiquitinating enzymes control replication inhibitor Geminin: molecular characterization and associations with breast cancer

DUB3 and USP7 de-ubiquitinating enzymes control replication inhibitor Geminin: molecular characterization and associations with breast cancer

Oncogene 36, 4802 (17 August 2017). doi:10.1038/onc.2017.21

Authors: S Hernández-Pérez, E Cabrera, E Salido, M Lim, L Reid, S R Lakhani, K K Khanna, J M Saunus & R Freire

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Aberrant low expression of p85α in stromal fibroblasts promotes breast cancer cell metastasis through exosome-mediated paracrine Wnt10b

Aberrant low expression of p85α in stromal fibroblasts promotes breast cancer cell metastasis through exosome-mediated paracrine Wnt10b

Oncogene 36, 4692 (17 August 2017). doi:10.1038/onc.2017.100

Authors: Y Chen, C Zeng, Y Zhan, H Wang, X Jiang & W Li

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DUB3 and USP7 de-ubiquitinating enzymes control replication inhibitor Geminin: molecular characterization and associations with breast cancer

DUB3 and USP7 de-ubiquitinating enzymes control replication inhibitor Geminin: molecular characterization and associations with breast cancer

Oncogene 36, 4817 (17 August 2017). doi:10.1038/onc.2017.220

Authors: S Hernández-Pérez, E Cabrera, E Salido, M Lim, L Reid, S R Lakhani, K K Khanna, J M Saunus & R Freire

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Erratum Regarding “Preemptive Correction of Arteriovenous Access Stenosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials” (Am J Kidney Dis. 67[3]:446-460)

In the Original Investigation entitled "Preemptive Correction of Arteriovenous Access Stenosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials" that appeared in the March 2016 issue of AJKD (Ravani et al, volume 67, issue 3, pages 446-460), there was an error in the tabulation of data from one of the articles that was included the meta-analysis of access loss. Specifically, in Figure 3, for the article identified as "Mayer 1993" (reference 20 in Ravani et al), the number of events for the control group was given as 10, when in fact that value should have been 13.

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Proximal Renal Tubular Acidosis (Fanconi syndrome) Induced by Apremilast: A Case Report

Apremilast is a recently developed phosphodiesterase 4–inhibitory medication approved for use to treat psoriasis and psoriatic arthritis. We report a case of Fanconi syndrome and proximal renal tubular acidosis that was associated with this medication. Our patient was started on treatment with apremilast 2 weeks before his admission. On arrival, laboratory test results were significant for hypokalemia, hyperchloremic metabolic acidosis, low uric acid concentration, positive urine anion gap, and proteinuria, which resolved on discontinuation of the drug.

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Risk of Venous Thromboembolism in Patients by Albuminuria and Estimated GFR

The risk for venous thromboembolism (VTE) is elevated with albuminuria or a low estimated glomerular filtration rate (eGFR). However, the VTE risk due to the combined effects of eGFR and albuminuria are unknown.

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Predictors of Health Deterioration Among Older Adults After 12 Months of Dialysis Therapy: A Longitudinal Cohort Study From New Zealand

Involving patients in dialysis decision making is crucial, yet little is known about patient-reported experiences and patient-reported outcomes of dialysis.

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Association Between Sonographically Diagnosed Nephrolithiasis and Subclinical Coronary Artery Calcification in Adults

Although recent studies suggest an association between nephrolithiasis and clinical cardiovascular events, this association has been underexplored.

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A Study of Appendiceal Crypt Cell Adenocarcinoma (So-Called Goblet Cell Carcinoid and Its Related Adenocarcinoma)

Goblet cell carcinoids (GCCs) of the appendix are rare tumors, characterized by a carcinoid-like organoid growth pattern. Despite the term carcinoid, neuroendocrine features are inconspicuous, and its behavior is distinct from carcinoid. Its high grade counterpart is designated as adenocarcinoma ex GCC. We conducted a retrospective study of 105 tumors to find prognostic values of a variety of clinico-pathologic features.The tumors were subclassified as low grade, equivalent to classic type, and high grade, defined as loss of organoid pattern, and a proportion (%) of low and high grades were documented in each tumor.

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Histopathological evidence of neoplastic progression of von Meyenburg complex to intrahepatic cholangiocarcinoma

Von Meyenburg complex (VMC) is generally thought to be benign, although its preneoplastic potential for intrahepatic cholangiocarcinoma (iCC) has been a subject of contention. We retrospectively reviewed 86 hepatectomy specimens with a diagnosis of iCC. Morphologically, an association between iCC and VMC was appreciated in 35% of cases that illustrated a gradual neoplastic progression from benign VMC to dysplasia and then to iCC. Among them, 24 cases had VMC lined by epithelial cells with low-grade biliary dysplasia and 13 with high-grade biliary dysplasia.

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MicroRNA-139: a potential diagnostic and therapeutic target for cancers

MicroRNA-139-5p/3p (miR-139-5p/3p) and their different target genes have been reported to be associated with tumorigenesis by participating in multiple biological processes via the modulation of various aspects of cell biology, such as cell growth, proliferation and signal transduction. However, the miR-139-5p/3p expression signatures and function profiles in human breast cancer are still largely elusive. Surprisingly, we read with great interest the recently published work by Dai et al. [1], demonstrating that miR-139-5p tissue expression level is significantly down-regulated in breast cancer patients and correlated with higher tumor grade, estrogen receptor negativity, progesterone receptor negativity, greater proliferation, or larger size.

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Pulmonary Invasive Mucinous Adenocarcinoma and Mixed Invasive Mucinous/Non-Mucinous Adenocarcinoma- A Clinicopathological and Molecular Genetic Study with Survival Analysis

Invasive mucinous adenocarcinoma is a variant of lung adenocarcinoma, which may be mixed with non-mucinous adenocarcinoma. KRAS mutations are common, but other clinical and genetic features are not clearly established. Lung adenocarcinomas (n=760) with ≥5years follow-up comprised 3 non-overlapping cohorts for survival analysis. Mucinous tumors were evaluated with Ion AmpliSeq™ Cancer Hotspot Panel v2. Cases without detected mutations were tested for ALK, ROS1, and by OncoScan array. Fifty-seven invasive mucinous adenocarcinomas and 54 mixed mucinous/non-mucinous adenocarcinomas were identified.

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The histologic evolution of revealed, acute abruptions

There is considerable interest in using pathology to confirm acute abruptions. It has been suggested that pathologic findings can help to determine the timing of abruptions. Because of the dearth of evidence in the literature supporting this claim and its medicolegal implications, we undertook this study to explore further the possibility of timing abruptions by histopathology. We sought to correlate bleeding interval (duration from maternal presentation with vaginal bleeding (revealed abruption) to placental delivery) with placental histopathologic findings.

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Nuciferine Relaxes Tracheal Rings via the Blockade of VDLCC and NSCC Channels

Planta Med
DOI: 10.1055/s-0043-118178

This study aimed to elucidate the mechanisms of nuciferine (a main aporphine alkaloid of lotus leaf extract), which can induce relaxation in contracted tracheal rings. Under Ca2+-free and 2 mM Ca2+ conditions, we found that nuciferine had no effect on the resting muscle tone of tracheal rings. In contrast, nuciferine relaxed high K+-contracted mouse tracheal rings in a dose-dependent manner and inhibited both Ca2+ influx and voltage-dependent L-type Ca2+ channel currents induced by high K+. Similarly, nuciferine also inhibited acetylcholine-induced contractions in mouse tracheal rings in a dose-dependent manner. Meanwhile, both acetylcholine-induced intracellular Ca2+ influx and whole-cell currents of nonselective cation channels were blocked by nuciferine. Together, the results indicate that nuciferine-induced relaxation in tracheal rings mainly occurred due to the inhibition of extracellular Ca2+ influx through the blockade of voltage-dependent L-type Ca2+ channels and/or nonselective cation channels. These results suggest that nuciferine has a therapeutic effect on respiratory diseases associated with the aberrant contraction of airway smooth muscles and/or bronchospasm.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Ggnbp2 Null Mutation in Mice Leads to Male Infertility Due to a Defect at the Spermiogenesis Stage

Gametogenetin binding protein 2 (GGNBP2) is an evolutionarily conserved zinc finger protein. Although Ggnbp2 null embryos in the B6 background died due to a defective placenta, 6.8% of Ggnbp2 null mice in the B6/129 mixed background were viable and continued to adulthood. Adult Ggnbp2 null males were sterile with smaller testes and an azoospermic phenotype, while mutant females were fertile. Histopathological analysis of 2-month-old Ggnbp2 null testes revealed absence of mature spermatozoa in the seminiferous tubules and epididymides and reduction of the number of spermatids.

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Deletion of Endothelial TGF-β Signaling Leads to Choroidal Neovascularization

The molecular pathogenesis of choroidal neovascularization (CNV), an angiogenic process that critically contributes to vision loss in age-related macular degeneration (AMD) is unclear. Here we analyzed the role of transforming growth factor (TGF)-β signaling for CNV formation by generating a series of mutant mouse models with induced conditional deletion of TGF-β signaling in the entire eye, the retinal pigment epithelium (RPE) or the vascular endothelium. Deletion of TGF-β signaling in the eye caused CNV, irrespectively if it was ablated in newborn or three-week-old mice.

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[Department of Error] Department of Error

Loewenberg S. Treating and preventing cholera in Bangladesh. Lancet 2017; 390: 637–38—This piece benefited from external funding from the European Journalism Centre via its Innovation in Development Reporting Grant Programme, which should have been declared. This information was added to the online version as of August 17, 2017.

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[Articles] Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up

Penile transplantation restored normal physiological functions in this transplant recipient without major complications in the first 24 months.

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Perfil vocal y psicosocial de los sujetos con puberfonía

Publication date: Available online 12 August 2017
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Loreto Nercelles Carvajal
IntroducciónEl proceso de muda vocal en varones no siempre se realiza con normalidad, y hay ocasiones en que el cambio de voz no se efectúa. Las causas son múltiples y pueden obedecer a desórdenes funcionales, orgánicos y ambientales. Esta investigación tiene por objetivo valorar el impacto vocal y psicosocial en los sujetos con puberfonía.Material y métodoMediante un diseño de casos y controles, se estudió una población de hombres mayores de 15 años con frecuencia fundamental sobre 165Hz. A estos sujetos se les aplicó una encuesta de evaluación de la muda vocal (PEMUV) validada por juicio de expertos y pilotaje.ResultadosSe realizó análisis estadístico con los softwares SSPS y Atlas TI. Ingresaron al estudio 26 casos y 107 controles. Los resultados de la encuesta indican que los sujetos con trastornos de la muda vocal presentan valoración negativa de la voz, tienden a confundirlos con alguien menor de edad, y usan el teléfono menos de lo que desearían. Además, se destaca el desmedro en el ámbito laboral.ConclusionesLa presente investigación permitió establecer un perfil del sujeto con puberfonía. El PEMUV fue un instrumento sensible que permitió valorar las molestias psicosociales que puede desencadenar esta alteración.IntroductionVoice mutation in men is a process not always normally achieved, sometimes this voice change is not fully developed. The causes are multiple and might follow functional, organic, and environmental disorders. This research intends to measure the vocal and psychosocial impact on subjects with puberphonia.Material and methodThrough an analytic case control design, a population of men older than 15 years old, with a fundamental frequency higher than 165Hz, was studied. These subjects responded to a vocal mutation evaluation survey (PEMUV), validated through pilotage and experts opinion.ResultsThe study group comprised 26 cases and 107 controls; the survey results indicate that subjects with voice change disorders show a negative perception of their voices, tend to confuse them with a minor, use the telephone less than they would wish and difficulties in their jobs. Statistical analysis was performed with SSPS and Atlas TI software.ConclusionsThis research led to the establishment of a puberphonia subject profile. The PEMUV was a sensitive instrument that permitted the measurement of the psychological discomfort this disturbance may trigger.



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Ordered and Atomically Perfect Fragmentation of Layered Transition Metal Dichalcogenides via Mechanical Instabilities

ACS Nano

DOI: 10.1021/acsnano.7b04158

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Green Fabrication of Silkworm Cocoon-like Silicon-Based Composite for High-Performance Li-Ion Batteries

ACS Nano

DOI: 10.1021/acsnano.7b03830

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Surface-Adaptive Gold Nanoparticles with Effective Adherence and Enhanced Photothermal Ablation of Methicillin-Resistant Staphylococcus aureus Biofilm

ACS Nano

DOI: 10.1021/acsnano.7b04731

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Docosahexaenoic acid (DHA), a fundamental fatty acid for the brain: New Dietary Sources

Publication date: Available online 14 August 2017
Source:Prostaglandins, Leukotrienes and Essential Fatty Acids (PLEFA)
Author(s): Francisca Echeverría, Rodrigo Valenzuela, María Catalina Hernandez-Rodas, Alfonso Valenzuela
Docosahexaenoic acid (C22: 6 n-3, DHA) is a long-chain polyunsaturated fatty acid of marine origin fundamental for the formation and function of the nervous system, particularly the brain and the retina of humans. It has been proposed a remarkable role of DHA during human evolution, mainly on the growth and development of the brain. Currently, DHA is considered a critical nutrient during pregnancy and breastfeeding due their active participation in the development of the nervous system in early life. DHA and specifically one of its derivatives known as neuroprotectin D-1 (NPD-1), has neuroprotective properties against brain aging, neurodegenerative diseases and injury caused after brain ischemia-reperfusion episodes. This paper discusses the importance of DHA in the human brain given its relevance in the development of the tissue and as neuroprotective agent. It is also included a critical view about the ways to supply this noble fatty acid to the population.



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DHA and EPA in Red Blood Cell Membranes Are Associated with Dietary Intakes of Omega-3-rich Fish in Healthy Children

Publication date: Available online 14 August 2017
Source:Prostaglandins, Leukotrienes and Essential Fatty Acids (PLEFA)
Author(s): Colleen A. Parks, Neil R. Brett, Sherry Agellon, Paula Lavery, Catherine A. Vanstone, Jonathon L. Maguire, Frank Rauch, Hope A. Weiler
Omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) are important in child development. The primary objective of this study was to investigate the associations between dietary intakes of n-3 LCPUFA and red blood cell (RBC) n-3 LCPUFA in young children. Healthy children, (2 – 8y) underwent RBC fatty acid profiling. Dietary intakes were parent-reported over 6 mo using three 24h dietary intake assessments and three 30 d food frequency questionnaires (FFQ). Participants (n = 49, 5.6 ± 1.9y), were 59% male, and had a body mass index (BMI) z-score of 0.65 ± 0.84. Dietary n-3 LCPUFA intakes were not different over time. RBC docosahexaenoic acid (DHA) positively correlated with average DHA from the 24h recalls. RBC DHA and eicosapentaenoic acid (EPA) positively correlated with average n-3 LCPUFA-rich fish intake from the FFQ. RBC appear to reflect long-term stable intakes of n-3 LCPUFA during growth in healthy young children.



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Maternal Long Chain Polyunsaturated Fatty Acid Status and Pregnancy Complications

Publication date: Available online 15 August 2017
Source:Prostaglandins, Leukotrienes and Essential Fatty Acids (PLEFA)
Author(s): Nisha Wadhwani, Vidya Patil, Sadhana Joshi
Maternal nutrition plays a crucial role in influencing fetal growth and birth outcome. Any nutritional insult starting several weeks before pregnancy and during critical periods of gestation is known to influence fetal development and increase the risk for diseases during later life. Literature suggests that chronic adult diseases may have their origin during early life – a concept referred to as Developmental Origins of Health and Disease (DOHaD) which states that adverse exposures early in life "program" risks for later chronic disorders. Long chain polyunsaturated fatty acids (LCPUFA), mainly omega-6 and omega-3 fatty acids are known to have an effect on fetal programming. The placental supply of optimal levels of LCPUFA to the fetus during early life is extremely important for the normal growth and development of both placenta and fetus. Any alteration in placental development will result in adverse pregnancy outcome such as gestational diabetes mellitus (GDM), preeclampsia, and intrauterine growth restriction (IUGR). A disturbed materno-fetal LCPUFA supply is known to be linked with each of these pathologies. Further, a disturbed LCPUFA metabolism is reported to be associated with a number of metabolic disorders. It is likely that LCPUFA supplementation during early pregnancy may be beneficial in improving the health of the mother, improving birth outcome and thereby reducing the risk of diseases in later life.



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Primary Renal Sarcomas With BCOR-CCNB3 Gene Fusion: A Report of 2 Cases Showing Histologic Overlap With Clear Cell Sarcoma of Kidney, Suggesting Further Link Between BCOR-related Sarcomas of the Kidney and Soft Tissues.

We report 2 primary renal sarcomas demonstrating BCOR-CCNB3 gene fusions that have recently been identified in undifferentiated round cell sarcomas of bone and soft tissue. These neoplasms occurred in male children aged 11 and 12 years, and both were cystic as a result of entrapment and dilatation of native renal tubules. Both cases were composed of variably cellular bland spindle cells with fine chromatin set in myxoid stroma and separated by a branching capillary vasculature. Both neoplasms demonstrated immunoreactivity for BCOR, cyclin D1, TLE1, and SATB2 in the spindle neoplastic cells and negativity in the prominent capillary vasculature. One case was extensively cystic and had hypocellular areas that simulated cystic nephroma; this neoplasm recurred 3 years later as a solid, highly cellular spindle cell sarcoma in the abdominal cavity. The morphology and immunoprofile of these renal neoplasms was compared with a control group of other sarcomas with BCOR genetic abnormalities, including clear cell sarcoma of the kidney (CCSK), infantile undifferentiated round cell sarcomas of soft tissue/primitive myxoid mesenchymal tumor of infancy, and bone/soft tissue sarcomas with BCOR-CCNB3 gene fusion; along with primary renal synovial sarcoma. Our findings show that the renal sarcomas with BCOR-CCNB3 gene fusion overlap with CCSK. These results are in keeping with a "BCOR-alteration family" of renal and extrarenal neoplasms which includes CCSK and undifferentiated round cell sarcomas of soft tissue/primitive myxoid mesenchymal tumor of infancy (which typically harbor BCOR internal tandem duplication), and BCOR-CCNB3 sarcomas, all of which are primarily driven by BCOR overexpression and have overlapping (but not identical) clinicopathologic features. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Cutaneous Eruptions in Patients Receiving Immune Checkpoint Blockade: Clinicopathologic Analysis of the Nonlichenoid Histologic Pattern.

Cutaneous eruptions are among the most common immune-related adverse events (irAEs) associated with anti-programmed cell death protein 1/programmed cell death ligand 1 therapy, and are often clinically and histologically characterized as lichenoid. Nonlichenoid patterns may also occur and are likely to be encountered by surgical pathologists, given the increasing clinical use of these agents. The purpose of this study is to describe the histopathologic features of nonlichenoid cutaneous irAEs from patients receiving anti-programmed cell death protein 1/programmed cell death ligand 1 therapies for a variety of underlying advanced malignancies. Sixteen patients with 17 biopsied eruptions were included from 2 academic institutions with extensive experience administering and monitoring responses to immune checkpoint blockade as well as treating the potential side effects. Eruptions occurred a median of 10 days (range, 1 d to 11.4 mo) after treatment initiation. Nearly half of specimens demonstrated either a psoriasiform/spongiotic or an urticarial-type reaction pattern on histologic review. Patterns consistent with Grover disease, bullous pemphigoid, and granulomatous dermatitis were also observed. Nearly two-thirds of patients required systemic corticosteroids for treatment of the cutaneous irAE, and 19% of patients discontinued immunotherapy due to their skin eruptions. 75% of patients showed an objective antitumor response. The diverse array of nonlichenoid cutaneous irAE presented here should reflect and inform the scope of histologic patterns encountered by the practicing surgical pathologist. Such eruptions are seen in patients with a variety of underlying tumor types, many of whom ultimately demonstrate a favorable response to immune checkpoint blockade. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Idiopathic Myointimal Hyperplasia of Mesenteric Veins: An Uncommon Cause of Ischemic Colitis With Distinct Mucosal Features.

Idiopathic myointimal hyperplasia of mesenteric veins causes chronic ischemic mucosal injury with segmental strictures that mimic inflammatory bowel disease and nonocclusive ischemic colitis. It is characterized by myointimal proliferative changes that narrow the lumina of veins combined with ischemic injury and ulcers. Most cases reported to date have been diagnosed following surgical resection. The aim of this study was to determine whether mucosal changes of idiopathic myointimal hyperplasia of mesenteric veins are sufficiently sensitive and specific to allow its recognition in biopsy material. The study group consisted of 10 patients with idiopathic myointimal hyperplasia of mesenteric veins who underwent surgical resection of the affected colon, 7 of whom had available prior endoscopic biopsies. The control group included 10 patients each with radiation, nonocclusive ischemia, Crohn disease, diverticulitis, and mucosal amyloidosis, and 5 cases of small vessel (leukocytoclastic) vasculitis. Study patients were mostly older men with distal colorectal disease. All resection specimens showed mucosal ischemia with numerous thick-walled (arteriolized) capillaries and glassy subendothelial fibrin deposits; numerous hyalinized, eosinophilic thrombi were detected in 90% of colectomy specimens. Biopsies showed arteriolized capillaries (100%), subendothelial fibrin deposits (86%), fibrin thrombi (43%), and perivascular hyalinization (43%). Fibrin thrombi were observed in only one case each of ischemic colitis and small vessel vasculitis, and none of the other abovementioned features were seen in any of the controls. We conclude that arteriolized capillaries, subendothelial fibrin deposits, and perivascular hyalinization are frequent and specific features that can facilitate recognition of idiopathic myointimal hyperplasia of mesenteric veins in biopsy samples. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Primary Bone Lymphoma Exhibits a Favorable Prognosis and Distinct Gene Expression Signatures Resembling Diffuse Large B-Cell Lymphoma Derived From Centrocytes in the Germinal Center.

Primary bone (PB) diffuse large B-cell lymphoma (DLBCL) is rare and has a favorable prognosis, but the underlying biological mechanisms remain unknown. In this study we analyzed the clinicopathologic features of 160 patients with PB-DLBCL in comparison with 499 nonosseous DLBCL. Compared with patients with nonosseous DLBCL and secondary involvement of bone by DLBCL, PB-DLBCL patients less frequently had elderly age, B-symptoms, elevated serum lactate dehydrogenase levels, and high International Prognostic Index at diagnosis, more frequently had germinal center (GC) subtype (approximately 90%) and complete remission, and had significantly better survival. The 5-year progression-free and overall survival rates of PB-DLBCL patients were 80% and 93%, respectively, superior to both GC B-cell-like (GCB) and activated B cell-like subtypes of DLBCL. Further stratifying nonosseous DLBCL cell-of-origin subtypes by clinical factors showed that PB-DLBCL had similar survival rates as the centrocyte-origin (CC) subtype of DLBCL-GCB classified by the B-cell-associated gene signature algorithm. To better understand the favorable outcome of PB-DLBCL patients, gene expression profiling and microRNA profiling were performed in a small subset of PB-DLBCL. The gene expression profiles of PB-DLBCL resembled those of nonosseous DLBCL-GCB-CC, but were distinct from other DLBCL cell-of-origin especially the centroblast-origin (CB) subtype. Compared with DLBCL-GCB-CB, PB-DLBCL and DLBCL-GCB-CC also had much higher levels of miR-125a-3p, miR-34-3p, and miR-155-5p, and significantly lower levels of miR-17-5p and miR-17-3p. These results demonstrated that PB-DLBCL is clinically distinct, and the cell-of-origin of PB-DLBCL stems from centrocytes in the GC, that are biologically attributed for the favorable prognosis of PB-DLBCL. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Primary Spinal Cord Glioblastoma Multiforme: A Retrospective Study of Patients at a Single Institution

Publication date: October 2017
Source:World Neurosurgery, Volume 106
Author(s): Xing Cheng, Silong Lou, Siqing Huang, Haifeng Chen, Jiagang Liu
Background and ObjectivePrimary spinal cord (PSC) glioblastoma multiforme (GBM) is extremely rare and accounts for only 1.5% of all spinal cord tumors. Therefore, its treatment is still ill defined. To elucidate prognostic factors, we performed a single-institutional retrospective review of the largest series to date of patients with PSC GBM who underwent surgical resection in West China Hospital between 2008 and 2014. A total of 14 patients with PSC GBM were reviewed.MethodsDemographic, operative, and postoperative factors were recorded. Overall survival (OS) and progression-free survival (PFS) were calculated and compared with the Kaplan-Meier method.ResultsEight males (57%) and 6 females (43%) were involved in the study. Their median age was 28 years (range, 14–56 years). Median Karnofsky Performance Status score was 60 (range, 20–90). Four patients (28.6%) received gross total resection, 5 (35.7%) partial resection, and the remaining 5 (35.7%) biopsy only. Nine patients (64.3%) received postoperative radiotherapy and chemotherapy, 3 (21.4%) chemotherapy only, and 2 (14.3%) neither. Median follow-up period was 15 months (range, 5–26 months). One-year and 2-year survival was 78.5% (11/14) and 7.1% (1/14), respectively. Median OS was 15 months, and median PFS 8 months. Univariate log-rank analysis showed that OS and PFS were significantly associated with patients' age (P = 0.007 and P = 0.04, respectively) and postoperative radiotherapy (P = 0.001 and P = 0.002, respectively). However, preoperative Karnofsky Performance Status score affected only OS and did not affect PFS (P = 0.033 and P = 0.106, respectively).ConclusionsAccording to our study, the combination of postoperative radiotherapy and temozolomide chemotherapy can improve prognosis and may serve as a feasible postoperative adjuvant treatment of PSC GBM.



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[News] Genetic basis for response to cancer immunotherapy

A new study has identified dozens of new genes that might affect a patient's response to cancer immunotherapy.

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[News] Individualised adaptive radiotherapy in liver cancer

According to new research in patients with liver cancer, biomarker-based individualised adaptive radiation therapy is safe and results in local tumour control, representing a new strategy for personalised cancer therapy.

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Functionalization of Cotton by RGO/TiO 2 to Enhance Photodegradation of Rhodamine B Under Simulated Solar Irradiation

Abstract

Reduced graphene oxide (RGO) and titanium dioxide (TiO₂) nanoparticles were immobilized on cotton textile substrates to produce self-cleaning textiles. Varying number of layers of RGO and TiO₂ nanoparticles were coated by a facile method, and their photocatalytic potential was evaluated by measuring the degradation rate of rhodamine B (Rh-B) in an aqueous solution in a photoreactor under simulated solar irradiation. X-ray diffraction (XRD) and zeta potential measurements of starting materials were studied as they are crucial for innovative methods of functionalization. The study confirms that it is possible to ensure a good adhesion of nanoparticles on textile samples without the use of a resin. The application of varying number of RGO and TiO₂ coatings has influence on photocatalytic properties of functionalized cotton textile substrates. The energy band gap of the samples reduces from 3.25 to −3.20 eV with the number of RGO coatings. All five de-ethylated intermediates of Rh-B during the photocatalytic degradation were identified using a high-performance liquid chromatography–mass spectrometry method. The experimental results show that, in general, the higher the number of RGO coatings is, the higher the photocatalytic efficiency (η) of the functionalized substrate is (η=87% for three RGO coatings on TiO₂).

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Panel Cointegration Estimates of the User Cost Elasticity

Publication date: Available online 12 August 2017
Source:Journal of Macroeconomics
Author(s): Huntley Schaller, Marcel Voia
The effect of user cost on the capital stock is an issue of central importance in economics, with implications for tax policy, economic development, growth, monetary policy, business cycle models, and other areas. Estimating the user cost elasticity raises serious simultaneity problems because of the large fluctuations in investment demand at business cycle frequencies. If shifts in the supply curve (due to technological change and tax reforms) are more persistent than shifts in demand, cointegration techniques, which emphasize long-run movements, can reduce the simultaneity problem. If shocks to capital demand are partially idiosyncratic, the use of firm-level panel data should also reduce the simultaneity problem. In this paper, we therefore use cointegration techniques to estimate the user cost elasticity on panel data. Specifically, we employ a newly constructed data set with a long time series of firm-level data on the capital stock and with detailed industry-specific data on the interest rate, the price of investment goods, risk, and taxes.



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[Correspondence] Global health: generation men

The Fearless Girl statue that faces down Wall Street's charging bull grabbed international headlines and triggered a debate about the glass ceiling that continues to obstruct women from reaching the higher echelons of the financial sector.

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[Comment] Intravenous fibrinolytics in STEMI: a 25-year perspective

Heart disease remains the number one cause of mortality and morbidity across most of the world.1 Although rates of acute myocardial infarction have fallen in high-income countries, mostly as a consequence of improved lifestyle modifications and continued evolution of risk factor modification,2 acute myocardial infarction remains the most important driver of cardiac mortality. The cornerstones of therapy for acute myocardial infarction have been based on the open-artery hypothesis.3 Previous experimental animal models have shown the initiation of myocardial cell death early after ligation of an epicardial coronary artery.

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[Editorial] 40 years of percutaneous coronary intervention: where next?

When cardiologists gather in Barcelona, Spain, from Aug 26–31 for the annual European Society of Cardiology meeting, they will celebrate Andreas Grüntzig in a special tribute session. Grüntzig performed the first percutaneous coronary angioplasty on Sept 16, 1977, at the University Hospital Zurich, Switzerland, on a 38-year-old patient with a high-grade discrete stenosis of the proximal left anterior descending coronary artery. He reported the first five patients in The Lancet in 1978. To mark this breakthrough and the birth of interventional cardiology, this year's conference spotlight is on 40 years of percutaneous coronary interventions (PCI).

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[Comment] Expansion of the treatment toolbox for mitral regurgitation

In The Lancet, Fabien Praz and colleagues1 report their preliminary experience with the PASCAL mitral repair device and its success among 23 patients, most of whom were not considered anatomically suitable for conventional percutaneous mitral repair.2 The authors did a multicentre, prospective, observational, first-in-man study, collecting data from seven tertiary care hospitals in five countries. Eligible patients were those with symptomatic, severe functional, degenerative, or mixed mitral regurgitation who were denied other surgical or transcatheter options.

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[Perspectives] Jeroen Bax: inspiring the next generation of cardiologists

A conversation with the eminent cardiologist Eugene Braunwald fuelled Jeroen Bax's interest in nurturing aspiring cardiologists. "Braunwald told me that what really matters is developing the next generation of researchers and clinicians", he recalls. By 2018, Bax will have mentored 60 international PhD students in his cardiac imaging research centre at Leiden University Medical Center (LUMC) in the Netherlands. "Jeroen's students have achieved prominent positions at medical institutions throughout the world", says Anthony DeMaria, Professor of Medicine at the University of California, San Diego.

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[Obituary] Prudence Mabele

South African HIV and gender rights activist. Born in Wattville, South Africa, on July 21, 1971, she died from pneumonia in Johannesburg, South Africa, on July 10, 2017, aged 45 years.

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[Correspondence] The BLISTER study: possible overestimation of tetracycline efficacy

The BLISTER study, by Hywell C Williams and colleagues (March 6, p 1630),1 indicated that a 25% decrease in the efficacy of tetracycline in the early control of blisters would be acceptable to most UK dermatologists, if accompanied by a reduction of at least 20% in long-term serious side-effects compared with prednisolone. The efficacy of the tetracycline doxycycline was acceptable according to the study's primary effectiveness measure at 6 weeks (upper limit of 90% CI of adjusted difference between treatments [UB], 26·1%, within the 37% predefined acceptable non-inferiority margin [AM]); however, we question the aspects of the study design that appear to favour doxycycline.

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[Correspondence] The BLISTER study: possible overestimation of tetracycline efficacy – Authors' reply

We thank Michael J Sladden and Peter E Hutchinson for their comments, but respectfully disagree that our study design1 favoured doxycycline. BLISTER was not an efficacy study of doxycycline versus prednisolone. We investigated whether a doxycycline-initiated pemphigoid treatment strategy could result in improved safety and acceptable effectiveness, when compared with starting with prednisolone. The doxycycline-initiated strategy was expected to be 25% less effective than prednisolone at 6 weeks.

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Black is the New Black

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Preoperative Determination of Artificial Chordae Length: Wishful Thinking?

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Hitting the target with lung perfusion

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Scoring System to Predict Nodal Metastases in Patients with Early-Stage Esophageal Cancer: Outstanding Tool to Complement Multi-Disciplinary Team-Based Care

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Further Controversies About Brain Tissue Oxygenation Pressure-Reactivity After Traumatic Brain Injury

Abstract

Background

Continuous monitoring of cerebral autoregulation is considered clinically useful due to its ability to warn against brain ischemic insults, which may translate to a relationship with adverse outcome. It is typically performed using the pressure reactivity index (PRx) based on mean arterial pressure and intracranial pressure. A new ORx index based on brain tissue oxygenation and cerebral perfusion pressure (CPP) has been proposed that similarly allows for evaluation of cerebrovascular reactivity. Conflicting results exist concerning its clinical utility.

Methods

Retrospective analysis was performed in 85 patients with traumatic brain injury (TBI). ORx was calculated using three time windows of 5, 20, and 60 min. Correlation coefficients and individual "optimal CPP" (CPP_opt) were calculated using both PRx and ORx, and relation to patient outcome investigated.

Results

Correlation coefficients for all comparisons between PRx and ORx indicated poor association between these indices (range from −0.04 to 0.07). PRx was significantly lower in patients with good outcome (p = 0.01), while none of the ORx indices proved to be significantly different in the two outcome groups. Higher mortality related to average CPP < CPP_opt was found regardless of which index was used to calculate CPP_opt.

Conclusion

In the TBI setting, ORx does not appear to correlate with vascular pressure reactivity as assessed with PRx. Its potential use for individualizing CPP thresholds remains unclear.

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Landmarks to Identify Petrous Apex Through Endonasal Approach Without Transgression of Sinus

J Neurol Surg B
DOI: 10.1055/s-0037-1604388

Objectives The use of nasopharyngeal landmarks to localize the petrous apex has not been previously described. We describe a purely endoscopic endonasal corridor to localize the petrous apex without transgressing any of the paranasal sinuses. Methods Anatomical dissections of four formalin preserved cadaveric heads (eight petrous apices) were performed to evaluate the feasibility of a nonsinus-based approach and illustrate the surgical landmarks and measurements that are useful for surgery in this area. Results The Eustachian tubes, fossa of Rosenmüller (FR), and posterior end of the middle and inferior turbinates are constant landmarks, which can be identified without opening any nasal sinuses. The petrous apex is located on an extended straight line connecting the upper end of the torus tubarius (TT) and the roof of the FR. The distance from upper end of TT to the roof of FR measured 9.875 (±0.99) mm, and the distance from roof of the FR to the petrous apex measured 9.75 (±1) mm. Conclusion With well-defined landmarks, the inferior, medial petrous apex can be reached using the endoscopic endonasal approach without crossing the sinus cavities.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Surgical Treatment of Olfactory Neuroblastoma: Major Complication Rates, Progression Free and Overall Survival

J Neurol Surg B
DOI: 10.1055/s-0037-1605593

Objective We aimed to compare major complication rates in patients undergoing open versus endoscopic resection of olfactory neuroblastoma (ONB) and to determine the prognostic utility of the Kadish staging and Hyams grading systems with respect to progression-free survival (PFS) and overall survival (OS). Methods It is a retrospective review of experience in treating ONB at a single tertiary care hospital from 1987 through 2015. Major complications were defined as cerebrospinal fluid (CSF) leak, meningitis, osteomyelitis, tracheostomy, and severe neurologic injury. Results Forty-one patients were included. An open approach was used in 34 (83%), endoscopic in 6 (15%), and combined in 1 (2%) case. Rates of major complications by surgical approach were 17% after endoscopic versus 31% after open (p = 0.65). There was no significant difference in PFS or OS based on Kadish B versus C (PFS, p = 0.28; OS, p = 0.11) or Hyams grade 1 and 2 versus Hyams grade 3 and 4 (PFS, p = 0.53; OS, p = 0.38). Conclusions There was no significant difference in major complications between open and endoscopic approaches for the treatment of ONB. Patient stratification using the Kadish staging and Hyams grading systems did not show significant differences in PFS or OS. Further research is needed to determine if a different staging system would better predict patient outcomes.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Masthead

Publication date: September 2017
Source:American Journal of Preventive Medicine, Volume 53, Issue 3, Supplement 1





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Information for CME Credit— Major Physical Health Conditions and Risk of Suicide

Publication date: September 2017
Source:American Journal of Preventive Medicine, Volume 53, Issue 3





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Information for CME Credit— Leisure Time Physical Activity Among U.S. Adults With Arthritis, 2008–2015

Publication date: September 2017
Source:American Journal of Preventive Medicine, Volume 53, Issue 3





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Letter Regarding “Improving the Nutritional Impact of the Supplemental Nutrition Assistance Program”

Publication date: September 2017
Source:American Journal of Preventive Medicine, Volume 53, Issue 3
Author(s): Benjamin Chrisinger




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Acknowledgments

Publication date: September 2017
Source:American Journal of Preventive Medicine, Volume 53, Issue 3, Supplement 1





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Masthead

Publication date: September 2017
Source:American Journal of Preventive Medicine, Volume 53, Issue 3





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American Journal of Preventive Medicine 2016 Article of the Year

Publication date: September 2017
Source:American Journal of Preventive Medicine, Volume 53, Issue 3
Author(s): Matthew L. Boulton




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Cancer Prevention During Early Adulthood: Highlights From a Meeting of Experts

Publication date: September 2017
Source:American Journal of Preventive Medicine, Volume 53, Issue 3, Supplement 1
Author(s): Dawn M. Holman, Mary C. White, Meredith L. Shoemaker, Greta M. Massetti, Mary C. Puckett, Claire D. Brindis
Using a life course approach, the Centers for Disease Control and Prevention's Division of Cancer Prevention and Control and the National Association of Chronic Disease Directors co-hosted a 2-day meeting with 15 multidisciplinary experts to consider evidence linking factors in early adulthood to subsequent cancer risk and strategies for putting that evidence into practice to reduce cancer incidence. This paper provides an overview of key themes from those meeting discussions, drawing attention to the influence that early adulthood can have on lifetime cancer risk and potential strategies for intervention during this phase of life. A number of social, behavioral, and environmental factors during early adulthood influence cancer risk, including dietary patterns, physical inactivity, medical conditions (e.g., obesity, diabetes, viral infections), circadian rhythm disruption, chronic stress, and targeted marketing of cancer-causing products (e.g., tobacco, alcohol). Suggestions for translating research into practice are framed in the context of the four strategic directions of the National Prevention Strategy: building healthy and safe community environments; expanding quality preventive services in clinical and community settings; empowering people to make healthy choices; and eliminating health disparities. Promising strategies for prevention among young adults include collaborating with a variety of community sectors as well as mobilizing young adults to serve as advocates for change. Young adults are a heterogeneous demographic group, and targeted efforts are needed to address the unique needs of population subgroups that are often underserved and under-represented in research studies.



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MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

Publication date: Available online 17 August 2017
Source:Brachytherapy
Author(s): Sophia C. Kamran, Matthias M. Manuel, Paul Catalano, Linda Cho, Antonio L. Damato, Larissa J. Lee, Ehud J. Schmidt, Akila N. Viswanathan
PurposeTo compare clinical outcomes of MR-based versus CT-based high-dose-rate interstitial brachytherapy (ISBT) for vaginal recurrence of endometrioid endometrial cancer (EC).Methods and MaterialsWe reviewed 66 patients with vaginal recurrent EC; 18 had MR-based ISBT on a prospective clinical trial and 48 had CT-based treatment. Kaplan–Meier survival modeling was used to generate estimates for local control (LC), disease-free interval (DFI), and overall survival (OS), and multivariate Cox modeling was used to assess prognostic factors. Toxicities were evaluated and compared.ResultsMedian followup was 33 months (CT 30 months, MR 35 months). Median cumulative equivalent dose in 2-Gy fractions was 75.5 Gy for MR-ISBT and 73.8 Gy for CT-ISBT (p = 0.58). MR patients were older (p = 0.03) and had larger tumor size (>4 cm vs. ≤ 4 cm) compared to CT patients (p = 0.04). For MR-based versus CT-based ISBT, 3-year KM rate for local control was 100% versus 78% (p = 0.04), DFI was 69% versus 55% (p = 0.1), and OS was 63% versus 75% (p = 0.81), respectively. On multivariate analysis, tumor Grade 3 was associated with worse OS (HR 3.57, 95% CI 1.25, 11.36) in a model with MR-ISBT (HR 0.56, 95% CI 0.16, 1.89). Toxicities were not significantly different between the two modalities.ConclusionDespite worse patient prognostic features, MR-ISBT was associated with a significantly better (100%) 3-year local control, comparable survival, and improved DFI rates compared to CT. Toxicities did not differ compared to CT-ISBT patients. Tumor grade contributed as the most significant predictor for survival. Larger prospective studies are needed to assess the impact of MR-ISBT on survival outcomes.



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MRI-based treatment planning and dose delivery verification for intraocular melanoma brachytherapy

Publication date: Available online 14 August 2017
Source:Brachytherapy
Author(s): Jacqueline Esthappan Zoberi, Jose Garcia-Ramirez, Samantha Hedrick, Vivian Rodriguez, Carol G. Bertelsman, Stacie Mackey, Yanle Hu, H. Michael Gach, P. Kumar Rao, Perry W. Grigsby
PurposeEpiscleral plaque brachytherapy (EPB) planning is conventionally based on approximations of the implant geometry with no volumetric imaging following plaque implantation. We have developed an MRI-based technique for EPB treatment planning and dose delivery verification based on the actual patient-specific geometry.Methods and MaterialsMR images of 6 patients, prescribed 85 Gy over 96 hours from Collaborative Ocular Melanoma Study–based EPB, were acquired before and after implantation. Preimplant and postimplant scans were used to generate "preplans" and "postplans", respectively. In the preplans, a digital plaque model was positioned relative to the tumor, sclera, and nerve. In the postplans, the same plaque model was positioned based on the imaged plaque. Plaque position, point doses, percentage of tumor volume receiving 85 Gy (V100), and dose to 100% of tumor volume (Dmin) were compared between preplans and postplans. All isodose plans were computed using TG-43 formalism with no heterogeneity corrections.ResultsShifts and tilts of the plaque ranged from 1.4 to 8.6 mm and 1.0 to 3.8 mm, respectively. V100 was ≥97% for 4 patients. Dmin for preplans and postplans ranged from 83 to 118 Gy and 45 to 110 Gy, respectively. Point doses for tumor apex and base were all found to decrease from the preimplant to the postimplant plan, with mean differences of 16.7 ± 8.6% and 30.5 ± 11.3%, respectively.ConclusionsBy implementing MRI for EPB, we eliminate reliance on approximations of the eye and tumor shape and the assumption of idealized plaque placement. With MRI, one can perform preimplant as well as postimplant imaging, facilitating EPB treatment planning based on the actual patient-specific geometry and dose-delivery verification based on the imaged plaque position.



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Dosimetric analysis and preliminary clinical result of image-guided brachytherapy with or without hybrid technique for cervical cancer using VariSource titanium ring applicator with “Siriraj Ring Cap”

Publication date: Available online 12 August 2017
Source:Brachytherapy
Author(s): Pittaya Dankulchai, Suphalerk Lohasammakul, Janjira Petsuksiri, Pitchayut Nakkrasae, Lalida Tuntipumiamorn, Chumpot Kakanaporn, Yaowalak Chansilpa
PurposeTitanium ring cap applicator (VariSource) was applied in treating cervical cancer patients by using image-guided brachytherapy (IGBT). However, its sizes appeared to be relatively large for most of our patients. Thus, we have developed a specific applicator "Siriraj Ring Cap," which is slightly smaller and more suitable for our patients. This study was to evaluate effectiveness of this equipment.Methods and MaterialsLocally advanced cervical cancer patients were treated with external beam radiation therapy with or without concomitant chemotherapy. Siriraj Ring Cap was applied in all of the patients for at least one fraction. Dosimetric analysis was performed in each fraction of IGBT. Clinical outcomes of these patients were evaluated.ResultsTwenty-nine patients with 117 dosimetric planning were evaluated between January and December of 2014. Siriraj Ring Cap was fit to all patients in this study. By using this applicator, radiation doses to the targets (D90 high-risk clinical target volume and D90 intermediate-risk clinical target volume) were higher in each fraction. There were no statistically differences of radiation doses to the bladder, rectum, sigmoid colon, and small bowel. Within 2-year followup, 3 patients (10.3%) developed locoregional recurrence. Two-year disease-free survival and overall survival were 75.9% and 89.7%, respectively. According to RTOG/EORTC complication criteria, Grade 1, 2, and 3 gastrointestinal complications were developed in 2 (6.9%), 4 (13.8%), and 1 (3.4%) patients, respectively. For genitourinary complications, 3 patients (10.3%) and 1 patient (3.4%) had Grades 1 and 2, respectively.ConclusionsSiriraj Ring Cap is feasible for IGBT in cervical cancer patients with narrow vagina. Dosimetry and clinical outcomes were satisfactory by using our specific applicator.



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Pretreatment 3T multiparametric MRI staging predicts for biochemical failure in high-risk prostate cancer treated with combination high-dose-rate brachytherapy and external beam radiotherapy

Publication date: Available online 12 August 2017
Source:Brachytherapy
Author(s): John V. Hegde, D. Jeffrey Demanes, Darlene Veruttipong, Jagdeep Raince, Sang-June Park, Steven S. Raman, Nicholas G. Nickols, Christopher R. King, Amar U. Kishan, Michael L. Steinberg, Mitchell Kamrava
PurposeTo determine whether pretreatment 3T multiparametric MRI (mpMRI) staging impacts biochemical recurrence-free survival (BRFS) or distant metastasis-free survival (DMFS) for men with high-risk prostate cancer treated with combination high-dose-rate (HDR) brachytherapy and external beam radiation therapy (EBRT).Materials and MethodsThis institutional review board–approved retrospective study included a cohort of 37 men with high-risk prostate cancer treated with HDR brachytherapy and EBRT after 3T mpMRI. Kaplan–Meier analysis was used to evaluate whether mpMRI evidence of extracapsular extension or seminal vesicle invasion (SVI) resulted in differences in BRFS or DMFS. Pretreatment and treatment-related variables were evaluated for association with biochemical failure (Phoenix definition) and distant metastatic failure using univariate Cox regression analysis.ResultsThe median prostate-specific antigen at diagnosis was 9 ng/mL (range 2–100). Biopsy Gleason score (bGS) was ≤8 in 38% and nine in 62%. Clinical T-category was T1-T2 in 89%, T3a in 8%, and T3b in 3%. With a median followup of 30.6 months, actuarial 3-year BRFS and DMFS were 76% and 86%, respectively. Kaplan-Meier analysis revealed that mpMRI evidence of extracapsular extension or SVI resulted in significantly higher rates of both biochemical recurrence and distant failure. Using Cox regression analysis, only mpMRI evidence of SVI vs. no SVI predicted for biochemical failure (hazard ratio 13.98, p = 0.0055).ConclusionsFor high-risk prostate cancer treated with combination HDR brachytherapy and EBRT, mpMRI evidence of SVI predicted for biochemical failure, whereas traditional pretreatment variables did not. Therefore, pretreatment 3T mpMRI appears useful for identifying men who may benefit from treatment intensification.



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DOT Decision to Withdraw Rulemaking Disappoints National Transportation Safety Board

The National Transportation Safety Board has said the agency is "disappointed" with the he Federal Motor Carrier Safety Administration and Federal Railroad Administration decision to withdraw the proposed rule which they published in March of 2016. The rule was in relation to screening commercial truck drivers and train engineers for sleep apnea. The Agencies received more than 700 comments from individuals, medical professionals, labor groups, and transportation industry stakeholders. The Agencies also received comments from the National Transportation Safety Board and three members of Congress, the Honorable Anna Eshoo, the Honorable Sam Farr, and the Honorable Michael M. Honda.

Sleep apnea is a common disorder that can cause daytime drowsiness, impaired decision making and reaction times and an altered mood, which all can have negative effects on transportation employees during the time they are operating vehicles. According to the Associated Press, "The agencies argue that it should be up to railroads and trucking companies to decide whether to test employees. One railroad that does test, Metro-North in the New York City suburbs, found that 11.6 percent of its engineers have sleep apnea."  There are low cost tests to screen for sleep apnea and effective treatment options that reduce the risk of railway and highway accidents. Evidence suggests that improved rules and regulations would make for safer roads.

 

Source: federalregister.gov

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Your NEJM Group Today: Navigating Life After Residency / Thromboembolism in Newly Diagnosed Cancer / New Orleans Hem-Onc Opportunities (FREE)

By the Editors Here's what we chose for you from NEJM Group today:NEJM Knowledge+ Blog: You powered through college to get into medical school. You …

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Blood Test Shows Promise for Detecting Early-Stage Cancer (FREE)

By Amy Orciari Herman Edited by William E. Chavey, MD, MS Patients may ask about a blood test that could potentially be used to detect cancer in its early stages. Findings for …

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Interview: A Conversation with a Former NEJM Editor (FREE)

By the Editors Clinical Conversations interviews Dr. Jerome P. Kassirer about …

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Banking on banking: does “when” flexibility mask the costs of stringent climate policy?

Abstract

Banking and borrowing emission allowances provide temporal flexibility in cap-and-trade systems, which can enhance the economic efficiency of environmental policy while adhering to the same cumulative emission budget. This paper investigates the role of temporal ("when") flexibility from emission banking provisions under an economy-wide cap-and-trade policy in the USA. The current literature on meeting deep decarbonization targets almost exclusively assumes unlimited banking, which may bias policy recommendations and have important consequences for R&D prioritization and model development. Numerical experiments using the energy-economic model US Regional Energy, GHG, and Economy (US-REGEN) indicate that assumptions about banking materially impact cost and emission pathways in meeting long-term targets like 80% reductions by 2050 relative to 2005 levels. Given the stringency of long-run targets and convexity of marginal abatement costs, the cost-minimizing time path for mitigation with banking suggests that 2025 abatement should exceed the pledged level under the Paris Agreement (42% instead of 26–28%) to reduce future costs. Total policy costs are approximately 30% higher when banking is excluded; however, political economy barriers and uncertainty may limit the use of banking provisions despite their appeal on economic efficiency grounds. Banking on policy implementation with unlimited temporal flexibility may distort insights about the pace, extent, and economic impacts of future energy transitions associated with long-term abatement targets, especially for more stringent climate policies.

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Tree height strongly affects estimates of water-use efficiency responses to climate and CO2 using isotopes

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Linker histone H1 prevents R-loop accumulation and genome instability in heterochromatin

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Non-coding RNAs participate in the regulatory network of CLDN4 via ceRNA mediated miRNA evasion

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Long-term consistency in chimpanzee consolation behaviour reflects empathetic personalities

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CD206+ M2-like macrophages regulate systemic glucose metabolism by inhibiting proliferation of adipocyte progenitors

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Sequential conformational transitions and α-helical supercoiling regulate a sensor histidine kinase

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Giant onsite electronic entropy enhances the performance of ceria for water splitting

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The Framework and Future Opportunities for Leadership in Clinical Dietetics

Publication date: Available online 17 August 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Emily Vaterlaus Patten, Kevin Sauer




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Does the Transformation of Dietitians from Counseling to Therapy Also Apply to the Physical and Therapeutic Environment? A Case Study of Israeli Practice

Publication date: Available online 17 August 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Anat Gesser-Edelsburg, Yael Birman
BackgroundLifestyle change can be influenced through effective interaction between care receiver and care provider. The physical environment where the interaction occurs can affect the dynamics of long-term therapeutic treatment. There have been no studies on the perception of the physical environment in nutritional treatment.ObjectiveOur aim was to ascertain the impact of the physical environment on the dynamics and communication between dietitian and patient based on perceptions of dietitians.DesignWe conducted qualitative constructivist phenomenological research.ParticipantsIn-depth interviews (n=10) and eight focus groups (n=62) were held with dietitians who offer treatment in a physical environment designed according to the medical model and/or in a physical dynamic environmental design according to the dynamic model.ResultsMost dietitians in Israel treat their patients in a physical environment arranged according to the medical model. The participants reported that the physical environment affects the interaction. However, the idea of transforming the physical environment according to the dynamic model raised reservations. Barriers include upsetting therapeutic boundaries, challenging professional authority, and lack of therapeutic tools suitable for the change.ConclusionsChanges in the spatial design in which the therapeutic interaction occurs might support the dietitians' transformation from counseling into therapy. The barriers toward such change suggest that professional training is needed to enable dietitians to overcome them. We recommend conducting further research to evaluate the current physical environment, as well as raising dietitians' awareness and training them to work in the new environment, reflecting a counseling/therapeutic mindset. These changes should be followed by additional research among practitioners to report on their effects.



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A Need for Empirical Evidence Concerning the Accuracy of Joint Parent–Child Reports of Children’s Dietary Intake

Publication date: Available online 12 August 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Suzanne D. Baxter, Caroline H. Guinn, Albert F. Smith, Julie A. Royer, David B. Hitchcock




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Differences in Psychosocial and Behavioral Variables by Dietary Screening Tool Risk Category in Older Adults

Publication date: Available online 17 August 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Geoffrey W. Greene, Ingrid Lofgren, Chelsea Paulin, Mary L. Greaney, Phillip G. Clark
BackgroundThe Dietary Screening Tool (DST) has been validated as a dietary screening instrument for older adults defining three categories of potential nutritional risk based on DST score cutoffs. Previous research has found that older adults classified as being "at risk" differed from those categorized as being "not at risk" for a limited number of health-related variables. The relationship between risk categories and a wide variety of variables has not yet been explored. This research will contribute to an increased understanding of clustering of multiple health concerns in this population.ObjectiveThe aim of this study was to determine whether DST risk categories differed by demographic, anthropometric, cognitive, functional, psychosocial, or behavioral variables in older adults.DesignThis study utilized a cross-sectional design with data collected from September 15, 2009 to July 31, 2012. Participants completed an interviewer-administered survey including the DST and other measures.Participants/settingCommunity-dwelling older adults (n=255) participating in the Study of Exercise and Nutrition in Older Rhode Islanders Project were included if they met study inclusion criteria (complete DST data with depression and cognitive status scores above cutoffs).Main outcome measuresDST scores were used to classify participants' dietary risk (at risk, possible risk, and not at risk).Statistical analyses performedMultiple analysis of variance and χ² analyses examined whether DST risk categories differed by variables. Significant predictors were entered into a logistic regression equation predicting at-risk compared to other risk categories combined.ResultsParticipants' mean age was 82.5±4.9 years. Nearly half (49%, n=125) were classified as being at possible risk, with the remainder 26% (n=66) not at risk and at risk 25% (n=64). At-risk participants were less likely to be in the Action/Maintenance Stages of Change (P<0.01). There was a multivariate effect of risk category (P<0.01). At-risk participants had a lower intake of fruits and vegetables, fruit and vegetable self-efficacy, satisfaction with life, and resilience, as well as higher Geriatric Depression Scale scores, indicating greater negative affect than individuals not at risk (P<0.05). In a logistic regression predicting at risk, fruit and vegetable self-efficacy, Satisfaction with Life Scale score, and fruit and vegetable intake were independent predictors of risk (P<0.05).ConclusionsOlder adults classified as at risk indicated a greater degree of negative affect and reduced self-efficacy to consume fruits and vegetables. This study supports the use of the DST in assessment of older adults and suggests a clustering of health concerns among those classified as at risk.



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Food Waste in the National School Lunch Program 1978-2015: A Systematic Review

Publication date: Available online 12 August 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Carmen Byker Shanks, Jinan Banna, Elena L. Serrano
BackgroundFood waste studies have been used for more than 40 years to assess nutrient intake, dietary quality, menu performance, food acceptability, cost, and effectiveness of nutrition education in the National School Lunch Program (NSLP).ObjectiveDescribe methods used to measure food waste and respective results in the NSLP across time.MethodsA systematic review using PubMed, Science Direct, Informaworld, and Institute of Scientific Information Web of Knowledge was conducted using the following search terms: waste, school lunch, plate waste, food waste, kitchen, half method, quarter method, weight, and photography. Studies published through June 2015 were included. The systematic review followed preferred reporting items for systematic reviews and meta-analyses recommendations.ResultsThe final review included 53 articles. Food waste methodologies included in-person visual estimation (n=11), digital photography (n=11), direct weighing (n=23), and a combination of in-person visual estimation, digital photography, and/or direct weighing (n=8). A majority of studies used a pre–post intervention or cross-sectional design. Fruits and vegetables were the most researched dietary component on the lunch tray and yielded the greatest amount of waste across studies.ConclusionsFood waste is commonly assessed in the NSLP, but the methods are diverse and reporting metrics are variable. Future research should focus on establishing more uniform metrics to measure and report on food waste in the NSLP. Consistent food waste measurement methods will allow for better comparisons between studies. Such measures may facilitate better decision making about NSLP practices, programs, and policies that influence student consumption patterns across settings and interventions.



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The cognitive profile of myotonic dystrophy type 1 A systematic review and meta-analysis

Publication date: Available online 16 August 2017
Source:Cortex
Author(s): Kees Okkersen, Melanie Buskes, Johannes Groenewoud, Roy P.C. Kessels, Hans Knoop, Baziel van Engelen, Joost Raaphorst
ObjectiveTo examine the cognitive profile of patients with myotonic dystrophy type 1 (DM1) on the basis of a systematic review and meta-analysis of the literature.MethodsEmbase, Medline and PsycInfo were searched for studies reporting ≥1 neuropsychological test in both DM1 patients and healthy controls. Search, data extraction and risk of bias analysis were independently performed by two authors to minimize error. Neuropsychological tests were categorized into 12 cognitive domains and effect sizes (Hedges' g) were calculated for each domain and for tests administered in ≥5 studies.ResultsDM1 participants demonstrated a significantly worse performance compared to controls in all cognitive domains. Effect sizes ranged from -0.33 (small) for verbal memory to -1.01 (large) for visuospatial perception. Except for the domains global cognition, intelligence and social cognition, wide confidence intervals were associated with moderate to marked statistical heterogeneity that necessitates careful interpretation of results. Out of the individual tests, the Rey-Osterrieth complex figure-copy (both non-verbal memory and visuoconstruction) showed consistent impairment with acceptable heterogeneity.ConclusionIn DM1 patients, cognitive deficits may include a variable combination of global cognitive impairment with involvement across different domains, including social cognition, memory and visuospatial functioning. Although DM1 is a heterogeneous disorder, our study shows that meta-analysis is feasible, contributes to the understanding of brain involvement and may direct bedside testing. The protocol for this study has been registered in PROSPERO (International prospective register of systematic reviews) under ID: 42016037415.



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The self survives extinction: Self-association biases attention in patients with visual extinction

Publication date: Available online 16 August 2017
Source:Cortex
Author(s): Jie Sui, Glyn W. Humphreys
People show biases to self-related information on a range of tasks. Key but controversial questions are whether self-related information is processed without attention, and whether self-related information determines what is attended. We examined this using patients showing visual extinction. We had patients associated shapes with themselves or their best friend prior to carrying out a shape identification task. We demonstrate that extinction was modulated by whether patients associated stimuli with themselves or their best friend. Notably, patients were biased to identify their own shape relative to the shape associated with their friend, when the two shapes were placed in competition. This occurred even when the self-associated shape fell in the contralesional field. The data indicate that self-relatedness can be computed pre-attentively and can cue attention to regions of space that would otherwise be ignored by neuropsychological patients.



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Antibiotic Prophylaxis in Breast Reduction Surgery: A Systematic Review and Meta-analysis

Publication date: Available online 16 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): James Zapata-Copete, Santiago Aguilera-Mosquera, Herney Andrés García-Perdomo
ObjectiveTo determine the effectiveness and harm of using antibiotic prophylaxis versus placebo or no intervention in patients undergoing breast reduction surgery to prevent surgical site infection.Materials and MethodsA search strategy was conducted in the MEDLINE, CENTRAL, EMBASE and LILACS databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of fixed effects was conducted. The primary outcome was surgical site infection. The secondary outcomes were delayed wound healing and adverse effects. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were antibiotic prophylaxis vs. placebo/no intervention.ResultsFive articles were included in the qualitative and quantitative analysis. A total of 584 patients were included from the five studies. A low risk of bias was shown for most of the study items. The overall risk difference (RD) for surgical site infection was -0.08 (95% CI -0.14 to -0.03) favouring antibiotic prophylaxis compared with placebo.ConclusionAntibiotic prophylaxis lowers the incidence of surgical site infection in breast reduction surgery compared with placebo or no intervention.



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Subungual Melanoma – Management in the Modern Era

Publication date: Available online 16 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): D.J. Reilly, G. Aksakal, R.F. Gilmour, D.E. Gyorki, A. Chauhan, A. Webb, M.A. Henderson
Subungual melanoma is a rare subtype of cutaneous melanoma that arises from the structures of the nail apparatus. It presents most commonly in older patients and at an advanced stage.A retrospective review of all patients with subungual melanoma in a single institution over a 15-year period was performed. 54 patients were included (26 males, average age 62.9 years). 28 cases involved the upper limb. Median tumour thickness was 4.5mm. 18 patients had lymph node metastasis at diagnosis, including 11 of 36 patients with positive sentinel lymph node biopsy. Median survival was 4.6 years.Subungual melanoma has a poor prognosis, strongly associated with presence of nodal disease at diagnosis. Sentinel lymph node biopsy should be considered to determine stage and prognosis.



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Endoconduits with “Pave and Crack” Technique Avoid Open Ilio-femoral Conduits with Sustainable Mid-term Results

Publication date: Available online 14 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): G. Asciutto, M. Aronici, T. Resch, B. Sonesson, T. Kristmundsson, N.V. Dias
Objective/BackgroundThe objective was to evaluate the feasibility and mid-term outcomes of endoconduits (EC) with the "pave and crack" technique during endovascular aneurysm repair (EVAR) of varying complexity.MethodsThis was a retrospective study. All patients undergoing EC between July 2009 and October 2015 were included. The primary endpoint was technical success of the EC defined as the ability to successfully deliver the aortic stent graft through the EC without rupture, dissection, or thrombosis of the iliac or femoral arteries, and with the absence of haemodynamically significant blood loss related to the EC. Secondary outcomes included EC patency and mortality.ResultsNineteen patients underwent EVAR with EC (16 juxtarenal or thoraco-abdominal, two infrarenal and one thoracic; four were ruptured). Fourteen patients (73.7%) had TASC D lesions. In 10 cases (52.6%) adjunctive open/endovascular procedures to improve the femoral outflow were required. EC was technically successful in all cases and all EC were patent at EVAR completion. Thirty day mortality occurred in two cases (10.5%) One of these patients had been treated for rupture. One patient required two endovascular re-interventions at 1 and 5 years post-operatively to restore patency of the EC. No open re-interventions related to the EC were necessary. After a median follow-up period of 17 (interquartile range 5–37) months, the primary assisted patency of the EC was 88.9% (SE 10.5). No new onset of claudication or lower limb amputations occurred during the follow-up.ConclusionEC allows EVAR of varying complexity without the need for open surgical ilio-femoral conduits in patients with concomitant advanced iliac occlusive disease. Intra-operative haemodynamic instability was always avoided and mid-term patency was high.



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Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Octogenarians: Meta-analysis and Systemic Review

Publication date: Available online 16 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Y. Han, S. Zhang, J. Zhang, C. Ji, H.-H. Eckstein
ObjectivesThis meta-analysis and systematic review aimed to highlight the results of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) to assess safety and effectiveness in patients older than 80 years of age compared with younger patients.MethodsPRISMA guidelines were used; quality was appraised, and data were extracted and analysed following the Cochrane collaboration. The MEDLINE and Embase databases were searched on December 31, 2016. All studies related to clinical outcomes following EVAR for AAA treatment in octogenarians compared with those in younger patients were included for a meta-analysis and systematic review of short- and midterm outcomes. Data were analysed using a fixed or random effects model by pooling and calculating odds ratios (ORs) or hazard ratios (HRs) and weighted mean differences, to investigate the safety and feasibility of endoluminal treatment in octogenarians.ResultsPublished literature search identified nine observational studies, comprising 25,723 patients with AAA (5989 octogenarians and 19,734 younger patients). More males (OR 0.621, p=.002) and smokers (OR 0.457, p<.001) were observed in the younger group. Frequent concomitant diseases were associated with advanced age, thus, the procedural duration, blood loss estimation, and length of stay were considerably higher among octogenarians. Although elderly patients have a higher 30 day mortality (2.7% vs. 1.5%, p<.001), endoleak, pulmonary, and renal diseases, no significant difference was found in the technical success of the procedure. As expected, the HR for octogenarians was markedly higher than that of younger patients (HR 1.946, p<.001) for midterm all-cause mortality. However, the re-intervention rate to maximum follow-up period of 5 years was not significantly different (HR 1.148, p=.408) between the groups.ConclusionCompared with younger patients, EVAR in octogenarians is associated with a significantly higher but still acceptable peri-operative and midterm mortality rate. Because of similar midterm re-intervention rates, these findings suggest that EVAR remains an appropriate therapeutic approach in the elderly group if comprehensive pre-operative evaluation and post-operative surveillance are incorporated.



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In case of (dicamba) drift

Pesticide drift is a severely underreported problem in rural, agricultural communities. And now we're in the middle of an epic summer of drift thanks to Monsanto's new dicamba-resistant seed line, Xtend. Expanded planting of Xtend soy and cotton are leading to more spraying of the herbicide. As a result, farmers in southern and midwestern states are reporting extensive and debilitating crop damage from dicamba traveling from where it's applied to nearby fields.

This is a crisis moment for many, but drift damage is not a new problem. For years, we at PAN have been been working with those impacted by drift — farmworkers, farmers and rual families who have experienced health harms or crop damage from drifting pesticides — and we've been pushing for preventative policies to protect these communities.

Now we have a new tool to offer in helping rural residents respond to drift incidents on farms, at work sites and in homes. This just-released guide, "In Case of Drift," was created to help anyone facing drift from agricultural pesticides protect their health and livelihood. And we hope it will inspire you to speak up if drift is a problem in your community.

An invisible problem

Families facing pesticide drift generally receive very little support from government agencies at all levels. Technically, drift is illegal. But our federal government sets such permissive regulations on pesticides that drift is almost a guaranteed outcome. On top of that, local agencies only enforce these insufficient rules if a drift incident is reported, and even then label violation fines are rarely high enough to change an applicator's behavior.

It's no wonder that many farmers and rural families decide not to report drift. When government agencies fail to act, conversations on the ground can quickly turn into a dispute between neighbors or employers and employees. But because so many cases of drift go unreported, our government agencies can keep claiming that drift isn't a problem for farm communities. That said, recent news headlines about dicamba drift damage are making it difficult for officials to continue ignoring the issue.

Dicamba disaster

A perfect storm of corporate greed and government failure has led to thousands of new cases of dicamba drift this season, with no quick solution in sight. It's not polite to say "we told you so," but it is important to note that PAN and a large coalition of farmer organizations predicted this crisis and presented compelling evidence against the introduction of the Xtend system — which the USDA and EPA ignored.

Dicamba is an old chemical, one known for volatility (likelihood to drift, no matter how it is applied). Yet Monsanto decided to make dicamba its solution for the superweed crisis caused by massive glyphosate use. Just keep using more, stronger chemicals once the current herbicides stop working, right? This is the "pesticide treadmill," and it keeps the likes of Monsanto and Dow profitable even at the expense of farmer livelihoods and community health.

When it came to dicamba, Monsanto representatives swore up and down that their new formula would solve the drift problem, and USDA and EPA basically accepted the ag giant's word in the rush to get Xtend crops to market.

Now some state governments are jumping in to temporarily ban dicamba, and some farmers are filing suits against Monsanto. PAN is working with our farmer allies to keep the pressure on USDA and EPA to pull Xtend products from the market.

But even without dicamba, drift will keep plaguing farms until we have serious policy and practice change around pesticides. In the meantime, PAN will keep helping rural families respond to individual incidents of drift.

How to respond

Our new guide, "In Case of Drift," was written to help anyone facing drift through the essential steps to responding: protecting health, observing, reporting, compensation and advocacy. PAN is offering this guide for free, and it can be downloaded here.

In the advocacy section, we provide tools for using your drift story to ask for stronger pesticide regulations. Already have a story about drift? You can share it here.

Photo: Tamina Miller| Flickr

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Optimal Lymphadenectomy in Small Bowel Neuroendocrine Tumors: Analysis of the NCDB

Abstract

Background

Current National Comprehensive Cancer Network guidelines for resectable small bowel neuroendocrine tumors (NETs) recommend regional lymphadenectomy. However, no consensus exists on the optimal nodal harvest.

Methods

The National Cancer Database was queried for patients with resectable small bowel NETs (1998–2013). Patients with metastatic disease and missing lymph node harvest data were excluded. We performed logistic regression of factors determining nodal positivity and multivariable survival analyses.

Results

Of 11,852 patients, 81.8% underwent lymphadenectomy. 79.3% were node positive (N+) and 46.9% of patients had tumors < 1 cm. Independent predictors of N+ were large tumor size, ileal location, and neuroendocrine carcinoma histology. Logistic regression found no difference between observed and expected proportions of N+ patients with lymphadenectomy greater than or equal to eight nodes. Lower metastatic node ratio predicted improved survival on multivariable analysis and is associated with high-volume institutions.

Conclusion

Small bowel NETs have high rates of nodal metastasis, even in patients with small tumors, and many patients do not undergo lymphadenectomy despite the clear benefit. Lymphadenectomy of eight nodes is optimal to identify N+ patients. Additionally, minimizing metastatic node ratio with complete regional lymphadenectomy is associated with improved survival in these patients.

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Comparison of age-related morphological changes in the masseter muscles of senescence-accelerated mouse (SAM)

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Author(s): Teruhide Hoshino, Masahito Yamamoto, Kiyohiro Kasahara, Akira Katakura
ObjectiveAge-related morphological changes in the perioral muscles are still garnering attention today. We planned an experiment using a senescence-accelerated mouse (SAM) to compare age-related morphological changes in the masseter muscle in young and old mice. The masseter muscle in elderly mice (40 -week- old) of SAM-prone 8 (SAMP8) mice has been found to demonstrate greater muscle fiber atrophy than that in a control group of SAM-resistant 1(SAMR1) mice. In the present study, in order to assess age-related morphological changes in the masseter muscles of SAMP8 mice, we compared three groups of mice: young mice (12 -week- old), elderly mice (40 -week- old), and later-stage elderly mice (55 -week- old).Materials and methodsThe body weight, the masseter muscle wet weight and the serum albumin levels of each stages in SAMP8 mice were measured. Also, SAMR1 mice were measured as control. Frozen sections of sampled muscles were prepared and dyed with Hematoxylin-eosin (H-E) and immunohistochemical staining.ResultsThe mean cross-sectional area of muscle fibers decreased from 12- week- old to 40- week-old and from 12- week- old to 55- week- old. Immunohistochemical staining showed that the percentage(%) of MyHC-IIa increased from 12- week- old to 55- week- old, whereas that of MyHC-IIb decreased from 12- week- old to 55- week- old and 40- week- old to 55- week- old.ConclusionsIn the present study, it showed that atrophy of the masseter muscle had occurred by 40- week- old and that there were additional subsequent changes in contraction characteristics.



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Adolescent Weapon Carrying and Use: Are the Correlates Gendered?

Violence and Gender , Vol. 0, No. 0.


from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2x8HiLD

What Makes Journal Club Effective?—A Survey of Orthopaedic Residents and Faculty

Publication date: Available online 17 August 2017
Source:Journal of Surgical Education
Author(s): Sean T. Campbell, Jason R. Kang, Julius A. Bishop
BackgroundJournal clubs play an important role in the education of orthopaedic surgery residents; however, there are sparse data available on the characteristics that make journal clubs effective.ObjectiveThe primary goal of this study was to determine the characteristics of effective journal clubs as identified by orthopaedic residents and faculty. We sought to compare the opinions of residents and faculty in order to identify areas that may benefit from future research and discussion.DesignOrthopaedic surgery residents and faculty at residency programs around the country were surveyed anonymously. The survey was designed to determine the contribution of various journal club characteristics on the effectiveness of journal club. Nonparametric statistics were used to test for goodness-of-fit, and to compare responses between faculty and residents.ResultsA total of 204 individuals participated. The most important goals of journal clubs were teaching the skillset of evaluating scientific papers (2.0 ± 1.2 [mean rank ± standard deviation, on a scale of 6, with 1 being most important]), encouraging participants to read current orthopaedic literature, (2.4 ± 1.1), and instilling career-long habits of reading the orthopaedic literature among residents (3.1 ± 1.3). Mandatory attendance (71.8%), monthly journal clubs (80.9%), resident presentation of articles (86.7%), and discussion of 3 to 5 papers (78.7%) were thought to lead to more effective clubs. The most clinically relevant articles published within the last year (63.8%), and classic articles that have influenced practice (68.1%) were preferred. Participation and attendance (2.4 ± 1.5) and paper selection (2.6 ± 1.5) were the most important characteristics overall.ConclusionsIn orthopaedics, journal clubs fulfill the role of encouraging reading of the literature, as well as educating residents and faculty. There are many possible club formats, but some are clearly felt to be more effective. Particular attention should be paid to attendance, participation, and paper selection.



from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2v5GBRZ