Surgical Treatment of Metastatic Ovarian Tumors From Extragenital Primary Sites.

PubMed

Sal, Veysel; Demirkiran, Fuat; Topuz, Samet; Kahramanoglu, Ilker; Yalcin, Ibrahim; Bese, Tugan; Sozen, Hamdullah; Tokgozoglu, Nedim; Salihoglu, Yavuz; Turan, Hasan; Iyibozkurt, Cem; Kolomuc, Tugba; Sofiyeva, Nigar; Berkman, Sinan; Arvas, Macit

2016-05-01

The purpose of this study was to investigate the outcomes and prognostic factors of metastasectomy in patients with metastatic ovarian tumors from extragenital primary sites. All patients with pathologically confirmed metastatic ovarian tumors between January 1997 and June 2015 were included in this study. A total of 131 patients were identified. The data were obtained from the patients' medical records. Clinicopathological features were evaluated by both univariate and multivariate analyses. The primary sites were colorectal region (53.4%), stomach (26%), and breast (13%). Preoperative serum CA 125 and CA 19-9 levels were elevated in 29.4% and 39.8% of the patients, respectively. Cytoreductive surgery was performed in 41.2% of the patients. Seventy-three (55.7%) patients had no residual disease after surgery. Sixty-six (49.6%) patients had combined metastases at the time of the surgery to sites including the liver, pancreas, lung, bone, lymph nodes, bladder, or the intestine. With a median follow-up of 33 months, the median survival time was 22 months. The estimated 5-year survival probability is 0.26. On univariate analysis, primary cancer site, combined metastasis outside the ovaries, residual disease, preoperative serum CA 125 and CA 19-9 levels, and histologic type were significant parameters for overall survival. Furthermore, residual disease, preoperative serum CA 19-9 level, and primary cancer site were found to be independent prognostic factors on multivariate analysis. The most common primary sites for ovarian metastasis are gastrointestinal tract. Metastasectomy may have beneficial effects on survival, especially if the residual disease is less than 5 mm. Prospective studies warranted to evaluate the value of metastasectomy in patients with ovarian metastasis.

Ain't No Makin' It in the Age of Austerity: The Making and Taking of Educational Life

ERIC Educational Resources Information Center

Bourassa, Gregory

2017-01-01

One of the more long-standing and commonly held views among educational theorists maintains that schools are one of the primary sites of social and cultural reproduction--sites where students are corralled and organized for the reproduction of the existing social arrangement. In this article author Gregory Bourassa argues that if this…

Management of split skin graft donor site in the West African sub region: survey of plastic surgeons' practice.

PubMed

Olawoye, O A; Ademola, S A; Iyun, A O; Michael, A I; Oluwatosin, O M

2017-06-30

Split skin graft (SSG) is one of the most commonly performed operations on any Plastic Surgery service. Rate of donor site healing is affected by various factors including the type of dressing applied. The aim of this study was to survey the practice of plastic surgeons in the sub region with respect to management of SSG donor site and see how it conforms to international standards. Structured questionnaires on various aspects of the harvest and management of SSG donor sites were administered to plastic surgeons during the 53rd annual conference of the West African College of Surgeons (WACS) at Lome, Togo in March 2013. The data were analyzed using descriptive statistics. There were 47 respondents out of 55 plastic surgeons from four West African countries, which represented 85.4% of registered participants at the plastic surgery section of the conference. All the respondents performed SSG regularly, and the thigh was the most commonly used donor site. Different types of paraffin gauze remained the most commonly used primary donor site dressing. Only 17% of the respondents apply a topical local anaesthetic agent on the donor site. The choice of SSG donor site dressing in the sub region was driven mainly by availability. Concerted efforts must be made to access newer wound care products for optimum management of this commonly performed operation.

The Kaiser Permanente shoulder arthroplasty registry: results from 6,336 primary shoulder arthroplasties.

PubMed

Dillon, Mark T; Ake, Christopher F; Burke, Mary F; Singh, Anshuman; Yian, Edward H; Paxton, Elizabeth W; Navarro, Ronald A

2015-06-01

Shoulder arthroplasty is being performed in the United States with increasing frequency. We describe the medium-term findings from a large integrated healthcare system shoulder arthroplasty registry. Shoulder arthroplasty cases registered between January 2005 and June 2013 were included for analysis. The registry included patient characteristics, surgical information, implant data, attrition, and patient outcomes such as surgical site infections, venous thromboembolism, and revision procedures. During the study period, 6,336 primary cases were registered. Median follow-up time for all primaries was 3.3 years; 461 cases were lost to follow-up by ending of health plan membership. Primary cases were predominantly female (56%) and white (81%), with an average age of 70 years. The most common reason for surgery was osteoarthritis in 60% of cases, followed by acute fracture (17%) and rotator cuff tear arthropathy (15%). In elective shoulder arthroplasty procedures, 200 all-cause revisions (4%) were reported, with glenoid wear being the most common reason. Most arthroplasties were elective procedures: over half performed for osteoarthritis. Glenoid wear was the most common reason for revision of primary shoulder arthroplasty in elective cases.

Mutation analysis of metastatic melanomas in the central nervous system: results of a panel of 5 genes in 48 cases.

PubMed

Gamsizkan, Mehmet; Yilmaz, Ismail; Simsek, Hasan Aktug; Onguru, Onder; Griffin, Ann; Tihan, Tarik

2016-01-01

Melanocytic lesions in the central nervous system (CNS) may be primary to the site but are more commonly metastases from cutaneous primaries. In fact, melanomas are one of the most common malignancies that can metastasize to the brain, and some patients may not have a diagnosis of melanoma prior to the discovery of the CNS lesion. In such cases, identifying the primary site may be challenging. We reviewed the archives of a large referral center for melanocytic tumors involving the CNS and selected 48 patients for this study based on our inclusion criteria. We used sequencing to identify mutation status of these tumors and compared these with clinicopathological features. Mutations in exon 9, 11, 13, 17, and 18 of KIT gene, exon 15 of BRAF gene, exon 2 and 3 of NRAS gene, exon 4 and 5 of GNAQ and GNA11 genes were analyzed. Mutations in BRAF-exon 15 were the most common among tumors (58.3%). NRAS-exon 2 and NRAS-exon 3 mutations were detected in 3 and 7 cases, respectively. GNAQ-exon 4, GNAQ-exon 5 and GNA11-exon 5 mutation were present in 1 tumor each. Eight tumors were wild type for all 5 genes, and 6 of these were not known primary despite a work-up and clinical follow-up. Only 1 of these tumors showed a mutation in exon 11 of KIT gene. When compared to primary melanocytic lesions of the CNS, metastatic melanomas were characterized by BRAF gene mutations and wild-type GNAQ and GNA11 genes.

[A single metastasis in the carpal bones as the first clinical manifestation of a hepatocellular carcinoma].

PubMed

Corrales Pinzón, R; Alonso Sánchez, J M; de la Mano González, S; El Karzazi Tarazona, K

2014-01-01

Hepatocellular carcinoma is the most common primary tumor of the liver. Spreading outside the liver usually takes place in advanced stages of the disease, and bone is the third most common site of metastases. We present a case of hepatocellular carcinoma in which the first clinical manifestation was a single metastasis to the carpal bones. The interest of this case lies in the way this hepatocellular carcinoma manifested as well as in the unusual site of the metastasis. Copyright © 2012 SERAM. Published by Elsevier Espana. All rights reserved.

A 36-year-old female with Krukenberg tumor from a colonic carcinoma.

PubMed

Umakanthan, Srikanth; Bukelo, Maryann M; Hardik, Khandelwal

2015-01-01

Krukenberg tumor is bilateral ovarian carcinoma's metastasizing most commonly from a gastric primary followed by a colon. We report a case of 36-year-old female with bilateral ovarian mass diagnosed as Krukenberg with a work up for locating the primary site. In this case, we discuss widely the clinical aspects with histopathological features and literature review of Krukenberg tumor.

Primary gastrointestinal lymphoma

PubMed Central

Ghimire, Prasanna; Wu, Guang-Yao; Zhu, Ling

2011-01-01

Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type. Although lymphoma can involve any part of the gastrointestinal tract, the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region. Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare. Gastrointestinal lymphomas are usually not clinically specific and indistinguishable from other benign and malignant conditions. Diffuse large B-cell lymphoma is the most common pathological type of gastrointestinal lymphoma in essentially all sites of the gastrointestinal tract, although recently the frequency of other forms has also increased in certain regions of the world. Although some radiological features such as bulky lymph nodes and maintenance of fat plane are more suggestive of lymphoma, they are not specific, thus mandating histopathological analysis for its definitive diagnosis. There has been a tremendous leap in the diagnosis, staging and management of gastrointestinal lymphoma in the last two decades attributed to a better insight into its etiology and molecular aspect as well as the knowledge about its critical signaling pathways. PMID:21390139

Epidemiology of neuroendocrine cancers in an Australian population.

PubMed

Luke, Colin; Price, Timothy; Townsend, Amanda; Karapetis, Christos; Kotasek, Dusan; Singhal, Nimit; Tracey, Elizabeth; Roder, David

2010-06-01

The aim was to explore incidence, mortality and case survivals for invasive neuroendocrine cancers in an Australian population and consider cancer control implications. Directly age-standardised incidence and mortality rates were investigated from 1980 to 2006, plus disease-specific survivals. Annual incidence per 100,000 increased from 1.7 in 1980-1989 to 3.3 in 2000-2006. A corresponding mortality increase was not observed, although numbers of deaths were low, reducing statistical power. Increases in incidence affected both sexes and were more evident for female lung, large bowel (excluding appendix), and unknown primary site. Common sites were lung (25.9%), large bowel (23.3%) (40.9% were appendix), small intestine (20.6%), unknown primary (15.0%), pancreas (6.5%), and stomach (3.7%). Site distribution did not vary by sex (p = 0.260). Younger ages at diagnosis applied for lung (p = 0.002) and appendix (p < 0.001) and older ages for small intestine (p < 0.001) and unknown primary site (p < 0.001). Five-year survival was 68.5% for all sites combined, with secular increases (p < 0.001). After adjusting for age and diagnostic period, survivals were higher for appendix and lower for unknown primary site, pancreas, and colon (excluding appendix). Incidence rates are increasing. Research is needed into possible aetiological factors for lung and large-bowel sites, including tobacco smoking, and excess body weight and lack of exercise, respectively; and Crohn's disease as a possible precursor condition.

In their own words: why teenagers don't use social networking sites.

PubMed

Baker, Rosland K; White, Katherine M

2011-06-01

We explored common reasons for non-use of the rapidly growing popularity of social networking sites among a sample of Australian adolescents (N = 69). Transcripts were coded by grouping responses along similar themes for non-use that had been commonly stated by participants. The primary reasons offered by adolescents were: lack of motivation, poor use of time, preference for other forms of communication, preference for engaging in other activities, cybersafety concerns, and a dislike of self-presentation online. The identification of these themes allows for a greater understanding of teenagers' decisions not to engage in the popular medium of communication and points to possible strategies that could be utilised by Web site developers in efforts to appeal to a wider teenage audience.

Identification and survival outcomes of a cohort of patients with cancer of unknown primary in Ontario, Canada.

PubMed

Kim, Chong S; Hannouf, Malek B; Sarma, Sisira; Rodrigues, George B; Rogan, Peter K; Mahmud, Salaheddin M; Winquist, Eric; Brackstone, Muriel; Zaric, Gregory S

2015-11-01

Cancer of unknown primary origin (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival (OS). We used the Ontario Cancer Registry (OCR) and the Same-Day Surgery and Discharge Abstract Database (SDS/DAD) to identify patients diagnosed with CUP in Ontario between 1 January 2000, and 31 December 2005. Patient diagnostic information, including histology and survival data, was obtained from the OCR. We cross-validated CUP diagnosis and obtained additional information about metastasis through data linkage with the SDS/DAD database. OS was assessed using Cox regression models adjusting for histology and sites of metastases. We identified 3564 patients diagnosed with CUP. Patients without histologically confirmed disease (n = 1821) had a one-year OS of 10.9%, whereas patients with confirmed histology (n = 1743) had a one-year OS of 15.6%. The most common metastatic sites were in the respiratory or digestive systems (n = 1603), and the most common histology was adenocarcinoma (n = 939). Three-year survival rates were 3.5%, 5.3%, 41.6% and 3.6% among adenocarcinoma, unspecified carcinoma, squamous cell carcinoma and undifferentiated histology, respectively. Three-year survival rates were 40%, 2.4%, 8.0% and 4.6% among patients with metastases localised to lymph nodes, the respiratory or digestive systems, other specified sites, and unspecified sites, respectively. CUP patients in Ontario have a poor prognosis. Some subgroups may have better survival rates, such as patients with metastases localised to lymph nodes and patients with squamous cell histology.

Genomic characterization of brain metastases reveals branched evolution and potential therapeutic targets

PubMed Central

Santagata, Sandro; Cahill, Daniel P.; Taylor-Weiner, Amaro; Jones, Robert T.; Van Allen, Eliezer M.; Lawrence, Michael S.; Horowitz, Peleg M.; Cibulskis, Kristian; Ligon, Keith L.; Tabernero, Josep; Seoane, Joan; Martinez-Saez, Elena; Curry, William T.; Dunn, Ian F.; Paek, Sun Ha; Park, Sung-Hye; McKenna, Aaron; Chevalier, Aaron; Rosenberg, Mara; Barker, Frederick G.; Gill, Corey M.; Van Hummelen, Paul; Thorner, Aaron R.; Johnson, Bruce E.; Hoang, Mai P.; Choueiri, Toni K.; Signoretti, Sabina; Sougnez, Carrie; Rabin, Michael S.; Lin, Nancy U.; Winer, Eric P.; Stemmer-Rachamimov, Anat; Meyerson, Matthew; Garraway, Levi; Gabriel, Stacey; Lander, Eric S.; Beroukhim, Rameen; Batchelor, Tracy T.; Baselga, Jose; Louis, David N.

2016-01-01

Brain metastases are associated with a dismal prognosis. Whether brain metastases harbor distinct genetic alterations beyond those observed in primary tumors is unknown. We performed whole-exome sequencing of 86 matched brain metastases, primary tumors and normal tissue. In all clonally related cancer samples, we observed branched evolution, where all metastatic and primary sites shared a common ancestor yet continued to evolve independently. In 53% of cases, we found potentially clinically informative alterations in the brain metastases not detected in the matched primary-tumor sample. In contrast, spatially and temporally separated brain metastasis sites were genetically homogenous. Distal extracranial and regional lymph node metastases were highly divergent from brain metastases. We detected alterations associated with sensitivity to PI3K/AKT/mTOR, CDK, and HER2/EGFR inhibitors in the brain metastases. Genomic analysis of brain metastases provides an opportunity to identify potentially clinically informative alterations not detected in clinically sampled primary tumors, regional lymph nodes, or extracranial metastases. PMID:26410082

Laboratory diagnosis of vaginal infections.

PubMed

Metzger, G D

1998-01-01

Vaginal discomfort and/or odor are a common complaint in primary care visits by female patients. This is especially true among sexually active women of childbearing age. Because treatment varies depending upon which syndrome is present, effective treatment depends upon accurate diagnosis. The microscopic exams for diagnosing vaginal complaints are most frequently done in primary care sites. Because of this, few clinical laboratory scientists (CLSs) have the opportunity to become familiar with microscopy on this specimen type. In addition, literature on the subject is only gradually becoming available. This paper will attempt to briefly review the clinical and microscopic features of the common syndromes associated with vaginal discomfort.

Incidence and prevalence of hyperhidrosis.

PubMed

Moraites, Eleni; Vaughn, Olushola Akinshemoyin; Hill, Samantha

2014-10-01

Hyperhidrosis is a skin disorder characterized by excessive sweating that often causes significant impairment in social, occupational, and emotional wellbeing. Hyperhidrosis is thought to affect 2.8% of the US population and can be of primary or secondary origin. Primary hyperhidrosis is usually bilateral, symmetric, and focal. The most common focal sites include, but are not limited to, the palms, soles, and axillae. Secondary hyperhidrosis is usually caused by an underlying medical condition or medication. Secondary hyperhidrosis must be ruled out before a diagnosis of primary hyperhidrosis is made. Copyright © 2014 Elsevier Inc. All rights reserved.

Childhood Obesity Research Demonstration (CORD): The Cross-Site Overview and Opportunities for Interventions Addressing Obesity Community-Wide

PubMed Central

Belay, Brook; Dooyema, Carrie A.; Williams, Nancy; Blanck, Heidi M.

2015-01-01

Abstract Background: This is the first of a set of articles in this issue on the Childhood Obesity Research Demonstration (CORD) project and provides an overview of the multisite approach and community-wide interventions. Innovative multisetting, multilevel approaches that integrate primary healthcare and public health interventions to improve outcomes for children with obesity need to be evaluated. The CORD project aims to improve BMI and obesity-related behaviors among underserved 2- to 12-year-old children by utilizing these approaches. Methods: The CORD consortium, structure, model terminology and key components, and common measures were solidified in year 1 of the CORD project. Demonstration sites applied the CORD model across communities in years 2 and 3. Evaluation plans for year 4 include site-specific analyses as well as cross-site impact, process, and sustainability evaluations. Results: The CORD approach resulted in commonalities and differences in participant, intervention, comparison, and outcome elements across sites. Products are to include analytic results as well as cost assessment, lessons learned, tools, and materials. Discussion: Foreseen opportunities and challenges arise from the similarities and unique aspects across sites. Communities adapted interventions to fit their local context and build on strengths, but, in turn, this flexibility makes cross-site evaluation challenging. Conclusion: The CORD project represents an evidence-based approach that integrates primary care and public health strategies and evaluates multisetting multilevel interventions, thus adding to the limited research in this field. CORD products will be disseminated to a variety of stakeholders to aid the understanding, prevention, and management of childhood obesity. PMID:25679059

Squamous Cell Carcinoma of the Anal Canal: Patterns and Predictors of Failure and Implications for Intensity-Modulated Radiation Treatment Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wright, Jean L., E-mail: jwright3@med.miami.ed; Patil, Sujata M.; Temple, Larissa K.F.

2010-11-15

Purpose: Intensity-modulated radiation treatment (IMRT) is increasingly used in the treatment of squamous cell carcinoma of the anal canal (SCCAC). Prevention of locoregional failure (LRF) using IMRT requires appropriate clinical target volume (CTV) definition. To better define the CTV for IMRT, we evaluated patterns and predictors of LRF in SCCAC patients given conventional radiation treatment. Methods and Materials: We reviewed records of 180 SCCAC patients treated with conventional radiation with or without chemotherapy at our institution between January 1990 and March 2007. All patients received radiation; the median primary tumor dose was 45 Gy. A total of 173 patients alsomore » received mitomycin-based chemotherapy. Results: Median follow-up was 40 months. Actuarial 3-year colostomy-free survival was 89% and overall survival (OS) 88%. Actuarial 3-year LRF was 23%. A total of 45 patients had LRF, with 35 (78%) occurring locally in the primary site (25 local only, 10 local and regional); however, 20 (44%) had regional components of failure within the pelvis or inguinal nodes (10 regional only, 10 local and regional). Cumulative sites of LRF (patients may have one or more site of failure) were as follows: primary, 35; inguinal, 8; external perianal, 5; common iliac, 4; presacral, 3; distal rectum, 2; external iliac, 2; and internal iliac, 2. All patients with common iliac failure had cT3 or N+ disease. Conclusions: The observed patterns of failure support inclusion of the inguinal and all pelvic nodal groups in the CTV for IMRT. In patients with advanced tumor or nodal stage, common iliac nodes should also be included in the CTV.« less

Pattern of distant extrahepatic metastases in primary liver cancer: a SEER based study.

PubMed

Wu, Wenrui; He, Xingkang; Andayani, Dewi; Yang, Liya; Ye, Jianzhong; Li, Yating; Chen, Yanfei; Li, Lanjuan

2017-01-01

Background and Aims : Primary liver cancer remains still the common cause of cancer-related deaths globally and the prognosis for patients with extrahepatic metastasis is poor. The aim of our study was to assess extrahepatic metastatic pattern of different histological subtypes and evaluate prognostic effects of extrahepatic metastasis in patients with advanced disease. Methods: Based on the Surveillance, Epidemiology and End Results (SEER) database, eligible patients diagnosed with primary liver cancer was identified between 2010 to 2012. We adopted Chi-square test to compared metastasis distribution among different histological types. We compared survival difference of patients with different extrahepatic metastasises by Kaplan-Meier analysis. Cox proportional hazard models were performed to identify other prognostic factors of overall survival. Results: We finally identified 8677 patients who were diagnosed with primary liver cancer from 2010 to 2012 and 1775 patients were in distant metastasis stages. Intrahepatic cholangiocarcinoma was more invasive and had a higher percentage of metastasis compared with hepatocellular carcinoma. Lung was the most common metastasis and brain was the least common site for both hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Extrahepatic metastasis could consider as an independent prognostic factor for patients with liver cancer. Patients with brain metastasis had the worst prognosis, compared with other metastasis in overall survival (OS) and cancer-specific survival (CSS) analysis. Conclusions: Different histological subtypes of liver cancer had different metastasis patterns. There were profound differences in risk of mortality among distant extrahepatic metastatic sites. Results from our studies would provide some information for follow-up strategies and future studies.

Extraneural metastases of primary central nervous system tumors identified by fine needle aspiration: a retrospective analysis.

PubMed

Vandenbussche, Christopher J; Ho, Cheng-Ying; Nugent, Summer L; Ali, Syed Z

2014-01-01

Extraneural metastasis (EM) of primary central nervous system (PCNS) neoplasms is rare and signifies a poor clinical outcome. Due to its infrequent occurrence, relatively few reports on the cytomorphology of these neoplasms have been published. We describe a series of 19 cases from 16 patients at a single, large tertiary care center. A retrospective analysis of 19 cases of metastases from PCNS neoplasms identified on fine needle aspiration (FNA) in 8 male and 8 female patients aged 14-72 years (mean age 39.6) from 1989 to 2013 was conducted to further characterize the cytomorphologic features identified at metastatic sites. Six different PCNS neoplasms were identified: meningioma, glioblastoma, hemangiopericytoma (HPC), oligodendroglioma, medulloblastoma, and retinoblastoma. The mean latency period between the diagnoses of the primary and first metastatic tumors was 7.4 years (range 0-15). The most common PCNS malignancy responsible for EM was HPC. The most common metastatic sites were the lung (31%) and soft tissue/bone (31%). EM of PCNS tumors is extremely rare. FNA allows for quick, safe and accurate diagnosis. Cytomorphologic features are characteristic, and in conjunction with the clinical history and immunohistochemistry, an accurate diagnosis was obtained in 100% of the cases.

Low meprin α expression differentiates primary ovarian mucinous carcinoma from gastrointestinal cancers that commonly metastasise to the ovaries

PubMed Central

Heinzelmann‐Schwarz, Viola A; Scolyer, Richard A; Scurry, James P; Smith, Alison N; Gardiner‐Garden, Margaret; Biankin, Andrew V; Baron‐Hay, Sally; Scott, Carolyn; Ward, Robyn L; Fink, Daniel; Hacker, Neville F; Sutherland, Robert L; O'Brien, Philippa M

2007-01-01

Background Currently, no specific immunohistochemical markers are available to differentiate primary mucinous epithelial ovarian cancer (MOC) from adenocarcinomas originating at other sites that have metastasised to the ovary, which may have an impact on patient management and prognosis. Aim To investigate the expression of two intestinal markers, galectin 4 and meprin α, in mucinous carcinomas of the ovary and gastrointestinal tract. Methods Using immunohistochemical analysis, the expression of galectin 4 and meprin α was investigated in 10 MOCs and in 38 mucinous adenocarcinomas of colon, pancreas, stomach and appendix, the most common sites of origin of ovarian metastases. Results Total cytoplasmic galectin 4 expression was relatively consistent between the different carcinomas. Membranous meprin α expression was significantly lower in MOCs compared with gastrointestinal carcinomas. Moreover, meprin α expression showed greater discrimination between the ovarian and gastrointestinal carcinomas than the cytokeratins CK7 and CK20, the current standard immunohistochemical markers used to determine the tissue origin of mucinous carcinomas involving the ovaries. Conclusions Meprin α is a useful additional marker in differentiating primary from secondary mucinous adenocarcinomas of the ovary. PMID:16822880

Effects of common seagrass restoration methods on ecosystem structure in subtropical seagrass meadows.

PubMed

Bourque, Amanda S; Fourqurean, James W

2014-06-01

Seagrass meadows near population centers are subject to frequent disturbance from vessel groundings. Common seagrass restoration methods include filling excavations and applying fertilizer to encourage seagrass recruitment. We sampled macrophytes, soil structure, and macroinvertebrate infauna at unrestored and recently restored vessel grounding disturbances to evaluate the effects of these restoration methods on seagrass ecosystem structure. After a year of observations comparing filled sites to both undisturbed reference and unrestored disturbed sites, filled sites had low organic matter content, nutrient pools, and primary producer abundance. Adding a nutrient source increased porewater nutrient pools at disturbed sites and in undisturbed meadows, but not at filled sites. Environmental predictors of infaunal community structure across treatments included soil texture and nutrient pools. At the one year time scale, the restoration methods studied did not result in convergence between restored and unrestored sites. Particularly in filled sites, soil conditions may combine to constrain rapid development of the seagrass community and associated infauna. Our study is important for understanding early recovery trajectories following restoration using these methods. Published by Elsevier Ltd.

Suppression of Metastasis by Primary Tumor and Acceleration of Metastasis Following Primary Tumor Resection: A Natural Law?

PubMed

Hanin, Leonid; Rose, Jason

2018-03-01

We study metastatic cancer progression through an extremely general individual-patient mathematical model that is rooted in the contemporary understanding of the underlying biomedical processes yet is essentially free of specific biological assumptions of mechanistic nature. The model accounts for primary tumor growth and resection, shedding of metastases off the primary tumor and their selection, dormancy and growth in a given secondary site. However, functional parameters descriptive of these processes are assumed to be essentially arbitrary. In spite of such generality, the model allows for computing the distribution of site-specific sizes of detectable metastases in closed form. Under the assumption of exponential growth of metastases before and after primary tumor resection, we showed that, regardless of other model parameters and for every set of site-specific volumes of detected metastases, the model-based likelihood-maximizing scenario is always the same: complete suppression of metastatic growth before primary tumor resection followed by an abrupt growth acceleration after surgery. This scenario is commonly observed in clinical practice and is supported by a wealth of experimental and clinical studies conducted over the last 110 years. Furthermore, several biological mechanisms have been identified that could bring about suppression of metastasis by the primary tumor and accelerated vascularization and growth of metastases after primary tumor resection. To the best of our knowledge, the methodology for uncovering general biomedical principles developed in this work is new.

Bone Metastasis in Prostate Cancer: Recurring Mitochondrial DNA Mutation Reveals Selective Pressure Exerted by the Bone Microenvironment

PubMed Central

Arnold, Rebecca S.; Fedewa, Stacey A.; Goodman, Michael; Osunkoya, Adeboye O.; Kissick, Haydn T.; Morrissey, Colm; True, Lawrence D.; Petros, John A.

2015-01-01

Background Cancer progression and metastasis occurs such that cells with acquired mutations enhancing growth and survival (or inhibiting cell death) increase in number, a concept that has been recognized as analogous to Darwinian evolution of species since Peter C. Nowell’s description in 1976. Selective forces include those intrinsic to the host (including metastatic site) as well as those resulting from anti-cancer therapies. By examining the mutational status of multiple tumor sites within an individual patient some insight may be gained into those genetic variants that enhance site-specific metastasis. By comparing these data across multiple individuals, recurrent patterns may identify alterations that are fundamental to successful site-specific metastasis. Methods We sequenced the mitochondrial genome in 10 prostate cancer patients with bone metastases enrolled in a rapid autopsy program. Patients had late stage disease and received androgen ablation and frequently other systemic therapies. For each of 9 patients, 4 separate tissues were sequenced: the primary prostate cancer, a soft tissue metastasis, a bone metastasis and an uninvolved normal tissue that served as the non-cancerous control. An additional (10th) patient had no primary prostate available for sequencing but had both metastatic sites (and control DNA) sequenced. We then examined the number and location of somatically acquired mitochondrial DNA (mtDNA) mutations in the primary and two metastatic sites in each individual patient. Finally, we compared patients with each other to determine any common patterns of somatic mutation. Results Somatic mutations were significantly more numerous in bone compared to either the primary tumor or soft tissue metastases. A missense mutation at nucleotide position (np) 10398 (A10398G; Thr114Ala) in the respiratory complex I gene ND3 was the most common (7 of 10 patients) and was detected only in bone. Other notable somatic mutations that occurred in more than one patient include a tRNA Arg mutation at np 10436 and a tRNA Thr mutation at np 15928. The tRNA Arg mutation was restricted to bone metastases and occurred in three of 10 patients (30%). Somatic mutation at 15928 was not restricted to bone and also occurred in three patients. Conclusions Mitochondrial genomic variation was greater in metastatic sites than the primary tumor and bone metastases had statistically significantly greater numbers of somatic mutations than either the primary or the soft tissue metastases. The genome was not mutated randomly. At least one mutational “hot-spot” was identified at the individual base level (nucleotide position 10398 in bone metastases) indicating a pervasive selective pressure for bone metastatic cells that had acquired the 10398 mtDNA mutation. Two additional recurrent mutations (tRNA Arg and tRNA Thr) support the concept of bone site-specific “survival of the fittest” as revealed by variation in the mitochondrial genome and selective pressure exerted by the metastatic site. PMID:25952970

Bone metastasis in prostate cancer: Recurring mitochondrial DNA mutation reveals selective pressure exerted by the bone microenvironment.

PubMed

Arnold, Rebecca S; Fedewa, Stacey A; Goodman, Michael; Osunkoya, Adeboye O; Kissick, Haydn T; Morrissey, Colm; True, Lawrence D; Petros, John A

2015-09-01

Cancer progression and metastasis occur such that cells with acquired mutations enhancing growth and survival (or inhibiting cell death) increase in number, a concept that has been recognized as analogous to Darwinian evolution of species since Peter C. Nowell's description in 1976. Selective forces include those intrinsic to the host (including metastatic site) as well as those resulting from anti-cancer therapies. By examining the mutational status of multiple tumor sites within an individual patient some insight may be gained into those genetic variants that enhance site-specific metastasis. By comparing these data across multiple individuals, recurrent patterns may identify alterations that are fundamental to successful site-specific metastasis. We sequenced the mitochondrial genome in 10 prostate cancer patients with bone metastases enrolled in a rapid autopsy program. Patients had late stage disease and received androgen ablation and frequently other systemic therapies. For each of 9 patients, 4 separate tissues were sequenced: the primary prostate cancer, a soft tissue metastasis, a bone metastasis and an uninvolved normal tissue that served as the non-cancerous control. An additional (10th) patient had no primary prostate available for sequencing but had both metastatic sites (and control DNA) sequenced. We then examined the number and location of somatically acquired mitochondrial DNA (mtDNA) mutations in the primary tumor and two metastatic sites in each individual patient. Finally, we compared patients with each other to determine any common patterns of somatic mutation. Somatic mutations were significantly more numerous in the bone compared to either the primary tumor or soft tissue metastases. A missense mutation at nucleotide position (n.p.) 10398 (A10398G; Thr114Ala) in the respiratory complex I gene ND3 was the most common (7 of 10 patients) and was detected only in the bone. Other notable somatic mutations that occurred in more than one patient include a tRNA Arg mutation at n.p. 10436 and a tRNA Thr mutation at n.p. 15928. The tRNA Arg mutation was restricted to bone metastases and occurred in three of 10 patients (30%). Somatic mutation at 15928 was not restricted to the bone and also occurred in three patients. Mitochondrial genomic variation was greater in metastatic sites than in the primary tumor and bone metastases had statistically significantly greater numbers of somatic mutations than either the primary or the soft tissue metastases. The genome was not mutated randomly. At least one mutational "hot-spot" was identified at the individual base level (nucleotide position 10398 in bone metastases) indicating a pervasive selective pressure for bone metastatic cells that had acquired the 10398 mtDNA mutation. Two additional recurrent mutations (tRNA Arg and tRNA Thr) support the concept of bone site-specific "survival of the fittest" as revealed by variation in the mitochondrial genome and selective pressure exerted by the metastatic site. Published by Elsevier Inc.

Krukenberg carcinoma metastasized from stomach resembling mucinous cystadenocarcinoma of the ovary.

PubMed

Doğanay, Melike; Topçu, Hasan Onur; Kokanalı, Mahmut Kuntay; Güzel, Ali I Rfan; Oskovi, Aslı; Akbay, Serap; Cavkaytar, Sabri

2017-09-01

The ovaries are common site of metastasis in a variety of primary neoplasms. Multiple tumors such as breast, lung, and pancreas have been reported to metastasize to the ovary, however; the colon and stomach are the most common primary cancer sites that of ovarian metastasis. An ovarian mass mostly originates from its self-tissue, but sometimes it can be a metastasis of a gastrointestinal system tumor. Such cases are often misdiagnosed as primary ovarian cancers. A 42-year-old woman was admitted to our hospital with pelvic pain. She had a history of her complaints for two months. Bilateral large ovarian mass was detected in transvaginal ultrasound. Laparotomy was performed, the pathologist suggested inspection of the stomach after the frozen section analysis; therefore, an irregular mass on the stomach was detected. The general surgeon was attended to the operation, and an inoperative stomach tumor was reported by the general surgeon. After that due to the partial obstruction of jejunum, a gastrojejunostomy was performed. It is in fact difficult to distinguish between metastatic mucinous carcinomas and primary mucinous carcinomas of the ovary, due to the similar appearance of as cystic tumors on gross examination. The clinicians should be aware of the likely concomitant gastrointestinal system tumor when a large and bilaterally mass was detected on physical examination. This case also reminds that a systemic examination is necessary even if the large ovarian tumors suspicious of primary malignancy were noticed.

Krukenberg carcinoma metastasized from stomach resembling mucinous cystadenocarcinoma of the ovary.

PubMed

Doğanay, Melike; Topçu, Hasan Onur; Kokanali, Mahmut Kuntay; Güzel, Ali Irfan; Oskovi, Asli; Akbay, Serap; Cavkaytar, Sabri

2015-01-01

The ovaries are common site of metastasis in a variety of primary neoplasms. Multiple tumors such as breast, lung, and pancreas have been reported to metastasize to the ovary, however; the colon and stomach are the most common primary cancer sites that of ovarian metastasis. An ovarian mass mostly originates from its self-tissue, but sometimes it can be a metastasis of a gastrointestinal system tumor. Such cases are often misdiagnosed as primary ovarian cancers. A 42-year-old woman was admitted to our hospital with pelvic pain. She had a history of her complaints for two months. Bilateral large ovarian mass was detected in transvaginal ultrasound. Laparotomy was performed, the pathologist suggested inspection of the stomach after the frozen section analysis; therefore, an irregular mass on the stomach was detected. The general surgeon was attended to the operation, and an inoperative stomach tumor was reported by the general surgeon. After that due to the partial obstruction of jejunum, a gastrojejunostomy was performed. It is in fact difficult to distinguish between metastatic mucinous carcinomas and primary mucinous carcinomas of the ovary, due to the similar appearance of as cystic tumors on gross examination. The clinicians should be aware of the likely concomitant gastrointestinal system tumor when a large and bilaterally mass was detected on physical examination. This case also reminds that a systemic examination is necessary even if the large ovarian tumors suspicious of primary malignancy were noticed.

Capacity for Cancer Care Delivery Research in National Cancer Institute Community Oncology Research Program Community Practices: Availability of Radiology and Primary Care Research Partners.

PubMed

Carlos, Ruth C; Sicks, JoRean D; Chang, George J; Lyss, Alan P; Stewart, Teresa L; Sung, Lillian; Weaver, Kathryn E

2017-12-01

Cancer care spans the spectrum from screening and diagnosis through therapy and into survivorship. Delivering appropriate care requires patient transitions across multiple specialties, such as primary care, radiology, and oncology. From the program's inception, the National Cancer Institute Community Oncology Research Program (NCORP) sites were tasked with conducting cancer care delivery research (CCDR) that evaluates structural, organizational, and social factors, including care transitions that determine patient outcomes. The aim of this study is to describe the capacity of the NCORP to conduct multidisciplinary CCDR that includes radiology and primary care practices. The NCORP includes 34 community and 12 minority and underserved community sites. The Landscape Capacity Assessment was conducted in 2015 across these 46 sites, composed of the 401 components and subcomponents designated to conduct CCDR. Each respondent had the opportunity to designate an operational practice group, defined as a group of components and subcomponents with common care practices and resources. The primary outcomes were the proportion of adult oncology practice groups with affiliated radiology and primary care practices. The secondary outcomes were the proportion of those affiliated radiology and primary care groups that participate in research. Eighty-seven percent of components and subcomponents responded to at least some portion of the assessment, representing 230 practice groups. Analyzing the 201 adult oncology practice groups, 85% had affiliated radiologists, 69% of whom participate in research. Seventy-nine percent had affiliated primary care practitioners, 31% of whom participate in research. Institutional size, multidisciplinary group practice, and ownership by large regional or multistate health systems was associated with research participation by affiliated radiology and primary care groups. Research participation by these affiliated specialists was not significantly different between the community and the minority and underserved community sites. Research relationships exist between the majority of community oncology sites and affiliated radiology practices. Research relationships with affiliated primary care practices lagged. NCORP as a whole has the opportunity to encourage continued and expanded engagement where relationships exist. Where no relationship exists, the NCORP can encourage recruitment, particularly of primary care practices as partners. Copyright © 2017. Published by Elsevier Inc.

Relation between primary tumor FDG avidity and site of first distant metastasis in patients with breast cancer.

PubMed

Lim, Chae Hong; Moon, Seung Hwan; Cho, Young Seok; Im, Young-Hyuck; Choe, Yearn Seong; Kim, Byung-Tae; Lee, Kyung-Han

2016-08-01

Identification of tumor imaging features associated with metastatic pattern may allow better understanding of cancer dissemination. Here, we investigated how primary tumor F-fluorodeoxyglucose (FDG) avidity influences the first site of breast cancer metastasis.Subjects were 264 patients with advanced breast cancer who underwent positron emission tomography/computed tomography at diagnosis and had metastasis at presentation (n = 193) or metastatic relapse after surgery (n = 71). Primary tumor FDG avidity (maximum SUV [SUVmax] ≥10.1) was compared with histology and first metastatic sites.The most common site of first metastasis was the bone, occurring in 62.7% of patients with metastasis at presentation and 38.0% of those with metastatic relapse. First metastasis to lung occurred in 30.1% and 35.2%, and to liver in 25.4% and 15.2% of respective groups. In patients with metastasis at presentation, primary tumors were FDG avid in 98/193 cases, and this was associated with more frequent first metastasis to lung (37.8% vs 22.1%; P = 0.018). In patients with metastasis relapse, primary tumors were FDG avid in 31/71 cases, and this was associated with more frequent first metastasis to lung (48.4% vs 25.0%; P = 0.041) and liver (29.0% vs 5.0%; P = 0.008). In patients with metastasis relapse, primary tumors that were FDG avid but hormone receptor negative had more first metastasis to lung (57.9% vs 26.9%; P = 0.016).FDG-avid primary breast tumors have favored first spread to the lung and liver, which suggests that tumor cells with heightened glycolytic activity better colonize these organs.

Metastatic Male Ductal Breast Cancer Mimicking Obstructing Primary Colon Cancer

PubMed Central

Koleilat, Issam; Syal, Anil; Hena, Muhammad

2010-01-01

Male breast cancer comprises only about 1% of all breast cancers. Commonly, sites of metastases include the central nervous system, lungs, bones, and even liver. In females, extrahepatic gastrointestinal metastases are unusual but have been reported with various clinical presentations. We are reporting the first case of a male patient with a history of ductal breast carcinoma that developed colonic metastasis and presented with mechanical large bowel obstruction masquerading as primary colon cancer. PMID:23675178

Primary non-Hodgkin's lymphoma of the infratemporal fossa: a rare case report.

PubMed

Thakur, Jagdeep S; Minhas, Ravinder S; Mohindroo, Narinder K; Sharma, Dev R; Mohindroo, Shobha; Thakur, Anamika

2009-06-21

The head and neck are two of the most common sites of extranodal non-Hodgkin's lymphoma (NHL). However, primary tumors of the infratemporal fossa are infrequent, and NHL in this region is extremely rare. We present a case of a 41-year-old female that presented with swelling in the right preauricular region that had persisted for the past two years. The patient was diagnosed as having a small lymphocytic NHL. She initially underwent chemo-radiation but reported relapse. The tumor was excised and again the patient underwent chemotherapy. The patient remained symptomatic and developed a second primary squamous cell carcinoma in the right retromolar trigone. We discussed NHL with an emphasis on extranodal manifestations. Extranodal NHL that is limited to a single site can be managed by surgery and regular follow up. To the best of our knowledge, this is only the second case of primary NHL of the infratemporal fossa to be reported in the literature.

Site Synthesis Report of DSDP Sites 417 and 418

DTIC Science & Technology

1989-06-01

radmolarsan sands including pyrite . chert and organics (black-clay facites) VII Pale to dark red brown, pink Upper Aptian to 291.5-324.0e -32,5 418A... pyrite , pyrrhotite, chalcopyrite, and pentlaudite. Plasse (1980) and Bleil and Smith (1980b) show that titanomaghemite, the primary magnetic mineral at...Hole 418A where it occurs as a rare phenocryst. Pyrite is the most common secondary opaque mineral. Except in Hole 417A, alteration products generally

Squamous cell carcinoma presenting with trigeminal anesthesia: An uncommon presentation of head & neck cancer with unknown primary.

PubMed

Shah, Ameer T; Dagher, Walid I; O'Leary, Miriam A; Wein, Richard O

The differential diagnosis of facial anesthesia is vast. This may be secondary to trauma, neoplasm, both intracranial and extracranial, infection, and neurologic disease. When evaluating a patient with isolated facial anesthesia, the head and neck surgeon often thinks of adenoid cystic carcinoma, which has a propensity for perineural invasion and spread. When one thinks of head and neck squamous cell carcinoma with or without unknown primary, the typical presentation involves dysphagia, odynophagia, weight loss, hoarseness, or more commonly, a neck mass. Squamous cell carcinoma presenting as facial anesthesia and perineural spread, with no primary site is quite rare. Case presentations and review of the literature. Trigeminal anesthesia is an uncommon presentation of head and neck squamous cell carcinoma with unknown primary. We present two interesting cases of invasive squamous cell carcinoma of the trigeminal nerve, with no primary site identified. We will also review the literature of head and neck malignancies with perineural spread and the management techniques for the two different cases presented. Copyright © 2016 Elsevier Inc. All rights reserved.

Primary Malignant Melanoma of Pleura: A Case Report and Literature Review.

PubMed

Agarwal, Poojan; Nambiyar, Kaniyyapan; Manju Kaushal; Bhardwaj, Minakshi

2016-07-01

Malignant melanoma is one of the most aggressive and treatment resistant skin cancers. India enjoys a low incidence of melanoma, and age specific incidence rates for cutaneous malignant melanoma (CMM) are being less than 0.5 per 1,000,000. This could be due to under-reporting of melanoma on account of a low index of suspicion by clinicians and pathologists alike. Most common site for origin of primary melanoma is skin, accounting for about 91.2% of all reported primary malignant melanoma cases. Other primary sites are relatively uncommon. Primary pleural melanoma is a very rare tumor and to the best of our knowledge, only seven cases have been reported so far worldwide. We hereby discuss a new case, only second from India. Our patient also had coexistent congenital hairy nevus, an unusual association also noted in two previously reported cases. Excluding primary cutaneous melanoma with pleural metastasis was a diagnostic challenge in this case but multiple cutaneous biopsies together with clinical and findings helped us arrive at this unusual diagnosis. Unfortunately, the patient succumbed to his illness. Diagn. Cytopathol. 2016;44:648-652. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Liver metastasis of meningeal hemangiopericytoma: a study of 5 cases

PubMed Central

Lo, Regina C.; Suriawinata, Arief A.; Rubin, Brian P.

2016-01-01

Mesenchymal tumors in the liver, whether primary or metastatic, are rare. Meningeal hemangiopericytoma (HPC) is characteristically associated with delayed metastasis and the liver is one of the most common sites. Despite its consistent histological features, a pathological diagnosis of HPC in the liver is sometimes not straightforward due to its rarity and usually remote medical history of the primary meningeal tumor. In this report, the clinicopathological features of 5 cases of metastatic HPC to the liver were reviewed and described. PMID:27044772

Patellar metastasis from primary tumor

PubMed Central

Li, Gang; Shan, Changxing; Sun, Ran; Liu, Song; Chen, Song; Song, Mingzhi; Lu, Ming

2018-01-01

Although bone tumors are frequently located in the knee area, primary tumors of the patella are rare and patellar metastases are even rarer. Knee pain is the most common complaint of patients with patellar metastases. Owing to the low incidence of patellar metastases, misdiagnosis is not unusual. The present review analyzes ~44 cases of patellar metastases originating from distinct primary sites. Reports of malignant tumors of the lung and kidney metastasizing to the patella were more common than those of other patellar metastases. Relative incidence, symptomatology, imaging features, histopathology and treatment options for these patellar metastatic lesions are described respectively along with a review of the literature. Despite numerous experiments demonstrating the reasons for implantation of tumor in patella, the answer to this question has not yet been revealed. In the light of the increasing attention on the diagnosis and the treatment of these lesions, the availability of the integrated information regarding metastases in the patella becomes more relevant. PMID:29434829

A modeling analysis of alternative primary and secondary US ozone standards in urban and rural areas

NASA Astrophysics Data System (ADS)

Nopmongcol, Uarporn; Emery, Chris; Sakulyanontvittaya, Tanarit; Jung, Jaegun; Knipping, Eladio; Yarwood, Greg

2014-12-01

This study employed the High-Order Decoupled Direct Method (HDDM) of sensitivity analysis in a photochemical grid model to determine US anthropogenic emissions reductions required from 2006 levels to meet alternative US primary (health-based) and secondary (welfare-based) ozone (O3) standards. Applying the modeling techniques developed by Yarwood et al. (2013), we specifically evaluated sector-wide emission reductions needed to meet primary standards in the range of 60-75 ppb, and secondary standards in the range of 7-15 ppm-h, in 22 cities and at 20 rural sites across the US for NOx-only, combined NOx and VOC, and VOC-only scenarios. Site-specific model biases were taken into account by applying adjustment factors separately for the primary and secondary standard metrics, analogous to the US Environmental Protection Agency's (EPA) relative response factor technique. Both bias-adjusted and unadjusted results are presented and analyzed. We found that the secondary metric does not necessarily respond to emission reductions the same way the primary metric does, indicating sensitivity to their different forms. Combined NOx and VOC reductions are most effective for cities, whereas NOx-only reductions are sufficient at rural sites. Most cities we examined require more than 50% US anthropogenic emission reductions from 2006 levels to meet the current primary 75 ppb US standard and secondary 15 ppm-h target. Most rural sites require less than 20% reductions to meet the primary 75 ppb standard and less than 40% reductions to meet the secondary 15 ppm-h target. Whether the primary standard is protective of the secondary standard depends on the combination of alternative standard levels. Our modeling suggests that the current 75 ppb standard achieves a 15 ppm-h secondary target in most (17 of 22) cities, but only half of the rural sites; the inability for several western cities and rural areas to achieve the seasonally-summed secondary 15 ppm-h target while meeting the 75 ppb primary target is likely driven by higher background O3 that is commonly reported in the western US. However, a 70 ppb primary standard is protective of a 15 ppm-h secondary standard in all cities and 18 of 20 rural sites we examined, and a 60 ppb primary standard is protective of a 7 ppm-h secondary standard in all cities and 19 of 20 rural sites. If EPA promulgates separate primary and secondary standards, exceedance areas will need to develop and demonstrate control strategies to achieve both. This HDDM analysis provides an illustrative screening assessment by which to estimate emissions reductions necessary to satisfy both standards.

Quantifying soil moisture impacts on light use efficiency across biomes.

PubMed

Stocker, Benjamin D; Zscheischler, Jakob; Keenan, Trevor F; Prentice, I Colin; Peñuelas, Josep; Seneviratne, Sonia I

2018-06-01

Terrestrial primary productivity and carbon cycle impacts of droughts are commonly quantified using vapour pressure deficit (VPD) data and remotely sensed greenness, without accounting for soil moisture. However, soil moisture limitation is known to strongly affect plant physiology. Here, we investigate light use efficiency, the ratio of gross primary productivity (GPP) to absorbed light. We derive its fractional reduction due to soil moisture (fLUE), separated from VPD and greenness changes, using artificial neural networks trained on eddy covariance data, multiple soil moisture datasets and remotely sensed greenness. This reveals substantial impacts of soil moisture alone that reduce GPP by up to 40% at sites located in sub-humid, semi-arid or arid regions. For sites in relatively moist climates, we find, paradoxically, a muted fLUE response to drying soil, but reduced fLUE under wet conditions. fLUE identifies substantial drought impacts that are not captured when relying solely on VPD and greenness changes and, when seasonally recurring, are missed by traditional, anomaly-based drought indices. Counter to common assumptions, fLUE reductions are largest in drought-deciduous vegetation, including grasslands. Our results highlight the necessity to account for soil moisture limitation in terrestrial primary productivity data products, especially for drought-related assessments. © 2018 The Authors. New Phytologist © 2018 New Phytologist Trust.

Primary Gastric Lymphoma Presenting as Acute Pancreatitis: A Case Report.

PubMed

Raj, Mithun; Ghoshal, Uday C; Choudhuri, Gourdas; Mohindra, Samir

2013-07-10

Diffuse large B-cell lymphoma is the commonest form of non-Hodgkin lymphoma. Gastro-intestinal tract and bone marrow are common extra-nodal sites of lymphomatous involvement. A 54-year-old woman presented with acute onset epigastric pain. On evaluation, raised serum amylase and radiological features of acute pancreatitis were detected. Gastroscopy revealed thickened folds in distal stomach, which on histopathology revealed large B-cell lymphoma. Subsequently, the patient developed extra-hepatic biliary obstruction due to peripancreatic lymph nodal mass that was relieved with plastic biliary stenting. Subsequent chemotherapy regime directed against lymphoma led to resolution of lymphoma. In this patient , pancreatitis was the initial presentation of primary gastric lymphoma, which has not been commonly reported and therefore should be considered in the etiological workup.

Cytogenetically confirmed primary Ewing's sarcoma of the pancreas.

PubMed

Golhar, Ankush; Ray, Samrat; Haugk, Beate; Singhvi, Suresh Kumar

2017-05-04

Ewing's sarcoma is a highly aggressive malignant tumour most commonly affecting long bones in children and adolescents. It is part of the Ewing's sarcoma family of tumours (ESFTs) that also include peripheral primitive neuroectodermal tumour and Askin's tumours. ESFTs share common cytogenetic aberrations, antigenic profiles and proto-oncogene expression with an overall similar clinical course. In 99% of ESFTs, genetic translocation with molecular fusion involves the EWSR1 gene on 22q12. Approximately 30% of ESFTs are extraosseous, most commonly occurring in the soft tissues of extremities, pelvis, retroperitoneum and chest wall. Primary presentation in solid organs is very rare but has been described in multiple sites including the pancreas. Accurate diagnosis of a Ewing's sarcoma in a solid organ is critical in facilitating correct treatment. We report the case of a 17-year-old girl with cytogenetically confirmed primary pancreatic Ewing's sarcoma and provide a brief review of the published literature. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

NEAR-COASTAL SEDIMENT AS A HABITAT IN THE GULF OF MEXICO: CHEMICAL QUALITY, TOXICITY, AND BENTHIC COMMUNITY COMPOSITION

EPA Science Inventory

Sediment quality was determined in a multiyear study for 108 near-coastal sites located in Mississippi, Alabama and Florida. The primary objective of the study was to determine the relative impact of common stressor sources on sediment quality utilizing a weight-of-evidence appro...

The fledging of common and thick-billed murres on Middleton Island, Alaska

USGS Publications Warehouse

Hatch, Scott A.

1983-01-01

Three species of alcids, Common and Thick-billed murres (Uria aalge and U. lomvia) and the Razorbill (Alca torda), have post-hatching developmental patterns intermediate to precocial and semi-precocial modes (Sealy 1973). The young leave their cliff nest sites at about one quarter of adult weight and complete their growth at sea. At departure, an event here loosely referred to as "fledging," neither primary nor secondary flight feathers are grown, but well-developed wing coverts enable limited, descending flight.

BRAF V600 Mutation Profile of Metastatic Melanoma in the Thrace Region of Turkey.

PubMed

Can, Nuray; Taştekin, Ebru; Deniz Yalta, Tülin; Süt, Necdet; Korkmaz, Selma; Usta, Ufuk; Öz Puyan, Fulya; Genç, Ezgi; Cezik, Mert; Binboğa Tutuğ, Busem; Köstek, Osman; Tozkir, Hilmi

2018-02-08

BRAF is the most common mutation in melanoma. The most common subtype is BRAF V600E, followed by V600K. Initially, the authors aimed to investigate whether clinicopathological features of melanoma are associated with BRAF mutations. We then aimed to present the relationships between the clinicopathological features and the mutated subtype (V600E vs V600K). 61 patients with metastatic malignant melanoma (affecting the lymph node or other distant sites) were selected. Patient data regarding age at the time of diagnosis, sex, metastatic site (lymph node, distant metastasis or both) and primary tumour site were obtained from the hospital's database. Tissue samples containing at least 30% tumour cells were isolated from the specimens of 61 patients (24 samples from primary tumours and 37 from metastatic foci) for BRAF analysis. Comparisons between the BRAF V600 mutation and clinicopathological and histopathological features were performed. BRAF V600 mutation was detected in 34 (55.7%) patients. The subtype was BRAF V600E in 22 (64.7%) patients, BRAF V600K in 11(32.4%) patients and BRAF V600R in 1(2.9%) patient. The crucial results of the present study may be summarized as follows: i) BRAF V600 mutation was more common in older patients and tumors with BRAF V600 mutation revealed necrosis and LVI more commonly than wild-type tumors, ii) BRAF V600K mutation was more common in older patients and BRAF V600K mutated tumors exhibited ulceration more commonly than tumors with BRAF V600E mutation (close to significant). The BRAF V600 mutation may have interactions with prognostic clinicoptahological features of melanoma including necrosis and lymphovascular invasion. V600K mutation may be more common than expected and may have different associations with properties of the tumor such as tumor ulceration and patient age. Investigation of the mutated subtype of the BRAF gene may therefore reveal more detailed data about the management of melanoma and may also prevent missing of candidates for BRAF inhibitor therapies.

School-Based Teacher Collaboration in Sweden and Greece: Formal Cooperation, Deprivatized Practices and Personalized Interaction in Primary and Lower Secondary Schools

ERIC Educational Resources Information Center

Kougioumtzis, Konstantin; Patriksson, Goran

2009-01-01

During recent years, educational restructuring efforts have commonly regarded schools as both learning communities and sites for teachers' professional development. A plethora of attributes influence prerequisites as well as outcomes of the efforts, while teachers' local cultures constitute a cornerstone. More specifically, enhanced school-based…

Increased Resistance of Skin Flora to Antimicrobial Prophylaxis in Patients Undergoing Hip Revision Arthroplasty.

PubMed

Mühlhofer, Heinrich M L; Deiss, Lukas; Mayer-Kuckuk, Philipp; Pohlig, Florian; Harrasser, Norbert; Lenze, Ulrich; Gollwitzer, Hans; Suren, Christian; Prodinger, Peter; VON Eisenhart-Rothe, Rüdiger; Schauwecker, Johannes

2017-01-01

Prosthetic joint infection (PJI) remains a major complication after total joint replacement and is the primary indication for revision arthroplasty. Specifically, coagulase-negative Staphylococci (CNS) can cause low-grade infections. Despite the use of cephalosporin-based antimicrobial prophylaxis (AMP) and antiseptic treatment at the surgical site, evidence suggests that a significant number of cases of dermal CNS results in low-grade PJI. Thus, this study examined the bacterial colonization and resistance patterns at the surgical site. We hypothesized that the bacteria developed resistance to antibiotics that are frequently used in primary and revision total hip arthroplasty (THA) procedures. Ninety patients, including 63 primary and 27 revision THA patients, were enrolled in this study. For each patient, a single swab of the skin at the surgical site was subjected to clinical microbiology to assess bacterial colonization. Furthermore, resistance to a sentinel panel of antibiotics (benzylpenicillin, erythromycin, tetracycline, oxacillin, fusidic acid, clindamycin, gentamicin, levofloxacin/moxifloxacin, rifampicin, linezolid and vancomycin) was tested. In 96.7% of the patients, at least one bacterial strain was identified at the surgical site, with CNS strains comprising 93.1% of the total. The sentinel panel showed that 30.7% of the CNS strains exhibited maximal resistance to oxacillin, a commonly used cephalosporin. Additionally, oxacillin resistance increased 1.9-fold (p=0.042) between primary and revision THA. Notably, 8.1% of the CNS stains found on patients undergoing primary THA were resistant to gentamicin, an aminoglycoside, and this rate increased 4.7-fold (p=0.001) for patients undergoing revision THA. CNS strains have significant resistance to standard AMP, particularly in individuals undergoing revision THA. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Ground-water quality and geochemistry in Carson and Eagle Valleys, western Nevada and eastern California

USGS Publications Warehouse

Welch, Alan H.

1994-01-01

Aquifers in Carson and Eagle Valleys are an important source of water for human consumption and agriculture. Concentrations of major constituents in water from the principal aquifers on the west sides of Carson and Eagle Valleys appear to be a result of natural geochemical reactions with minerals derived primarily from plutonic rocks. In general, water from principal aquifers is acceptable for drinking when compared with current (1993) Nevada State drinking-water maximum contaminant level standards. Water was collected and analyzed for all inorganic constituents for which primary or secondary drinking-water standards have been established. About 3 percent of these sites had con- stituents that exceeded one or more primary or secondary drinking-water standards have been established. About 3 percent of these sites had con- stituents that exceeded one or more primary standards and water at about 10 percent of the sites had at least one constituent that surpassed a secondary standard. Arsenic exceeded the standard in water at less than 1 percent of the principal aquifer sites; nitrate surpassed its standard in water at 3 percent of 93 sites. Water from wells in the principal aquifer with high concentrations of nitrate was in areas where septic systems are used; these concentrations indicate that contamination may be entering the wells. Concentrations of naturally occurring radionuclides in water from the principal aquifers, exceed the proposed Federal standards for some constituents, but were not found t be above current (1993) State standards. The uranium concen- trations exceeded the proposed 20 micrograms per liter Federal standard at 10 percent of the sites. Of the sites analyzed for all of the inorganic constituents with primary standards plus uranium, 15 percent exceed one or more established standards. If the proposed 20 micrograms per liter standard for uranium is applied to the sampled sites, then 23 percent would exceed the standard for uranium or some other constituent with a primary drinking water standard. This represents a 50-percent increase in the frequency of exceedance. Almost all water sampled from the principal aquifers exceeds the 300 picocuries per liter proposed standard for radon. Ground-water sampling sites with the highest radon activities in water are most commonly located in the upland aquifers in the Sierra Nevada and in the principal aquifers beneath the west sides of Carson and Eagle Valleys.

The Role of Publicly Funded Family Planning Sites In Health Insurance Enrollment.

PubMed

Yarger, Jennifer; Daniel, Sara; Biggs, M Antonia; Malvin, Jan; Brindis, Claire D

2017-06-01

Publicly funded family planning providers are well positioned to help uninsured individuals learn about health insurance coverage options and effectively navigate the enrollment process. Understanding how these providers are engaged in enrollment assistance and the challenges they face in providing assistance is important for maximizing their role in health insurance outreach and enrollment. In 2014, some 684 sites participating in California's family planning program were surveyed about their involvement in helping clients enroll in health insurance. Weighted univariate and bivariate analyses were conducted to examine enrollment activities and perceived barriers to facilitating enrollment by site characteristics. Most family planning program sites provided eligibility screening (68%), enrollment education (77%), on-site enrollment assistance (55%) and referrals for off-site enrollment support (91%). The proportion of sites offering each type of assistance was highest among community clinics (83-96%), primary care and multispecialty sites (65-95%), Title X-funded sites (72-98%), sites with contracts to provide primary care services (64-93%) and sites using only electronic health records (66-94%). Commonly identified barriers to providing assistance were lack of staff time (reported by 52% of sites), lack of funding (47%), lack of physical space (34%) and lack of staff knowledge (33%); only 20% of sites received funding to support enrollment activities. Although there were significant variations among them, publicly funded family planning providers in California are actively engaged in health insurance enrollment. Supporting their vital role in enrollment could help in the achievement of universal health insurance coverage. Copyright © 2017 by the Guttmacher Institute.

Metastases to the thyroid gland: A report of 32 cases in PUMCH.

PubMed

Zhang, Liyang; Liu, Yuewu; Li, Xiaoyi; Gao, Weisheng; Zheng, Chaoji

2017-09-01

Metastases of nonthyroid malignancies to the thyroid gland are rare, and only sporadic cases have been reported in literature. We present our experience in treating patients with metastases to the thyroid gland at Peking Union Medical College Hospital. The clinical data of 32 patients who presented with secondary thyroid tumors were retrospectively analyzed. Eleven patients (34.5%) had thyroidectomy.Two patients (6.25%) had tracheostomies to alleviate compression caused by enlarged thyroid tumors. The most common primary lesion was in the lungs (14/32), followed by the kidney (5/32) and gastrointestinal system (5/32). The interval from the diagnosis of the primary tumor to thyroid metastasis varied from 0 month to 16 years. Ten patients (31.3%) are still alive, and the longest follow-up survival time was 7 years. Thyroid metastases are rare, and the lung was the most common primary site of origin. It seems that thyroidectomy has not been considered in cases with a high clinical stage of the neoplastic process such as lung cancer.

Primary Pulmonary Ewing's Sarcoma: Rare Cause of Superior Vena Cava Syndrome in Children.

PubMed

Mehra, Shibani; Atwal, Swapndeep Singh; Garga, Umesh Chandra

2014-08-01

Ewing's sarcoma is a common malignant bone tumour presenting in children and young adults. Rarely extra- skeletal soft tissues and visceral organs can also be the site of origin of Ewing's sarcoma. Primary pulmonary Ewing's sarcoma is an extremely rare malignancy which occurs in the paediatric population. We report an unusual case of primary pulmonary Ewing's sarcoma in a nine year old girl who presented with features of superior vena cava syndrome in the emergency department. The diagnosis was confirmed pathologically both by light microscopy and immunohistochemistry. The patient was put on chemotherapy and surgery was planned but the patient expired within three days of starting chemotherapy.

Medical home capabilities of primary care practices that serve sociodemographically vulnerable neighborhoods.

PubMed

Friedberg, Mark W; Coltin, Kathryn L; Safran, Dana Gelb; Dresser, Marguerite; Schneider, Eric C

2010-06-14

Under current medical home proposals, primary care practices using specific structural capabilities will receive enhanced payments. Some practices disproportionately serve sociodemographically vulnerable neighborhoods. If these practices lack medical home capabilities, their ineligibility for enhanced payments could worsen disparities in care. Via survey, 308 Massachusetts primary care practices reported their use of 13 structural capabilities commonly included in medical home proposals. Using geocoded US Census data, we constructed racial/ethnic minority and economic disadvantage indices to describe the neighborhood served by each practice. We compared the structural capabilities of "disproportionate-share" practices (those in the most sociodemographically vulnerable quintile on each index) and others. Racial/ethnic disproportionate-share practices were more likely than others to have staff assisting patient self-management (69% vs 55%; P = .003), on-site language interpreters (54% vs 26%; P < .001), multilingual clinicians (80% vs 51%; P < .001), and multifunctional electronic health records (48% vs 29%; P = .01). Similarly, economic disproportionate-share practices were more likely than others to have physician awareness of patient experience ratings (73% vs 65%; P = .03), on-site language interpreters (56% vs 25%; P < .001), multilingual clinicians (78% vs 51%; P < .001), and multifunctional electronic health records (40% vs 31%; P = .03). Disproportionate-share practices were larger than others. After adjustment for practice size, only language capabilities continued to have statistically significant relationships with disproportionate-share status. Contrary to expectations, primary care practices serving sociodemographically vulnerable neighborhoods were more likely than other practices to have structural capabilities commonly included in medical home proposals. Payments tied to these capabilities may aid practices serving vulnerable populations.

Patterns and operative treatment of recurrent Crohn's disease: a prospective longitudinal study.

PubMed

Fichera, Alessandro; Lovadina, Stefano; Rubin, Michele; Cimino, Fabrizio; Hurst, Roger D; Michelassi, Fabrizio

2006-10-01

It is believed commonly that Crohn's recurrences always occur at the site of a previous intestinal anastomosis; yet this concept is probably inaccurate and not mindful of the panintestinal nature of the disease. Between October, 1984 and March, 2003, we carried out 1,132 procedures (464 for primary and 668 for recurrent disease) on 981 consecutive patients. Patients in whom we carried out both the original procedure as well as the procedure for recurrent disease constitute this study population. Operative procedures for perineal complications were excluded from this analysis. Data were accrued prospectively. Seventy-eight patients met the study inclusion criteria. They had a total of 149 sites of disease (duodenum, n = 3; jejunum/ileum, n = 53; terminal ileum/neo terminal ileum, n = 67; colon and rectum, n = 26). One hundred thirty-four sites required operative intervention (85 resections and 49 strictureplasties) and 15 did not. Crohn's disease recurred in 79 sites after a mean of 48.4 months (range, 1-161 months, median, 41 months). Site of operative intervention and operative technique influenced patterns of recurrence: when an anastomosis or strictureplasty was constructed with small bowel, the majority of recurrences were limited to the anastomotic line (17/29, 59%); when it was constructed with small bowel and colon, the majority of recurrences extended to the proximal limb (29/35, 83%). The difference in recurrence pattern is significant (P < .01). In addition, fewer recurrences occurred at strictureplasty than resection sites (22/49, 45%, vs 57/85, 70%, respectively, P < .05). At the time of the second procedure, 40 additional recurrences were identified distant from the original operative site. Four of these represented progression of disease at the 15 sites that did not originally need operative intervention. Of 119 total recurrences, 115 required 73 resections, 40 strictureplasties, and 2 other procedures. The site of the original operative intervention is the most common site for recurrence, although as many as one-third of recurrences occur separate from it. Pattern of recurrence is influenced by site of the operative intervention (anastomotic for small bowel, proximal limb for ileocolonic) and by operative technique (fewer recurrences occurred at strictureplasty than resection sites). Disease progression occurred in 25% of the sites not addressed operatively at the original procedure. The operative strategy applied to Crohn's complications in different intestinal sites was similar for primary and recurrent disease.

18F-FDG PET/CT in the detection of asymptomatic malignant melanoma recurrence.

PubMed

Lawal, Ismaheel; Lengana, Thabo; Ololade, Kehinde; Boshomane, Tebatso; Reyneke, Florette; Modiselle, Moshe; Vorster, Mariza; Sathekge, Mike

2017-06-12

To evaluate the diagnostic accuracy of FDG PET/CT in the detection of asymptomatic recurrence in patients with malignant melanoma who have had resection of their primary lesion. We also aimed to determine the pattern and factors predisposing to disease recurrence. Patients with malignant melanoma who have had surgical resection of their disease and without any clinical evidence of disease recurrence were followed-up with FDG PET/CT. The diagnostic accuracy of FDG PET/CT, pattern of recurrence and factors predictive of disease recurrence were determined. A total of 144 patients were followed-up for a median period of 50.50 months. Asymptomatic recurrence was seen in 37 patients (25.7 %) with a median time to recurrence of 20 months. Lymph node was the commonest site of asymptomatic recurrence. Sex, tumour depth, histology type and presence of nodal metastasis were significant predictors of tumour recurrence. Age, race, site of primary lesion, type of lymph node resection were not significant predictors of disease recurrence. Race has a significant effect on the histological subtype of tumour (nodular maligna was more common in Caucasian while acral lentiginous was more prevalent in the Blacks) and the site of the primary lesion (lower limb in Blacks and trunk in Caucasians). Sensitivity, specificity and accuracy of FDG PET/CT for the detection of disease recurrence were 94.5 %, 87.6 % and 89.6 % respectively. FDG PET/CT is a suitable modality for early detection of asymptomatic recurrence of malignant melanoma. Asymptomatic recurrence most commonly occurs in lymph nodes. Sex, nodal metastasis and tumour pathologic features are predictors of recurrence.

Psychometric Study of the Aberrant Behavior Checklist in Fragile X Syndrome and Implications for Targeted Treatment

ERIC Educational Resources Information Center

Sansone, Stephanie M.; Widaman, Keith F.; Hall, Scott S.; Reiss, Allan L.; Lightbody, Amy; Kaufmann, Walter E.; Berry-Kravis, Elizabeth; Lachiewicz, Ave; Brown, Elaine C.; Hessl, David

2012-01-01

Animal studies elucidating the neurobiology of fragile X syndrome (FXS) have led to multiple controlled trials in humans, with the Aberrant Behavior Checklist-Community (ABC-C) commonly adopted as a primary outcome measure. A multi-site collaboration examined the psychometric properties of the ABC-C in 630 individuals (ages 3-25) with FXS using…

A simple method for estimating potential relative radiation (PRR) for landscape-vegetation analysis.

Treesearch

Kenneth B. Jr. Pierce; Todd Lookingbill; Dean Urban

2005-01-01

Radiation is one of the primary influences on vegetation composition and spatial pattern. Topographic orientation is often used as a proxy for relative radiation load due to its effects on evaporative demand and local temperature. Common methods for incorporating this information (i.e., site measures of slope and aspect) fail to include daily or annual changes in solar...

A splice site mutation in a gene encoding for PDK4, a mitochondrial protein, is associated with the development of dilated cardiomyopathy in the Doberman pinscher

USDA-ARS?s Scientific Manuscript database

Familial dilated cardiomyopathy is a primary myocardial disease that can result in the development of congestive heart failure and sudden cardiac death. Spontaneous animal models of familial dilated cardiomyopathy exist and the Doberman pinscher dog is one of the most commonly reported canine breeds...

An Epidemiological Study of Hyperhidrosis Patients Visiting the Ajou University Hospital Hyperhidrosis Center in Korea

PubMed Central

Park, Eun Jung; Han, Kyung Ream; Choi, Ho; Kim, Do Wan

2010-01-01

Hyperhidrosis is a disorder of perspiration in excess of the body's physiologic need and significantly impacts one's occupational, physical, emotional, and social life. The purpose of our study was to investigate the characteristics of primary hyperhidrosis in 255 patients at Ajou University Hospital Hyperhidrosis Center from March 2006, to February 2008. Information collected from the medical records was: sex, sites of hyperhidrosis, age at visit, age of onset, aggravating factors, hyperhidrosis disease severity scale (HDSS) rank, family history, occupation, and past treatment. A total of 255 patient records were reviewed; 57.6% were male. Patients with a family history (34.1%) showed a lower age of onset (13.21±5.80 yr vs. 16.04±9.83 yr in those without family history); 16.5% had previous treatment, most commonly oriental medicine. Palmar and plantar sites were the most commonly affected, and 87.9% of patients felt their sweating was intolerable and always interfered with their daily activities. Our study provides some original information on the Korean primary hyperhidrosis population. Patients who have a family history show signs of disease in early age than those without family history. PMID:20436716

E-consult implementation: lessons learned using consolidated framework for implementation research.

PubMed

Haverhals, Leah M; Sayre, George; Helfrich, Christian D; Battaglia, Catherine; Aron, David; Stevenson, Lauren D; Kirsh, Susan; Ho, Michael; Lowery, Julie

2015-12-01

In 2011, the Veterans Health Administration (VHA) implemented electronic consults (e-consults) as an alternative to in-person specialty visits to improve access and reduce travel for veterans. We conducted an evaluation to understand variation in the use of the new e-consult mechanism and the causes of variable implementation, guided by the Consolidated Framework for Implementation Research (CFIR). Qualitative case studies of 3 high- and 5 low-implementation e-consult pilot sites. Participants included e-consult site leaders, primary care providers, specialists, and support staff identified using a modified snowball sample. We used a 3-step approach, with a structured survey of e-consult site leaders to identify key constructs, based on the CFIR. We then conducted open-ended interviews, focused on key constructs, with all participants. Finally, we produced structured, site-level ratings of CFIR constructs and compared them between high- and low-implementation sites. Site leaders identified 14 initial constructs. We conducted 37 interviews, from which 4 CFIR constructs distinguished high implementation e-consult sites: compatibility, networks and communications, training, and access to knowledge and information. For example, illustrating compatibility, a specialist at a high-implementation site reported that the site changed the order of consult options so that all specialties listed e-consults first to maintain consistency. High-implementation sites also exhibited greater agreement on constructs. By using the CFIR to analyze results, we facilitate future synthesis with other findings, and we better identify common patterns of implementation determinants common across settings.

The Clinical Significance of Occult Gastrointestinal Primary Tumours in Metastatic Cancer: A Population Retrospective Cohort Study.

PubMed

Hannouf, Malek B; Winquist, Eric; Mahmud, Salaheddin M; Brackstone, Muriel; Sarma, Sisira; Rodrigues, George; Rogan, Peter K; Hoch, Jeffrey S; Zaric, Gregory S

2018-01-01

The purpose of this study was to estimate the incidence of occult gastrointestinal (GI) primary tumours in patients with metastatic cancer of uncertain primary origin and evaluate their influence on treatments and overall survival (OS). We used population heath data from Manitoba, Canada to identify all patients initially diagnosed with metastatic cancer between 2002 and 2011. We defined patients to have "occult" primary tumour if the primary was found at least 6 months after initial diagnosis. Otherwise, we considered primary tumours as "obvious." We used propensity-score methods to match each patient with occult GI tumour to four patients with obvious GI tumour on all known clinicopathologic features. We compared treatments and 2-year survival data between the two patient groups and assessed treatment effect on OS using Cox regression adjustment. Eighty-three patients had occult GI primary tumours, accounting for 17.6% of men and 14% of women with metastatic cancer of uncertain primary. A 1:4 matching created a matched group of 332 patients with obvious GI primary tumour. Occult cases compared to the matched group were less likely to receive surgical interventions and targeted biological therapy, and more likely to receive cytotoxic empiric chemotherapeutic agents. Having an occult GI tumour was associated with reduced OS and appeared to be a nonsignificant independent predictor of OS when adjusting for treatment differences. GI tumours are the most common occult primary tumours in men and the second most common in women. Patients with occult GI primary tumours are potentially being undertreated with available GI site-specific and targeted therapies.

Clinical course and prognosis of musculoskeletal pain in patients referred for physiotherapy: does pain site matter?

PubMed

de Vos Andersen, Nils-Bo; Kent, Peter; Hjort, Jakob; Christiansen, David Høyrup

2017-03-29

Danish patients with musculoskeletal disorders are commonly referred for primary care physiotherapy treatment but little is known about their general health status, pain diagnoses, clinical course and prognosis. The objectives of this study were to 1) describe the clinical course of patients with musculoskeletal disorders referred to physiotherapy, 2) identify predictors associated with a satisfactory outcome, and 3) determine the influence of the primary pain site diagnosis relative to those predictors. This was a prospective cohort study of patients (n = 2,706) newly referred because of musculoskeletal pain to 30 physiotherapy practices from January 2012 to May 2012. Data were collected via a web-based questionnaire 1-2 days prior to the first physiotherapy consultation and at 6 weeks, 3 and 6 months, from clinical records (including primary musculoskeletal symptom diagnosis based on the ICPC-2 classification system), and from national registry data. The main outcome was the Patient Acceptable Symptom State. Potential predictors were analysed using backwards step-wise selection during longitudinal Generalised Estimating Equation regression modelling. To assess the influence of pain site on these associations, primary pain site diagnosis was added to the model. Of the patients included, 66% were female and the mean age was 48 (SD 15). The percentage of patients reporting their symptoms as acceptable was 32% at 6 weeks, 43% at 3 months and 52% at 6 months. A higher probability of satisfactory outcome was associated with place of residence, being retired, no compensation claim, less frequent pain, shorter duration of pain, lower levels of disability and fear avoidance, better mental health and being a non-smoker. Primary pain site diagnosis had little influence on these associations, and was not predictive of a satisfactory outcome. Only half of the patients rated their symptoms as acceptable at 6 months. Although satisfactory outcome was difficult to predict at an individual patient level, there were a number of prognostic factors that were associated with this outcome. These factors should be considered when developing generic prediction tools to assess the probability of satisfactory outcome in musculoskeletal physiotherapy patients, because the site of pain did not affect that prognostic association.

Cancer incidence and mortality in Mongolia - National Registry Data.

PubMed

Sandagdorj, Tuvshingerel; Sanjaajamts, Erdenechimeg; Tudev, Undarmaa; Oyunchimeg, Dondov; Ochir, Chimedsuren; Roder, David

2010-01-01

The National Cancer Registry of Mongolia began as a hospital-based registry in the early 1960s but then evolved to have a population-wide role. The Registry provides the only cancer data available from Mongolia for international comparison. The descriptive data presented in this report are the first to be submitted on cancer incidence in Mongolia to a peer-reviewed journal. The purpose was to describe cancer incidence and mortality for all invasive cancers collectively, individual primary sites, and particularly leading sites, and consider cancer control opportunities. This study includes data on new cancer cases registered in Mongolia in 2003-2007. Incidence and mortality rates were calculated as mean annual numbers per 100,000 residents. Age-standardized incidence (ASR) and age-standardized mortality (ASMR) rates were calculated from age-specific rates by weighting directly to the World Population standard. Between 2003 and 2007, 17,271 new cases of invasive cancer were recorded (52.2% in males, 47.7% in females). The five leading primary sites in males were liver, stomach, lung, esophagus, and colon/rectum; whereas in females they were liver, cervix, stomach, esophagus and breast. ASRs were lower in females than males for cancers of the liver at 63.0 and 99.1 per 100,000 respectively; cancers of the stomach at 19.1 and 42.1 per 100,000 respectively; and cancers of the lung at 8.3 and 33.2 per 100,000 respectively. Liver cancer was the most common cause of death in each gender, the ASMR being lower for females than males at 60.6 compared with 94.8 per 100,000. In females the next most common sites of cancer death were the stomach and esophagus, whereas in males, they were the stomach and lung. Available data indicate that ASRs of all cancers collectively have increased over the last 20 years. Rates are highest for liver cancer, at about four times the world average. The most common cancers are those with a primary site of liver, stomach and esophagus, for which cases fatality rates are high in all populations. Emphasis is given in the National Cancer Control Program (NCCP) to limiting treatment for these and other high-fatality cancers to the small sub-set of potentially curable cases, while focusing on palliative care and patient support for the remainder. Meanwhile opportunities are being pursued to prevent liver cancer through hepatitis B vaccination and lung cancer through tobacco control, and to reduce cervical cancer mortality by finding lesions at a pre-malignant or early invasive stage.

Primary appendiceal lymphoma presenting as suspected perforated acute appendicitis: clinical, sonography and CT findings with pathologic correlation.

PubMed

Guo, Jingjing; Wu, Gang; Chen, Xiaojun; Li, Xiaodong

2014-01-01

The gastrointestinal tract is the most common site for extranodal involvement by non-Hodgkin's lymphoma. However, primary appendiceal lymphomas presenting as perforated acute appendicitis are very rare: they occur in only 0.015% of all gastrointestinal lymphoma cases. The management of this condition is still controversial, and a multimodality approach (e.g., surgery, radiation therapy, and chemotherapy) is the optimal treatment. In these cases, appendiceal non-Hodgkin's lymphomas typically manifest with acute symptoms in patients with no prior lymphoma history. Additionally, we treated our patient with a right hemicolectomy and postoperative multiagent chemotherapy.

Curriculum renewal in child psychiatry.

PubMed

Hanson, M; Tiberius, R; Charach, A; Ulzen, T; Sackin, D; Jain, U; Reiter, S; Shomair, G

1999-11-01

To ensure uniform design and evaluation of a clerkship curriculum for child and adolescent psychiatry teaching common disorders and problems in an efficient manner across 5 teaching sites and to include structures for continuous improvement. The curriculum committee selected for course inclusion disorders and problems of child psychiatry that were commonly encountered by primary care physicians. Instruction methods that encouraged active student learning were selected. Course coordination across sites was encouraged by several methods: involving faculty, adopting a centralized examination format, and aligning teaching methods with examination format. Quantitative and qualitative methods were used to measure students' perceptions of the course's value. These evaluative results were reviewed, and course modifications were implemented and reevaluated. The average adjusted student return rate for course evaluation questionnaires for the 3-year study period was 63%. Clerks' ratings of course learning value demonstrated that the course improved significantly and continually across all sites, according to a Scheffé post-hoc analysis. Analysis of student statements from focus-group transcripts contributed to course modifications, such as the Brief Focused Interview (BFI). Our curriculum in child psychiatry, which focused on common problems and used active learning methods, was viewed as a valuable learning experience by clinical clerks. Curriculum coordination across multiple teaching sites was accomplished by including faculty in the process and by using specific teaching and examination strategies. Structures for continuous course improvement were effective.

Chiropractic wellness on the web: the content and quality of information related to wellness and primary prevention on the Internet.

PubMed

Evans, Marion Willard; Perle, Stephen M; Ndetan, Harrison

2011-02-02

The Internet has become a common source of information for patients wishing to learn about health information. Previous studies found information related to back pain poor and often contradictory to current guidelines. Wellness has become a common topic in the field of chiropractic and accrediting agencies have standards on delivery of wellness-based content in college curricula as well as directives for clinical applications. The purpose of this study was to evaluate the quality of the information on the Internet using the terms "chiropractic wellness," or "wellness chiropractic". Five commonly used search engines were selected and the first 10 sites found using the strategy above were evaluated by two raters. Demographic assessments of the sites were made along with whether they were Health on the Net Foundation (HON) certified, contained standard wellness content, mentioned any Healthy People Focus Areas, and other chiropractic topics. Kappa statistics compared inter-rater agreement. Potential patients appeared to be the audience 87% of the time and a private doctor of chiropractic appeared to be the typical site owner. The sites usually promoted the provider. No sites displayed HON certification logo nor did any appear to meet the HON certification criteria. Twenty-six sites (55%) promoted regular physical activity in some manner and 18 (38%) had information on health risks of tobacco. Four (9%) had mental health or stress-reduction content but none had information supportive of vaccination. Some had information contradictory to common public health measures. Patients searching the Internet for chiropractic wellness information will often find useless information that will not help them maintain health or become well. Most simply market the chiropractic practice or allow for a patients to provide personal information in exchange for more 'wellness' information. More research should be done on how providers determine site content, pay any attention to the details on their sites, or agree with content as some appear to be prefabricated sites. Website content could be enhanced by sharing of information from reputable sources like US Centers for Disease Control, the National Institutes of Health and other authoritative sources. HON certification should also be sought.

Chiropractic wellness on the web: the content and quality of information related to wellness and primary prevention on the Internet

PubMed Central

2011-01-01

Background The Internet has become a common source of information for patients wishing to learn about health information. Previous studies found information related to back pain poor and often contradictory to current guidelines. Wellness has become a common topic in the field of chiropractic and accrediting agencies have standards on delivery of wellness-based content in college curricula as well as directives for clinical applications. The purpose of this study was to evaluate the quality of the information on the Internet using the terms "chiropractic wellness," or "wellness chiropractic". Methods Five commonly used search engines were selected and the first 10 sites found using the strategy above were evaluated by two raters. Demographic assessments of the sites were made along with whether they were Health on the Net Foundation (HON) certified, contained standard wellness content, mentioned any Healthy People Focus Areas, and other chiropractic topics. Kappa statistics compared inter-rater agreement. Results Potential patients appeared to be the audience 87% of the time and a private doctor of chiropractic appeared to be the typical site owner. The sites usually promoted the provider. No sites displayed HON certification logo nor did any appear to meet the HON certification criteria. Twenty-six sites (55%) promoted regular physical activity in some manner and 18 (38%) had information on health risks of tobacco. Four (9%) had mental health or stress-reduction content but none had information supportive of vaccination. Some had information contradictory to common public health measures. Conclusions Patients searching the Internet for chiropractic wellness information will often find useless information that will not help them maintain health or become well. Most simply market the chiropractic practice or allow for a patients to provide personal information in exchange for more 'wellness' information. More research should be done on how providers determine site content, pay any attention to the details on their sites, or agree with content as some appear to be prefabricated sites. Website content could be enhanced by sharing of information from reputable sources like US Centers for Disease Control, the National Institutes of Health and other authoritative sources. HON certification should also be sought. PMID:21288336

Other primary systemic cancers in patients with melanoma: Analysis of balanced acral and nonacral melanomas.

PubMed

Bae, Soo Hyeon; Seon, Hyun Ju; Choi, Yoo Duk; Shim, Hyun-Jeong; Lee, Jee-Bum; Yun, Sook Jung

2016-02-01

Although other primary systemic cancers in patients with melanoma have been studied, there have been few focusing on acral melanomas. We assessed other primary systemic cancers in patients with acral and nonacral melanomas. We analyzed other primary cancers in 452 patients with melanoma from 1994 to 2013. Metachronous cancers were defined as those given a diagnosis more than 2 months after diagnosis of melanoma. The others were considered prechronous or synchronous cancers. Among 51 cases of other primary cancers, gastrointestinal cancer (35.3%, n = 18/51) was the most common, followed by thyroid (17.6%), lung (11.8%), and breast (5.9%). Those were more prevalent in the acral melanoma group (12.8%, n = 31/243) compared with the nonacral melanoma group (9.6%, n = 20/209). Of 23 cases of metachronous cancer, the risk was the highest in bone marrow, followed by oral cavity, bladder, colon, lung, and thyroid. Among 28 cases of prechronous or synchronous cancers, gastrointestinal tract (35.7%, n = 10/28) was the most common site, followed by thyroid (17.9%), breast (10.7%), and lung (7.1%). The study is limited by a small number of patients. Careful follow-up and imaging studies are necessary for early detection of other primary cancers and metastatic lesions in patients with melanoma. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

WAG 2 remedial investigation and site investigation site-specific work plan/health and safety checklist for the ecological assessment task, Kingfisher Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Holt, V.L.; Baron, L.A.

1994-05-01

This report provides specific details and requirements for the WAG 2 remedial investigation and site investigation Ecological Assessment Task, Kingfisher Study, including information that will contribute to safe completion of the project. The report includes historical background; a site map; project organization; task descriptions and hazard evaluations; controls; and monitoring, personal protective equipment, decontamination, and medical surveillance program requirements. The report also includes descriptions of site personnel and their certifications as well as suspected WAG 2 contaminants and their characteristics. The primary objective of the WAG 2 Kingfisher Study is to assess the feasibility of using kingfishers as biological monitorsmore » of contaminants on the Oak Ridge Reservation (ORR). Kingfisher sample collection will be used to determine the levels of contaminants and degree of bioaccumulation within a common piscivorous bird feeding on contaminated fish from streams on the ORR.« less

Biliary tract obstruction secondary to cancer: management guidelines and selected literature review.

PubMed

Lokich, J J; Kane, R A; Harrison, D A; McDermott, W V

1987-06-01

Malignant biliary tract obstruction (MBTO) due to either primary biliary tract cancer or metastasis to the porta hepatis is a common clinical problem. The most common metastatic tumors causing MBTO in order of frequency are gastric, colon, breast, and lung cancers. Radiographic diagnostic procedures should proceed in a cost-effective sequence from ultrasonography, computerized tomography (CT), percutaneous transhepatic cholangiography (PTHC), and endoscopic retrograde pancreatography with the goal of establishing the site of the biliary tract obstruction. The identification of the site of obstruction could be established by ultrasound 70% to 80%, CT scan 80% to 90%, PTHC 100%, and endoscopic retrograde cholangiography (ERCP) 85%. Therapeutic intervention by radiographic decompression (PTHC or endoscopic prosthesis), surgical bypass, or radiation therapy with or without chemotherapy may be selectively used based on (1) the site of obstruction; (2) the type of primary tumor; and (3) the presence of specific symptoms related to the obstruction. ("Prophylactic" biliary tract decompression to prevent ascending cholangitis is not supported by the literature in that the frequency of sepsis in the face of malignant obstruction is small (in contrast to sepsis associated with stone disease). Furthermore, PTHC with drainage as a long-term procedure is associated with a substantial frequency of sepsis and is unnecessary and possibly problematic as a preoperative procedure simply to reduce the bilirubin level. The use of radiation therapy in conjunction with chemotherapy for patients not deemed suitable for a surgical bypass because of the presence of proximal obstruction is an important alternative to PTHC.

Clinicopathological characteristics and prognostic factors of primary gastrointestinal lymphoma: a 22-year experience from South China.

PubMed

Li, Minrui; Zhang, Shenghong; Gu, Fang; Xiao, Weiwei; Yao, Jiayan; Chao, Kang; Chen, Minhu; Li, Juan; Zhong, Bihui

2014-01-01

Primary gastrointestinal lymphoma (PGIL) is a kind of relatively rare cancer and easily misdiagnosed due to its unspecific signs in digestive tract. Data including 216 patients histologically diagnosed as PGIL between January 1991 and October 2012 from The First Affiliated Hospital of Sun Yat-sen University were reviewed. This study was to investigate the clinicopathological features and prognosis, and make the comparison between the different sites of PGIL. Abdominal pain (75.9%) was the most frequent symptom and intermediate-grade lymphoma (53.7%) presented as the most common histological type. Intestine (55.1%) was the most common site involved, followed by stomach (38.5%), both intestine and stomach (6.4%). PGIL of different original site showed distinguished clinicopathological characteristics that patients in Stomach and GI group were older than Intestine group (Mean age: 54 and 53 vs. 43 years, p<0.001); diarrhea, B symptom, abdominal mass and complication occurred more in intestine group. Histologically, high-grade lymphoma (especially T-cell type) almost located in Intestine group (82.5%). Five-year overall survival (OS) and event-free survival (EFS) for all PGIL patients were 56.4% and 49.3%, respectively. Stomach group had better OS (72.3%) and EFS (48.4%) than Intestine group (43.1% and 23.6% respectively), but it lost the significance in the multivariate analysis. Univariate and multivariate analysis revealed that performance status, lactate dehydrogenase (LDH) level and histological type were independent prognostic factors for PGIL.

NEON: Transforming Environmental Data into Free, Open Information

NASA Astrophysics Data System (ADS)

Wee, B.

2010-12-01

The National Ecological Observatory Network (NEON) will collect data across the United States on the impacts of climate change, land use change and invasive species on natural resources and biodiversity. NEON is a project of the U.S. National Science Foundation (NSF), with many other U.S. agencies and NGOs cooperating. The Observatory’s construction plans call for 60 sites distributed across 20 ecoclimatic Domains. Data will be collected from strategically selected sites within each Domain and synthesized into information products that can be used to describe changes in the nation’s ecosystem through space and time. Sites are arrayed across different land-use types in order to understand large-scale environmental drivers affect biodiversity, ecohydrology, biogeochemistry, and disease ecology across the US continent. NEON is an instrument that listens to the pulse of the US continental ecosystem: infrastructure deployed at these sites will collect an average of over 500 primary measurements at each site, including annual high-resolution airborne LiDAR and hyperspectral data. These primary measurements will be transformed by a state-of-the-art cyberinfrastruture into over 100 higher-order data products. All measurements, data products, algorithms used to compute the data products, and protocols used to collect the primary measurements will be freely available to the public and assessable over the internet. The information products, including selected socio-economic datasets from cooperating Federal agencies, will be served in standard formats, grid-sizes, and geographical projections. This type of information is anticipated to have a wide range of uses, including ecological forecasting, education, public engagement, socio-economic analyses, decision support for climate-change adaptation and mitigation, resource management, and environmental risk management. Open data, interoperability, an open and integrated observation infrastructure, public engagement, and a deliberate approach to making sure that research data can be repurposed for operational purposes are the cornerstones of the NEON strategy: they facilitate the repurposing of credible, reliable data and information for multiple purposes. Often, the same data is useful in an undergraduate course on correlations as it is for public discourse on the effects of increased precipitation on stream water quality. This suggests a strategy for evolving an ecosystem of institutions whose primary responsibility is contributing to an open information commons that creates and curates credible sources of data and information products with clearly documented provenance, quality protocols, uncertainty estimates, and other qualitative descriptors. This information commons is deliberately designed to be tapped by another ecosystem of institutions whose individual missions revolve around some combination of discovery (e.g. research, forecasting, innovation), learning (e.g. public engagement, informal and formal learning, education research), and solutions (e.g. science and technology policy). This talk explores how the NEON information commons is envisioned to interact with this other community of institutions, and how the cornerstone principles enable that community to better focus their creative capabilities around their respective core missions.

Jupyter and Galaxy: Easing entry barriers into complex data analyses for biomedical researchers.

PubMed

Grüning, Björn A; Rasche, Eric; Rebolledo-Jaramillo, Boris; Eberhard, Carl; Houwaart, Torsten; Chilton, John; Coraor, Nate; Backofen, Rolf; Taylor, James; Nekrutenko, Anton

2017-05-01

What does it take to convert a heap of sequencing data into a publishable result? First, common tools are employed to reduce primary data (sequencing reads) to a form suitable for further analyses (i.e., the list of variable sites). The subsequent exploratory stage is much more ad hoc and requires the development of custom scripts and pipelines, making it problematic for biomedical researchers. Here, we describe a hybrid platform combining common analysis pathways with the ability to explore data interactively. It aims to fully encompass and simplify the "raw data-to-publication" pathway and make it reproducible.

Biology, diagnosis and treatment of canine appendicular osteosarcoma: similarities and differences with human osteosarcoma.

PubMed

Morello, Emanuela; Martano, Marina; Buracco, Paolo

2011-09-01

Osteosarcoma (OSA) is the most common primary bone tumour in dogs. The appendicular locations are most frequently involved and large to giant breed dogs are commonly affected, with a median age of 7-8 years. OSA is a locally invasive neoplasm with a high rate of metastasis, mostly to the lungs. Due to similarities in biology and treatment of OSA in dogs and humans, canine OSA represents a valid and important tumour model. Differences between canine and human OSAs include the age of occurrence (OSA is most commonly an adolescent disease in humans), localisation (the stifle is the most common site of localisation in humans) and limited use of neoadjuvant chemotherapy in canine OSA. Copyright © 2010 Elsevier Ltd. All rights reserved.

Using the CER Hub to ensure data quality in a multi-institution smoking cessation study.

PubMed

Walker, Kari L; Kirillova, Olga; Gillespie, Suzanne E; Hsiao, David; Pishchalenko, Valentyna; Pai, Akshatha Kalsanka; Puro, Jon E; Plumley, Robert; Kudyakov, Rustam; Hu, Weiming; Allisany, Art; McBurnie, MaryAnn; Kurtz, Stephen E; Hazlehurst, Brian L

2014-01-01

Comparative effectiveness research (CER) studies involving multiple institutions with diverse electronic health records (EHRs) depend on high quality data. To ensure uniformity of data derived from different EHR systems and implementations, the CER Hub informatics platform developed a quality assurance (QA) process using tools and data formats available through the CER Hub. The QA process, implemented here in a study of smoking cessation services in primary care, used the 'emrAdapter' tool programmed with a set of quality checks to query large samples of primary care encounter records extracted in accord with the CER Hub common data framework. The tool, deployed to each study site, generated error reports indicating data problems to be fixed locally and aggregate data sharable with the central site for quality review. Across the CER Hub network of six health systems, data completeness and correctness issues were prevalent in the first iteration and were considerably improved after three iterations of the QA process. A common issue encountered was incomplete mapping of local EHR data values to those defined by the common data framework. A highly automated and distributed QA process helped to ensure the correctness and completeness of patient care data extracted from EHRs for a multi-institution CER study in smoking cessation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Amyopathic Dermatomyositis: A Concise Review of Clinical Manifestations and Associated Malignancies.

PubMed

Udkoff, Jeremy; Cohen, Philip R

2016-10-01

Amyopathic dermatomyositis is a rare, idiopathic, connective tissue disease that presents with dermatologic lesions of classic dermatomyositis but lacks the myopathy of this disease. Cutaneous manifestations may include Gottron's sign, heliotrope rash, and characteristic patterns of poikiloderma. There is a substantial risk for developing interstitial lung disease or malignancy in patients with amyopathic dermatomyositis. A literature review of amyopathic dermatomyositis was performed using the PubMed medical database. The key features of amyopathic dermatomyositis, including autoantibodies, clinical presentation and dermatologic manifestations, epidemiology, history, associated malignancies, management, and pathogenesis, are summarized in this review. Cancer (solid tumor) (73/79, 89 %) and hematologic malignancies (9/79, 11 %) were reported in 79 patients, with three patients having more than one malignancy. In addition, there were six patients with amyopathic dermatomyositis who had tumor of unknown primary, and eight patients with cancer-associated amyopathic dermatomyositis for whom no additional details were provided. From the group of 73 tumors for whom primary origin and sex were available, malignancy of the genitourinary organs (24/73, 33 %), aerorespiratory organs (15/73, 21 %), and breast (14/73, 19 %) were the most commonly observed solid organ tumors. Tumors of the genitourinary organs (15/48, 31 %) and breast (14/48, 29 %) were the most frequent neoplasms in women, accounting for 29 of 48 (60 %) cancers, with the most common sites being breast (14/48, 29 %), ovary (8/48, 17 %), and cervix or uterus (5/48, 10 %). In men, tumors of the aerorespiratory (9/25, 36 %) and genitourinary (9/25, 36 %) tracts were the most common neoplasms, accounting for 72 % (18/25) of cancers; the most common sites of primary malignancy were nasopharyngeal (6/25, 24 %), bladder (4/25, 16 %), and either colorectal, lung or prostate cancer (three cancers each, 12 %). In summary, the search for an undiagnosed associated malignancy in patients with amyopathic dermatomyositis should focus towards the organs most frequently affected. Similar to classic dermatomyositis, ovarian and nasopharyngeal cancers are also common in amyopathic dermatomyositis. However, in contrast to lung cancer, which is the most frequent malignancy associated with classic dermatomyositis, breast cancer was the most common type of malignancy reported in patients with amyopathic dermatomyosotis.

A rare presentation of metastasis of prostate adenocarcinoma to the stomach and rectum.

PubMed

Soe, Aye Min; Bordia, Sonal; Xiao, Philip Q; Lopez-Morra, Hernan; Tejada, Juan; Atluri, Sreedevi; Krishnaiah, Mahesh

2014-12-01

Prostate cancer is the second most common cause of cancer death in men in the United States. The most common sites of metastasis include the bone, lymph nodes, lung, liver, pleura, and adrenal glands, whereas metastatic prostate cancer involving the gastrointestinal tract has been rarely reported. A 64-year-old African-American man with a history of prostate cancer presented with anemia. He reported the passing of dark colored stools but denied hematemesis or hematochezia. Colonoscopy revealed circumferential nodularity, and histology demonstrated metastatic carcinoma of the prostate. Esophagogastroduodenoscopy showed hypertrophic folds in the gastric fundus, and microscopic examination revealed tumor cells positive for prostate-specific antigen. Bone scanning and computed tomography of the abdomen and pelvis did not show metastasis. It is crucial to distinguish primary gastrointestinal cancer from metastatic lesions, especially in patients with a history of cancer at another site, for appropriate management.

A Rare Presentation of Metastasis of Prostate Adenocarcinoma to the Stomach and Rectum

PubMed Central

Bordia, Sonal; Xiao, Philip Q; Lopez-Morra, Hernan; Tejada, Juan; Atluri, Sreedevi; Krishnaiah, Mahesh

2014-01-01

Prostate cancer is the second most common cause of cancer death in men in the United States. The most common sites of metastasis include the bone, lymph nodes, lung, liver, pleura, and adrenal glands, whereas metastatic prostate cancer involving the gastrointestinal tract has been rarely reported. A 64-year-old African-American man with a history of prostate cancer presented with anemia. He reported the passing of dark colored stools but denied hematemesis or hematochezia. Colonoscopy revealed circumferential nodularity, and histology demonstrated metastatic carcinoma of the prostate. Esophagogastroduodenoscopy showed hypertrophic folds in the gastric fundus, and microscopic examination revealed tumor cells positive for prostate-specific antigen. Bone scanning and computed tomography of the abdomen and pelvis did not show metastasis. It is crucial to distinguish primary gastrointestinal cancer from metastatic lesions, especially in patients with a history of cancer at another site, for appropriate management. PMID:25580360

Breast cancer metastatic to the pituitary gland: a case report.

PubMed

Spinelli, Gian Paolo; Lo Russo, Giuseppe; Miele, Evelina; Prinzi, Natalie; Tomao, Federica; Antonelli, Manila; Giangaspero, Felice; Stati, Valeria; Strudel, Martina; Tomao, Silverio

2012-07-09

Metastases to the pituitary gland are rare events, and usually indicate widespread malignant disease. The lung and the breast are the most common sites of primary tumors that metastasize to the pituitary gland.Metastases are more frequent in older patients and the most common symptoms at presentation are diabetes insipidus and visual alterations. 72-year-old white woman was treated for a breast carcinoma with right superoexternal quadrantectomy, radiotherapy, and hormone therapy. Twelve years later, the patient presented with bone pain, bilateral progressive visual decline, and onset of hypopituitarism. A diagnosis of secondary bone involvement and pituitary metastasis was made. This was an unusual disease course, and stresses the importance of intensive follow-up in patients with breast cancer even many years after the initial diagnosis This case emphasizes that diagnosis can be difficult and controversial when relapse occurs at uncommon sites.

Primary primitive neuroectodermal tumor of the cervix

PubMed Central

Li, Bo; Ouyang, Ling; Han, Xue; Zhou, Yang; Tong, Xin; Zhang, Shulang; Zhang, Qingfu

2013-01-01

Primary primitive neuroectodermal tumors (PNETs) are rare and high-grade malignant tumors that mostly occur in children and young adults. The most common sites are the trunk, limbs, and retroperitoneum. Herein, we present a case of a PNET involving the cervix uteri in a 27-year-old woman. The lesion showed characteristic histologic features of a PNET and was positive for the immunohistochemical markers cluster of differentiation (CD) 99, vimentin, neuron-specific enolase, neural cell adhesion molecule 1 (CD56), and CD117 (c-kit), further defining the tumor while helping to confirm PNET. The clinical Stage IIIB tumor was treated with chemotherapy and radiotherapy. PMID:23836982

Neck Dissection Technique Commonality and Variance: A Survey on Neck Dissection Technique Preferences among Head and Neck Oncologic Surgeons in the American Head and Neck Society

PubMed Central

Hemmat, Shirin M.; Wang, Steven J.; Ryan, William R.

2016-01-01

Introduction Neck dissection (ND) technique preferences are not well reported. Objective The objective of this study is to educate practitioners and trainees about surgical technique commonality and variance used by head and neck oncologic surgeons when performing a ND. Methods Online survey of surgeon members of the American Head and Neck Society (AHNS). Survey investigated respondents' demographic information, degree of surgical experience, ND technique preferences. Results In our study, 283 out of 1,010 (28%) AHNS surgeon members with a mean age of 50.3 years (range 32–77 years) completed surveys from 41 states and 24 countries. We found that 205 (72.4%) had completed a fellowship in head and neck surgical oncology. Also, 225 (79.5%) respondents reported completing more than 25 NDs per year. ND technique commonalities (>66% respondents) included: preserving level 5 (unless with suspicious lymph nodes (LN)), only excising the portion of sternocleidomastoid muscle involved with tumor, resecting lymphatic tissue en bloc, preservation of cervical sensory rootlets, not performing submandibular gland (SMG) transfer, placing one drain for unilateral selective NDs, and performing a ND after parotidectomy and thyroidectomy and before transcervical approaches to upper aerodigestive tract primary site. Variability existed in the sequence of LN levels excised, instrument preferences, criteria for drain removal, the timing of a ND with transoral upper aerodigestive tract primary site resections, and submandibular gland preservation. Results showed that 122 (43.1%) surgeons reported that they preserve the submandibular gland during the level 1b portion of a ND. Conclusions The commonalities and variances reported for the ND technique may help put individual preferences into context. PMID:28050201

INVESTIGATING THE EFFICACY OF CLINICAL TRIAL MONITORING STRATEGIES: Design and Implementation of the Cluster Randomized START Monitoring Substudy

PubMed Central

Hullsiek, Katherine Huppler; Kagan, Jonathan M; Engen, Nicole; Grarup, Jesper; Hudson, Fleur; Denning, Eileen T; Carey, Catherine; Courtney-Rodgers, David; Finley, Elizabeth B; Jansson, Per O; Pearson, Mary T; Peavy, Dwight E; Belloso, Waldo H

2014-01-01

Background Trial monitoring protects participant safety and study integrity. While monitors commonly go on-site to verify source data, there is little evidence that this practice is efficient or effective. An ongoing international HIV treatment trial (START) provides an opportunity to explore the usefulness of different monitoring approaches. Methods All START sites are centrally monitored and required to follow a local monitoring plan requiring specific quality assurance activities. Additionally, sites were randomized (1:1) to receive, or not receive, annual on-site monitoring. The study will determine if on-site monitoring increases the identification of major protocol deviations (eligibility or consent violations, improper study drug use, primary or serious event underreporting, data alteration or fraud). Results The START study completed enrollment in December 2013, with planned follow-up through December 2016. The monitoring study is ongoing at 196 sites in 34 countries. Results are expected when the START study concludes in December 2016. PMID:25973346

Beyond Electronic Brochures: An Analysis of Singapore Primary School Web Sites

ERIC Educational Resources Information Center

Hu, Chun; Soong, Andrew Kheng Fah

2007-01-01

This study aims to investigate how Singapore primary schools use their web sites, what kind of information is contained in the web sites, and how the information is presented. Based on an analysis of 176 primary school web sites, which represent all but one of the country's primary schools, findings indicate that most of Singapore's primary school…

42 CFR 81.23 - Guidelines for cancers for which primary site is unknown.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Guidelines for cancers for which primary site is... Estimate Probability of Causation § 81.23 Guidelines for cancers for which primary site is unknown. (a) In claims for which the primary cancer site cannot be determined, but a site of metastasis is known, DOL...

42 CFR 81.23 - Guidelines for cancers for which primary site is unknown.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Guidelines for cancers for which primary site is... Estimate Probability of Causation § 81.23 Guidelines for cancers for which primary site is unknown. (a) In claims for which the primary cancer site cannot be determined, but a site of metastasis is known, DOL...

42 CFR 81.23 - Guidelines for cancers for which primary site is unknown.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Guidelines for cancers for which primary site is... Estimate Probability of Causation § 81.23 Guidelines for cancers for which primary site is unknown. (a) In claims for which the primary cancer site cannot be determined, but a site of metastasis is known, DOL...

42 CFR 81.23 - Guidelines for cancers for which primary site is unknown.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Guidelines for cancers for which primary site is... Estimate Probability of Causation § 81.23 Guidelines for cancers for which primary site is unknown. (a) In claims for which the primary cancer site cannot be determined, but a site of metastasis is known, DOL...

42 CFR 81.23 - Guidelines for cancers for which primary site is unknown.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Guidelines for cancers for which primary site is... Estimate Probability of Causation § 81.23 Guidelines for cancers for which primary site is unknown. (a) In claims for which the primary cancer site cannot be determined, but a site of metastasis is known, DOL...

Sites, frequencies, and causes of self-reported fractures in 9,720 rheumatoid arthritis patients: a large prospective observational cohort study in Japan.

PubMed

Ochi, Kensuke; Furuya, Takefumi; Ikari, Katsunori; Taniguchi, Atsuo; Yamanaka, Hisashi; Momohara, Shigeki

2013-01-01

Sites, frequencies, and causes of self-reported fractures in Japanese patients with rheumatoid arthritis (RA) were evaluated in a prospective, observational cohort study. The incidence and cause of fracture differ by anatomical site, sex, and age. These differences may be considered in establishing custom strategies for preventing fractures in RA patients in the future. The literature contains limited data describing the details of fractures at different skeletal sites in patients with RA. We evaluated the details of fractures in Japanese RA patients on the basis of our Institute of Rheumatology Rheumatoid Arthritis cohort study in 9,720 RA patients (82 % women; mean age, 56 years) who were enrolled from 2000 to 2010. The details of fractures were obtained through biannual patient self-report questionnaires. Over a mean duration of 5.2 years, 1,317 patients (13.5 %) reported 2,323 incident fractures comprising 563 (24.2 %) clinical vertebral fractures and 1,760 (75.8 %) nonvertebral fractures. Rib fractures were the most common fractures in men, followed by clinical vertebral and hip fractures; the most common fractures in women were clinical vertebral fractures, followed by rib, foot, and hip fractures. There was a significant difference between sexes in the rates of rib, clavicle, shoulder, and ankle fractures. Spontaneous event was the primary cause of clinical vertebral fracture (65.4 %), whereas falls were the primary cause of upper extremity (76.5 %) and lower extremity (57.8 %) fractures. Rates of clinical vertebral and hip fractures increased, while those of rib and foot fractures decreased with increasing age. Incidence of falls, as causes of nonvertebral fractures, also increased in older age groups. Our results suggest that the causes of fractures may differ depending on anatomical site and that prevention of falls may be the most effective way to reduce upper and lower extremity fractures, especially in older patients with RA.

Do On-site Mental Health Professionals Change Pediatricians’ Responses to Children’s Mental Health Problems?

PubMed Central

Horwitz, Sarah McCue; Storfer-Isser, Amy; Kerker, Bonnie D.; Szilagyi, Moira; Garner, Andrew S.; O’Connor, Karen G.; Hoagwood, Kimberly E.; Green, Cori M.; Foy, Jane M.; Stein, Ruth E.K.

2016-01-01

Objective The objectives were to: assess the availability of on-site mental health professionals (MHP) in primary care; examine practice/pediatrician characteristics associated with on-site MHPs; and determine whether presence of on-site MHPs is related to pediatricians’ co-managing or more frequently identifying, treat/managing or referring MH problems. Methods Analyses included AAP members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (N=321). Measures included socio-demographics, practice characteristics, questions on about on-site MHPs, co-management of MH problems and pediatricians’ behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate and multivariable analyses were performed. Results Thirty-five percent reported on-site MHPs. Practice characteristics (medical schools/universities/HMOs, <100 visits/week, <80% of patients privately insured), and interactions of practice location (urban) with visits and patient insurance, were associated with on-site MHPs. There was no overall association between co-location and co-management or whether pediatricians usually identified, treat/managed or referred 5 common child MH problems. Among the subset of pediatricians who reported co-managing there was an association with co-management when the on-site MHP was a child psychiatrist, SA counselor, or social worker. Conclusions On-site MHPs are more frequent in settings where low-income children are served and where pediatricians train. Pediatricians who co-manage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, SA counselor, or social worker. Overall, on-site MHPs were not associated with co-management or increased likelihood of pediatricians identifying, treating/managing, or referring children with 5 common child MH problems. PMID:27064141

Do On-Site Mental Health Professionals Change Pediatricians' Responses to Children's Mental Health Problems?

PubMed

McCue Horwitz, Sarah; Storfer-Isser, Amy; Kerker, Bonnie D; Szilagyi, Moira; Garner, Andrew S; O'Connor, Karen G; Hoagwood, Kimberly E; Green, Cori M; Foy, Jane M; Stein, Ruth E K

2016-01-01

To assess the availability of on-site mental health professionals (MHPs) in primary care; to examine practice/pediatrician characteristics associated with on-site MHPs; and to determine whether the presence of on-site MHPs is related to pediatricians' comanaging or more frequently identifying, treating/managing, or referring mental health (MH) problems. Analyses included American Academy of Pediatrics (AAP) members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (n = 321). Measures included sociodemographics, practice characteristics, questions about on-site MHPs, comanagement of MH problems, and pediatricians' behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate, and multivariable analyses were performed. Thirty-five percent reported on-site MHPs. Practice characteristics (medical schools, universities, health maintenance organizations, <100 visits per week, <80% of patients privately insured) and interactions of practice location (urban) with visits and patient insurance were associated with on-site MHPs. There was no overall association between colocation and comanagement, or whether pediatricians usually identified, treated/managed, or referred 5 common child MH problems. Among the subset of pediatricians who reported comanaging, there was an association with comanagement when the on-site MHP was a child psychiatrist, substance abuse counselor, or social worker. On-site MHPs are more frequent in settings where low-income children are served and where pediatricians train. Pediatricians who comanage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, substance abuse counselor, or social worker. Overall, on-site MHPs were not associated with comanagement or increased likelihood of pediatricians identifying, treating/managing, or referring children with 5 common child MH problems. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Multicenter retrospective analysis of systemic chemotherapy for advanced neuroendocrine carcinoma of the digestive system.

PubMed

Yamaguchi, Tomohiro; Machida, Nozomu; Morizane, Chigusa; Kasuga, Akiyoshi; Takahashi, Hideaki; Sudo, Kentaro; Nishina, Tomohiro; Tobimatsu, Kazutoshi; Ishido, Kenji; Furuse, Junji; Boku, Narikazu; Okusaka, Takuji

2014-09-01

This study analyzed outcomes of systemic chemotherapy for advanced neuroendocrine carcinoma (NEC) of the digestive system. Clinical data from 258 patients with unresectable or recurrent NEC of the gastrointestinal tract (GI) or hepato-biliary-pancreatic system (HBP), who received chemotherapy, were collected from 23 Japanese institutions and analyzed retrospectively. Patients had primary sites in the esophagus (n = 85), stomach (n = 70), small bowel (n = 6), colorectum (n = 31), hepato-biliary system (n = 31) and pancreas (n = 31). Median overall survival (OS) was 13.4 months the esophagus, 13.3 months for the stomach, 29.7 months for the small bowel, 7.6 months for the colorectum, 7.9 months for the hepato-biliary system and 8.5 months for the pancreas. Irinotecan plus cisplatin (IP) and etoposide plus cisplatin (EP) were most commonly selected for GI-NEC and HBP-NEC. For patients treated with IP/EP (n = 160/46), the response rate was 50/28% and median OS was 13.0/7.3 months. Multivariate analysis among patients treated with IP or EP showed that the primary site (GI vs HBP; hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.35-0.97) and baseline serum lactate dehydrogenase levels (not elevated vs elevated; HR 0.65, 95% CI 0.46-0.94) were independent prognostic factors for OS, while the efficacy of IP was slightly better than for EP (HR 0.80, 95% CI 0.48-1.33; P = 0.389). IP and EP are the most common treatment regimens for NEC of the digestive system. HBP primary sites and elevated lactate dehydrogenase levels are unfavorable prognostic factors for survival. A randomized controlled trial is required to establish the appropriate chemotherapy regimen for advanced NEC of the digestive system. This study was registered at UMIN as trial number 000005176. © 2014 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Cancer Association.

Mechanisms and Permanence of Sequestered Pb and As in Soils: Impact on Human Bioavailability

DTIC Science & Technology

2016-12-01

Human health risk assessment ICP-MS Inductively coupled plasma - mass spectrometry ICP-OES Inductively coupled plasma – optical emission spectrometry...the most common contaminants of concern exceeding risk criteria because soil ingestion is the primary human health risk driver at many DoD sites...development activities must address to realize the use of bioavailability in human health risk assessment (HHRA). Our proposal addressed three of the

Outcome-dependent coactivation of lip and tongue primary somatosensory representation following hypoglossal-facial transfer after peripheral facial palsy.

PubMed

Rottler, Philipp; Schroeder, Henry W S; Lotze, Martin

2014-02-01

A hypoglossal-facial transfer is a common surgical strategy for reanimating the face after persistent total hemifacial palsy. We were interested in how motor recovery is associated with cortical reorganization of lip and tongue representation in the primary sensorimotor cortex after the transfer. Therefore, we used functional magnetic resonance imaging (fMRI) in 13 patients who underwent a hypoglossal-facial transfer after unilateral peripheral facial palsy. To identify primary motor and somatosensory tongue and lip representation sites, we measured repetitive tongue and lip movements during fMRI. Electromyography (EMG) of the perioral muscles during tongue and lip movements and standardized evaluation of lip elevation served as outcome parameters. We found an association of cortical representation sites in the pre- and postcentral gyrus (decreased distance of lip and tongue representation) with symmetry of recovered lip movements (lip elevation) and coactivation of the lip during voluntary tongue movements (EMG-activity of the lip during tongue movements). Overall, our study shows that hypoglossal-facial transfer resulted in an outcome-dependent cortical reorganization with activation of the cortical tongue area for restituded movement of the lip. Copyright © 2012 Wiley Periodicals, Inc.

Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center.

PubMed

Suki, Dima; Khoury Abdulla, Rami; Ding, Minming; Khatua, Soumen; Sawaya, Raymond

2014-10-01

Metastasis to the brain is frequent in adult cancer patients but rare among children. Advances in primary tumor treatment and the associated prolonged survival are said to have increased the frequency of brain metastasis in children. The authors present a series of cases of brain metastases in children diagnosed with a solid primary cancer, evaluate brain metastasis trends, and describe tumor type, patterns of occurrence, and prognosis. Patients with brain metastases whose primary cancer was diagnosed during childhood were identified in the 1990-2012 Tumor Registry at The University of Texas M.D. Anderson Cancer Center. A review of their hospital records provided demographic data, history, and clinical data, including primary cancer sites, number and location of brain metastases, sites of extracranial metastases, treatments, and outcomes. Fifty-four pediatric patients (1.4%) had a brain metastasis from a solid primary tumor. Sarcomas were the most common (54%), followed by melanoma (15%). The patients' median ages at diagnosis of the primary cancer and the brain metastasis were 11.37 years and 15.03 years, respectively. The primary cancer was localized at diagnosis in 48% of patients and disseminated regionally in only 14%. The primary tumor and brain metastasis presented synchronously in 15% of patients, and other extracranial metastases were present when the primary cancer was diagnosed. The remaining patients were diagnosed with brain metastasis after initiation of primary cancer treatment, with a median presentation interval of 17 months after primary cancer diagnosis (range 2-77 months). At the time of diagnosis, the brain metastasis was the first site of systemic metastasis in only 4 (8%) of the 51 patients for whom data were available. Up to 70% of patients had lung metastases when brain metastases were found. Symptoms led to the brain metastasis diagnosis in 65% of cases. Brain metastases were single in 60% of cases and multiple in 35%; 6% had only leptomeningeal disease. The median Kaplan-Meier estimates of survival after diagnoses of primary cancer and brain metastasis were 29 months (95% CI 24-34 months) and 9 months (95% CI 6-11 months), respectively. Untreated patients survived for a median of 0.9 months after brain metastasis diagnosis (95% CI 0.3-1.5 months). Those receiving treatment survived for a median of 8 months after initiation of therapy (95% CI 6-11 months). The results of this study challenge the current notion of an increased incidence of brain metastases among children with a solid primary cancer. The earlier diagnosis of the primary cancer, prior to its dissemination to distant sites (especially the brain), and initiation of presumably more effective treatments may support such an observation. However, although the actual number of cases may not be increasing, the prognosis after the diagnosis of a brain metastasis remains poor regardless of the management strategy.

Analysis of tumor- and stroma-supplied proteolytic networks reveals a brain metastasis-promoting role for cathepsin S

PubMed Central

Sevenich, Lisa; Bowman, Robert L.; Mason, Steven D.; Quail, Daniela F.; Rapaport, Franck; Elie, Benelita T.; Brogi, Edi; Brastianos, Priscilla K.; Hahn, William C.; Holsinger, Leslie J.; Massagué, Joan; Leslie, Christina S.; Joyce, Johanna A.

2014-01-01

Metastasis remains the most common cause of death in most cancers, with limited therapies for combating disseminated disease. While the primary tumor microenvironment is an important regulator of cancer progression, it is less well understood how different tissue environments influence metastasis. We analyzed tumor-stroma interactions that modulate organ tropism of brain, bone and lung metastasis in xenograft models. We identified a number of potential modulators of site-specific metastasis, including cathepsin S as a regulator of breast-to-brain metastasis. High cathepsin S expression at the primary site correlated with decreased brain metastasis-free survival in breast cancer patients. Both macrophages and tumor cells produce cathepsin S, and only the combined depletion significantly reduced brain metastasis in vivo. Cathepsin S specifically mediates blood-brain barrier transmigration via proteolytic processing of the junctional adhesion molecule (JAM)-B. Pharmacological inhibition of cathepsin S significantly reduced experimental brain metastasis, supporting its consideration as a therapeutic target for this disease. PMID:25086747

Metastatic mucosal melanoma: imaging patterns of metastasis and recurrence.

PubMed

O'Regan, Kevin; Breen, Micheál; Ramaiya, Nikhil; Jagannathan, Jyothi; DiPiro, Pamela J; Hodi, F Stephen; Van den Abbeele, Annick D

2013-12-30

Mucosal melanoma is a rare but aggressive subtype of melanoma with unique clinicopathologic features. We hypothesize that mucosal melanoma shows predilection for separate and unique metastatic pathways. This was a retrospective analysis of 19 patients (5 men and 14 women; median age 60 years, range 38-76 years) with metastatic mucosal melanoma presenting to a tertiary oncology center between 2005 and 2010. We performed a review of medical records and histologic and imaging studies to evaluate the natural history, metastatic patterns and the role of imaging in the management of patients with advanced mucosal melanoma. At presentation, disease was confined to the primary site (58%, n = 11) or to the regional lymph nodes (32%, n = 6) in most patients. The most common site of metastasis was the lungs (89%, n = 16), followed by the liver (67%, n = 12) and peritoneum (44%, n = 8). Sinonasal melanoma preferentially spread to the liver (100%, n = 4), vaginal melanoma to the lungs (100%, n = 7) and anal melanoma to the inguinal lymph nodes (100%, n = 4). Pathways of metastatic spread in mucosal melanoma may differ from other forms of melanoma and between different primary sites of mucosal origin.

Canopy structural complexity as a continental predictor of primary production: Using NEON to transform understanding of forest structure-function

NASA Astrophysics Data System (ADS)

Atkins, J. W.; Fahey, R. T.; Gough, C. M.; Hardiman, B. S.

2016-12-01

Ecosystem structure-function relationships represent a long-standing research area for ecosystem science. Relationships between canopy structural complexity (CSC) and net primary productivity (NPP), have been characterized for a limited number of sites, yet whether these relationships are conserved across eco-climatic boundaries remains unknown. We hypothesize an underlying mechanistic basis for global NPP-CSC linkages to include improved resource-use efficiency as CSC increases, examined here by correlating CSC with measures of light-use efficiency and nitrogen-use efficiency. Here we present a broad, continental scale analysis of CSC-NPP linkages. We are using multiple NEON sites coupled with other sites across a diverse array of temperate forest types spanning six eco-climatic domains of the continental United States to examine CSC-NPP relationships. Portable canopy LiDAR (PCL) data were used to calculate a suite of CSC metrics at the plot-level within each site. Ongoing work compares CSC to co-located measurements of wood net primary production estimated from the incremental change in woody biomass calculated using tree allometries. Results to date show CSC is highly variable across forest sites and may provide additional explanatory power for predicting NPP that is independent of other commonly used forest structural attributes such as leaf area index. CSC metrics such as rugosity vary widely across sites—ranging from high values (30 - 35) in complex canopies such as the Great Smoky Mountains to low values in open, savanna systems like North-Central Florida (< 0.5 - 2). NPP, and light- and nitrogen-use calculations are underway and will be paired with site-level CSC, with the expectation that CSC, resource-use efficiency, and NPP are positively correlated. Advancing understanding of how and why CSC affects forest NPP across a broad spatial dimension could transform mechanistic understanding of ecosystem structure-carbon cycling relationships, and greatly improve carbon cycling models and remote sensing applications, while providing a crucial linkage between the two.

Comparison of breeding bird and vegetation communities in primary and secondary forests of Great Smoky Mountains National Park

USGS Publications Warehouse

Simons, Theodore R.; Shriner, Susan A.; Farnsworth, George L.

2006-01-01

We compared breeding bird communities and vegetation characteristics at paired point locations in primary (undisturbed) and mature secondary forest (70-100 years old) sites in Great Smoky Mountains National Park, USA to understand how sites logged prior to creation of the park compare to undisturbed sites following 70 years of protection from human disturbance. We found that bird and vegetation communities are currently similar, but retain some differences in species composition. Rank abundance curves for primary and secondary forest bird communities showed very similar patterns of species dominance. Species composition was also similar on the two sites which shared 24 of the 25 most frequently recorded species. Nonetheless, comparisons of density estimates derived from distance sampling showed three bird species were more abundant on primary forest sites and that one bird species was significantly more abundant on secondary forest sites. Notably, comparisons based on raw counts (unadjusted for potential differences in detectability) produced somewhat different results. Analyses of vegetation samples for the paired sites also showed relative similarity, but with some differences between primary and secondary forests. Primary forest sites had more large trees (trees greater than 50 cm diameter at breast height) and late successional species. Primary forest sites had a denser tall shrub layer while secondary forest sites had a denser canopy layer. Nonetheless, tree species richness, basal area of live trees and number of standing snags did not differ between primary and secondary forest sites. Results indicate that breeding bird communities on sites within the park that were logged commercially 70 years ago are currently quite similar to bird communities on sites with no history of human disturbance. Similarities between the bird communities on previously disturbed and undisturbed sites in Great Smoky Mountains National Park may exceed those on more fragmented landscapes because large patches of primary forest, adjacent to commercially logged sites, remained in the park when it was established in 1935. These patches of primary forest may have served as source areas for commercially logged sites.

Primary structure of Lep d I, the main Lepidoglyphus destructor allergen.

PubMed

Varela, J; Ventas, P; Carreira, J; Barbas, J A; Gimenez-Gallego, G; Polo, F

1994-10-01

The most relevant allergen of the storage mite Lepidoglyphus destructor (Lep d I) has been characterized. Lep d I is a monomer protein of 13273 Da. The primary structure of Lep d I was determined by N-terminal Edman degradation and partially confirmed by cDNA sequencing. Sequence polymorphism was observed at six positions, with non-conservative substitutions in three of them. No potential N-glycosylation site was revealed by peptide sequencing. The 125-residue sequence of Lep d I shows approximately 40% identity (including the six cysteines) with the overlapping regions of group II allergens from the genus Dermatophagoides, which, however, do not share common allergenic epitopes with Lep d I.

Colorectal breast carcinoma metastasis diagnosed as an obstructive colonic primary tumor. A case report and review of the literature.

PubMed

Théraux, J; Bretagnol, F; Guedj, N; Cazals-Hatem, D; Panis, Y

2009-12-01

Common sites of colorectal breast carcinoma metastasis are bones, lungs, the central nervous system and the liver. Metastases in the gastrointestinal (GI) tract are rare and especially involve the stomach rather than the colon. Clinical or radiological features usually cannot differentiate them from a primary colorectal tumor, resulting in inappropriate treatment. In some cases, this lesion suggests multifocal spread of breast cancer with peritoneal carcinomatosis. Colorectal breast cancer metastasis is a rare finding and there is no consensus on the management of these lesions. The present case report describes a 69-year-old female with metastatic breast cancer presenting as an obstructive tumor of the transverse colon.

42 CFR 82.18 - How will NIOSH calculate internal dose to the primary cancer site(s)?

Code of Federal Regulations, 2010 CFR

2010-10-01

... primary cancer site(s)? 82.18 Section 82.18 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND... Dose Reconstruction Process § 82.18 How will NIOSH calculate internal dose to the primary cancer site(s... cancer covered by a claim is in a tissue not covered by existing ICRP models, NIOSH will use the ICRP...

42 CFR 82.18 - How will NIOSH calculate internal dose to the primary cancer site(s)?

Code of Federal Regulations, 2011 CFR

2011-10-01

... primary cancer site(s)? 82.18 Section 82.18 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND... Dose Reconstruction Process § 82.18 How will NIOSH calculate internal dose to the primary cancer site(s... cancer covered by a claim is in a tissue not covered by existing ICRP models, NIOSH will use the ICRP...

42 CFR 82.18 - How will NIOSH calculate internal dose to the primary cancer site(s)?

Code of Federal Regulations, 2013 CFR

2013-10-01

... primary cancer site(s)? 82.18 Section 82.18 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND... Dose Reconstruction Process § 82.18 How will NIOSH calculate internal dose to the primary cancer site(s... cancer covered by a claim is in a tissue not covered by existing ICRP models, NIOSH will use the ICRP...

42 CFR 82.18 - How will NIOSH calculate internal dose to the primary cancer site(s)?

Code of Federal Regulations, 2014 CFR

2014-10-01

... primary cancer site(s)? 82.18 Section 82.18 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND... Dose Reconstruction Process § 82.18 How will NIOSH calculate internal dose to the primary cancer site(s... cancer covered by a claim is in a tissue not covered by existing ICRP models, NIOSH will use the ICRP...

42 CFR 82.18 - How will NIOSH calculate internal dose to the primary cancer site(s)?

Code of Federal Regulations, 2012 CFR

2012-10-01

... primary cancer site(s)? 82.18 Section 82.18 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND... Dose Reconstruction Process § 82.18 How will NIOSH calculate internal dose to the primary cancer site(s... cancer covered by a claim is in a tissue not covered by existing ICRP models, NIOSH will use the ICRP...

The unpredictability of lymphatic drainage from the ear in melanoma patients, and its implications for management.

PubMed

Peach, Howard S; van der Ploeg, Augustinus P T; Haydu, Lauren E; Stretch, Jonathan R; Shannon, Kerwin F; Uren, Roger F; Thompson, John F

2013-05-01

The ear is known to have variable lymphatic drainage. The purpose of this study was to define better the lymphatic drainage patterns of the ear by correlating the location of primary tumors, classified according to the embryologically derived anatomical subunits of the ear, with their mapped sentinel nodes (SNs) identified by lymphoscintigraphy (LS). Lymphatic drainage data for patients with a primary melanoma of the ear were reviewed and correlated with the precise primary melanoma site. Between 1993 and 2010, LS was performed in 111 patients with a primary melanoma on the ear, identifying 281 SNs in 195 lymph node (LN) fields. The mean numbers of SNs and LN fields identified by LS per patient were 2.65 and 1.76. SN biopsy was performed in 71 patients (64 %). The mean number of SNs removed was 2.36. The 111 ear melanomas were mostly located on the helical rim (55 %), followed by the lobule (24.3 %). The five different primary ear sites drained mainly to SNs in level CII, level CV and the preauricular region. Drainage was most often to level CII (36.4 %). Drainage to the contralateral neck was not observed. Lymphatic drainage of the ear has no predictable pattern and can be to SNs anywhere in the ipsilateral neck. Most commonly drainage is to cervical level II and the preauricular and postauricular LN fields. LS defines the lymphatic drainage pattern in individual melanoma patients and is essential for accurate SN identification and reliable SN biopsy.

Case report of metastatic invasive breast lobular carcinoma to the urinary bladder.

PubMed

Al Ibraheemi, Ahmed A

2016-01-01

Breast cancer is the most common cancer in women except skin cancer. The common metastatic sites include lymph node, lung, liver and bone. However, metastasis to the bladder is extremely rare. To our knowledge, this is the first case of breast cancer metastasis to urinary bladder in Jordan which is reported. Nine years after the initial diagnosis of lobular breast carcinoma, the patient suffered from left side leg edema; Ultrasonography and Computed tomography scanning showed thickening of posterior bladder wall and bilateral hydronephrosis. The biopsy of the bladder confirmed metastatic lesion from the breast. In contrast to the primary tumor, bladder metastasis showed negative expression of estrogen (ER) and progesterone (PR) receptors. However, Her2neu test was negative in both. The reported case confirms that bladder metastasis from breast cancer tend to occur late after the diagnosis of the primary tumor. Furthermore, bladder metastasis can be asymptomatic and heterogeneous in ER and PR expression in comparison with the primary tumor. This report supports the need for careful follow-up and early intervention whenever such clinical situation is suspected. This report supports further evaluation of receptor status at time of metastasis.

Co-evolution of somatic variation in primary and metastatic colorectal cancer may expand biopsy indications in the molecular era.

PubMed

Kim, Richard; Schell, Michael J; Teer, Jamie K; Greenawalt, Danielle M; Yang, Mingli; Yeatman, Timothy J

2015-01-01

Metastasis is thought to be a clonal event whereby a single cell initiates the development of a new tumor at a distant site. However the degree to which primary and metastatic tumors differ on a molecular level remains unclear. To further evaluate these concepts, we used next generation sequencing (NGS) to assess the molecular composition of paired primary and metastatic colorectal cancer tissue specimens. 468 colorectal tumor samples from a large personalized medicine initiative were assessed by targeted gene sequencing of 1,321 individual genes. Eighteen patients produced genomic profiles for 17 paired primary:metastatic (and 2 metastatic:metastatic) specimens. An average of 33.3 mutations/tumor were concordant (shared) between matched samples, including common well-known genes (APC, KRAS, TP53). An average of 2.3 mutations/tumor were discordant (unshared) among paired sites. KRAS mutational status was always concordant. The overall concordance rate for mutations was 93.5%; however, nearly all (18/19 (94.7%)) paired tumors showed at least one mutational discordance. Mutations were seen in: TTN, the largest gene (5 discordant pairs), ADAMTS20, APC, MACF1, RASA1, TP53, and WNT2 (2 discordant pairs), SMAD2, SMAD3, SMAD4, FBXW7, and 66 others (1 discordant pair). Whereas primary and metastatic tumors displayed little variance overall, co-evolution produced incremental mutations in both. These results suggest that while biopsy of the primary tumor alone is likely sufficient in the chemotherapy-naïve patient, additional biopsies of primary or metastatic disease may be necessary to precisely tailor therapy following chemotherapy resistance or insensitivity in order to adequately account for tumor evolution.

Co-Evolution of Somatic Variation in Primary and Metastatic Colorectal Cancer May Expand Biopsy Indications in the Molecular Era

PubMed Central

Kim, Richard; Schell, Michael J.; Teer, Jamie K.; Greenawalt, Danielle M.; Yang, Mingli; Yeatman, Timothy J.

2015-01-01

Introduction Metastasis is thought to be a clonal event whereby a single cell initiates the development of a new tumor at a distant site. However the degree to which primary and metastatic tumors differ on a molecular level remains unclear. To further evaluate these concepts, we used next generation sequencing (NGS) to assess the molecular composition of paired primary and metastatic colorectal cancer tissue specimens. Methods 468 colorectal tumor samples from a large personalized medicine initiative were assessed by targeted gene sequencing of 1,321 individual genes. Eighteen patients produced genomic profiles for 17 paired primary:metastatic (and 2 metastatic:metastatic) specimens. Results An average of 33.3 mutations/tumor were concordant (shared) between matched samples, including common well-known genes (APC, KRAS, TP53). An average of 2.3 mutations/tumor were discordant (unshared) among paired sites. KRAS mutational status was always concordant. The overall concordance rate for mutations was 93.5%; however, nearly all (18/19 (94.7%)) paired tumors showed at least one mutational discordance. Mutations were seen in: TTN, the largest gene (5 discordant pairs), ADAMTS20, APC, MACF1, RASA1, TP53, and WNT2 (2 discordant pairs), SMAD2, SMAD3, SMAD4, FBXW7, and 66 others (1 discordant pair). Conclusions Whereas primary and metastatic tumors displayed little variance overall, co-evolution produced incremental mutations in both. These results suggest that while biopsy of the primary tumor alone is likely sufficient in the chemotherapy-naïve patient, additional biopsies of primary or metastatic disease may be necessary to precisely tailor therapy following chemotherapy resistance or insensitivity in order to adequately account for tumor evolution. PMID:25974029

The retrospective annual surgical incidence of cystic echinococcosis in Sivas, Turkey.

PubMed

Gonlugur, U; Ozcelik, S; Gonlugur, T E; Arici, S; Celiksoz, A; Elagoz, S; Cevit, R

2009-06-01

Cystic echinococcosis is an important public health problem in our region. The aim of this study was to assess the surgical incidence of cystic echinococcosis in Sivas, Turkey. A retrospective follow-up study was carried out between 1997 and 2004. The mean age of 124 men (39.2%) and 192 women was 36.4 years. The liver was the primary site of cyst development (76.6%), followed by the lungs (19.9%), the spleen (5.4%), the kidneys (3.5%) and the peritoneal cavity (3.2%). Mean annual surgical incidence was 6.4 per 100,000 inhabitants for a 7-year period. The most common site of recurrence was the liver. Hepatic cysts were more frequently infected than pulmonary cysts (P < 0.05). In those patients with an infected cyst, the mean circulating eosinophil level was significantly lower than in those without. Rupture and infection were more common in men (P < 0.01). In conclusion, serious structural, legislative, surveillance, prevention and control measures for echinooccus should be undertaken in our region.

Diablotin Pterodroma hasitata: a biography of the endangered Black-capped Petrel

USGS Publications Warehouse

Simons, Theodore R.; Lee, David S.; Haney, J. Christopher

2013-01-01

Our findings are in accord with the recent decision by the US Fish and Wildlife Service (USFWS) to evaluate the need for additional protection of the species and the primary foraging habitat off the southeastern United States under the Endangered Species Act (USFWS 2012). Additional conservation measures and research strategies that warrant further consideration include (1) protection, monitoring, and management of known breeding populations and nesting habitat in the Dominican Republic and Haiti through controlling predators, installing artificial nest burrows in appropriate sites and hiring local wardens at breeding sites during the nesting season; (2) local and regional training, education and public awareness (e.g. Blanchard & Nettleship 1992); (3) restoration of the original common name Diablotin to common usage to promote the historical and cultural importance of this species; (4) studies to determine the distribution and genetic variability in the remaining populations; and (5) studies of satellite-tagged birds to assess their seasonal and geographic use of pelagic habitats.

NASA Integrated Space Communications Network

NASA Technical Reports Server (NTRS)

Tai, Wallace; Wright, Nate; Prior, Mike; Bhasin, Kul

2012-01-01

The NASA Integrated Network for Space Communications and Navigation (SCaN) has been in the definition phase since 2010. It is intended to integrate NASA s three existing network elements, i.e., the Space Network, Near Earth Network, and Deep Space Network, into a single network. In addition to the technical merits, the primary purpose of the Integrated Network is to achieve a level of operating cost efficiency significantly higher than it is today. Salient features of the Integrated Network include (a) a central system element that performs service management functions and user mission interfaces for service requests; (b) a set of common service execution equipment deployed at the all stations that provides return, forward, and radiometric data processing and delivery capabilities; (c) the network monitor and control operations for the entire integrated network are conducted remotely and centrally at a prime-shift site and rotating among three sites globally (a follow-the-sun approach); (d) the common network monitor and control software deployed at all three network elements that supports the follow-the-sun operations.

Evaluation of the OnSite malaria rapid test performance in Miandrivazo, Madagascar.

PubMed

Ravaoarisoa, E; Andriamiandranoro, T; Raherinjafy, R; Jahevitra, M; Razanatsiorimalala, S; Andrianaranjaka, V; Randrianarivelojosia, M

2017-10-01

The performance of the malaria rapid diagnostic test OnSite-for detecting pan specific pLDH and Plasmodium falciparum specific HRP2 - was assessed during the malaria transmission peak period in Miandrivazo, in the southwestern part of Madagascar from April 20 to May 6, 2010. At the laboratory, the quality control OnSite Malaria Rapid Test according to the WHO/TDR/FIND method demonstrated that the test had good sensitivity. Of the 218 OnSite tests performed at the Miandrivazo Primary Health Center on patients with fever or a recent history of fever, four (1.8%, 95% CI: 0.6-4.9%) were invalid. Ninety four (43,1%) cases of malaria were confirmed by microscopy, of which 90 were P. falciparum malaria and 4 Plasmodium vivax malaria. With a Cohen's kappa coefficient of 0.94, the agreement between microscopy and OnSite is excellent. Compared with the rapid test CareStart™ commonly used within the public health structures in Madagascar, the sensitivity and specificity of the OnSite test were 97.9% and 96.8%.

Primary breast tuberculosis: diagnostic and therapeutic dilemmas.

PubMed

Hiremath, Bharati V; Subramaniam, Narayana

2015-01-01

To review the diagnostic and therapeutic challenges associated with treating isolated primary breast tuberculosis through discussion of our series of seven cases. Although breast is an uncommon site of occurrence of tuberculosis and isolated primary breast tuberculosis is an even rarer entity, its importance lies in distinguishing it from more common pathologies like abscesses or malignancy and avoiding unnecessary erroneous surgical intervention. The spectrum and presentation is wide and varied and we present our experience in managing seven such cases. A retrospective analysis of all the cases of histopathologically proven primary breast tuberculosis in the last three years at M.S. Ramaiah Hospital (2012-2014) was done. Analysis was in terms of mode of presentation, clinical features, diagnostic modalities used for evaluation and confirmation of the diagnosis, medical treatment and surgical intervention, if any. Special emphasis was placed on dilemmas in diagnosis and difficulties encountered during treatment. All cases were followed up till cure. Patients most commonly presented with a breast abscess, painful breast lumps and recurrent abscesses. Other foci of tuberculosis were ruled out in all of these patients. Majority were treated exclusively with anti-tubercular therapy (although regimens varied), but those with abscesses underwent incision and drainage. All cases were treated and followed up till cure. The challenges associated with primary breast tuberculosis are multiple, including which anti-tubercular therapy regimen to use, when to surgically intervene (as the breast is a cosmetically important area) and treating atypical mycobacteria. We provide a detailed discussion of the challenges we faced and review of literature.

Septic arthritis due to tubercular and Aspergillus co-infection

PubMed Central

Kumar, Mukesh; Thilak, Jai; Zahoor, Adnan; Jyothi, Arun

2016-01-01

Aspergillus septic arthritis is a rare and serious medical and surgical problem. It occurs mainly in immunocompromised patients. Aspergillus fumigatus is the most common causative organism followed by Aspergillus flavus. The most common site affected is knee followed by shoulder, ankle, wrist, hip and sacroiliac joint. Debridement and voriconazole are primary treatment of articular aspergilosis. To the best of our knowledge, there are no reported cases of co-infection of tuberculosis (TB) and Aspergillus infecting joints. We report a case of co-infection of TB and A. flavus of hip and knee of a 60-year-old male, with type 2 diabetes mellitus. He was treated with debridement, intravenous voriconazole, and antitubercular drugs. PMID:27293296

Septic arthritis due to tubercular and Aspergillus co-infection.

PubMed

Kumar, Mukesh; Thilak, Jai; Zahoor, Adnan; Jyothi, Arun

2016-01-01

Aspergillus septic arthritis is a rare and serious medical and surgical problem. It occurs mainly in immunocompromised patients. Aspergillus fumigatus is the most common causative organism followed by Aspergillus flavus. The most common site affected is knee followed by shoulder, ankle, wrist, hip and sacroiliac joint. Debridement and voriconazole are primary treatment of articular aspergilosis. To the best of our knowledge, there are no reported cases of co-infection of tuberculosis (TB) and Aspergillus infecting joints. We report a case of co-infection of TB and A. flavus of hip and knee of a 60-year-old male, with type 2 diabetes mellitus. He was treated with debridement, intravenous voriconazole, and antitubercular drugs.

Remagnetization mechanisms in Triassic red beds from South China

NASA Astrophysics Data System (ADS)

Jiang, Zhaoxia; Liu, Qingsong; Dekkers, Mark J.; Zhao, Xiang; Roberts, Andrew P.; Yang, Zhenyu; Jin, Chunsheng; Liu, Jianxing

2017-12-01

Paleogeographic reconstructions based on paleomagnetic data rely on the reliability of the natural remanent magnetization (NRM) as a primary geomagnetic signal. Remagnetizations, however, can be common in many rock types, including late Paleozoic and Mesozoic red beds, and they complicate paleogeographic interpretations. Extracting the primary NRM from partially remagnetized rocks, and understanding the remagnetization mechanism are important in these contexts. We carried out a systematic paleomagnetic study of red bed samples from the Triassic Huangmaqing Formation, Nanjing (32.0°N, 118.9°E), South China. Two NRM components carried by secondary and primary hematite are isolated in 47 of the 94 samples studied, where the latter component has a direction in stratigraphic coordinates of D = 29.2 °, I = 34.6 ° (α95 = 10.9 °, 47 samples from 6 sites) that yields a paleopole of λ = 60.8°N, ϕ = 228.1°E, dp / dm = 12.5 / 7.2, which is consistent with Triassic pole positions for the South China Block. A secondary chemical remanent magnetization (CRM) (D = 227.1 °, I = 80.8 °, α95 = 7.3 °) is documented in all 94 samples from 10 sites and is carried by pigmentary hematite that is inferred to have been generated by magnetite oxidation during orogenic activity. This secondary component has steep inclinations and is interpreted to have been influenced by a combination of the remanence carried by original parent magnetite, the orogenic stress field, and the prevailing geomagnetic field direction during deformation. This CRM direction is recorded commonly by red beds from the South China Block, and is significant for regional tectonic studies in the area.

UVA and UVB Irradiation Differentially Regulate microRNA Expression in Human Primary Keratinocytes

PubMed Central

Kraemer, Anne; Chen, I-Peng; Henning, Stefan; Faust, Alexandra; Volkmer, Beate; Atkinson, Michael J.; Moertl, Simone; Greinert, Ruediger

2013-01-01

MicroRNA (miRNA)-mediated regulation of the cellular transcriptome is an important epigenetic mechanism for fine-tuning regulatory pathways. These include processes related to skin cancer development, progression and metastasis. However, little is known about the role of microRNA as an intermediary in the carcinogenic processes following exposure to UV-radiation. We now show that UV irradiation of human primary keratinocytes modulates the expression of several cellular miRNAs. A common set of miRNAs was influenced by exposure to both UVA and UVB. However, each wavelength band also activated a distinct subset of miRNAs. Common sets of UVA- and UVB-regulated miRNAs harbor the regulatory elements GLYCA-nTRE, GATA-1-undefined-site-13 or Hox-2.3-undefined-site-2 in their promoters. In silico analysis indicates that the differentially expressed miRNAs responding to UV have potential functions in the cellular pathways of cell growth and proliferation. Interestingly, the expression of miR-23b, which is a differentiation marker of human keratinocytes, is remarkably up-regulated after UVA irradiation. Studying the interaction between miR-23b and its putative skin-relevant targets using a Luciferase reporter assay revealed that RRAS2 (related RAS viral oncogene homolog 2), which is strongly expressed in highly aggressive malignant skin cancer, to be a direct target of miR-23b. This study demonstrates for the first time a differential miRNA response to UVA and UVB in human primary keratinocytes. This suggests that selective regulation of signaling pathways occurs in response to different UV energies. This may shed new light on miRNA-regulated carcinogenic processes involved in UV-induced skin carcinogenesis. PMID:24391759

Childhood Obesity Research Demonstration Project: Cross-Site Evaluation Methods

PubMed Central

Lee, Rebecca E.; Mehta, Paras; Thompson, Debbe; Bhargava, Alok; Carlson, Coleen; Kao, Dennis; Layne, Charles S.; Ledoux, Tracey; O'Connor, Teresia; Rifai, Hanadi; Gulley, Lauren; Hallett, Allen M.; Kudia, Ousswa; Joseph, Sitara; Modelska, Maria; Ortega, Dana; Parker, Nathan; Stevens, Andria

2015-01-01

Abstract Introduction: The Childhood Obesity Research Demonstration (CORD) project links public health and primary care interventions in three projects described in detail in accompanying articles in this issue of Childhood Obesity. This article describes a comprehensive evaluation plan to determine the extent to which the CORD model is associated with changes in behavior, body weight, BMI, quality of life, and healthcare satisfaction in children 2–12 years of age. Design/Methods: The CORD Evaluation Center (EC-CORD) will analyze the pooled data from three independent demonstration projects that each integrate public health and primary care childhood obesity interventions. An extensive set of common measures at the family, facility, and community levels were defined by consensus among the CORD projects and EC-CORD. Process evaluation will assess reach, dose delivered, and fidelity of intervention components. Impact evaluation will use a mixed linear models approach to account for heterogeneity among project-site populations and interventions. Sustainability evaluation will assess the potential for replicability, continuation of benefits beyond the funding period, institutionalization of the intervention activities, and community capacity to support ongoing program delivery. Finally, cost analyses will assess how much benefit can potentially be gained per dollar invested in programs based on the CORD model. Conclusions: The keys to combining and analyzing data across multiple projects include the CORD model framework and common measures for the behavioral and health outcomes along with important covariates at the individual, setting, and community levels. The overall objective of the comprehensive evaluation will develop evidence-based recommendations for replicating and disseminating community-wide, integrated public health and primary care programs based on the CORD model. PMID:25679060

International use of an academic nephrology World Wide Web site: from medical information resource to business tool.

PubMed

Abbott, Kevin C; Oliver, David K; Boal, Thomas R; Gadiyak, Grigorii; Boocks, Carl; Yuan, Christina M; Welch, Paul G; Poropatich, Ronald K

2002-04-01

Studies of the use of the World Wide Web to obtain medical knowledge have largely focused on patients. In particular, neither the international use of academic nephrology World Wide Web sites (websites) as primary information sources nor the use of search engines (and search strategies) to obtain medical information have been described. Visits ("hits") to the Walter Reed Army Medical Center (WRAMC) Nephrology Service website from April 30, 2000, to March 14, 2001, were analyzed for the location of originating source using Webtrends, and search engines (Google, Lycos, etc.) were analyzed manually for search strategies used. From April 30, 2000 to March 14, 2001, the WRAMC Nephrology Service website received 1,007,103 hits and 12,175 visits. These visits were from 33 different countries, and the most frequent regions were Western Europe, Asia, Australia, the Middle East, Pacific Islands, and South America. The most frequent organization using the site was the military Internet system, followed by America Online and automated search programs of online search engines, most commonly Google. The online lecture series was the most frequently visited section of the website. Search strategies used in search engines were extremely technical. The use of "robots" by standard Internet search engines to locate websites, which may be blocked by mandatory registration, has allowed users worldwide to access the WRAMC Nephrology Service website to answer very technical questions. This suggests that it is being used as an alternative to other primary sources of medical information and that the use of mandatory registration may hinder users from finding valuable sites. With current Internet technology, even a single service can become a worldwide information resource without sacrificing its primary customers.

Metastatic spread pattern after curative colorectal cancer surgery. A retrospective, longitudinal analysis.

PubMed

Augestad, K M; Bakaki, P M; Rose, J; Crawshaw, B P; Lindsetmo, R O; Dørum, L M; Koroukian, S M; Delaney, C P

2015-10-01

The most common sites of colorectal cancer (CRC) recurrence are the local tissues, liver or lungs. The objective was to identify risk factors associated with the primary CRC tumor and cancer recurrence in these anatomical sites. Retrospective, longitudinal analyses of data on CRC survivors. Multivariable Cox regression analysis was performed to examine the association between possible cofounders with recurrence to various anatomical sites. Data for 10,398CRC survivors (tumor location right colon=3870, left colon=2898, high rectum=2569, low rectum=1061) were analyzed; follow up time was up to five years. Mean age at curative surgery was 71.5 (SD 11.8) years, 20.2% received radio-chemotherapy, stage T3 (64.4%) and N0 (65.1%) were most common. Overall 1632 (15.7%) had cancer recurrence (Isolated liver n=412, 3,8%;  isolated lung n=252, 2,4%; isolated local n=223, 2.1%). Risk factors associated with recurrent CRC were identified, i.e. isolated liver metastases (male: Adjusted Hazard Ratio (AHR) 1,45; colon left: AHR 1,63; N2 disease: AHR 3,35; T2 disease: AHR 2,82), isolated lung metastases (colon left: AHR 1,53; rectum high: AHR 2,48; rectum low: AHR 2,65; N2 disease 3,76), and local recurrence (glands examined<12: AHR 1,51; CRM <3mm: AHR 1,60; rectum high: AHR 2,15; N2 disease: AHR 2,58) (all p values <0001). Our study finds that the site of the primary CRC tumor is associated with location of subsequent metastasis. Left sided colon cancers have increased risk of metastatic spread to the liver, whereas rectal cancers have increased risk of local recurrence and metastatic spread to the lungs. These results, in combination with other risk factors for CRC recurrence, should be taken into consideration when designing risk adapted post-treatment CRC surveillance programs. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Patterns of metal composition and biological condition and their association in male common carp across an environmental contaminant gradient in Lake Mead National Recreation Area, Nevada and Arizona, USA

USGS Publications Warehouse

Patino, R.; Rosen, Michael R.; Orsak, E.L.; Goodbred, S.L.; May, T.W.; Alvarez, David; Echols, K.R.; Wieser, C.M.; Ruessler, S.; Torres, L.

2012-01-01

There is a contaminant gradient in Lake Mead National Recreation Area (LMNRA) that is partly driven by municipal and industrial runoff and wastewater inputs via Las Vegas Wash (LVW). Adult male common carp (Cyprinus carpio; 10 fish/site) were collected from LVW, Las Vegas Bay (receiving LVW flow), Overton Arm (OA, upstream reference), and Willow Beach (WB, downstream) in March 2008. Discriminant function analysis was used to describe differences in metal concentrations and biological condition of fish collected from the four study sites, and canonical correlation analysis was used to evaluate the association between metal and biological traits. Metal concentrations were determined in whole-body extracts. Of 63 metals screened, those initially used in the statistical analysis were Ag, As, Ba, Cd, Co, Fe, Hg, Pb, Se, Zn. Biological variables analyzed included total length (TL), Fulton's condition factor, gonadosomatic index (GSI), hematocrit (Hct), and plasma estradiol-17?? and 11-ketotestosterone (11kt) concentrations. Analysis of metal composition and biological condition both yielded strong discrimination of fish by site (respective canonical model, p< 0.0001). Compared to OA, pairwise Mahalanobis distances between group means were WB < LVB < LVW for metal concentrations and LVB < WB < LVW for biological traits. Respective primary drivers for these separations were Ag, As, Ba, Hg, Pb, Se and Zn; and TL, GSI, 11kt, and Hct. Canonical correlation analysis using the latter variable sets showed they are significantly associated (p<0.0003); with As, Ba, Hg, and Zn, and TL, 11kt, and Hct being the primary contributors to the association. In conclusion, male carp collected along a contaminant gradient in LMNRA have distinct, collection site-dependent metal and morpho-physiological profiles that are significantly associated with each other. These associations suggest that fish health and reproductive condition (as measured by the biological variables evaluated in this study) are influenced by levels of certain metals in the Lake Mead environment. ?? 2011.

Comparison of Multivariate Spatial Dependence Structures of DPIL and Flowmeter Hydraulic Conductivity Data Sets at the MADE Site

NASA Astrophysics Data System (ADS)

Xiao, B.; Haslauer, C. P.; Bohling, G. C.; Bárdossy, A.

2017-12-01

The spatial arrangement of hydraulic conductivity (K) determines water flow and solute transport behaviour in groundwater systems. This presentation demonstrates three advances over commonly used geostatistical methods by integrating measurements from novel measurement techniques and novel multivariate non-Gaussian dependence models: The spatial dependence structure of K was analysed using both data sets of K. Previously encountered similarities were confirmed in low-dimensional dependence. These similarities become less stringent and deviate more from symmetric Gaussian dependence in dimensions larger than two. Measurements of small and large K values are more uncertain than medium K values due to decreased sensitivity of the measurement devices at both ends of the K scale. Nevertheless, these measurements contain useful information that we include in the estimation of the marginal distribution and the spatial dependence structure as ``censored measurements'' that are estimated jointly without the common assumption of independence. The spatial dependence structure of the two data sets and their cross-covariances are used to infer the spatial dependence and the amount of the bias between the two data sets. By doing so, one spatial model for K is constructed that is used for simulation and that reflects the characteristics of both measurement techniques. The concept of the presented methodology is to use all available information for the estimation of a stochastic model of the primary parameter (K) at the highly heterogeneous Macrodispersion Experiment (MADE) site. The primary parameter has been measured by two independent measurement techniques whose sets of locations do not overlap. This site offers the unique opportunity of large quantities of measurements of K (31123 direct push injection logging based measurements and 2611 flowmeter based measurements). This improved dependence structure of K will be included into the estimated non-Gaussian dependence models and is expected to reproduce observed solute concentrations at the site better than existing dependence models of K.

Cytology of primary vaginal melanoma: An unusual report on fine needle aspiration.

PubMed

Agarwal, Poojan; Kaushal, Manju

2017-03-01

Primary malignant melanoma of the vagina is an extremely uncommon malignancy comprising of less than 10% malignancies of the female genital tract and 0.3% of all melanomas. Melanoblasts are neural crest derivatives and are notorious for causing primary cutaneous neoplasms. However, they involve virtually every organ of the body including eye, intestines and ocular mucosa, probably due to aberrancies in cell migration. Vagina is a rare site and primary melanoma of the vagina occurs in postmenopausal women with vaginal discharge, bleeding, or mass as common presenting complaints. Only a handful of case reports are available describing this entity on biopsy and PAP smear samples; however, fine needle aspiration has seldom been discussed. In the present report we discuss a case of an elderly female who complained of mass protruding through the vaginal opening, FNAC was done from the mass as well as from the right inguinal lymph node. An extensive clinicoradiological workup, and immunohistochemical confirmation is essential to rule out metastatic lesions and confirm primary. Diagn. Cytopathol. 2017;45:252-256. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Impact of WWII dumpsites on Saipan (CNMI): heavy metal status of soils and sediments.

PubMed

Denton, Gary R W; Emborski, Carmen A; Hachero, April A B; Masga, Ray S; Starmer, John A

2016-06-01

A number of dumpsites occur on the island of Saipan and in the surrounding coastal waters. Many of these sites date back to the immediate post WWII clean-up period and contain a variety of wartime wastes. Metallic debris is generally the most visible waste material and commonly includes bomb fragments, artillery shells, bullets, and other military hardware. In this investigation, we examined the heavy metal status of soils from around several of these dumpsites and in any obvious drainage pathways leading from them to the coast. Sediments were also taken for analysis from a number of coastal discharge points and three submerged sites. Metal enrichment was evident for one or more elements in deposits from two of the three submerged sites and 24 of the 32 land-based sites visited. Copper, Pb, and Zn were the most commonly encountered contaminant metals with levels well in excess of 1000 μg/g(-1) in several instances. Elevated Hg and Cd concentrations were also relatively widespread throughout the study area although levels of each element seldom exceeded 1.0 and 10.0 μg/g(-1), respectively. Silver, another element of toxicological concern, was only occasionally detected despite registering a high of 42 μg/g(-1) at one particular site. The metal data were weighed against established benchmarks formulated for the protection of human and ecological health. Implications of the findings and issues of primary concern are briefly addressed.

A Cluster-Randomized Controlled Trial to Reduce Diarrheal Disease and Dengue Entomological Risk Factors in Rural Primary Schools in Colombia

PubMed Central

Overgaard, Hans J.; Alexander, Neal; Matiz, Maria Ines; Jaramillo, Juan Felipe; Olano, Victor Alberto; Vargas, Sandra; Sarmiento, Diana; Lenhart, Audrey; Stenström, Thor Axel

2016-01-01

Background As many neglected tropical diseases are co-endemic and have common risk factors, integrated control can efficiently reduce disease burden and relieve resource-strained public health budgets. Diarrheal diseases and dengue fever are major global health problems sharing common risk factors in water storage containers. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Integrating improved water management and educational strategies for both diseases in the school environment can potentially improve the health situation for students and the larger community. The objective of this trial was to investigate whether interventions targeting diarrhea and dengue risk factors would significantly reduce absence due to diarrheal disease and dengue entomological risk factors in schools. Methodology/Principal Findings A factorial cluster randomized controlled trial was carried out in 34 rural primary schools (1,301 pupils) in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Schools were randomized to one of four study arms: diarrhea interventions (DIA), dengue interventions (DEN), combined diarrhea and dengue interventions (DIADEN), and control (CON). Interventions had no apparent effect on pupil school absence due to diarrheal disease (p = 0.45) or on adult female Aedes aegypti density (p = 0.32) (primary outcomes). However, the dengue interventions reduced the Breteau Index on average by 78% (p = 0.029), with Breteau indices of 10.8 and 6.2 in the DEN and DIADEN arms, respectively compared to 37.5 and 46.9 in the DIA and CON arms, respectively. The diarrhea interventions improved water quality as assessed by the amount of Escherichia coli colony forming units (CFU); the ratio of Williams mean E. coli CFU being 0.22, or 78% reduction (p = 0.008). Conclusions/Significance Integrated control of dengue and diarrhea has never been conducted before. This trial presents an example for application of control strategies that may affect both diseases and the first study to apply such an approach in school settings. The interventions were well received and highly appreciated by students and teachers. An apparent absence of effect in primary outcome indicators could be the result of pupils being exposed to risk factors outside the school area and mosquitoes flying in from nearby uncontrolled breeding sites. Integrated interventions targeting these diseases in a school context remain promising because of the reduced mosquito breeding and improved water quality, as well as educational benefits. However, to improve outcomes in future integrated approaches, simultaneous interventions in communities, in addition to schools, should be considered; using appropriate combinations of site-specific, effective, acceptable, and affordable interventions. Trial Registration ClinicalTrials.gov no. ISRCTN40195031 PMID:27820821

External and interstitial radiation therapy of carcinoma of the oral tongue. A review of 32 years' experience.

PubMed

Fu, K K; Ray, J W; Chan, E K; Phillips, T L

1976-01-01

In 204 patients with squamous cell carcinoma of the oral tongue treated with radiation therapy, the most significant prognostic factors appeared to be the presence of neck lymph node metastasis on presentation and the status of the disease three months after treatment. The most common site of failure was the primary lesion, either alone or with neck disease. External irradiation alone was seldom successful. Use of peroral cone irradiation or interstitial implants, either alone or in combination with external irradiation, achieved good local control in early lesions. When the primary tumor was uncontrolled by radiation therapy, salvage with surgery was rare. When failure occurred in the neck alone, radical neck dissection was successful in the majority of cases.

Common coastal foraging areas for loggerheads in the Gulf of Mexico: Opportunities for marine conservation

USGS Publications Warehouse

Hart, Kristen M.; Lamont, Margaret M.; Fujisaki, Ikuko; Tucker, Anton D.; Carthy, Raymond R.

2012-01-01

Designing conservation strategies that protect wide-ranging marine species is a significant challenge, but integrating regional telemetry datasets and synthesizing modeled movements and behavior offer promise for uncovering distinct at-sea areas that are important habitats for imperiled marine species. Movement paths of 10 satellite-tracked female loggerheads (Caretta caretta) from three separate subpopulations in the Gulf of Mexico, USA, revealed migration to discrete foraging sites in two common areas at-sea in 2008, 2009, and 2010. Foraging sites were 102–904 km away from nesting and tagging sites, and located off southwest Florida and the northern Yucatan Peninsula, Mexico. Within 3–35 days, turtles migrated to foraging sites where they all displayed high site fidelity over time. Core-use foraging areas were 13.0–335.2 km2 in size, in water <50 m deep, within a mean distance to nearest coastline of 58.5 km, and in areas of relatively high net primary productivity. The existence of shared regional foraging sites highlights an opportunity for marine conservation strategies to protect important at-sea habitats for these imperiled marine turtles, in both USA and international waters. Until now, knowledge of important at-sea foraging areas for adult loggerheads in the Gulf of Mexico has been limited. To better understand the spatial distribution of marine turtles that have complex life-histories, we propose further integration of disparate tracking data-sets at the oceanic scale along with modeling of movements to identify critical at-sea foraging habitats where individuals may be resident during non-nesting periods.

Emergence of Secondary Trigger Sites after Primary Migraine Surgery.

PubMed

Punjabi, Ayesha; Brown, Matthew; Guyuron, Bahman

2016-04-01

Surgical decompression of a migraine headache may unmask headaches originating from secondary sites. A retrospective chart review investigated the incidence and characteristics of secondary trigger sites to identify clinical patterns that could aid in predicting and perhaps reducing postoperative migraines. One hundred eighty-five charts for migraine patients who underwent surgery at the senior author's (B.G.) practice were reviewed. Sites from which migraine headaches initiated or occurred independently were considered primary. The sites that were not active at the time of preoperative evaluation but became active after surgery were considered secondary. Bivariate analysis was performed to characterize postoperative migraines. Of 185 patients, 33 (17.8 percent) developed secondary migraine headache trigger sites. Of patients with primary site I (frontal) symptoms, 20.83 percent had site III (septonasal) symptoms unmasked after surgery (versus 7 percent for patients with other primary sites; p = 0.04). Of the patients with site II (temporal) migraines, 17.14 percent had secondary frontal symptoms (versus 5.68 percent; p = 0.04). Primary site II symptoms predicted postoperative site IV (occipital) symptoms (11.43 versus 1.1 percent; p = 0.008), and primary occipital symptoms predicted postoperative temporal symptoms (11.1 versus 2.33 percent; p = 0.04). The authors observed that 17.8 percent of patients develop postoperative migraine headache triggers that are not reported during the initial assessment. Knowledge of secondary migraine emergence patterns, and the presence of some preoperative symptoms, can aid in predicting the migraines that will arise from a new site postoperatively. Therapeutic, IV.

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

PubMed

Pellegrini, Joseph E; Toledo, Paloma; Soper, David E; Bradford, William C; Cruz, Deborah A; Levy, Barbara S; Lemieux, Lauren A

2017-01-01

Surgical site infections are the most common complication of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged.

Benign metastasizing leiomyoma: A review of current literature in respect to the time and type of previous gynecological surgery

PubMed Central

Barnaś, Edyta; Książek, Mariusz; Raś, Renata; Skręt, Andrzej; Skręt- Magierło, Joanna; Dmoch- Gajzlerska, Ewa

2017-01-01

Introduction Benign metastasizing leiomyoma (BML) is a rare disorder that affects women with a history of uterine leiomyoma, which is found to metastasise within extrauterine sites. The aetiology of BML remains unexplained. Because BML is rare, and most publications contain descriptions of single cases, no statistically determined time relations were found between the primary and secondary surgeries, which may have aetiological implications. Objectives To determine age before BML surgery, age during diagnosis of BML, type of prior surgery, and location of metastasis based on the literature. Methods A systematic review of four databases (Medline/PubMed, Embase, Web of Science, and Cochrane) covering articles published from 1 January 1965 to 10 April 2016. The inclusion criteria were full-text articles in English and articles containing case reports. Articles in languages other than English (39), articles containing incomplete data (14), i.e. no information regarding the time of surgery and/or the site of metastasis, articles bereft of case studies (25), and articles with access only to summaries, without access to the complete text (10) were excluded. Of 321 titles identified, only 126 articles met the aforementioned criteria. Results and conclusions The mean age during primary surgery and BML diagnosis was 38.5 years and 47.3 years, respectively. The most common surgery was total hysterectomy. The most frequent site of metastasis was the lungs; other organs were affected less frequently.The site of metastases and their number were not related to the longer time span between the patient’s initial surgery and occurrence of metastasis. The analysed data, such as the age during primary surgery, age during BML diagnosis, site and type of metastasis, do not provide us a clear answer. Thus, BML pathogenesis is most probably complex in nature and requires further multidirectional research. PMID:28426767

Contamination of the Surgical Field with Propionibacterium acnes in Primary Shoulder Arthroplasty.

PubMed

Falconer, Travis M; Baba, Mohammed; Kruse, Lisa M; Dorrestijn, Oscar; Donaldson, Matthew J; Smith, Margaret M; Figtree, Melanie C; Hudson, Bernard J; Cass, Benjamin; Young, Allan A

2016-10-19

Propionibacterium acnes is a common pathogen identified in postoperative shoulder infection. It has been shown to be present in culture specimens during primary shoulder arthroplasty; however, recent work has suggested that it is most likely to be a contaminant. Our aim was to identify the potential sources of contamination in shoulder arthroplasty. Tissue swabs were obtained for microbiological analysis from consecutive patients undergoing primary shoulder arthroplasty. Routine surgical technique was maintained, and 5 specimens were taken from different sites: (1) the subdermal layer, (2) the tip of the surgeon's glove, (3) the inside scalpel blade (used for deeper incision), (4) the forceps, and (5) the outside scalpel blade (used for the skin incision). Forty patients (25 female patients and 15 male patients) were included. Thirteen (33%) of the 40 patients had at least 1 culture specimen positive for P. acnes. Two (8%) of the 25 female patients and 11 (73%) of the 15 male patients had ≥1 culture specimen positive for P. acnes. The most common site of growth of P. acnes was the subdermal layer (12 positive samples), followed by the forceps (7 positive samples), the tip of the surgeon's glove (7 positive samples), the outside scalpel blade (4 positive samples), and the inside scalpel blade (1 positive sample). There were 27 of 75 swabs that were positive on culture for P. acnes in male patients compared with 4 of 125 swabs in female patients. Male patients had 66 times (95% confidence interval, 6 to 680 times) higher odds of having a positive culture indicating subdermal colonization compared with female patients (p < 0.001). P. acnes is a common contaminant of the surgical field in primary shoulder arthroplasty. The subdermal layer may be the source of this contamination, and the prevalence of P. acnes in the surgical wound may be due to the surgeon's manipulation with gloves and instruments. Our findings are consistent with those regarding the increased rates of P. acnes bacterial load and intraoperative growth in male patients compared with female patients. P. acnes is likely to be spread throughout the surgical field from the subdermal layer via soft-tissue handling by the surgeon and instruments. Strategies need to be utilized to minimize this contact and to reduce the chance of colonization. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Clinicopathological and immunohistochemical features of primary central nervous system germ cell tumors: a 24-years experience.

PubMed

Gao, Yuping; Jiang, Jiyao; Liu, Qiang

2014-01-01

Primary central nervous system (CNS) germ cell tumors (GCTs) are a rare heterogeneous group of lesions, which the clinicopathological features have a marked degree of heterogeneity comparing with that of gonadal GCTs. Accurately diagnosing CNS GCTs might be extremely difficult and requires immunohistochemical verification. This study was to investigate the biological feature of CNS GCTs and diagnostic value of immunohistochemical markers OCT3/4, C-kit, PLAP, and CD30 in CNS GCTs. A retrospective study was performed on 34 patients with CNS germ cell tumors between 1990 and 2014. 34 CNS GCTs account for 9.2% of all primary CNS neoplasms. The sellar region (35.3%) and pineal gland (17.6%) were the most common sites of intracranial GCTs. Hydrocephalus (82.4%) and diplopia (46.9%) were the two most common clinical presentations. The most common histological subtypes were germinoma (67.6%). PLAP, c-kit, OCT3/4 were highly expressed in gernimomas. CD30 and CK AE1/3 stainings were positive in embryonal carcinoma. Yolk sac tumor component showed positive staining for AFP and CK AE1/3. β-HCG staining was positive in choriocarcinoma and STGC. Patients with mature teratomas and germinomas had a better prognosis (a 5-year survival rate) than those with embryonal carcinoma and choriocarcinoma (a 5-year survival rates were 0). Our finding suggest that the incidences of primary CNS GCTs are higher in South China than in the West, but mixed GCTs are uncommon in our study. The judicious use of a panel of selected markers is helpful in diagnosing and predicting the prognosis for CNS GCTs.

Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

PubMed Central

Hill, Jonathan C.; Foster, Nadine E.; Protheroe, Joanne

2017-01-01

Background & aims Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. Methods A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach. Results Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options. Conclusion This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed. PMID:28640822

Concurrent Umbilical Hernia Repair at the Time of Liver Transplantation: A Six-Year Experience from a Single Institution

PubMed Central

Perez, A. J.; Haskins, I. N.; Prabhu, A. S.; Krpata, D. M.; Tu, C.; Rosenblatt, S.; Hashimoto, K.; Diago, T.; Eghtesad, B.; Rosen, M. l. J.

2018-01-01

Background: Umbilical hernias are common in patients with end-stage liver disease undergoing liver transplantation. Management of those persisting at the time of liver transplantation is important to define. Objective: To evaluate the long-term results of patients undergoing simultaneous primary umbilical hernia repair (UHR) at the time of liver transplantation at a single institution. Methods: Retrospective chart review was performed on patients undergoing simultaneous UHR and liver transplantation from 2010 through 2016. 30-day morbidity and mortality outcomes and long-term hernia recurrence were investigated. Results: 59 patients had primary UHR at the time of liver transplantation. All hernias were reducible with no overlying skin breakdown or leakage of ascites. 30-day morbidity and mortality included 5 (8%) superficial surgical site infections, 1 (2%) deep surgical site infection, and 7 (12%) organ space infections. Unrelated to the UHR, 10 (17%) patients had an unplanned return to the operating room, 16 (27%) were readmitted within 30 days of their index operation, and 1 (2%) patient died. With a mean follow-up of 21.8 months, 7 (18%) patients experienced an umbilical hernia recurrence. Conclusion: Despite the high perioperative morbidity associated with the transplant procedure, concurrent primary UHR resulted in an acceptable long-term recurrence rate with minimal associated morbidity. PMID:29531643

Concurrent Umbilical Hernia Repair at the Time of Liver Transplantation: A Six-Year Experience from a Single Institution.

PubMed

Perez, A J; Haskins, I N; Prabhu, A S; Krpata, D M; Tu, C; Rosenblatt, S; Hashimoto, K; Diago, T; Eghtesad, B; Rosen, M L J

2018-01-01

Umbilical hernias are common in patients with end-stage liver disease undergoing liver transplantation. Management of those persisting at the time of liver transplantation is important to define. To evaluate the long-term results of patients undergoing simultaneous primary umbilical hernia repair (UHR) at the time of liver transplantation at a single institution. Retrospective chart review was performed on patients undergoing simultaneous UHR and liver transplantation from 2010 through 2016. 30-day morbidity and mortality outcomes and long-term hernia recurrence were investigated. 59 patients had primary UHR at the time of liver transplantation. All hernias were reducible with no overlying skin breakdown or leakage of ascites. 30-day morbidity and mortality included 5 (8%) superficial surgical site infections, 1 (2%) deep surgical site infection, and 7 (12%) organ space infections. Unrelated to the UHR, 10 (17%) patients had an unplanned return to the operating room, 16 (27%) were readmitted within 30 days of their index operation, and 1 (2%) patient died. With a mean follow-up of 21.8 months, 7 (18%) patients experienced an umbilical hernia recurrence. Despite the high perioperative morbidity associated with the transplant procedure, concurrent primary UHR resulted in an acceptable long-term recurrence rate with minimal associated morbidity.

Botulinum Toxin Type A for the Treatment of Primary Hyperhidrosis: A Prospective Study of 52 Patients.

PubMed

Martí, N; Ramón, D; Gámez, L; Reig, I; García-Pérez, M Á; Alonso, V; Jordá, E

2010-09-01

Primary hyperhidrosis is characterized by excessive sweating in a defined region of the body. It should not be considered a purely cosmetic problem as it has a significant impact on the social and professional relationships of affected individuals. The aim of this study was to determine the clinical profile of patients with primary hyperhidrosis and assess the results obtained with the use of botulinum toxin type A (BTX-A) in clinical practice. The study included 52 patients (39 women and 13 men) with a diagnosis of primary hyperhidrosis treated for the first time with BTX-A. All patients completed a questionnaire that included the following information: age; sex; profession; age at onset, family history, and site of hyperhidrosis; accompanying signs and symptoms, and previous treatment; time to effect of BTX-A; local or systemic side effects; and severity of hyperhidrosis before and after BTX-A treatment. Primary hyperhidrosis began during puberty in 61.5% of the patients included in the study, 75% were women, and the mean age was 29.9 years. In 36.5% of patients, first-degree relatives also had primary hyperhidrosis. Hyperhidrosis was classified as palmar in 61.5% of cases, plantar in 53.8%, and axillary in 59.6%. Other sites were affected less frequently. The most common accompanying symptoms were facial erythema (32.7%), palpitations (30.7%), muscle tension (28.8%), shivering (23%), and headache (17.3%). Treatment with BTX-A was well tolerated and there was a highly significant reduction in the severity of hyperhidrosis 2 months after performing the treatment (P<0.001). Copyright © 2009 Elsevier España, S.L. y AEDV. All rights reserved.

Primary production export flux in Marguerite Bay (Antarctic Peninsula): Linking upper water-column production to sediment trap flux

NASA Astrophysics Data System (ADS)

Weston, Keith; Jickells, Timothy D.; Carson, Damien S.; Clarke, Andrew; Meredith, Michael P.; Brandon, Mark A.; Wallace, Margaret I.; Ussher, Simon J.; Hendry, Katharine R.

2013-05-01

A study was carried out to assess primary production and associated export flux in the coastal waters of the western Antarctic Peninsula at an oceanographic time-series site. New, i.e., exportable, primary production in the upper water-column was estimated in two ways; by nutrient deficit measurements, and by primary production rate measurements using separate 14C-labelled radioisotope and 15N-labelled stable isotope uptake incubations. The resulting average annual exportable primary production estimates at the time-series site from nutrient deficit and primary production rates were 13 and 16 mol C m-2, respectively. Regenerated primary production was measured using 15N-labelled ammonium and urea uptake, and was low throughout the sampling period. The exportable primary production measurements were compared with sediment trap flux measurements from 2 locations; the time-series site and at a site 40 km away in deeper water. Results showed ˜1% of the upper mixed layer exportable primary production was exported to traps at 200 m depth at the time-series site (total water column depth 520 m). The maximum particle flux rate to sediment traps at the deeper offshore site (total water column depth 820 m) was lower than the flux at the coastal time-series site. Flux of particulate organic carbon was similar throughout the spring-summer high flux period for both sites. Remineralisation of particulate organic matter predominantly occurred in the upper water-column (<200 m depth), with minimal remineralisation below 200 m, at both sites. This highly productive region on the Western Antarctic Peninsula is therefore best characterised as 'high recycling, low export'.

Differential responses of carbon and water vapor fluxes to climate among evergreen needleleaf forests in the USA

DOE PAGES

Wagle, Pradeep; Xiao, Xiangming; Kolb, Thomas E.; ...

2016-05-31

Here, understanding the differences in carbon and water vapor fluxes of spatially distributed evergreen needleleaf forests (ENFs) is crucial for accurately estimating regional or global carbon and water budgets and when predicting the responses of ENFs to current and future climate. We compared the fluxes of ten AmeriFlux ENF sites to investigate cross-site variability in net ecosystem exchange of carbon (NEE), gross primary production (GPP), and evapotranspiration (ET). We used wavelet cross-correlation analysis to examine responses of NEE and ET to common climatic drivers over multiple timescales and also determined optimum values of air temperature (T a) and vapor pressuremore » deficit (VPD) for NEE and ET.« less

Differential responses of carbon and water vapor fluxes to climate among evergreen needleleaf forests in the USA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wagle, Pradeep; Xiao, Xiangming; Kolb, Thomas E.

Here, understanding the differences in carbon and water vapor fluxes of spatially distributed evergreen needleleaf forests (ENFs) is crucial for accurately estimating regional or global carbon and water budgets and when predicting the responses of ENFs to current and future climate. We compared the fluxes of ten AmeriFlux ENF sites to investigate cross-site variability in net ecosystem exchange of carbon (NEE), gross primary production (GPP), and evapotranspiration (ET). We used wavelet cross-correlation analysis to examine responses of NEE and ET to common climatic drivers over multiple timescales and also determined optimum values of air temperature (T a) and vapor pressuremore » deficit (VPD) for NEE and ET.« less

Metastatic mucosal melanoma: imaging patterns of metastasis and recurrence

PubMed Central

O’Regan, Kevin; Ramaiya, Nikhil; Jagannathan, Jyothi; DiPiro, Pamela J.; Stephen Hodi, F.; Van den Abbeele, Annick D.

2013-01-01

Abstract Purpose: Mucosal melanoma is a rare but aggressive subtype of melanoma with unique clinicopathologic features. We hypothesize that mucosal melanoma shows predilection for separate and unique metastatic pathways. Materials and methods: This was a retrospective analysis of 19 patients (5 men and 14 women; median age 60 years, range 38–76 years) with metastatic mucosal melanoma presenting to a tertiary oncology center between 2005 and 2010. We performed a review of medical records and histologic and imaging studies to evaluate the natural history, metastatic patterns and the role of imaging in the management of patients with advanced mucosal melanoma. Results: At presentation, disease was confined to the primary site (58%, n = 11) or to the regional lymph nodes (32%, n = 6) in most patients. The most common site of metastasis was the lungs (89%, n = 16), followed by the liver (67%, n = 12) and peritoneum (44%, n = 8). Sinonasal melanoma preferentially spread to the liver (100%, n = 4), vaginal melanoma to the lungs (100%, n = 7) and anal melanoma to the inguinal lymph nodes (100%, n = 4). Conclusion: Pathways of metastatic spread in mucosal melanoma may differ from other forms of melanoma and between different primary sites of mucosal origin. PMID:24434078

Heat shock protein 27 regulates human prostate cancer cell motility and metastatic progression

PubMed Central

Voll, Eric A; Ogden, Irene M; Pavese, Janet M; Huang, XiaoKe; Xu, Li; Jovanovic, Borko D; Bergan, Raymond C

2014-01-01

Prostate cancer (PCa) is the most common form of cancer in American men. Mortality from PCa is caused by the movement of cancer cells from the primary organ to form metastatic tumors at distant sites. Heat shock protein 27 (HSP27) is known to increase human PCa cell invasion and its overexpression is associated with metastatic disease. The role of HSP27 in driving PCa cell movement from the prostate to distant metastatic sites is unknown. Increased HSP27 expression increased metastasis as well as primary tumor mass. In vitro studies further examined the mechanism of HSP27-induced metastatic behavior. HSP27 did not affect cell detachment, adhesion, or migration, but did increase cell invasion. Cell invasion was dependent upon matrix metalloproteinase 2 (MMP-2), whose expression was increased by HSP27. In vivo, HSP27 induced commensurate changes in MMP-2 expression in tumors. These findings demonstrate that HSP27 drives metastatic spread of cancer cells from the prostate to distant sites, does so across a continuum of expression levels, and identifies HSP27-driven increases in MMP-2 expression as functionally relevant. These findings add to prior studies demonstrating that HSP27 increases PCa cell motility, growth and survival. Together, they demonstrate that HSP27 plays an important role in PCa progression. PMID:24798191

Revisiting renal amyloidosis with clinicopathological characteristics, grading, and scoring: A single-institutional experience.

PubMed

Kalle, Abhiram; Gudipati, Archana; Raju, Sree Bhushan; Kalidindi, Karthik; Guditi, Swarnalatha; Taduri, Gangadhar; Uppin, Megha S

2018-01-01

Kidney involvement is a major cause of mortality in systemic amyloidosis. Glomerulus is the most common site of deposition in renal amyloidosis, and nephrotic syndrome is the most common presentation. Distinction between AA and AL is done using immunofluorescence (IF) and immunohistochemistry (IHC). Renal biopsy helps in diagnosis and also predicting the clinical course by applying scoring and grading to the biopsy findings. The study includes all cases of biopsy-proven renal amyloidosis from January 2008 to May 2017. Light microscopic analysis; Congo red with polarization; IF; IHC for Amyloid A, kappa, and lambda; and bone marrow evaluation were done. Classification of glomerular amyloid deposition and scoring and grading are done as per the guidelines of Sen S et al . There are 40 cases of biopsy-proven renal amyloidosis with 12 primary and 23 secondary cases. Mean age at presentation was 42.5 years. Edema was the most common presenting feature. Secondary amyloidosis cases were predominant. Tuberculosis was the most common secondary cause. Multiple myeloma was detected in four primary cases. Grading of renal biopsy features showed a good correlation with the class of glomerular involvement. Clinical history, IF, and IHC are essential in amyloid typing. Grading helps provide a subtle guide regarding the severity of disease in the background of a wide range of morphological features and biochemical values. Typing of amyloid is also essential for choosing the appropriate treatment.

Pathways to Medical Home Recognition: A Qualitative Comparative Analysis of the PCMH Transformation Process.

PubMed

Mendel, Peter; Chen, Emily K; Green, Harold D; Armstrong, Courtney; Timbie, Justin W; Kress, Amii M; Friedberg, Mark W; Kahn, Katherine L

2017-12-15

To understand the process of practice transformation by identifying pathways for attaining patient-centered medical home (PCMH) recognition. The CMS Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration was designed to help FQHCs achieve NCQA Level 3 PCMH recognition and improve patient outcomes. We used a stratified random sample of 20 (out of 503) participating sites for this analysis. We developed a conceptual model of structural, cultural, and implementation factors affecting PCMH transformation based on literature and initial qualitative interview themes. We then used conventional cross-case analysis, followed by qualitative comparative analysis (QCA), a cross-case method based on Boolean logic algorithms, to systematically identify pathways (i.e., combinations of factors) associated with attaining-or not attaining-Level 3 recognition. Site-level indicators were derived from semistructured interviews with site leaders at two points in time (mid- and late-implementation) and administrative data collected prior to and during the demonstration period. The QCA results identified five distinct pathways to attaining PCMH recognition and four distinct pathways to not attaining recognition by the end of the demonstration. Across these pathways, one condition (change leader capacity) was common to all pathways for attaining recognition, and another (previous improvement or recognition experience) was absent in all pathways for not attaining recognition. In general, sites could compensate for deficiencies in one factor with capacity in others, but they needed a threshold of strengths in cultural and implementation factors to attain PCMH recognition. Future efforts at primary care transformation should take into account multiple pathways sites may pursue. Sites should be assessed on key cultural and implementation factors, in addition to structural components, in order to differentiate interventions and technical assistance. © Health Research and Educational Trust.

Consequences of buffelgrass pasture development for primary productivity, perennial plant richness, and vegetation structure in the drylands of Sonora, Mexico.

PubMed

Franklin, Kimberly; Molina-Freaner, Francisco

2010-12-01

In large parts of northern Mexico native plant communities are being converted to non-native buffelgrass (Pennisetum ciliare) pastures, and this conversion could fundamentally alter primary productivity and species richness. In Sonora, Mexico land conversion is occurring at a regional scale along a rainfall-driven gradient of primary productivity, across which native plant communities transition from desert scrub to thorn scrub. We used a paired sampling design to compare a satellite-derived index of primary productivity, richness of perennial plant species, and canopy-height profiles of native plant communities with buffelgrass pastures. We sampled species richness across a gradient of primary productivity in desert scrub and thorn scrub vegetation to examine the influence of site productivity on the outcomes of land conversion. We also examined the influence of pasture age on species richness of perennial plants. Index values of primary productivity were lower in buffelgrass pastures than in native vegetation, which suggests a reduction in primary productivity. Land conversion reduced species richness by approximately 50% at local and regional scales, reduced tree and shrub cover by 78%, and reduced canopy height. Land conversion disproportionately reduced shrub species richness, which reflects the common practice among Sonoran ranchers of conserving certain tree and cactus species. Site productivity did not affect the outcomes of land conversion. The age of a buffelgrass pasture was unrelated to species richness within the pasture, which suggests that passive recovery of species richness to preconversion levels is unlikely. Our findings demonstrate that land conversion can result in large losses of plant species richness at local and regional scales and in substantial changes to primary productivity and vegetation structure, which casts doubt on the feasibility of restoring native plant communities without active intervention on the part of land managers. © 2010 Society for Conservation Biology.

Non-primary breast malignancies: a single institution's experience of a diagnostic challenge with important therapeutic consequences-a retrospective study.

PubMed

Buisman, Florian E; van Gelder, Linda; Menke-Pluijmers, Marian B E; Bisschops, Bob H C; Plaisier, Peter W; Westenend, Pieter J

2016-06-23

Breast cancer is a common malignancy, but metastases to the breast of extramammary malignancies are very rare. Treatment and prognosis are different. The aim of the study is to report the incidence of lymphomas and metastases to the breast of extramammary malignancies in our 30-year archive. The pathology database of a single institute was reviewed for all breast neoplasms which were coded in our system as a metastasis in the period 1985-2014. Metastatic tumors from primary breast carcinoma were excluded. A total of 47 patients were included (7 men/40 women, mean age 63 years). The majority originated from lymphoma (n = 18) and primary melanoma (n = 11). Other primary tumor sites included the ovary (n = 6), lung (n = 6), colon (n = 3), kidney (n = 1), stomach (n = 1), and chorion (n = 1). In 24/47 patients (51 %), metastasis was the first sign of the specific malignant disease. In seven patients (15 %) surgery was performed, the diagnosis of metastatic disease was adjusted in four patients (9 %) postoperatively. It is important to distinguish lymphomas and metastases to the breast from common primary breast carcinoma for proper treatment and prognosis. Therefore, we emphasize the need for a histological or cytopathological diagnosis before any treatment is commenced. The pathologist plays a key role in considering the diagnosis of metastasis if the histological features are unusual for a primary breast carcinoma. The pathologist should therefore be properly informed by the clinical physician although lymphomas and metastases to the breast are the first presentation of malignant disease in half the cases.

Operation and challenges of home-based medical practices in the US: findings from six aggregated case studies.

PubMed

Norman, Gregory J; Orton, Kristann; Wade, Amy; Morris, Andrea M; Slaboda, Jill C

2018-01-27

Home-based primary care (HBPC) is a multidisciplinary, ongoing care strategy that can provide cost-effective, in-home treatment to meet the needs of the approximately four million homebound, medically complex seniors in the U.S. Because there is no single model of HBPC that can be adopted across all types of health organizations and U.S. geographic regions, we conducted a six-site HBPC practice assessment to better understand different operation structures, common challenges, and approaches to delivering HBPC. Six practices varying in size, care team composition and location agreed to participate. At each site we conducted unstructured interviews with key informants and directly observed practices and procedures in the field and back office. The aggregated case studies revealed important issues focused on team composition, patient characteristics, use of technology and urgent care delivery. Common challenges across the practices included provider retention and unmet community demand for home-based care services. Most practices, regardless of size, faced challenges around using electronic medical records (EMRs) and scheduling systems not designed for use in a mobile practice. Although many practices offered urgent care, practices varied in the methods used to provide care including the use of community paramedics and telehealth technology. Learnings compiled from these observations can inform other HBPC practices as to potential best practices that can be implemented in an effort to improve efficiency and scalability of HBPC so that seniors with multiple chronic conditions can receive comprehensive primary care services in their homes.

Synchronous diagnosis of metastatic cancer to the thyroid is associated with poor prognosis.

PubMed

Chen, Jeng-Yeou; Chen, I-Wen; Hsueh, Chuen; Chao, Tzu-Chieh; Gao, Bing-Ru; Lin, Jen-Der

2015-03-01

The incidence and histopathological characteristics of metastatic cancers to the thyroid (MCT) are different in various geographic areas. The aim of this study was to elucidate the clinical features of MCT, including histocytological diagnosis and therapeutic outcomes. A retrospective analysis of patients with thyroid cancer treated and followed up at the Chang Gung Medical Center in Linkou was performed. Among 3957 patients with thyroid cancer, a total of 56 patients with MCT were evaluated. Of them, 47 patients (83.9 %) were diagnosed with malignancy or suspected malignancy via fine needle aspiration cytology of the thyroid. Synchronous primary cancers were diagnosed in 44 of the patients with MCT. Of the MCT, metastasis of lung cancer to the thyroid was the leading category. Other primary sites of MCT were the head and neck, gastrointestinal tract, kidneys, breast, cervix, and unknown primary site. The mean 5-, 10-, 20-, and 60-month survival rates were 46.4, 32.1, 21.4, and 7.9 % for the patients. Patients with metachronous thyroid carcinoma had significantly better survival than patients with synchronous cancer. In conclusions, the incidence of MCT in patients with thyroid cancer is low; however, the prognosis of patients with MCT is poor, especially in patients diagnosed with synchronous primary tumors. In this study, MCT commonly originated in organs located near the thyroid, such as the lungs, head, and neck. Close monitoring of these malignancies may improve the prognosis of patients with MCT in the future.

Analysis of Dose at the Site of Second Tumor Formation After Radiotherapy to the Central Nervous System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Galloway, Thomas J.; University of Florida Proton Therapy Institute, Jacksonville, FL; Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org

Purpose: Second tumors are an uncommon complication of multimodality treatment of childhood cancer. The present analysis attempted to correlate the dose received as a component of primary treatment and the site of the eventual development of a second tumor. Methods and Materials: We retrospectively identified 16 patients who had received radiotherapy to sites in the craniospinal axis and subsequently developed a second tumor. We compared the historical fields and port films of the primary treatment with the modern imaging of the second tumor locations. We classified the location of the second tumors as follows: in the boost field; marginal tomore » the boost field, but in a whole-brain field; in a whole-brain field; marginal to the whole brain/primary treatment field; and distant to the field. We divided the dose received into 3 broad categories: high dose (>45 Gy), moderate dose (20-36 Gy), and low dose (<20 Gy). Results: The most common location of the second tumor was in the whole brain field (57%) and in the moderate-dose range (81%). Conclusions: Our data contradict previous publications that suggested that most second tumors develop in tissues that receive a low radiation dose. Almost all the second tumors in our series occurred in tissue within a target volume in the cranium that had received a moderate dose (20-36 Gy). These findings suggest that a major decrease in the brain volume that receives a moderate radiation dose is the only way to substantially decrease the second tumor rate after central nervous system radiotherapy.« less

Malignant oral tumors in iran: ten-year analysis on patient and tumor characteristics of 1042 patients in Tehran.

PubMed

Sargeran, Katayoun; Murtomaa, Heikki; Safavi, Seyed Mohammad Reza; Vehkalahti, Miira; Teronen, Olli

2006-11-01

This study analyzed characteristics of oral cancer patients from Tehran, Iran, and their tumors. Data came from the patient records of 30 major hospitals in Tehran. Patients (n = 1042), diagnosed with invasive oral cancer in 1993-2003, were classified by primary tumor site according to ICD-10 (C00-C10). Data were analyzed separately for lip, oral cavity and salivary gland tumors. Statistical evaluation included chi and t-test. Of all cases, 59% were male. Age for all cases ranged from 6-103 years, mean age was 58.8 years (SD 16; median 62); 89% were older than 40. Tumor site breakdown was 65% oral cavity, 21% major salivary glands and 14% lip. A clear gender difference (P < 0.001) appeared regarding the primary tumor sites: women dominated in oral cavity cancers and men in lip cancers. The most common cancer site was the tongue (32%), accounting for 50% of the oral cavity cancers. Histologically, 88% of all oral cavity and lip cancers were squamous cell carcinomas, 10% of those were in age /= age 65. At the time of diagnosis, 59% of oral cavity cancers and 29% of lip cancers were at stage III or IV (P < 0.001). The results emphasize an urgent need for a national program focusing on early detection of oral cancers, including educational information addressed to oral health professionals.

Changes in Species, Areal Cover, and Production of Moss across a Fire Chronosequence in Interior Alaska

USGS Publications Warehouse

Harden, J.W.; Munster, J.; Manies, K.L.; Mack, M.C.; Bubier, J.L.

2009-01-01

In an effort to characterize the species and production rates of various upland mosses and their relationship to both site drainage and time since fire, annual net primary production of six common moss species was measured. Several stands located near Delta Junction, interior Alaska, were located. These stands ranged from one to 116 years since fire in well-drained (dry) and moderately to somewhat poorly drained (wet) black spruce (Picea mariana)-feathermoss systems. Moss species composition varied greatly during the fire cycle, with Ceratodon purpureus dominating the earliest years after a fire, Aulacomnium palustre dominating the transitional and older stages, and Hylocomium splendens dominating the oldest, mature sites. Polytrichum spp. was found at all sites. Average moss cover ranged from <10 percent in the youngest sites to almost 90 percent in the mature sites. Species from the genus Polytrichum were the most productive and contributed up to 30 g m2 of organic matter in one growing season. Least productive was Rhytidium rugosum, which contributed about 1.5 g m2 of organic matter in mature stands. Recovery of moss productivity after fire was not significantly different for wet and dry sites.

Rapid Assessment of Ecosystem Services Provided by Two Mineral Extraction Sites Restored for Nature Conservation in an Agricultural Landscape in Eastern England

PubMed Central

Blaen, Phillip J.; Jia, Li; Peh, Kelvin S.-H.; Field, Rob H.; Balmford, Andrew; MacDonald, Michael A.; Bradbury, Richard B.

2015-01-01

Despite growing recognition that mineral sites restored for nature conservation can enhance local biodiversity, the wider societal benefits provided by this type of restoration relative to alternative options are not well understood. This study addresses this research gap by quantifying differences in ecosystem services provision under two common mineral site after-uses: nature conservation and agriculture. Using a combination of site-specific primary field data, benefits transfer and modelling, we show that for our sites restoration for nature conservation provides a more diverse array of ecosystem services than would be delivered under an agricultural restoration scenario. We also explore the effects of addressing different conservation targets, which we find alter the provision of ecosystem services on a service-specific basis. Highly species-focused intervention areas are associated with increased carbon storage and livestock grazing provision, whereas non-intervention areas are important for carbon sequestration, fishing, recreation and flood risk mitigation. The results of this study highlight the wider societal importance of restored mineral sites and may help conservation managers and planners to develop future restoration strategies that provide benefits for both biodiversity and human well-being. PMID:25894293

Rapid assessment of ecosystem services provided by two mineral extraction sites restored for nature conservation in an agricultural landscape in eastern England.

PubMed

Blaen, Phillip J; Jia, Li; Peh, Kelvin S-H; Field, Rob H; Balmford, Andrew; MacDonald, Michael A; Bradbury, Richard B

2015-01-01

Despite growing recognition that mineral sites restored for nature conservation can enhance local biodiversity, the wider societal benefits provided by this type of restoration relative to alternative options are not well understood. This study addresses this research gap by quantifying differences in ecosystem services provision under two common mineral site after-uses: nature conservation and agriculture. Using a combination of site-specific primary field data, benefits transfer and modelling, we show that for our sites restoration for nature conservation provides a more diverse array of ecosystem services than would be delivered under an agricultural restoration scenario. We also explore the effects of addressing different conservation targets, which we find alter the provision of ecosystem services on a service-specific basis. Highly species-focused intervention areas are associated with increased carbon storage and livestock grazing provision, whereas non-intervention areas are important for carbon sequestration, fishing, recreation and flood risk mitigation. The results of this study highlight the wider societal importance of restored mineral sites and may help conservation managers and planners to develop future restoration strategies that provide benefits for both biodiversity and human well-being.

Eight Nucleotide Substitutions Inhibit Splicing to HPV-16 3′-Splice Site SA3358 and Reduce the Efficiency by which HPV-16 Increases the Life Span of Primary Human Keratinocytes

PubMed Central

Li, Xiaoze; Johansson, Cecilia; Cardoso Palacios, Carlos; Mossberg, Anki; Dhanjal, Soniya; Bergvall, Monika; Schwartz, Stefan

2013-01-01

The most commonly used 3′-splice site on the human papillomavirus type 16 (HPV-16) genome named SA3358 is used to produce HPV-16 early mRNAs encoding E4, E5, E6 and E7, and late mRNAs encoding L1 and L2. We have previously shown that SA3358 is suboptimal and is totally dependent on a downstream splicing enhancer containingmultiple potential ASF/SF2 binding sites. Here weshow that only one of the predicted ASF/SF2 sites accounts for the majority of the enhancer activity. We demonstrate that single nucleotide substitutions in this predicted ASF/SF2 site impair enhancer function and that this correlates with less efficient binding to ASF/SF2 in vitro. We provide evidence that HPV-16 mRNAs that arespliced to SA3358 interact with ASF/SF2 in living cells. In addition,mutational inactivation of the ASF/SF2 site weakened the enhancer at SA3358 in episomal forms of the HPV-16 genome, indicating that the enhancer is active in the context of the full HPV-16 genome.This resulted in induction of HPV-16 late gene expression as a result of competition from late splice site SA5639. Furthermore, inactivation of the ASF/SF2 site of the SA3358 splicing enhancer reduced the ability of E6- and E7-encoding HPV-16 plasmids to increase the life span of primary keratinocytes in vitro, demonstrating arequirement for an intact splicing enhancer of SA3358 forefficient production of the E6 and E7 mRNAs. These results link the strength of the HPV-16 SA3358 splicing enhancer to expression of E6 and E7 and to the pathogenic properties of HPV-16. PMID:24039800

Divergent and convergent evolution in metastases suggest treatment strategies based on specific metastatic sites

PubMed Central

Cunningham, Jessica J.; Brown, Joel S.; Vincent, Thomas L.

2015-01-01

Background and objective: Systemic therapy for metastatic cancer is currently determined exclusively by the site of tumor origin. Yet, there is increasing evidence that the molecular characteristics of metastases significantly differ from the primary tumor. We define the evolutionary dynamics of metastases that govern this molecular divergence and examine their potential contribution to variations in response to targeted therapies. Methodology: Darwinian interactions of transformed cells with the tissue microenvironments at primary and metastatic sites are analyzed using evolutionary game theory. Computational models simulate responses to targeted therapies in different organs within the same patient. Results: Tumor cells, although maximally fit at their primary site, typically have lower fitness on the adaptive landscapes offered by the metastatic sites due to organ-specific variations in mesenchymal properties and signaling pathways. Clinically evident metastases usually exhibit time-dependent divergence from the phenotypic mean of the primary population as the tumor cells evolve and adapt to their new circumstances. In contrast, tumors from different primary sites evolving on identical metastatic adaptive landscapes exhibit phenotypic convergence. Thus, metastases in the liver from different primary tumors and even in different hosts will evolve toward similar adaptive phenotypes. The combination of evolutionary divergence from the primary cancer phenotype and convergence towards similar adaptive strategies in the same tissue cause significant variations in treatment responses particularly for highly targeted therapies. Conclusion and implications: The results suggest that optimal therapies for disseminated cancer must take into account the site(s) of metastatic growth as well as the primary organ. PMID:25794501

Experiences of practice facilitators working on the Improved Delivery of Cardiovascular Care project: Retrospective case study.

PubMed

Liddy, Clare; Rowan, Margo; Valiquette-Tessier, Sophie-Claire; Drosinis, Paul; Crowe, Lois; Hogg, William

2018-01-01

To examine the barriers to and facilitators of practice facilitation experienced by participants in the Improving Delivery of Cardiovascular Care (IDOCC) project. Case studies of practice facilitators' narrative reports. Eastern Ontario. Primary care practices that participated in the IDOCC project. Cases were identified by calculating sum scores in order to determine practices' performance relative to their peers. Two case exemplars were selected that scored within ± 1 SD of the total mean score, and a qualitative analysis of practice facilitators' narrative reports was conducted using a 5-factor implementation framework to identify barriers and facilitators. Narratives were divided into 3 phases: planning, implementation, and sustainability. Barriers and facilitators fluctuated over the intervention's 3 phases. Site A reported more barriers (n = 47) than facilitators (n = 38), while site B reported a roughly equal number of barriers (n = 144) and facilitators (n = 136). In both sites, the most common barriers involved organizational and provider factors and the most common facilitators were associated with innovation and structural factors. Both practices encountered various barriers and facilitators throughout the IDOCC's 3 phases. The case studies reveal the complex interactions of these factors over time, and provide insight into the implementation of practice facilitation programs. Copyright© the College of Family Physicians of Canada.

Isolated splenic metastasis in a patient with two distinct genitourinary malignancies.

PubMed

Zhang, Lulu; Pasquale, Donald; Le, Maithao; Patel, Raina; Mehdi, Syed

2015-06-01

Splenic metastasis is rare, occurring in 2.3%- 7.1% of cases, of which 95% are carcinomas.1 The lung is the most common primary tumor site (21% of cases), followed by the gastrointestinal system, breast, ovaries, and skin. In a retrospective study evaluating the clinical and pathological impact of splenic metastases during a 25-year period in China, it was found that about 5.3% of metastases were isolated splenic metastasis.2 Isolated splenic metastasis from kidney cancer is very rare and is often an incidental finding. Here we report a case with isolated splenic metastasis in a patient with both primary renal cell carcinoma and prostate cancer, which turned out to be metastatic renal cell carcinoma in the spleen. ©2015 Frontline Medical Communications.

Cervical lymph node metastases from remote primary tumor sites

PubMed Central

López, Fernando; Rodrigo, Juan P.; Silver, Carl E.; Haigentz, Missak; Bishop, Justin A.; Strojan, Primož; Hartl, Dana M.; Bradley, Patrick J.; Mendenhall, William M.; Suárez, Carlos; Takes, Robert P.; Hamoir, Marc; Robbins, K. Thomas; Shaha, Ashok R.; Werner, Jochen A.; Rinaldo, Alessandra; Ferlito, Alfio

2016-01-01

Although most malignant lymphadenopathy in the neck represent lymphomas or metastases from head and neck primary tumors, occasionally, metastatic disease from remote, usually infraclavicular, sites presents as cervical lymphadenopathy with or without an obvious primary tumor. In general, these tumors metastasize to supraclavicular lymph nodes, but occasionally may present at an isolated higher neck level. A search for the primary tumor includes information gained by histology, immunohistochemistry, and evaluation of molecular markers that may be unique to the primary tumor site. In addition, 18F-fluoro-2-deoxyglocose positron emission tomography combined with CT (FDG-PET/CT) has greatly improved the ability to detect the location of an unknown primary tumor, particularly when in a remote location. Although cervical metastatic disease from a remote primary site is often incurable, there are situations in which meaningful survival can be achieved with appropriate local treatment. Management is quite complex and requires a truly multidisciplinary approach. PMID:26713674

Radiation Therapy to the Primary and Postinduction Chemotherapy MIBG-Avid Sites in High-Risk Neuroblastoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mazloom, Ali; Louis, Chrystal U.; Nuchtern, Jed

2014-11-15

Purpose: Although it is generally accepted that consolidation therapy for neuroblastoma includes irradiation of the primary site and any remaining metaiodobenzylguanidine (MIBG)-avid metastatic sites, limited information has been published regarding the efficacy of this approach. Methods and Materials: Thirty patients with high-risk neuroblastoma were treated at 1 radiation therapy (RT) department after receiving 5 cycles of induction chemotherapy and resection. All patients had at least a partial response after induction therapy, based upon international neuroblastoma response criteria. The primary sites were treated with 24 to 30 Gy whereas the MIBG-avid metastatic sites were treated with 24 Gy. RT was followed by high-dosemore » chemotherapy with autologous stem cell rescue and 6 months of cis-retinoic acid. Results: The 5-year progression-free survival (PFS) and overall survival (OS) rates were 48% and 59%, respectively. The 5-year locoregional control at the primary site was 84%. There were no differences in locoregional control according to degree of primary surgical resection. The 5-year local control rate for metastatic sites was 74%. The 5-year PFS rates for patients with 0, 1, 2, and >3 postinduction MIBG sites were 66%, 57%, 20%, and 0% (P<.0001), respectively, whereas 5-year OS rates were 80%, 57%, 50%, and 0%, respectively (P<.0001). Conclusions: RT to the primary site and postinduction MIBG-positive metastatic sites was associated with 84% and 74% local control, respectively. The number of MIBG-avid sites present after induction chemotherapy and surgery was predictive of progression-free and overall survival.« less

Culicoides and other biting flies on the Palos Verdes Peninsula of Southern California, and their possible relationship to equine dermatitis.

PubMed

Mullens, Bradley A; Owen, Jeb P; Heft, David E; Sobeck, Ruth V

2005-03-01

Biting insects were sampled to investigate the cause(s) of dermatitis (putative Culicoides hypersensitivity [CHS]) on horses on the Palos Verdes Peninsula, Los Angeles County, California. Suction traps baited with CO2 were operated at 5 sites from April 2002 to August 2003, supplemented by sampling from horses. Six species of Culicoides, 7 species of mosquitoes, and occasional Simulium and Stomoxys were collected in traps. Culicoides sonorensis was the most common midge trapped, although C. obsoletus and C. freeborni also were collected repeatedly. Insects from the belly region of horses in spring (peak dermatitis period) were mostly C. obsoletus, which were far more abundant than indicated by CO2-baited suction traps. The predominant mosquito was Culiseta incidens; Culex quinquefasciatus and Cx. tarsalis also could be common, depending on the site. Mosquitoes, particularly Cs. incidens, were more abundant the 2nd year (normal rainfall), whereas C. sonorensis and C. freeborni were more abundant the 1st year (drought period). Culicoides obsoletus, supplemented by C. sonorensis, is regarded as a primary suspect causing CHS in this area.

Central nervous system.

PubMed

Adamson, D Cory; Rasheed, B Ahmed K; McLendon, Roger E; Bigner, Darell D

2010-01-01

Several different types of tumors, benign and malignant, have been identified in the central nervous system (CNS). The prognoses for these tumors are related to several factors, such as the age of the patient and the location and histology of the tumor. In adults, about half of all CNS tumors are malignant, whereas in pediatric patients, more than 75% are malignant. For most benign CNS tumors that require treatment, neurosurgeons can offer curative resections or at least provide significant relief from mass effect. Unfortunately, we still lack effective treatments for most primary and secondary malignant CNS tumors. However, the past decade has witnessed an explosion in the understanding of the early molecular events in malignant primary CNS tumors, and for the first time in history, oncologists are seeing that a plethora of new therapies targeting these molecular events are being tested in clinical trials. There is hope on the horizon for the fight against these deadly tumors. The distribution of CNS tumors by location has remained constant for numerous years. The majority of primary CNS tumors arise in the major cortical lobes. Twenty nine percent of primary CNS tumors arise from the dural meninges that encase the CNS structures. The vast majority of these are meningiomas, of which over 90% are benign. About 10% of primary CNS tumors are found in the sella turcica region, where the pituitary gland resides. Other much less common sites of primary CNS tumors include the pineal region, ventricular system, cerebellum, brain stem, cranial nerves, and spinal cord. The distribution of CNS tumors by histology has seen a slight increase in more malignant tumors over the past decade, possibly due to increased neuroimaging practices or environmental exposures. Arising from glial cells, gliomas represent over 36% of all primary CNS tumors and consist of astrocytomas, oligodendrogliomas, ependymomas, mixed gliomas, and neuroepithelial tumors. The benign meningiomas make up 32% of primary CNS tumors, followed by nerve sheath tumors and pituitary tumors. Primary CNS lymphomas, embryonal tumors, and craniopharyngiomas are uncommon. The most common gliomas are astrocytomas, and these tumors are typically classified by the World Health Organization (WHO) as Grades I through IV. Grade IV, the most malignant grade of astrocytoma, includes glioblastoma multiforme (GBM), the most common malignant primary CNS glioma in adults, which represents 51% of all CNS gliomas. GBM is unfortunately the most challenging to effectively treat and has the worst patient survival. This chapter is therefore primarily devoted to the current understanding of this topic. Here we describe the molecular and cellular events associated with malignant glioma initiation and progression. We also review the importance of glioma stem cell biology and tumor immunology in early gliomagenesis. In addition, we present a brief description of the most common malignant primary CNS glioma in pediatric patients - medulloblastoma, as well as familial cancer syndromes that include gliomas as part of the syndrome.

Musculoskeletal injuries in young ballet dancers.

PubMed

Leanderson, Charlotte; Leanderson, Johan; Wykman, Anders; Strender, Lars-Erik; Johansson, Sven-Erik; Sundquist, Kristina

2011-09-01

The aim of this study was to examine the incidence of musculoskeletal injuries, site and type of injury, and the most common injury diagnoses in young ballet dancers at the Royal Swedish Ballet School, a public school in Stockholm. This retrospective study of 476 students (297 girls and 179 boys) aged 10-21 years was based on medical records for the period August 1988 to June 1995. Data on diagnosis, site of injury and type of injury were collected, and the injuries were classified as traumatic or due to overuse. In total, 438 injuries were recorded. The injury incidence rate was 0.8 per 1,000 dance hours in both female and male dancers and tended to increase with increasing age. Most injuries occurred as the result of overuse. Seventy-six per cent of all injuries occurred in the lower extremities. Ankle sprain was the most common traumatic diagnosis, while the most common overuse-related diagnosis was tendinosis pedis. A few gender differences were noted. The findings of this study suggest that there is a need to apply primary injury prevention in young ballet dancers. Future studies could aim to identify (1) injury risk factors and (2) injury prevention programmes that are effective at reducing injury rates in young dancers.

Association of the g.19074G>A genetic variant in the osteoprotegerin gene with bone mineral density in Chinese postmenopausal women.

PubMed

Zhang, Y D; Zhang, Z; Zhou, N F; Jia, W T; Cheng, X G; Wei, X J

2014-08-28

Primary osteoporosis is a common health problem in postmenopausal women. This study aimed to detect the association of the g.19074G>A genetic variant in the osteoprotegerin gene (OPG) with bone mineral density (BMD) and primary osteoporosis. The created restriction site-polymerase chain reaction method was used to investigate the g.19074G>A genetic variant. The BMD of the femoral neck hip, lumbar spine (L2-4), and total hip were assessed by dual-energy X-ray absorptiometry (DEXA) in 856 unrelated Chinese postmenopausal women. We found significant differences in the BMDs of the femoral neck hip, lumbar spine (L2-4), and total hip among different genotypes; individuals with the GG genotype had significantly higher BMDs than those with the GA and AA genotypes (P < 0.05). Our results indicated that the A allele was an increased risk factor for primary osteoporosis and the g.19074G>A genetic variant of the OPG gene was associated with BMD and primary osteoporosis in Chinese postmenopausal women.

PHL7/441: Fixing a Broken Line between the Perceived "Anarchy" of the Web and a Process-Comfortable Pharmaceutical Company

PubMed Central

Vercellesi, L

1999-01-01

Introduction In 1998 a pharmaceutical company published its Web site to provide: an institutional presence multifunctional information to primary customers and general public a new way of access to the company a link to existing company-sponsored sites a platform for future projects Since the publication, some significant integration have been added; in particular one is a primary interactive service, addressed to a selected audience. The need has been felt to foster new projects and establish the idea of routinely considering the site as a potential tool in the marketing mix, to provide advanced services to customers. Methods Re-assessment of the site towards objectives. Assessment of its perception with company potential suppliers. Results The issue "web use" was discussed in various management meetings; the trend of use of Internet among the primary customers was known; major concerns expressed were about staffing and return of investment for activities run in the Web. These perceptions are being addressed by making the company more comfortable by: Running the site through a detailed process and clear procedures, defining A new process of maintenance of the site, involving representatives of all the functions. Procedures and guidelines. A master file of approved answers and company contacts. Categories of activities (information, promotion, education, information to investors, general services, target-specific services). Measures for all the activities run in the Web site Specifically for the Web site a concise periodical report is being assessed, covering 1. Statistics about hits and mails, compared to the corporate data. Indication of new items published. Description by the "supplier" of new or ongoing innovative projects, to transfer best practice. Basic figures on the Italian trend in internet use and specifically in the pharmaceutical and medical fields. Comments to a few competitor sites. Examples of potential uses deriving from other Web sites. Discussion The comparatively low use of Internet in Italy has affected the systematic professional exploitation of the company site. The definition of "anarchic" commonly linked to the Web by local media has lead to the attempt to "master" and "normalize" the site with a stricter approach than usual: most procedures and guidelines have been designed from scratch as not available for similar activities traditionally run. A short set of information has been requested for inclusion in the report: its wide coverage will help to receive a flavour of the global parallel new world developing in the net. Hopefully this approach will help to create a comfortable attitude towards the medium in the whole organisation and to acquire a working experience with the net.

Climate change impacts on potential recruitment in an ecosystem engineer

PubMed Central

Morgan, Emer; O' Riordan, Ruth M; Culloty, Sarah C

2013-01-01

Climate variability and the rapid warming of seas undoubtedly have huge ramifications for biological processes such as reproduction. As such, gametogenesis and spawning were investigated at two sites over 200 km apart on the south coast of Ireland in an ecosystem engineer, the common cockle, Cerastoderma edule. Both sites are classed as Special Areas of Conservation (SACs), but are of different water quality. Cerastoderma edule plays a significant biological role by recycling nutrients and affecting sediment structure, with impacts upon assemblage biomass and functional diversity. It plays a key role in food webs, being a common foodstuff for a number of marine birds including the oystercatcher. Both before and during the study (early 2010–mid 2011), Ireland experienced its two coldest winters for 50 years. As the research demonstrated only slight variation in the spawning period between sites, despite site differences in water and environmental quality, temperature and variable climatic conditions were the dominant factor controlling gametogenesis. The most significant finding was that the spawning period in the cockle extended over a greater number of months compared with previous studies and that gametogenesis commenced over winter rather than in spring. Extremely cold winters may impact on the cockle by accelerating and extending the onset and development of gametogenesis. Whether this impact is positive or negative would depend on the associated events occurring on which the cockle depends, that is, presence of primary producers and spring blooms, which would facilitate conversion of this extended gametogenesis into successful recruitment. PMID:23532482

LLNL Experimental Test Site (Site 300) Potable Water System Operations Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ocampo, R. P.; Bellah, W.

The existing Lawrence Livermore National Laboratory (LLNL) Site 300 drinking water system operation schematic is shown in Figures 1 and 2 below. The sources of water are from two Site 300 wells (Well #18 and Well #20) and San Francisco Public Utilities Commission (SFPUC) Hetch-Hetchy water through the Thomas shaft pumping station. Currently, Well #20 with 300 gallons per minute (gpm) pump capacity is the primary source of well water used during the months of September through July, while Well #18 with 225 gpm pump capacity is the source of well water for the month of August. The well watermore » is chlorinated using sodium hypochlorite to provide required residual chlorine throughout Site 300. Well water chlorination is covered in the Lawrence Livermore National Laboratory Experimental Test Site (Site 300) Chlorination Plan (“the Chlorination Plan”; LLNL-TR-642903; current version dated August 2013). The third source of water is the SFPUC Hetch-Hetchy Water System through the Thomas shaft facility with a 150 gpm pump capacity. At the Thomas shaft station the pumped water is treated through SFPUC-owned and operated ultraviolet (UV) reactor disinfection units on its way to Site 300. The Thomas Shaft Hetch- Hetchy water line is connected to the Site 300 water system through the line common to Well pumps #18 and #20 at valve box #1.« less

Lawrence Livermore National Laboratory Experimental Test Site (Site 300) Potable Water System Operations Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ocampo, Ruben P.; Bellah, Wendy

The existing Lawrence Livermore National Laboratory (LLNL) Site 300 drinking water system operation schematic is shown in Figures 1 and 2 below. The sources of water are from two Site 300 wells (Well #18 and Well #20) and San Francisco Public Utilities Commission (SFPUC) Hetch-Hetchy water through the Thomas shaft pumping station. Currently, Well #20 with 300 gallons per minute (gpm) pump capacity is the primary source of well water used during the months of September through July, while Well #18 with 225 gpm pump capacity is the source of well water for the month of August. The well watermore » is chlorinated using sodium hypochlorite to provide required residual chlorine throughout Site 300. Well water chlorination is covered in the Lawrence Livermore National Laboratory Experimental Test Site (Site 300) Chlorination Plan (“the Chlorination Plan”; LLNL-TR-642903; current version dated August 2013). The third source of water is the SFPUC Hetch-Hetchy Water System through the Thomas shaft facility with a 150 gpm pump capacity. At the Thomas shaft station the pumped water is treated through SFPUC-owned and operated ultraviolet (UV) reactor disinfection units on its way to Site 300. The Thomas Shaft Hetch- Hetchy water line is connected to the Site 300 water system through the line common to Well pumps #18 and #20 at valve box #1.« less

Learning primary care in medical school: does specialty or geographic location of the teaching site make a difference?

PubMed

Irigoyen, M M; Kurth, R J; Schmidt, H J

1999-05-01

The Liaison Committee on Medical Education mandates a core curriculum in primary care but does not specify its content or structure. In this study, we explored the question of whether primary care specialty or geographic location affects student learning and satisfaction. From 1994 to 1996, 294 third-year medical students at one medical school in New York state were randomly assigned to multiple teaching sites for a required 5-week primary care clerkship. Independent predictor variables were primary care specialty of the preceptor (family medicine, medicine, pediatrics, or joint medicine and pediatrics) and geographic location of the site (urban, suburban, rural). Outcome measures included four areas of student satisfaction, one of patient volume, and two of student performance. Primary care specialty had no detectable association with the outcome measures, except for a lower rating of patient diversity in pediatric experiences (P <0.001). Geographic location of the site had a significant association with all measures of student satisfaction and patient volume (all P values <0.001). Students at rural sites rated the experience more highly and saw on average 15 more patients per rotation. Ratings of student satisfaction remained high after adjusting for patient volume. Primary care specialty and geographic location did not influence student performance in the clerkship or scores on standardized patient examination. Rural geographic location of teaching site, but not primary care specialty, was associated with higher student satisfaction. However, higher student satisfaction ratings did not correspond to better student performance. Provided that all sites meet the screening criteria for inclusion in a teaching program, these findings support the continued development of high-quality, heterogeneous, interdisciplinary, primary care experiences.

Ga-68 DOTANOC PET/CT imaging in detection of primary site in patients with metastatic neuroendocrine tumours of unknown origin and its impact on clinical decision making: experience from a tertiary care centre in India

PubMed Central

Pankaj, Promila; Verma, Ritu; Jain, Anjali; Belho, Ethel S.; Mahajan, Harsh

2016-01-01

Background Neuroendocrine tumours (NETs) are rare, heterogeneous group of tumours which usually originate from small, occult primary sites and are characterized by over-expression of somatostatin receptors (SSTRs). Positron emission tomography/computed tomography (PET/CT) using Ga-68-labeled-somatostatin-analogues have shown superiority over other modalities for imaging of NETs. The objective of the study was to retrospectively evaluate the efficacy of Ga-68 DOTANOC PET/CT imaging in detecting the primary site in patients with metastatic NETs of unknown origin and its impact on clinical decision making in such patients. Methods Between December 2011 and September 2014, a total of 263 patients underwent Ga-68 DOTANOC PET/CT study in our department for various indications. Out of them, 68 patients (45 males, 23 females; mean age, 54.9±10.7 years; range, 31–78 years) with histopathologically proven metastatic NETs and unknown primary site (CUP-NET) on conventional imaging, who underwent Ga-68 DOTANOC PET/CT scan as part of their clinical work-up were included for analyses. Histopathology (wherever available) and/or follow-up imaging were taken as reference standard. Quantitative estimation of SSTR expression in the form of maximal standardized uptake value (SUVmax) of detected primary and metastatic sites was calculated. Follow-up data of individual patients was collected through careful survey of hospital medical records and telephonic interviews. Results Maximum patients presented to our department with hepatic metastasis (50 out of 68 patients) and grade I NETs (>50%). Ga-68 DOTANOC PET/CT scan identified primary sites in 40 out of these 68 patients i.e., in approximately 59% patients. Identified primary sites were: small intestine [19], rectum [8], pancreas [7], stomach [4], lung [1] and one each in rare sites in kidney and prostate. In one patient, 2 primary sites were identified (one each in stomach and duodenum). Mean SUVmax of the detected primary sites was 25.1±18.0 (median: 16.25; range, 2.1–150). Significant positive correlation was found between SUVmax of detected primary site and SUVmax of the histopathologically proven sites of metastasis (r=0.662; P<0.0001). Based on the findings of the Ga-68 DOTANOC PET/CT scan, 3 out of 40 patients underwent definitive treatment for their primary tumour (1 gastric, 1 ileal and 1 prostatic tumour). One patient was being planned for resection of primary rectal lesion at the time of data-collection. Thirty-six out of 68 patients were started on long-acting somatostatin analogues or chemotherapy or targeted therapy. Two patients underwent multiple cycles of peptide receptor radionuclide therapy (PRRNT) using 90Y and 177Lu labeled somatostatin analogues. Conclusions Our findings indicate that Ga-68 DOTANOC PET/CT is a promising imaging modality in patients with metastatic NETs of unknown origin for detection of the primary site and in guiding their therapeutic management. PMID:27284479

Habitat of calling blue and fin whales in the Southern California Bight

NASA Astrophysics Data System (ADS)

Sirovic, A.; Chou, E.; Roch, M. A.

2016-02-01

Northeast Pacific blue whale B calls and fin whale 20 Hz calls were detected from passive acoustic data collected over seven years at 16 sites in the Southern California Bight (SCB). Calling blue whales were most common in the coastal areas, during the summer and fall months. Fin whales began calling in fall and continued through winter, in the southcentral SCB. These data were used to develop habitat models of calling blue and fin whales in areas of high and low abundance in the SCB, using remotely sensed variables such as sea surface temperature, sea surface height, chlorophyll a, and primary productivity as model covariates. A random forest framework was used for variable selection and generalized additive models were developed to explain functional relationships, evaluate relative contribution of each significant variable, and investigate predictive abilities of models of calling whales. Seasonal component was an important feature of all models. Additionally, areas of high calling blue and fin whale abundance both had a positive relationship with the sea surface temperature. In areas of lower abundance, chlorophyll a concentration and primary productivity were important variables for blue whale models and sea surface height and primary productivity were significant covariates in fin whale models. Predictive models were generally better for predicting general trends than absolute values, but there was a large degree of variation in year-to-year predictability across different sites.

Switching benchmarks in cancer of unknown primary: from autopsy to microarray.

PubMed

Pentheroudakis, George; Golfinopoulos, Vassilios; Pavlidis, Nicholas

2007-09-01

Cancer of unknown primary (CUP) is associated with unknown biology and dismal prognosis. Information on the primary site of origin is scant and has never been analysed. We systematically reviewed all published evidence on the CUP primary site identified by two different approaches, either autopsy or microarray gene expression profiling. Published reports on identification of CUP primary site by autopsy or microarray-based multigene expression platforms were retrieved and analysed for year of publication, primary site, patient age, gender, histology, rate of primary identification, manifestations and metastatic deposits, microarray chip technology, training and validation sets, mathematical modelling, classification accuracy and number of classifying genes. From 1944 to 2000, a total of 884 CUP patients (66% males) underwent autopsy in 12 studies after presenting with metastatic or systemic symptoms and succumbing to their disease. A primary was identified in 644 (73%) of them, mostly in the lung (27%), pancreas (24%), hepatobiliary tree (8%), kidneys (8%), bowel, genital system and stomach, as a small focus of adenocarcinoma or poorly differentiated carcinoma. An unpredictable systemic dissemination was evident with high frequency of lung (46%), nodal (35%), bone (17%), brain (16%) and uncommon (18%) deposits. Between the 1944-1980 and the 1980-2000 series, female representation increased, 'undetermined neoplasm' diagnosis became rarer, pancreatic primaries were found less often while colonic ones were identified more frequently. Four studies using microarray technology profiled more than 500 CUP cases using classifier set of genes (ranging from 10 to 495) and reported strikingly dissimilar frequencies of assigned primary sites (lung 11.5%, pancreas 12.5%, bowel 12%, breast 15%, hepatobiliary tree 8%, kidneys 6%, genital system 9%, bladder 5%) in 75-90% of the cases. Evolution in medical imaging technology, diet and lifestyle habits probably account for changing epidemiology of CUP primaries in autopsies. Discrepant assignment of primary sites by microarrays may be due to the presence of 'sanctuary sites' in autopsies, molecular misclassification and the postulated presence of a pro-metastatic genetic signature. In view of the absence of patient therapeutic or prognostic benefit with primary identification, gene expression profiling should be re-orientated towards unraveling the complex pathophysiology of metastases.

Revisiting renal amyloidosis with clinicopathological characteristics, grading, and scoring: A single-institutional experience

PubMed Central

Kalle, Abhiram; Gudipati, Archana; Raju, Sree Bhushan; Kalidindi, Karthik; Guditi, Swarnalatha; Taduri, Gangadhar; Uppin, Megha S.

2018-01-01

INTRODUCTION: Kidney involvement is a major cause of mortality in systemic amyloidosis. Glomerulus is the most common site of deposition in renal amyloidosis, and nephrotic syndrome is the most common presentation. Distinction between AA and AL is done using immunofluorescence (IF) and immunohistochemistry (IHC). Renal biopsy helps in diagnosis and also predicting the clinical course by applying scoring and grading to the biopsy findings. MATERIALS AND METHODS: The study includes all cases of biopsy-proven renal amyloidosis from January 2008 to May 2017. Light microscopic analysis; Congo red with polarization; IF; IHC for Amyloid A, kappa, and lambda; and bone marrow evaluation were done. Classification of glomerular amyloid deposition and scoring and grading are done as per the guidelines of Sen S et al. RESULTS: There are 40 cases of biopsy-proven renal amyloidosis with 12 primary and 23 secondary cases. Mean age at presentation was 42.5 years. Edema was the most common presenting feature. Secondary amyloidosis cases were predominant. Tuberculosis was the most common secondary cause. Multiple myeloma was detected in four primary cases. Grading of renal biopsy features showed a good correlation with the class of glomerular involvement. CONCLUSION: Clinical history, IF, and IHC are essential in amyloid typing. Grading helps provide a subtle guide regarding the severity of disease in the background of a wide range of morphological features and biochemical values. Typing of amyloid is also essential for choosing the appropriate treatment. PMID:29692592

Interprofessional population health advocacy: Developing and implementing a panel management curriculum in five Veterans Administration primary care practices.

PubMed

Dulay, Maya; Bowen, Judith L; Weppner, William G; Eastburn, Abigail; Poppe, Anne P; Spanos, Pete; Wojtaszek, Danielle; Printz, Destiny; Kaminetzky, Catherine P

2018-05-10

Health care systems expect primary care clinicians to manage panels of patients and improve population health, yet few have been trained to do so. An interprofessional panel management (PM) curriculum is one possible strategy to address this training gap and supply future primary care practices with clinicians and teams prepared to work together to improve the health of individual patients and populations. This paper describes a Veterans Administration (VA) sponsored multi-site interprofessional PM curriculum development effort. Five VA Centers of Excellence in Primary Care Education collaborated to identify a common set of interprofessionally relevant desired learning outcomes (DLOs) for the PM and to develop assessment instruments for monitoring trainees' PM learning. Authors cataloged teaching and learning activities across sites. Results from pilot testing were systematically discussed leading to iterative revisions of curricular elements. Authors completed a retrospective self-assessment of curriculum implementation for the academic year 2015-16 using a 5-point scale: contemplation (score = 0), pilot (1), action (2), maintenance (3), and embedded (4). Implementation scores were analyzed using descriptive statistics. DLOs were organized into five categories (individual patients, populations, guidelines/measures, teamwork, and improvement) along with a developmental continuum and mapped to program competencies. Instruction and implementation varied across sites based on resources and priorities. Between 2015 and 2016, 159 trainees (internal medicine residents, nurse practitioner students and residents, pharmacy residents, and psychology post-doctoral fellows) participated in the PM curriculum. Curriculum implementation scores for guidelines/measures and improvement DLOs were similar for all trainees; scores for individual patients, populations, and teamwork DLOs were more advanced for nurse practitioner and physician trainees. In conclusion, collaboratively identified DLOs for PM guided development of assessment instruments and instructional approaches for panel management activities in interprofessional teams. This PM curriculum and associated tools provide resources for educators in other settings.

Some open issues in the analysis of the storage and migration properties of fractured carbonate reservoirs

NASA Astrophysics Data System (ADS)

Agosta, Fabrizio

2017-04-01

Underground CO2 storage in depleted hydrocarbon reservoirs may become a common practice in the future to lower the concentration of greenhouse gases in the atmosphere. Results from the first experiments conducted in carbonate rocks, for instance the Lacq integrated CCS Pilot site, SW France, are quite exciting. All monitored parameters, such as the CO2 concentration at well sites, well pressures, cap rock integrity and environmental indicators show the long-term integrity of this type of geological reservoirs. Other positive news arise from the OXY-CFB-300 Compostilla Project, NW Spain, where most of the injected CO2 dissolved into the formation brines, suggesting the long-term security of this method. However, in both cases, the CO2- rich fluids partially dissolved the carbonate minerals during their migration through the fractured reservoir, modifying the overall pore volume and pressure regimes. These results support the growing need for a better understanding of the mechanical behavior of carbonate rocks over geological time of scales. In fact, it is well known that carbonates exhibit a variety of deformation mechanisms depending upon many intrinsic factors such as composition, texture, connected pore volume, and nature of the primary heterogeneities. Commonly, tight carbonates are prone to opening-mode and/or pressure solution deformation. The interplay between these two mechanisms likely affects the petrophysical properties of the fault damage zones, which form potential sites for CO2 storage due to their high values of both connected porosity and permeability. On the contrary, cataclastic deformation produces fault rocks that often form localized fluid barriers for cross-fault fluid flow. Nowadays, questions on the conditions of sealing/leakage of carbonate fault rocks are still open. In particular, the relative role played by bulk crushing, chipping, cementation, and pressure solution on connected porosity of carbonate fault rocks during structural evolution and diagenesis is not determined yet. Differently, porous rocks are mainly affected by deformation banding. The latter process involves the collapse of primary porosity within narrow bands, which often localize into well-developed clusters. Currently, researchers focus on the assessment of the 3D pore geometry of the shear bands, which may act as possible sites for residual C02 trapping. The fault-bounded rock volumes are mainly crosscut by background fractures. These diffuse fractures are often compartmentalized into discrete mechanical units, which are bounded by primary heterogeneities such as bed interfaces and transgressive erosional surfaces. Moreover, bed-parallel pressure solution seams, structural elements that commonly form in limestone rocks during burial diagenesis, can also act as mechanical interfaces during growth of background fractures. However, early embrittlement of carbonates was also documented, suggesting to further investigate their diagenetic evolution to determine the conditions at which the latter phenomenon takes place. Results could shed new lights into the storage properties and, hence, the amount of CO2 that can be securely stored within significant volumes of fractured carbonates in the underground.

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

PubMed

Pellegrini, Joseph E; Toledo, Paloma; Soper, David E; Bradford, William C; Cruz, Deborah A; Levy, Barbara S; Lemieux, Lauren A

Surgical site infections are the most common complications of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

PubMed

Pellegrini, Joseph E; Toledo, Paloma; Soper, David E; Bradford, William C; Cruz, Deborah A; Levy, Barbara S; Lemieux, Lauren A

2017-02-06

Surgical site infections are the most common complication of surgery in the United states. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effot to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged. Copyright ©2016 American College of Obstetricians and Gynecologists.

Brief educational interventions to improve performance on novel quality metrics in ambulatory settings in Kenya: A multi-site pre-post effectiveness trial.

PubMed

Korom, Robert Ryan; Onguka, Stephanie; Halestrap, Peter; McAlhaney, Maureen; Adam, Mary

2017-01-01

The quality of primary care delivered in resource-limited settings is low. While some progress has been made using educational interventions, it is not yet clear how to sustainably improve care for common acute illnesses in the outpatient setting. Management of urinary tract infection is particularly important in resource-limited settings, where it is commonly diagnosed and associated with high levels of antimicrobial resistance. We describe an educational programme targeting non-physician health care providers and its effects on various clinical quality metrics for urinary tract infection. We used a series of educational interventions including 1) formal introduction of a clinical practice guideline, 2) peer-to-peer chart review, and 3) peer-reviewed literature describing local antimicrobial resistance patterns. Interventions were conducted for clinical officers (N = 24) at two outpatient centers near Nairobi, Kenya over a one-year period. The medical records of 474 patients with urinary tract infections were scored on five clinical quality metrics, with the primary outcome being the proportion of cases in which the guideline-recommended antibiotic was prescribed. The results at baseline and following each intervention were compared using chi-squared tests and unpaired two-tailed T-tests for significance. Logistic regression analysis was used to assess for possible confounders. Clinician adherence to the guideline-recommended antibiotic improved significantly during the study period, from 19% at baseline to 68% following all interventions (Χ2 = 150.7, p < 0.001). The secondary outcome of composite quality score also improved significantly from an average of 2.16 to 3.00 on a five-point scale (t = 6.58, p < 0.001). Interventions had different effects at different clinical sites; the primary outcome of appropriate antibiotic prescription was met 83% of the time at Penda Health, and 50% of the time at AICKH, possibly reflecting differences in onboarding and management of clinical officers. Logistic regression analysis showed that intervention stage and clinical site were independent predictors of the primary outcome (p < 0.0001), while all other features, including provider and patient age, were not significant at a conservative threshold of p < 0.05. This study shows that brief educational interventions can dramatically improve the quality of care for routine acute illnesses in the outpatient setting. Measurement of quality metrics allows for further targeting of educational interventions depending on the needs of the providers and the community. Further study is needed to expand routine measurement of quality metrics and to identify the interventions that are most effective in improving quality of care.

Long-term neuroplasticity of the face primary motor cortex and adjacent somatosensory cortex induced by tooth loss can be reversed following dental implant replacement in rats.

PubMed

Avivi-Arber, Limor; Lee, Jye-Chang; Sood, Mandeep; Lakschevitz, Flavia; Fung, Michelle; Barashi-Gozal, Maayan; Glogauer, Michael; Sessle, Barry J

2015-11-01

Tooth loss is common, and exploring the neuroplastic capacity of the face primary motor cortex (face-M1) and adjacent primary somatosensory cortex (face-S1) is crucial for understanding how subjects adapt to tooth loss and their prosthetic replacement. The aim was to test if functional reorganization of jaw and tongue motor representations in the rat face-M1 and face-S1 occurs following tooth extraction, and if subsequent dental implant placement can reverse this neuroplasticity. Rats (n = 22) had the right maxillary molar teeth extracted under local and general anesthesia. One month later, seven rats had dental implant placement into healed extraction sites. Naive rats (n = 8) received no surgical treatment. Intracortical microstimulation (ICMS) and recording of evoked jaw and tongue electromyographic responses were used to define jaw and tongue motor representations at 1 month (n = 8) or 2 months (n = 7) postextraction, 1 month postimplant placement, and at 1-2 months in naive rats. There were no significant differences across study groups in the onset latencies of the ICMS-evoked responses (P > 0.05), but in comparison with naive rats, tooth extraction caused a significant (P < 0.05) and sustained (1-2 months) decreased number of ICMS-defined jaw and tongue sites within face-M1 and -S1, and increased thresholds of ICMS-evoked responses in these sites. Furthermore, dental implant placement reversed the extraction-induced changes in face-S1, and in face-M1 the number of jaw sites even increased as compared to naive rats. These novel findings suggest that face-M1 and adjacent face-S1 may play a role in adaptive mechanisms related to tooth loss and their replacement with dental implants. © 2015 Wiley Periodicals, Inc.

Adding ultrasound to clinical examination reduced frequency of enthesitis in primary care psoriasis patients with musculoskeletal complaints.

PubMed

van der Ven, Myrthe; Karreman, Maren C; Weel, Angelique E A M; Tchetverikov, Ilja; Vis, Marijn; Nijsten, Tamar E C; Hazes, Johanna M W; Luime, Jolanda J

2016-01-01

Part of the psoriasis patients with musculoskeletal complaints will have inflammation of the entheses. Entheseal inflammation is difficult to assess by clinical examination only. Therefore, we aimed to determine the frequency of clinically relevant ultrasound inflammation at the most commonly assessed entheses (MASEI; Madrid Sonographic Enthesis Index) in primary care psoriasis patients with one or more tender entheses. Adult primary care psoriasis patients with musculoskeletal complaints (tender enthesis or arthritis at physical examination) had an ultrasound examination of seven entheses according to the MASEI. Clinically relevant ultrasound inflammation was defined as active inflammation on ultrasound in combination with at least one clinical feature at the same enthesis. Active ultrasound inflammation contained positive power Doppler signal or in case of the plantar aponeurosis increased thickness. Structural changes entailed calcifications, enthesophytes, increased thickness, hypoechogeneicity indicating irregular fibre structure and erosions. Clinically, an enthesis was scored positive by a tender enthesis at clinical examination, reported pain in the history or self-reported pain in the questionnaires. Of 542 primary care psoriasis patient, 111 patients had tender entheses and/or arthritis. These patients were both clinically and ultrasonographically evaluated. Active ultrasound inflammation accompanied with pain or tenderness at the enthesis was found in 36% of the patients (n=40). Most common were inflammation at the knee (n=11) and at the plantar aponeurosis (n=10). Structural changes were observed in 95% of the psoriasis patients independent of their clinical manifestation. We found concurrent presence of ultrasound inflammatory changes and clinical symptoms in 36% of the primary care psoriasis patients who had tenderness at one or more entheseal sites.

Comparison of ligand migration and binding in heme proteins of the globin family

NASA Astrophysics Data System (ADS)

Karin, Nienhaus; Ulrich Nienhaus, G.

2015-12-01

The binding of small diatomic ligands such as carbon monoxide or dioxygen to heme proteins is among the simplest biological processes known. Still, it has taken many decades to understand the mechanistic aspects of this process in full detail. Here, we compare ligand binding in three heme proteins of the globin family, myoglobin, a dimeric hemoglobin, and neuroglobin. The combination of structural, spectroscopic, and kinetic experiments over many years by many laboratories has revealed common properties of globins and a clear mechanistic picture of ligand binding at the molecular level. In addition to the ligand binding site at the heme iron, a primary ligand docking site exists that ensures efficient ligand binding to and release from the heme iron. Additional, secondary docking sites can greatly facilitate ligand escape after its dissociation from the heme. Although there is only indirect evidence at present, a preformed histidine gate appears to exist that allows ligand entry to and exit from the active site. The importance of these features can be assessed by studies involving modified proteins (via site-directed mutagenesis) and comparison with heme proteins not belonging to the globin family.

Orbitofacial Metastatic Basal Cell Carcinoma: Report of 10 Cases.

PubMed

Branson, Sara V; McClintic, Elysa; Ozgur, Omar; Esmaeli, Bita; Yeatts, R Patrick

To explore the clinical features, management, and prognosis of metastatic basal cell carcinoma originating in the orbitofacial region. Ten cases of orbitofacial metastatic basal cell carcinoma were identified by searching databases at 2 institutions from 1995 to 2015. A retrospective chart review was performed. Main outcome measures included patient demographics, lesion size, location of metastases, histologic subtype, recurrence rate, time between primary tumor diagnosis and metastasis, perineural invasion, treatment modalities, and survival from time of metastasis. The median tumor size at largest dimension was 3.3 cm (range, 1.9-11.5 cm), and 6 of 10 patients had at least 1 local recurrence before metastasis (range, 0-2 recurrences). The most common sites of metastasis included the ipsilateral parotid gland (n = 6) and cervical lymph nodes (n = 5). Histologic subtypes included infiltrative (n = 5), basosquamous (n = 2), nodular (n = 1), and mixed (n = 1). The median time from primary tumor diagnosis to metastasis was 7.5 years (range, 0-13). The median survival time from diagnosis of metastasis to last documented encounter or death was 5.3 years (range, 7 months-22.8 years). Treatment regimens included surgical excision, radiotherapy, and hedgehog inhibitors. Based on our findings, the following features may be markers of high risk orbitofacial basal cell carcinoma: 1) increasing tumor size, 2) local recurrence of the primary tumor, 3) aggressive histologic subtype, and 4) perineural invasion. Screening should include close observation of the primary site and tissues in the distribution of regional lymphatics, particularly the parotid gland and cervical lymph nodes.

Importance of seep primary production to Lophelia pertusa and associated fauna in the Gulf of Mexico

NASA Astrophysics Data System (ADS)

Becker, Erin L.; Cordes, Erik E.; Macko, Stephen A.; Fisher, Charles R.

2009-05-01

To investigate the importance of seep primary production to the nutrition of Lophelia pertusa and associated communities and examine local trophic interactions, we analyzed stable carbon, nitrogen, and sulfur compositions in seven quantitative L. pertusa community collections. A significant seep signature was only detected in one of the 35 species tested ( Provanna sculpta, a common seep gastropod) despite the presence of seep fauna at the three sample sites. A potential predator of L. pertusa was identified ( Coralliophila sp.), and a variety of other trophic interactions among the fauna occupying the coral framework were suggested by the data, including the galatheid crab Munidopsis sp. 2 feeding upon hydroids and the polychaete Eunice sp. feeding upon the sabellid polychaete Euratella sp. Stable carbon abundances were also determined for different sections of L. pertusa skeleton representing different stages in the growth and life of the aggregation. There was no temporal trend detected in the skeleton isotope values, suggesting that L. pertusa settles in these areas only after seepage has largely subsided. Isotope values of individual taxa that were collected from both L. pertusa and vestimentiferan habitats showed decreasing reliance upon seep primary production with average age of the vestimentiferan aggregation, and finally, no seep signature was detected in the coral collections. Together our data suggest that it is the presence of authigenic carbonate substrata, a product of past seep microbial activity, as well as hydrodynamic processes that drive L. pertusa occurrence at seep sites in the Gulf of Mexico, not nutritional dependence upon primary production by seep microbes.

Primary nerve grafting: A study of revascularization.

PubMed

Chalfoun, Charbel; Scholz, Thomas; Cole, Matthew D; Steward, Earl; Vanderkam, Victoria; Evans, Gregory R D

2003-01-01

It was the purpose of this study to evaluate the revascularization of primary nerve repair and grafts using orthogonal polarization spectral (OPS) (Cytometrix, Inc.) imaging, a novel method for real-time evaluation of microcirculatory blood flow. Twenty male Sprague Dawley rats (250 g) were anesthetized with vaporized halothane and surgically prepared for common peroneal nerve resection. Group I animals (n = 10) underwent primary neurorraphy following transection, utilizing a microsurgical technique with 10-0 nylon suture. Group II (n = 10) animals had a 7-mm segment of nerve excised, reversed, and subsequently replaced as a nerve graft under similar techniques. All animals were evaluated using the OPS imaging system on three portions (proximal, transection site/graft, and distal) of the nerve following repair or grafting. Reevaluation of 5 animals randomly selected from each group using the OPS imaging system was again performed on days 14 and 28 following microsurgical repair/grafting. Values were determined by percent change in vascularity of the common peroneal nerve at 0 hr following surgery. Real-time evaluation of blood flow was utilized as an additional objective criterion. Percent vascularity in group I and II animals increased from baseline in all segments at day 14. By day 28, vascularity in nerves of group I rats decreased in all segments to values below baseline, with the exception of the transection site, which remained at a higher value than obtained directly after surgical repair. In group II animals, vascularity remained above baseline in all segments except the distal segment, which returned to vascularity levels similar to those at 0 hr. Further, occlusion of the vessels demonstrated in the graft and distal segments following initial transection appeared to be corrected. This study suggests that revascularization may occur via bidirectional inosculation with favored proximal vascular growth advancement. The use of real-time imaging offers a unique evaluation of tissues through emerging technologies. Copyright 2003 Wiley-Liss, Inc.

A Sleeping Beauty forward genetic screen identifies new genes and pathways driving osteosarcoma development and metastasis

PubMed Central

Moriarity, Branden S; Otto, George M; Rahrmann, Eric P; Rathe, Susan K; Wolf, Natalie K; Weg, Madison T; Manlove, Luke A; LaRue, Rebecca S; Temiz, Nuri A; Molyneux, Sam D; Choi, Kwangmin; Holly, Kevin J; Sarver, Aaron L; Scott, Milcah C; Forster, Colleen L; Modiano, Jaime F; Khanna, Chand; Hewitt, Stephen M; Khokha, Rama; Yang, Yi; Gorlick, Richard; Dyer, Michael A; Largaespada, David A

2016-01-01

Osteosarcomas are sarcomas of the bone, derived from osteoblasts or their precursors, with a high propensity to metastasize. Osteosarcoma is associated with massive genomic instability, making it problematic to identify driver genes using human tumors or prototypical mouse models, many of which involve loss of Trp53 function. To identify the genes driving osteosarcoma development and metastasis, we performed a Sleeping Beauty (SB) transposon-based forward genetic screen in mice with and without somatic loss of Trp53. Common insertion site (CIS) analysis of 119 primary tumors and 134 metastatic nodules identified 232 sites associated with osteosarcoma development and 43 sites associated with metastasis, respectively. Analysis of CIS-associated genes identified numerous known and new osteosarcoma-associated genes enriched in the ErbB, PI3K-AKT-mTOR and MAPK signaling pathways. Lastly, we identified several oncogenes involved in axon guidance, including Sema4d and Sema6d, which we functionally validated as oncogenes in human osteosarcoma. PMID:25961939

Primary mapping and stratigraphic data and field methods for the Snowmastodon Project

USGS Publications Warehouse

Lucking, Carol; Johnson, Kirk R.; Pigati, Jeffery S.; Miller, Ian

2012-01-01

During the Snowmastodon Project, many different people collected data for a wide array of purposes under a variety of conditions. Early in the process and in an attempt to provide project-wide consistency, Kirk Johnson appointed Carol Lucking as the project’s data manager both in the field and the lab. She was responsible for using GIS to create maps on an ongoing basis throughout the project. Jeff Pigati agreed to measure stratigraphic sections and coordinate the collection of various nonvertebrate samples to make sure that all resulting data could be plotted on common diagrams. Kirk Johnson was onsite for the entire project and measured the basin margin stratigraphy on a daily basis as it was destroyed by the digging teams. In the fall of 2010, we treated the upper part of the site (which included discrete excavations for the mammoth, deer, and bison skeletons) as an archaeological excavation and the lower part of the site (which contained isolated mastodon, ground sloth, and bison bones) as a construction salvage site.

Comparison of upper arm and forearm blood pressure.

PubMed

Domiano, Kathy L; Hinck, Susan M; Savinske, Debra L; Hope, Kathryn L

2008-11-01

The upper arm is the primary site used to obtain a blood pressure measurement (BPM); however, when it is not possible to use the upper arm, the forearm is a commonly used alternate site. This study determines if there is a significant difference between upper arm and forearm BPMs among adults and examines the relationship of participant characteristics to the BPM difference. A convenience sample was recruited from a low-income, independent-living, 104-apartment complex in the Midwest. Of the 106 participants, 64% were female and 89% were White. Ages ranged from 20 to 85 years (M = 50.7). The investigators calculated the BMIs (range = 18 to 42, M = 29.3, SD = 5.4) for the 89% (n = 94) of participants who reported their weight. The forearm tended to have higher BPMs than the upper arm (M difference = 4.0 mm Hg systolic, 2.3 mm Hg diastolic). However, site differences were greatest for men, obese adults, and middle aged (36 to 65) adults.

Primary Care Emergency Preparedness Network, New York City, 2015: Comparison of Member and Nonmember Sites

PubMed Central

Jean, Marc C.; Chen, Bei; Molinari, Noelle-Angelique M.; LeBlanc, Tanya T.

2017-01-01

Objectives. To assess whether Primary Care Emergency Preparedness Network member sites reported indicators of preparedness for public health emergencies compared with nonmember sites. The network—a collaboration between government and New York City primary care associations—offers technical assistance to primary care sites to improve disaster preparedness and response. Methods. In 2015, we administered an online questionnaire to sites regarding facility characteristics and preparedness indicators. We estimated differences between members and nonmembers with natural logarithm–linked binomial models. Open-ended assessments identified preparedness gaps. Results. One hundred seven sites completed the survey (23.3% response rate); 47 (43.9%) were nonmembers and 60 (56.1%) were members. Members were more likely to have completed hazard vulnerability analysis (risk ratio [RR] = 1.94; 95% confidence interval [CI] = 1.28, 2.93), to have identified essential services for continuity of operations (RR = 1.39; 95% CI = 1.03, 1.86), to have memoranda of understanding with external partners (RR = 2.49; 95% CI = 1.42, 4.36), and to have completed point-of-dispensing training (RR = 4.23; 95% CI = 1.76, 10.14). Identified preparedness gaps were improved communication, resource availability, and train-the-trainer programs. Public Health Implications. Primary Care Emergency Preparedness Network membership is associated with improved public health emergency preparedness among primary care sites. PMID:28892448

Spreaders and Sponges define metastasis in lung cancer: A Markov chain Monte Carlo Mathematical Model

PubMed Central

Newton, Paul K.; Mason, Jeremy; Bethel, Kelly; Bazhenova, Lyudmila; Nieva, Jorge; Norton, Larry; Kuhn, Peter

2013-01-01

The classic view of metastatic cancer progression is that it is a unidirectional process initiated at the primary tumor site, progressing to variably distant metastatic sites in a fairly predictable, though not perfectly understood, fashion. A Markov chain Monte Carlo mathematical approach can determine a pathway diagram that classifies metastatic tumors as ‘spreaders’ or ‘sponges’ and orders the timescales of progression from site to site. In light of recent experimental evidence highlighting the potential significance of self-seeding of primary tumors, we use a Markov chain Monte Carlo (MCMC) approach, based on large autopsy data sets, to quantify the stochastic, systemic, and often multi-directional aspects of cancer progression. We quantify three types of multi-directional mechanisms of progression: (i) self-seeding of the primary tumor; (ii) re-seeding of the primary tumor from a metastatic site (primary re-seeding); and (iii) re-seeding of metastatic tumors (metastasis re-seeding). The model shows that the combined characteristics of the primary and the first metastatic site to which it spreads largely determine the future pathways and timescales of systemic disease. For lung cancer, the main ‘spreaders’ of systemic disease are the adrenal gland and kidney, whereas the main ‘sponges’ are regional lymph nodes, liver, and bone. Lung is a significant self-seeder, although it is a ‘sponge’ site with respect to progression characteristics. PMID:23447576

Prostate cancer invasion and metastasis: Insights from mining genomic data

DOE PAGES

Hudson, Bryan D.; Kulp, Kristen S.; Loots, Gabriela G.

2013-07-22

Prostate cancer (PCa) is the second most commonly diagnosed malignancy in men in the Western world and the second leading cause of cancer-related deaths among men worldwide. Although most cancers have the potential to metastasize under appropriate conditions, PCa favors the skeleton as a primary site of metastasis, suggesting that the bone microenvironment is conducive to its growth. PCa metastasis proceeds through a complex series of molecular events that include angiogenesis at the site of the original tumor, local migration within the primary site, intravasation into the blood stream, survival within the circulation, extravasation of the tumor cells to themore » target organ and colonization of those cells within the new site. In turn, each one of these steps involves a complicated chain of events that utilize multiple protein–protein interactions, protein signaling cascades and transcriptional changes. Despite the urgent need to improve current biomarkers for diagnosis, prognosis and drug resistance, advances have been slow. Global gene expression methods such as gene microarrays and RNA sequencing enable the study of thousands of genes simultaneously and allow scientists to examine molecular pathways of cancer pathogenesis. In this review, we summarize the current literature that explored high-throughput transcriptome analysis toward the advancement of biomarker discovery for PCa. Novel biomarkers are strongly needed to enable more accurate detection of PCa, improve prediction of tumor aggressiveness and facilitate the discovery of new therapeutic targets for tailored medicine. Furthermore, promising molecular markers identified from gene expression profiling studies include HPN, CLU1, WT1, WNT5A, AURKA and SPARC.« less

Effects of resource addition on recovery of production and plant functional composition in degraded semiarid grasslands.

PubMed

Chen, Qing; Hooper, David U; Li, Hui; Gong, Xiao Ying; Peng, Fei; Wang, Hong; Dittert, Klaus; Lin, Shan

2017-05-01

Degradation of semiarid ecosystems from overgrazing threatens a variety of ecosystem services. Rainfall and nitrogen commonly co-limit production in semiarid grassland ecosystems; however, few studies have reported how interactive effects of precipitation and nitrogen addition influence the recovery of grasslands degraded by overgrazing. We conducted a 6-year experiment manipulating precipitation (natural precipitation and simulated wet year precipitation) and nitrogen (0, 25 and 50 kg N ha -1 ) addition at two sites with different histories of livestock grazing (moderately and heavily grazed) in Inner Mongolian steppe. Our results suggest that recovery of plant community composition and recovery of production can be decoupled. Perennial grasses provide long-term stability of high-quality forage production in this system. Supplemental water combined with exclosures led, in the heavily grazed site, to the strongest recovery of perennial grasses, although widespread irrigation of rangeland is not a feasible management strategy in many semiarid and arid regions. N fertilization combined with exclosures, but without water addition, increased dominance of unpalatable annual species, which in turn retarded growth of perennial species and increased inter-annual variation in primary production at both sites. Alleviation of grazing pressure alone allowed recovery of desired perennial species via successional processes in the heavily grazed site. Our experiments suggest that recovery of primary production and desirable community composition are not necessarily correlated. The use of N fertilization for the management of overgrazed grassland needs careful and systematic evaluation, as it has potential to impede, rather than aid, recovery.

Prostate cancer invasion and metastasis: Insights from mining genomic data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hudson, Bryan D.; Kulp, Kristen S.; Loots, Gabriela G.

Prostate cancer (PCa) is the second most commonly diagnosed malignancy in men in the Western world and the second leading cause of cancer-related deaths among men worldwide. Although most cancers have the potential to metastasize under appropriate conditions, PCa favors the skeleton as a primary site of metastasis, suggesting that the bone microenvironment is conducive to its growth. PCa metastasis proceeds through a complex series of molecular events that include angiogenesis at the site of the original tumor, local migration within the primary site, intravasation into the blood stream, survival within the circulation, extravasation of the tumor cells to themore » target organ and colonization of those cells within the new site. In turn, each one of these steps involves a complicated chain of events that utilize multiple protein–protein interactions, protein signaling cascades and transcriptional changes. Despite the urgent need to improve current biomarkers for diagnosis, prognosis and drug resistance, advances have been slow. Global gene expression methods such as gene microarrays and RNA sequencing enable the study of thousands of genes simultaneously and allow scientists to examine molecular pathways of cancer pathogenesis. In this review, we summarize the current literature that explored high-throughput transcriptome analysis toward the advancement of biomarker discovery for PCa. Novel biomarkers are strongly needed to enable more accurate detection of PCa, improve prediction of tumor aggressiveness and facilitate the discovery of new therapeutic targets for tailored medicine. Furthermore, promising molecular markers identified from gene expression profiling studies include HPN, CLU1, WT1, WNT5A, AURKA and SPARC.« less

Testing high resolution numerical models for analysis of contaminant storage and release from low permeability zones

NASA Astrophysics Data System (ADS)

Chapman, Steven W.; Parker, Beth L.; Sale, Tom C.; Doner, Lee Ann

2012-08-01

It is now widely recognized that contaminant release from low permeability zones can sustain plumes long after primary sources are depleted, particularly for chlorinated solvents where regulatory limits are orders of magnitude below source concentrations. This has led to efforts to appropriately characterize sites and apply models for prediction incorporating these effects. A primary challenge is that diffusion processes are controlled by small-scale concentration gradients and capturing mass distribution in low permeability zones requires much higher resolution than commonly practiced. This paper explores validity of using numerical models (HydroGeoSphere, FEFLOW, MODFLOW/MT3DMS) in high resolution mode to simulate scenarios involving diffusion into and out of low permeability zones: 1) a laboratory tank study involving a continuous sand body with suspended clay layers which was 'loaded' with bromide and fluorescein (for visualization) tracers followed by clean water flushing, and 2) the two-layer analytical solution of Sale et al. (2008) involving a relatively simple scenario with an aquifer and underlying low permeability layer. All three models are shown to provide close agreement when adequate spatial and temporal discretization are applied to represent problem geometry, resolve flow fields and capture advective transport in the sands and diffusive transfer with low permeability layers and minimize numerical dispersion. The challenge for application at field sites then becomes appropriate site characterization to inform the models, capturing the style of the low permeability zone geometry and incorporating reasonable hydrogeologic parameters and estimates of source history, for scenario testing and more accurate prediction of plume response, leading to better site decision making.

An Uncommon Presentation of a Metachronous Testicular Primary Nonseminoma and Seminoma Separated by Two Decades and a Testicular Cancer Literature Review.

PubMed

Buck, Dennis Andrew; Smith, Tristan Dean; Montana, Wilbur Nelson

2017-01-01

Testicular cancer is the most common malignancy in men aged 15-40 years [Bols et al.: Philadelphia, Wolters Kluwer, Lippincott Williams & Wilkins, 2011]. Its incidence comprises 0.8% of all male cancers worldwide, with a mortality rate of 0.1%. The incidence has nearly doubled from 1975 to 2007 leading to the concern of environmental causes [Thomas: Am J Epidemiol 2013; 178: 1240-1245]. Testicular cancer presents as a painless testicular mass without transillumination. Testicular cancer is subcategorized under germ cell testicular cancer or sex cord-stromal tumors. Of the germ cell tumors, approximately 90% originate in the testis, with the other 10% being extragonadal [Bols et al.: Philadelphia, Wolters Kluwer, Lippincott Williams & Wilkins, 2011]. Typically, if a patient presents with a testicular mass and is 50 years old or older, the diagnosis of a primary lymphoma is considered until proven otherwise [Bols et al.: Philadelphia, Wolters Kluwer, Lippincott Williams & Wilkins, 2011]. Germ cell testicular cancer is further divided into the subtypes of seminomatous and nonseminomatous; each presents with a unique histology and differing treatment implications. Given the uniqueness of our patient's metachronous second testicular primary, we sought to compare our case findings to available historic publications. We sought to address the issues of the incidence of a second primary testicular malignancy with regard to varying histology, age of incidence, and timing of a second primary testicular cancer, the presence of bowel involvement, and finally a brief discussion of testosterone replacement therapy. A review of our case presents several unique factors. The above varying literature has shown our patient to have met the odds of a contralateral testicular primary development in that he had a nonseminomatous primary, followed by a second testicular primary seminoma. Our patient exceeded the 15-year cumulative risk of contralateral metachronous testicular cancer of 1.9% versus the seemingly contradictory 5.2% cumulative risk 25 years after the first testicular germ cell tumor. With his second primary (seminoma), he presented with the common retroperitoneal landing zone site, though with an uncommon involvement of the gastrointestinal tract (<1%) and rare incidence of involving the duodenum.

The Risk of Misdiagnosing the Primary Site Responsible for Bone Metastases in Patients With Chronic Lymphocytic Leukemia and a Second Primary Carcinoma

PubMed Central

Hatoum, Georges; Meshkin, Cyrus; Alkhunaizi, Sufana; Levene, Richard; Formoso-Onofrio, Julie

2015-01-01

Chronic lymphocytic leukemia (CLL) is a common malignancy which may coexist with other primary cancers. CLL is rarely the cause of solitary bone lesions; such lesions in the context of CLL are believed to result from either Richter’s transformation or metastasis from another primary malignancy. Renal cell carcinoma (RCC), on the other hand, is a malignancy which frequently metastasizes to bone and may cause an osteolytic solitary bone lesion. The origin of a solitary bone lesion in a patient with multiple potential primary malignancies has prognostic implications and affects treatment protocol, and as such must be diagnosed accurately. We describe a patient with CLL and a history of RCC who is found to have an incidental solitary bone lesion of the T11 vertebra. After two separate CT-guided biopsies revealed various lymphoid cell predominance and no evidence of RCC, treatment with low dose external beam radiation therapy (EBRT) was employed. Post-therapy MRI showed further propagation of the lesion. Surgical corpectomy was subsequently performed and postoperative pathology of the lesion was consistent with RCC. The patient was treated with bisphosphonates and a higher dose of EBRT. Our case illustrates the importance of surgical excisional biopsy for accurately diagnosing the primary source metastatic to the bone in a patient with CLL and another potential primary cancer. PMID:29147427

Global resistance and resilience of primary production following extreme drought are predicted by mean annual precipitation

NASA Astrophysics Data System (ADS)

Stuart-Haëntjens, E. J.; De Boeck, H. J.; Lemoine, N. P.; Gough, C. M.; Kröel-Dulay, G.; Mänd, P.; Jentsch, A.; Schmidt, I. K.; Bahn, M.; Lloret, F.; Kreyling, J.; Wohlgemuth, T.; Stampfli, A.; Anderegg, W.; Classen, A. T.; Smith, M. D.

2017-12-01

Extreme drought is increasing globally in frequency and intensity, with uncertain consequences for the resistance and resilience of key ecosystem functions, including primary production. Primary production resistance, the capacity of an ecosystem to withstand change in primary production following extreme climate, and resilience, the degree to which primary production recovers, vary among and within ecosystem types, obscuring global patterns of resistance and resilience to extreme drought. Past syntheses on resistance have focused climatic gradients or individual ecosystem types, without assessing interactions between the two. Theory and many empirical studies suggest that forest production is more resistant but less resilient than grassland production to extreme drought, though some empirical studies reveal that these trends are not universal. Here, we conducted a global meta-analysis of sixty-four grassland and forest sites, finding that primary production resistance to extreme drought is predicted by a common continuum of mean annual precipitation (MAP). However, grasslands and forests exhibit divergent production resilience relationships with MAP. We discuss the likely mechanisms underlying the mixed production resistance and resilience patterns of forests and grasslands, including different plant species turnover times and drought adaptive strategies. These findings demonstrate the primary production responses of forests and grasslands to extreme drought are mixed, with far-reaching implications for Earth System Models, ecosystem management, and future studies of extreme drought resistance and resilience.

The effect of undersizing and tapping on bone to implant contact and implant primary stability: A histomorphometric study on bovine ribs.

PubMed

Di Stefano, Danilo Alessio; Perrotti, Vittoria; Greco, Gian Battista; Cappucci, Claudia; Arosio, Paolo; Piattelli, Adriano; Iezzi, Giovanna

2018-06-01

Implant site preparation may be adjusted to achieve the maximum possible primary stability. The aim of this investigation was to study the relation among bone-to-implant contact at insertion, bone density, and implant primary stability intra-operatively measured by a torque-measuring implant motor, when implant sites were undersized or tapped. Undersized (n=14), standard (n=13), and tapped (n=13) implant sites were prepared on 9 segments of bovine ribs. After measuring bone density using the implant motor, 40 implants were placed, and their primary stability assessed by measuring the integral of the torque-depth insertion curve. Bovine ribs were then processed histologically, the bone-to-implant contact measured and statistically correlated to bone density and the integral. Bone-to-implant contact and the integral of the torque-depth curve were significantly greater for undersized sites than tapped sites. Moreover, a correlation between bone to implant contact, the integral and bone density was found under all preparation conditions. The slope of the bone-to-implant/density and integral/density lines was significantly greater for undersized sites, while those corresponding to standard prepared and tapped sites did not differ significantly. The integral of the torque-depth curve provided reliable information about bone-to-implant contact and primary implant stability even in tapped or undersized sites. The linear relations found among the parameters suggests a connection between extent and modality of undersizing and the corresponding increase of the integral and, consequently, of primary stability. These results might help the physician determine the extent of undersizing needed to achieve the proper implant primary stability, according to the planned loading protocol.

Patients with gout can be cured in primary care.

PubMed

Rees, Frances; Doherty, Michael

2014-12-01

Gout affects 2.5% of the total UK population and is four times more common in men than women. The peak prevalence and incidence in the UK is in those aged 80-84 years. Gout is associated with comorbidities such as nephrolithiasis, chronic renal impairment, metabolic syndrome, depression and heart disease. It is also associated with increased mortality. Untreated gout can result in disabling irreversible peripheral joint damage and chronic usage-related pain. However, gout is curable. The pathogenic agents that cause gout i.e.urate crystals can be eliminated through a combination of effective patient education and evidence-based, targeted urate-lowering therapy. Gout is caused by the precipitation of monosodium urate crystals in and around a joint. The crystals preferentially form in peripheral, cooler joints and especially in those with osteoarthritis. It is thought that some of these preformed crystals within articular cartilage spill over into the joint space and trigger an acute attack of inflammation. Uric acid is predominantly renally excreted and the common heritable component of gout results from relative inefficiency of urate excretion. Chronic kidney disease, metabolic syndrome and drugs that reduce renal function (e.g. thiazide diuretics, beta-blockers and ACE inhibitors) will all lead to reduced elimination. Patients with chronic gout can present with monoarthritis but more commonly present with asymmetrical polyarthritis or tophi. Joints affected by osteoarthritis are preferentially targeted, the most common sites of involvement are feet, knees, hands and elbows. Diagnosis can be confirmed in primary care by taking a good history and clinical examination. An acute peripheral monoarthritis which reaches its peak within 24 hours and causes 'the worst pain ever experienced' is characteristic of an acute attack. A patient may have co-existing risk factors for gout such as osteoarthritis, obesity, hypertension, renal impairment, diuretic and antihypertensive drug use or increased beer or spirit consumption. A raised serum uric acid can confirm the diagnosis, however, this can be normal in the acute phase. Radiographs are rarely helpful but joint ultrasound may demonstrate deposits in cartilage, the synovium and peri-articular sites.

Diagnostic value of 18F-fluordesoxyglucose positron emission tomography for patients with brain metastasis from unknown primary site.

PubMed

Wolpert, Fabian; Weller, Michael; Berghoff, Anna Sophie; Rushing, Elisabeth; Füreder, Lisa Michaela; Petyt, Gregory; Leske, Henning; Andratschke, Nicolaus; Regli, Luca; Neidert, Marian Christoph; Stupp, Roger; Stahel, Rolf; Dummer, Reinhard; Frauenfelder, Thomas; Roth, Patrick; Reyns, Nicolas; Kaufmann, Philipp Antonio; Preusser, Matthias; Le Rhun, Emilie

2018-04-17

In 30% of patients with brain metastasis (BM), neurological symptoms are the first clinical manifestation of systemic malignancy, referred to as BM from cancer of unknown primary site (BM-CUPS). Here, we define the diagnostic value of 18 F-fluordesoxyglucose positron emission tomography (FDG-PET/CT) in the workup of BM-CUPS. We screened 565 patients operated for BM at the University Hospital Zurich and identified 64 patients with BM-CUPS with data on both FDG-PET/CT and contrast-enhanced chest/abdomen computed tomography (CT) available at BM diagnosis. A cohort of 125 patients with BM-CUPS from Lille and Vienna was used for validation. FDG-PET/CT was not superior to chest/abdomen CT in localising the primary lesion in the discovery cohort, presumably because most primary tumours were lung cancers. However, FDG-PET/CT identified additional lesions suspicious of extracranial metastases in 27 of 64 patients (42%). The inclusion of FDG-PET/CT findings shifted the graded prognostic assessment (GPA) score from 3 with CT alone to 2.5 for PET/CT (p = 3.8 × 10 -5 , Wilcoxon's test), resulting in a predicted survival of 5.3 versus 3.8 months (p = 6.1 × 10 -5 ; Wilcoxon's test). All observations were confirmed in the validation cohort. Lung cancers are the most common primary tumour in BM-CUPS; accordingly, CT alone shows similar overall sensitivity for detecting the primary tumour as FDG-PET/CT. Yet, FDG-PET/CT improves the accuracy of staging by detecting more metastases, reflected by decreased GPA scores and decreased predicted survival. Therefore, randomised trials on patients with BM should standardise methods of staging, notably when stratifying for GPA. Copyright © 2018 Elsevier Ltd. All rights reserved.

Differences Between Colon Cancer Primaries and Metastases Using a Molecular Assay for Tumor Radiation Sensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahmed, Kamran A.; Fulp, William J.; Berglund, Anders E.

2015-07-15

Purpose: We previously developed a multigene expression model of tumor radiation sensitivity index (RSI) with clinical validation in multiple independent cohorts (breast, rectal, esophageal, and head and neck patients). The purpose of this study was to assess differences between RSI scores in primary colon cancer and metastases. Methods and Materials: Patients were identified from our institutional review board–approved prospective observational protocol. A total of 704 metastatic and 1362 primary lesions were obtained from a de-identified metadata pool. RSI was calculated using the previously published rank-based algorithm. An independent cohort of 29 lung or liver colon metastases treated with 60 Gy in 5more » fractions stereotactic body radiation therapy (SBRT) was used for validation. Results: The most common sites of metastases included liver (n=374; 53%), lung (n=116; 17%), and lymph nodes (n=40; 6%). Sixty percent of metastatic tumors, compared with 54% of primaries, were in the RSI radiation-resistant peak, suggesting metastatic tumors may be slightly more radiation resistant than primaries (P=.01). In contrast, when we analyzed metastases based on anatomical site, we uncovered large differences in RSI. The median RSIs for metastases in descending order of radiation resistance were ovary (0.48), abdomen (0.47), liver (0.43), brain (0.42), lung (0.32), and lymph nodes (0.31) (P<.0001). These findings were confirmed when the analysis was restricted to lesions from the same patient (n=139). In our independent cohort of treated lung and liver metastases, lung metastases had an improved local control rate compared to that in patients with liver metastases (2-year local control rate of 100% vs 73.0%, respectively; P=.026). Conclusions: Assessment of radiation sensitivity between primary and metastatic tissues of colon cancer histology revealed significant differences based on anatomical location of metastases. These initial results warrant validation in a larger clinical cohort.« less

Minimizing human error in radiopharmaceutical preparation and administration via a bar code-enhanced nuclear pharmacy management system.

PubMed

Hakala, John L; Hung, Joseph C; Mosman, Elton A

2012-09-01

The objective of this project was to ensure correct radiopharmaceutical administration through the use of a bar code system that links patient and drug profiles with on-site information management systems. This new combined system would minimize the amount of manual human manipulation, which has proven to be a primary source of error. The most common reason for dosing errors is improper patient identification when a dose is obtained from the nuclear pharmacy or when a dose is administered. A standardized electronic transfer of information from radiopharmaceutical preparation to injection will further reduce the risk of misadministration. Value stream maps showing the flow of the patient dose information, as well as potential points of human error, were developed. Next, a future-state map was created that included proposed corrections for the most common critical sites of error. Transitioning the current process to the future state will require solutions that address these sites. To optimize the future-state process, a bar code system that links the on-site radiology management system with the nuclear pharmacy management system was proposed. A bar-coded wristband connects the patient directly to the electronic information systems. The bar code-enhanced process linking the patient dose with the electronic information reduces the number of crucial points for human error and provides a framework to ensure that the prepared dose reaches the correct patient. Although the proposed flowchart is designed for a site with an in-house central nuclear pharmacy, much of the framework could be applied by nuclear medicine facilities using unit doses. An electronic connection between information management systems to allow the tracking of a radiopharmaceutical from preparation to administration can be a useful tool in preventing the mistakes that are an unfortunate reality for any facility.

Qualitative Comparison of IGRA and ESRL Radiosonde Archived Databases

NASA Technical Reports Server (NTRS)

Walker, John R.

2014-01-01

Multiple databases of atmospheric profile information are freely available to individuals and groups such as the Natural Environments group. Two of the primary database archives provided by NOAA that are most frequently used are those from the Earth Science Research Laboratory (ESRL) and the Integrated Global Radiosonde Archive (IGRA). Inquiries have been made as to why one database is used as opposed to the other, yet to the best of knowledge, no formal comparison has been performed. The goal of this study is to provide a qualitative comparison of the ESRL and IGRA radiosonde databases. For part of this analyses, 14 upper air observation sites were selected. These sites all have the common attribute of having been used or are planned for use in the development of Range Reference Atmospheres (RRAs) in support of NASA's and DOD's current and future goals.

Paraneoplastic hypercalcemia.

PubMed

Bergman, Philip J

2012-11-01

Paraneoplastic syndromes (PNSs) are neoplasm-associated alterations in bodily structure or function or both that occur distant to the tumor. They are an extremely diverse group of clinical aberrations that are associated with the noninvasive actions of the tumor. In many situations, the PNS parallels the underlying malignancy, and therefore, successful treatment of the tumor leads to disappearance of the PNS. Alternatively, recurrence of the PNS after successful treatment signals recurrence of the tumor, and the return of the PNS often significantly precedes the detectable recurrence of the tumor. This is often the case with paraneoplastic hypercalcemia, often referred to as hypercalcemia of malignancy (HM). The most common cause of hypercalcemia in dogs is cancer. Neoplasia is diagnosed in approximately two-thirds of dogs with hypercalcemia vs. approximately one-third in cats. A variety of tumors have been associated with HM. Lymphoma is the most common cause of HM, and the most common anatomical site for dogs with lymphoma-associated HM is the cranial mediastinum. Other tumors associated with HM in dogs and cats include anal sac apocrine gland adenocarcinoma, thyroid carcinoma, multiple myeloma, bone tumors, thymoma, squamous cell carcinoma, mammary gland carcinoma/adenocarcinoma, melanoma, primary lung tumors, chronic lymphocytic leukemia, renal angiomyxoma, and parathyroid gland tumors. As HM is a potential medical emergency, the primary goal in cases of HM is the elucidation of the underlying cause and thereby instituting the appropriate specific therapy. Copyright © 2012 Elsevier Inc. All rights reserved.

[Clinical significance of four quadrant localization in the diagnosis and treatment of metastatic carcinoma of the neck with unknown primary].

PubMed

Gao, Y Y; Chen, X H

2017-06-05

Objective: The aim of this study is to investigate the clinical significance of four quadrant localization in the diagnosis and treatment of unknown primary cervical metastases. Method: The clinical data with unknown primary cervical metastases, were analyzed retrospectively. All the patients have not been found the original site in the initial treatment. There are four quadrants in the neck, the neck line as the longitudinal axis, and edge of cricoid cartilage as the horizontal axis. When cervical metastasis occurred in the left and right upper quadrant, the primary tumor site and radiotherapy from the skull base to the root of the neck; when appear in left and right lower quadrant, the primary investigation site and radiotherapy from neck to thoracic mediastinum, left lower abdomen also includes following primary search. At the same time, bilateral cervical metastasis cancers, focusing on the central line near the primary focus. Specific treatment strategies include ipsilateral total neck dissection and radical radiotherapy of the above radiotherapy site. Result: Left upper neck in 4 cases, right upper neck in 5 cases, left lower neck in 7 cases, lower right neck in 8 cases and mixed area in 6 cases. Only 10 of 30 patients (33.3%) with primary sites were found in the follow up period. In accordance with the four quadrant localization, the median time was 6 months. Conclusion: Four quadrant localization to locate the primary site is accurate, and individualized comprehensive treatment is the key to improve the curative effect. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

Asymmetric Responses of Primary Productivity to Altered Precipitation Simulated by Land Surface Models across Three Long-term Grassland Sites

NASA Astrophysics Data System (ADS)

Wu, D.; Ciais, P.; Viovy, N.; Knapp, A.; Wilcox, K.; Bahn, M.; Smith, M. D.; Ito, A.; Arneth, A.; Harper, A. B.; Ukkola, A.; Paschalis, A.; Poulter, B.; Peng, C.; Reick, C. H.; Hayes, D. J.; Ricciuto, D. M.; Reinthaler, D.; Chen, G.; Tian, H.; Helene, G.; Zscheischler, J.; Mao, J.; Ingrisch, J.; Nabel, J.; Pongratz, J.; Boysen, L.; Kautz, M.; Schmitt, M.; Krohn, M.; Zeng, N.; Meir, P.; Zhang, Q.; Zhu, Q.; Hasibeder, R.; Vicca, S.; Sippel, S.; Dangal, S. R. S.; Fatichi, S.; Sitch, S.; Shi, X.; Wang, Y.; Luo, Y.; Liu, Y.; Piao, S.

2017-12-01

Changes in precipitation variability including the occurrence of extreme events strongly influence plant growth in grasslands. Field measurements of aboveground net primary production (ANPP) in temperate grasslands suggest a positive asymmetric response with wet years resulting in ANPP gains larger than ANPP declines in dry years. Whether land surface models used for historical simulations and future projections of the coupled carbon-water system in grasslands are capable to simulate such non-symmetrical ANPP responses remains an important open research question. In this study, we evaluate the simulated responses of grassland primary productivity to altered precipitation with fourteen land surface models at the three sites of Colorado Shortgrass Steppe (SGS), Konza prairie (KNZ) and Stubai Valley meadow (STU) along a rainfall gradient from dry to wet. Our results suggest that: (i) Gross primary production (GPP), NPP, ANPP and belowground NPP (BNPP) show nonlinear response curves (concave-down) in all the models, but with different curvatures and mean values. In contrast across the sites, primary production increases and then saturates along increasing precipitation with a flattening at the wetter site. (ii) Slopes of spatial relationships between modeled primary production and precipitation are steeper than the temporal slopes (obtained from inter-annual variations). (iii) Asymmetric responses under nominal precipitation range with modeled inter-annual primary production show large uncertainties, and model-ensemble median generally suggests negative asymmetry (greater declines in dry years than increases in wet years) across the three sites. (iv) Primary production at the drier site is predicted to more sensitive to precipitation compared to wetter site, and median sensitivity consistently indicates greater negative impacts of reduced precipitation than positive effects of increased precipitation under extreme conditions. This study implies that most models overemphasize the drought effects or underestimate the watering impacts on primary production in the normal-state, with the direct consequence that carbon-water interactions need to be improved in future model generations with improved mechanistic representations.

Equine nasal and paranasal sinus tumours. Part 1: review of the literature and tumour classification.

PubMed

Head, K W; Dixon, P M

1999-05-01

The normal gross and histological anatomy of the equine nasal and paranasal sinuses are reviewed and the relationships between the local anatomy, the occurrence of different tumour types, and of tumour spread are examined. The histological classification of the more common equine sinonasal tumours and tumour-like lesions are discussed. Clinical and pathological descriptions of 50 more recently recorded such tumours are separately tabulated. The literature shows that equine sinonasal tumours, both endemic and sporadic, are relatively uncommon in horses, with non-neoplastic growths such as maxillary (sinus) cysts, progressive ethmoid haematoma and inflammatory nasal polyps more commonly recorded. The equine paranasal sinuses, especially the caudal maxillary sinus, are the most common sites for sinonasal tumours and, in contrast to other species, primary nasal tumours are uncommon. The more common tumour types include squamous cell carcinoma that, in some cases, arise in the oral cavity and spread to the maxillary sinuses; adenocarcinomas; bone and dental tumours; fibrosarcomas and haemangiosarcomas. Except for some benign bone tumours, there are few records of successful treatment of equine sinonasal tumours.

Surveying the Commons: Current Implementation of Information Commons Web sites

ERIC Educational Resources Information Center

Leeder, Christopher

2009-01-01

This study assessed the content of 72 academic library Information Commons (IC) Web sites using content analysis, quantitative assessment and qualitative surveys of site administrators to analyze current implementation by the academic library community. Results show that IC Web sites vary widely in content, design and functionality, with few…

Reconstruction in oral malignancy: Factors affecting morbidity of various procedures

PubMed Central

Chakrabarti, Suvadip; Chakrabarti, Preeti Rihal; Desai, Sanjay M.; Agrawal, Deepak; Mehta, Dharmendra Y.; Pancholi, Mayank

2015-01-01

Aims and Objective: (1) To study the age and sex distribution of patient with oral malignancies. (2) To analyze various types of surgery performed. (3) Evaluation of reconstruction and factors affecting complications and its relation to the type of reconstruction. Materials and Methods: Cases of oral malignancies, undergoing surgery for the same in Sri Aurobindo Medical College and PG Institute, Indore from the period from October 1, 2012, to March 31, 2015. Results: Out of analysis of 111 cases of oral malignancy, 31 (27.9%) cases were in the fifth decade of life with male to female ratio 1.9:1. The commonest site of cancer was buccal mucosa. Forty-seven cases (43.2%) were in stage IVa. Diabetes was the most common co-morbidity reported, accounting for 53.9% of cases with reported morbidity. Tobacco chewing was the common entity in personal habits. All the cases underwent neck dissection along with resection of the primary. Hemimandibulectomy was the most preferred form of primary resection accounting for 53.15% (59 cases), followed by wide resection of primary 27% (30 cases). Pectoralis major myocutaneous (PMMC) flap only was the most common reconstruction across the study population. PMMC alone accounted for 38.7% (43 cases). The infection rate was 16.21%. PMMC alone accounted for 5 out of 18 (27.8%) of total infection rate, and 4.5% of the total study population. PMMC + deltopectoral accounted for 5 out of 18 (27.8%) of total infection rate, and 4.5% of the total study population. Conclusion: PMMC is a major workhorse for reconstruction with better functional outcome and acceptance among operated patients. PMID:26981469

Atypical extraspinal musculoskeletal tuberculosis in immunocompetent patients: part II, tuberculous myositis, tuberculous bursitis, and tuberculous tenosynovites.

PubMed

Abdelwahab, Ibrahim Fikry; Bianchi, Stefano; Martinoli, Carlo; Klein, Michael; Hermann, George

2006-12-01

Tuberculosis involving the soft tissue from adjacent bone or joint is well recognized. However, primary tuberculous pyomyositis, tuberculous bursitis, and tuberculous tenosynovitis are rare entities constituting 1% of skeletal tuberculosis. Tuberculous tenosynovitis involves most commonly the tendon sheaths of the hand and wrist, and tuberculous bursitis occurs most commonly around the hip. The greater trochanteric bursa and the greater trochanter are the most frequent sites of tuberculous bursitis. Cases of primary tuberculous pyomyositis and tenosynovitis of the tendons of the ankle and foot are seldom reported in the radiology literature. All imaging modalities-plain radiography, bone scan, computed tomography, and magnetic resonance imaging (MRI)--provide information that is helpful in determining therapy. MRI in particular, with its multiplanar capabilities and superb contrast of soft tissue, can demonstrate the extent of the soft tissue mass and access the adjacent bones and joints. However, MRI has no diagnostic specificity in regard to tuberculosis, and in nonendemic areas, biopsy is strongly recommended. All patients in this review were permanent residents of North America or Western Europe and were immunocompetent. Examples of atypical presentations of the above entities are demonstrated.

An unusual presentation of papillary fibroelastoma originating from right ventricular outflow tract.

PubMed

Erdogan, Mehmet; Guney, Murat Can; Ayhan, Hüseyin; Kasapkara, Hacı Ahmet; Uğuz, Emrah; Durmaz, Tahir; Keleş, Telat; Bozkurt, Engin

2017-03-01

Papillary fibroelastomas (PFEs) are primary cardiac tumors with a benign and avascular nature. Majority of the PFEs are originated from the valvular endocardium, while the most common site is aortic valve. In this case, we present a patient with multiple PFEs originating from the right ventricular outflow tract who was admitted to our clinic with exertional dyspnea. As far as we know, this is the first case of this unusual presentation of multiple PFEs and also had a history of breast cancer and permanent pacemaker reported in the literature. © 2017, Wiley Periodicals, Inc.

Site-level evaluation of satellite-based global terrestrial gross primary production and net primary production monitoring.

Treesearch

David P. Turner; William D. Ritts; Warren B. Cohen; Thomas K. Maeirsperger; Stith T. Gower; Al A. Kirschbaum; Steve W. Runnings; Maosheng Zhaos; Steven C. Wofsy; Allison L. Dunn; Beverly E. Law; John L. Campbell; Walter C. Oechel; Hyo Jung Kwon; Tilden P. Meyers; Eric E. Small; Shirley A. Kurc; John A. Gamon

2005-01-01

Operational monitoring of global terrestrial gross primary production (GPP) and net primary production (NPP) is now underway using imagery from the satellite-borne Moderate Resolution Imaging Spectroradiometer (MODIS) sensor. Evaluation of MODIS GPP and NPP products will require site-level studies across a range of biomes, with close attention to numerous scaling...

Profiles of Brain Metastases: Prioritization of Therapeutic Targets.

PubMed

Ferguson, Sherise D; Zheng, Siyuan; Xiu, Joanne; Zhou, Shouhao; Khasraw, Mustafa; Brastianos, Priscilla K; Kesari, Santosh; Hu, Jethro; Rudnick, Jeremy; Salacz, Michael E; Piccioni, David; Huang, Suyun; Davies, Michael A; Glitza, Isabella C; Heymach, John V; Zhang, Jianjun; Ibrahim, Nuhad K; DeGroot, John F; McCarty, Joseph; O'Brien, Barbara J; Sawaya, Raymond; Verhaak, Roeland G W; Reddy, Sandeep K; Priebe, Waldemar; Gatalica, Zoran; Spetzler, David; Heimberger, Amy B

2018-06-19

We sought to compare the tumor profiles of brain metastases from common cancers with those of primary tumors and extracranial metastases in order to identify potential targets and prioritize rational treatment strategies. Tumor samples were collected from both the primary and metastatic sites of non-small cell lung cancer, breast cancer, and melanoma from patients in locations worldwide, and these were submitted to Caris Life Sciences for tumor multiplatform analysis, including gene sequencing (Sanger and next-generation sequencing with a targeted 47-gene panel), protein expression (assayed by immunohistochemistry), and gene amplification (assayed by in situ hybridization). The data analysis considered differential protein expression, gene amplification, and mutations among brain metastases, extracranial metastases, and primary tumors. The analyzed population included: 16,999 unmatched primary tumor and/or metastasis samples: 8178 non-small cell lung cancers (5098 primaries; 2787 systemic metastases; 293 brain metastases), 7064 breast cancers (3496 primaries; 3469 systemic metastases; 99 brain metastases), and 1757 melanomas (660 primaries; 996 systemic metastases; 101 brain metastases). TOP2A expression was increased in brain metastases from all 3 cancers, and brain metastases overexpressed multiple proteins clustering around functions critical to DNA synthesis and repair and implicated in chemotherapy resistance, including RRM1, TS, ERCC1, and TOPO1. cMET was overexpressed in melanoma brain metastases relative to primary skin specimens. Brain metastasis patients may particularly benefit from therapeutic targeting of enzymes associated with DNA synthesis, replication, and/or repair. This article is protected by copyright. All rights reserved. © 2018 UICC.

Analysis of prognostic factors for survival in patients with primary spinal chordoma using the SEER Registry from 1973 to 2014.

PubMed

Pan, Yue; Lu, Lingyun; Chen, Junquan; Zhong, Yong; Dai, Zhehao

2018-04-06

Spinal chordomas are rare primary osseous tumors that arise from the remnants of the notochord. They are commonly considered slow-growing, locally invasive neoplasms with little tendency to metastasize, but the high recurrent rate of spinal chordomas may seriously affect the survival rate and quality of life of patients. The aim of the study is to describe the epidemiological data and determine the prognostic factors for decreased survival in patients with primary spinal chordoma. The Surveillance, Epidemiology, and End Results (SEER) Registry database, a US population-based cancer registry database, was used to identify all patients diagnosed with primary spinal chordoma from 1973 to 2014. We utilized Kaplan-Meier method and Cox proportional hazards regression analysis to evaluate the association between patients overall survival and relevant characteristics, including age, gender, race, disease stage, treatment methods, primary tumor site, marital status, and urban county background. In the data set between 1973 and 2014, a total of 808 patients were identified with primary spinal chordoma. The overall rate of distant metastatic cases in our cohort was only 7.7%. Spinal chordoma was more common occurred in men (62.6%) than women (37.3%). Majority of neoplasms were found in the White (87.9%), while the incidence of the Black is relatively infrequent (3.3%). Three hundred fifty-seven spinal chordomas (44.2%) were located in the vertebral column, while 451 patients' tumor (55.8%) was located in the sacrum or pelvis. Age ≥ 60 years (HR = 2.72; 95%CI, 1.71 to 2.89), distant metastasis (HR = 2.16; 95%CI, 1.54 to 3.02), and non-surgical therapy (HR = 2.14; 95%CI, 1.72 to 2.69) were independent risk factors for survival reduction in analysis. Survival did not significantly differ as a factor of tumor site (vertebrae vs sacrum/pelvis) for primary spinal chordoma (HR = 0.93, P = 0.16). Race (P = 0.52), gender (P = 0.11), marital status (P = 0.94), and urban background (P = 0.72) were not main factors which affected overall survival rate. There was no significant difference in overall survival rate between chordomas located in the sacrum and vertebral column. Spinal chordoma patients with an elderly age (age ≥ 60), performing non-surgical therapy, and distant metastasis were associated with worse overall survival. Performing surgery was an effective and reliable treatment method for patients with spinal chordoma, and public health efforts should pay more attention to the elderly patients with spinal chordoma prior to distant metastasis.

[Free flap reconstruction in the head and neck. Indications, technical aspects and outcomes].

PubMed

Llorente, José Luis; López, Fernando; Suárez, Vanessa; Fueyo, Angel; Carnero, Susana; Martín, Clara; López, Victoria; Camporro, Daniel; Suárez, Carlos

2014-01-01

The use of microvascular free flaps (MFF) has become a common method of head and neck reconstruction because of its high success rates and better functional results. We report our experience in reconstructing complex defects with MFF. We analysed a series of 246 patients that underwent reconstruction using MFF in our Department from 1991 to 2013. There were 259 interventions performed in 246 patients. The most common reason for surgery was tumour recurrence (46%), followed by primary tumour resection (25%). The hypopharynx (52%) and the craniofacial region (22%) were the most frequently reconstructed sites. The free flaps most commonly used were the radial forearm free flap (41%) and the anterolateral thigh free flap (35%). Overall success and complication rates of 92% and 20% respectively were reported. The microvascular free flap is a reliable and useful tool for reconstructing complex head and neck defects and continues to be the reconstructive modality of choice for these defects. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Choroidal metastases: Origin, features, and therapy

PubMed Central

Arepalli, Sruthi; Kaliki, Swathi; Shields, Carol L

2015-01-01

The choroid is the most common ocular site for metastatic disease, owing to abundant vascular supply. The primary cancers that most commonly lead to choroidal metastases include breast cancer (40-47%) and lung cancer (21-29%). Bilateral, multifocal metastases are most often secondary to breast cancer, whereas unilateral, unifocal metastasis are more commonly found with lung cancer. The treatment of choroidal metastasis depends on the systemic status of the patient and number, location, and laterality of the choroidal tumors. Treatment options include observation in patients with poor systemic status or those with resolved or asymptomatic disease; systemic chemotherapy, immunotherapy, hormone therapy, or whole eye radiotherapy if the metastases are active, multifocal and bilateral; plaque radiotherapy, transpupillary radiotherapy, or photodynamic therapy for active, solitary metastasis; and enucleation for those with blind painful eye. A database search was performed on PubMed, using the terms “choroidal metastasis,” or “choroidal metastases,” in combination with terms such as “treatment,” “features,” or “diagnosis.” Relevant articles were extracted and reviewed. PMID:25827542

Infant Gastroesophageal Reflux Information on the World Wide Web.

PubMed

Balgowan, Regina; Greer, Leah C; D'Auria, Jennifer P

2016-01-01

The purpose of this study was to describe the type and quality of health information about infant gastroesophageal reflux (GER) that a parent may find on the World Wide Web. The data collection tool included evaluation of Web site quality and infant GER-specific content on the 30 sites that met the inclusion criteria. The most commonly found content categories in order of frequency were management strategies, when to call a primary care provider, definition, and clinical features. The most frequently mentioned strategies included feeding changes, infant positioning, and medications. Thirteen of the 30 Web sites included information on both GER and gastroesophageal reflux disease. Mention of the use of medication to lessen infant symptoms was found on 15 of the 30 sites. Only 10 of the 30 sites included information about parent support and coping strategies. Pediatric nurse practitioners (PNPs) should utilize well-child visits to address the normalcy of physiologic infant GER and clarify any misperceptions parents may have about diagnosis and the role of medication from information they may have found on the Internet. It is critical for PNPs to assist in the development of Web sites with accurate content, advise parents on how to identify safe and reliable information, and provide examples of high-quality Web sites about child health topics such as infant GER. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Effects of stimulation parameters and electrode location on thresholds for epidural stimulation of cat motor cortex

NASA Astrophysics Data System (ADS)

Wongsarnpigoon, Amorn; Grill, Warren M.

2011-12-01

Epidural electrical stimulation (ECS) of the motor cortex is a developing therapy for neurological disorders. Both placement and programming of ECS systems may affect the therapeutic outcome, but the treatment parameters that will maximize therapeutic outcomes and minimize side effects are not known. We delivered ECS to the motor cortex of anesthetized cats and investigated the effects of electrode placement and stimulation parameters on thresholds for evoking motor responses in the contralateral forelimb. Thresholds were inversely related to stimulation frequency and the number of pulses per stimulus train. Thresholds were lower over the forelimb representation in motor cortex (primary site) than surrounding sites (secondary sites), and thresholds at sites <4 mm away from the primary site were significantly lower than at sites >4 mm away. Electrode location and montage influenced the effects of polarity on thresholds: monopolar anodic and cathodic thresholds were not significantly different over the primary site, cathodic thresholds were significantly lower than anodic thresholds over secondary sites and bipolar thresholds were significantly lower with the anode over the primary site than with the cathode over the primary site. A majority of bipolar thresholds were either between or equal to the respective monopolar thresholds, but several bipolar thresholds were greater than or less than the monopolar thresholds of both the anode and cathode. During bipolar stimulation, thresholds were influenced by both electric field superposition and indirect, synaptically mediated interactions. These results demonstrate the influence of stimulation parameters and electrode location during cortical stimulation, and these effects should be considered during the programming of systems for therapeutic cortical stimulation.

Resident away rotations allow adaptive neurosurgical training.

PubMed

Gephart, Melanie Hayden; Derstine, Pamela; Oyesiku, Nelson M; Grady, M Sean; Burchiel, Kim; Batjer, H Hunt; Popp, A John; Barbaro, Nicholas M

2015-04-01

Subspecialization of physicians and regional centers concentrate the volume of certain rare cases into fewer hospitals. Consequently, the primary institution of a neurological surgery training program may not have sufficient case volume to meet the current Residency Review Committee case minimum requirements in some areas. To ensure the competency of graduating residents through a comprehensive neurosurgical education, programs may need for residents to travel to outside institutions for exposure to cases that are either less common or more regionally focused. We sought to evaluate off-site rotations to better understand the changing demographics and needs of resident education. This would also allow prospective monitoring of modifications to the neurosurgery training landscape. We completed a survey of neurosurgery program directors and query of data from the Accreditation Council of Graduate Medical Education to characterize the current use of away rotations in neurosurgical education of residents. We found that 20% of programs have mandatory away rotations, most commonly for exposure to pediatric, functional, peripheral nerve, or trauma cases. Most of these rotations are done during postgraduate year 3 to 6, lasting 1 to 15 months. Twenty-six programs have 2 to 3 participating sites and 41 have 4 to 6 sites distinct from the host program. Programs frequently offset potential financial harm to residents rotating at a distant site by support of housing and transportation costs. As medical systems experience fluctuating treatment paradigms and demographics, over time, more residency programs may adapt to meet the Accreditation Council of Graduate Medical Education case minimum requirements through the implementation of away rotations.

Evaluation of the Content and Accessibility of Web Sites for Accredited Orthopaedic Trauma Surgery Fellowships.

PubMed

Shaath, M Kareem; Yeranosian, Michael G; Ippolito, Joseph A; Adams, Mark R; Sirkin, Michael S; Reilly, Mark C

2018-05-02

Orthopaedic trauma fellowship applicants use online-based resources when researching information on potential U.S. fellowship programs. The 2 primary sources for identifying programs are the Orthopaedic Trauma Association (OTA) database and the San Francisco Match (SF Match) database. Previous studies in other orthopaedic subspecialty areas have demonstrated considerable discrepancies among fellowship programs. The purpose of this study was to analyze content and availability of information on orthopaedic trauma surgery fellowship web sites. The online databases of the OTA and SF Match were reviewed to determine the availability of embedded program links or external links for the included programs. Thereafter, a Google search was performed for each program individually by typing the program's name, followed by the term "orthopaedic trauma fellowship." All identified fellowship web sites were analyzed for accessibility and content. Web sites were evaluated for comprehensiveness in mentioning key components of the orthopaedic trauma surgery curriculum. By consensus, we refined the final list of variables utilizing the methodology of previous studies on the topic. We identified 54 OTA-accredited fellowship programs, offering 87 positions. The majority (94%) of programs had web sites accessible through a Google search. Of the 51 web sites found, all (100%) described their program. Most commonly, hospital affiliation (88%), operative experiences (76%), and rotation overview (65%) were listed, and, least commonly, interview dates (6%), selection criteria (16%), on-call requirements (20%), and fellow evaluation criteria (20%) were listed. Programs with ≥2 fellows provided more information with regard to education content (p = 0.0001) and recruitment content (p = 0.013). Programs with Accreditation Council for Graduate Medical Education (ACGME) accreditation status also provided greater information with regard to education content (odds ratio, 4.0; p = 0.0001). Otherwise, no differences were seen by region, residency affiliation, medical school affiliation, or hospital affiliation. The SF Match and OTA databases provide few direct links to fellowship web sites. Individual program web sites do not effectively and completely convey information about the programs. The Internet is an underused resource for fellow recruitment. The lack of information on these sites allows for future opportunity to optimize this resource.

Determining the impact of a new physiotherapist-led primary care model for back pain: protocol for a pilot cluster randomized controlled trial.

PubMed

Miller, Jordan; Barber, David; Donnelly, Catherine; French, Simon; Green, Michael; Hill, Jonathan; MacDermid, Joy; Marsh, Jacquelyn; Norman, Kathleen; Richardson, Julie; Taljaard, Monica; Wideman, Timothy; Cooper, Lynn; McPhee, Colleen

2017-11-09

Back pain is a leading contributor to disability, healthcare costs, and lost work. Family physicians are the most common first point of contact in the healthcare system for people with back pain, but physiotherapists (PTs) may be able to support the primary care team through evidence-based primary care. A cluster randomized trial is needed to determine the clinical, health system, and societal impact of a primary care model that integrates physiotherapists at the first visit for people with back pain. Prior to conducting a future fully powered cluster randomized trial, we need to demonstrate feasibility of the methods. Therefore, the purpose of this pilot study will be to: 1) Determine feasibility of patient recruitment, assessment procedures, and retention. 2) Determine the feasibility of training and implementation of a new PT-led primary care model for low back pain (LBP) 3) Explore the perspectives of patients and healthcare providers (HCPs) related to their experiences and attitudes towards the new service delivery model, barriers/facilitators to implementation, perceived satisfaction, perceived value, and impact on clinic processes and patient outcomes. This pilot cluster randomized controlled trial will enroll four sites and randomize them to implement a new PT-led primary care model for back pain or a usual physician-led primary care model. All adults booking a primary care visit for back pain will be invited to participate. Feasibility outcomes will include: recruitment and retention rates, completeness of assessment data, PT training participation and confidence after training, and PT treatment fidelity. Secondary outcomes will include the clinical, health system, cost, and process outcomes planned for the future fully powered cluster trial. Results will be analyzed and reported descriptively and qualitatively. To explore perspectives of both HCPs and patients, we will conduct semi-structured qualitative interviews with patients and focus groups with HCPs from participants in the PT-led primary care sites. If this pilot demonstrates feasibility, a fully powered trial will provide evidence that has the potential to transform primary care for back pain. The full trial will inform future service design, whether these models should be more widely implemented, and training agendas. ClinicalTrials.gov, NCT03320148 . Submitted for registration on 17 September 2017.

Clinical stage of oral cancer patients at the time of initial diagnosis.

PubMed

Shah, Irfan; Sefvan, Omer; Luqman, Uzair; Ibrahim, Waseem; Mehmood, Sana; Alamgir, Wajiha

2010-01-01

Squamous cell carcinoma is the most common oral cancer. Early diagnosis ensures better prognosis. Late diagnosis is however common around the world and contributes to the high morbidity and mortality related to oral cancer. The objective of this study was to determine the clinical stage of oral cancer patients at the time of diagnosis. This retrospective study was carried out on 334 oral cancer patients who presented to the outdoor departments of Armed Forces Institute of Dentistry, and Armed Forces Institute of Pathology, Rawalpindi from July 2008 to December 2009. The records that were reviewed included history and clinical examination findings. OPG and CT scans of the head and neck region, chest X-rays, abdominal ultrasounds and liver function tests. Size of the primary tumour, the size, number and laterality of the involved cervical lymph nodes and the presence/absence of distant metastases were documented and statistically analysed using SPSS-17. Out of the 334 patients, 203 (60.8%) were males and 131 (39.2%) females. The age range was from 21 to 88 years. Buccal mucosa was the most commonly involved site (32%). The primary tumour was 4 Cm or more in size, (T3/T4) 71.25% of the cases. Cervical lymph nodes were involved in 211 patients (63.2%) and distant metastases were present in 39 patients (11.7%). Overall, clinical stage IV was the most common (57.18%) followed by stage III (24.55%), stage II (13.77%) and stage I (4.49%). Oral cancers are diagnosed late (Stage III and IV) in Pakistan and need immediate public and professional attention.

Variability of patient spine education by Internet search engine.

PubMed

Ghobrial, George M; Mehdi, Angud; Maltenfort, Mitchell; Sharan, Ashwini D; Harrop, James S

2014-03-01

Patients are increasingly reliant upon the Internet as a primary source of medical information. The educational experience varies by search engine, search term, and changes daily. There are no tools for critical evaluation of spinal surgery websites. To highlight the variability between common search engines for the same search terms. To detect bias, by prevalence of specific kinds of websites for certain spinal disorders. Demonstrate a simple scoring system of spinal disorder website for patient use, to maximize the quality of information exposed to the patient. Ten common search terms were used to query three of the most common search engines. The top fifty results of each query were tabulated. A negative binomial regression was performed to highlight the variation across each search engine. Google was more likely than Bing and Yahoo search engines to return hospital ads (P=0.002) and more likely to return scholarly sites of peer-reviewed lite (P=0.003). Educational web sites, surgical group sites, and online web communities had a significantly higher likelihood of returning on any search, regardless of search engine, or search string (P=0.007). Likewise, professional websites, including hospital run, industry sponsored, legal, and peer-reviewed web pages were less likely to be found on a search overall, regardless of engine and search string (P=0.078). The Internet is a rapidly growing body of medical information which can serve as a useful tool for patient education. High quality information is readily available, provided that the patient uses a consistent, focused metric for evaluating online spine surgery information, as there is a clear variability in the way search engines present information to the patient. Published by Elsevier B.V.

Landscape characteristics and livestock presence influence common ravens: Relevance to greater sage-grouse conservation

USGS Publications Warehouse

Coates, Peter S.; Brussee, Brianne E.; Howe, Kristy; Gustafson, K. Ben; Casazza, Michael L.; Delehanty, David J.

2016-01-01

Common raven (Corvus corax; hereafter, raven) population abundance in the sagebrush steppe of the American West has increased threefold during the previous four decades, largely as a result of unintended resource subsidies from human land-use practices. This is concerning because ravens frequently depredate nests of species of conservation concern, such as greater sage-grouse (Centrocercus urophasianus; hereafter, sage-grouse). Grazing by livestock in sagebrush ecosystems is common practice on most public lands, but associations between livestock and ravens are poorly understood. The primary objective of this study was to identify the effects of livestock on raven occurrence while accounting for landscape characteristics within human-altered sagebrush steppe habitat, particularly in areas occupied by breeding sage-grouse. Using data from southeastern Idaho collected during spring and summer across 3 yr, we modeled raven occurrence as a function of the presence of livestock while accounting for multiple landscape covariates, including land cover features, topographical features, and proximity to sage-grouse lek sites (breeding grounds), as well as site-level anthropogenic features. While accounting for landscape characteristics, we found that the odds of raven occurrence increased 45.8% in areas where livestock were present. In addition, ravens selected areas near sage-grouse leks, with the odds of occurrence decreasing 8.9% for every 1-km distance, increase away from the lek. We did not find an association between livestock use and distance to lek. We also found that ravens selected sites with relatively lower elevation containing increased amounts of cropland, wet meadow, and urbanization. Limiting raven access to key anthropogenic subsidies and spatially segregating livestock from sage-grouse breeding areas would likely reduce exposure of predatory ravens to sage-grouse nests and chicks.

In Vivo Investigation of Escitalopram’s Allosteric Site on the Serotonin Transporter

PubMed Central

Murray, Karen E.; Ressler, Kerry J.; Owens, Michael J.

2015-01-01

Escitalopram is a commonly prescribed antidepressant of the selective serotonin reuptake inhibitor class. Clinical evidence and mapping of the serotonin transporter (SERT) identified that escitalopram, in addition to its binding to a primary uptake-blocking site, is capable of binding to the SERT via an allosteric site that is hypothesized to alter escitalopram’s kinetics at the SERT. The studies reported here examined the in vivo role of the SERT allosteric site in escitalopram action. A knockin mouse model that possesses an allosteric-null SERT was developed. Autoradiographic studies indicated that the knockin protein was expressed at a lower density than endogenous mouse SERT (approximately 10–30% of endogenous mouse SERT), but the knockin mice are a viable tool to study the allosteric site. Microdialysis studies in the ventral hippocampus found no measurable decrease in extracellular serotonin response after local escitalopram challenge in mice without the allosteric site compared to mice with the site (p = 0.297). In marble burying assays there was a modest effect of the absence of the allosteric site, with a larger systemic dose of escitalopram (10-fold) necessary for the same effect as in mice with intact SERT (p = 0.023). However, there was no effect of the allosteric site in the tail suspension test. Together these data suggest that there may be a regional specificity in the role of the allosteric site. The lack of a robust effect overall suggests that the role of the allosteric site for escitalopram on the SERT may not produce meaningful in vivo effects. PMID:26621784

Impact of Stent-to-Vessel Diameter Ratio on Restenosis in the Superficial Femoral Artery After Endovascular Therapy.

PubMed

Kurata, Naoya; Iida, Osamu; Shiraki, Tatsuya; Fujita, Masashi; Masuda, Masaharu; Okamoto, Shin; Ishihara, Takayuki; Nanto, Kiyonori; Kanda, Takashi; Sunaga, Akihiro; Tsujimura, Takuya; Takahara, Mitsuyoshi; Mano, Toshiaki

2018-04-25

Although stent-to-vessel (S/V) diameter ratio has been described as a restenotic factor after superficial femoral artery (SFA) stenting, the reference vessel diameter is commonly measured distally at a healthy site. It remains unclear whether S/V ratio assessed at the lesion site would be more predictive than that assessed distally at a healthy site.Methods and Results:A total of 117 patients (mean age, 73±7 years; 74% male) who underwent successful nitinol stent implantation in SFA lesions (mean lesion length, 172±104 mm) on intravascular ultrasound (IVUS) were retrospectively analyzed. S/V ratio at the proximal and distal healthy site, and at the smallest lesion site, was evaluated on IVUS. One-year restenosis predictors were evaluated on multivariate analysis. Mean S/V diameter ratio on IVUS at proximal and distal healthy sites, and at the lesion site, was 0.98±0.11, 1.02±0.11 and 1.15±0.16, respectively. One-year primary patency was 77%. On multivariate analysis, lesion length (OR, 1.06 per 10-mm increment; P=0.046) and S/V ratio measured at the lesion site (OR, 1.34 per 0.1 increment; P=0.032), but not that at the distal healthy site (OR, 1.05 per 0.1 increment; P=0.705), were significantly associated with 1-year restenosis. S/V ratio assessed on IVUS at the lesion site, but not at the distal healthy site, was independently associated with 1-year restenosis after SFA stenting.

Trophic connections in Lake Superior Part I: the offshore fish community

USGS Publications Warehouse

Gamble, A.E.; Hrabik, T.R.; Stockwell, J.D.; Yule, D.L.

2011-01-01

Detailed diet linkages within the offshore (> 80 m bathymetric depth) food web of Lake Superior are currently not well identified. We used analyses of fish stomach contents to create an empirically based food web model of the Lake Superior offshore fish community. Stomachs were collected seasonally (spring, summer, and fall) from nine offshore locations in 2005, using bottom and midwater trawls. In total, 2643 stomachs representing 12 fish species were examined. The predominant fish species collected were deepwater sculpin (Myoxocephalus thompsonii), siscowet (Salvelinus namaycush siscowet), kiyi (Coregonus kiyi), and cisco (Coregonus artedi). Mysis diluviana was the most common prey item, indicating that changes in Mysis abundance could have a profound impact on the entire offshore food web. Mysis was the primary diet item of deepwater sculpin (≥ 53% by mass) and kiyi (≥ 96% by mass) regardless of depth or season. The invasive Bythotrephes was an important diet component of the pelagic cisco in summer and fall. Deepwater sculpin were the primary diet item of siscowet (≥ 52% by mass), with coregonines appearing in the diet of larger (> 400 mm) siscowet. Non-metric multidimensional scaling analysis indicated that there were no statistically significant seasonal or site-specific differences in diets of deepwater sculpin, cisco, or kiyi. Site was the primary structuring factor in siscowet diets. Generally, in Lake Superior, the diet items of the dominant offshore species did not appear to be in danger from those types of major ecological shifts occurring in the lower Laurentian Great Lakes.

Primary pyomyositis of the pelvis in children: a retrospective review of 8 cases.

PubMed

Bertrand, Styles L; Lincoln, Eric D; Prohaska, Matthew G

2011-12-06

Primary pyomyositis of the pelvic musculature is a condition rarely seen in temperate climates, although its frequency has been increasing in the United States. The condition should be considered in the initial differential diagnosis of an adolescent presenting with fever, difficulty ambulating, and hip pain. This is a retrospective review of 8 cases of primary pelvic pyomyositis in patients aged 18 years or younger who were treated at the Children's Medical Center in Augusta, Georgia. The site of infection was the obturator internus in the majority of the cases (5). The site was the gluteus, iliopsoas, and iliacus in 1 case each. Four patients who were diagnosed early responded to intravenous antibiotics with no need for further intervention. Two patients required incision and drainage of an abscess combined with antibiotics. Two patients had prolonged hospital courses requiring intensive unit care and mechanical ventilation. Blood cultures were positive in 87.5% of patients, and all patients presented with elevated acute phase reactants. One of the most difficult diagnostic aspects of presentation is an inconclusive symptom profile. It is noteworthy that patients with pelvic pyomyositis may present with limited range of motion in a specific plane (the motion placing the infected muscle on stretch) vs global limited range of motion of the joint as is commonly seen in septic arthritis. Early diagnosis is essential to prevent systemic illness and complications associated with this condition. Magnetic resonance imaging with gadolinium is helpful to diagnose and guide treatment. Copyright © 2011, SLACK Incorporated.

Community Level Offset of Rain Use- and Transpiration Efficiency for a Heavily Grazed Ecosystem in Inner Mongolia Grassland

PubMed Central

Gao, Ying Z.; Giese, Marcus; Gao, Qiang; Brueck, Holger; Sheng, Lian X.; Yang, Hai J.

2013-01-01

Water use efficiency (WUE) is a key indicator to assess ecosystem adaptation to water stress. Rain use efficiency (RUE) is usually used as a proxy for WUE due to lack of transpiration data. Furthermore, RUE based on aboveground primary productivity (RUEANPP) is used to evaluate whole plant water use because root production data is often missing as well. However, it is controversial as to whether RUE is a reliable parameter to elucidate transpiration efficiency (TE), and whether RUEANPP is a suitable proxy for RUE of the whole plant basis. The experiment was conducted at three differently managed sites in the Inner Mongolia steppe: a site fenced since 1979 (UG79), a winter grazing site (WG) and a heavily grazed site (HG). Site HG had consistent lowest RUEANPP and RUE based on total net primary productivity (RUENPP). RUEANPP is a relatively good proxy at sites UG79 and WG, but less reliable for site HG. Similarly, RUEANPP is good predictor of transpiration efficiency based on aboveground net primary productivity (TEANPP) at sites UG79 and WG but not for site HG. However, if total net primary productivity is considered, RUENPP is good predictor of transpiration efficiency based on total net primary productivity (TENPP) for all sites. Although our measurements indicate decreased plant transpiration and consequentially decreasing RUE under heavy grazing, productivity was relatively compensated for with a higher TE. This offset between RUE and TE was even enhanced under water limited conditions and more evident when belowground net primary productivity (BNNP) was included. These findings suggest that BNPP should be considered when studies fucus on WUE of more intensively used grasslands. The consideration of the whole plant perspective and “real” WUE would partially revise our picture of system performance and therefore might affect the discussion on the C-sequestration and resilience potential of ecosystems. PMID:24058632

Community level offset of rain use- and transpiration efficiency for a heavily grazed ecosystem in inner Mongolia grassland.

PubMed

Gao, Ying Z; Giese, Marcus; Gao, Qiang; Brueck, Holger; Sheng, Lian X; Yang, Hai J

2013-01-01

Water use efficiency (WUE) is a key indicator to assess ecosystem adaptation to water stress. Rain use efficiency (RUE) is usually used as a proxy for WUE due to lack of transpiration data. Furthermore, RUE based on aboveground primary productivity (RUEANPP) is used to evaluate whole plant water use because root production data is often missing as well. However, it is controversial as to whether RUE is a reliable parameter to elucidate transpiration efficiency (TE), and whether RUEANPP is a suitable proxy for RUE of the whole plant basis. The experiment was conducted at three differently managed sites in the Inner Mongolia steppe: a site fenced since 1979 (UG79), a winter grazing site (WG) and a heavily grazed site (HG). Site HG had consistent lowest RUEANPP and RUE based on total net primary productivity (RUENPP). RUEANPP is a relatively good proxy at sites UG79 and WG, but less reliable for site HG. Similarly, RUEANPP is good predictor of transpiration efficiency based on aboveground net primary productivity (TEANPP) at sites UG79 and WG but not for site HG. However, if total net primary productivity is considered, RUENPP is good predictor of transpiration efficiency based on total net primary productivity (TENPP) for all sites. Although our measurements indicate decreased plant transpiration and consequentially decreasing RUE under heavy grazing, productivity was relatively compensated for with a higher TE. This offset between RUE and TE was even enhanced under water limited conditions and more evident when belowground net primary productivity (BNNP) was included. These findings suggest that BNPP should be considered when studies fucus on WUE of more intensively used grasslands. The consideration of the whole plant perspective and "real" WUE would partially revise our picture of system performance and therefore might affect the discussion on the C-sequestration and resilience potential of ecosystems.

Clinical outcomes of gastrointestinal stromal tumor in southern Thailand

PubMed Central

Pornsuksiri, Kittima; Chewatanakornkul, Siripong; Kanngurn, Samornmas; Maneechay, Wanwisa; Chaiyapan, Walawee; Sangkhathat, Surasak

2012-01-01

AIM: To review a single institutional experience in clinical management of gastrointestinal stromal tumors (GIST) and analyze for factors determining treatment outcome. METHODS: Clinicopathological data of patients with a diagnosis of GIST who were treated at our institute during November 2004 to September 2009 were retrospectively reviewed. RESULTS: Ninety-nine cases were included in the analysis. Primary tumor sites were at the stomach in and small bowel in 44% and 33%, respectively. Thirty-one cases already had metastasis at presentation and the most common metastatic site was the liver. Sixty-four cases (65%) were in the high-risk category. Surgical treatment was performed in 77 cases (78%), 3 of whom received upfront targeted therapy. Complete resection was achieved in 56 cases (73% of operative cases) and of whom 27 developed local recurrence or distant metastasis at a median duration of 2 years. Imatinib was given as a primary therapy in unresectable cases (25 cases) and as an adjuvant in cases with residual tumor (21 cases). Targeted therapy gave partial response in 7 cases (15%), stable disease in 27 cases (57%) and progressive disease in 13 cases (28%). Four-year overall survival was 74% (95% CI: 61%-83%). Univariate survival analysis found that low-risk tumor, gastric site, complete resection and response to imatinib were associated with better survival. CONCLUSION: The overall outcomes of GIST can be predicted by risk-categorization. Surgery alone may not be a curative treatment for GIST. Response to targeted therapy is a crucial survival determinant in these patients. PMID:23444235

Assembly And Initial Characterization Of A Panel Of 85 Genomically Validated Cell Lines From Diverse Head And Neck Tumor Sites

PubMed Central

Zhao, Mei; Sano, Daisuke; Pickering, Curtis R.; Jasser, Samar A.; Henderson, Ying C.; Clayman, Gary L.; Sturgis, Erich M.; Ow, Thomas J.; Lotan, Reuben; Carey, Thomas E.; Sacks, Peter G.; Grandis, Jennifer R.; Sidransky, David; Heldin, Nils Erik; Myers, Jeffrey N.

2011-01-01

Purpose Human cell lines are useful for studying cancer biology and pre-clinically modeling cancer therapy, but can be misidentified and cross contamination is unfortunately common. The purpose of this study was to develop a panel of validated head and neck cell lines representing the spectrum of tissue sites and histologies that could be used for studying the molecular, genetic, and phenotypic diversity of head and neck cancer. Methods A panel of 122 clinically and phenotypically diverse head and neck cell lines from head and neck squamous cell carcinoma (HNSCC), thyroid cancer, cutaneous squamous cell carcinoma, adenoid cystic carcinoma, oral leukoplakia, immortalized primary keratinocytes, and normal epithelium, was assembled from the collections of several individuals and institutions. Authenticity was verified by performing short tandem repeat (STR) analysis. Human papillomavirus (HPV) status and cell morphology were also determined. Results Eighty-five of the 122 cell lines had unique genetic profiles. HPV-16 DNA was detected in 2 cell lines. These 85 cell lines included cell lines from the major head and neck primary tumor sites, and close examination demonstrates a wide range of in vitro phenotypes. Conclusion This panel of 85 genomically validated head and neck cell lines represents a valuable resource for the head and neck cancer research community that can help advance understanding of the disease by providing a standard reference for cell lines that can be utilized for biological as well as preclinical studies. PMID:21868764

National Structural Survey of Veterans Affairs Home-Based Primary Care Programs.

PubMed

Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas

2017-12-01

To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

The genomic complexity of primary human prostate cancer

PubMed Central

Berger, Michael F.; Lawrence, Michael S.; Demichelis, Francesca; Drier, Yotam; Cibulskis, Kristian; Sivachenko, Andrey Y.; Sboner, Andrea; Esgueva, Raquel; Pflueger, Dorothee; Sougnez, Carrie; Onofrio, Robert; Carter, Scott L.; Park, Kyung; Habegger, Lukas; Ambrogio, Lauren; Fennell, Timothy; Parkin, Melissa; Saksena, Gordon; Voet, Douglas; Ramos, Alex H.; Pugh, Trevor J.; Wilkinson, Jane; Fisher, Sheila; Winckler, Wendy; Mahan, Scott; Ardlie, Kristin; Baldwin, Jennifer; Simons, Jonathan W.; Kitabayashi, Naoki; MacDonald, Theresa Y.; Kantoff, Philip W.; Chin, Lynda; Gabriel, Stacey B.; Gerstein, Mark B.; Golub, Todd R.; Meyerson, Matthew; Tewari, Ashutosh; Lander, Eric S.; Getz, Gad; Rubin, Mark A.; Garraway, Levi A.

2010-01-01

Prostate cancer is the second most common cause of male cancer deaths in the United States. Here we present the complete sequence of seven primary prostate cancers and their paired normal counterparts. Several tumors contained complex chains of balanced rearrangements that occurred within or adjacent to known cancer genes. Rearrangement breakpoints were enriched near open chromatin, androgen receptor and ERG DNA binding sites in the setting of the ETS gene fusion TMPRSS2-ERG, but inversely correlated with these regions in tumors lacking ETS fusions. This observation suggests a link between chromatin or transcriptional regulation and the genesis of genomic aberrations. Three tumors contained rearrangements that disrupted CADM2, and four harbored events disrupting either PTEN (unbalanced events), a prostate tumor suppressor, or MAGI2 (balanced events), a PTEN interacting protein not previously implicated in prostate tumorigenesis. Thus, genomic rearrangements may arise from transcriptional or chromatin aberrancies to engage prostate tumorigenic mechanisms. PMID:21307934

New frontiers: discovering cilia-independent functions of cilia proteins.

PubMed

Vertii, Anastassiia; Bright, Alison; Delaval, Benedicte; Hehnly, Heidi; Doxsey, Stephen

2015-10-01

In most vertebrates, mitotic spindles and primary cilia arise from a common origin, the centrosome. In non-cycling cells, the centrosome is the template for primary cilia assembly and, thus, is crucial for their associated sensory and signaling functions. During mitosis, the duplicated centrosomes mature into spindle poles, which orchestrate mitotic spindle assembly, chromosome segregation, and orientation of the cell division axis. Intriguingly, both cilia and spindle poles are centrosome-based, functionally distinct structures that require the action of microtubule-mediated, motor-driven transport for their assembly. Cilia proteins have been found at non-cilia sites, where they have distinct functions, illustrating a diverse and growing list of cellular processes and structures that utilize cilia proteins for crucial functions. In this review, we discuss cilia-independent functions of cilia proteins and re-evaluate their potential contributions to "cilia" disorders. © 2015 The Authors.

Breast cancer metastatic to the kidney with renal vein involvement.

PubMed

Nasu, Hatsuko; Miura, Katsutoshi; Baba, Megumi; Nagata, Masao; Yoshida, Masayuki; Ogura, Hiroyuki; Takehara, Yasuo; Sakahara, Harumi

2015-02-01

The common sites of breast cancer metastases include bones, lung, brain, and liver. Renal metastasis from the breast is rare. We report a case of breast cancer metastatic to the kidney with extension into the renal vein. A 40-year-old woman had undergone left mastectomy for breast cancer at the age of 38. A gastric tumor, which was later proved to be metastasis from breast cancer, was detected by endoscopy. Computed tomography performed for further examination of the gastric tumor revealed a large left renal tumor with extension into the left renal vein. It mimicked a primary renal tumor. Percutaneous biopsy of the renal tumor confirmed metastasis from breast cancer. Surgical intervention of the stomach and the kidney was avoided, and she was treated with systemic chemotherapy. Breast cancer metastatic to the kidney may present a solitary renal mass with extension into the renal vein, which mimics a primary renal tumor.

Mitochondrial Function in Sepsis

PubMed Central

Arulkumaran, Nishkantha; Deutschman, Clifford S.; Pinsky, Michael R.; Zuckerbraun, Brian; Schumacker, Paul T.; Gomez, Hernando; Gomez, Alonso; Murray, Patrick; Kellum, John A.

2015-01-01

Mitochondria are an essential part of the cellular infrastructure, being the primary site for high energy adenosine triphosphate (ATP) production through oxidative phosphorylation. Clearly, in severe systemic inflammatory states, like sepsis, cellular metabolism is usually altered and end organ dysfunction not only common but predictive of long term morbidity and mortality. Clearly, interest is mitochondrial function both as a target for intracellular injury and response to extrinsic stress have been a major focus of basic science and clinical research into the pathophysiology of acute illness. However, mitochondria have multiple metabolic and signaling functions that may be central in both the expression of sepsis and its ultimate outcome. In this review, the authors address five primary questions centered on the role of mitochondria in sepsis. This review should be used as both a summary source in placing mitochondrial physiology within the context of acute illness and as a focal point for addressing new research into diagnostic and treatment opportunities these insights provide. PMID:26871665

MITOCHONDRIAL FUNCTION IN SEPSIS.

PubMed

Arulkumaran, Nishkantha; Deutschman, Clifford S; Pinsky, Michael R; Zuckerbraun, Brian; Schumacker, Paul T; Gomez, Hernando; Gomez, Alonso; Murray, Patrick; Kellum, John A

2016-03-01

Mitochondria are an essential part of the cellular infrastructure, being the primary site for high-energy adenosine triphosphate production through oxidative phosphorylation. Clearly, in severe systemic inflammatory states, like sepsis, cellular metabolism is usually altered, and end organ dysfunction is not only common, but also predictive of long-term morbidity and mortality. Clearly, interest is mitochondrial function both as a target for intracellular injury and response to extrinsic stress have been a major focus of basic science and clinical research into the pathophysiology of acute illness. However, mitochondria have multiple metabolic and signaling functions that may be central in both the expression of sepsis and its ultimate outcome. In this review, the authors address five primary questions centered on the role of mitochondria in sepsis. This review should be used both as a summary source in placing mitochondrial physiology within the context of acute illness and as a focal point for addressing new research into diagnostic and treatment opportunities these insights provide.

Does the primary site of colorectal cancer impact outcomes for patients with metastatic disease?

PubMed

Price, Timothy J; Beeke, Carol; Ullah, Shahid; Padbury, Robert; Maddern, Guy; Roder, David; Townsend, Amanda R; Moore, James; Roy, Amitesh; Tomita, Yoko; Karapetis, Christos

2015-03-15

Previous reports have described differences in biology and outcome for colorectal cancer based on whether the primary is right or left sided. Further division by right, left, and rectum or even exact primary site has also been explored. Possible differences in response to biological agents have also been reported based on side of primary lesion. We explored the South Australian registry for metastatic colorectal cancer to assess if there were any differences in patient characteristics, prognostic markers, and treatment received and outcomes based on whether the primary was right or left sided. We also explored if differences exist based on left colon and rectum and by exact primary site. Two thousand nine hundred seventy-two patients were analyzed. Thirty-five percent had a right-sided primary. The median overall survival for the entire group right versus left was 9.6 versus 20.3 months (P < .001). Multivariate analysis confirmed side of primary as an independent prognostic factor. For the group that had active therapy, defined as chemotherapy (± metastasis resection), median overall survival was right, 18.2 months; and left, 29.4 months (P < .001). Importantly, we found no suggestion of major differences if left side was divided by left colon and rectum, and trends by individual site still supported a left and right division. Patients with a right-sided primary have more negative prognostic factors and indeed have inferior outcomes compared with those with a left-sided primary. Our data with further breakdown by exact site still favor a simple left-versus-right division moving forward for metastatic colorectal cancer. © 2014 American Cancer Society.

The natural history and patterns of metastases from mucosal melanoma: an analysis of 706 prospectively-followed patients.

PubMed

Lian, B; Cui, C L; Zhou, L; Song, X; Zhang, X S; Wu, D; Si, L; Chi, Z H; Sheng, X N; Mao, L L; Wang, X; Tang, B X; Yan, X Q; Kong, Y; Dai, J; Li, S M; Bai, X; Zheng, N; Balch, C M; Guo, J

2017-04-01

We examined whether mucosal melanomas are different in their clinical course and patterns of metastases when arising from different anatomic sites. Our hypothesis was that metastatic behavior would differ from primary mucosal melanomas at different anatomical sites. Clinical and pathological data from 706 patients were compared for their stage distribution, patterns of metastases, CKIT/BRAF mutation status, and overall survival for different anatomical sites. The anatomic sites of the primary mucosal melanomas were from the lower GI tract (26.5%), nasal cavity and paranasal sinuses (23%), gynecological sites (22.5%), oral cavity (15%), urological sites (5%), upper GI tract (5%), and other sites (3.0%). At initial diagnosis, 14.5% were stage I disease, 41% Stage II, 21.5% Stage III, and 23.0% stage IV. Predominant metastatic sites were regional lymph nodes (21.5%), lung (21%), liver (18.5%), and distant nodes (9%). Oral cavity mucosal melanoma had a higher incidence of regional nodal metastases (31.7% versus 19.8%, P = 0.009), and a higher incidence of lung metastases (32.5% versus 18.5%, P = 0.007) compared to other primary mucosal melanomas. There was a 10% incidence of CKIT mutation and 12% BRAF mutation. Mucosal melanomas from nasal pharyngeal and oral, gastrointestinal, gynecological, and urological had a similar survival with a 1-year survival rate (88%, 83%, 86%), 2-year survival rate (66%, 57%, 61%), 5-year survival rate (27%, 16%, 20%), respectively. The largest sample size allows, for the first time, a comparison of primary melanoma stage and patterns of metastases across anatomical sites. With few exceptions, the presenting stages, incidence of nodal and distant metastases, the site of predilection of distant metastases, or overall survival were similar despite different primary anatomic sites. These findings suggest that clinical trials involving mucosal melanomas and the administration of systemic therapy can be applied equally to mucosal melanomas regardless of their primary anatomic site. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Site-Specific Measurement of Water Dynamics in the Substrate Pocket of Ketosteroid Isomerase Using Time-Resolved Vibrational Spectroscopy

PubMed Central

Jha, Santosh Kumar; Ji, Minbiao; Gaffney, Kelly J.; Boxer, Steven G.

2012-01-01

Little is known about the reorganization capacity of water molecules at the active sites of enzymes and how this couples to the catalytic reaction. Here, we study the dynamics of water molecules at the active site of a highly proficient enzyme, Δ5-3-ketosteroid isomerase (KSI), during a light-activated mimic of its catalytic cycle. Photo-excitation of a nitrile containing photo-acid, coumarin183 (C183), mimics the change in charge density that occurs at the active site of KSI during the first step of the catalytic reaction. The nitrile of C183 is exposed to water when bound to the KSI active site, and we used time-resolved vibrational spectroscopy as a site-specific probe to study the solvation dynamics of water molecules in the vicinity of the nitrile. We observed that water molecules at the active site of KSI are highly rigid, during the light-activated catalytic cycle, compared to the solvation dynamics observed in bulk water. Based upon this result we hypothesize that rigid water dipoles at the active site might help in the maintenance of the pre-organized electrostatic environment required for efficient catalysis. The results also demonstrate the utility of nitrile probes in measuring the dynamics of local (H-bonded) water molecules in contrast to the commonly used fluorescence methods which measure the average behavior of primary and subsequent spheres of solvation. PMID:22931297

Trace elements in shells of common gastropods in the near vicinity of a natural CO2 vent: no evidence of pH-dependent contamination

NASA Astrophysics Data System (ADS)

McClintock, J. B.; Amsler, C. D.; Amsler, M. O.; Duquette, A.; Angus, R. A.; Hall-Spencer, J. M.; Milazzo, M.

2014-04-01

There is concern that the use of natural volcanic CO2 vents as analogs for studies of the impacts of ocean acidification on marine organisms are biased due to physiochemical influences other than seawater pH alone. One issue that has been raised is whether potentially harmful trace elements in sediments that are rendered more soluble and labile in low pH environments are made more bioavailable, and sequestered in the local flora and fauna at harmful levels. In order to evaluate this hypothesis, we analyzed the concentrations of trace elements in shells (an established proxy for tissues) of four species of gastropods (two limpets, a topshell and a whelk) collected from three sites in Levante Bay, Vulcano Island. Each sampling site increased in distance from the primary CO2 vent and thus represented low, moderate, and ambient seawater pH conditions. Concentrations of As, Cd, Co, Cr, Hg, Mo, Ni, Pb, and V measured in shells using ICP-OES were below detection thresholds for all four gastropod species at all three sites. However, there were measurable concentrations of Sr, Mn, and U in the shells of the limpets Patella caerulea, P. rustica, and the snail Osilinus turbinatus, and similarly, Sr, Mn, U, and also Zn in the shells of the whelk Hexaplex trunculus. Levels of these elements were within the ranges measured in gastropod shells in non-polluted environments, and with the exception of U in the shells of P. caerulea, where the concentration was significantly lower at the collecting site closest to the vent (low pH site), there were no site-specific spatial differences in concentrations for any of the trace elements in shells. Thus trace element enhancement in sediments in low-pH environments was not reflected in greater bioaccumulations of potentially harmful elements in the shells of common gastropods.

Radial growth rate increases in naturally occurring ponderosa pine trees: a late-20th century CO2 fertilization effect?

PubMed

Soulé, Peter T; Knapp, Paul A

2006-01-01

The primary objective of this study was to determine if gradually increasing levels of atmospheric CO2, as opposed to 'step' increases commonly employed in controlled studies, have a positive impact on radial growth rates of ponderosa pine (Pinus ponderosa) in natural environments, and to determine the spatial extent and variability of this growth enhancement. We developed a series of tree-ring chronologies from minimally disturbed sites across a spectrum of environmental conditions. A series of difference of means tests were used to compare radial growth post-1950, when the impacts of rising atmospheric CO2 are best expressed, with that pre-1950. Spearman's correlation was used to relate site stress to growth-rate changes. Significant increases in radial growth rates occurred post-1950, especially during drought years, with the greatest increases generally found at the most water-limited sites. Site harshness is positively related to enhanced radial growth rates. Atmospheric CO2 fertilization is probably operative, having a positive effect on radial growth rates of ponderosa pine through increasing water-use efficiency. A CO2-driven growth enhancement may affect ponderosa pine growing under both natural and controlled conditions.

Prognostic factors and treatment outcomes in 444 patients with mucosal melanoma.

PubMed

Heppt, Markus V; Roesch, Alexander; Weide, Benjamin; Gutzmer, Ralf; Meier, Friedegund; Loquai, Carmen; Kähler, Katharina C; Gesierich, Anja; Meissner, Markus; von Bubnoff, Dagmar; Göppner, Daniela; Schlaak, Max; Pföhler, Claudia; Utikal, Jochen; Heinzerling, Lucie; Cosgarea, Ioana; Engel, Jutta; Eckel, Renate; Martens, Alexander; Mirlach, Laura; Satzger, Imke; Schubert-Fritschle, Gabriele; Tietze, Julia K; Berking, Carola

2017-08-01

Mucosal melanoma (MM) is a rare but diverse cancer entity. Prognostic factors are not well established for Caucasians with MM. We analysed the disease course of 444 patients from 15 German skin cancer centres. Disease progression was determined with the cumulative incidence function. Survival times were estimated with the Kaplan-Meier method. Prognostic parameters were identified with multivariate Cox regression analysis. Common anatomic sites of primary tumours were head and neck (MMHN, 37.2%), female genital tract (MMFG, 30.4%) and anorectal region (MMAN, 21.8%). MMAN patients showed the highest vertical tumour thickness (p = 0.001), had a more advanced nodal status (p = 0.014) and a higher percentage of metastatic disease (p = 0.001) at diagnosis. Mutations of NRAS (13.8%), KIT (8.6%) and BRAF (6.4%) were evenly distributed across all tumour site groups. Local relapses were observed in 32.4% and most commonly occurred in the MMHN group (p = 0.016). Male gender (p = 0.047), advanced tumour stage (p = 0.001), nodal disease (p = 0.001) and incomplete resection status (p = 0.001) were independent risk factors for disease progression. Overall survival (OS) was highest in the MMFG group (p = 0.030) and in patients without ulceration (p = 0.004). Multivariate risk factors for OS were M stage at diagnosis (p = 0.002) and incomplete resection of the primary tumour (p = 0.001). In this large series of MM patients in a European population, anorectal MM was associated with the poorest prognosis. Copyright © 2017 Elsevier Ltd. All rights reserved.

Parental beliefs and practices regarding childhood fever in Turkish primary care.

PubMed

Yavuz, E; Yayla, E; Cebeci, S E; Kırımlı, E; Gümüştakım, R Ş; Çakır, L; Doğan, S

2017-01-01

Fever is a very common problem in pediatric age and is one of the most common reasons parents seek medical attention. We aimed to investigate beliefs, habits, and concerns of Turkish parents regarding their children's fever. We performed a cross-sectional survey which was conducted as face-to-face interviews by family physicians from April to June 2014 in family healthcare centers in nine different cities in Turkey. Parents with a child with fever aged between 0 and 14 years were interviewed. The participants were asked questions about sociodemographic data, the definition and measurement of fever, antipyretics, and other interventions used to reduce fever before presenting to the primary care center. A total of 205 parents participated in this study. Ninety-four parents (45.8%) measured fever with a thermometer prior to presentation. Only 36 parents (38%) used the thermometer correctly. Thirty-eight parents (18.5%) knew the correct temperature definition of fever for the measured site. A mercury-in-glass thermometer was the choice for most parents (78%) and preferred site for measurement was axillary region (85%). The fever was treated prior to arrival by 171 parents (83.4%). Paracetamol was the most frequently used antipyretic. Fifty-four parents (31.5%) failed to administer the correct antipyretic dose, and 73 parents (42.6%) failed to give the antipyretics at proper intervals. One hundred and fifty-three parents (67%) believed that if not treated fever could cause convulsions. We conclude that parents share important misconceptions about definition, treatment, and consequences of childhood fever and tend to treat fever before seeking medical care with a substantial rate of wrong doses and wrong intervals.

Peat conditions mapping using MODIS time series

NASA Astrophysics Data System (ADS)

Poggio, Laura; Gimona, Alessandro; Bruneau, Patricia; Johnson, Sally; McBride, Andrew; Artz, Rebekka

2016-04-01

Large areas of Scotland are covered in peatlands, providing an important sink of carbon in their near natural state but act as a potential source of gaseous and dissolved carbon emission if not in good conditions. Data on the condition of most peatlands in Scotland are, however, scarce and largely confined to sites under nature protection designations, often biased towards sites in better condition. The best information available at present is derived from labour intensive field-based monitoring of relatively few designated sites (Common Standard Monitoring Dataset). In order to provide a national dataset of peat conditions, the available point information from the CSM data was modelled with morphological features and information derived from MODIS sensor. In particular we used time series of indices describing vegetation greenness (Enhanced Vegetation Index), water availability (Normalised Water Difference index), Land Surface Temperature and vegetation productivity (Gross Primary productivity). A scorpan-kriging approach was used, in particular using Generalised Additive Models for the description of the trend. The model provided the probability of a site to be in favourable conditions and the uncertainty of the predictions was taken into account. The internal validation (leave-one-out) provided a mis-classification error of around 0.25. The derived dataset was then used, among others, in the decision making process for the selection of sites for restoration.

A BiomeBGC-based Evaluation of Dryness Stress of Central European Forests

NASA Astrophysics Data System (ADS)

Buddenbaum, H.; Hientgen, J.; Dotzler, S.; Werner, W.; Hill, J.

2015-04-01

Dryness stress is expected to become a more common problem in central European forests due to the predicted regional climate change. Forest management has to adapt to climate change in time and think ahead several decades in decisions on which tree species to plant at which locations. The summer of 2003 was the most severe dryness event in recent time, but more periods like this are expected. Since forests on different sites react quite differently to drought conditions, we used the process-based growth model BiomeBGC and climate time series from sites all over Germany to simulate the reaction of deciduous and coniferous tree stands in different characteristics of drought stress. Times with exceptionally high values of water vapour pressure deficit coincided with negative modelled values of net primary production (NPP). In addition, in these warmest periods the usually positive relationship between temperature and NPP was inversed, i.e., under stress conditions, more sunlight does not lead to more photosynthesis but to stomatal closure and reduced productivity. Thus we took negative NPP as an indicator for drought stress. In most regions, 2003 was the year with the most intense stress, but the results were quite variable regionally. We used the Modis MOD17 gross and net primary production product time series and MOD12 land cover classification to validate the spatial patterns observed in the model runs and found good agreement between modelled and observed behaviour. Thus, BiomeBGC simulations with realistic site parameterization and climate data in combination with species- and variety-specific ecophysiological constants can be used to assist in decisions on which trees to plant on a given site.

A randomized controlled trial comparing mupirocin versus Polysporin Triple for the prevention of catheter-related infections in peritoneal dialysis patients (the MP3 study).

PubMed

Jassal, Sarbjit V; Lok, Charmaine E

2008-01-01

Peritonitis remains the most serious complication of peritoneal dialysis (PD). Gram-positive organisms are among the most common causes of PD peritonitis; however, recent trends show increasing rates of gram-negative and fungal infections. Strategies to prevent peritonitis include the use of prophylactic topical mupirocin at the site where the PD catheter exits from the abdominal wall; however, mupirocin does not afford protection against gram-negative or fungal infections. The aim of this study is to determine if the incidence of catheter-related infections (exit-site infection, tunnel infection, or peritonitis) is significantly reduced by the routine application of Polysporin Triple antibiotic ointment (Pfizer Canada, Markham, Ontario, Canada) in comparison to mupirocin ointment. The Mupirocin Versus Polysporin Triple Study (MP3) is a multicenter, randomized, double-blinded controlled study comparing Polysporin Triple (P3) against the current standard of care. The aim of the study is to recruit 200 patients being treated with or starting on PD and randomize them to receive either mupirocin or P3 at the catheter exit site. Patients will be followed for 18 months or until death or transfer from PD to an alternate treatment modality. The primary outcome will be the time to first catheter-related infection. Catheter-related infections will be strictly defined using current guidelines and categorized into exit-site infections, infective peritonitis, or tunnel infections. The primary analysis will be an intention-to-treat analysis. The results of this study will help determine if the use of P3 is superior to mupirocin ointment in the prevention of catheter-related infections and will help guide evidence-based best practices.

Testing high resolution numerical models for analysis of contaminant storage and release from low permeability zones.

PubMed

Chapman, Steven W; Parker, Beth L; Sale, Tom C; Doner, Lee Ann

2012-08-01

It is now widely recognized that contaminant release from low permeability zones can sustain plumes long after primary sources are depleted, particularly for chlorinated solvents where regulatory limits are orders of magnitude below source concentrations. This has led to efforts to appropriately characterize sites and apply models for prediction incorporating these effects. A primary challenge is that diffusion processes are controlled by small-scale concentration gradients and capturing mass distribution in low permeability zones requires much higher resolution than commonly practiced. This paper explores validity of using numerical models (HydroGeoSphere, FEFLOW, MODFLOW/MT3DMS) in high resolution mode to simulate scenarios involving diffusion into and out of low permeability zones: 1) a laboratory tank study involving a continuous sand body with suspended clay layers which was 'loaded' with bromide and fluorescein (for visualization) tracers followed by clean water flushing, and 2) the two-layer analytical solution of Sale et al. (2008) involving a relatively simple scenario with an aquifer and underlying low permeability layer. All three models are shown to provide close agreement when adequate spatial and temporal discretization are applied to represent problem geometry, resolve flow fields and capture advective transport in the sands and diffusive transfer with low permeability layers and minimize numerical dispersion. The challenge for application at field sites then becomes appropriate site characterization to inform the models, capturing the style of the low permeability zone geometry and incorporating reasonable hydrogeologic parameters and estimates of source history, for scenario testing and more accurate prediction of plume response, leading to better site decision making. Copyright © 2012 Elsevier B.V. All rights reserved.

Websites for Primary Sources and Civics Education

ERIC Educational Resources Information Center

Rulli, Daniel

2005-01-01

This article features a list of websites for primary sources and civics education. The World Wide Web has become an excellent source for facsimiles, images, and transcriptions of primary sources. As it would be impossible to provide a comprehensive list of all the sites, this annotated list highlights selective sites that provide access to…

Variation in primary site resection practices for advanced colon cancer: a study using the National Cancer Data Base.

PubMed

Healy, Mark A; Pradarelli, Jason C; Krell, Robert W; Regenbogen, Scott E; Suwanabol, Pasithorn A

2016-10-01

Treatment of metastatic colon cancer may be driven as much by practice patterns as by features of disease. To optimize management, there is a need to better understand what is determining primary site resection use. We evaluated all patients with stage IV cancers in the National Cancer Data Base from 2002 to 2012 (50,791 patients, 1,230 hospitals). We first identified patient characteristics associated with primary tumor resection. Then, we assessed nationwide variation in hospital resection rates. Overall, 27,387 (53.9%) patients underwent primary site resection. Factors associated with resection included younger age, having less than 2 major comorbidities, and white race (P < .001). Nationwide, hospital-adjusted primary tumor resection rates ranged from 26.0% to 87.8% with broad differences across geographical areas and hospital accreditation types. There is statistically significant variation in hospital rates of primary site resection. This demonstrates inconsistent adherence to guidelines in the presence of conflicting evidence regarding resection benefit. Copyright © 2016 Elsevier Inc. All rights reserved.

Poly(A) RNA a new component of Cajal bodies.

PubMed

Kołowerzo, Agnieszka; Smoliński, Dariusz Jan; Bednarska, Elzbieta

2009-07-01

In European larch microsporocytes, spherical structures 0.5 to 6 microm in diameter are present in which poly(A) RNA accumulates. There were one to several bodies per cell and they were often present in the vicinity of the nucleolus. No nascent transcripts were observed within them. Splicing factors of the SR family, including protein SC35, which participates in bringing the 3' and 5' sites closer in the splicing reaction, were also not observed. The absence of the above-mentioned elements within bodies containing poly(A) RNA disqualifies them as sites of synthesis and preliminary stages of primary transcript maturation. However, they contained abundant elements of the splicing machinery commonly occurring in Cajal bodies, i.e., Sm proteins or small nuclear RNA (snRNA). The molecular composition as well as the characteristic ultrastructure of bodies containing poly(A) RNA proves that these were Cajal bodies. This is the first report of such poly(A) RNA localization.

Distally based posterior interosseous flap: primary role in soft-tissue reconstruction of the hand.

PubMed

Agir, Hakan; Sen, Cenk; Alagöz, Sahin; Onyedi, Murat; Isil, Eda

2007-09-01

A series of 15 consecutive patients with various hand defects requiring flap coverage was reviewed in this study. The defects were all covered with the distally based posterior interosseous flap. Its main indications were in complex hand trauma, severe burn injury, or skin cancer ablation, either acute or postprimary. In 12 of the patients, flaps survived completely. In 3 patients, there was partial necrosis of the distal part of the flap, which did not require additional surgical procedure. Radial nerve palsy was noted in one of the cases, with a complete recovery after 3 months. Donor site was closed directly in up to 4-cm-wide flaps, while larger flaps required skin grafting. No major anatomic variation was observed. Distally based posterior interosseous flap is a reliable choice for various types and areas of hand defects, with very low donor-site morbidity, and should be more commonly considered in clinical practice.

Endoliths in Lithophaga lithophaga shells--Variation in intensity of infestation and species occurrence.

PubMed

Peharda, Melita; Calcinai, Barbara; Puljas, Sanja; Golubić, Stjepko; Arapov, Jasna; Thébault, Julien

2015-07-01

Pronounced differences with respect to the extent of infestation and the degree of Lithophaga lithophaga shell damage inflicted by euendolithic taxa at two sites in the Adriatic Sea representing different productivity conditions, are described. Shells collected from the eastern part of Kaštela Bay, which is characterized by higher primary productivity, have significantly more shell damage then the shell collected from a site on the outer coast of the island of Čiovo exposed to the oligotrophic Adriatic Sea. The presence of endoliths and their perforations were detected in different layers of the shell, including solidly mineralized parts of the skeleton and within the organic lamellae incorporated into the shell. Phototrophic endoliths were not observed in the specimens. The most serious damage to L. lithophaga shells was the boring clionaid sponge Pione vastifica, which was more common in shells collected from Kaštela. Copyright © 2015 Elsevier Ltd. All rights reserved.

Primary hydatid cyst of the neck.

PubMed

Mujtaba, Syeddah Shafaq; Faridi, Naveen; Haroon, Saroona

2013-11-01

Hydatid cysts in the neck are relatively exceptional, even in areas where Echinococcus granulosis is endemic, such as Asia. Although liver and lung are frequent sites of involvement, it can involve all tissues, with neck remaining one of the most rare sites. It should come in the differential diagnosis of cystic lesion of neck, as the treatment options differ widely from common neck cysts. The role of radiological investigation is important and, in these cases, the involvement of other organs should be investigated. Serological tests may be helpful. The major treatment modality is surgical and the cyst should be excised as a whole, without being ruptured, to prevent any treatment complications, as the cyst fluid can initiate an anaphylactic reaction. Postoperative albendazole therapy is recommended particularly when there is intra-operative spillover. We report a case of an isolated hydatid cyst localized in the anterior triangle of the neck without any pulmonary or hepatic involvement.

Breast and splenic metastases of squamous cell carcinoma from the uterine cervix: a case report.

PubMed

Aitelhaj, Meryem; Khoyaali, Siham L; Boukir, Anouar; Elkabous, Mustapha; Abahssain, Halima; Mrabti, Hind; El Khannoussi, Basma; Errihani, Hassan

2014-11-04

Metastases to the breast from extramammary malignancies are infrequent, the most common primary sites are malignant melanoma, leukemia, lymphoma, and cancer of the lung, stomach, prostate and ovary. The cervical origin is exceptional. Splenic metastasis from squamous cell carcinoma of the cervix is also rare. To the best of our knowledge, only three cases of isolated splenic metastasis have been reported in the literature. We describe the case of a 55-year-old North African woman who presented with a nodule in her left breast eight months after treatment for stage IIB squamous cell uterine cervical carcinoma. The excisional biopsy with histological study demonstrated a poorly differentiated squamous cell carcinoma. A computed tomography scan revealed a splenic secondary location. We report here a case of two unusual metastatic sites of uterine cervical carcinoma, the breast and spleen. It is the first case of this association without widespread disease.

Misdiagnosis of primary pleural DLBCL as tuberculosis: A case report and literature review.

PubMed

Yang, Xinmei; Xu, Xiaofang; Song, Binbin; Zhou, Qiang; Zheng, Ying

2018-06-01

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL). DLBCL presents with pleural involvement at an advanced stage; however, primary pleural lymphomas without any other site of involvement are rare, and the possibility of misdiagnosis is high, particularly in developing countries, where tuberculosis or other severe pulmonary infections remain a major health concern. Furthermore, lymphoma and tuberculosis share a number of common clinical characteristics, such as fever, night sweats, feeling of satiety after a small meal, fatigue and unexplained weight loss, among others. We herein describe a case of misdiagnosis of primary pleural lymphoma as tuberculosis in a 49-year-old male patient who presented with pleural effusion and high adenosine deaminase (ADA) level in the pleural fluid. Anti-tuberculosis treatment was administered for 1 month, but the patient's condition deteriorated. A surgical biopsy was performed and was diagnostic of DLBCL. CHOP chemotherapy was administered with a significant delay due to the misdiagnosis, and it was not efficient, as rituximab was not added to the regimen. The therapeutic efficacy was monitored by computed tomography scans, which revealed that the lesion had shrunk slightly. The overall survival of the patient was ~1 year and he eventually succumbed to severe thoracic infection and pleural effusion. Suspicion should be raised when a patient presents with pleural effusion and extremely high ADA levels, as ADA activity of >250 U/L should raise the suspicion of empyema or lymphoma rather than tuberculosis.

Primary Care Physicians Practicing Preventive Medicine in the Outpatient Setting

PubMed Central

Snipelisky, David; Carter, Kimberly; Sundsted, Karna; Burton, M. Caroline

2016-01-01

Background: Preventive care is an important part of primary care medicine, yet much variation in its practice exists. The aim of this study is to assess physicians’ perspectives of practicing preventive medicine and evaluate which topics are deemed most important. Methods: All primary care medicine providers at two separate academic medical centers (Mayo Clinic, MN and Mayo Clinic, FL) were surveyed via an E-mail questionnaire assessing physicians’ perception of the role of preventive medicine during both acute/routine and yearly visits, physicians’ perception of patients’ response to preventive medicine topics, and which preventive medicine topics are commonly practiced. Results: Of 445 providers meeting inclusion criteria, a total of 183 (41.1%) responded. Providers were more likely to engage patients in preventive medicine during yearly visits more so than acute visits (3.82 vs. 4.72, range 1–5 Likert Scale), yet providers were very likely to partake in such practices during both visits. Providers perceived that patients received the practice of preventive medicine very well (4.13 on 1–5 Likert Scale). No significant difference between provider practice and patient perception was noted between the two sites, although there was some variation based on clinical experience of the provider. Providers were found to most commonly practice topics recommended by the United States Preventive Services Task Force. Conclusions: Our study found a high predisposition to practicing preventive medicine. Providers seem to practice according to published evidence-based medicine recommendations. PMID:26941906

Barriers to a healthy lifestyle among patients attending primary care clinics at a university hospital in Riyadh.

PubMed

AlQuaiz, Aljoharah M; Tayel, Salwa A

2009-01-01

The occurrence and progress of chronic non-communicable diseases (NCDs) is associated with unhealthy lifestyles and behaviors. Modification of barriers to healthy lifestyle can produce great benefits. The objective of this study was to identify barriers to physical activity and healthy eating among patients attending primary health care clinics in Riyadh city. A cross-sectional study was conducted at King Khalid University Hospital (KKUH) in Riyadh city. Four hundred and fifty participants attending primary health care clinics (PHCC) from 1 March to 30 April 2007 were randomly selected. A questionnaire about barriers to physical activity and healthy eating was adapted from the CDC web site. The prevalence of physical inactivity among the Saudi population in the study was 82.4% (371/450). Females were more physically inactive (87.6%, 268/306) compared to males (71.5%, 103/144) (P<.001). The most common barrier to physical activity was lack of resources (80.5%, 326/405), which was significantly higher among females than males and among the lower income versus the higher income group. The most common barrier to healthy diet was lack of willpower. More than four-fifths (80.3%, 354/441) of the study group stated that they did not have enough will to stick to a diet. Lack of resources was the most important barrier for physical activity, while lack of willpower and social support were both barriers for adherence to physical activity and a healthy diet.

Challenges of Making a Diagnosis in the Outpatient Setting: A Multi-Site Survey of Primary Care Physicians

PubMed Central

Sarkar, Urmimala; Bonacum, Doug; Strull, William; Spitzmueller, Christiane; Jin, Nancy; Lopez, Andrea; Giardina, Traber Davis; Meyer, Ashley N.D.; Singh, Hardeep

2013-01-01

Background Although misdiagnosis in the outpatient setting leads to significant patient harm and wasted resources, it is not well studied. We surveyed primary care physicians (PCPs) about barriers to timely diagnosis in the outpatient setting and assessed their perceptions of diagnostic difficulty. Methods We conducted a survey of general internists and family physicians practicing in an integrated health system across 10 geographically dispersed states in 2005. The survey elicited information on key cognitive failures (such as in clinical knowledge or judgment) for a specific case, and solicited strategies for reducing diagnostic delays. Content analysis was used to categorize cognitive failures and strategies for improvement. We examined the extent and predictors of diagnostic difficulty, defined as reporting >5% patients difficult to diagnose. Results Of 1817 physicians surveyed, 1054 (58%) responded; 848 (80%) respondents primarily practiced in outpatient settings and had an assigned patient panel (inclusion sample). Inadequate knowledge (19.9%) was the most commonly reported cognitive factor. Half reported >5% of their patients were difficult to diagnose; more experienced physicians reported less diagnostic difficulty. In adjusted analyses, problems with information processing (information availability and time to review it) and the referral process, were associated with greater diagnostic difficulty. Strategies for improvement most commonly involved workload issues (panel size, non-visit tasks). Conclusions PCPs report a variety of reasons for diagnostic difficulties in primary care practice. In our study, knowledge gaps appear to be a prominent concern. Interventions that address these gaps as well as practice level issues such as time to process diagnostic information and better subspecialty input may reduce diagnostic difficulties in primary care. PMID:22626738

Primary site and regional lymph node involvement are independent prognostic factors for early-stage extranodal nasal-type natural killer/T cell lymphoma.

PubMed

Niu, Shao-Qing; Yang, Yong; Li, Yi-Yang; Wen, Ge; Wang, Liang; Li, Zhi-Ming; Wang, Han-Yu; Zhang, Lu-Lu; Xia, Yun-Fei; Zhang, Yu-Jing

2016-04-04

Nasal-type extranodal natural killer/T-cell lymphoma (ENKTCL) originates primarily in the nasal cavity or extra-nasal sites within the upper aerodigestive tract. However, it is unclear whether the primary site can serve as an independent prognostic factor or whether the varying clinical outcomes observed with different primary sites can be attributed merely to their propensities of regional lymph node involvement. The aim of this study was to investigate the prognostic implications of the primary site and regional lymph node involvement in patients with early-stage nasal-type ENKTCL. To develop a nomogram, we reviewed the clinical data of 215 consecutively diagnosed patients with early-stage nasal-type ENKTCL who were treated in Sun Yat-sen University Cancer Center with chemotherapy and radiotherapy between 2000 and 2011. The predictive accuracy and discriminative ability of the nomogram were determined using a concordance index (C-index) and calibration curve. The 5-year overall survival (OS) and progression-free survival (PFS) rates of patients with nasal ENKTCL were higher than those of patients with extra-nasal ENKTCL (OS: 68.2% vs. 46.0%, P = 0.030; PFS: 53.4% vs. 26.6%, P = 0.010). The 5-year OS and PFS rates of patients with Ann Arbor stage IE ENKTCL were higher than those of patients with Ann Arbor stage IIE ENKTCL (OS: 66.3% vs. 59.2%, P = 0.003; PFS: 51.4% vs. 40.3%, P = 0.009). Multivariate analysis showed that age >60 years, ECOG performance status score ≥2, elevated lactate dehydrogenase (LDH) level, extra-nasal primary site, and regional lymph node involvement were significantly associated with lower 5-year OS rate; age >60 years, elevated LDH level, extra-nasal primary site, and regional lymph node involvement were significantly associated with lower 5-year PFS rate. The nomogram included the primary site and regional lymph node involvement based on multivariate analysis. The calibration curve showed good agreement between the predicted and actual 5-year OS and PFS rates, and the C-indexes of the nomogram for the OS and PFS rates were 0.697 and 0.634, respectively. The primary site and regional lymph node involvement are independent prognostic factors for early-stage ENKTCL treated with chemotherapy followed by definitive radiotherapy.

Better Together: Co-Location of Dental and Primary Care Provides Opportunities to Improve Oral Health.

PubMed

Pourat, Nadereh; Martinez, Ana E; Crall, James J

2015-09-01

Community Health Centers (CHCs) are one of the principal safety-net providers of health care for low-income and uninsured populations. Co-locating dental services in primary care settings provides an opportunity to improve access to dental care. Yet this study of California CHCs that provide primary care services shows that only about one-third of them co-located primary and dental care services on-site. An additional one-third were members of multisite organizations in which at least one other site provided dental care. The remaining one-third of CHC sites had no dental care capacity. Policy options to promote co-location include requiring on-site availability of dental services, providing infrastructure funding to build and equip dental facilities, and offering financial incentives to provide dental care and recruit dental providers.

Vaginal type-II mucosa is an inductive site for primary CD8+ T-cell mucosal immunity

PubMed Central

Wang, Yichuan; Sui, Yongjun; Kato, Shingo; Hogg, Alison E.; Steel, Jason C.; Morris, John C.; Berzofsky, Jay A.

2014-01-01

The structured lymphoid tissues are considered the only inductive sites where primary T cell immune responses occur. The naïve T cells in structured lymphoid tissues, once being primed by antigen -bearing dendritic cells, differentiate into memory T cells and traffic back to the mucosal sites through the bloodstream. Contrary to this belief, here we show that the vaginal type-II mucosa itself, despite lack of structured lymphoid tissues, can act as an inductive site during primary CD8+ T cell immune responses. We provide evidence that the vaginal mucosa supports both the local immune priming of naïve CD8+ T cells and the local expansion of antigen-specific CD8+ T cells, thereby demonstrating a different paradigm for primary mucosal T cell immune induction. PMID:25600442

Clinical, Biologic, and Prognostic Differences on the Basis of Primary Tumor Site in Neuroblastoma: A Report From the International Neuroblastoma Risk Group Project

PubMed Central

Vo, Kieuhoa T.; Matthay, Katherine K.; Neuhaus, John; London, Wendy B.; Hero, Barbara; Ambros, Peter F.; Nakagawara, Akira; Miniati, Doug; Wheeler, Kate; Pearson, Andrew D.J.; Cohn, Susan L.; DuBois, Steven G.

2014-01-01

Purpose Neuroblastoma (NB) is a heterogeneous tumor arising from sympathetic tissues. The impact of primary tumor site in influencing the heterogeneity of NB remains unclear. Patients and Methods Children younger than age 21 years diagnosed with NB or ganglioneuroblastoma between 1990 and 2002 and with known primary site were identified from the International Neuroblastoma Risk Group database. Data were compared between sites with respect to clinical and biologic features, as well as event-free survival (EFS) and overall survival (OS). Results Among 8,369 children, 47% had adrenal tumors. All evaluated clinical and biologic variables differed statistically between primary sites. The features that were > 10% discrepant between sites were stage 4 disease, MYCN amplification, elevated ferritin, elevated lactate dehydrogenase, and segmental chromosomal aberrations, all of which were more frequent in adrenal versus nonadrenal tumors (P < .001). Adrenal tumors were more likely than nonadrenal tumors (adjusted odds ratio, 2.09; 95% CI, 1.67 to 2.63; P < .001) and thoracic tumors were less likely than nonthoracic tumors (adjusted odds ratio, 0.20; 95% CI, 0.11 to 0.39; P < .001) to have MYCN amplification after controlling for age, stage, and histologic grade. EFS and OS differed significantly according to the primary site (P < .001 for both comparisons). After controlling for age, MYCN status, and stage, patients with adrenal tumors had higher risk for events (hazard ratio, 1.13 compared with nonadrenal tumors; 95% CI, 1.03 to 1.23; P = .008), and patients with thoracic tumors had lower risk for events (HR, 0.79 compared with nonthoracic; 95% CI, 0.67 to 0.92; P = .003). Conclusion Clinical and biologic features show important differences by NB primary site, with adrenal and thoracic sites associated with inferior and superior survival, respectively. Future studies will need to investigate the biologic origin of these differences. PMID:25154816

Napsin A levels in epithelial lining fluid as a diagnostic biomarker of primary lung adenocarcinoma.

PubMed

Uchida, Akifumi; Samukawa, Takuya; Kumamoto, Tomohiro; Ohshige, Masahiro; Hatanaka, Kazuhito; Nakamura, Yoshihiro; Mizuno, Keiko; Higashimoto, Ikkou; Sato, Masami; Inoue, Hiromasa

2017-12-12

It is crucial to develop novel diagnostic approaches for determining if peripheral lung nodules are malignant, as such nodules are frequently detected due to the increased use of chest computed tomography scans. To this end, we evaluated levels of napsin A in epithelial lining fluid (ELF), since napsin A has been reported to be an immunohistochemical biomarker for histological diagnosis of primary lung adenocarcinoma. In consecutive patients with indeterminate peripheral lung nodules, ELF samples were obtained using a bronchoscopic microsampling (BMS) technique. The levels of napsin A and carcinoembryonic antigen (CEA) in ELF at the nodule site were compared with those at the contralateral site. A final diagnosis of primary lung adenocarcinoma was established by surgical resection. We performed BMS in 43 consecutive patients. Among patients with primary lung adenocarcinoma, the napsin A levels in ELF at the nodule site were markedly higher than those at the contralateral site, while there were no significant differences in CEA levels. Furthermore, in 18 patients who were undiagnosed by bronchoscopy and finally diagnosed by surgery, the napsin A levels in ELF at the nodule site were identically significantly higher than those at the contralateral site. In patients with non-adenocarcinoma, there were no differences in napsin A levels in ELF. The area under the receiver operator characteristic curve for identifying primary lung adenocarcinoma was 0.840 for napsin A and 0.542 for CEA. Evaluation of napsin A levels in ELF may be useful for distinguishing primary lung adenocarcinoma.

47 CFR 73.635 - Use of common antenna site.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 4 2012-10-01 2012-10-01 false Use of common antenna site. 73.635 Section 73.635 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Television Broadcast Stations § 73.635 Use of common antenna site. No television license...

47 CFR 73.635 - Use of common antenna site.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 4 2013-10-01 2013-10-01 false Use of common antenna site. 73.635 Section 73.635 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Television Broadcast Stations § 73.635 Use of common antenna site. No television license...

47 CFR 73.239 - Use of common antenna site.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 4 2013-10-01 2013-10-01 false Use of common antenna site. 73.239 Section 73.239 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES FM Broadcast Stations § 73.239 Use of common antenna site. No FM broadcast station...

47 CFR 73.239 - Use of common antenna site.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 4 2011-10-01 2011-10-01 false Use of common antenna site. 73.239 Section 73.239 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES FM Broadcast Stations § 73.239 Use of common antenna site. No FM broadcast station...

47 CFR 73.239 - Use of common antenna site.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 4 2012-10-01 2012-10-01 false Use of common antenna site. 73.239 Section 73.239 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES FM Broadcast Stations § 73.239 Use of common antenna site. No FM broadcast station...

47 CFR 73.635 - Use of common antenna site.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Use of common antenna site. 73.635 Section 73.635 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Television Broadcast Stations § 73.635 Use of common antenna site. No television license...

47 CFR 73.239 - Use of common antenna site.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 4 2010-10-01 2010-10-01 false Use of common antenna site. 73.239 Section 73.239 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES FM Broadcast Stations § 73.239 Use of common antenna site. No FM broadcast station...

47 CFR 73.635 - Use of common antenna site.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 4 2010-10-01 2010-10-01 false Use of common antenna site. 73.635 Section 73.635 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Television Broadcast Stations § 73.635 Use of common antenna site. No television license...

47 CFR 73.239 - Use of common antenna site.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Use of common antenna site. 73.239 Section 73.239 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES FM Broadcast Stations § 73.239 Use of common antenna site. No FM broadcast station...

47 CFR 73.635 - Use of common antenna site.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 4 2011-10-01 2011-10-01 false Use of common antenna site. 73.635 Section 73.635 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Television Broadcast Stations § 73.635 Use of common antenna site. No television license...

Primary cancers of extrahepatic biliary passages.

PubMed

Mittal, B; Deutsch, M; Iwatsuki, S

1985-04-01

We analyzed the records of 22 patients with cancers of extrahepatic biliary passages (EHBP) to understand their natural histories and patterns of failure and to evaluate the effectiveness of various treatments. None of the preoperative investigations consistently defined the entire extent of tumor. Percutaneous transhepatic cholangiography (PTHC) was the most helpful (100%) in accurately defining the site of ductal obstruction. Computed tomography was helpful in diagnosing liver metastases in 53% and primary tumor mass in 23% of patients. The most common sites of tumor failure or persistence were: liver (67%), tumor bed (56%), peritoneum (22%), porta hepatis and lymph nodes (17%). The median survival for the entire group was 6.8 months. Surgery plays an important role in managing these tumors and in defining tumor extent for subsequent adjuvant irradiation. Patients receiving radiation doses greater than or equal to 70 TDF had a longer median survival (11 months) than patients receiving less than 70 TDF (4.4 months). All three patients, who were alive and free of disease greater than 1 year, received radiation doses greater than or equal to 70 TDF. From our data, it is difficult to comment on the effectiveness of chemotherapy. We have made suggestions regarding radiation volume and doses to various structures. The need for entering these patients into multi-institutional clinical trials is stressed.

CAN A MODEL TRANSFERABILITY FRAMEWORK IMPROVE ECOSYSTEM SERVICE ESTIMATES? A CASE STUDY OF SOIL FOREST CARBON SEQUESTRATION IN TILLAMOOK BAY, OR, USA

EPA Science Inventory

Budget constraints and policies that limit primary data collection have fueled a practice of transferring estimates (or models to generate estimates) of ecological endpoints from sites where primary data exists to sites where little to no primary data were collected. Whereas bene...

Genetics of Primary Intraocular Tumors

PubMed Central

Nagarkatti-Gude, Nisha; Wang, Yujuan; Ali, Mohammad Javed; Honavar, Santosh G.; Jager, Martine J.; Chan, Chi-Chao

2012-01-01

Primary intraocular neoplasms are tumors that originate within the eye. The most common malignant primary intraocular tumor in adults is uveal melanoma and the second is primary intraocular lymphoma or vitreoretinal (intraocular) lymphoma. The most common malignant intraocular tumor in children is retinoblastoma. Genetics plays a vital role in the diagnosis and detection of ocular tumors. In uveal melanoma, monosomy 3 is the most common genetic alteration and somatic mutations of BAP1, a tumor suppressor gene, have been reported in nearly 50% of primary uveal melanomas. The retinoblastoma gene RB1 is the prototype tumor suppressor gene—mutations in RB1 alleles lead to inactivated RB protein and the development of retinoblastoma. Immunoglobulin heavy chain (IgH) or T-cell receptor (TCR) gene rearrangement is observed in B-cell or T-cell primary vitreoretinal lymphoma, respectively. Other factors related to the genetics of these three common malignancies in the eye are discussed and reviewed. PMID:22834783

Cutaneous metastasis: clinicopathological study of 72 patients from a tertiary care center in Lebanon.

PubMed

El Khoury, Jinane; Khalifeh, Ibrahim; Kibbi, Abdul-Ghani; Abbas, Ossama

2014-02-01

Cutaneous metastasis is the result of malignant cell spread from primary malignancy to the skin. This is not uncommon, and rates reported in the literature are as high as 10.4%. To the best of our knowledge, there are no studies assessing the epidemiologic, clinical, and histopathological features of cutaneous metastasis in our region. To assess the clinical and histopathological findings of all patients diagnosed with cutaneous metastasis at the American University of Beirut - Medical Center (AUB-MC) and to compare our findings with those published in the literature. Retrospective clinical and histopathologic evaluation of all cases diagnosed as cutaneous metastasis at AUB-MC between 1992 and 2010. A total of 72 patients (50 females and 22 males) were identified. The mean age at diagnosis was 55.2 years. The most common primary cancer was breast cancer in women and laryngeal cancer in men. The most common clinical presentation was a single nodule in 27% of cases followed by multiple nodules in 23%. Cutaneous metastasis lesions were asymptomatic in the majority. The chest was the most commonly affected site. On microscopy, the majority of metastatic cases were adenocarcinomas (74%). This is, to our knowledge, the first study characterizing the epidemiological, clinical, and histopathological features of cutaneous metastasis in the Lebanese population. The clinical and histopathological features observed were in concordance with the published literature, with minor differences. © 2013 The International Society of Dermatology.

Comparing homeless persons' care experiences in tailored versus nontailored primary care programs.

PubMed

Kertesz, Stefan G; Holt, Cheryl L; Steward, Jocelyn L; Jones, Richard N; Roth, David L; Stringfellow, Erin; Gordon, Adam J; Kim, Theresa W; Austin, Erika L; Henry, Stephen Randal; Kay Johnson, N; Shanette Granstaff, U; O'Connell, James J; Golden, Joya F; Young, Alexander S; Davis, Lori L; Pollio, David E

2013-12-01

We compared homeless patients' experiences of care in health care organizations that differed in their degree of primary care design service tailoring. We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the "Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P < .001). Adjusting for patient characteristics, these differences remained significant for subscales assessing the patient-clinician relationship (P < .001) and perceptions of cooperation among providers (P = .004). There were 1.5- to 3-fold increased odds of an unfavorable experience in the domains of the patient-clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results. Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness.

Principles of Antibiotic Prophylaxis in Total Joint Arthroplasty: Current Concepts.

PubMed

Bosco, Joseph; Bookman, Jared; Slover, James; Edusei, Emmanuel; Levine, Brett

2016-01-01

Infection is a rare, serious complication after total joint arthroplasty and constitutes a considerable emotional and financial burden for patients, surgeons, and healthcare systems. Prevention of surgical site and periprosthetic joint infections is crucial. This requires knowledge of the microorganisms that commonly cause these infections, including Staphylococcus species. Selection of the appropriate antibiotic regimen to treat infection remains controversial, but cefazolin and cefuroxime are the most commonly recommended antibiotics for prophylaxis. Appropriate timing of administration before surgery, with redosing performed as needed, can help to ensure optimal antibiotic concentration during surgery. Given the increasing evidence that S aureus colonization is a risk factor for periprosthetic joint infection, an exploration of the potential benefits of preoperative S aureus carrier screening and decolonization protocols is warranted. The use of antibiotic-loaded bone cement in primary total joint arthroplasty and antibiotic powder at wound closure are other controversial topics that require additional research.

Is Privacy at Risk when Commercial Websites Target Primary School Children? A Case Study in Korea

ERIC Educational Resources Information Center

Kim, Sora; Yi, Soon-Hyung

2010-01-01

This study discusses privacy risk factors when commercial web sites target primary school children in Korea. Specifically, the authors examined types of personal information required for membership subscriptions and whether privacy policies at commercial sites for children abide by privacy guidelines. A total of 159 commercial sites targeting…

Identifying research priorities for effective retention strategies in clinical trials.

PubMed

Kearney, Anna; Daykin, Anne; Shaw, Alison R G; Lane, Athene J; Blazeby, Jane M; Clarke, Mike; Williamson, Paula; Gamble, Carrol

2017-08-31

The failure to retain patients or collect primary-outcome data is a common challenge for trials and reduces the statistical power and potentially introduces bias into the analysis. Identifying strategies to minimise missing data was the second highest methodological research priority in a Delphi survey of the Directors of UK Clinical Trial Units (CTUs) and is important to minimise waste in research. Our aim was to assess the current retention practices within the UK and priorities for future research to evaluate the effectiveness of strategies to reduce attrition. Seventy-five chief investigators of NIHR Health Technology Assessment (HTA)-funded trials starting between 2009 and 2012 were surveyed to elicit their awareness about causes of missing data within their trial and recommended practices for improving retention. Forty-seven CTUs registered within the UKCRC network were surveyed separately to identify approaches and strategies being used to mitigate missing data across trials. Responses from the current practice surveys were used to inform a subsequent two-round Delphi survey with registered CTUs. A consensus list of retention research strategies was produced and ranked by priority. Fifty out of seventy-five (67%) chief investigators and 33/47 (70%) registered CTUs completed the current practice surveys. Seventy-eight percent of trialists were aware of retention challenges and implemented strategies at trial design. Patient-initiated withdrawal was the most common cause of missing data. Registered CTUs routinely used newsletters, timeline of participant visits, and telephone reminders to mitigate missing data. Whilst 36 out of 59 strategies presented had been formally or informally evaluated, some frequently used strategies, such as site initiation training, have had no research to inform practice. Thirty-five registered CTUs (74%) participated in the Delphi survey. Research into the effectiveness of site initiation training, frequency of patient contact during a trial, the use of routinely collected data, the frequency and timing of reminders, triggered site training and the time needed to complete questionnaires was deemed critical. Research into the effectiveness of Christmas cards for site staff was not of critical importance. The surveys of current practices demonstrates that a variety of strategies are being used to mitigate missing data but with little evidence to support their use. Six retention strategies were deemed critically important within the Delphi survey and should be a primary focus of future retention research.

Bone taphonomy of the Schöningen "Spear Horizon South" and its implications for site formation and hominin meat provisioning.

PubMed

Starkovich, Britt M; Conard, Nicholas J

2015-12-01

This paper presents the faunal remains from the new excavation area at the Lower Paleolithic site of Schöningen. The focus of the study is on the southern extension of the main find horizon (Spear Horizon South), which includes the layer that yielded the famous Schöningen spears (13 II-4). Taxonomic data corroborate previous studies, that hominins primarily hunted Equus mosbachensis, a large Pleistocene horse. Equid body part representation at the site suggests that the animals were hunted and butchered locally. There is no evidence for density-mediated attrition in the assemblage. Weathering damage is uncommon, though there is ample evidence that carnivores had access to the bone. Carnivore bite sizes were measured and compared to experimental data provided by previous authors. Based on relationships between bite size and carnivore behavior and body size, we conclude that the primary modifying agents were large carnivores (i.e., wolves or saber-toothed cats). Previous studies show that carnivores often had secondary access to the remains, after hominins. Cut marks are commonly arranged haphazardly on the bones. This may indicate that multiple hominins participated in the butchery of horse skeletons, or that they were butchered over the course of hours or days. Cut marks on axial elements are more "orderly," which probably reflects the physical logistics of orienting one's body in relation to a large carcass. These data differ from sites formed by Middle and Upper Paleolithic hominins, which might suggest that in later times, a system of organized meat provisioning was already in place. Taken together, the faunal evidence from the Spear Horizon South indicates that late Lower Paleolithic hominins using the site understood the behaviors of different prey species, hunted socially to take down large game, and successfully competed with large carnivores on the landscape for primary access to ungulate remains. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Competing Risk Model of First Failure Site after Definitive Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer.

PubMed

Nygård, Lotte; Vogelius, Ivan R; Fischer, Barbara M; Kjær, Andreas; Langer, Seppo W; Aznar, Marianne C; Persson, Gitte F; Bentzen, Søren M

2018-04-01

The aim of the study was to build a model of first failure site- and lesion-specific failure probability after definitive chemoradiotherapy for inoperable NSCLC. We retrospectively analyzed 251 patients receiving definitive chemoradiotherapy for NSCLC at a single institution between 2009 and 2015. All patients were scanned by fludeoxyglucose positron emission tomography/computed tomography for radiotherapy planning. Clinical patient data and fludeoxyglucose positron emission tomography standardized uptake values from primary tumor and nodal lesions were analyzed by using multivariate cause-specific Cox regression. In patients experiencing locoregional failure, multivariable logistic regression was applied to assess risk of each lesion being the first site of failure. The two models were used in combination to predict probability of lesion failure accounting for competing events. Adenocarcinoma had a lower hazard ratio (HR) of locoregional failure than squamous cell carcinoma (HR = 0.45, 95% confidence interval [CI]: 0.26-0.76, p = 0.003). Distant failures were more common in the adenocarcinoma group (HR = 2.21, 95% CI: 1.41-3.48, p < 0.001). Multivariable logistic regression of individual lesions at the time of first failure showed that primary tumors were more likely to fail than lymph nodes (OR = 12.8, 95% CI: 5.10-32.17, p < 0.001). Increasing peak standardized uptake value was significantly associated with lesion failure (OR = 1.26 per unit increase, 95% CI: 1.12-1.40, p < 0.001). The electronic model is available at http://bit.ly/LungModelFDG. We developed a failure site-specific competing risk model based on patient- and lesion-level characteristics. Failure patterns differed between adenocarcinoma and squamous cell carcinoma, illustrating the limitation of aggregating them into NSCLC. Failure site-specific models add complementary information to conventional prognostic models. Copyright © 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Necrotizing Fasciitis of the Upper Extremity, Case Report and Review of the Literature

PubMed Central

Nazerani, Shahram; Maghari, Ahmad; Kalantar Motamedi, Mohammad Hosein; Vahedian Ardakani, Jalal; Rashidian, Nikdokht; Nazerani, Tina

2012-01-01

ABSTRACT Necrotizing fasciitis is a rare, life-threatening infection most commonly seen in patients with diabetes mellitus, intravenous drug abuse, and immunocompromised conditions. The extremities are the primary sites of involvement in as many as two thirds of the cases. In a significant proportion of patients, the extremities are involved as a result of trauma, needle puncture or extravasation of drugs. The infection is usually polymicrobial. Treatment involves broad-spectrum antibiotics and multiple surgical debridements or amputation. We present a patient with necrotizing fasciitis of the upper limb and present our experience with this often lethal condition. PMID:24350113

Mechanisms and management of the heart in Myotonic Dystrophy

PubMed Central

McNally, Elizabeth M.; Sparano, Dina

2015-01-01

Myotonic dystrophy (DM) is the most common form of adult onset muscular dystrophy and is caused by expansion of short nucleotide repeats that, in turn, produce toxic RNA aggregates within cells. DM is multisystemic, and the heart is primary site of pathology. DM patients exhibit cardiac conduction disorders including atrial fibrillation, atrio-ventricular heart block and ventricular arrhythmias. DM patients are also at risk for cardiomyopathy and congestive heart failure. Myotonic dystrophy is also characterized by myotonia, muscle weakness, and profound fatigue. The management of these symptoms requires input from the cardiologist and a team approach to minimize the debilitating aspects of the disorder and optimize cardiac function. PMID:21642660

Paleomagnetic dating of the Cu-Zn-Pb Kupferschiefer deposit at Sangerhausen, Germany

NASA Astrophysics Data System (ADS)

Symons, D. T.; Kawasaki, K.; Walther, S.; Borg, G.

2010-12-01

Paleomagnetic and rock magnetic results are reported for the Cu-Zn-Pb Kupferschiefer mineralization at Sangerhausen, Germany. The mineralization is richest in the ~0.5 m thick Upper Permian (258±2 Ma) Kupferschiefer black marly shale (9 sites) and dies out over ~0.2 m in the underlying Weisliegend sandstones (3 sites) and overlying Zechstein carbonates (2 sites). Paleomagnetic and rock magnetic analysis were made on 205 specimens from 15 sites on the margin of the Sangerhausen Syncline. Except for the one site from fault zone gypsum, stable characteristic remanent magnetization (ChRM) directions were isolated in pyrrhotite with minor magnetite for the 14 sites using alternating field and thermal step demagnetization. Rock magnetic measurements show that the Kupferschiefer shale marks a redox front between the oxidized Weissliegend sandstones and non-oxidized Zechstein carbonates. A negative paleomagnetic fold test indicates that the ChRM postdates Jurassic fault block tilting. The ChRM directions from the 14 sites give a Late Jurassic paleopole at 149±3 Ma on the European apparent polar wander path. The observed age is significantly younger than the 254±6 Ma primary age of the associated red beds near Lubin in Poland, based on re-interpretation of the 1987 paleopole of Jowett et al. Overall the paleomagnetic results at Sangerhausen favour a very late diagenetic or epigenetic Late Jurassic origin for the Cu-Pb-Zn mineralization in the Kupferschiefer rather than the commonly proposed Late Permian syngenetic to mid-Triassic diagenetic origin.

Analysis of Internet information on the controversial X-Stop device.

PubMed

Anderson, Joshua T; Sullivan, T Barrett; Ahn, Uri M; Ahn, Nicholas U

2014-10-01

The Internet is frequently used by patients to aid in medical decision making. Multiple studies display the Internet's ineffectiveness in presenting high-quality information regarding surgical procedures and devices. With recent reports of unacceptably high complication rates and poor outcomes with the X-Stop device, it is important that online information is comprehensive and accurate. This study is the first to examine Internet information on the controversial X-Stop. To determine how accurately public information over the Internet portrays the existing primary literature on the X-Stop, how extensively the X-Stop is characterized online, and how patient decision making could foreseeably be affected. This cross-sectional study analyzed publicly available Internet information, including videos on the web site YouTube regarding the X-Stop device. No patients were involved in this study. No specific outcome measures were used. Search engines Google, Yahoo, and Bing were used to identify 105 web sites providing information on the X-Stop. Videos on the web site YouTube were included. Web sites were categorized based on the authorship. Each site was analyzed for the provision of appropriate patient inclusion and exclusion criteria, surgical and nonsurgical treatment alternatives, purported benefits, common complications, peer-reviewed literature citations, and descriptions/diagrams of the procedure. Data were evaluated for each authorship subgroup and the entire group of sites. Forty-three percent of sites were authored by a private medical group, 4% by an academic medical group, 16% by an insurance company, 9% by a biomedical industry, 10% by news sources, and 19% by other. Thirty-one percent of web sites and 11% of sites authored by private medical groups contained references to peer-reviewed literature. Fifty-six percent of web sites reported patient inclusion criteria, whereas 33% reported exclusion criteria. Benefits and complications were reported within 91% and 23% of sites, respectively. Surgical and nonsurgical treatment options were mentioned within 59% and 61% of web sites, respectively. Our study demonstrates the Internet's ineffectiveness in reporting quality information on the X-Stop. Information was often incomplete and potentially misleading. Significant controversy exists within primary literature regarding the safety and efficacy of the X-Stop. Yet, publicly available Internet information largely provided misinformation and did not reflect any such controversy. This raises the concern that such information lends itself more toward patient recruitment than patient education. Medical professionals need to know how this may affect their patients' decision making. Copyright © 2014 Elsevier Inc. All rights reserved.

Corresponding Functional Dynamics across the Hsp90 Chaperone Family: Insights from a Multiscale Analysis of MD Simulations

PubMed Central

Morra, Giulia; Potestio, Raffaello; Micheletti, Cristian; Colombo, Giorgio

2012-01-01

Understanding how local protein modifications, such as binding small-molecule ligands, can trigger and regulate large-scale motions of large protein domains is a major open issue in molecular biology. We address various aspects of this problem by analyzing and comparing atomistic simulations of Hsp90 family representatives for which crystal structures of the full length protein are available: mammalian Grp94, yeast Hsp90 and E.coli HtpG. These chaperones are studied in complex with the natural ligands ATP, ADP and in the Apo state. Common key aspects of their functional dynamics are elucidated with a novel multi-scale comparison of their internal dynamics. Starting from the atomic resolution investigation of internal fluctuations and geometric strain patterns, a novel analysis of domain dynamics is developed. The results reveal that the ligand-dependent structural modulations mostly consist of relative rigid-like movements of a limited number of quasi-rigid domains, shared by the three proteins. Two common primary hinges for such movements are identified. The first hinge, whose functional role has been demonstrated by several experimental approaches, is located at the boundary between the N-terminal and Middle-domains. The second hinge is located at the end of a three-helix bundle in the Middle-domain and unfolds/unpacks going from the ATP- to the ADP-state. This latter site could represent a promising novel druggable allosteric site common to all chaperones. PMID:22457611

Involving patients in setting priorities for healthcare improvement: a cluster randomized trial.

PubMed

Boivin, Antoine; Lehoux, Pascale; Lacombe, Réal; Burgers, Jako; Grol, Richard

2014-02-20

Patients are increasingly seen as active partners in healthcare. While patient involvement in individual clinical decisions has been extensively studied, no trial has assessed how patients can effectively be involved in collective healthcare decisions affecting the population. The goal of this study was to test the impact of involving patients in setting healthcare improvement priorities for chronic care at the community level. Cluster randomized controlled trial. Local communities were randomized in intervention (priority setting with patient involvement) and control sites (no patient involvement). Communities in a canadian region were required to set priorities for improving chronic disease management in primary care, from a list of 37 validated quality indicators. Patients were consulted in writing, before participating in face-to-face deliberation with professionals. Professionals established priorities among themselves, without patient involvement. A total of 172 individuals from six communities participated in the study, including 83 chronic disease patients, and 89 health professionals. The primary outcome was the level of agreement between patients' and professionals' priorities. Secondary outcomes included professionals' intention to use the selected quality indicators, and the costs of patient involvement. Priorities established with patients were more aligned with core generic components of the Medical Home and Chronic Care Model, including: access to primary care, self-care support, patient participation in clinical decisions, and partnership with community organizations (p < 0.01). Priorities established by professionals alone placed more emphasis on the technical quality of single disease management. The involvement intervention fostered mutual influence between patients and professionals, which resulted in a 41% increase in agreement on common priorities (95%CI: +12% to +58%, p < 0.01). Professionals' intention to use the selected quality indicators was similar in intervention and control sites. Patient involvement increased the costs of the prioritization process by 17%, and required 10% more time to reach consensus on common priorities. Patient involvement can change priorities driving healthcare improvement at the population level. Future research should test the generalizability of these findings to other contexts, and assess its impact on patient care. The Netherlands National Trial Register #NTR2496.

Involving patients in setting priorities for healthcare improvement: a cluster randomized trial

PubMed Central

2014-01-01

Background Patients are increasingly seen as active partners in healthcare. While patient involvement in individual clinical decisions has been extensively studied, no trial has assessed how patients can effectively be involved in collective healthcare decisions affecting the population. The goal of this study was to test the impact of involving patients in setting healthcare improvement priorities for chronic care at the community level. Methods Design: Cluster randomized controlled trial. Local communities were randomized in intervention (priority setting with patient involvement) and control sites (no patient involvement). Setting: Communities in a canadian region were required to set priorities for improving chronic disease management in primary care, from a list of 37 validated quality indicators. Intervention: Patients were consulted in writing, before participating in face-to-face deliberation with professionals. Control: Professionals established priorities among themselves, without patient involvement. Participants: A total of 172 individuals from six communities participated in the study, including 83 chronic disease patients, and 89 health professionals. Outcomes: The primary outcome was the level of agreement between patients’ and professionals’ priorities. Secondary outcomes included professionals’ intention to use the selected quality indicators, and the costs of patient involvement. Results Priorities established with patients were more aligned with core generic components of the Medical Home and Chronic Care Model, including: access to primary care, self-care support, patient participation in clinical decisions, and partnership with community organizations (p < 0.01). Priorities established by professionals alone placed more emphasis on the technical quality of single disease management. The involvement intervention fostered mutual influence between patients and professionals, which resulted in a 41% increase in agreement on common priorities (95%CI: +12% to +58%, p < 0.01). Professionals’ intention to use the selected quality indicators was similar in intervention and control sites. Patient involvement increased the costs of the prioritization process by 17%, and required 10% more time to reach consensus on common priorities. Conclusions Patient involvement can change priorities driving healthcare improvement at the population level. Future research should test the generalizability of these findings to other contexts, and assess its impact on patient care. Trial registration The Netherlands National Trial Register #NTR2496. PMID:24555508

Cell-type-specific replication initiation programs set fragility of the FRA3B fragile site.

PubMed

Letessier, Anne; Millot, Gaël A; Koundrioukoff, Stéphane; Lachagès, Anne-Marie; Vogt, Nicolas; Hansen, R Scott; Malfoy, Bernard; Brison, Olivier; Debatisse, Michelle

2011-02-03

Common fragile sites have long been identified by cytogeneticists as chromosomal regions prone to breakage upon replication stress. They are increasingly recognized to be preferential targets for oncogene-induced DNA damage in pre-neoplastic lesions and hotspots for chromosomal rearrangements in various cancers. Common fragile site instability was attributed to the fact that they contain sequences prone to form secondary structures that may impair replication fork movement, possibly leading to fork collapse resulting in DNA breaks. Here we show, in contrast to this view, that the fragility of FRA3B--the most active common fragile site in human lymphocytes--does not rely on fork slowing or stalling but on a paucity of initiation events. Indeed, in lymphoblastoid cells, but not in fibroblasts, initiation events are excluded from a FRA3B core extending approximately 700 kilobases, which forces forks coming from flanking regions to cover long distances in order to complete replication. We also show that origins of the flanking regions fire in mid-S phase, leaving the site incompletely replicated upon fork slowing. Notably, FRA3B instability is specific to cells showing this particular initiation pattern. The fact that both origin setting and replication timing are highly plastic in mammalian cells explains the tissue specificity of common fragile site instability we observed. Thus, we propose that common fragile sites correspond to the latest initiation-poor regions to complete replication in a given cell type. For historical reasons, common fragile sites have been essentially mapped in lymphocytes. Therefore, common fragile site contribution to chromosomal rearrangements in tumours should be reassessed after mapping fragile sites in the cell type from which each tumour originates.

Continuing education for primary health care nurse practitioners in Ontario, Canada.

PubMed

Baxter, Pamela; DiCenso, Alba; Donald, Faith; Martin-Misener, Ruth; Opsteen, Joanne; Chambers, Tracey

2013-04-01

The Council of Ontario University Programs in Nursing offers a nine-university, consortium-based primary health care nurse practitioner education program and on-line continuing education courses for primary health care nurse practitioners. Our study sought to determine the continuing education needs of primary health care nurse practitioners across Ontario, how best to meet these needs, and the barriers they face in completing continuing education. Surveys were completed by 83 (40%) of 209 learners who had participated in continuing education offered by the Council of Ontario University Programs in Nursing between 2004 and 2007. While 83% (n=50) of nurse practitioners surveyed indicated that continuing education was extremely important to them, they also identified barriers to engaging in continuing education offerings including; time intensity of the courses, difficulty taking time off work, family obligations, finances and fatigue. The most common reason for withdrawal from a continuing education offering was the difficulty of balancing work and study demands. Continuing education opportunities are important to Ontario primary health care nurse practitioners, and on-line continuing education offerings have been well received, but in order to be taken up by their target audience they must be relevant, readily accessible, flexible, affordable and offered over brief, intense periods of time using technology that is easy to use and Internet sites that are easily navigated. Copyright © 2012 Elsevier Ltd. All rights reserved.

B cell lymphoma with lung involvement: what is it about?

PubMed

Mian, Michael; Wasle, Ines; Gritsch, Stefan; Willenbacher, Wolfgang; Fiegl, Michael

2015-01-01

Primary lymphoma of the lung or pleural is a very rare condition. Due to the outdated literature data, the approximate occurrence of primary and secondary lung and/or pleural involvement according to the most common B cell lymphoma entities is unknown. To answer this open question in Austria, we screened the Tyrolean registry for B cell non-Hodgkin's lymphomas regarding primary and secondary lung involvement. Of 854 patients affected by B cell lymphoma, 7.5% had lung/pleural disease. This organ was the primary site in only 0.7%, while a secondary involvement was registered in 6.8%. Most of them were affected by diffuse large B cell lymphoma (DLBCL; 29/368, 8%) followed by follicular lymphoma (7/188, 4%), mantle cell lymphoma (7/57, 12%), mucosa-associated tissue lymphoma (10/37, 27%), posttransplant lymphoproliferative disease (6/24, 25%), Burkitt lymphoma (3/19, 16%), other lymphomas (1/32, 3%) and Richter transformation (1/11, 9%). Moreover, primary lung/pleural lymphoma is one of the rarest neoplasias affecting the lung, accounting for only 0.4% of cases. Lung/pleural involvement is a very rare condition among B cell lymphomas since it mainly occurs in the setting of a generalized disease. A large majority of patients with secondary organ involvement are affected by DLBCL and have similar clinical features at diagnosis to others with advanced-stage disease. © 2014 S. Karger AG, Basel.

Implementation of data management and effect on chronic disease coding in a primary care organisation: A parallel cohort observational study.

PubMed

Greiver, Michelle; Wintemute, Kimberly; Aliarzadeh, Babak; Martin, Ken; Khan, Shahriar; Jackson, Dave; Leggett, Jannet; Lambert-Lanning, Anita; Siu, Maggie

2016-10-12

Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions. Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada. Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%-8.2%, p < 0.01). The use of standard codes, consisting of the most common diagnostic codes for each condition in the CPCSSN database, increased by 8.9% more (95% CI 8.3%-9.5%, p < 0.01). Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.

Mucosal colonization by metastatic carcinoma in the gastrointestinal tract: a potential mimic of primary neoplasia.

PubMed

Estrella, Jeannelyn S; Wu, Tsung-Teh; Rashid, Asif; Abraham, Susan C

2011-04-01

The gastrointestinal (GI) tract is a common site for both primary and metastatic carcinomas. Distinguishing the two can occasionally be difficult, particularly when metastatic tumor reaches the mucosal surface. Features that are typically used to make this distinction include the presence of an adenomatous precursor lesion, regional lymph node involvement, and gross configuration of the tumor. However, we recently encountered 2 index cases of metastatic carcinoma in the small intestine (1 from the colorectum and 1 of endocervical origin) that were initially misinterpreted as primary small bowel carcinomas because of apparent in situ growth in the mucosal surface resembling polypoid, adenomatous precursor lesions. We, therefore, studied 100 GI resections from 1987 to 2009 that were reported to show mucosal involvement by metastatic carcinoma, and compared the histologic features with a control group of 29 primary small bowel adenocarcinomas. Gross descriptions and histologic sections were evaluated for the following: (1) tumor spread along an intact basement membrane of villi/crypts (mucosal colonization), (2) resemblance to an adenoma/precursor lesion, (3) gross configuration of the tumor, (4) lymphovascular invasion, and (5) regional lymph node involvement in the metastatic site. Metastatic sites included the small intestine (n=74), colorectum (n=16), or both (n=10). Primary tumors were GI (n=55, with 47 from colorectum), gynecologic (n=28), pulmonary (n=8), genitourinary (n=6), head and neck (n=2), and breast (n=1). Overall, 42 (42%) of the metastases that reached the mucosal surface of the bowel showed at least focal mucosal colonization, 26% resembled a precursor adenoma, 62% had regional lymph node positivity, and only 24% cases showed a classic serosal-based configuration. In 4 cases (2 of GI origin and 2 of gynecologic origin), metastatic tumors were initially interpreted as new primaries by the pathologist (n=2) or clinicians (n=2). Metastatic carcinomas originating from the GI tract were significantly more likely to show mucosal colonization (60% vs. 20%, P<0.0001) and resemblance to a precursor lesion (45% vs. 2%, P<0.0001) than other primary tumors. In a comparison between 29 primary small bowel carcinomas and 41 metastatic colorectal carcinomas in the small bowel, metastatic tumors were distinguished by a higher prevalence of multiple lesions (0% vs. 39%, P<0.0001), whereas small bowel primaries were more likely to show high tumor grade (41% vs. 17%, P=0.03). There were no significant differences in the mean age (61.4 y vs. 60.9 y), number of male participants (69% vs. 56%), growth along basement membranes (62% vs. 63%), apparent precursor lesion (55% vs. 46%), lymphovascular invasion (69% vs. 73%), or lymph node positivity (68% vs. 37.5%, P=0.065). These results confirm that metastatic carcinomas involving the mucosal surface of the intestines frequently exhibit gross and histologic features, which mimic second primaries, especially when they originate from the GI tract. In situ growth and presence of an apparent adenoma cannot be taken as prima facie evidence of a primary neoplasm.

Genome-Wide Progesterone Receptor Binding: Cell Type-Specific and Shared Mechanisms in T47D Breast Cancer Cells and Primary Leiomyoma Cells

PubMed Central

Huang, Lei; Owen, Jonas K.; Xie, Anna; Navarro, Antonia; Monsivais, Diana; Coon V, John S.; Kim, J. Julie; Dai, Yang; Bulun, Serdar E.

2012-01-01

Background Progesterone, via its nuclear receptor (PR), exerts an overall tumorigenic effect on both uterine fibroid (leiomyoma) and breast cancer tissues, whereas the antiprogestin RU486 inhibits growth of these tissues through an unknown mechanism. Here, we determined the interaction between common or cell-specific genome-wide binding sites of PR and mRNA expression in RU486-treated uterine leiomyoma and breast cancer cells. Principal Findings ChIP-sequencing revealed 31,457 and 7,034 PR-binding sites in breast cancer and uterine leiomyoma cells, respectively; 1,035 sites overlapped in both cell types. Based on the chromatin-PR interaction in both cell types, we statistically refined the consensus progesterone response element to G•ACA• • •TGT•C. We identified two striking differences between uterine leiomyoma and breast cancer cells. First, the cis-regulatory elements for HSF, TEF-1, and C/EBPα and β were statistically enriched at genomic RU486/PR-targets in uterine leiomyoma, whereas E2F, FOXO1, FOXA1, and FOXF sites were preferentially enriched in breast cancer cells. Second, 51.5% of RU486-regulated genes in breast cancer cells but only 6.6% of RU486-regulated genes in uterine leiomyoma cells contained a PR-binding site within 5 kb from their transcription start sites (TSSs), whereas 75.4% of RU486-regulated genes contained a PR-binding site farther than 50 kb from their TSSs in uterine leiomyoma cells. RU486 regulated only seven mRNAs in both cell types. Among these, adipophilin (PLIN2), a pro-differentiation gene, was induced via RU486 and PR via the same regulatory region in both cell types. Conclusions Our studies have identified molecular components in a RU486/PR-controlled gene network involved in the regulation of cell growth, cell migration, and extracellular matrix function. Tissue-specific and common patterns of genome-wide PR binding and gene regulation may determine the therapeutic effects of antiprogestins in uterine fibroids and breast cancer. PMID:22272226

The role of cytokeratins 20 and 7 and estrogen receptor analysis in separation of metastatic lobular carcinoma of the breast and metastatic signet ring cell carcinoma of the gastrointestinal tract.

PubMed

Tot, T

2000-06-01

Metastatic signet ring cell carcinomas of unknown primary site can represent a clinical problem. Gastrointestinal signet ring cell carcinomas and invasive lobular carcinomas of the breast are the most common sources of these metastases. Immunohistochemical algorithms have been successfully used in the search for the unknown primary adenocarcinomas. In the present study a series of primary invasive lobular breast carcinomas (79 cases) and their metastases and a series of gastrointestinal signet ring cell carcinomas (22 primary and 13 metastases) were stained with monoclonal antibodies for cytokeratin (CK) 20 and CK7 and for estrogen receptors (ER). The staining was evaluated as negative (no staining), focally (less than 10% of the tumor cells stained) or diffusely positive. All the primary and metastatic gastrointestinal signet ring cell carcinomas proved to be CK20 positive, while only 2/79 (3%) of the primary and 1/21 metastatic lobular carcinomas (5%) stained positively for this CK. None of the gastrointestinal carcinomas and the majority of the lobular carcinomas expressed ER. The majority of the tumors were CK7+. Using CK20 alone, 33 of 34 metastases could be properly classified as gastrointestinal (CK20+) or mammary (CK20-). ER identified 31/34 of breast cancer metastases. By combining the results of CK20 and ER staining all the metastases could be properly classified as the CK20+/ER- pattern identified all the gastrointestinal tumors.

Gene expression profiles help identify the tissue of origin for metastatic brain cancers.

PubMed

Wu, Alan H B; Drees, Julia C; Wang, Hangpin; VandenBerg, Scott R; Lal, Anita; Henner, William D; Pillai, Raji

2010-04-26

Metastatic brain cancers are the most common intracranial tumor and occur in about 15% of all cancer patients. In up to 10% of these patients, the primary tumor tissue remains unknown, even after a time consuming and costly workup. The Pathwork Tissue of Origin Test (Pathwork Diagnostics, Redwood City, CA, USA) is a gene expression test to aid in the diagnosis of metastatic, poorly differentiated and undifferentiated tumors. It measures the expression pattern of 1,550 genes in these tumors and compares it to the expression pattern of a panel of 15 known tumor types. The purpose of this study was to evaluate the performance of the Tissue of Origin Test in the diagnosis of primary sites for metastatic brain cancer patients. Fifteen fresh-frozen metastatic brain tumor specimens of known origins met specimen requirements. These specimens were entered into the study and processed using the Tissue of Origin Test. Results were compared to the known primary site and the agreement between the two results was assessed. Fourteen of the fifteen specimens produced microarray data files that passed all quality metrics. One originated from a tissue type that was off-panel. Among the remaining 13 cases, the Tissue of Origin Test accurately predicted the available diagnosis in 12/13 (92.3%) cases. This study demonstrates the accuracy of the Tissue of Origin Test when applied to predict the tissue of origin of metastatic brain tumors. This test could be a very useful tool for pathologists as they classify metastatic brain cancers.

Gene expression profiles help identify the Tissue of Origin for metastatic brain cancers

PubMed Central

2010-01-01

Background Metastatic brain cancers are the most common intracranial tumor and occur in about 15% of all cancer patients. In up to 10% of these patients, the primary tumor tissue remains unknown, even after a time consuming and costly workup. The Pathwork® Tissue of Origin Test (Pathwork Diagnostics, Redwood City, CA, USA) is a gene expression test to aid in the diagnosis of metastatic, poorly differentiated and undifferentiated tumors. It measures the expression pattern of 1,550 genes in these tumors and compares it to the expression pattern of a panel of 15 known tumor types. The purpose of this study was to evaluate the performance of the Tissue of Origin Test in the diagnosis of primary sites for metastatic brain cancer patients. Methods Fifteen fresh-frozen metastatic brain tumor specimens of known origins met specimen requirements. These specimens were entered into the study and processed using the Tissue of Origin Test. Results were compared to the known primary site and the agreement between the two results was assessed. Results Fourteen of the fifteen specimens produced microarray data files that passed all quality metrics. One originated from a tissue type that was off-panel. Among the remaining 13 cases, the Tissue of Origin Test accurately predicted the available diagnosis in 12/13 (92.3%) cases. Discussion This study demonstrates the accuracy of the Tissue of Origin Test when applied to predict the tissue of origin of metastatic brain tumors. This test could be a very useful tool for pathologists as they classify metastatic brain cancers. PMID:20420692

Symptom clusters in advanced cancer.

PubMed

Jiménez, Ana; Madero, Rosario; Alonso, Alberto; Martínez-Marín, Virginia; Vilches, Yolanda; Martínez, Beatriz; Feliu, Marta; Díaz, Leyre; Espinosa, Enrique; Feliu, Jaime

2011-07-01

Patients with advanced cancer often experience multiple concurrent symptoms. Few studies have explored symptom clusters (SCs) in this population. The aim of the present study was to explore SCs in advanced cancer, evaluate the characteristics associated with various clusters, and determine their relationship to survival. This study included patients in the palliative care program of the Hospital Universitario La Paz from 2003 to 2005. The Edmonton Symptom Assessment System and a supplement including 13 other symptoms were used to detect symptoms. Principal component analysis was performed to determine symptom relationships and compare SCs with associated parameters. In total, 406 patients were included, 61% men and 39% women. The median age was 66.4 (range 18-95). The most common primaries were gastrointestinal (35%), lung (25%), genitourinary (8%), breast (5%), and head and neck (5%) carcinomas. The following clusters were identified: confusion (cognitive impairment, agitation, urinary incontinence), neuropsychological (anxiety, depression, and insomnia), anorexia-cachexia (anorexia, weight loss, and tiredness), and gastrointestinal (nausea and vomiting). The presence of these SCs was influenced by primary cancer site, gender, age, and performance status. Survival was related to the number of SCs present in a given patient: zero SC, 52 days; one SC, 38 days; two SCs, 23 days; and three to four SCs, 19 days; P < 0.001. Different SCs can be identified in patients with advanced cancer. These SCs are influenced by primary cancer site, gender, age, and Eastern Cooperative Oncology Group performance status, and they can have prognostic value. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Clinical results of primary malignant musculoskeletal tumor treated by wide resection and recycling autograft reconstruction using liquid nitrogen.

PubMed

Paholpak, Permsak; Sirichativapee, Winai; Wisanuyotin, Taweechok; Kosuwon, Weerachai; Jeeravipoolvarn, Polasak

2015-06-01

To evaluate the clinical results of primary malignant musculoskeletal tumors treated with wide resection and recycling autograft reconstruction using liquid nitrogen. We reviewed 12 patients who had a primary malignant bone and soft tissue tumor treated by wide resection and recycling autograft reconstruction using liquid nitrogen between March 2006 and March 2013. The results were judged by recurrence, functional status and complications. Functional status was assessed according to the Musculoskeletal Tumor Society Score (MSTSS). Clinical failure was defined as need for reoperation in order to change the type of reconstruction or to amputate, and the presence of local recurrence. The most common tumor was osteosarcoma (eight cases) followed by Ewing's sarcoma (two cases). The tibia was the most frequently involved skeletal site (six cases) followed by the femur (three cases). The median follow-up period was 32 months. In 12 patients, 7 were still alive without recurrence. There were 3 clinical failures: 1 local recurrence and 2 graft complications at 28, 51 and 20 months after reconstruction, respectively. The main complication was infection (three cases). All osteotomy sites were radiographic unions, and the union time was 8.2 ± 2.7 months. The mean ± SD MSTSS score was 79% ± 11%; excellent functional results were achieved in seven patients. Recycling autograft reconstruction using liquid nitrogen had favorable clinical outcomes in terms of functional status and local recurrence. This reconstruction method, therefore, represents a reasonable alternative for limb salvage surgery. © 2014 Wiley Publishing Asia Pty Ltd.

UV radiation is the primary factor driving the variation in leaf phenolics across Chinese grasslands

PubMed Central

Chen, Litong; Niu, Kechang; Wu, Yi; Geng, Yan; Mi, Zhaorong; Flynn, Dan FB; He, Jin-Sheng

2013-01-01

Due to the role leaf phenolics in defending against ultraviolet B (UVB) under previously controlled conditions, we hypothesize that ultraviolet radiation (UVR) could be a primary factor driving the variation in leaf phenolics in plants over a large geographic scale. We measured leaf total phenolics, ultraviolet-absorbing compounds (UVAC), and corresponding leaf N, P, and specific leaf area (SLA) in 151 common species. These species were from 84 sites across the Tibetan Plateau and Inner Mongolian grasslands of China with contrasting UVR (354 vs. 161 mW/cm2 on average). Overall, leaf phenolics and UVAC were all significantly higher on the Tibetan Plateau than in the Inner Mongolian grasslands, independent of phylogenetic relationships between species. Regression analyses showed that the variation in leaf phenolics was strongly affected by climatic factors, particularly UVR, and soil attributes across all sites. Structural equation modeling (SEM) identified the primary role of UVR in determining leaf phenolic concentrations, after accounting for colinearities with altitude, climatic, and edaphic factors. In addition, phenolics correlated positively with UVAC and SLA, and negatively with leaf N and N: P. These relationships were steeper in the lower-elevation Inner Mongolian than on the Tibetan Plateau grasslands. Our data support that the variation in leaf phenolics is controlled mainly by UV radiation, implying high leaf phenolics facilitates the adaptation of plants to strong irradiation via its UV-screening and/or antioxidation functions, particularly on the Tibetan Plateau. Importantly, our results also suggest that leaf phenolics may influence on vegetation attributes and indirectly affect ecosystem processes by covarying with leaf functional traits. PMID:24363898

Anorectal Cancer: Critical Anatomic and Staging Distinctions That Affect Use of Radiation Therapy

PubMed Central

Mamon, Harvey J.; Fuchs, Charles S.; Doyle, Leona A.; Tirumani, Sree Harsha; Ramaiya, Nikhil H.; Rosenthal, Michael H.

2015-01-01

Although rectal and anal cancers are anatomically close, they are distinct entities with different histologic features, risk factors, staging systems, and treatment pathways. Imaging is at the core of initial clinical staging of these cancers and most commonly includes magnetic resonance imaging for local-regional staging and computed tomography for evaluation of metastatic disease. The details of the primary tumor and involvement of regional lymph nodes are crucial in determining if and how radiation therapy should be used in treatment of these cancers. Unfortunately, available imaging modalities have been shown to have imperfect accuracy for identification of nodal metastases and imaging features other than size. Staging of nonmetastatic rectal cancers is dependent on the depth of invasion (T stage) and the number of involved regional lymph nodes (N stage). Staging of nonmetastatic anal cancers is determined according to the size of the primary mass and the combination of regional nodal sites involved; the number of positive nodes at each site is not a consideration for staging. Patients with T3 rectal tumors and/or involvement of perirectal, mesenteric, and internal iliac lymph nodes receive radiation therapy. Almost all anal cancers warrant use of radiation therapy, but the extent and dose of the radiation fields is altered on the basis of both the size of the primary lesion and the presence and extent of nodal involvement. The radiologist must recognize and report these critical anatomic and staging distinctions, which affect use of radiation therapy in patients with anal and rectal cancers. ©RSNA, 2015 PMID:26562239

"Chance favors only the prepared mind": preparing minds to systematically reduce hazards in the testing process in primary care.

PubMed

Singh, Ranjit; Hickner, John; Mold, Jim; Singh, Gurdev

2014-03-01

Testing plays a vital role in primary care. Failures in the process are common and can be harmful. As the great 19th century microbiologist Louis Pasteur put it "chance favors only the prepared mind." Our objective is to prepare minds in primary care practices to improve safety in the testing process. Various principles from safety science can be applied. A prospective methodology that uses an anonymous practice survey based on concepts from failure modes and effects analysis is proposed. Responses are used to rank perceived hazards in the testing process, leading to prioritization of areas for intervention. Secondary data analysis (using data from a study of medication safety) was used to explore the value of this approach in the context of assessing the testing process. At 3 primary care practice sites, a total of 61 staff members completed 4 survey items examining the testing process. Comparison across practices shows that each has a distinct profile of hazards, which would lead each on a different path toward improvement. The proposed approach treats each practice as a unique complex adaptive system aiming to help it thrive by inculcating trust, mutual respect, and collaboration. Implications for patient safety research and practice are discussed.

Bacterial infections after pediatric heart transplantation: Epidemiology, risk factors and outcomes.

PubMed

Rostad, Christina A; Wehrheim, Karla; Kirklin, James K; Naftel, David; Pruitt, Elizabeth; Hoffman, Timothy M; L'Ecuyer, Thomas; Berkowitz, Katie; Mahle, William T; Scheel, Janet N

2017-09-01

Bacterial infections represent a major cause of morbidity and mortality in heart transplant recipients. However, data describing the epidemiology and outcomes of these infections in children are limited. We analyzed the Pediatric Heart Transplant Study database of patients transplanted between 1993 and 2014 to determine the etiologies, risk factors and outcomes of children with bacterial infections post-heart transplantation. Of 4,458 primary transplants in the database, there were 4,815 infections that required hospitalization or intravenous therapy, 2,047 (42.51%) of which were bacterial. The risk of bacterial infection was highest in the first month post-transplant, and the bloodstream was the most common site (24.82%). In the early post-transplant period (<30 days post-transplant), coagulase-negative staphylococci were the most common pathogens (16.97%), followed by Enterobacter sp (11.99%) and Pseudomonas sp (11.62%). In the late post-transplant period, community-acquired pathogens Streptococcus pneumoniae (6.27%) and Haemophilus influenzae (2.82%) were also commonly identified. Patients' characteristics independently associated with acquisition of bacterial infection included younger age (p < 0.0001) and ventilator (p < 0.0001) or extracorporeal membrane oxygenation (p = 0.03) use at time of transplant. Overall mortality post-bacterial infection was 33.78%, and previous cardiac surgery (p < 0.001) and multiple sites of infection (p = 0.004) were independent predictors of death. Bacteria were the most common causes of severe infections in pediatric heart transplant recipients and were associated with high mortality rates. The risk of acquiring a bacterial infection was highest in the first month post-transplant, and a large proportion of the infections were caused by multidrug-resistant pathogens. Copyright © 2017 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

CSL311, a novel, potent, therapeutic monoclonal antibody for the treatment of diseases mediated by the common β chain of the IL-3, GM-CSF and IL-5 receptors

PubMed Central

Panousis, Con; Dhagat, Urmi; Edwards, Kirsten M.; Rayzman, Veronika; Hardy, Matthew P.; Braley, Hal; Gauvreau, Gail M.; Hercus, Timothy R.; Smith, Steven; Sehmi, Roma; McMillan, Laura; Dottore, Mara; McClure, Barbara J.; Fabri, Louis J.; Vairo, Gino; Lopez, Angel F; Parker, Michael W.; Nash, Andrew D.; Wilson, Nicholas J.; Wilson, Michael J.; Owczarek, Catherine M.

2016-01-01

ABSTRACT The β common-signaling cytokines interleukin (IL)-3, granulocyte-macrophage colony stimulating factor (GM-CSF) and IL-5 stimulate pro-inflammatory activities of haematopoietic cells via a receptor complex incorporating cytokine-specific α and shared β common (βc, CD131) receptor. Evidence from animal models and recent clinical trials demonstrate that these cytokines are critical mediators of the pathogenesis of inflammatory airway disease such as asthma. However, no therapeutic agents, other than steroids, that specifically and effectively target inflammation mediated by all 3 of these cytokines exist. We employed phage display technology to identify and optimize a novel, human monoclonal antibody (CSL311) that binds to a unique epitope that is specific to the cytokine-binding site of the human βc receptor. The binding epitope of CSL311 on the βc receptor was defined by X-ray crystallography and site-directed mutagenesis. CSL311 has picomolar binding affinity for the human βc receptor, and at therapeutic concentrations is a highly potent antagonist of the combined activities of IL-3, GM-CSF and IL-5 on primary eosinophil survival in vitro. Importantly, CSL311 inhibited the survival of inflammatory cells present in induced sputum from human allergic asthmatic subjects undergoing allergen bronchoprovocation. Due to its high potency and ability to simultaneously suppress the activity of all 3 β common cytokines, CSL311 may provide a new strategy for the treatment of chronic inflammatory diseases where the human βc receptor is central to pathogenesis. The coordinates for the βc/CSL311 Fab complex structure have been deposited with the RCSB Protein Data Bank (PDB 5DWU). PMID:26651396

Circular dichroism study of the interaction between mutagens and bilirubin bound to different binding sites of serum albumins

NASA Astrophysics Data System (ADS)

Orlov, Sergey; Goncharova, Iryna; Urbanová, Marie

Although recent investigations have shown that bilirubin not only has a negative role in the organism but also exhibits significant antimutagenic properties, the mechanisms of interactions between bilirubin and mutagens are not clear. In this study, interaction between bilirubin bound to different binding sites of mammalian serum albumins with structural analogues of the mutagens 2-aminofluorene, 2,7-diaminofluorene and mutagen 2,4,7-trinitrofluorenone were investigated by circular dichroism and absorption spectroscopy. Homological human and bovine serum albumins were used as chiral matrices, which preferentially bind different conformers of bilirubin in the primary binding sites and make it observable by circular dichroism. These molecular systems approximated a real system for the study of mutagens in blood serum. Differences between the interaction of bilirubin bound to primary and to secondary binding sites of serum albumins with mutagens were shown. For bilirubin bound to secondary binding sites with low affinity, partial displacement and the formation of self-associates were observed in all studied mutagens. The associates of bilirubin bound to primary binding sites of serum albumins are formed with 2-aminofluorene and 2,4,7-trinitrofluorenone. It was proposed that 2,7-diaminofluorene does not interact with bilirubin bound to primary sites of human and bovine serum albumins due to the spatial hindrance of the albumins binding domains. The spatial arrangement of the bilirubin bound to serum albumin along with the studied mutagens was modelled using ligand docking, which revealed a possibility of an arrangement of the both bilirubin and 2-aminofluorene and 2,4,7-trinitrofluorenone in the primary binding site of human serum albumin.

Well differentiated "lipoma-like" liposarcoma of the sigmoid mesocolon and multiple lipomatosis of the rectosigmoid colon. Report of a case.

PubMed

Amato, G; Martella, A; Ferraraccio, F; Di Martino, N; Maffettone, V; Landolfi, V; Fei, L; Del Genio, A

1998-01-01

Liposarcoma is the second most common soft tissue sarcoma in adults. These neoplasms take their origin from primitive mesenchymal cells and are rarely encountered in fat rich areas, such as subcutaneous tissue and/or the subserosa of the intestinal tract which, on the contrary, are the two most common sites of lipomas. The two major locations of liposarcomas are the extremities and the retroperitoneum followed with much less frequency by the inguinal region. Other sites are uncommon, particularly the mesentery (9 cases to date in the literature) and, even more so, the mesocolon (only 3 cases of primary sarcoma of the mesocolon reported to date). This paper reports on the case of a well differentiated "lipoma-like" liposarcoma of the sigmoid mesocolon, associated with multiple lipomatosis of the recto-sigmoid colon in a 75 year-old female patient. Surgical treatment consisted of a trans-anal extra-peritoneal anterior resection by CEEA 28 stapler under endoscopic vision. The patient has been followed up for the last 2 years and is still disease-free and well. The peculiarity of the case consists in the contemporaneous presence in close contiguity of two different rare neoplasms whose association is not yet known.

General health status of residents of the Selebi Phikwe Ni-Cu mine area, Botswana.

PubMed

Ekosse, Georges

2005-10-01

Residents of the Selebi Phikwe area, Botswana where nickel-copper (Ni-Cu) is being exploited often exhibit symptoms of varied degrees of ailments, sicknesses and diseases. A need to investigate their general health status was therefore eminent. Primary data was obtained by means of a questionnaire and structured interviews conducted with individuals, health service providers, business enterprises and educational Institutions. The generated data revealed common ailments, sicknesses and diseases in the area with the four most frequent health complaints being frequent coughing headaches, influenza/common colds and rampant chest pains. Research findings indicated that residents had respiratory tract-related problems, suspected to be linked to the effects of air pollution caused by the emission of sulphur dioxide (SO2) from mining and smelting activities. Residents were frequently in contact with SO2 and related gases and fumes, mineral and silica dust generated from the mining processes. No clearly demarcating differences were noticed in the health status of residents living in the control site from those in the main study area. However, sites most affected were those close to where Ni-Cu is exploited. Environmental factors resulting from mining and smelting activities, among others, could be contributory to the negative health effects occurring at Selebi Phikwe.

Guideline-conforming timing of invasive management in troponin-positive or high-risk ACS without persistent ST-segment elevation in German chest pain units. Urban university maximum care vs. rural regional primary care.

PubMed

Breuckmann, F; Remberg, F; Böse, D; Lichtenberg, M; Kümpers, P; Pavenstädt, H; Waltenberger, J; Fischer, D

2016-03-01

This study aimed to analyze guideline adherence in the timing of invasive management for myocardial infarction without persistent ST-segment elevation (NSTEMI) in two exemplary German centers, comparing an urban university maximum care facility and a rural regional primary care facility. All patients diagnosed as having NSTEMI during 2013 were retrospectively enrolled in two centers: (1) site I, a maximum care center in an urban university setting, and (b) site II, a primary care center in a rural regional care setting. Data acquisition included time intervals from admission to invasive management, risk criteria, rate of intervention, and medical therapy. The median time from admission to coronary angiography was 12.0 h (site I) or 17.5 h (site II; p = 0.17). Guideline-adherent timing was achieved in 88.1 % (site I) or 82.9 % (site II; p = 0.18) of cases. Intervention rates were high in both sites (site I-75.5 % vs. site II-75.3 %; p = 0.85). Adherence to recommendations of medical therapy was high and comparable between the two sites. In NSTEMI or high-risk acute coronary syndromes without persistent ST-segment elevation, guideline-adherent timing of invasive management was achieved in about 85 % of cases, and was comparable between urban maximum and rural primary care settings. Validation by the German Chest Pain Unit Registry including outcome analysis is required.

Radiological bioconcentration factors for aquatic, terrestrial, and wetland ecosystems at the Savannah River Site

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cummins, C.L.

As a result of operations at the Savannah River Site (SRS), over 50 radionuclides have been released to the atmosphere and to onsite streams and seepage basins. Now, many of these radionuclides are available to aquatic and/or terrestrial organisms for uptake and cycling through the food chain. Knowledge about the uptake and cycling of these radionuclides is now crucial in evaluating waste management and clean-up alternatives for the site. Numerous studies have been conducted at the SRS over the past forty years to study the uptake and distribution of radionuclides in the Savannah River Site environment. In many instances, bioconcentrationmore » factors have been calculated to quantify the uptake of a radionuclide by an organism from the surrounding medium (i.e., soil or water). In the past, it has been common practice to use bioconcentration factors from the literature because site-specific data were not readily available. However, because of the variability of bioconcentration factors due to experimental or environmental conditions, site-specific data should be used when available. This report compiles and summarizes site-specific bioconcentration factors for selected radionuclides released at the Savannah River Site (SRS). An extensive literature search yielded site-specific bioconcentration factors for cesium, strontium, cobalt, plutonium, americium, curium, and tritium. These eight radionuclides have been the primary radionuclides studied at SRS because of their long half lives or because they are major contributors to radiological dose from exposure. For most radionuclides, it was determined that the site-specific bioconcentration factors were higher than those reported in literature. This report also summarizes some conditions that affect radionuclide bioavailability to and bioconcentration by aquatic and terrestrial organisms.« less

Halogen bond: a long overlooked interaction.

PubMed

Cavallo, Gabriella; Metrangolo, Pierangelo; Pilati, Tullio; Resnati, Giuseppe; Terraneo, Giancarlo

2015-01-01

Because of their high electronegativity, halogen atoms are typically considered, in most of their derivatives, as sites of high electron density and it is commonly accepted that they can form attractive interactions by functioning as the electron donor site (nucleophilic site). This is the case when they work as hydrogen bond acceptor sites. However, the electron density in covalently bound halogens is anisotropically distributed. There is a region of higher electron density, accounting for the ability of halogens to function as electron donor sites in attractive interactions, and a region of lower electron density where the electrostatic potential is frequently positive (mainly in the heavier halogens). This latter region is responsible for the ability of halogen atoms to function as the electron-acceptor site (electrophilic site) in attractive interactions formed with a variety of lone pair-possessing atoms, anions, and π-systems. This ability is quite general and is shown by a wide diversity of halogenated compounds (e.g., organohalogen derivatives and dihalogens). According to the definition proposed by the International Union of Pure and Applied Chemistry, any attractive interactions wherein the halogen atom is the electrophile is named halogen bond (XB). In this chapter, it is discussed how the practice and the concept of XB developed and a brief history of the interaction is presented. Papers (either from the primary or secondary literature) which have reported major experimental findings in the field or which have given important theoretical contributions for the development of the concept are recollected in order to trace how a unifying and comprehensive categorization emerged encompassing all interactions wherein halogen atoms function as the electrophilic site.

Novel immunohistochemistry-based signatures to predict metastatic site of triple-negative breast cancers.

PubMed

Klimov, Sergey; Rida, Padmashree Cg; Aleskandarany, Mohammed A; Green, Andrew R; Ellis, Ian O; Janssen, Emiel Am; Rakha, Emad A; Aneja, Ritu

2017-09-05

Although distant metastasis (DM) in breast cancer (BC) is the most lethal form of recurrence and the most common underlying cause of cancer related deaths, the outcome following the development of DM is related to the site of metastasis. Triple negative BC (TNBC) is an aggressive form of BC characterised by early recurrences and high mortality. Athough multiple variables can be used to predict the risk of metastasis, few markers can predict the specific site of metastasis. This study aimed at identifying a biomarker signature to predict particular sites of DM in TNBC. A clinically annotated series of 322 TNBC were immunohistochemically stained with 133 biomarkers relevant to BC, to develop multibiomarker models for predicting metastasis to the bone, liver, lung and brain. Patients who experienced metastasis to each site were compared with those who did not, by gradually filtering the biomarker set via a two-tailed t-test and Cox univariate analyses. Biomarker combinations were finally ranked based on statistical significance, and evaluated in multivariable analyses. Our final models were able to stratify TNBC patients into high risk groups that showed over 5, 6, 7 and 8 times higher risk of developing metastasis to the bone, liver, lung and brain, respectively, than low-risk subgroups. These models for predicting site-specific metastasis retained significance following adjustment for tumour size, patient age and chemotherapy status. Our novel IHC-based biomarkers signatures, when assessed in primary TNBC tumours, enable prediction of specific sites of metastasis, and potentially unravel biomarkers previously unknown in site tropism.

Oncocytic metaplasia in inflammatory fibrous hyperplasia: Histopathological and immunohistochemical analysis.

PubMed

Rangel, Ana Lúcia Carrinho Ayrosa; León, Jorge Esquiche; Jorge, Jacks; Lopes, Márcio Ajudarte; Vargas, Pablo Agustín

2008-03-01

Oncocytic metaplasia (OM) is not a well-known feature in inflammatory fibrous hyperplasia (IFH) lesions, although it may be common, as proposed in our previous study about this lesion. In the present paper, we assessed the histopathological and immunohistochemical features of 18 cases of IFH containing OM areas. All the samples were examined on haematoxylin and eosin stained sections and cytokeratins (AE1/AE3, 34betaE12, CK5, CK7, CK8, CK13, CK14 and CK19), CD15, CD20, CD68, CD45Ro, and LCA primary antibodies were used. The vast majority of IFH occurred in women (n=14) and the most common site of presentation was the buccal vestibule. Oncocytic and salivary duct cells showed uniform immunoreactivity for AE1/AE3, CK7, CK8 and CK19. CD45Ro+ T-lymphocytes were the most common inflammatory cells surrounding the OM areas followed by CD20+ B-lymphocytes. These findings suggest that oncocytic cells present in IFH might develop from salivary duct epithelium, and T-lymphocytes might play an important role in its etiopathogenesis.

[Characteristics of extracranial malignant germ cell tumours in two age groups of children (0-10 and 10-18 years). Multicentre experiences].

PubMed

Drozyńska, Elzbieta; Połczyńska, Katarzyna; Popadiuk, Stefan; Niedzwiecki, Maciej; Wiśniewski, Jakub; Balcerska, Anna; Izycka-Swieszewska, Ewa; Bilska, Katarzyna; Balwierz, Walentyna; Chełmecka, Lilianna; Chybicka, Alicja; Dudeńko, Izabella; Karolczyk, Grazyna; Kowalczyk, Jerzy; Krawczuk-Rybak, Maryna; Kurylak, Andrzej; Leszczyńska, Elzbieta; Matysiak, Michał; Młynarski, Wojciech; Pobudejska, Aneta; Sobol, Grazyna; Sońta-Jakimczyk, Danuta; Szajdak, Katarzyna; Tredowska-Skoczeń, Dorota; Szmyd, Krzysztof; Trelińska, Joanna; Urasiński, Tomasz; Wachowiak, Jacek; Wieczorek, Maria; Wiśniewska-Slusarz, Hanna; Woźniak, Sebastian; Woźniak, Wojciech; Wysocki, Mariusz

2011-01-01

In order to assess if any differences exist in children germ cell tumours depending on age, we compared some features of germ cell tumours in two age groups:younger than 10 and between 11 and 18 years. Data of 146 patients with germ cell tumours treated in 15 Polish paediatric oncology departments between 1995 and 2005 were evaluated. They were divided into two groups: 76 children 0-10 years old (group I) and 70 patients 11-18 years old (group II). Tumour morphology, sex of patients, primary tumour and metastases localization, disease stage, biochemical markers, treatment response, disease relapse and long survival were analyzed. Every patient was treated according to the TGM 95 protocol. In group 1, 67 tumours were assessed histologically. 64%t tumours had homogenous structure with yolk sac tumour in predominance and 36% were mixed. Yolk sac tumour (YST) or teratoma as components of mixed tumours were the most commonly found. In older group 64 tumours were examined, 41% were homogenous, and seminoma/dysgerminoma predominated. In 59% mixed tumours the most common components were YST embryonal carcinoma and teratoma. The most common primary site in group I was the sacrococcygeal region while in group II - the gonads. Disseminated disease was recognized mostly in older children. Among two evaluated serum markers, AFP was increased mostly in younger patients (76% vs 44%), and 3HCG in older group (40% vs 9%). Treatment response was comparable in both groups. Two relapses were observed in each group. Poor outcome was noted in 17/140 analyzed patients: 9 (12%) in group I and 8 (11%) in group II. In 12 of patients with poor outcome the cause of death was progression and in 5 of them - treatment complications. 1. Germ cell tumours in younger and older children differ in histology, primary localization and serum level of biochemical markers. 2. In older patients germ cell tumours are recognized more frequently in advanced clinical stages. 3. Treatment response was comparable in both groups. 4. There is a need to analyze the intensity of chemotherapy to precise the adequate risk groups according to primary treatment response.

Metastatic orbital tumors in southern China during an 18-year period.

PubMed

Yan, Jianhua; Gao, Shaohui

2011-09-01

To determine the primary sites, clinical features, treatment, and outcome of 46 patients with cancer metastatic to the orbits in southern China. Retrospective review of medical records at a tertiary center in southern China between Jan 1, 1991 and Dec 31, 2008. The study included 35 males and 11 females, with an age range of 3-78 years (average 47 years). All of the patients came from southern China. The left orbit was affected more frequently than the right orbit (3:2), and no cases were bilaterally involved. The most common primary cancer that metastasizes to the orbit is nasopharyngeal carcinoma (30.34%), followed by lung cancer (8.70%), liver cancer (6.52%), breast carcinoma (4.35%), renal cell cancer (4.35%), medullary thyroid carcinoma (2.17%), lacrimal gland carcinoma (2.17%), stomach carcinoma (2.17%), mediastinum carcinoma (2.17%), other forms (6.52%), and unknown carcinomas (30.34%). Orbital metastasis was the first sign of systemic cancer in 24 patients (52.17%). The five most common clinical findings at the initial examination were abnormal eye position (65.22%), proptosis (63.04%), increased orbital pressure (54.35%), diplopia (54.35%), and limited ocular motility (52.17%), followed by swollen eyelid (50%), visible mass or swelling (46%), blurred vision (41%), conjunctival hyperemia, and edema (35%), pain (28%), blepharoptosis (20%), papilledema (17%), and vasodilatation of the retina (7%). Primary treatment included surgical excision, radiotherapy, systemic chemotherapy, and observation. Among the patients (78% of 46) with sufficient follow-up time (mean 20.7 months), 30.56% of them died of disseminated metastasis. Twenty-five percent of them were in remission with no active metastases and 27.78% of them were living with active metastases. Overall, the mean survival time was 18 months (range, 5-38 months) after diagnosis of orbital metastasis. The most common primary cancer that metastasizes to the orbit is nasopharyngeal carcinoma (30.34%), followed by lung cancer (8.70%) and liver cancer (6.52%) in southern China. Orbital metastasis can display a variety of clinical features and should be considered in patients with known systemic cancer. The systemic prognosis is generally poor.

Primary cilia proteins: ciliary and extraciliary sites and functions.

PubMed

Hua, Kiet; Ferland, Russell J

2018-05-01

Primary cilia are immotile organelles known for their roles in development and cell signaling. Defects in primary cilia result in a range of disorders named ciliopathies. Because this organelle can be found singularly on almost all cell types, its importance extends to most organ systems. As such, elucidating the importance of the primary cilium has attracted researchers from all biological disciplines. As the primary cilia field expands, caution is warranted in attributing biological defects solely to the function of this organelle, since many of these "ciliary" proteins are found at other sites in cells and likely have non-ciliary functions. Indeed, many, if not all, cilia proteins have locations and functions outside the primary cilium. Extraciliary functions are known to include cell cycle regulation, cytoskeletal regulation, and trafficking. Cilia proteins have been observed in the nucleus, at the Golgi apparatus, and even in immune synapses of T cells (interestingly, a non-ciliated cell). Given the abundance of extraciliary sites and functions, it can be difficult to definitively attribute an observed phenotype solely to defective cilia rather than to some defective extraciliary function or a combination of both. Thus, extraciliary sites and functions of cilia proteins need to be considered, as well as experimentally determined. Through such consideration, we will understand the true role of the primary cilium in disease as compared to other cellular processes' influences in mediating disease (or through a combination of both). Here, we review a compilation of known extraciliary sites and functions of "cilia" proteins as a means to demonstrate the potential non-ciliary roles for these proteins.

COSMIC: A Regimen of Intensity Modulated Radiation Therapy Plus Dose-Escalated, Raster-Scanned Carbon Ion Boost for Malignant Salivary Gland Tumors: Results of the Prospective Phase 2 Trial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jensen, Alexandra D., E-mail: alexdjensen@gmx.de; Nikoghosyan, Anna V.; Lossner, Karen

Purpose: To investigate the effect of intensity modulated radiation therapy (IMRT) and dose-escalated carbon ion (C12) therapy in adenoid cystic carcinoma (ACC) and other malignant salivary gland tumors (MSGTs) of the head and neck. Patients and Methods: COSMIC (combined treatment of malignant salivary gland tumors with intensity modulated radiation therapy and carbon ions) is a prospective phase 2 trial of 24 Gy(RBE) C12 followed by 50 Gy IMRT in patients with pathologically confirmed MSGT. The primary endpoint is mucositis Common Terminology Criteria grade 3; the secondary endpoints are locoregional control (LC), progression-free survival (PFS), overall survival (OS), and toxicity. Toxicity was scoredmore » according to the Common Terminology Criteria for Adverse Events version 3; treatment response was scored according to Response Evaluation Criteria in Solid Tumors 1.1. Results: Between July 2010 and August 2011, 54 patients were accrued, and 53 were available for evaluation. The median follow-up time was 42 months; patients with microscopically incomplete resections (R1, n=20), gross residual disease (R2, n=17), and inoperable disease (n=16) were included. Eighty-nine percent of patients had ACC, and 57% had T4 tumors. The most common primary sites were paranasal sinus (34%), submandibular gland, and palate. At the completion of radiation therapy, 26% of patients experienced grade 3 mucositis, and 20 patients reported adverse events of the ear (38%). The most common observed late effects were grade 1 xerostomia (49%), hearing impairment (25%, 2% ipsilateral hearing loss), and adverse events of the eye (20%), but no visual impairment or loss of vision. Grade 1 central nervous system necrosis occurred in 6%, and 1 grade 4 ICA hemorrhage without neurologic sequelae. The best response was 54% (complete response/partial remission). At 3 years, the LC, PFS, and OS were 81.9%, 57.9%, and 78.4%, respectively. No difference was found regarding resection status. The most common site of failure was distant (55%). Local relapse was predominantly in field (79%). Conclusion: Treatment was tolerated, with moderate acute and late toxicity. The LC at 3 years was promising. No significant difference could be shown regarding resection status; hence, extensive and mutilating surgical procedures should be rediscussed. Further dose escalation may be limited in view of potential vascular adverse events.« less

Epidemiology of burns caused by moxibustion in Korea.

PubMed

Yoon, Cheonjae; Cho, Young Soon; Park, Seungchoon; Chung, Sung Phil; Choi, Young Hwan

2016-11-01

Moxibustion, a traditional Chinese treatment that uses dried Artemisia argyi, is a common cause of burns treated in Korean hospitals. We aimed to examine the characteristics of moxibustion-induced burns. This retrospective study examined the records of 59 patients who were treated for moxibustion-induced burns (April 2014-October 2015). All patients completed a questionnaire regarding their general characteristics and moxibustion use. The patients included 16 men and 43 women (average age: 49.1 years, 68 burn sites). Superficial second-degree burns were present at 21 sites, deep second- or third-degree burns at 44 sites, and unknown burns at 3 sites. The most common sites were the lower extremities, abdomen, and upper extremities. The most common practitioners were the patients (27/59, 45.7%) and Oriental medicine practitioners (23/59, 38.9%). The most common locations were the patient's home, Oriental medicine clinic, and moxibustion clinic. The most common reason for moxibustion was pain. Only the burn site was significantly associated with burn depth, and non-abdominal sites were 9.37-fold more likely to involve deep burns (vs. abdominal sites). Korean patients routinely undergo moxibustion, and care must be taken when using moxibustion at non-abdominal sites, due to the risk of deep burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

The effect of multiple primary rules on population-based cancer survival

PubMed Central

Weir, Hannah K.; Johnson, Christopher J.; Thompson, Trevor D.

2015-01-01

Purpose Different rules for registering multiple primary (MP) cancers are used by cancer registries throughout the world, making international data comparisons difficult. This study evaluates the effect of Surveillance, Epidemiology, and End Results (SEER) and International Association of Cancer Registries (IACR) MP rules on population-based cancer survival estimates. Methods Data from five US states and six metropolitan area cancer registries participating in the SEER Program were used to estimate age-standardized relative survival (RS%) for first cancers-only and all first cancers matching the selection criteria according to SEER and IACR MP rules for all cancer sites combined and for the top 25 cancer site groups among men and women. Results During 1995–2008, the percentage of MP cancers (all sites, both sexes) increased 25.4 % by using SEER rules (from 14.6 to 18.4 %) and 20.1 % by using IACR rules (from 13.2 to 15.8 %). More MP cancers were registered among females than among males, and SEER rules registered more MP cancers than IACR rules (15.8 vs. 14.4 % among males; 17.2 vs. 14.5 % among females). The top 3 cancer sites with the largest differences were melanoma (5.8 %), urinary bladder (3.5 %), and kidney and renal pelvis (2.9 %) among males, and breast (5.9 %), melanoma (3.9 %), and urinary bladder (3.4 %) among females. Five-year survival estimates (all sites combined) restricted to first primary cancers-only were higher than estimates by using first site-specific primaries (SEER or IACR rules), and for 11 of 21 sites among males and 11 of 23 sites among females. SEER estimates are comparable to IACR estimates for all site-specific cancers and marginally higher for all sites combined among females (RS 62.28 vs. 61.96 %). Conclusion Survival after diagnosis has improved for many leading cancers. However, cancer patients remain at risk of subsequent cancers. Survival estimates based on first cancers-only exclude a large and increasing number of MP cancers. To produce clinically and epidemiologically relevant and less biased cancer survival estimates, data on all cancers should be included in the analysis. The multiple primary rules (SEER or IACR) used to identify primary cancers do not affect survival estimates if all first cancers matching the selection criteria are used to produce site-specific survival estimates. PMID:23558444

Primary care nursing activities with patients affected by physical chronic disease and common mental disorders: a qualitative descriptive study.

PubMed

Girard, Ariane; Hudon, Catherine; Poitras, Marie-Eve; Roberge, Pasquale; Chouinard, Maud-Christine

2017-05-01

To describe nursing activities in primary care with patients affected by physical chronic disease and common mental disorders. Patients in primary care who are affected by physical chronic disease and common mental disorders such as anxiety and depression require care and follow-up based on their physical and mental health condition. Primary care nurses are increasingly expected to contribute to the care and follow-up of this growing clientele. However, little is known about the actual activities carried out by primary care nurses in providing this service in the Province of Quebec (Canada). A qualitative descriptive study was conducted. Data were obtained through semistructured individual interviews with 13 nurses practising among patients with physical chronic disease in seven Family Medicine Groups in Quebec (Canada). Participants described five activity domains: assessment of physical and mental health condition, care planning, interprofessional collaboration, therapeutic relationship and health promotion. The full potential of primary care nurses is not always exploited, and some activities could be improved. Evidence for including nurses in collaborative care for patients affected by physical chronic disease and common mental disorders has been shown but is not fully implemented in Family Medicine Groups. Future research should emphasise collaboration among mental health professionals, primary care nurses and family physicians in the care of patients with physical chronic disease and common mental disorders. Primary care nurses would benefit from gaining more knowledge about common mental disorders and from identifying the resources they need to contribute to managing them in an interdisciplinary team. © 2016 John Wiley & Sons Ltd.

Comparing Homeless Persons’ Care Experiences in Tailored Versus Nontailored Primary Care Programs

PubMed Central

Holt, Cheryl L.; Steward, Jocelyn L.; Jones, Richard N.; Roth, David L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa W.; Austin, Erika L.; Henry, Stephen Randal; Kay Johnson, N.; Shanette Granstaff, U.; O’Connell, James J.; Golden, Joya F.; Young, Alexander S.; Davis, Lori L.; Pollio, David E.

2013-01-01

Objectives. We compared homeless patients’ experiences of care in health care organizations that differed in their degree of primary care design service tailoring. Methods. We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the “Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. Results. Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P < .001). Adjusting for patient characteristics, these differences remained significant for subscales assessing the patient–clinician relationship (P < .001) and perceptions of cooperation among providers (P = .004). There were 1.5- to 3-fold increased odds of an unfavorable experience in the domains of the patient–clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results. Conclusions. Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness. PMID:24148052

Influence of dietary carbon on mercury bioaccumulation in streams of the Adirondack Mountains of New York and the Coastal Plain of South Carolina, USA

USGS Publications Warehouse

Riva-Murray, Karen; Bradley, Paul M.; Chasar, Lia C.; Button, Daniel T.; Brigham, Mark E.; Eikenberry, Barbara C. Scudder; Journey, Celeste A.; Lutz, Michelle A.

2013-01-01

We studied lower food webs in streams of two mercury-sensitive regions to determine whether variations in consumer foraging strategy and resultant dietary carbon signatures accounted for observed within-site and among-site variations in consumer mercury concentration. We collected macroinvertebrates (primary consumers and predators) and selected forage fishes from three sites in the Adirondack Mountains of New York, and three sites in the Coastal Plain of South Carolina, for analysis of mercury (Hg) and stable isotopes of carbon (δ13C) and nitrogen (δ15N). Among primary consumers, scrapers and filterers had higher MeHg and more depleted δ13C than shredders from the same site. Variation in δ13C accounted for up to 34 % of within-site variation in MeHg among primary consumers, beyond that explained by δ15N, an indicator of trophic position. Consumer δ13C accounted for 10 % of the variation in Hg among predatory macroinvertebrates and forage fishes across these six sites, after accounting for environmental aqueous methylmercury (MeHg, 5 % of variation) and base-N adjusted consumer trophic position (Δδ15N, 22 % of variation). The δ13C spatial pattern within consumer taxa groups corresponded to differences in benthic habitat shading among sites. Consumers from relatively more-shaded sites had more enriched δ13C that was more similar to typical detrital δ13C, while those from the relatively more-open sites had more depleted δ13C. Although we could not clearly attribute these differences strictly to differences in assimilation of carbon from terrestrial or in-channel sources, greater potential for benthic primary production at more open sites might play a role. We found significant variation among consumers within and among sites in carbon source; this may be related to within-site differences in diet and foraging habitat, and to among-site differences in environmental conditions that influence primary production. These observations suggest that different foraging strategies and habitats influence MeHg bioaccumulation in streams, even at relatively small spatial scales. Such influence must be considered when selecting lower trophic level consumers as sentinels of MeHg bioaccumulation for comparison within and among sites.

Cervical lymph node metastases of squamous cell carcinoma from an unknown primary: outcomes and patterns of failure.

PubMed

Mistry, R C; Qureshi, S S; Talole, S D; Deshmukh, S

2008-01-01

Management of cervical lymph nodes metastases of squamous cell carcinoma (SCC) from primary of unknown origin (PUO) is contentious and there is insignificant data from India on this subject. To present experience of management of these patients treated with curative intent at a single institution. Retrospective study of patients treated between 1989-1994 in a tertiary referral cancer centre. Eighty-nine patients were evaluated in the study period and their survival compared with patients with common sites of primary in the head and neck with comparable node stage. Kaplan-Meier method. The clinical stage of the neck nodes at presentation was N1 in 11%, N2a in 28.5%, N2b in 22.5%, N3 in 35% and Nx in 3.4% patients. All patients underwent surgery and 70 patients received more than 40Gy postoperative radiotherapy. Twenty-nine (32.6%) patients had relapse of which 19 (21%) were in the neck. Postoperative radiotherapy did not influence the neck relapse (p=0.72). Primary was detected in 13 patients (14.6%) on subsequent follow up. The overall five and eight-years survival was 55% and 51% respectively. The overall five-year survival was better compared to patients with known primary with comparable node stage. Patients with cervical lymph nodes metastases of SCC from PUO have reasonable survival and low rate of development of subsequent primary when treated with surgery and radiotherapy. The overall survival is comparable to that of patients with known primary and hence an attempt at cure should always be made.

Aberrant DNA methylation at genes associated with a stem cell-like phenotype in cholangiocarcinoma tumours

PubMed Central

Dai, Wei; Siddiq, Afshan; Walley, Andrew J; Limpaiboon, Temduang; Brown, Robert

2013-01-01

Genetic abnormalities of cholangiocarcinoma have been widely studied; however, epigenomic changes related to cholangiocarcinogenesis have been less well characterised. We have profiled the DNA methylomes of 28 primary cholangiocarcinoma and six matched adjacent normal tissues using Infinium’s HumanMethylation27 BeadChips with the aim of identifying gene sets aberrantly epigenetically regulated in this tumour type. Using a linear model for microarray data we identified 1610 differentially methylated autosomal CpG sites with 809 CpG sites (representing 603 genes) being hypermethylated and 801 CpG sites (representing 712 genes) being hypomethylated in cholangiocarcinoma versus adjacent normal tissues (false discovery rate ≤ 0.05). Gene ontology and gene set enrichment analyses identified gene sets significantly associated with hypermethylation at linked CpG sites in cholangiocarcinoma including homeobox genes and target genes of PRC2, EED, SUZ12 and histone H3 trimethylation at lysine 27. We confirmed frequent hypermethylation at the homeobox genes HOXA9 and HOXD9 by bisulfite pyrosequencing in a larger cohort of cholangiocarcinoma (n = 102). Our findings indicate a key role for hypermethylation of multiple CpG sites at genes associated with a stem cell-like phenotype as a common molecular aberration in cholangiocarcinoma. These data have implications for cholangiocarcinogenesis, as well as possible novel treatment options using histone methyltransferase inhibitors. PMID:24089088

A systemic identification approach for primary transcription start site of Arabidopsis miRNAs from multidimensional omics data.

PubMed

You, Qi; Yan, Hengyu; Liu, Yue; Yi, Xin; Zhang, Kang; Xu, Wenying; Su, Zhen

2017-05-01

The 22-nucleotide non-coding microRNAs (miRNAs) are mostly transcribed by RNA polymerase II and are similar to protein-coding genes. Unlike the clear process from stem-loop precursors to mature miRNAs, the primary transcriptional regulation of miRNA, especially in plants, still needs to be further clarified, including the original transcription start site, functional cis-elements and primary transcript structures. Due to several well-characterized transcription signals in the promoter region, we proposed a systemic approach integrating multidimensional "omics" (including genomics, transcriptomics, and epigenomics) data to improve the genome-wide identification of primary miRNA transcripts. Here, we used the model plant Arabidopsis thaliana to improve the ability to identify candidate promoter locations in intergenic miRNAs and to determine rules for identifying primary transcription start sites of miRNAs by integrating high-throughput omics data, such as the DNase I hypersensitive sites, chromatin immunoprecipitation-sequencing of polymerase II and H3K4me3, as well as high throughput transcriptomic data. As a result, 93% of refined primary transcripts could be confirmed by the primer pairs from a previous study. Cis-element and secondary structure analyses also supported the feasibility of our results. This work will contribute to the primary transcriptional regulatory analysis of miRNAs, and the conserved regulatory pattern may be a suitable miRNA characteristic in other plant species.

Surface structural ion adsorption modeling of competitive binding of oxyanions by metal (hydr)oxides

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hiemstra, T.; Riemsdijk, W.H. van

1999-02-01

An important challenge in surface complexation models (SCM) is to connect the molecular microscopic reality to macroscopic adsorption phenomena. This study elucidates the primary factor controlling the adsorption process by analyzing the adsorption and competition of PO{sub 4}, AsO{sub 4}, and SeO{sub 3}. The authors show that the structure of the surface-complex acting in the dominant electrostatic field can be ascertained as the primary controlling adsorption factor. The surface species of arsenate are identical with those of phosphate and the adsorption behavior is very similar. On the basis of the selenite adsorption, The authors show that the commonly used 1pKmore » models are incapable to incorporate in the adsorption modeling the correct bidentate binding mechanism found by spectroscopy. The use of the bidentate mechanism leads to a proton-oxyanion ratio and corresponding pH dependence that are too large. The inappropriate intrinsic charge attribution to the primary surface groups and the condensation of the inner sphere surface complex to a point charge are responsible for this behavior of commonly used 2pK models. Both key factors are differently defined in the charge distributed multi-site complexation (CD-MUSIC) model and are based in this model on a surface structural approach. The CD-MUSIC model can successfully describe the macroscopic adsorption phenomena using the surface speciation and binding mechanisms as found by spectroscopy. The model is also able to predict the anion competition well. The charge distribution in the interface is in agreement with the observed structure of surface complexes.« less

Climatological Processing and Product Development for the TRMM Ground Validation Program

NASA Technical Reports Server (NTRS)

Marks, D. A.; Kulie, M. S.; Robinson, M.; Silberstein, D. S.; Wolff, D. B.; Ferrier, B. S.; Amitai, E.; Fisher, B.; Wang, J.; Augustine, D.;

Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factors.

PubMed

Woo, P Ym; Wong, H T; Pu, J Ks; Wong, W K; Wong, L Yw; Lee, M Wy; Yam, K Y; Lui, W M; Poon, W S

2016-10-01

To determine the frequency of primary ventriculoperitoneal shunt infection among patients treated at neurosurgical centres of the Hospital Authority and to identify underlying risk factors. This multicentre historical cohort study included consecutive patients who underwent primary ventriculoperitoneal shunting at a Hospital Authority neurosurgery centre from 1 January 2009 to 31 December 2011. The primary endpoint was shunt infection, defined as: (1) the presence of cerebrospinal fluid or shunt hardware culture that yielded the pathogenic micro-organism with associated compatible symptoms and signs of central nervous system infection or shunt malfunction; or (2) surgical incision site infection requiring shunt reinsertion (even in the absence of positive culture); or (3) intraperitoneal pseudocyst formation (even in the absence of positive culture). Secondary endpoints were shunt malfunction, defined as unsatisfactory cerebrospinal fluid drainage that required shunt reinsertion, and 30-day mortality. A primary ventriculoperitoneal shunt was inserted in 538 patients during the study period. The mean age of patients was 48 years (range, 13-88 years) with a male-to-female ratio of 1:1. Aneurysmal subarachnoid haemorrhage was the most common aetiology (n=169, 31%) followed by intracranial tumour (n=164, 30%), central nervous system infection (n=42, 8%), and traumatic brain injury (n=27, 5%). The mean operating time was 75 (standard deviation, 29) minutes. Shunt reinsertion and infection rates were 16% (n=87) and 7% (n=36), respectively. The most common cause for shunt reinsertion was malfunction followed by shunt infection. Independent predictors for shunt infection were: traumatic brain injury (adjusted odds ratio=6.2; 95% confidence interval, 2.3-16.8), emergency shunting (2.3; 1.0-5.1), and prophylactic vancomycin as the sole antibiotic (3.4; 1.1-11.0). The 30-day all-cause mortality was 6% and none were directly procedure-related. This is the first Hong Kong territory-wide review of infection in primary ventriculoperitoneal shunts. Although the ventriculoperitoneal shunt infection rate met international standards, there are areas of improvement such as vancomycin administration and the avoidance of scheduling the procedure as an emergency.

Age dependency of primary tumor sites and metastases in patients with Ewing sarcoma.

PubMed

Worch, Jennifer; Ranft, Andreas; DuBois, Steven G; Paulussen, Michael; Juergens, Heribert; Dirksen, Uta

2018-06-01

The median age of patients with Ewing sarcoma (EwS) at diagnosis is around 14-15 years. Older age is associated with a worse outcome. The correlation of age at diagnosis on sites of disease has not been fully described. The goal of this study was to evaluate the differences in sites of primary tumor and metastatic tumor involvement according to age groups. EwS data from the Gesellschaft für Pädiatrische Onkologie und Hämatology (GPOH) database of the Cooperative Ewing Sarcoma Study (CESS) 81/86 and the European Intergroup Cooperative Ewing's Sarcoma Study EICESS 92 and the EUROpean Ewing tumor Working Initiative of National Groups-99-Protocol (EURO-E.W.I.N.G.-99) study were analyzed. Patient and tumor characteristics were evaluated statistically using chi square tests. The study population included 2,635 patients with bone EwS. Sites of primary and metastatic tumors differed according to the age groups of young children (0-9 years), early adolescence (10-14 years), late adolescence (15-19 years), young adults (20-24 years), and adults (more than 24 years). Young children demonstrated the most striking differences in site of disease with a lower proportion of pelvic primary and axial tumors. They presented less often with metastatic disease at diagnosis. Site of primary and metastatic tumor involvement in EwS differs according to patient age. The biological and developmental etiology for these differences requires further investigations. © 2018 Wiley Periodicals, Inc.

Comparison of HER-2 overexpression in primary breast cancer and metastatic sites and its effect on biological targeting therapy of metastatic disease

PubMed Central

Zidan, J; Dashkovsky, I; Stayerman, C; Basher, W; Cozacov, C; Hadary, A

2005-01-01

HER-2 overexpression, a predictive marker of tumour aggressiveness and responsiveness to therapy, occurs in 20–30% of breast cancer. Although breast cancer is a heterogeneous disease, HER-2 measurement is carried out in primary tumour. This study aims to evaluate HER-2 overexpression in primary and metastases and its effect on treatment decisions. Biopsies from primary breast cancer and corresponding metastases from 58 patients were studied. HER-2 overexpression was evaluated immunohistochemically in all primary and metastatic sites. Positive overexpression in primary and/or metastases was confirmed by fluorescence in situ hybridisation (FISH). Discordance in HER-2 overexpression between primary and metastatic sites was 14% (eight of 58 patients). Concordance was found in 50 (86%) of patients (95% CI: 77–95). In one patient (2%), HER-2 was negative in metastasis but positive in primary. In seven (12%) patients, HER-2 was positive in metastases and negative in primary (95% CI: 3.7–20), and three of them responded to trastuzumab. Gene amplification by FISH was found in all cases with HER-2 positive (+2 and +3) by immunohistochemistry. Our data suggest that a possible discordance of HER-2 overexpression between primary and metastases should be considered when making treatment decisions in patients with primary HER-2-negative tumours. PMID:16106267

Large mass affecting retroperitoneal great vessels: a rare presentation of a cancer of unknown primary with diagnostic dilemma and challenged surgical intervention.

PubMed

Stakia, Paraskevi; Lagos, Panagiotis; Gourgiotis, Stavros; Tzilalis, Vasilios D; Aloizos, Stavros; Salemis, Nikolaos S

2009-01-01

Cancers of unknown primary site (CUPs) consist of a clinical entity which accounts for 3-5% of all solid tumor patients. They are metastatic solid tumors whose fundamental characteristic is the absence of identifiable site of the primary tumor. We report the case of a completely asymptomatic 34-year-old man with a palpated huge mass found incidentally in the left abdomen. All the investigations were normal. During the operation, a large mass was identified 2 cm below the left renal artery which was displacing and encompassing the great retroperitoneal vessels and the left ureter. A complete resection of the mass was performed while the histological examination revealed a solitary retroperitoneal lymph node categorized as metastatic adenocarcinoma of unknown primary site. It is essential to assess the high incidence of patients with cancer who present with CUP. Early surgical excision of the metastatic lesion followed by adjuvant combination chemotherapy should be considered for patients with only a single site of malignancy.

Radioimmunoguided surgery using iodine 125 B72. 3 in patients with colorectal cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cohen, A.M.; Martin, E.W. Jr.; Lavery, I.

1991-03-01

Preliminary data using B72.3 murine monoclonal antibody labeled with iodine 125 suggested that both clinically apparent as well as occult sites of colorectal cancer could be identified intraoperatively using a hand-held gamma detecting probe. We report the preliminary data of a multicenter trial of this approach in patients with primary or recurrent colorectal cancer. One hundred four patients with primary, suspected, or known recurrent colorectal cancer received an intravenous infusion of 1 mg of B72.3 monoclonal antibody radiolabeled with 7.4 x 10 Bq of iodine 125. Twenty-six patients with primary colorectal cancer and 72 patients with recurrent colorectal cancer weremore » examined. Using the gamma detecting probe, 78% of the patients had localization of the antibody in their tumor; this included 75% of primary tumor sites and 63% of all recurrent tumor sites; 9.2% of all tumor sites identified represented occult sites detected only with the gamma detecting probe. The overall sensitivity was 77% and a predictive value of a positive detection was 78%. A total of 30 occult sites in 26 patients were identified. In patients with recurrent cancer, the antibody study provided unique data that precluded resection in 10 patients, and in another eight patients it extended the potentially curative procedure.« less

Relapsed cervicomediastinal lymph node carcinoma with an unknown primary site treated with TS-1 alone: a case report.

PubMed

Yajima, Toshiki; Onozato, Ryoichi; Shitara, Yoshinori; Mogi, Akira; Tanaka, Shigebumi; Kuwano, Hiroyuki

2013-12-27

Cervicomediastinal lymph node carcinoma with an unknown primary site is quite rare, and useful treatment of these diseases has not been established. We report here the case of a patient successfully treated with TS-1 alone after the relapse of cervicomediastinal lymph node carcinoma with an unknown primary site. A 62-year-old man was referred to our hospital because of cervicomediastinal lymph node swelling and high serum levels of carbohydrate antigen 19-9 and carcinoembryonic antigen. Fluorodeoxyglucose-positron emission tomography/computed tomography revealed an accumulation of fluorodeoxyglucose in the left supraclavicular lymph nodes, mediastinal lymph nodes, and the pelvic cavity. Colonoscopy revealed rectal cancer, which was diagnosed by biopsy as a tubular adenocarcinoma. Because metastases from rectal cancer to the cervicomediastinal lymph nodes are rare, the patient underwent thoracoscopic mediastinal lymphadenectomy. A biopsy specimen from the paraaortic lymph nodes demonstrated papillary adenocarcinoma that was pathologically different from the rectal cancer; therefore, a diagnosis of mediastinal carcinoma with an unknown primary site was established. The patient underwent low anterior resection of the rectum for the rectal cancer, and no abdominal lymph node metastasis (pMP, N0/stage I) was found. Although radiotherapy was performed for the cervicomediastinal lymph nodes, the mediastinal carcinoma relapsed after 6 months. Because the patient desired oral chemotherapy on an outpatient basis, TS-1 was administered at a dosage of 80 mg/day for 2 weeks, followed by a 1-week rest. TS-1 treatment resulted in a decrease in the size of the cervicomediastinal lymph nodes, and the serum tumor marker levels decreased to normal after the fourth course. The patient continued TS-1 treatment without adverse events and is currently alive without recurrence or identification of the primary site at the 32nd month after TS-1 treatment. This is the first reported case of relapsed cervicomediastinal lymph node carcinoma with an unknown primary site treated by TS-1 alone. TS-1 treatment for the carcinoma with an unknown primary site may be useful in patients who are not candidates for systemic platinum-based chemotherapy.

Gastroenteropancreatic Neuroendocrine Tumors with Liver Metastases in Korea: A Clinicopathological Analysis of 72 Cases in a Single Institute

PubMed Central

Shin, Yooju; Ha, Sang Yun; Hyeon, Jiyeon; Lee, Boram; Lee, Jeeyun; Jang, Kee-Taek; Kim, Kyoung-Mee; Park, Young Suk; Park, Cheol-Keun

2015-01-01

Purpose Management of gastroenteropancreatic (GEP) neuroendocrine tumors with liver metastases (NETLM) presents many clinical challenges. Assessment of the extent of disease and primary tumor site is crucial for management. In this study, we investigated the primary tumor sites and prognostic factors in GEP NETLM among Korean patients. Materials and Methods We reviewed the medical records of 72 Korean patients diagnosed with GEP NETLM between January 1999 and May 2013, focusing on their clinical and pathologic characteristics. Results The most frequently encountered primary tumor sites were the pancreas (n=25, 35%), stomach (n=8, 11%), gall bladder (n=4, 6%) and rectum (n=3, 4%). Twenty-five patients (35%) had occult primary tumor. Twelve patients (17%) had histological grade G1 tumors, 30 patients (42%) had G2 tumors, and 30 patients (42%) had G3 tumors. The mean follow-up period after histological confirmation of hepatic metastases was 11.30±2.44 months for G3 tumors, 19.67±4.09 months for G2 tumors, and 30.67±6.51 months for G1 tumors. Multivariate analyses revealed that an unknown primary tumor site (p=0.001) and higher histological grade (p < 0.001) were independent prognostic indicators for shorter overall survival (OS). Most long-term survivors (OS > 24 months) had received antitumor treatment. Conclusion The primary tumor site most frequently associated with GEP NETLM was the pancreas. Unknown primary tumor and higher histological grade were independent prognostic indicators for shorter OS. Patients identified as being at a risk of shorter OS should be followed up closely. PMID:25687852

Microscopic character of marine sediment containing disseminated gas hydrate. Examples from the Blake Ridge and the Middle America Trench

USGS Publications Warehouse

Lorenson, T.D.

2000-01-01

The presence of disseminated gas hydrate was inferred based on pore fluid geochemistry and downhole logging data, but was rarely observed at Ocean Drilling Program (ODP) Leg 164 (Blake Ridge), and Leg 170 (Middle America Trench, offshore from Costa Rica) drilling sites. Gas hydrate nucleation is likely to occur first in larger voids rather than in constricted pore space, where capillary forces depress the temperature-pressure stability field for gas hydrate formation. Traditional macroscopic descriptions of sediment fail to detect the microscopic character of primary and secondary porosity in sediment hosting disseminated gas hydrate. Light transmission and scanning electron microscopy of sediments within and below the depth of gas hydrate occurrences reveal at least four general types of primary and secondary porosity: (1) microfossils (diatoms, foraminifera, and spicules) void of infilling sediment, but commonly containing small masses of pyrite framboids; (2) infauna burrows filled with unconsolidated sand and or microfossil debris; (3) irregularly shaped pods of nonconsolidated framboidial pyrite; and (4) nonlithified volcanic ash.

Observation of a unique case of metastatic basal cell carcinoma found by radiographic evaluation in a patient with oculocutaneous albinism

PubMed Central

Johnston, Mickaila

2014-01-01

Background: Basal cell carcinoma is one of the more common cancers worldwide; 2.8 million are diagnosed annually in the USA.  However, the rate at which it metastasizes is considered very low, between 0.0028 and 0.5%.  For those rare cases in which metastases occur, approximately one third metastasize to the lung.  Case: Presented is a 62-year-old Caucasian male with oculocutaneous albinism and a history of basal cell carcinomas occurring in multiple anatomic sites, most recently at the bilateral forearm and back.  Surveillance PET/CT imaging led to the discovery of no less than 30 lung nodules which were consistent with basal cell carcinoma on biopsy.  Histological features were remarkably similar in both the primary tumor and in the metastases. Conclusion:  An unusual case of a non-head and neck primary basal cell carcinoma metastatic to the lung was discovered on surveillance PET/CT imaging, in a patient with oculocutaneous albinism. PMID:24555117

Examining the interaction between food outlets and outdoor food advertisements with primary school food environments.

PubMed

Walton, Mat; Pearce, Jamie; Day, Peter

2009-09-01

Schools are commonly seen as a site of intervention to improve children's nutrition, and prevent excess weight gain. Schools may have limited influence over children's diets; however, with home and community environments also exerting an influence within schools. This study considered the environment of food outlets and outdoor food advertisements surrounding four case study primary schools in New Zealand, and the impact of that external environment on within-school food environments. The shortest travel route between school and home addresses, and the number of food outlets and advertisements passed on that route, was calculated for each student. Interviews with school management were conducted. The schools with a higher percentage of students passing food outlets and advertisements considered that their presence impacted on efforts within schools to improve the food environment. Limiting students' exposure to food outlets and outdoor food adverts through travel route planning, reducing advertising, or limiting the location of food outlets surrounding schools could be explored as intervention options to support schools in promoting nutrition.

Independent but coordinated trials: insights from the practice-based Opportunities for Weight Reduction Trials Collaborative Research Group.

PubMed

Yeh, Hsin-Chieh; Clark, Jeanne M; Emmons, Karen E; Moore, Reneé H; Bennett, Gary G; Warner, Erica T; Sarwer, David B; Jerome, Gerald J; Miller, Edgar R; Volger, Sheri; Louis, Thomas A; Wells, Barbara; Wadden, Thomas A; Colditz, Graham A; Appel, Lawrence J

2010-08-01

The National Heart, Lung, and Blood Institute (NHLBI) funded three institutions to conduct effectiveness trials of weight loss interventions in primary care settings. Unlike traditional multi-center clinical trials, each study was established as an independent trial with a distinct protocol. Still, efforts were made to coordinate and standardize several aspects of the trials. The three trials formed a collaborative group, the 'Practice-based Opportunities for Weight Reduction (POWER) Trials Collaborative Research Group.' We describe the common and distinct features of the three trials, the key characteristics of the collaborative group, and the lessons learned from this novel organizational approach. The Collaborative Research Group consists of three individual studies: 'Be Fit, Be Well' (Washington University in St. Louis/Harvard University), 'POWER Hopkins' (Johns Hopkins), and 'POWER-UP' (University of Pennsylvania). There are a total of 15 participating clinics with ~1100 participants. The common primary outcome is change in weight at 24 months of follow-up, but each protocol has trial-specific elements including different interventions and different secondary outcomes. A Resource Coordinating Unit at Johns Hopkins provides administrative support. The Collaborative Research Group established common components to facilitate potential cross-site comparisons. The main advantage of this approach is to develop and evaluate several interventions, when there is insufficient evidence to test one or two approaches, as would be done in a traditional multi-center trial. The challenges of the organizational design include the complex decision-making process, the extent of potential data pooling, time intensive efforts to standardize reports, and the additional responsibilities of the DSMB to monitor three distinct protocols.

Centralized Data Management in a Multicountry, Multisite Population-based Study.

PubMed

Rahman, Qazi Sadeq-ur; Islam, Mohammad Shahidul; Hossain, Belal; Hossain, Tanvir; Connor, Nicholas E; Jaman, Md Jahiduj; Rahman, Md Mahmudur; Ahmed, A S M Nawshad Uddin; Ahmed, Imran; Ali, Murtaza; Moin, Syed Mamun Ibne; Mullany, Luke; Saha, Samir K; El Arifeen, Shams

2016-05-01

A centralized data management system was developed for data collection and processing for the Aetiology of Neonatal Infection in South Asia (ANISA) study. ANISA is a longitudinal cohort study involving neonatal infection surveillance and etiology detection in multiple sites in South Asia. The primary goal of designing such a system was to collect and store data from different sites in a standardized way to pool the data for analysis. We designed the data management system centrally and implemented it to enable data entry at individual sites. This system uses validation rules and audit that reduce errors. The study sites employ a dual data entry method to minimize keystroke errors. They upload collected data weekly to a central server via internet to create a pooled central database. Any inconsistent data identified in the central database are flagged and corrected after discussion with the relevant site. The ANISA Data Coordination Centre in Dhaka provides technical support for operations, maintenance and updating the data management system centrally. Password-protected login identifications and audit trails are maintained for the management system to ensure the integrity and safety of stored data. Centralized management of the ANISA database helps to use common data capture forms (DCFs), adapted to site-specific contextual requirements. DCFs and data entry interfaces allow on-site data entry. This reduces the workload as DCFs do not need to be shipped to a single location for entry. It also improves data quality as all collected data from ANISA goes through the same quality check and cleaning process.

Computational identification of developmental enhancers:conservation and function of transcription factor binding-site clustersin drosophila melanogaster and drosophila psedoobscura

DOE Office of Scientific and Technical Information (OSTI.GOV)

Berman, Benjamin P.; Pfeiffer, Barret D.; Laverty, Todd R.

2004-08-06

The identification of sequences that control transcription in metazoans is a major goal of genome analysis. In a previous study, we demonstrated that searching for clusters of predicted transcription factor binding sites could discover active regulatory sequences, and identified 37 regions of the Drosophila melanogaster genome with high densities of predicted binding sites for five transcription factors involved in anterior-posterior embryonic patterning. Nine of these clusters overlapped known enhancers. Here, we report the results of in vivo functional analysis of 27 remaining clusters. We generated transgenic flies carrying each cluster attached to a basal promoter and reporter gene, and assayedmore » embryos for reporter gene expression. Six clusters are enhancers of adjacent genes: giant, fushi tarazu, odd-skipped, nubbin, squeeze and pdm2; three drive expression in patterns unrelated to those of neighboring genes; the remaining 18 do not appear to have enhancer activity. We used the Drosophila pseudoobscura genome to compare patterns of evolution in and around the 15 positive and 18 false-positive predictions. Although conservation of primary sequence cannot distinguish true from false positives, conservation of binding-site clustering accurately discriminates functional binding-site clusters from those with no function. We incorporated conservation of binding-site clustering into a new genome-wide enhancer screen, and predict several hundred new regulatory sequences, including 85 adjacent to genes with embryonic patterns. Measuring conservation of sequence features closely linked to function--such as binding-site clustering--makes better use of comparative sequence data than commonly used methods that examine only sequence identity.« less

Regulation of the Carnitine Pathway in Escherichia coli: Investigation of the cai-fix Divergent Promoter Region

PubMed Central

Buchet, Anne; Eichler, Knut; Mandrand-Berthelot, Marie-Andrée

1998-01-01

The divergent structural operons caiTABCDE and fixABCX of Escherichia coli are required for anaerobic carnitine metabolism. Transcriptional monocopy lacZ fusion studies showed that both operons are coexpressed during anaerobic growth in the presence of carnitine, respond to common environmental stimuli (like glucose and nitrate), and are modulated positively by the same general regulators, CRP and FNR, and negatively by H-NS. Overproduction of the CaiF specific regulatory protein mediating the carnitine signal restored induction in an fnr mutant, corresponding to its role as the primary target for anaerobiosis. Transcript analysis identified two divergent transcription start points initiating 289 bp apart. DNase I footprinting revealed three sites with various affinities for the binding of the cAMP-CRP complex inside this regulatory region. Site-directed mutagenesis experiments indicated that previously reported perfect CRP motif 1, centered at −41.5 of the cai transcriptional start site, plays a direct role in the sole cai activation. In contrast, mutation in CRP site 2, positioned at −69.5 of the fix promoter, caused only a threefold reduction in fix expression. Thus, the role of the third CRP site, located at −126.5 of fix, might be to reinforce the action of site 2. A critical 50-bp cis-acting sequence overlapping the fix mRNA start site was found, by deletion analysis, to be necessary for cai transcription. This region is thought to be involved in transduction of the signal mediated by the CaiF regulator. PMID:9573142

Juvenile xanthogranuloma: an unusual cause of intratesticular mass in childhood.

PubMed

Weiss, Vivian L; Brock, John W; Cajaiba, Mariana M

2014-05-01

Juvenile xanthogranuloma (JXG) is a common histiocytic disorder of infancy and early childhood, most frequently presenting with cutaneous lesions. Whereas involvement of several visceral sites is well documented, only 4 cases of primary testicular JXG have been reported. Although this benign disorder typically presents with a favorable clinical outcome, the unusual presentation as an intratesticular lesion can lead to diagnostic challenges. In this study, we present the case of a 6-month-old male child with an incidentally discovered testicular mass that was diagnosed as a JXG and briefly review the existing literature in an attempt to bring awareness to this uncommon presentation. Copyright © 2014 Elsevier Inc. All rights reserved.

Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction.

PubMed

Todor, Adrian; Caterev, Sergiu; Nistor, Dan Viorel; Khallouki, Youssef

2016-06-01

The most commonly used autografts for anterior cruciate ligament reconstruction are the bone-patellar tendon-bone and hamstring tendons. Each has its advantages and limitations. The bone-patellar tendon-bone autograft can lead to more donor-site morbidity, and the hamstring autograft can be unpredictable in size. The quadriceps tendon, with or without a bone block, has been described as an alternative graft source and has been used especially in revision cases, but in recent years, it has attracted attention even for primary cases. We report a technique for harvesting a free bone quadriceps tendon graft and attaching an extracortical button for femoral fixation for anterior cruciate ligament reconstruction.

Presentation of renal cell carcinoma as cervical polyp metastasis.

PubMed

Godfrey, Gwendolyn J; Moore, Grace; Alatassi, Houda

2010-10-01

Secondary cervical adenocarcinomas are most commonly seen owing to the extension of a primary endometrial adenocarcinoma. Metastatic tumors from other sites are rather uncommon and, when seen, are most frequently from the ovaries, gastrointestinal tract, or breast. We report a case of metastatic renal cell carcinoma, clear cell variant, to the cervix, which presented as a cervical polyp in a postmenopausal female. To our knowledge, this is the fourth reported case of renal cell carcinoma metastatic to the cervix. This case is only the third in which the cervical metastasis was the presenting sign of renal cell carcinoma and the first in which the clinical presentation was as a cervical polyp.

Breast as an unusual site of metastasis- series of 3 cases and review of literature.

PubMed

Hebbar, Ashwin K; Shashidhar, K; S, Krishna Murthy; Kumar, Veerendra; Arjunan, Ravi

2014-09-01

Background and objectives Metastasis to the breast from extra mammary sites is uncommon with an incidence ranging from 1.2 to 2 % in clinical reports. Approximately 300 cases of breast metastasis from extra mammary sites have been reported, mostly in small series or as a single case report. Gastrointestinal adenocarcinoma metastasising to the breast is also very rare and only 30 cases have been reported in the literature. Metastatic deposits within the breast may be difficult to distinguish from primary breast carcinoma. Radiological features and immunohistochemistry especially for steroid hormone receptors (ER/PR) and expression of gross cystic disease fluid protein (GCDFP) and presence of other immunohistochemistry protein factors in breast metastasis which are specific to primary site may be helpful in differentiating these two conditions. Materials and methods In this series of 3 cases of breast as an unusual site of metastasis, we present different cases of adenocarcinoma of stomach, sigmoid colon and kidney with metastasis to the breast and discuss the differential diagnosis and management plans. Conclusion In conclusion, secondary tumors to the breast are rare and thus differentiating primary tumors from metastatic breast carcinoma is important for rational and optimum therapy and avoidance of unnecessary radical surgery. Palpable breast lump without typical radiological signs of primary breast carcinoma in patients with known primary should be suspected of representing metastasis.

Primary cancers of extrahepatic biliary passages

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mittal, B.; Deutsch, M.; Iwatsuki, S.

The records of 22 patients with cancers of extrahepatic biliary passages (EHBP) were analyzed to understand their natural histories and patterns of failure and to evaluate the effectiveness of various treatments. None of the preoperative investigations consistently defined the entire extent of tumor. Percutaneous transhepatic cholangiography (PTHC) was the most helpful (100%) in accurately defining the site of ductal obstruction. Computed tomography was helpful in diagnosing liver metastases in 53% and primary tumor mass in 23% of patients. The most common sites of tumor failure or persistence were: liver (67%), tumor bed (56%), peritoneum (22%), porta hepatis and lymph nodesmore » (17%). The median survival for the entire group was 6.8 months. Surgery plays an important role in managing these tumors and in defining tumor extent for subsequent adjuvant irradiation. Patients receiving radiation doses greater than or equal to 70 TDF had a longer median survival (11 months) than patients receiving less than 70 TDF (4.4 months). All three patients, who were alive and free of disease greater than 1 year, received radiation doses greater than or equal to 70 TDF. From the data, it is difficult to comment on the effectiveness of chemotherapy. The authors have made suggestions regarding radiation volume and doses to various structures. The need for entering these patients into multi-institutional clinical trials is stressed.« less

A novel conduit-based coaptation device for primary nerve repair.

PubMed

Bamba, Ravinder; Riley, D Colton; Kelm, Nathaniel D; Cardwell, Nancy; Pollins, Alonda C; Afshari, Ashkan; Nguyen, Lyly; Dortch, Richard D; Thayer, Wesley P

2018-06-01

Conduit-based nerve repairs are commonly used for small nerve gaps, whereas primary repair may be performed if there is no tension on nerve endings. We hypothesize that a conduit-based nerve coaptation device will improve nerve repair outcomes by avoiding sutures at the nerve repair site and utilizing the advantages of a conduit-based repair. The left sciatic nerves of female Sprague-Dawley rats were transected and repaired using a novel conduit-based device. The conduit-based device group was compared to a control group of rats that underwent a standard end-to-end microsurgical repair of the sciatic nerve. Animals underwent behavioral assessments at weekly intervals post-operatively using the sciatic functional index (SFI) test. Animals were sacrificed at four weeks to obtain motor axon counts from immunohistochemistry. A sub-group of animals were sacrificed immediately post repair to obtain MRI images. SFI scores were superior in rats which received conduit-based repairs compared to the control group. Motor axon counts distal to the injury in the device group at four weeks were statistically superior to the control group. MRI tractography was used to demonstrate repair of two nerves using the novel conduit device. A conduit-based nerve coaptation device avoids sutures at the nerve repair site and leads to improved outcomes in a rat model. Conduit-based nerve repair devices have the potential to standardize nerve repairs while improving outcomes.

Effect of mosaic representation of vegetation in land surface schemes on simulated energy and carbon balances

NASA Astrophysics Data System (ADS)

Li, R.; Arora, V. K.

2012-01-01

Energy and carbon balance implications of representing vegetation using a composite or mosaic approach in a land surface scheme are investigated. In the composite approach the attributes of different plant functional types (PFTs) present in a grid cell are aggregated in some fashion for energy and water balance calculations. The resulting physical environmental conditions (including net radiation, soil moisture and soil temperature) are common to all PFTs and affect their ecosystem processes. In the mosaic approach energy and water balance calculations are performed separately for each PFT tile using its own vegetation attributes, so each PFT "sees" different physical environmental conditions and its carbon balance evolves somewhat differently from that in the composite approach. Simulations are performed at selected boreal, temperate and tropical locations to illustrate the differences caused by using the composite versus mosaic approaches of representing vegetation. These idealized simulations use 50% fractional coverage for each of the two dominant PFTs in a grid cell. Differences in simulated grid averaged primary energy fluxes at selected sites are generally less than 5% between the two approaches. Simulated grid-averaged carbon fluxes and pool sizes at these sites can, however, differ by as much as 46%. Simulation results suggest that differences in carbon balance between the two approaches arise primarily through differences in net radiation which directly affects net primary productivity, and thus leaf area index and vegetation biomass.

Improving education in primary care: development of an online curriculum using the blended learning model.

PubMed

Lewin, Linda Orkin; Singh, Mamta; Bateman, Betzi L; Glover, Pamela Bligh

2009-06-10

Standardizing the experiences of medical students in a community preceptorship where clinical sites vary by geography and discipline can be challenging. Computer-assisted learning is prevalent in medical education and can help standardize experiences, but often is not used to its fullest advantage. A blended learning curriculum combining web-based modules with face-to-face learning can ensure students obtain core curricular principles. This course was developed and used at The Case Western Reserve University School of Medicine and its associated preceptorship sites in the greater Cleveland area. Leaders of a two-year elective continuity experience at the Case Western Reserve School of Medicine used adult learning principles to develop four interactive online modules presenting basics of office practice, difficult patient interviews, common primary care diagnoses, and disease prevention. They can be viewed at (http://casemed.case.edu/cpcp/curriculum). Students completed surveys rating the content and technical performance of each module and completed a Generalist OSCE exam at the end of the course. Participating students rated all aspects of the course highly; particularly those related to charting and direct patient care. Additionally, they scored very well on the Generalist OSCE exam. Students found the web-based modules to be valuable and to enhance their clinical learning. The blended learning model is a useful tool in designing web-based curriculum for enhancing the clinical curriculum of medical students.

Mucinous cystic neoplasms of the mesentery: a case report and review of the literature

PubMed Central

Metaxas, Georgios; Tangalos, Athanasios; Pappa, Polyxeni; Papageorgiou, Irene

2009-01-01

Background Mucinous cystic neoplasms arise in the ovary and various extra-ovarian sites. While their pathogenesis remains conjectural, their similarities suggest a common pathway of development. There have been rare reports involving the mesentery as a primary tumour site. Case presentation A cystic mass of uncertain origin was demonstrated radiologically in a 22 year old female with chronic abdominal pain. At laparotomy, the mass was fixed within the colonic mesentery. Histology demonstrated a benign mucinous cystadenoma. Methods and results We review the literature on mucinous cystic neoplasms of the mesentery and report on the pathogenesis, biologic behavior, diagnosis and treatment of similar extra-ovarian tumors. We propose an updated classification of mesenteric cysts and cystic tumors. Conclusion Mucinous cystic neoplasms of the mesentery present almost exclusively in women and must be considered in the differential diagnosis of mesenteric tumors. Only full histological examination of a mucinous cystic neoplasm can exclude a borderline or malignant component. An updated classification of mesenteric cysts and cystic tumors is proposed. PMID:19454018

Quantitative assessment of anthrax vaccine immunogenicity using the dried blood spot matrix.

PubMed

Schiffer, Jarad M; Maniatis, Panagiotis; Garza, Ilana; Steward-Clark, Evelene; Korman, Lawrence T; Pittman, Phillip R; Mei, Joanne V; Quinn, Conrad P

2013-03-01

The collection, processing and transportation to a testing laboratory of large numbers of clinical samples during an emergency response situation present significant cost and logistical issues. Blood and serum are common clinical samples for diagnosis of disease. Serum preparation requires significant on-site equipment and facilities for immediate processing and cold storage, and significant costs for cold-chain transport to testing facilities. The dried blood spot (DBS) matrix offers an alternative to serum for rapid and efficient sample collection with fewer on-site equipment requirements and considerably lower storage and transport costs. We have developed and validated assay methods for using DBS in the quantitative anti-protective antigen IgG enzyme-linked immunosorbent assay (ELISA), one of the primary assays for assessing immunogenicity of anthrax vaccine and for confirmatory diagnosis of Bacillus anthracis infection in humans. We have also developed and validated high-throughput data analysis software to facilitate data handling for large clinical trials and emergency response. Published by Elsevier Ltd.

Characterizing the Mineralogy of Potential Lunar Landing Sites

NASA Technical Reports Server (NTRS)

Pieters, Carle; Head, James W., III; Mustard, Jack; Boardman, Joe; Buratti, Bonnie; Clark, Roger; Green, Rob; Head, James W, III; McCord, Thomas B.; Mustard, Jack;

What "price" means when buying food: insights from a multisite qualitative study with Black Americans.

PubMed

DiSantis, Katherine Isselmann; Grier, Sonya A; Odoms-Young, Angela; Baskin, Monica L; Carter-Edwards, Lori; Young, Deborah Rohm; Lassiter, Vikki; Kumanyika, Shiriki K

2013-03-01

We explored the role of price in the food purchasing patterns of Black adults and youths. We analyzed qualitative data from interviews and focus groups with socioeconomically diverse, primarily female, Black adults or parents (n = 75) and youths (n = 42) in 4 US cities. Interview protocols were locality specific, but all were designed to elicit broad discussion of food marketing variables. We performed a conventional qualitative content analysis by coding and analyzing data from each site to identify common salient themes. Price emerged as a primary influence on food purchases across all sites. Other value considerations (e.g., convenience, food quality, healthfulness of product, and family preferences) were discussed, providing a more complex picture of how participants considered the price of a product. Food pricing strategies that encourage consumption of healthful foods may have high relevance for Black persons across income or education levels. Accounting for how price intersects with other value considerations may improve the effectiveness of these strategies.

Micro-tattoo guided OCT imaging of site specific inflammation

NASA Astrophysics Data System (ADS)

Phillips, Kevin G.; Choudhury, Niloy; Samatham, Ravikant V.; Singh, Harvinder; Jacques, Steven L.

2010-02-01

Epithelial biologists studying human skin diseases such as cancer formation and psoriasis commonly utilize mouse models to characterize the interplay among cells and intracellular signal transduction pathways that result in programmed changes in gene expression and cellular behaviors. The information obtained from animal models is useful only when phenotypic presentations of disease recapitulate those observed in humans. Excision of tissues followed by histochemical analysis is currently the primary means of establishing the morphological presentation. Non invasive imaging of animal models provides an alternate means to characterize tissue morphology associated with the disease of interest in vivo. While useful, the ability to perform in vivo imaging at different time points in the same tissue location has been a challenge. This information is key to understanding site specific changes as the imaged tissue can now be extracted and analyzed for mRNA expression. We present a method employing a micro-tattoo to guide optical coherence tomography (OCT) imaging of ultraviolet induced inflammation over time in the same tissue locations.

Breast and splenic metastases of squamous cell carcinoma from the uterine cervix: a case report

PubMed Central

2014-01-01

Introduction Metastases to the breast from extramammary malignancies are infrequent, the most common primary sites are malignant melanoma, leukemia, lymphoma, and cancer of the lung, stomach, prostate and ovary. The cervical origin is exceptional. Splenic metastasis from squamous cell carcinoma of the cervix is also rare. To the best of our knowledge, only three cases of isolated splenic metastasis have been reported in the literature. Case presentation We describe the case of a 55-year-old North African woman who presented with a nodule in her left breast eight months after treatment for stage IIB squamous cell uterine cervical carcinoma. The excisional biopsy with histological study demonstrated a poorly differentiated squamous cell carcinoma. A computed tomography scan revealed a splenic secondary location. Conclusions We report here a case of two unusual metastatic sites of uterine cervical carcinoma, the breast and spleen. It is the first case of this association without widespread disease. PMID:25366471

Experience of Primary Care among Homeless Individuals with Mental Health Conditions

PubMed Central

Chrystal, Joya G.; Glover, Dawn L.; Young, Alexander S.; Whelan, Fiona; Austin, Erika L.; Johnson, Nancy K.; Pollio, David E.; Holt, Cheryl L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa A.; Daigle, Shanette G.; Steward, Jocelyn L.; Kertesz, Stefan G

2015-01-01

The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons’ needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers. PMID:25659142

Experience of primary care among homeless individuals with mental health conditions.

PubMed

Chrystal, Joya G; Glover, Dawn L; Young, Alexander S; Whelan, Fiona; Austin, Erika L; Johnson, Nancy K; Pollio, David E; Holt, Cheryl L; Stringfellow, Erin; Gordon, Adam J; Kim, Theresa A; Daigle, Shanette G; Steward, Jocelyn L; Kertesz, Stefan G

2015-01-01

The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons' needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.

Asymmetric responses of primary productivity to altered precipitation simulated by ecosystem models across three long-term grassland sites

NASA Astrophysics Data System (ADS)

Wu, Donghai; Ciais, Philippe; Viovy, Nicolas; Knapp, Alan K.; Wilcox, Kevin; Bahn, Michael; Smith, Melinda D.; Vicca, Sara; Fatichi, Simone; Zscheischler, Jakob; He, Yue; Li, Xiangyi; Ito, Akihiko; Arneth, Almut; Harper, Anna; Ukkola, Anna; Paschalis, Athanasios; Poulter, Benjamin; Peng, Changhui; Ricciuto, Daniel; Reinthaler, David; Chen, Guangsheng; Tian, Hanqin; Genet, Hélène; Mao, Jiafu; Ingrisch, Johannes; Nabel, Julia E. S. M.; Pongratz, Julia; Boysen, Lena R.; Kautz, Markus; Schmitt, Michael; Meir, Patrick; Zhu, Qiuan; Hasibeder, Roland; Sippel, Sebastian; Dangal, Shree R. S.; Sitch, Stephen; Shi, Xiaoying; Wang, Yingping; Luo, Yiqi; Liu, Yongwen; Piao, Shilong

2018-06-01

Field measurements of aboveground net primary productivity (ANPP) in temperate grasslands suggest that both positive and negative asymmetric responses to changes in precipitation (P) may occur. Under normal range of precipitation variability, wet years typically result in ANPP gains being larger than ANPP declines in dry years (positive asymmetry), whereas increases in ANPP are lower in magnitude in extreme wet years compared to reductions during extreme drought (negative asymmetry). Whether the current generation of ecosystem models with a coupled carbon-water system in grasslands are capable of simulating these asymmetric ANPP responses is an unresolved question. In this study, we evaluated the simulated responses of temperate grassland primary productivity to scenarios of altered precipitation with 14 ecosystem models at three sites: Shortgrass steppe (SGS), Konza Prairie (KNZ) and Stubai Valley meadow (STU), spanning a rainfall gradient from dry to moist. We found that (1) the spatial slopes derived from modeled primary productivity and precipitation across sites were steeper than the temporal slopes obtained from inter-annual variations, which was consistent with empirical data; (2) the asymmetry of the responses of modeled primary productivity under normal inter-annual precipitation variability differed among models, and the mean of the model ensemble suggested a negative asymmetry across the three sites, which was contrary to empirical evidence based on filed observations; (3) the mean sensitivity of modeled productivity to rainfall suggested greater negative response with reduced precipitation than positive response to an increased precipitation under extreme conditions at the three sites; and (4) gross primary productivity (GPP), net primary productivity (NPP), aboveground NPP (ANPP) and belowground NPP (BNPP) all showed concave-down nonlinear responses to altered precipitation in all the models, but with different curvatures and mean values. Our results indicated that most models overestimate the negative drought effects and/or underestimate the positive effects of increased precipitation on primary productivity under normal climate conditions, highlighting the need for improving eco-hydrological processes in those models in the future.

Telepathology in cytopathology: challenges and opportunities.

PubMed

Collins, Brian T

2013-01-01

Telepathology in cytopathology is becoming more commonly utilized, and newer technologic infrastructures afford the laboratory a variety of options. The options and design of a telepathology system are driven by the clinical needs. This is primarily focused on providing rapid on-site evaluation service for fine needle aspiration. The clinical requirements and needs of a system are described. Available tools to design and implement a telepathology system are covered, including methods of image capture, network connectivity and remote viewing options. The primary telepathology method currently used and described involves the delivery via a network connection of a live video image to a remote site which is passively viewed by an internet web-based browser. By utilizing live video information and a voice connection to the on-site location, the remote viewer can collect clinical information and direct their view of the slides. Telepathology systems for use in cytopathology can be designed and implemented with commercially available infrastructure. It is necessary for the laboratory to validate the designed system and adhere to the required regulatory requirements. Telepathology for cytopathology can be reliably utilized by adapting existing technology, and newer advances hold great promise for further applications in the cytopathology laboratory. Copyright © 2013 S. Karger AG, Basel.

A simple algorithm for identifying periods of snow accumulation on a radiometer

NASA Astrophysics Data System (ADS)

Lapo, Karl E.; Hinkelman, Laura M.; Landry, Christopher C.; Massmann, Adam K.; Lundquist, Jessica D.

2015-09-01

Downwelling solar, Qsi, and longwave, Qli, irradiances at the earth's surface are the primary energy inputs for many hydrologic processes, and uncertainties in measurements of these two terms confound evaluations of estimated irradiances and negatively impact hydrologic modeling. Observations of Qsi and Qli in cold environments are subject to conditions that create additional uncertainties not encountered in other climates, specifically the accumulation of snow on uplooking radiometers. To address this issue, we present an automated method for estimating these periods of snow accumulation. Our method is based on forest interception of snow and uses common meteorological observations. In this algorithm, snow accumulation must exceed a threshold to obscure the sensor and is only removed through scouring by wind or melting. The algorithm is evaluated at two sites representing different mountain climates: (1) Snoqualmie Pass, Washington (maritime) and (2) the Senator Beck Basin Study Area, Colorado (continental). The algorithm agrees well with time-lapse camera observations at the Washington site and with multiple measurements at the Colorado site, with 70-80% of observed snow accumulation events correctly identified. We suggest using the method for quality controlling irradiance observations in snow-dominated climates where regular, daily maintenance is not possible.

Prospective randomized controlled trial: fibrin sealant reduces split skin graft donor-site pain.

PubMed

Healy, Ciaran; Greig, Aina V H; Murphy, Adrian D; Powell, Christopher; Pinder, Richard J; Saour, Samer; Abela, Christopher; Knight, William; Geh, Jenny L C

2013-07-01

Pain at split skin graft donor sites is common. Fibrin sealant has been demonstrated to reduce time to hemostasis at wound sites, and patients receiving this treatment were incidentally noted to report less pain. This study aimed to evaluate pain and incapacity in split skin graft donor sites treated with and without fibrin sealant. Fifty patients requiring thigh donor-site split skin grafts were prospectively randomized to receive either a self-adhesive fabric dressing alone or fibrin sealant plus the self-adhesive fabric dressing as primary donor-site dressings. External secondary dressings were the same. Patients were blinded with regard to treatment group. Using visual analogue scales (scored 0 to 5), patients rated their donor-site pain and incapacity for 14 days postoperatively. Secondary endpoints were length of hospital stay and duration of requirement for dressings. Forty patients were included in the study analysis and completed self-reported pain and incapacity scores. Twenty received the fibrin sealant plus self-adhesive fabric dressing and 20 received the fabric dressing only (controls). Patients using the fibrin sealant plus the dressing reported significantly less pain (mean score, 0.42 versus 1.60, p < 0.001) and significantly less incapacity (mean score, 0.48 versus 1.71, p < 0.001). Patients allocated to the fibrin sealant group recorded shorter lengths of stay and faster time to discontinuation of dressing, though statistical significance was not achieved. Patients whose split skin graft donor sites were dressed with fibrin sealant plus self-adhesive fabric dressing experienced significantly less pain and incapacity than patients with self-adhesive fabric dressings alone, allowing a more rapid return to normal activity. Therapeutic, II.

Variation in abundance of Pacific Blue Mussel (Mytilus trossulus) in the Northern Gulf of Alaska, 2006-2015

NASA Astrophysics Data System (ADS)

Bodkin, James L.; Coletti, Heather A.; Ballachey, Brenda E.; Monson, Daniel H.; Esler, Daniel; Dean, Thomas A.

2018-01-01

Mussels are conspicuous and ecologically important components of nearshore marine communities around the globe. Pacific blue mussels (Mytilus trossulus) are common residents of intertidal habitats in protected waters of the North Pacific, serving as a conduit of primary production to a wide range of nearshore consumers including predatory invertebrates, sea ducks, shorebirds, sea otters, humans, and other terrestrial mammals. We monitored seven metrics of intertidal Pacific blue mussel abundance at five sites in each of three regions across the northern Gulf of Alaska: Katmai National Park and Preserve (Katmai) (2006-2015), Kenai Fjords National Park (Kenai Fjords) (2008-2015) and western Prince William Sound (WPWS) (2007-2015). Metrics included estimates of: % cover at two tide heights in randomly selected rocky intertidal habitat; and in selected mussel beds estimates of: the density of large mussels (≥ 20 mm); density of all mussels > 2 mm estimated from cores extracted from those mussel beds; bed size; and total abundance of large and all mussels, i.e. the product of density and bed size. We evaluated whether these measures of mussel abundance differed among sites or regions, whether mussel abundance varied over time, and whether temporal patterns in abundance were site specific, or synchronous at regional or Gulf-wide spatial scales. We found that, for all metrics, mussel abundance varied on a site-by-site basis. After accounting for site differences, we found similar temporal patterns in several measures of abundance (both % cover metrics, large mussel density, large mussel abundance, and mussel abundance estimated from cores), in which abundance was initially high, declined significantly over several years, and subsequently recovered. Averaged across all sites, we documented declines of 84% in large mussel abundance through 2013 with recovery to 41% of initial abundance by 2015. These findings suggest that factors operating across the northern Gulf of Alaska were affecting mussel survival and subsequently abundance. In contrast, density of primarily small mussels obtained from cores (as an index of recruitment), varied markedly by site, but did not show meaningful temporal trends. We interpret this to indicate that settlement was driven by site-specific features rather than Gulf wide factors. By extension, we hypothesize that temporal changes in mussel abundance observed was not a result of temporal variation in larval supply leading to variation in recruitment, but rather suggestive of mortality as a primary demographic factor driving mussel abundance. Our results highlight the need to better understand underlying mechanisms of change in mussels, as well as implications of that change to nearshore consumers.

Variation in abundance of Pacific Blue Mussel (Mytilus trossulus) in the Northern Gulf of Alaska, 2006–2015

USGS Publications Warehouse

Bodkin, James L.; Coletti, Heather A.; Ballachey, Brenda E.; Monson, Daniel; Esler, Daniel N.; Dean, Thomas A.

2017-01-01

Mussels are conspicuous and ecologically important components of nearshore marine communities around the globe. Pacific blue mussels (Mytilus trossulus) are common residents of intertidal habitats in protected waters of the North Pacific, serving as a conduit of primary production to a wide range of nearshore consumers including predatory invertebrates, sea ducks, shorebirds, sea otters, humans, and other terrestrial mammals. We monitored seven metrics of intertidal Pacific blue mussel abundance at five sites in each of three regions across the northern Gulf of Alaska: Katmai National Park and Preserve (Katmai) (2006–2015), Kenai Fjords National Park (Kenai Fjords) (2008–2015) and western Prince William Sound (WPWS) (2007–2015). Metrics included estimates of: % cover at two tide heights in randomly selected rocky intertidal habitat; and in selected mussel beds estimates of: the density of large mussels (≥ 20 mm); density of all mussels > 2 mm estimated from cores extracted from those mussel beds; bed size; and total abundance of large and all mussels, i.e. the product of density and bed size. We evaluated whether these measures of mussel abundance differed among sites or regions, whether mussel abundance varied over time, and whether temporal patterns in abundance were site specific, or synchronous at regional or Gulf-wide spatial scales. We found that, for all metrics, mussel abundance varied on a site-by-site basis. After accounting for site differences, we found similar temporal patterns in several measures of abundance (both % cover metrics, large mussel density, large mussel abundance, and mussel abundance estimated from cores), in which abundance was initially high, declined significantly over several years, and subsequently recovered. Averaged across all sites, we documented declines of 84% in large mussel abundance through 2013 with recovery to 41% of initial abundance by 2015. These findings suggest that factors operating across the northern Gulf of Alaska were affecting mussel survival and subsequently abundance. In contrast, density of primarily small mussels obtained from cores (as an index of recruitment), varied markedly by site, but did not show meaningful temporal trends. We interpret this to indicate that settlement was driven by site-specific features rather than Gulf wide factors. By extension, we hypothesize that temporal changes in mussel abundance observed was not a result of temporal variation in larval supply leading to variation in recruitment, but rather suggestive of mortality as a primary demographic factor driving mussel abundance. Our results highlight the need to better understand underlying mechanisms of change in mussels, as well as implications of that change to nearshore consumers.

Protocol for a randomised controlled trial evaluating the effects of providing essential medicines at no charge: the Carefully seLected and Easily Accessible at No Charge Medicines (CLEAN Meds) trial.

PubMed

Persaud, Nav; Lee, Taehoon; Ahmad, Haroon; Li, Winny; Taglione, Michael Sergio; Rajakulasingam, Yathavan; Umali, Norman; Boozary, Andrew; Glazier, Richard H; Gomes, Tara; Hwang, Stephen W; Jüni, Peter; Law, Michael; Mamdani, Muhammad M; Manns, Braden; Martin, Danielle; Morgan, Steve; Oh, Paul; Pinto, Andrew David; Shah, Baiju R; Sullivan, Frank M; Thorpe, Kevin E; Tu, Karen; Laupacis, Andreas

2017-06-12

Cost-related non-adherence to medicines is common in low-income, middle-income and high-income countries such as Canada. Medicine non-adherence is associated with poor health outcomes and increased mortality. This randomised trial will test the impact of a carefully selected list of essential medicines at no charge (compared with usual medicine access) in primary care patients reporting cost-related non-adherence. This is an open-label, parallel two-arm, superiority, individually randomised controlled trial conducted in three primary care sites (one urban, two rural) in Ontario, Canada, that was codesigned by a community guidance panel. Adult patients (≥18 years) who report cost-related non-adherence to medicines are eligible to participate in the study. Participants will be randomised to receive free and convenient access to a carefully selected list of 125 essential medicines (based on the WHO's Model List of Essential Medicines) or usual means of medicine access. Care for patients in both groups will otherwise be unchanged. The primary outcome of this trial is adherence to appropriately prescribed medicines. Secondary outcomes include medicine adherence, appropriate prescribing, blood pressure, haemoglobin A1c, low-density lipoprotein cholesterol, patient-oriented outcomes and healthcare costs. All participants will be followed for at least 12 months. Ethics approval was obtained in all three participating sites. Results of the main trial and secondary outcomes will be submitted for publication in a peer-reviewed journal and discussed with members of the public and decision makers. NCT02744963. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Assessing the Quality of a Nonrandomized Pragmatic Trial for Primary Prevention of Falls among Older Adults

PubMed Central

Albert, Steven M.; Edelstein, Offer; King, Jennifer; Flatt, Jason; Lin, Chyongchiou J.; Boudreau, Robert; Newman, Anne B.

2014-01-01

Background Current approaches to falls prevention mostly rely on secondary and tertiary prevention and target individuals at high risk of falls. An alternative is primary prevention, in which all seniors are screened, referred as appropriate, and educated regarding falls risk. Little information is available on research designs that allow investigation of this approach in the setting of aging services delivery, where randomization may not be possible. Methods Healthy Steps for Older Adults, a statewide program of the Pennsylvania (PA) Department of Aging, involves a combination of education about falls and screening for balance problems, with referral to personal physicians and home safety assessments. We developed a nonrandomized statewide trial, Falls Free PA, to assess its effectiveness in reducing falls incidence over 12 months. We recruited 814 seniors who completed the program (503 first time participants, 311 people repeating the program) and 1020 who did not participate in the program, from the same sites. We assessed the quality of this nonrandomized design by examining recruitment, follow-up across study groups, and comparability at baseline. Results Of older adults approached in senior centers, 90.5% (n=2219) signed informed consent, and 1834 (82.4%) completed baseline assessments and were eligible for follow-up. Attrition in the three groups over 12 months was low and non-differential (<10% for withdrawal and <2% for other loss to follow-up). Median follow-up, which involved standardized monthly assessment of falls, was 10 months in all study groups. At baseline the groups did not differ in measures of health or falls risk factors. Conclusions Comparable status at baseline, recruitment from common sites, and similar experience with retention suggest that the nonrandomized design will be effective for assessment of this approach to primary prevention of falls. PMID:24488533

Assessing the quality of a non-randomized pragmatic trial for primary prevention of falls among older adults.

PubMed

Albert, Steven M; Edelstein, Offer; King, Jennifer; Flatt, Jason; Lin, Chyongchiou J; Boudreau, Robert; Newman, Anne B

2015-01-01

Current approaches to falls prevention mostly rely on secondary and tertiary prevention and target individuals at high risk of falls. An alternative is primary prevention, in which all seniors are screened, referred as appropriate, and educated regarding falls risk. Little information is available on research designs that allow investigation of this approach in the setting of aging services delivery, where randomization may not be possible. Healthy Steps for Older Adults, a statewide program of the Pennsylvania (PA) Department of Aging, involves a combination of education about falls and screening for balance problems, with referral to personal physicians and home safety assessments. We developed a non-randomized statewide trial, Falls Free PA, to assess its effectiveness in reducing falls incidence over 12 months. We recruited 814 seniors who completed the program (503 first-time participants, 311 people repeating the program) and 1,020 who did not participate in the program, from the same sites. We assessed the quality of this non-randomized design by examining recruitment, follow-up across study groups, and comparability at baseline. Of older adults approached in senior centers, 90.5 % (n = 2,219) signed informed consent, and 1,834 (82.4 %) completed baseline assessments and were eligible for follow-up. Attrition in the three groups over 12 months was low and non-differential (<10 % for withdrawal and <2 % for other loss to follow-up). Median follow-up, which involved standardized monthly assessment of falls, was 10 months in all study groups. At baseline, the groups did not differ in measures of health or falls risk factors. Comparable status at baseline, recruitment from common sites, and similar experience with retention suggest that the non-randomized design will be effective for assessment of this approach to primary prevention of falls.

Bilayered buccal films as child-appropriate dosage form for systemic administration of propranolol.

PubMed

Abruzzo, Angela; Nicoletta, Fiore Pasquale; Dalena, Francesco; Cerchiara, Teresa; Luppi, Barbara; Bigucci, Federica

2017-10-05

Buccal mucosa has emerged as an attractive site for systemic administration of drug in paediatric patients. This route is simple and non-invasive, even if the saliva wash-out effect and the relative permeability of the mucosa can reduce drug absorption. Mucoadhesive polymers represent a common employed strategy to increase the contact time of the formulation at the application site and to improve drug absorption. Among the different mucoadhesive dosage forms, buccal films are particularly addressed for paediatric population since they are thin, adaptable to the mucosal surface and able to offer an exact and flexible dose. The objective of the present study was to develop bilayered buccal films for the release of propranolol hydrochloride. A primary polymeric layer was prepared by casting and drying of solutions of film-forming polymers, such as polyvinylpyrrolidone (PVP) or polyvinylalcohol (PVA), added with different weight ratios of gelatin (GEL) or chitosan (CH). In order to achieve unidirectional drug delivery towards buccal mucosa, a secondary ethylcellulose layer was applied onto the primary layer. Bilayered films were characterized for their physico-chemical (morphology, thickness, drug content and solid state) and functional (water uptake, mucoadhesion, drug release and permeation) properties. The inclusion of CH into PVP and PVA primary layer provided the best mucoadhesion ability. Films containing CH provided a lower drug release with respect to films containing GEL and increased the amount of permeated drug through buccal mucosa, thanks to its ability of interfering with the lipid organization. The secondary ethylcellulose layer did not interfere with drug permeation, but it could limit drug release in the buccal cavity. Copyright © 2017 Elsevier B.V. All rights reserved.

Palatine tonsillar metastasis of a small pulmonary adenocarcinoma showing an invasive micropapillary carcinoma pattern and Pagetoid spread at the tonsil: a case suggesting retrograde lymphatic metastasis from bulky lymph node metastases of the neck.

PubMed

Tajima, Shogo; Koda, Kenji

2015-01-01

Metastasis rarely occurs in the palatine tonsils. Among primary pulmonary carcinoma subtypes, small cell carcinoma more frequently metastasizes to this site. Herein, we present an exceedingly rare case of a small pulmonary adenocarcinoma that metastasized to the cervical lymph nodes and the right palatine tonsil in a 62-year-old man. In spite of the small size of the primary site, such extensive metastasis may have occurred because of the invasive micropapillary carcinoma pattern seen in the metastatic sites. The manner of metastasis to the palatine tonsil was considered retrograde lymphatic metastasis originating from carcinoma cells in the cervical lymph nodes. Furthermore, Pagetoid spread was observed at the palatine tonsil. Although there have been only a few cases showing retrograde lymphatic metastasis and Pagetoid spread at the metastatic site, we should be careful when speculating about the primary site based on such metastatic sites, especially when dealing with a biopsy sample exhibiting Pagetoid spread.

Distribution and habitat associations of juvenile Common Snook in the lower Rio Grande, Texas

USGS Publications Warehouse

Huber, Caleb G.; Grabowski, Timothy B.; Patino, Reynaldo; Pope, Kevin L.

2014-01-01

Common Snook Centropomus undecimalis were once abundant off the Texas coast, but these populations are now characterized by low abundance and erratic recruitment. Most research concerning Common Snook in North America has been conducted in Florida and very little is known about the specific biology and habitat needs of Common Snook in Texas. The primary objective of this study was to describe the habitat use patterns of juvenile Common Snook and their role in the fish assemblage in the lower portion of the Rio Grande, Texas. Secondarily, we documented the relationship between age and juvenile reproductive development. Fish were collected during January–March 2006 from the lower 51.5 km of the Rio Grande using a bottom trawl and boat-mounted electrofisher. Measurements of water quality and other habitat traits were recorded at each sampling site. We captured 225 Common Snook exclusively in freshwater habitats above river kilometer 12.9. The distribution of juvenile Common Snook was not random, but influenced primarily by turbidity and dissolved oxygen. Sex differentiation and gonadal development based on histological examination of gonads established that age-1 and age-2 Common Snook were juvenile, prepubertal males. There was no difference between the age groups in their overall distribution in the river. However, age-2 Common Snook were associated with deeper areas with faster currents, higher conductivity, and steeper banks. Overall, Common Snook in the lower Rio Grande show substantial differences in habitat use than their counterparts in other parts of the range of the species, but it is unclear whether this is due to differences in habitat availability, behavioral plasticity, or some combination thereof.

The variability in the relationship between black carbon and carbon monoxide over the eastern coast of China: BC aging during transport

NASA Astrophysics Data System (ADS)

Guo, Qingfeng; Hu, Min; Guo, Song; Wu, Zhijun; Peng, Jianfei; Wu, Yusheng

2017-09-01

East Asia is a densely populated region with a myriad of primary emissions of pollutants such as black carbon (BC) and carbon monoxide (CO). To characterize primary emissions over the eastern coast of China, a series of field campaigns were conducted in 2011, including measurements from a ship cruise, island, and coastal receptor sites. The relationship between BC and CO is presented here for the first ship cruise (C1), the second ship cruise (C2), an island site (Changdao Island, CD), and a coastal site (Wenling, WL). The average BC mass concentrations were 2.43, 2.73, 1.09, 0.94, and 0.77 µg m-3 for CD, WL, C1-YS (Yellow Sea), C1-ES (East China Sea), and C2-ES, respectively. For those locations, the average CO mixing ratios were 0.55, 0.48, 0.31, 0.36, and 0.27 ppm. The high loadings of both BC and CO imply severe anthropogenic pollution over the eastern coast of China. Additionally, the linear correlation between BC and CO was regressed for each location. The slopes, i.e., the ratios of ΔBC to ΔCO derived from their relationship, correlated well with the ratios of diesel consumption to gasoline consumption in each province/city, which reveals vehicular emission to be the common source for BC and CO and that there are distinct fuel structures between North and South China. The ΔBC/ΔCO values at coastal sites (Changdao Island and Wenling) were much higher than those over the Yellow Sea and East China Sea, and the correlation coefficients also showed a decreasing trend from the coast to the sea. Therefore, the quantity of ΔBC/ΔCO and the correlation coefficients are possible indicators for the aging and removal of BC.

Canine hyperlipidaemia.

PubMed

Xenoulis, P G; Steiner, J M

2015-10-01

Hyperlipidaemia refers to an increased concentration of lipids in the blood. Hyperlipidaemia is common in dogs and has recently emerged as an important clinical condition that requires a systematic diagnostic approach and appropriate treatment. Hyperlipidaemia can be either primary or secondary to other diseases. Secondary hyperlipidaemia is the most common form in dogs, and it can be a result of endocrine disorders, pancreatitis, cholestasis, protein-losing nephropathy, obesity, as well as other conditions and the use of certain drugs. Primary hyperlipidaemia is less common in the general canine population but it can be very common within certain breeds. Hypertriglyceridaemia of Miniature Schnauzers is the most common form of primary hyperlipidaemia in dogs but other breeds are also affected. Possible complications of hyperlipidaemia in dogs include pancreatitis, liver disease, atherosclerosis, ocular disease and seizures. Management of primary hyperlipidaemia in dogs is achieved by administration of ultra low-fat diets with or without the administration of lipid lowering drugs such as omega-3 fatty acids, fibrates, niacin and statins. © 2015 British Small Animal Veterinary Association.

Common genetic variants of the human UMOD gene are functional on transcription and predict plasma uric acid in two distinct populations

PubMed Central

Han, Jia; Liu, Ying; Rao, Fangwen; Nievergelt, Caroline M.; O’Connor, Daniel T.; Wang, Xingyu; Liu, Lisheng; Bu, Dingfang; Liang, Yu; Wang, Fang; Zhang, Luxia; Zhang, Hong; Chen, Yuqing; Wang, Haiyan

2013-01-01

Uromodulin (UMOD) genetic variants cause familial juvenile hyperuricemic nephropathy, characterized by hyperuricemia, decreased renal excretion of UMOD and uric acid; such findings suggest a role for UMOD in the regulation of plasma uric acid. We screened common variants across the UMOD locus in two populations, one from a community-based Chinese population, the other from California twins and siblings. Transcriptional activity of promoter variants was estimated in luciferase reporter plasmids transfected into HEK293 cells and mlMCD3 cells. By variance components in twin pairs, uric acid concentration and excretion were heritable traits. In the primary population from Beijing, we identified that carriers of haplotype GCC displayed higher plasma uric acid, and 3 UMOD promoter variants associated with plasma uric acid. UMOD promoter variants displayed reciprocal effects on urine uric acid excretion and plasma uric acid concentration, suggesting a primary effect on renal tubular handling of urate. These UMOD genetic marker-on-trait associations for uric acid were replicated in an independent American population sample. Site-directed mutagenesis at trait-associated UMOD promoter variants altered promoter activity in transfected luciferase reporter plasmids. These results suggest that UMOD promoter variants seem to initiate a cascade of transcriptional and biochemical changes influencing UMOD secretion, eventuating in elevation of plasma uric acid. PMID:23344472

Sinonasal fibrosarcoma: analysis of the Surveillance, Epidemiology, and End Results database.

PubMed

Patel, Tapan D; Carniol, Eric T; Vázquez, Alejandro; Baredes, Soly; Liu, James K; Eloy, Jean Anderson

2016-02-01

Primary fibrosarcoma of the sinonasal region is an infrequently occurring malignant neoplasm. Fibrosarcomas are most commonly found in the extremities, with only 1% of fibrosarcomas reported in the head and neck region. This study analyzes the demographic, clinicopathologic, and survival characteristics of sinonasal fibrosarcoma (SNFS). The Surveillance, Epidemiology, and End Results (SEER) database (1973 to 2012) was queried for SNFS cases. Data were analyzed with respect to various demographic and clinicopathologic factors. Survival was analyzed using the Kaplan-Meier model. Fifty-one cases of fibrosarcoma were identified in the sinonasal region. The mean age at diagnosis was 54.5 years and the mean survival was 119.7 months. There was no gender predilection with a male-to-female ratio of 1.04:1. The maxillary sinus was the most common site of involvement (54.9%), followed by the nasal cavity (23.5%). Five-year survival analysis revealed an overall survival rate of 71.7%, disease-specific survival rate of 77.8%, and relative survival (RS) rate of 78.8%. Disease-specific survival was better among those treated with surgery (with [76.2%] or without [87.5%] adjuvant radiotherapy) than those treated with primary radiotherapy alone (33.3%) (p = 0.0069). SNFS is a rare entity. This study represents the largest series of SNFS to date. The mainstay of treatment for this tumor is surgical resection with or without radiotherapy. © 2015 ARS-AAOA, LLC.

The tumor macroenvironment and systemic regulation of breast cancer progression.

PubMed

Castaño, Zafira; Tracy, Kristin; McAllister, Sandra S

2011-01-01

Breast cancer is the most common malignancy among women worldwide and is the most common cause of death for women between 35 and 50 years of age. Women with breast cancer are at risk of developing metastases for their entire lifetime and, despite local and systemic therapies, approximately 30% of breast cancer patients will relapse (Jemal et al., 2010). Nearly all breast cancer related deaths are due to metastatic disease, even though metastasis is considered to be an inefficient process. In some cases, tumor cells disseminate from primary sites at an early stage, but remain indolent for protracted periods of time before becoming overt, life-threatening tumors. Little is known about the mechanisms that cause these indolent tumors to grow into malignant disease. Because of this gap in our understanding, we are unable to predict which breast cancer patients are likely to experience disease relapse or develop metastases years after treatment of their primary tumor. A better understanding of the mechanisms and signals involved in the exit of tumor cells from dormancy would not only allow for more accurate selection of patients that would benefit from systemic therapy, but could also lead to the development of more targeted therapies to inhibit the signals that promote disease progression. In this review, we address the systemic, or "macroenvironmental", contribution to tumor initiation and progression and what is known about how a pro-tumorigenic systemic environment is established.

Standby-battery autonomy versus power quality

NASA Astrophysics Data System (ADS)

Bitterlin, Ian F.

Batteries are used in a wide variety of applications as an energy store to bridge gaps in the primary source of supplied power for a given period of time. In some cases this bridging time, the battery's "autonomy", is fixed by local legislation but it is also often set by historically common practices. However, even if common practice dictates a long autonomy time, we are entering a new era of "cost and benefit realism" underpinned by environmentally friendly policies and we should challenge these historical practices at every opportunity if it can lead to resource and cost savings. In some cases the application engineer has no choice in the design autonomy; either follow a piece of local legislation (e.g. 4 h autonomy for a "life safety" application), or actually work out what is needed! An example of the latter would be for a remote site, off-grid, using integrated wind/solar power (without emergency generator back-up) where you may have to design-in several days' battery autonomy. This short paper proposes that a battery's autonomy should be related to the time expected for the system to be without the primary power source, balanced by the capital costs and commercial risk of power failure. To discuss this we shall consider the factors in selecting the autonomy time and other related aspects for high voltage battery systems used in facility-wide uninterruptible power supply (UPS) systems.

An intraorganizational model for developing and spreading quality improvement innovations.

PubMed

Kellogg, Katherine C; Gainer, Lindsay A; Allen, Adrienne S; OʼSullivan, Tatum; Singer, Sara J

Recent policy reforms encourage quality improvement (QI) innovations in primary care, but practitioners lack clear guidance regarding spread inside organizations. We designed this study to identify how large organizations can facilitate intraorganizational spread of QI innovations. We conducted ethnographic observation and interviews in a large, multispecialty, community-based medical group that implemented three QI innovations across 10 primary care sites using a new method for intraorganizational process development and spread. We compared quantitative outcomes achieved through the group's traditional versus new method, created a process model describing the steps in the new method, and identified barriers and facilitators at each step. The medical group achieved substantial improvement using its new method of intraorganizational process development and spread of QI innovations: standard work for rooming and depression screening, vaccine error rates and order compliance, and Pap smear error rates. Our model details nine critical steps for successful intraorganizational process development (set priorities, assess the current state, develop the new process, and measure and refine) and spread (develop support, disseminate information, facilitate peer-to-peer training, reinforce, and learn and adapt). Our results highlight the importance of utilizing preexisting organizational structures such as established communication channels, standardized roles, common workflows, formal authority, and performance measurement and feedback systems when developing and spreading QI processes inside an organization. In particular, we detail how formal process advocate positions in each site for each role can facilitate the spread of new processes. Successful intraorganizational spread is possible and sustainable. Developing and spreading new QI processes across sites inside an organization requires creating a shared understanding of the necessary process steps, considering the barriers that may arise at each step, and leveraging preexisting organizational structures to facilitate intraorganizational process development and spread.

An intraorganizational model for developing and spreading quality improvement innovations

PubMed Central

Kellogg, Katherine C.; Gainer, Lindsay A.; Allen, Adrienne S.; O'Sullivan, Tatum; Singer, Sara J.

2017-01-01

Background: Recent policy reforms encourage quality improvement (QI) innovations in primary care, but practitioners lack clear guidance regarding spread inside organizations. Purpose: We designed this study to identify how large organizations can facilitate intraorganizational spread of QI innovations. Methodology/Approach: We conducted ethnographic observation and interviews in a large, multispecialty, community-based medical group that implemented three QI innovations across 10 primary care sites using a new method for intraorganizational process development and spread. We compared quantitative outcomes achieved through the group’s traditional versus new method, created a process model describing the steps in the new method, and identified barriers and facilitators at each step. Findings: The medical group achieved substantial improvement using its new method of intraorganizational process development and spread of QI innovations: standard work for rooming and depression screening, vaccine error rates and order compliance, and Pap smear error rates. Our model details nine critical steps for successful intraorganizational process development (set priorities, assess the current state, develop the new process, and measure and refine) and spread (develop support, disseminate information, facilitate peer-to-peer training, reinforce, and learn and adapt). Our results highlight the importance of utilizing preexisting organizational structures such as established communication channels, standardized roles, common workflows, formal authority, and performance measurement and feedback systems when developing and spreading QI processes inside an organization. In particular, we detail how formal process advocate positions in each site for each role can facilitate the spread of new processes. Practice Implications: Successful intraorganizational spread is possible and sustainable. Developing and spreading new QI processes across sites inside an organization requires creating a shared understanding of the necessary process steps, considering the barriers that may arise at each step, and leveraging preexisting organizational structures to facilitate intraorganizational process development and spread. PMID:27428788

The Role of Organizational Factors in the Provision of Comprehensive Women's Health in the Veterans Health Administration.

PubMed

Reddy, Shivani M; Rose, Danielle E; Burgess, James F; Charns, Martin P; Yano, Elizabeth M

Increasing numbers of women veterans present an organizational challenge to a health care system that historically has served men. Women veterans require comprehensive women's health services traditionally not provided by the Veterans Health Administration. Examine the association of organizational factors and adoption of comprehensive women's health care. Cross-sectional analysis of the 2007 Veterans Health Administration National Survey of Women Veterans Health Programs and Practices. Dependent measures included a) model of women's health care: separate women's health clinic (WHC), designated women's health provider in primary care (DWHP), both (WHC+DWHP), or neither and b) the availability of five women's health services: cervical cancer screening and evaluation and management of vaginitis, menstrual disorders, contraception, and menopause. Exposure variables were organizational factors drawn from the Greenhalgh model of diffusion of innovations including measures of structure, absorptive capacity, and system readiness for innovation. The organizational factors of a gynecology clinic, an academic affiliation with a medical school, a women's health representative on one or more high-impact committees, and a greater caseload of women veterans were more common at sites with WHCs and WHC+DWHPs, compared with sites relying on general primary care with or without a DWHP. Academic affiliation and high-impact committee involvement remained significant in multivariable analysis. Sites with WHCs or WHC+DWHPs were more likely to offer all five women's health services. Facilities with greater apparent absorptive capacity (academic affiliation and women's health representation on high-impact committees) are more likely to adopt WHCs. Facilities with separate WHCs are more likely to deliver a package of women's health services, promoting comprehensive care for women veterans. Copyright © 2016 Jacobs Institute of Women's Health. All rights reserved.

Nutrient limitation drives response of Calamagrostis epigejos to arbuscular mycorrhiza in primary succession.

PubMed

Rydlová, Jana; Püschel, David; Dostálová, Magdalena; Janoušková, Martina; Frouz, Jan

2016-10-01

Little is known about the functioning of arbuscular mycorrhizal (AM) symbiosis over the course of primary succession, where soil, host plants, and AM fungal communities all undergo significant changes. Over the course of succession at the studied post-mining site, plant cover changes from an herbaceous community to the closed canopy of a deciduous forest. Calamagrostis epigejos (Poaceae) is a common denominator at all stages, and it dominates among AM host species. Its growth response to AM fungi was studied at four distinctive stages of natural succession: 12, 20, 30, and 50 years of age, each represented by three spatially separated sites. Soils obtained from all 12 studied sites were γ-sterilized and used in a greenhouse experiment in which C. epigejos plants were (1) inoculated with a respective community of native AM fungi, (2) inoculated with reference AM fungal isolates from laboratory collection, or (3) cultivated without AM fungi. AM fungi strongly boosted plant growth during the first two stages but not during the latter two, where the effect was neutral or even negative. While plant phosphorus (P) uptake was generally increased by AM fungi, no contribution of mycorrhizae to nitrogen (N) uptake was recorded. Based on N:P in plant biomass, we related the turn from a positive to a neutral/negative effect of AM fungi on plant growth, observed along the chronosequence, to a shift in relative P and N availability. No functional differences were found between native and reference inocula, yet root colonization by the native AM fungi decreased relative to the reference inoculum in the later succession stages, thereby indicating shifts in the composition of AM fungal communities reflected in different functional characteristics of their members.

Guidelines for treatment naming in radiation oncology

PubMed Central

Shields, Lisa B. E.; Hahl, Michael; Maudlin, Casey; Bassett, Mark; Spalding, Aaron C.

2015-01-01

Safety concerns may arise from a lack of standardization and ambiguity during the treatment planning and delivery process in radiation therapy. A standardized target and organ‐at‐risk naming convention in radiation therapy was developed by a task force comprised of several Radiation Oncology Societies. We present a nested‐survey approach in a community setting to determine the methodology for radiation oncology departments to standardize their practice. Our Institution's continuous quality improvement (CQI) committee recognized that, due to growth from one to three centers, significant variability existed within plan parameters specific to patients’ treatment. A multidiscipline, multiclinical site consortium was established to create a guideline for standard naming. Input was gathered using anonymous, electronic surveys from physicians, physicists, dosimetrists, chief therapists, and nurse managers. Surveys consisted of several primary areas of interest: anatomical sites, course naming, treatment plan naming, and treatment field naming. Additional concepts included capitalization, specification of laterality, course naming in the event of multiple sites being treated within the same course of treatment, primary versus boost planning, the use of bolus, revisions for plans, image‐guidance field naming, forbidden characters, and standard units for commonly used physical quantities in radiation oncology practice. Guidelines for standard treatment naming were developed that could be readily adopted. This multidisciplinary study provides a clear, straightforward, and easily implemented protocol for the radiotherapy treatment process. Standard nomenclature facilitates the safe means of communication between team members in radiation oncology. The guidelines presented in this work serve as a model for radiation oncology clinics to standardize their practices. PACS number(s): 87.56.bd, 87.56.Fc, 87.55.Qr, 87.55.‐x, 87.55.N‐, 87.55.T‐, 87.55.D‐ PMID:27074449

Randomized ablation strategies for the treatment of persistent atrial fibrillation: RASTA study.

PubMed

Dixit, Sanjay; Marchlinski, Francis E; Lin, David; Callans, David J; Bala, Rupa; Riley, Michael P; Garcia, Fermin C; Hutchinson, Mathew D; Ratcliffe, Sarah J; Cooper, Joshua M; Verdino, Ralph J; Patel, Vickas V; Zado, Erica S; Cash, Nancy R; Killian, Tony; Tomson, Todd T; Gerstenfeld, Edward P

2012-04-01

The single-procedure efficacy of pulmonary vein isolation (PVI) is less than optimal in patients with persistent atrial fibrillation (AF). Adjunctive techniques have been developed to enhance single-procedure efficacy in these patients. We conducted a study to compare 3 ablation strategies in patients with persistent AF. Subjects were randomized as follows: arm 1, PVI + ablation of non-PV triggers identified using a stimulation protocol (standard approach); arm 2, standard approach + empirical ablation at common non-PV AF trigger sites (mitral annulus, fossa ovalis, eustachian ridge, crista terminalis, and superior vena cava); or arm 3, standard approach + ablation of left atrial complex fractionated electrogram sites. Patients were seen at 6 weeks, 6 months, and 1 year; transtelephonic monitoring was performed at each visit. Antiarrhythmic drugs were discontinued at 3 to 6 months. The primary study end point was freedom from atrial arrhythmias off antiarrhythmic drugs at 1 year after a single-ablation procedure. A total of 156 patients (aged 59±9 years; 136 males; AF duration, 47±50 months) participated (arm 1, 55 patients; arm 2, 50 patients; arm 3, 51 patients). Procedural outcomes (procedure, fluoroscopy, and PVI times) were comparable between the 3 arms. More lesions were required to target non-PV trigger sites than a complex fractionated electrogram (33±9 versus 22±9; P<0.001). The primary end point was achieved in 71 patients and was worse in arm 3 (29%) compared with arm 1 (49%; P=0.04) and arm 2 (58%; P=0.004). These data suggest that additional substrate modification beyond PVI does not improve single-procedure efficacy in patients with persistent AF. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00379301.

Effects of a 12-month multi-faceted mentoring intervention on knowledge, quality, and usage of spirometry in primary care: a before-and-after study.

PubMed

Gupta, Samir; Moosa, Dilshad; MacPherson, Ana; Allen, Christopher; Tamari, Itamar E

2016-04-21

Asthma is among the most common chronic diseases in adults. International guidelines have emphasized the importance of regular spirometry for asthma control evaluation. However, spirometry use in primary care remains low across jurisdictions. We sought to design and evaluate a knowledge translation intervention to address both the poor quality of spirometry and the underuse of spirometry in primary care. We designed a 1-year intervention consisting of initial interactive education and hands-on training followed by unstructured peer expert mentoring (through an online portal, email, telephone, videoconference, fax, and/or in-person). We recruited physician and allied health mentees from across primary care sites in Ontario, Canada. We compared spirometry-related knowledge immediately before and after the 1-year intervention period and the quality of spirometry testing and the usage of spirometry in patients with asthma in the year before and the year of the intervention. Seven of 10 (70 %) invited sites participated, including 25/90 (28 %) invited allied health mentees and 23/68 (34 %) invited physician mentees. We recruited 7 physician mentors and 4 allied health mentors to form 3 mentor-mentee pods. Spirometry knowledge scores increased from 21.4 +/- 3.1 pre- to 27.3 +/- 3.5 (out of 35) (p < 0.01) post-intervention. Spirometry acceptability and repeatability criteria were met by 59/191 (30.9 %) spirometries and 86/193 (44.6 %) spirometries [odds ratio 1.7 (1.0, 3.0)], in the pre-intervention and intervention periods, respectively. Spirometry was ordered in 75/512 (14.6 %) and 129/336 (38.4 %) respiratory visits (p < 0.01), and in 20/3490 (0.6 %) and 36/2649 (1.4 %) non-respiratory visits (p < 0.01), in the pre-intervention and intervention periods, respectively. A mentorship-based intervention involving physicians and allied health team members can enhance knowledge, quality, and actual use of spirometry in real world primary care settings. A future controlled study should assess the impact of this intervention on patient outcomes, its cost-effectiveness, and its sustainability.

Principles of Antibiotic Prophylaxis in Total Joint Arthroplasty: Current Concepts.

PubMed

Bosco, Joseph A; Bookman, Jared; Slover, James; Edusei, Emmanuel; Levine, Brett

2015-08-01

Infection is a rare, serious complication following total joint arthroplasty and constitutes a considerable emotional and financial burden for patients, surgeons, and healthcare systems. Prevention of surgical site and periprosthetic joint infections is crucial. This requires knowledge of the microorganisms that commonly cause these infections, including Staphylococcus species. Selection of the appropriate antibiotic regimen to treat infection remains controversial, but cefazolin and cefuroxime are the most commonly recommended antibiotics for prophylaxis. Appropriate timing of administration before surgery, with redosing performed as needed, can help to ensure optimal antibiotic concentration during surgery. Given the increasing evidence that S aureus colonization is a risk factor for periprosthetic joint infection, an exploration of the potential benefits of preoperative S aureus carrier screening and decolonization protocols is warranted. The use of antibiotic-loaded bone cement in primary total joint arthroplasty and antibiotic powder at wound closure are other controversial topics that require additional research. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

Staphylococcus aureus leukocidin ED contributes to systemic infection by targeting neutrophils and promoting bacterial growth in vivo

PubMed Central

Alonzo, Francis; Benson, Meredith A.; Chen, John; Novick, Richard P.; Shopsin, Bo; Torres, Victor J.

2011-01-01

SUMMARY Bloodstream infection with Staphylococcus aureus is common and can be fatal. However, virulence factors that contribute to lethality in S. aureus bloodstream infection are poorly defined. We discovered that LukED, a commonly overlooked leukotoxin, is critical for S. aureus bloodstream infection in mice. We also determined that LukED promotes S. aureus replication in vivo by directly killing phagocytes recruited to sites of hematogenously-seeded tissue. Furthermore, we established that murine neutrophils are the primary target of LukED, as the greater virulence of wild type S. aureus compared to a lukED mutant was abrogated by depleting neutrophils. The in vivo toxicity of LukED toward murine phagocytes is unique among S. aureus leukotoxins, implying its crucial role in pathogenesis. Moreover, the tropism of LukED for murine phagocytes highlights the utility of murine models to study LukED pathobiology, including development and testing of strategies to inhibit toxin activity and control bacterial infection. PMID:22142035

Cervical necrotizing fasciitis: descriptive, retrospective analysis of 59 cases treated at a single center.

PubMed

Elander, Johanna; Nekludov, Michael; Larsson, Agneta; Nordlander, Britt; Eksborg, Staffan; Hydman, Jonas

2016-12-01

To provide retrospective, descriptive information on patients with cervical necrotizing fasciitis treated at a single center during the years 1998-2014, and to evaluate the outcome of a newly introduced treatment strategy. Retrospective analysis of clinical data obtained from medical records. Mortality, pre-morbidity, severity of illness, primary site of infection, type of bacteria, time parameters. The observed 3-month mortality was 6/59 (10 %). The most common initial foci of the infection were pharyngeal, dental or hypopharyngeal. The most common pathogen was Streptococcus milleri bacteria within the Streptococcus anginosus group (66 % of the cases). Using a combined treatment with early surgical debridement combined with hyperbaric oxygen treatment, it is possible to reduce the mortality rate among patients suffering from cervical necrotizing fasciitis, compared to the expected mortality rate and to previous historical reports. Data indicated that early onset of hyperbaric oxygen treatment may have a positive impact on survival rate, but no identifiable factor was found to prognosticate outcome.

Productivity and soil properties 45 years after timber harvest and mechanical site preparation in western Montana

Treesearch

Luke M. Cerise; Deborah S. Page-Dumroese; Paul McDaniel; Cole Mayn; Robert Heinse

2013-01-01

Site preparation following timber harvests is widely used to increase seedling establishment postharvest. Historically, dozer piling and ripping were the most common forms of site preparation in the Intermountain West. Less commonly, terracing of hill slopes was another form of site preparation on the Bitterroot National Forest in western Montana from 1961-1970 on...

Common skin cancers in the United States: a practical guide for diagnosis and treatment.

PubMed

Leber, K; Perron, V D; Sinni-McKeehen, B

1999-06-01

Cutaneous malignancies are the most common cancers found in the primary care setting. It is imperative that all primary care providers become competent in evaluating skin lesions. Actinic keratoses are the most common premalignant lesions. These rough scaly plaques are the direct result of ultraviolet and other carcinogenic exposure. Actinic keratoses may be the first clinical sign to alert primary care practitioners of severe solar dermatitis and herald the development of skin cancer. Treatment is cryotherapy or topical chemotherapeutic agents such as 5-fluorouracil. Basal and squamous cell carcinomas are the most common nonmelanoma skin cancers. The primary cause is cumulative exposure to ultraviolet radiation from the sun, although other factors exist. Treatment is generally surgical excision performed by a practitioner skilled in this type of procedure contingent on tumor type, size, location, aggressiveness, and other factors. Other common treatments include electrodesiccation and curettage and cryotherapy. The incidence of malignant melanoma is the fastest rising cancer in the United States. Early detection and prevention are the mainstays of a good outcome. Depth of the lesion is the primary determinant in staging and prognosis, although other factors are also important. As the incidence of skin cancer increases, primary care practitioners play an integral role in the diagnosis, treatment, and prevention of skin cancer. The importance of early detection and appropriate referral by primary care providers will become even more crucial in the prognosis of afflicted patients.

Metastatic serous carcinoma presenting as inflammatory carcinoma over the breast-Report of two cases and literature review.

PubMed

Panse, Gauri; Bossuyt, Veerle; Ko, Christine J

2018-03-01

Non-mammary metastases involving breast are rare and most commonly involve the breast parenchyma. Infrequently, metastasis from an extramammary primary site presents as inflammatory carcinoma over the breast. Diagnosis of such lesions can be challenging, especially in patients with coexisting primary breast carcinoma. Few such cases have been described in literature; however, none of the previously reported cases had a prior history of primary breast carcinoma. We present 2 patients with history of breast carcinoma and serous carcinoma of ovarian/peritoneal origin that presented with inflammatory carcinoma over the breast. Biopsies from breast tissue showed atypical cells in the dermis forming cords and papillary structures. Histopathologic differential diagnosis included infiltrating ductal carcinoma of breast origin and metastatic serous carcinoma. Immunohistochemical studies showed that the tumor cells were positive for markers of ovarian origin such as PAX-8 and CA-125 and negative for breast markers such as GATA-3, thus supporting the diagnosis. In summary, we describe the unusual presentation of metastatic serous carcinoma as inflammatory carcinoma over breast and discuss the diagnostic challenges in patients with coexisting primary breast and ovarian malignancies. We also review the morphologic features of tumors of breast and ovarian origin and the immunohistochemical stains to differentiate these 2 entities. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A repetitive intracortical microstimulation pattern induces long-lasting synaptic depression in brain slices of the rat primary somatosensory cortex.

PubMed

Heusler, P; Cebulla, B; Boehmer, G; Dinse, H R

2000-12-01

Repetitive intracortical microstimulation (ICMS) applied to the rat primary somatosensory cortex (SI) in vivo was reported to induce reorganization of receptive fields and cortical maps. The present study was designed to examine the effect of such an ICMS pattern applied to layer IV of brain slices containing SI on the efficacy of synaptic input to layer II/III. Effects of ICMS on the synaptic strength was quantified for the first synaptic component (s1) of cortical field potentials (FPs) recorded from layer II/III of SI. FPs were evoked by stimulation in layer IV. The pattern of ICMS was identical to that used in vivo. However, stimulation intensity had to be raised to induce an alteration of synaptic strength. In brain slices superfused with standard ACSF, repetitive ICMS induced a short-lasting (60 min) reduction of the amplitude (-37%) and the slope (-61%) of s1 evoked from the ICMS site, while the amplitude and the slope of s1 evoked from a control stimulation site in cortical layer IV underwent a slow onset increase (13% and 50%, respectively). In brain slices superfused with ACSF containing 1.25 microM bicuculline, ICMS induced an initial strong reduction of the amplitude (-50%) and the slope (-79%) of s1 evoked from the ICMS site. These effects decayed to a sustained level of depression by -30% (amplitude) and -60% (slope). In contrast to experiments using standard ACSF, s1 evoked from the control site was not affected by ICMS. The presynaptic volley was not affected in either of the two groups of experiments. A conventional high frequency stimulation (HFS) protocol induced input-specific long-term potentiation (LTP) of the amplitude and slope of s1 (25% and 76%, respectively). Low frequency stimulation (LFS) induced input-specific long-term depression (LTD) of the amplitude and slope of s1 (24% and 30%, respectively). Application of common forms of conditioning stimulation (HFS and LFS) resulted in LTP or LTD of s1, indicating normal susceptibility of the brain slices studied to the induction of common forms of synaptic plasticity. Therefore, the effects of repetitive ICMS on synaptic FP components were considered ICMS-specific forms of short-lasting (standard ACSF) or long-lasting synaptic depression (ACSF containing bicuculline), the latter resembling neocortical LTD. Results of this study suggest that synaptic depression of excitatory mechanisms are involved in the cortical reorganization induced by repetitive ICMS in vivo. An additional contribution of an ICMS-induced modification of inhibitory mechanisms to cortical reorganization is discussed.

Investigation on Chinese herbal medicine for primary dysmenorrhea: implication from a nationwide prescription database in Taiwan.

PubMed

Chen, Hsing-Yu; Lin, Yi-Hsuan; Su, Irene H; Chen, Yu-Chun; Yang, Sien-Hung; Chen, Jiun-Liang

2014-02-01

Primary dysmenorrhea is a common gynecological condition, for which Chinese herbal medicine (CHM) has been widely used in addition to western medicine. The aim of this study is to explore CHM commonly used to treat dysmenorrhea in young Chinese women. Observational retrospective study. The National Health Insurance Research Database in Taiwan. Women aged from 13 to 25 years with single diagnosis of primary dysmenorrhea. CHM prescriptions made for primary dysmenorrhea women during 1998-2008 were extracted to build up CHM prescription database. Association rule mining was used to explore the prevalent CHM combination patterns in treating primary dysmenorrhea. Prevalence and mechanisms of CHM combinations. Totally 57,315 prescriptions were analyzed and, on average, 5.3 CHM was used in one prescription. Dang-Gui-Shao-Yao-San (DGSYS) was the most commonly used herbal formula (27.2%), followed by Jia-Wei-Xiao-Yao-San (JWXYS) (20.7%) and Wen-Jing-Tang (WJT) (20.5%). Corydalis yanhusuo and Cyperus rotundus were the most commonly used single herb, found in 33.1% and 29.2% of all prescriptions. Additionally, C. yanhusuo with C. rotundus is the most commonly used two CHM in combination, accounting for 14.24% of all prescriptions, followed by DGSYS with C. yanhusuo (10.47%). Multi-target effects on primary dysmenorrhea, such as analgesia, mood modifying and hormone adjustment, were found among commonly prescribed CHM in this study. This study discovered the potential importance of C. yanhusuo, C. rotundus and DGSYS in treating primary dysmenorrhea. Further clinical trials or bench studies are warranted based on the results. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Using standardised patients to measure physicians' practice: validation study using audio recordings

PubMed Central

Luck, Jeff; Peabody, John W

2002-01-01

Objective To assess the validity of standardised patients to measure the quality of physicians' practice. Design Validation study of standardised patients' assessments. Physicians saw unannounced standardised patients presenting with common outpatient conditions. The standardised patients covertly tape recorded their visit and completed a checklist of quality criteria immediately afterwards. Their assessments were compared against independent assessments of the recordings by a trained medical records abstractor. Setting Four general internal medicine primary care clinics in California. Participants 144 randomly selected consenting physicians. Main outcome measures Rates of agreement between the patients' assessments and independent assessment. Results 40 visits, one per standardised patient, were recorded. The overall rate of agreement between the standardised patients' checklists and the independent assessment of the audio transcripts was 91% (κ=0.81). Disaggregating the data by medical condition, site, level of physicians' training, and domain (stage of the consultation) gave similar rates of agreement. Sensitivity of the standardised patients' assessments was 95%, and specificity was 85%. The area under the receiver operator characteristic curve was 90%. Conclusions Standardised patients' assessments seem to be a valid measure of the quality of physicians' care for a variety of common medical conditions in actual outpatient settings. Properly trained standardised patients compare well with independent assessment of recordings of the consultations and may justify their use as a “gold standard” in comparing the quality of care across sites or evaluating data obtained from other sources, such as medical records and clinical vignettes. What is already known on this topicStandardised patients are valid and reliable reporters of physicians' practice in the medical education settingHowever, validating standardised patients' measurements of quality of care in actual primary practice is more difficult and has not been done in a prospective studyWhat this study addsReports of physicians' quality of care by unannounced standardised patients compare well with independent assessment of the consultations PMID:12351358

Using in-situ Glider Data to Improve the Interpretation of Time-Series Data in the San Pedro Channel

NASA Astrophysics Data System (ADS)

Teel, E.; Liu, X.; Seegers, B. N.; Ragan, M. A.; Jones, B. H.; Levine, N. M.

2016-02-01

Oceanic time-series have provided insight into biological, physical, and chemical processes and how these processes change over time. However, time-series data collected near coastal zones have not been used as broadly because of regional features that may prevent extrapolation of local results. Though these sites are inherently more affected by local processes, broadening the application of coastal data is crucial for improved modeling of processes such as total carbon drawdown and the development of oxygen minimum zones. Slocum gliders were deployed off the coast of Los Angeles from February to July of 2013 and 2014 providing high temporal and spatial resolution data of the San Pedro Channel (SPC), which includes the San Pedro Ocean Time Series (SPOT). The data were collapsed onto a standardized grid and primary and secondary characteristics of glider profiles were analyzed by principal component analysis to determine the processes impacting SPC and SPOT. The data fell into four categories: active upwelling, offshore intrusion, subsurface bloom, and surface bloom. Waters across the SPC were most similar to offshore water masses, even during the upwelling season when near-shore blooms are commonly observed. The SPOT site was found to be representative of the SPC 86% of the time, suggesting that the findings from SPOT are applicable for the entire SPC. Subsurface blooms were common in both years with co-located chlorophyll and particle maxima, and results suggested that these subsurface blooms contribute significantly to the local primary production. Satellite estimation of integrated chlorophyll was poor, possibly due to the prevalence of subsurface blooms and shallow optical depths during surface blooms. These results indicate that high resolution in-situ glider deployments can be used to determine the spatial domain of coastal time-series data, allowing for broader application of these datasets and greater integration into modeling efforts.

Nine-Month Outcomes of the DURABILITY Iliac Study on Self-Expanding Stents for Symptomatic Peripheral Artery Disease.

PubMed

Faries, Peter; Jaff, Michael; Peeters, Patrick; Khatib, Yazan; Roberts, David; Bosiers, Marc; Malik, Rajesh; Ravin, Reid; Rundback, John

2018-04-17

The DURABILITY Iliac clinical study evaluated the safety and effectiveness of two nitinol self-expanding stents for the treatment of atherosclerotic common and external iliac artery lesions up to 10 cm in length and >50% stenosis in subjects with Rutherford Classification peripheral arterial disease stages 2-4. DURABILITY Iliac was a prospective, multicenter, core lab adjudicated, nonrandomized clinical study enrolling 75 subjects from 15 sites in the United States and Europe. Clinical follow-up visits were at 30 days, 9 months, and 1, 2, and 3 years post procedure. The primary outcome measured was the major adverse event rate (MAE) at 9 months, defined as a composite of periprocedural death, in-hospital myocardial infarction (MI), clinically-driven target lesion revascularization (CD-TLR), and amputation of the treated limb through 9 months post-procedure. Secondary outcomes included primary patency rate at 9 months, clinically-driven target vessel revascularization (CD-TVR), change in ankle-brachial index, and change in Walking Impairment Questionnaire score at 30 days and 9 months. Device success was defined as the ability to deploy the stent as intended at the treatment site. The MAE rate at 9 months was 1.3% (1/75), with 1 subject experiencing a CD-TLR. No periprocedural deaths, myocardial infarctions, or amputations were reported. Primacy patency at 9 months was 95.8%. Freedom from CD-TVR was 98.6% at 9 months. Subjects improved in Walking Impairment Questionnaire scores for all categories (walking impairment, walking speed, walking distance, and stair climbing) at the 30-day and 9-month visit. Device success was 100%. The 9-month results of the DURABILITY Iliac study demonstrate the safety and effectiveness of 2 nitinol self-expanding stents for the treatment of atherosclerotic lesions of the common and external iliac arteries. Copyright © 2018. Published by Elsevier Inc.

Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

PubMed Central

Green, Bonnie L.; Saunders, Pamela A.; Power, Elizabeth; Dass-Brailsford, Priscilla; Schelbert, Kavitha Bhat; Giller, Esther; Wissow, Larry; Hurtado de Mendoza, Alejandra; Mete, Mihriye

2016-01-01

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs. PMID:27721673

Fall and winter habitat use and movement by Columbia River redband trout in a small stream in Montana

USGS Publications Warehouse

Muhlfeld, Clint C.; Bennett, David H.; Marotz, B.

2001-01-01

We used radiotelemetry to quantify the movements and habitat use of resident adult Columbia River redband trout Oncorhynchus mykiss gairdneri (hereafter, redband trout) from October to December 1997 in South Fork Callahan Creek, a third-order tributary to Callahan Creek in the Kootenai River drainage in northwestern Montana. All redband trout (N = 23) were consistently relocated in a stream reach with moderate gradient (2.3%) near the site of original capture. Some fish (N = 13) displayed sedentary behavior, whereas others were mobile (N = 10). The mean total distance moved during the study for all fish combined was 64 m (SD = 105 m; range, 0–362 m), and the mean home range from October through December was 67 m (SD = 99 m; range, 5–377 m). Thirteen redband trout made short upstream and downstream movements (mean total movement = 134 m; range, 8–362 m) that were related to habitat use. Mobile fish commonly migrated to complex pools that spanned the entire channel width (primary pools). Eight of 10 fish that did not change habitat location occupied primary pools, whereas the remaining 2 fish occupied lateral pools. Fish commonly overwintered in primary pools dominated by cobble and boulder substrates that contained large woody debris. As water temperatures decreased from 3.2–6.3°C in October to 0–3.8°C in November and December, we found a 29% average increase (46–75%) in the proportional use of primary pool habitats. The lack of extensive movement and small home ranges indicate that adult redband trout found suitable overwintering habitat in deep pools with extensive amounts of cover within a third-order mountain stream. Resource managers who wish to protect overwintering habitat features preferred by redband trout throughout their limited range in streams affected by land management practices could apply strategies that protect and enhance pool habitat and stream complexity.

Operative management of patients with non-spinal metastatic bone disease. Does it actually improve quality of life?

PubMed

Umer, Masood; Mohib, Yasir; Umer, Hafiz

2014-12-01

To determine the survival rate and functional outcome of skeletal stabilisation in patients with metastatic bone disease. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients with non-spinal metastatic bone disease managed surgically from January 2002 to December 2010. All patients had been managed by experienced orthopaedic, oncology and multidisciplinary teams. Patients managed by non-oncologic orthopaedic surgeons were excluded. The prognostic influence of clinical, pathological and treatment variables on Musculoskeletal Tumour Society score, range of motion, local complications and death rate were measured. SPSS 19 was used for statistical analysis. Of the 49 patients whose records were included in the study, 21(42.9%) males and 28(57.1%) females with an overall median age of 59 years. Most common primary tumour site was breast in 15(3.8%) followed by lungs in 11(22.4%), Open reduction and internal fixation was the mpst commonly used procedure in 18(36.7%) patients. Mean duration of follow-up was 30.20±29.2 SD months (range: 10-48 months). The median patient survival was 23 months. 23% patients have superficial surgical site infection. Mean Musculoskeletal Tumour Society score was 23.73±14.3 SD. The results confirm the principle that surgery for metastatic disease is done primarily to improve quality of life and ambulation status, and to alleviate pain.

Patient profile, referral sources, and consultant utilization in a primary care sports medicine clinic.

PubMed

Butcher, J D; Zukowski, C W; Brannen, S J; Fieseler, C; O'Connor, F G; Farrish, S; Lillegard, W A

1996-12-01

Sports medicine has matured as a focused discipline within primary care with the number of primary care sports medicine physicians growing annually. The practices of these physicians range from "part-time" sports medicine as a part of a broader practice in their primary specialty, to functioning as a full-time team physician for a university or college. Managed care organizations are increasingly incorporating primary care sports medicine providers into their organizations. The optimal role of these providers in a managed care system has not been described. A descriptive analysis was made of patient contacts in a referral-based, free-standing primary care sports medicine clinic associated with a large managed care system. This study describes patient information including demographic data, referral source, primary diagnosis, specialized diagnostic testing, and subsequent specialty consultation. A total of 1857 patient contacts were analyzed. New patients were referred from a full range of physicians both primary care (family practice, internal medicine, pediatrics, and emergency physicians) and other specialists, with family practice clinic providers (physicians, physician assistants, and nurse practitioners) accounting for the largest percentage of new referrals. The majority of patient visits were for orthopedic injuries (95.4%); the most frequently involved injury sites were: knee (26.5%), shoulder (18.2%), back (14.3%), and ankle (10%). The most common types of injury were: tendinitis (21.3%), chronic anterior knee pain (10.6%), and ligament sprains (9.9%). Specialized testing was requested for 8% of all patients. The majority of patients were treated at the Ft Belvoir Sports Medicine Clinic by primary care sports medicine physicians without further specialty referral. Primary care sports medicine physicians offer an intermediate level of care for patients while maintaining a practice in their primary care specialty. This dual practice is ideal in the managed care setting. This study demonstrates the complementary nature of primary care sports medicine and orthopedics, with the primary care sports medicine physician reducing the demand on orthopedists for nonsurgical treatment. This study also demonstrates the need for revision in the orthopedic curriculum for primary care physicians.

The Economy in Autologous Tissue Transfer: Part 1. The Kiss Flap Technique.

PubMed

Zhang, Yi Xin; Hayakawa, Thomas J; Levin, L Scott; Hallock, Geoffrey G; Lazzeri, Davide

2016-03-01

All reconstructive microsurgeons realize the need to improve aesthetic and functional donor-site outcomes. A "kiss" flap design concept was developed to increase the surface area of skin flap coverage while minimizing donor-site morbidity. The main goal of the kiss flap technique is to harvest multiple skin paddles that are smaller than those raised with traditional techniques, to minimize donor-site morbidity. These smaller flap components are then sutured to each other, or said to kiss each other side-by-side, to create a large, wide flap. The skin paddles in the kiss technique can be linked to one another by a variety of native intrinsic vascular connections, by additional microanastomosis, or both. This technique can be widely applied to both free and pedicle flaps, and essentially allows for the reconstruction of a large defect while providing the easy primary closure of a smaller donor-site defect. According to their origin of blood supply, kiss flaps are classified into three styles and five types. All of the different types of kiss flaps are unique in both flap design and harvest technique. Most kiss flaps are based on common flaps already familiar to the reconstructive surgeon. The basis of the kiss flap design concept is to convert multiple narrow flaps into a single unified flap of the desired greater width. This maximizes the size of the resulting flap and minimizes donor-site morbidity, as a direct linear closure is usually possible. Therapeutic, V.

Partial splenic embolization to permit continuation of systemic chemotherapy.

PubMed

Luz, Jose Hugo M; Luz, Paula M; Marchiori, Edson; Rodrigues, Leonardo A; Gouveia, Hugo R; Martin, Henrique S; Faria, Igor M; Souza, Roberto R; Gil, Roberto de Almeida; Palladino, Alexandre de M; Pimenta, Karina B; de Souza, Henrique S

2016-10-01

Systemic chemotherapy treatments, commonly those that comprise oxaliplatin, have been linked to the appearance of distinctive liver lesions that evolves to portal hypertension, spleen enlargement, platelets sequestration, and thrombocytopenia. This outcome can interrupt treatment or force dosage reduction, decreasing efficiency of cancer therapy. We conducted a prospective phase II study for the evaluation of partial splenic embolization in patients with thrombocytopenia that impeded systemic chemotherapy continuation. From August 2014 through July 2015, 33 patients underwent partial splenic embolization to increase platelets count and allow their return to treatment. Primary endpoint was the accomplishment of a thrombocyte level superior to 130 × 10 9 /L and the secondary endpoints were the return to chemotherapy and toxicity. Partial splenic embolization was done 36 times in 33 patients. All patients presented gastrointestinal cancer and colorectal malignancy was the commonest primary site. An average of 6.4 cycles of chemotherapy was done before splenic embolization and the most common regimen was Folfox. Mean platelet count prior to embolization was 69 × 10 9 /L. A total of 94% of patients achieved primary endpoint. All patients in need reinitiated treatment and median time to chemotherapy return was 14 days. No grade 3 or above adverse events were identified. Aiming for a 50% to 70% infarction area may be sufficient to achieve success without the complications associated with more extensive infarction. Combined with the better safety profile, partial splenic embolization is an excellent option in the management of thrombocytopenia, enabling the resumption of systemic chemotherapy with minimal procedure-related morbidity. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Eruption of supernumerary permanent teeth in a sample of urban primary school population in Genoa, Italy.

PubMed

Alberti, G; Mondani, P M; Parodi, V

2006-06-01

The aim of this epidemiological study was to describe the incidence and distribution of hyperdontia in the primary school population in Genoa (Italy) and to check its influence on the development of orthodontic problems in children. The collected data should also help to find out what is the best age range among children to direct a program for early diagnosis and prevention of malocclusion and oral diseases related to hyperdontia. The participating children (total number 1577, 814 males and 763 females, between 6 and 10 years of age) chosen in 19 public primary schools in Genoa have been examined by the same specialist through year 2004. Erupted permanent teeth, presence, position and form of supernumerary teeth, malocclusion presence and class, presence of orthodontic devices, age and sex have been noted down for each child. The global percentage of hyperdontia was 0.38%, more frequent in males (0.49%) than in females (0.26%). The most common kind of supernumerary tooth was mesiodens (83%). A significant increase of hyperdontia prevalence (from 0.64% to 1.06%) was noticed in children 9 years old. The incidence of malocclusion among children presenting hyperdontia was 83.3%, while the global incidence of malocclusion was 40%. An orthodontic treatment had been planned and started for 20% of children presenting malocclusion. The study has revealed an incidence of hyperdontia much more frequent in males than in females (2:1). The most common site of eruption of supernumerary teeth is maxillary anterior region. Hyperdontia is strictly related with dental malocclusion. The best age range to direct a program of early diagnosis and prevention of malocclusion and hyperdontia is 9 years old children.

Poor Prognosis of Lower Inner Quadrant in Lymph Node-negative Breast Cancer Patients Who Received No Chemotherapy: A Study Based on Nationwide Korean Breast Cancer Registry Database.

PubMed

Hwang, Ki-Tae; Kim, Jongjin; Kim, Eun-Kyu; Jung, Sung Hoo; Sohn, Guiyun; Kim, Seung Il; Jeong, Joon; Lee, Hyouk Jin; Park, Jin Hyun; Oh, Sohee

2017-07-01

We aimed to investigate the prognostic influence of primary tumor site on the survival of patients with breast cancer. Data of 63,388 patients with primary breast cancer from the Korean Breast Cancer Registry were analyzed. Primary tumor sites were classified into 5 groups: upper outer quadrant, lower outer quadrant, upper inner quadrant, lower inner quadrant (LIQ), and central portion. We analyzed overall survival (OS) and breast cancer-specific survival (BCSS) according to primary tumor site. Central portion and LIQ showed lower survival rates regarding both OS and BCSS compared with the other 3 quadrants (all P < .05) and hazard ratios were 1.267 (95% CI, 1.180-1.360, P < .001) and 1.215 (95% CI, 1.097-1.345, P < .001), respectively. Although central portion showed more unfavorable clinicopathologic features, LIQ showed more favorable features than the other 3 quadrants. Primary tumor site was a significant factor in univariate and multivariate analyses for OS and BCSS (all P < .001). For lymph node-negative patients, LIQ showed a worse OS than the other primary tumor sites in the subgroup with no chemotherapy (P < .001), but that effect disappeared in the subgroup with chemotherapy (P = .058). LIQ showed a worse prognosis despite having more favorable clinicopathologic features than other tumor locations and it was more prominent for lymph node-negative patients who received no chemotherapy. The hypothesis of possible hidden internal mammary node metastasis could be suggested to play a key role in LIQ lesions. Copyright © 2017 Elsevier Inc. All rights reserved.

How technology transfer issues are managed

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sink, C.H.; Easley, K.R.

1991-12-31

In 1989, Secretary of Energy James Watkins made a commitment to accelerate DOE compliance with all applicable laws and standards aimed at protecting human health and the environment. At a minimum, this pledge requires the remediation of the 1989 inventory of chemical, radioactive, and mixed wastes at DOE production sites by 2019. The 1989 Complex inventory consisted of more than 3,700 sites, encompassing more than 26,000 acres contaminated with radioactive, hazardous, and mixed wastes. In addition, over 500 surplus sites are awaiting decontamination and decommissioning (D and D), and approximately 5,000 peripheral properties have contaminated soils (e.g., uranium tailings). Moreover,more » these problems exist at both inactive sites, where the primary focus is on environmental restoration, and at active sites, where the major emphasis is on improved waste management techniques. Although some of DOE`s problems are considered unique due to radioactivity, most forms of contamination resident in the Complex are not; rather, contaminants such as waste chemicals (e.g., inorganics), organics (e.g., fuels and solvents), halogenated organics (e.g., PCBs) and heavy metals commonly result in conventional industrial processes. Although certain other forms of contamination are more unique to DOE operations (e.g., radioactive materials, explosives, and pyrophorics), they are not exclusive to DOE. As DOE develops innovative solutions to these and related waste problems, it is imperative that technology systems and lessons learned be transferred from DOE sites and its R and D laboratories to private industry to maximize the nation`s return on environmental management technology investments.« less

Prognostic effect of liver metastasis in lung cancer patients with distant metastasis.

PubMed

Ren, Yijiu; Dai, Chenyang; Zheng, Hui; Zhou, Fangyu; She, Yunlang; Jiang, Gening; Fei, Ke; Yang, Ping; Xie, Dong; Chen, Chang

2016-08-16

Because the need of clinical prognostic evaluation by specific metastatic organ, we aim to analyze the prognostic factors in lung cancer patients with M1b disease with Surveillance Epidemiology and End-Results database (SEER). This retrospective study evaluated lung cancer patients of adenocarcinoma (AD), squamous cell carcinoma (SQCC), and small cell lung cancer (SCLC) selected from SEER. We provided the prognostic correlates of overall survival (OS) and lung cancer-specific survival (LCSS) in this population. 23,679 eligible patients were included. Bone was the most common metastatic site in AD (63.1%) and SQCC (61.1%), while liver was the most prevalent site (61.9%) in SCLC. Single site metastasis was significantly associated with better outcome compared to multiple sites metastases in all patients. Among patients with single site metastasis, OS and LCSS were longer for AD and SCLC if involving brain or bone, with median survival time of 5 to 7 months, comparing to 3 months if invloving liver (all p-values < 0.001). Similarly, among patients with multiple metastases, better outcomes were observed in AD patients (4 vs 3 months; OS and LCSS, p < 0.001) and SCLC patients (6 vs 4 months; OS, p = 0.017; LCSS, p = 0.023) without liver metastasis compared to those with liver metastasis. In conclusion, we estimated multiple survival outcomes by histology of primary tumor and sites of metastasis. Liver metastasis is found to be the worst prognostic factor for AD and SCLC patients with distant metastasis. More in-depth research is warranted to identify patients who are prone to develop distance metastasis, especially to liver.

Primary succession of Bistorta vivipara (L.) Delabre (Polygonaceae) root-associated fungi mirrors plant succession in two glacial chronosequences.

PubMed

Davey, Marie; Blaalid, Rakel; Vik, Unni; Carlsen, Tor; Kauserud, Håvard; Eidesen, Pernille B

2015-08-01

Glacier chronosequences are important sites for primary succession studies and have yielded well-defined primary succession models for plants that identify environmental resistance as an important determinant of the successional trajectory. Whether plant-associated fungal communities follow those same successional trajectories and also respond to environmental resistance is an open question. In this study, 454 amplicon pyrosequencing was used to compare the root-associated fungal communities of the ectomycorrhizal (ECM) herb Bistorta vivipara along two primary succession gradients with different environmental resistance (alpine versus arctic) and different successional trajectories in the vascular plant communities (directional replacement versus directional non-replacement). At both sites, the root-associated fungal communities were dominated by ECM basidiomycetes and community composition shifted with increasing time since deglaciation. However, the fungal community's successional trajectory mirrored the pattern observed in the surrounding plant community at both sites: the alpine site displayed a directional-replacement successional trajectory, and the arctic site displayed a directional-non-replacement successional trajectory. This suggests that, like in plant communities, environmental resistance is key in determining succession patterns in root-associated fungi. The need for further replicated study, including in other host species, is emphasized. © 2015 Society for Applied Microbiology and John Wiley & Sons Ltd.

Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration.

PubMed

Burkhart, Lisa; Sohn, Min-Woong; Jordan, Neil; Tarlov, Elizabeth; Gampetro, Pamela; LaVela, Sherri L

2016-01-01

The Veterans Health Administration piloted patient-centered care (PCC) innovations beginning in 2010 to improve patient and provider experience and environment in ambulatory care. We use secondary data to look at longitudinal trends, evaluate system redesign, and identify areas for further quality improvement. This was a retrospective, observational study using existing secondary data from multiple US Department of Veteran Affairs sources to evaluate changes in veteran and facility outcomes associated with PCC innovations at 2 innovation and matched comparison sites between FY 2008-2010 (pre-PCC innovations) and FY 2011-2012 (post-PCC innovations). Outcomes included access to primary care providers (PCPs); primary, specialty, and emergency care use; and clinical indicators for chronic disease. Longitudinal trends revealed a different story at each site. One site demonstrated better PCP access, decrease in emergency and primary care use, increase in specialty care use, and improvement in diabetic glucose control. The other site demonstrated a decrease in PCP access and primary care use, no change in specialty care use, and an increase in diastolic blood pressure in relation to the comparison site. Secondary data analysis can reveal longitudinal trends associated with system changes, thereby informing program evaluation and identifying opportunities for quality improvement.

Incidence of eye cancer in Taiwan: an 18-year review.

PubMed

Cheng, C-Y; Hsu, W-M

2004-02-01

To describe the incidence and histologic patterns of eye cancers in Chinese in Taiwan. Beginning in 1979, cases of cancer in Taiwan were reported to the Taiwan National Cancer Registry. Information on all Chinese patients diagnosed with eye malignancies under the International Classification of Disease, Ninth Revision, site 190, was retrieved for analysis from the data bank of the Taiwan National Cancer Registry. In all, 733 cases with primary eye cancers were identified from 1979 to 1996, an 18-year period. The average annual age-standardized incidence of eye cancers was 2.46 per million population (2.57 for male and 2.33 for female). For cases less than 15 years of age, the most common eye malignancy was retinoblastoma (86.0%), followed by rhabdomyosarcoma (3.9%) and lymphoma (2.8%). For cases 15 years of age or older, the most common eye malignancy was melanoma (28.6%), followed by squamous cell sarcoma (21.0%) and lymphoma (20.8%). The time trends of the incidence of eye cancers were relatively stable over the 18-year period in Taiwan. Retinobalstoma, melanoma, and lymphoma were the three most common eye cancers in this Chinese population.

A model and nomogram to predict tumor site origin for squamous cell cancer confined to cervical lymph nodes.

PubMed

Ali, Arif N; Switchenko, Jeffrey M; Kim, Sungjin; Kowalski, Jeanne; El-Deiry, Mark W; Beitler, Jonathan J

2014-11-15

The current study was conducted to develop a multifactorial statistical model to predict the specific head and neck (H&N) tumor site origin in cases of squamous cell carcinoma confined to the cervical lymph nodes ("unknown primaries"). The Surveillance, Epidemiology, and End Results (SEER) database was analyzed for patients with an H&N tumor site who were diagnosed between 2004 and 2011. The SEER patients were identified according to their H&N primary tumor site and clinically positive cervical lymph node levels at the time of presentation. The SEER patient data set was randomly divided into 2 data sets for the purposes of internal split-sample validation. The effects of cervical lymph node levels, age, race, and sex on H&N primary tumor site were examined using univariate and multivariate analyses. Multivariate logistic regression models and an associated set of nomograms were developed based on relevant factors to provide probabilities of tumor site origin. Analysis of the SEER database identified 20,011 patients with H&N disease with both site-level and lymph node-level data. Sex, race, age, and lymph node levels were associated with primary H&N tumor site (nasopharynx, hypopharynx, oropharynx, and larynx) in the multivariate models. Internal validation techniques affirmed the accuracy of these models on separate data. The incorporation of epidemiologic and lymph node data into a predictive model has the potential to provide valuable guidance to clinicians in the treatment of patients with squamous cell carcinoma confined to the cervical lymph nodes. © 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Women with peritoneal carcinomatosis of unknown origin: Efficacy of image-guided biopsy to determine site-specific diagnosis.

PubMed

Hewitt, M J; Anderson, K; Hall, G D; Weston, M; Hutson, R; Wilkinson, N; Perren, T J; Lane, G; Spencer, J A

2007-01-01

To evaluate the use of image-guided biopsy (IGB) in routine clinical practice to obtain site-specific diagnoses in women presenting with peritoneal carcinomatosis (PC). Retrospective case study. Tertiary referral centre. A total of 149 consecutive women with PC who underwent IGB. Biopsy was performed in women considered unsuitable for primary surgery because of poor performance status or disease unlikely to be optimally debulked, with a prior history of malignancy or where there was clinicoradiological uncertainty about primary tumour site. Standard haematoxylin-eosin histological analysis was supplemented with immunohistochemistry. The rate of site-specific diagnosis. A total of 149 women underwent IGB using computed tomography or ultrasound over a 6-year period. The only complication was one rectus sheath haematoma. In 138 (93%) women, a site-specific cancer diagnosis was made on the IGB (including 111 müllerian tract, 8 gastrointestinal tract, 4 breast and 3 lymphoma); in ten women, a repeat biopsy was necessary, giving an overall failure rate of 7%. In a further six women, malignancy was confirmed but a site-specific diagnosis could not be made, and in four women, biopsy showed benign tissue. A site-specific diagnosis was obtained in 29 of the 32 women (94%) with previous malignancy, of which 18/32 (56%) showed a new primary cancer. IGB is a safe and accurate technique for providing site-specific diagnoses in women with PC in routine clinical practice, including those with a previous relevant malignancy. IGB can replace laparoscopic or open biopsy in defining primary therapeutic options. The data would suggest that the biopsy should be performed with ultrasound where feasible.

T-tube drainage versus primary closure after open common bile duct exploration.

PubMed

Gurusamy, Kurinchi Selvan; Koti, Rahul; Davidson, Brian R

2013-06-21

Between 5% and 11% of people undergoing cholecystectomy have common bile duct stones. Stones may be removed at the time of cholecystectomy by opening and clearing the common bile duct. The optimal technique is unclear. The aim is to assess the benefits and harms of T-tube drainage versus primary closure without biliary stent after open common bile duct exploration for common bile duct stones. We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2013. We included all randomised clinical trials comparing T-tube drainage versus primary closure after open common bile duct exploration. Two of four authors independently identified the studies for inclusion and extracted data. We analysed the data with both the fixed-effect and the random-effects model using Review Manager (RevMan) analyses. For each outcome we calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence interval (CI) based on intention-to-treat analysis. We included six trials randomising 359 participants, 178 to T-tube drainage and 181 to primary closure. All trials were at high risk of bias. There was no significant difference in mortality between the two groups (4/178 (weighted percentage 1.2%) in the T-tube group versus 1/181 (0.6%) in the primary closure group; RR 2.25; 95% CI 0.55 to 9.25; six trials). There was no significant difference in the serious morbidity rate between the two groups (24/136 (weighted serious morbidity rate, 145 events per 1000 patients) in the T-tube group versus 9/136 (weighted serious morbidity rate, 66 events per 1000 patients) in the primary closure group; RaR 2.19; 95% CI 0.98 to 4.91; four trials). Quality of life and return to work were not reported in any of the trials. The operating time was significantly longer in the T-tube drainage group compared with the primary closure group (MD 28.90 minutes; 95% CI 17.18 to 40.62 minutes; one trial). The hospital stay was significantly longer in the T-tube drainage group compared with the primary closure group (MD 4.72 days; 95% CI 0.83 days to 8.60 days; five trials). T-tube drainage appeared to result in significantly longer operating time and hospital stay compared with primary closure without any apparent evidence of benefit on clinically important outcomes after open common bile duct exploration. Based on the currently available evidence, there is no justification for the routine use of T-tube drainage after open common bile duct exploration in patients with common bile duct stones. T-tube drainage should not be used outside well designed randomised clinical trials. More randomised trials comparing the effects of T-tube drainage versus primary closure after open common bile duct exploration may be needed. Such trials should be conducted with low risk of bias and assessing the long-term beneficial and harmful effects of T-tube drainage, including long-term complications such as bile stricture and recurrence of common bile duct stones.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maheras, Steven J.; Best, Ralph E.; Ross, Steven B.

This report presents a preliminary evaluation of removing used nuclear fuel (UNF) from 12 shutdown nuclear power plant sites. At these shutdown sites the nuclear power reactors have been permanently shut down and the sites have been decommissioned or are undergoing decommissioning. The shutdown sites are Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, Zion, Crystal River, Kewaunee, and San Onofre. The evaluation was divided into four components: characterization of the UNF and greater-than-Class C low-level radioactive waste (GTCC waste) inventory; a description of the on-site infrastructure and conditions relevant to transportationmore » of UNF and GTCC waste; an evaluation of the near-site transportation infrastructure and experience relevant to shipping transportation casks containing UNF and GTCC waste, including identification of gaps in information; and, an evaluation of the actions necessary to prepare for and remove UNF and GTCC waste. The primary sources for the inventory of UNF and GTCC waste are the U.S. Department of Energy (DOE) RW-859 used nuclear fuel inventory database, industry sources such as StoreFUEL and SpentFUEL, and government sources such as the U.S. Nuclear Regulatory Commission. The primary sources for information on the conditions of site and near-site transportation infrastructure and experience included observations and information collected during visits to the Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, and Zion sites; information provided by managers at the shutdown sites; Facility Interface Data Sheets compiled for DOE in 2005; Services Planning Documents prepared for DOE in 1993 and 1994; industry publications such as Radwaste Solutions; and Google Earth. State and Regional Group representatives, a Tribal representative, and a Federal Railroad Administration representative participated in six of the shutdown site visits. Every site was found to have at least one off-site transportation mode option for removing its UNF and GTCC waste; some have multiple options. Experience removing large components during reactor decommissioning provided an important source of information used to identify the transportation mode options for the sites. Especially important in conducting the evaluation were site visits, through which information was obtained that would not have been available otherwise. Extensive photographs taken during the site visits proved to be particularly useful in documenting the current conditions at or near the sites. Additional conclusions from this evaluation include: The 12 shutdown sites use designs from 4 different suppliers involving 9 different (horizontal and vertical) dry storage systems that would require the use of 8 different transportation cask designs to remove the UNF and GTCC waste from the shutdown sites; Although there are common aspects, each site has some unique features and/or conditions; Although some regulatory actions will be required, all UNF at the initial 9 shutdown sites (Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, and Zion) is in licensed systems that can be transported, including a small amount of high-burnup fuel; Each site indicated that 2-3 years of advance time would be required for its preparations before shipments could begin; Most sites have more than one transportation option, e.g., rail, barge, or heavy haul truck, as well as constraints and preferences. It is expected that additional site visits will be conducted to add to the information presented in the evaluation.« less

Multi-site study of diffusion metric variability: effects of site, vendor, field strength, and echo time on regions-of-interest and histogram-bin analyses.

PubMed

Helmer, K G; Chou, M-C; Preciado, R I; Gimi, B; Rollins, N K; Song, A; Turner, J; Mori, S

2016-02-27

It is now common for magnetic-resonance-imaging (MRI) based multi-site trials to include diffusion-weighted imaging (DWI) as part of the protocol. It is also common for these sites to possess MR scanners of different manufacturers, different software and hardware, and different software licenses. These differences mean that scanners may not be able to acquire data with the same number of gradient amplitude values and number of available gradient directions. Variability can also occur in achievable b-values and minimum echo times. The challenge of a multi-site study then, is to create a common protocol by understanding and then minimizing the effects of scanner variability and identifying reliable and accurate diffusion metrics. This study describes the effect of site, scanner vendor, field strength, and TE on two diffusion metrics: the first moment of the diffusion tensor field (mean diffusivity, MD), and the fractional anisotropy (FA) using two common analyses (region-of-interest and mean-bin value of whole brain histograms). The goal of the study was to identify sources of variability in diffusion-sensitized imaging and their influence on commonly reported metrics. The results demonstrate that the site, vendor, field strength, and echo time all contribute to variability in FA and MD, though to different extent. We conclude that characterization of the variability of DTI metrics due to site, vendor, field strength, and echo time is a worthwhile step in the construction of multi-center trials.

The human myelin oligodendrocyte glycoprotein (MOG) gene: Complete nucleotide sequence and structural characterization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Paule Roth, M.; Malfroy, L.; Offer, C.

1995-07-20

Human myelin oligodendrocyte glycoprotein (MOG), a myelin component of the central nervous system, is a candidate target antigen for autoimmune-mediated demyelination. We have isolated and sequenced part of a cosmid clone that contains the entire human MOG gene. The primary nuclear transcript, extending from the putative start of transcription to the site of poly(A) addition, is 15,561 nucleotides in length. The human MOG gene contains 8 exons, separated by 7 introns; canonical intron/exon boundary sites are observed at each junction. The introns vary in size from 242 to 6484 bp and contain numerous repetitive DNA elements, including 14 Alu sequencesmore » within 3 introns. Another Alu element is located in the 3{prime}-untranslated region of the gene. Alu sequences were classified with respect to subfamily assignment. Seven hundred sixty-three nucleotides 5{prime} of the transcription start and 1214 nucleotides 3{prime} of the poly(A) addition sites were also sequenced. The 5{prime}-flanking region revealed the presence of several consensus sequences that could be relevant in the transcription of the MOG gene, in particular binding sites in common with other myelin gene promoters. Two polymorphic intragenic dinucleotide (CA){sub n} and tetranucleotide (TAAA){sub n} repeats were identified and may provide genetic marker tools for association and linkage studies. 50 refs., 3 figs., 3 tabs.« less

Children with severe early childhood caries: streptococci genetic strains within carious and white spot lesions.

PubMed

Gilbert, Kenneth; Joseph, Raphael; Vo, Alex; Patel, Trusha; Chaudhry, Samiya; Nguyen, Uyen; Trevor, Amy; Robinson, Erica; Campbell, Margaret; McLennan, John; Houran, Farielle; Wong, Tristan; Flann, Kendra; Wages, Melissa; Palmer, Elizabeth A; Peterson, John; Engle, John; Maier, Tom; Machida, Curtis A

2014-01-01

Mutans streptococci (MS) are one of the major microbiological determinants of dental caries. The objectives of this study are to identify distinct MS and non-MS streptococci strains that are located at carious sites and non-carious enamel surfaces in children with severe early childhood caries (S-ECC), and assess if cariogenic MS and non-cariogenic streptococci might independently exist as primary bacterial strains on distinct sites within the dentition of individual children. Dental plaque from children (N=20; aged 3-6) with S-ECC was collected from carious lesions (CLs), white spot lesions (WSLs) and non-carious enamel surfaces. Streptococcal isolates (N=10-20) from each site were subjected to polymerase chain reaction (PCR) to identify MS, and arbitrarily primed-PCR for assignment of genetic strains. Primary strains were identified as ≥50% of the total isolates surveyed at any site. In several cases, strains were characterized for acidurity using ATP-driven bioluminescence and subjected to PCR-determination of potential MS virulence products. Identification of non-MS was determined by 16S rRNA gene sequencing. Sixty-four independent MS or non-MS streptococcal strains were identified. All children contained 1-6 strains. In many patients (N=11), single primary MS strains were identified throughout the dentition. In other patients (N=4), primary MS strains were identified within CLs that were distinct from primary strains found on enamel. Streptococcus gordonii strains were identified as primary strains on enamel or WSLs in four children, and in general were less aciduric than MS strains. Many children with S-ECC contained only a single primary MS strain that was present in both carious and non-carious sites. In some cases, MS and non-cariogenic S. gordonii strains were found to independently exist as dominant strains at different locations within the dentition of individual children, and the aciduric potential of these strains may influence susceptibility in the development of CLs.

Clinicopathological parameters, recurrence, locoregional and distant metastasis in 115 T1-T2 oral squamous cell carcinoma patients

PubMed Central

2010-01-01

The incidence of oral squamous cell carcinoma remains high. Oral and oro-pharyngeal carcinomas are the sixth most common cancer in the world. Several clinicopathological parameters have been implicated in prognosis, recurrence and survival, following oral squamous cell carcinoma. In this retrospective analysis, clinicopathological parameters of 115 T1/T2 OSCC were studied and compared to recurrence and death from tumour-related causes. The study protocol was approved by the Joint UCL/UCLH committees of the ethics for human research. The patients' data was entered onto proformas, which were validated and checked by interval sampling. The fields included a range of clinical, operative and histopathological variables related to the status of the surgical margins. Data collection also included recurrence, cause of death, date of death and last clinic review. Causes of death were collated in 4 categories (1) death from locoregional spread, (2) death from distant metastasis, (3) death from bronchopulmonary pneumonia, and (4) death from any non-tumour event that lead to cardiorespiratory failure. The patients' population comprised 65 males and 50 females. Their mean age at the 1st diagnosis of OSCC was 61.7 years. Two-thirds of the patients were Caucasians. Primary sites were mainly identified in the tongue, floor of mouth (FOM), buccal mucosa and alveolus. Most of the identified OSCCs were low-risk (T1N0 and T2N0). All patients underwent primary resection ± neck dissection and reconstruction when necessary. Twenty-two patients needed adjuvant radiotherapy. Pathological analysis revealed that half of the patients had moderately differentiated OSCC. pTNM slightly differed from the cTNM and showed that 70.4% of the patients had low-risk OSCC. Tumour clearance was ultimately achieved in 107 patients. Follow-up resulted in a 3-year survival of 74.8% and a 5-year survival of 72.2%. Recurrence was identified in 23 males and 20 females. The mean age of 1st diagnosis of the recurrence group was 59.53 years. Most common oral sites included the lateral border of tongue and floor of mouth. Recurrence was associated with clinical N-stage disease. The surgical margins in this group was evaluated and found that 17 had non-cohesive invasion, 30 had dysplasia at margin, 21 had vascular invasion, 9 had nerve invasion and 3 had bony invasion. Severe dysplasia was present in 37 patients. Tumour clearance was achieved in only 8 patients. The mean depth of tumour invasion in the recurrence group was 7.6 mm. An interesting finding was that 5/11 patients who died of distant metastasis had their primary disease in the tongue. Nodal disease comparison showed that 8/10 patients who died of locoregional metastasis and 8/11 patients who died from distant metastasis had clinical nodal involvement. Comparing this to pathological nodal disease (pTNM) showed that 10/10 patients and 10/11 patients who died from locoregional and distant metastasis, respectively, had nodal disease. All patients who died from locoregional and distant metastasis were shown to have recurrence after the primary tumour resection. Squamous cell carcinoma of the oral cavity has a poor overall prognosis with a high tendency to recur at the primary site and extend to involve the cervical lymph nodes. Several clinicopathological parameters can be employed to assess outcome, recurrence and overall survival. PMID:20406474

Local tumor control probability modeling of primary and secondary lung tumors in stereotactic body radiotherapy.

PubMed

Guckenberger, Matthias; Klement, Rainer J; Allgäuer, Michael; Andratschke, Nicolaus; Blanck, Oliver; Boda-Heggemann, Judit; Dieckmann, Karin; Duma, Marciana; Ernst, Iris; Ganswindt, Ute; Hass, Peter; Henkenberens, Christoph; Holy, Richard; Imhoff, Detlef; Kahl, Henning K; Krempien, Robert; Lohaus, Fabian; Nestle, Ursula; Nevinny-Stickel, Meinhard; Petersen, Cordula; Semrau, Sabine; Streblow, Jan; Wendt, Thomas G; Wittig, Andrea; Flentje, Michael; Sterzing, Florian

2016-03-01

To evaluate whether local tumor control probability (TCP) in stereotactic body radiotherapy (SBRT) varies between lung metastases of different primary cancer sites and between primary non-small cell lung cancer (NSCLC) and secondary lung tumors. A retrospective multi-institutional (n=22) database of 399 patients with stage I NSCLC and 397 patients with 525 lung metastases was analyzed. Irradiation doses were converted to biologically effective doses (BED). Logistic regression was used for local tumor control probability (TCP) modeling and the second-order bias corrected Akaike Information Criterion was used for model comparison. After median follow-up of 19 months and 16 months (n.s.), local tumor control was observed in 87.7% and 86.7% of the primary and secondary lung tumors (n.s.), respectively. A strong dose-response relationship was observed in the primary NSCLC and metastatic cohort but dose-response relationships were not significantly different: the TCD90 (dose to achieve 90% TCP; BED of maximum planning target volume dose) estimates were 176 Gy (151-223) and 160 Gy (123-237) (n.s.), respectively. The dose-response relationship was not influenced by the primary cancer site within the metastatic cohort. Dose-response relationships for local tumor control in SBRT were not different between lung metastases of various primary cancer sites and between primary NSCLC and lung metastases. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A Variable Active Site Residue Influences the Kinetics of Response Regulator Phosphorylation and Dephosphorylation.

PubMed

Immormino, Robert M; Silversmith, Ruth E; Bourret, Robert B

2016-10-04

Two-component regulatory systems, minimally composed of a sensor kinase and a response regulator protein, are common mediators of signal transduction in microorganisms. All response regulators contain a receiver domain with conserved active site residues that catalyze the signal activating and deactivating phosphorylation and dephosphorylation reactions. We explored the impact of variable active site position T+1 (one residue C-terminal to the conserved Thr/Ser) on reaction kinetics and signaling fidelity, using wild type and mutant Escherichia coli CheY, CheB, and NarL to represent the three major sequence classes observed across response regulators: Ala/Gly, Ser/Thr, and Val/Ile/Met, respectively, at T+1. Biochemical and structural data together suggested that different amino acids at T+1 impacted reaction kinetics by altering access to the active site while not perturbing overall protein structure. A given amino acid at position T+1 had similar effects on autodephosphorylation in each protein background tested, likely by modulating access of the attacking water molecule to the active site. Similarly, rate constants for CheY autophosphorylation with three different small molecule phosphodonors were consistent with the steric constraints on access to the phosphorylation site arising from combination of specific phosphodonors with particular amino acids at T+1. Because other variable active site residues also influence response regulator phosphorylation biochemistry, we began to explore how context (here, the amino acid at T+2) affected the influence of position T+1 on CheY autocatalytic reactions. Finally, position T+1 affected the fidelity and kinetics of phosphotransfer between sensor kinases and response regulators but was not a primary determinant of their interaction.

Transversus Abdominis Plane Block Versus Surgical Site Infiltration for Pain Management After Open Total Abdominal Hysterectomy.

PubMed

Gasanova, Irina; Alexander, John; Ogunnaike, Babatunde; Hamid, Cherine; Rogers, David; Minhajuddin, Abu; Joshi, Girish P

2015-11-01

Surgical site infiltration and transversus abdominis plane (TAP) blocks are commonly used to improve pain relief after lower abdominal surgery. This randomized, observer-blinded study was designed to compare the analgesic efficacy of TAP blocks with surgical site infiltration in patients undergoing open total abdominal hysterectomy via a Pfannenstiel incision. Patients were randomized to receive either bilateral ultrasound-guided TAP blocks using bupivacaine 0.5% 20 mL on each side (n = 30) or surgical site infiltration with liposomal bupivacaine 266 mg diluted to 60 mL injected in the preperitoneal, subfascial, and subcutaneous planes (n = 30). The remaining aspects of the perioperative care were standardized. An investigator blinded to the group allocation documented pain scores at rest and with coughing, opioid requirements, nausea, vomiting, and rescue antiemetics in the postanesthesia care unit and at 2, 6, 12, 24, and 48 hours postoperatively. The primary outcome measure was pain scores on coughing at 6 hours postoperatively. One patient in each group was excluded from the analysis because of reoperation within 24 hours in the TAP block group and change of incision type in the infiltration group. The pain scores at rest and with coughing were significantly lower in the surgical site infiltration group at all postoperative time points (P < 0.0001) except at rest in the postanesthesia care unit. The opioid requirements between 24 and 48 hours were significantly lower in the infiltration group (P = 0.009). The nausea scores, occurrence of vomiting, and need for rescue antiemetics were similar. Surgical site infiltration provided superior pain relief at rest and on coughing, as well as reduced opioid consumption for up to 48 hours. Future studies need to compare TAP blocks with liposomal bupivacaine with surgical site infiltration with liposomal bupivacaine.

Hyperfractionated Low-Dose (21 Gy) Radiotherapy for Cranial Skeletal Metastases in Patients With High-Risk Neuroblastoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kushner, Brian H., E-mail: kushnerb@mskcc.or; Cheung, Nai-Kong V.; Barker, Christopher A.

2009-11-15

Purpose: To present a large experience (73 patients) using a standard radiotherapy (RT) protocol to prevent relapse in cranial sites where measurable metastatic neuroblastoma (NB), an adverse prognostic marker, is common. Methods and Materials: High-risk NB patients with measurable cranial disease at diagnosis or residual cranial disease after induction therapy had those sites irradiated with hyperfractionated 21 Gy; a brain-sparing technique was used for an extensive field. The patients were grouped according to the response to systemic therapy. Thus, when irradiated, Group 1 patients were in complete remission and Group 2 patients had primary refractory disease. Follow-up was from themore » start of cranial RT. Results: At 3 years, the 39 Group 1 patients had a progression-free survival rate of 51%; control of cranial disease was 79%. Two relapses involved irradiated cranial sites. Two other patients relapsed in the irradiated cranial sites 6 and 12 months after a systemic relapse. At 3 years, the 34 Group 2 patients had a progression-free survival rate of 33%; control of cranial disease was 52%. Group 2 included 19 patients who had residual cranial (with or without extracranial) disease. The cranial sites showed major (n = 13), minor (n = 2), or no response (n = 4) to RT. Five patients had progression in the cranial RT field at 10-27 months. Group 2 also included 15 patients who had persistent NB in extracranial, but not cranial, sites. Of these 15 patients, 2 relapsed in the irradiated cranial sites and elsewhere at 8 and 14 months. Cranial RT was well tolerated, with no Grade 2 or greater toxicity. Conclusion: Hyperfractionated 21-Gy cranial RT might help control NB and is feasible without significant toxicity in children.« less

Successional Distance between the Source and Recipient Influence Seed Germination and Seedling Survival during Surface Soil Replacement in SW China

PubMed Central

Shen, You-xin; Gao, Lei; Xia, Xue; Li, Yuhui; Guan, Huilin

2013-01-01

Adding propagules (source) to a degraded site (recipient) is a common way of manipulating secondary succession to restore diversity and services formerly provided by forests. However, heretofore no study has considered the effect of “successional distance” between source and recipient site. Four sites in the Shilin karst area of SW China were treated as different states along a secondary successional sere: grass, shrub, young secondary forest, and primary forest. Ten 1 m ×1m soil quadrats in the grass, shrub and young forest sites were replaced with 10 cm deep soil sources from corresponding later successional stage(s) in January 2009. Woody plant seed germination was monitored in the first year and seedling survival was monitored until the end of the second year. At the end of 2010, 2097 seeds of woody plants belonging to 45 taxa had germinated, and 3.9% of the seedlings and 7.8% of the species survived. Germination of most species was sensitive to ambient light (red, far-red, R:FR ratios, photosynthetically active radiation). Soil source and recipient site had a significant effect on the total number of seeds and number of species that germinated, and on the percentage of seedlings that survived through the end of the second year. Closer successional stages between recipient site and soil source had higher seed germination and seedling-survival percentages. However, a transition threshold exists in the young forest state, where seeds can germinate but not survive the second year. Our results, although based on an unreplicated chronosequence, suggest that successional distance between soil sources and recipient sites affect forest recruitment and restoration in degraded karst of SW China. PMID:24223891

Computational identification of developmental enhancers:conservation and function of transcription factor binding-site clustersin drosophila melanogaster and drosophila psedoobscura

DOE Office of Scientific and Technical Information (OSTI.GOV)

Berman, Benjamin P.; Pfeiffer, Barret D.; Laverty, Todd R.

2004-08-06

Background The identification of sequences that control transcription in metazoans is a major goal of genome analysis. In a previous study, we demonstrated that searching for clusters of predicted transcription factor binding sites could discover active regulatory sequences, and identified 37 regions of the Drosophila melanogaster genome with high densities of predicted binding sites for five transcription factors involved in anterior-posterior embryonic patterning. Nine of these clusters overlapped known enhancers. Here, we report the results of in vivo functional analysis of 27 remaining clusters. Results We generated transgenic flies carrying each cluster attached to a basal promoter and reporter gene,more » and assayed embryos for reporter gene expression. Six clusters are enhancers of adjacent genes: giant, fushi tarazu, odd-skipped, nubbin, squeeze and pdm2; three drive expression in patterns unrelated to those of neighboring genes; the remaining 18 do not appear to have enhancer activity. We used the Drosophila pseudoobscura genome to compare patterns of evolution in and around the 15 positive and 18 false-positive predictions. Although conservation of primary sequence cannot distinguish true from false positives, conservation of binding-site clustering accurately discriminates functional binding-site clusters from those with no function. We incorporated conservation of binding-site clustering into a new genome-wide enhancer screen, and predict several hundred new regulatory sequences, including 85 adjacent to genes with embryonic patterns. Conclusions Measuring conservation of sequence features closely linked to function - such as binding-site clustering - makes better use of comparative sequence data than commonly used methods that examine only sequence identity.« less

Convergent evolution of chromatin modification by structurally distinct enzymes: comparative enzymology of histone H3 Lys²⁷ methylation by human polycomb repressive complex 2 and vSET.

PubMed

Swalm, Brooke M; Hallenbeck, Kenneth K; Majer, Christina R; Jin, Lei; Scott, Margaret Porter; Moyer, Mikel P; Copeland, Robert A; Wigle, Tim J

2013-07-15

H3K27 (histone H3 Lys27) methylation is an important epigenetic modification that regulates gene transcription. In humans, EZH (enhancer of zeste homologue) 1 and EZH2 are the only enzymes capable of catalysing methylation of H3K27. There is great interest in understanding structure-function relationships for EZH2, as genetic alterations in this enzyme are thought to play a causal role in a number of human cancers. EZH2 is challenging to study because it is only active in the context of the multi-subunit PRC2 (polycomb repressive complex 2). vSET is a viral lysine methyltransferase that represents the smallest protein unit capable of catalysing H3K27 methylation. The crystal structure of this minimal catalytic protein has been solved and researchers have suggested that vSET might prove useful as an EZH2 surrogate for the development of active site-directed inhibitors. To test this proposition, we conducted comparative enzymatic analysis of human EZH2 and vSET and report that, although both enzymes share similar preferences for methylation of H3K27, they diverge in terms of their permissiveness for catalysing methylation of alternative histone lysine sites, their relative preferences for utilization of multimeric macromolecular substrates, their active site primary sequences and, most importantly, their sensitivity to inhibition by drug-like small molecules. The cumulative data led us to suggest that EZH2 and vSET have very distinct active site structures, despite the commonality of the reaction catalysed by the two enzymes. Hence, the EZH2 and vSET pair of enzymes represent an example of convergent evolution in which distinct structural solutions have developed to solve a common catalytic need.

KIT pathway alterations in mucosal melanomas of the vulva and other sites.

PubMed

Omholt, Katarina; Grafström, Eva; Kanter-Lewensohn, Lena; Hansson, Johan; Ragnarsson-Olding, Boel K

2011-06-15

A significant proportion of mucosal melanomas contain alterations in KIT. The aim of this study was to characterize the pattern of KIT, NRAS, and BRAF mutations in mucosal melanomas at specific sites and to assess activation of the KIT downstream RAF/MEK/extracellular signal-regulated kinase (ERK) and phosphoinositide 3-kinase (PI3K)/AKT pathways in mucosal melanoma specimens. Seventy-one primary mucosal melanomas from various sites were studied. Mutation analysis was done by DNA sequencing. Expression of KIT, phosphorylated (p)-ERK, and p-AKT was evaluated by immunohistochemistry. KIT mutations were detected in 35% (8 of 23) of vulvar, 9% (2 of 22) of anorectal, 7% (1 of 14) of nasal cavity, and 20% (1 of 5) of penile melanomas. No KIT mutations were found in 7 vaginal melanomas. The difference in KIT mutation frequency between vulvar and nonvulvar cases was statistically significant (P = 0.014). The overall frequencies of NRAS and BRAF mutations were 10% and 6%, respectively. Notably, vaginal melanomas showed a NRAS mutation rate of 43%. KIT gene amplification (≥4 copies), as assessed by quantitative real-time PCR, was observed in 19% of cases. KIT expression was associated with KIT mutation status (P < 0.001) and was more common in vulvar than nonvulvar tumors (P = 0.016). Expression of p-ERK and p-AKT was observed in 42% and 59% of tumors, respectively, and occurred irrespective of KIT/NRAS/BRAF mutation status. NRAS mutation was associated with worse overall survival in univariate analysis. Results show that KIT mutations are more common in vulvar melanomas than other types of mucosal melanomas and that both the RAF/MEK/ERK and PI3K/AKT pathways are activated in mucosal melanoma specimens. ©2011 AACR.

Contrast-enhanced [18F] fluorodeoxyglucose-positron emission tomography-computed tomography as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin.

PubMed

Jain, Avani; Srivastava, Madhur Kumar; Pawaskar, Alok Suresh; Shelley, Simon; Elangovan, Indirani; Jain, Hasmukh; Pandey, Somnath; Kalal, Shilpa; Amalachandran, Jaykanth

2015-01-01

To evaluate the advantages of contrast enhanced F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-contrast enhanced CT [CECT]) when used as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin (MUO). A total of 243 patients with fine needle aspiration cytology/biopsy proven MUO were included in this prospective study. Patients who were thoroughly evaluated for primary or primary tumor was detected by any other investigation were excluded from the analysis. Totally, 163 patients with pathological diagnosis of malignancy but no apparent sites of the primary tumor were finally selected for analysis. The site of probable primary malignancy suggested by PET-CECT was confirmed by biopsy/follow-up. PET-CECT suggested probable site of primary in 128/163 (78.52%) patients. In 30/35 remaining patients, primary tumor was not detected even after extensive work-up. In 5 patients, where PET-CECT was negative, primary was found on further extensive investigations or follow-up. The sensitivity, specificity, positive predictive value and negative predictive value of the study were 95.76%, 66.67%, 88.28% and 85.71% respectively. F-18 FDG PET-CECT aptly serves the purpose of initial imaging modality owing to high sensitivity, negative and positive predictive value. PET-CECT not only surveys the whole body for the primary malignancy but also stages the disease accurately. Use of contrast improves the diagnostic utility of modality as well as help in staging of the primary tumor. Although benefits of using PET-CECT as initial diagnostic modality are obvious from this study, there is a need for a larger study comparing conventional methods for diagnosing primary in patients with MUO versus PET-CECT.

Mechanotransduction: all signals point to cytoskeleton, matrix, and integrins

NASA Technical Reports Server (NTRS)

Alenghat, Francis J.; Ingber, Donald E.

2002-01-01

Mechanical stresses modulate cell function by either activating or tuning signal transduction pathways. Mechanotransduction, the process by which cells convert mechanical stimuli into a chemical response, occurs both in cells specialized for sensing mechanical cues and in parenchymal cells whose primary function is not mechanosensory. However, common among the various responses to mechanical stress is the importance of direct or indirect connections between the internal cytoskeleton, the extracellular matrix (ECM), and traditional signal transducing molecules. In many instances, these elements converge at focal adhesions, sites of structural attachment between the cytoskeleton and ECM that are anchored by cell surface integrin receptors. Alenghat and Ingber discuss the accumulating evidence for the central role of cytoskeleton, ECM, and integrin-anchored focal adhesions in several mechanotransduction pathways.

The Mast Cameras and Mars Descent Imager (MARDI) for the 2009 Mars Science Laboratory

NASA Technical Reports Server (NTRS)

Malin, M. C.; Bell, J. F.; Cameron, J.; Dietrich, W. E.; Edgett, K. S.; Hallet, B.; Herkenhoff, K. E.; Lemmon, M. T.; Parker, T. J.; Sullivan, R. J.

2005-01-01

Based on operational experience gained during the Mars Exploration Rover (MER) mission, we proposed and were selected to conduct two related imaging experiments: (1) an investigation of the geology and short-term atmospheric vertical wind profile local to the Mars Science Laboratory (MSL) landing site using descent imaging, and (2) a broadly-based scientific investigation of the MSL locale employing visible and very near infra-red imaging techniques from a pair of mast-mounted, high resolution cameras. Both instruments share a common electronics design, a design also employed for the MSL Mars Hand Lens Imager (MAHLI) [1]. The primary differences between the cameras are in the nature and number of mechanisms and specific optics tailored to each camera s requirements.

Molecular Determinants for Substrate Interactions with the Glycine Transporter GlyT2.

PubMed

Carland, Jane E; Thomas, Michael; Mostyn, Shannon N; Subramanian, Nandhitha; O'Mara, Megan L; Ryan, Renae M; Vandenberg, Robert J

2018-03-21

Transporters in the SLC6 family play key roles in regulating neurotransmission and are the targets for a wide range of therapeutics. Important insights into the transport mechanisms and the specificity of drug interactions of SLC6 transporters have been obtained from the crystal structures of a bacterial homologue of the family, LeuT Aa , and more recently the Drosophila dopamine transporter and the human serotonin transporter. However, there is disputed evidence that the bacterial leucine transporter, LeuT Aa , contains two substrate binding sites that work cooperatively in the mechanism of transport, with the binding of a second substrate being required for the release of the substrate from the primary site. An alternate proposal is that there may be low affinity binding sites that serve to direct the flow of substrates to the primary site. We have used a combination of molecular dynamics simulations of substrate interactions with a homology model of GlyT2, together with radiolabeled amino acid uptake assays and electrophysiological analysis of wild-type and mutant transporters, to provide evidence that substrate selectivity of GlyT2 is determined entirely by the primary substrate binding site and, furthermore, if a secondary site exists then it is a low affinity nonselective amino acid binding site.

Head and neck cutaneous squamous cell carcinoma metastatic to cervical sublevel IIb lymph nodes occurred from primary sites involving the auricle and adjacent neck.

PubMed

Maher, Nigel Gordon; Hoffman, Gary Russell

2014-03-01

Neck dissections that include sublevel IIb increase the risk of postoperative shoulder dysfunction. The purpose of this investigation was to document the incidence of level IIb metastatic lymphatic spread in a group of patients undergoing neck dissection as part of the surgical management of cutaneous squamous cell carcinoma of the head and neck. A retrospective review of the pathology records taken from 1 surgeon from June 2006 through June 2013 was carried out. The predictor variable was the primary tumor site. The outcome variable was the metastatic nodal involvement according to neck level and sublevel. Secondary variables included T stage, pathologist, tumor depth, and the presence of perineural, perilymphatic, and perivascular invasion. Data analyses were by descriptive statistics. Thirty-six patients with a total of 40 neck dissections met the inclusion criteria. The average primary site tumor depth was 14.7 mm, and there were 16 cases of poorly differentiated squamous cell carcinoma. Sublevel IIb was involved in 7.5% of cases, all of which occurred from lateralized primary sites of the head and neck. Cutaneous squamous cell carcinoma arising from the auricle and neck sites adjacent to sublevel IIb may have increased risk of metastatic involvement of sublevel IIb nodes. Further studies with larger numbers are required to determine the risk of metastasis to sublevel IIb from midline sites of the face. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

Environmental impacts of remediation of a trichloroethene-contaminated site: life cycle assessment of remediation alternatives.

PubMed

Lemming, Gitte; Hauschild, Michael Z; Chambon, Julie; Binning, Philip J; Bulle, Cécile; Margni, Manuele; Bjerg, Poul L

2010-12-01

The environmental impacts of remediation of a chloroethene-contaminated site were evaluated using life cycle assessment (LCA). The compared remediation options are (i) in situ bioremediation by enhanced reductive dechlorination (ERD), (ii) in situ thermal desorption (ISTD), and (iii) excavation of the contaminated soil followed by off-site treatment and disposal. The results showed that choosing the ERD option will reduce the life-cycle impacts of remediation remarkably compared to choosing either ISTD or excavation, which are more energy-demanding. In addition to the secondary impacts of remediation, this study includes assessment of local toxic impacts (the primary impact) related to the on-site contaminant leaching to groundwater and subsequent human exposure via drinking water. The primary human toxic impacts were high for ERD due to the formation and leaching of chlorinated degradation products, especially vinyl chloride during remediation. However, the secondary human toxic impacts of ISTD and excavation are likely to be even higher, particularly due to upstream impacts from steel production. The newly launched model, USEtox, was applied for characterization of primary and secondary toxic impacts and combined with a site-dependent fate model of the leaching of chlorinated ethenes from the fractured clay till site.

10 CFR 960.3-1-5 - Basis for site evaluations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... comparative evaluations of sites in terms of the capabilities of the natural barriers for waste isolation and.... Comparative site evaluations shall place primary importance on the natural barriers of the site. In such... only to the extent necessary to obtain realistic source terms for comparative site evaluations based on...

10 CFR 960.3-1-5 - Basis for site evaluations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... comparative evaluations of sites in terms of the capabilities of the natural barriers for waste isolation and.... Comparative site evaluations shall place primary importance on the natural barriers of the site. In such... only to the extent necessary to obtain realistic source terms for comparative site evaluations based on...

10 CFR 960.3-1-5 - Basis for site evaluations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... comparative evaluations of sites in terms of the capabilities of the natural barriers for waste isolation and.... Comparative site evaluations shall place primary importance on the natural barriers of the site. In such... only to the extent necessary to obtain realistic source terms for comparative site evaluations based on...

10 CFR 960.3-1-5 - Basis for site evaluations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... comparative evaluations of sites in terms of the capabilities of the natural barriers for waste isolation and.... Comparative site evaluations shall place primary importance on the natural barriers of the site. In such... only to the extent necessary to obtain realistic source terms for comparative site evaluations based on...

10 CFR 960.3-1-5 - Basis for site evaluations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... comparative evaluations of sites in terms of the capabilities of the natural barriers for waste isolation and.... Comparative site evaluations shall place primary importance on the natural barriers of the site. In such... only to the extent necessary to obtain realistic source terms for comparative site evaluations based on...

USEPA'S SITE PROGRAM IMPACT ON THE DEVELOPMENT AND USE OF INNOVATIVE HAZARDOUS WASTE TREATMENT

EPA Science Inventory

The USEPA's SITE Program was created to meet the increased demand for innovative technologies for hazardous waste treatment. The primary mission of the SITe Program is to expedite the cleanup of sites on the NPL. The SITE Program has two components: The Demonstration Program and ...

USEPA SITE PROGRAM APPROACH TO TECHNOLOGY TRANSFER AND REGULATORY ACCEPTANCE

EPA Science Inventory

The USEPA's SITE program was created to meet the demand for innovative technologies for hazardous waste treatment. The primary mission of the SITe Program is to expedite the cleanup of sites on the NPL. These sites often have multiple contaminants in soil and groundwater, and few...

36 CFR 228.64 - Community sites and common-use areas.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Community sites and common-use areas. 228.64 Section 228.64 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Disposal of Mineral Materials Types and Methods of Disposal § 228.64 Community sites and...

36 CFR 228.64 - Community sites and common-use areas.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 36 Parks, Forests, and Public Property 2 2014-07-01 2014-07-01 false Community sites and common-use areas. 228.64 Section 228.64 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Disposal of Mineral Materials Types and Methods of Disposal § 228.64 Community sites and...

36 CFR 228.64 - Community sites and common-use areas.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 36 Parks, Forests, and Public Property 2 2013-07-01 2013-07-01 false Community sites and common-use areas. 228.64 Section 228.64 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Disposal of Mineral Materials Types and Methods of Disposal § 228.64 Community sites and...

36 CFR 228.64 - Community sites and common-use areas.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Community sites and common-use areas. 228.64 Section 228.64 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Disposal of Mineral Materials Types and Methods of Disposal § 228.64 Community sites and...

36 CFR 228.64 - Community sites and common-use areas.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 2 2012-07-01 2012-07-01 false Community sites and common-use areas. 228.64 Section 228.64 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Disposal of Mineral Materials Types and Methods of Disposal § 228.64 Community sites and...

Sulfometuron methyl: Its use in forestry and potential phytotoxicity

Treesearch

Nathan D. Robertson; Anthony S. Davis

2010-01-01

Planting site preparation is a common practice used to enhance seedling establishment success. Site preparations include herbicide, fire, and mechanical methods. Studies designed to explore the use of herbicides as site preparation and release tools are common, and herbicides have shown their use in forestry to be logistically, economically, and ecologically...

A Learning Collaborative Approach to Improve Primary Care STI Screening.

PubMed

McKee, M Diane; Alderman, Elizabeth; York, Deborah V; Blank, Arthur E; Briggs, Rahil D; Hoidal, Kelsey E S; Kus, Christopher; Lechuga, Claudia; Mann, Marie; Meissner, Paul; Patel, Nisha; Racine, Andrew D

2017-10-01

The Bronx Ongoing Pediatric Screening (BOPS) project sought to improve screening for sexual activity and sexually transmitted infections (gonorrhea and chlamydia [GCC] and HIV) in a primary care network, employing a modified learning collaborative, real-time clinical data feedback to practices, improvement coaching, and a pay-for-quality monetary incentive. Outcomes are compared for 11 BOPS-participating sites and 10 non-participating sites. The quarterly median rate for documenting sexual activity status increased from 55% to 88% (BOPS sites) and from 13% to 74% (non-BOPS sites). GCC screening of sexually active youth increased at BOPS and non-BOPS sites. Screening at non-health care maintenance visits improved more at BOPS than non-BOPS sites. Data from nonparticipating sites suggests that introduction of an adolescent EMR template or other factors improved screening rates regardless of BOPS participation; BOPS activities appear to promote additional improvement of screening during non-health maintenance visits.

Empty Sella Syndrome

MedlinePlus

... hormone prolactin, which can interfere with the normal function of the testicles and ovaries. Primary ESS is most common in adults and women, ... hormone prolactin, which can interfere with the normal function of the testicles and ovaries. Primary ESS is most common in adults and women, ...

Variation in Postsepsis Readmission Patterns: A Cohort Study of Veterans Affairs Beneficiaries.

PubMed

Prescott, Hallie C

2017-02-01

Rehospitalization is common after sepsis, but little is known about the variation in readmission patterns across patient groups and care locations. To examine the variation in postsepsis readmission rates and diagnoses by patient age, nursing facility use, admission year, and hospital among U.S. Veterans Affairs (VA) beneficiaries. Observational cohort study of VA beneficiaries who survived a sepsis hospitalization (2009-2011) at 114 VA hospitals, stratified by age (<65 vs. ≥65 yr), nursing home usage (none, chronic, or acute), year of admission (2009, 2010, 2011), and hospital. In the primary analysis, sepsis hospitalizations were identified using a previously validated method. Sensitivity analyses were performed using alternative definitions with explicit International Classification of Diseases, Ninth Revision, Clinical Modification, codes for sepsis, and separately for severe sepsis and septic shock. The primary outcomes were rate of 90-day all-cause hospital readmission after sepsis hospitalization and proportion of readmissions resulting from specific diagnoses, including the proportion of "potentially preventable" readmissions. Readmission diagnoses were similar from 2009 to 2011, with little variation in readmission rates across hospitals. The top six readmission diagnoses (heart failure, pneumonia, sepsis, urinary tract infection, acute renal failure, and chronic obstructive pulmonary disease) accounted for 30% of all readmissions. Although about one in five readmissions had a principal diagnosis for infection, 58% of all readmissions received early systemic antibiotics. Infection accounted for a greater proportion of readmissions among patients discharged to nursing facilities compared with patients discharged to home (25.0-27.1% vs. 16.8%) and among older vs. younger patients (22.2% vs. 15.8%). Potentially preventable readmissions accounted for a quarter of readmissions overall and were more common among older patients and patients discharged to nursing facilities. Hospital readmission rates after sepsis were similar by site and admission year. Heart failure, pneumonia, sepsis, and urinary tract infection were common readmission diagnoses across all patient groups. Readmission for infection and potentially preventable diagnoses were more common in older patients and patients discharged to nursing facilities.

Quality improvement of International Classification of Diseases, 9th revision, diagnosis coding in radiation oncology: single-institution prospective study at University of California, San Francisco.

PubMed

Chen, Chien P; Braunstein, Steve; Mourad, Michelle; Hsu, I-Chow J; Haas-Kogan, Daphne; Roach, Mack; Fogh, Shannon E

2015-01-01

Accurate International Classification of Diseases (ICD) diagnosis coding is critical for patient care, billing purposes, and research endeavors. In this single-institution study, we evaluated our baseline ICD-9 (9th revision) diagnosis coding accuracy, identified the most common errors contributing to inaccurate coding, and implemented a multimodality strategy to improve radiation oncology coding. We prospectively studied ICD-9 coding accuracy in our radiation therapy--specific electronic medical record system. Baseline ICD-9 coding accuracy was obtained from chart review targeting ICD-9 coding accuracy of all patients treated at our institution between March and June of 2010. To improve performance an educational session highlighted common coding errors, and a user-friendly software tool, RadOnc ICD Search, version 1.0, for coding radiation oncology specific diagnoses was implemented. We then prospectively analyzed ICD-9 coding accuracy for all patients treated from July 2010 to June 2011, with the goal of maintaining 80% or higher coding accuracy. Data on coding accuracy were analyzed and fed back monthly to individual providers. Baseline coding accuracy for physicians was 463 of 661 (70%) cases. Only 46% of physicians had coding accuracy above 80%. The most common errors involved metastatic cases, whereby primary or secondary site ICD-9 codes were either incorrect or missing, and special procedures such as stereotactic radiosurgery cases. After implementing our project, overall coding accuracy rose to 92% (range, 86%-96%). The median accuracy for all physicians was 93% (range, 77%-100%) with only 1 attending having accuracy below 80%. Incorrect primary and secondary ICD-9 codes in metastatic cases showed the most significant improvement (10% vs 2% after intervention). Identifying common coding errors and implementing both education and systems changes led to significantly improved coding accuracy. This quality assurance project highlights the potential problem of ICD-9 coding accuracy by physicians and offers an approach to effectively address this shortcoming. Copyright © 2015. Published by Elsevier Inc.

Growth Rate and Relocation Movements of Common Nighthawk (Chordeiles minor) Nestlings in Relation to Age

USGS Publications Warehouse

Kramer, Gunnar R.; Chalfoun, Anna D.

2012-01-01

Relocation by dependent young is a survival strategy that occurs among a wide range of taxa. The Common Nighthawk (Chordeiles minor) lays its eggs on bare substrate and, once hatched, nestlings may relocate to new sites daily. We located and monitored eight Common Nighthawk nests in Grand Teton National Park, Wyoming, quantified inter-use-site distances in relation to nestling age, and calculated a nestling growth rate curve. Common Nighthawk nestlings grow in a nearly linear fashion. Nestlings moved up to 48 m in a single day and larger, older nestlings tended to move greater distances between daily use-sites.

Collaboration, Communication and Co-ordination in Agile Software Development Practice

NASA Astrophysics Data System (ADS)

Robinson, Hugh; Sharp, Helen

This chapter analyses the results of a series of observational studies of agile software developmentagile software development teams, identifying commonalities in collaboration, co-ordination and communication activities. Pairing and customer collaborationcustomer collaboration are focussed on to illustrate the nature of collaboration and communication, as are two simple physical artefacts that emerged through analysis as being an information-rich focal point for the co-ordination of collaboration and communication activities. The analysis shows that pairingpairing has common characteristics across all teams, while customer collaboration differs between the teams depending on the application and organisational context of development.

Ethnic differences in the association between depression and chronic pain: cross sectional results from UK Biobank.

PubMed

Nicholl, Barbara I; Smith, Daniel J; Cullen, Breda; Mackay, Daniel; Evans, Jonathan; Anderson, Jana; Lyall, Donald M; Fawns-Ritchie, Chloe; McIntosh, Andrew M; Deary, Ian J; Pell, Jill P; Mair, Frances S

2015-10-06

Comorbid chronic pain and depression is a challenging dyad of conditions to manage in primary care and reporting has shown to vary by ethnic group. Whether the relationship between depression and chronic pain varies by ethnicity is unclear. This study aims to explore chronic pain and depression reporting across ethnic groups and examine whether this association differs, independently of potential confounding factors. Cross-sectional study of UK Biobank participants with complete data on chronic pain and probable lifetime history of depression, who reported their ethnic group as White, Asian/Asian British or Black/Black British. Chronic pain classification: present if participants had ≥ 1 site of body pain (up to seven sites or "pain all over the body" could be selected) that lasted ≥ 3 months; extent of chronic pain categories: 0, 1, 2-3, 4-7 sites or pain all over the body. Probable depression classification: an algorithm of low mood, anhedonia and help-seeking behaviour. Relationship between depression and presence/extent of chronic pain assessed using logistic/multinomial regression models (odds ratio (OR); relative risk ratio (RRR), 95 % confidence intervals), adjusted for sociodemographic, lifestyle, and morbidity factors; and a final adjustment for current depressive symptoms. The number of participants eligible for inclusion was 144,139: 35,703 (94 %) White, 4539 (3 %) Asian, and 3897 (3 %) Black. Chronic pain was less (40.5 %, 45.8 %, 45.0 %, respectively) and depression more (22.1 %, 12.9 %, 13.8 %, respectively) commonly reported in White participants than Asian and Black participants. Statistically significant associations between depression and presence/extent of chronic pain persisted following adjustment for potential confounding variables; this relationship was strongest for Black participants (presence of chronic pain: OR 1.86 (1.52, 2.27); RRR 1 site 1.49 (1.16, 1.91), 2-3 sites 1.98 (1.53, 2.56), 4-7 sites 3.23 (2.09, 4.99), pain all over the body 3.31 (2.05, 5.33). When current depressive symptoms were considered these relationships were attenuated. Chronic pain and depression reporting varies across ethnic groups. Differences in health seeking behaviour between ethnic groups may impact on the results reported. Clinicians, particularly in primary care, need to be aware of the cultural barriers within certain ethic groups to expressing concern over mood and to consider their approach accordingly.

Elusive or Illuminating: Using the Web To Explore the Salem Witchcraft Trials.

ERIC Educational Resources Information Center

Hurter, Stephanie R.

2003-01-01

Presents Web sites useful for teaching about the Salem (Massachusetts) witchcraft trials. Includes Web sites that offer primary source material, collections of Web sites, teaching material, and sites that are interactive, including features, such as QuickTime movies. (CMK)

Single-nucleotide polymorphism in the human mu opioid receptor gene alters beta-endorphin binding and activity: possible implications for opiate addiction.

PubMed

Bond, C; LaForge, K S; Tian, M; Melia, D; Zhang, S; Borg, L; Gong, J; Schluger, J; Strong, J A; Leal, S M; Tischfield, J A; Kreek, M J; Yu, L

1998-08-04

Opioid drugs play important roles in the clinical management of pain, as well as in the development and treatment of drug abuse. The mu opioid receptor is the primary site of action for the most commonly used opioids, including morphine, heroin, fentanyl, and methadone. By sequencing DNA from 113 former heroin addicts in methadone maintenance and 39 individuals with no history of drug or alcohol abuse or dependence, we have identified five different single-nucleotide polymorphisms (SNPs) in the coding region of the mu opioid receptor gene. The most prevalent SNP is a nucleotide substitution at position 118 (A118G), predicting an amino acid change at a putative N-glycosylation site. This SNP displays an allelic frequency of approximately 10% in our study population. Significant differences in allele distribution were observed among ethnic groups studied. The variant receptor resulting from the A118G SNP did not show altered binding affinities for most opioid peptides and alkaloids tested. However, the A118G variant receptor binds beta-endorphin, an endogenous opioid that activates the mu opioid receptor, approximately three times more tightly than the most common allelic form of the receptor. Furthermore, beta-endorphin is approximately three times more potent at the A118G variant receptor than at the most common allelic form in agonist-induced activation of G protein-coupled potassium channels. These results show that SNPs in the mu opioid receptor gene can alter binding and signal transduction in the resulting receptor and may have implications for normal physiology, therapeutics, and vulnerability to develop or protection from diverse diseases including the addictive diseases.

Gastric metastasis of breast cancer: a single centre retrospective study.

PubMed

Almubarak, Maher M; Laé, Marick; Cacheux, Wulfran; de Cremoux, Patricia; Pierga, Jean-Yves; Reyal, Fabien; Bennett, Simon P; Falcou, Marie-Christine; Salmon, Remy J; Baranger, Bernard; Mariani, Pascale

2011-10-01

Digestive metastasis of breast cancer are rare but when they do occur the stomach is one of the commoner sites. To describe the clinical, endoscopic, pathological features and treatment. 35 cases of gastric metastasis were identified retrospectively between 1980 and 2008. The location of the gastric metastasis was fundus (n=15, 43%), antrum (n=15, 43%) or both (n=5, 14%). The histological subtype of primary breast cancer was invasive lobular carcinoma in 34 patients (97%). Hormonal receptors were positive in 19 out of 24 cases (79%), two out of 22 analysed were HER2 positive (9%). There were 16 (46%) patients with peritoneal carcinosis. The treatment was chemotherapy (n=13, 37%), hormonotherapy (n=2, 6%) or both (n=13, 37%). The 2-year survival rate after gastric metastasis diagnosis was 53% with a median follow up of 31 months [7-84 months]. Ninety-seven percent of gastric metastasis from breast cancers are derived from invasive lobular carcinoma. Seventy-nine percent of these are HER+ and comparison with the original histopathological slides of primary breast carcinoma should be performed to differentiate gastric metastasis from primary gastric carcinoma. Peritoneal carcinomatosis accompanied gastric metastasis in almost half the cases in this series and treatment was generally chemotherapy. Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

An unusual mode of failure of a tripolar constrained acetabular liner: a case report.

PubMed

Banks, Louisa N; McElwain, John P

2010-04-01

Dislocation after primary total hip arthroplasty (THA) is the most commonly encountered complication and is unpleasant for both the patient and the surgeon. Constrained acetabular components can be used to treat or prevent instability after primary total hip arthroplasty. We present the case of a 42-year-old female with a BMI of 41. At 18 months post-primary THA the patient underwent further revision hip surgery after numerous (more than 20) dislocations. She had a tripolar Trident acetabular cup (Stryker-Howmedica-Osteonics, Rutherford, New Jersey) inserted. Shortly afterwards the unusual mode of failure of the constrained acetabular liner was noted from radiographs in that the inner liner had dissociated from the outer. The reinforcing ring remained intact and in place. We believe that the patient's weight, combined with poor abductor musculature caused excessive demand on the device leading to failure at this interface when the patient flexed forward. Constrained acetabular components are useful implants to treat instability but have been shown to have up to 42% long-term failure rates with problems such as dissociated inserts, dissociated constraining rings and dissociated femoral rings being sited. Sometimes they may be the only option left in difficult cases such as illustrated here, but still unfortunately have the capacity to fail in unusual ways.

Management of Postembolization Syndrome Following Hepatic Transarterial Chemoembolization for Primary or Metastatic Liver Cancer.

PubMed

Blackburn, Helen; West, Sandra

2016-01-01

Transarterial chemoembolization (TACE) is an established treatment in managing liver primary neoplasms or liver metastases. Postembolization syndrome (PES) is a common adverse event defined as fever without associated sepsis, pain in the right upper quadrant, and nausea and/or vomiting. This integrative review aims to identify effective management strategies for PES or one of its characterizing symptoms (fever, pain, and nausea and/or vomiting). Searches of electronic databases MEDLINE, EMBASE, and CINAHL were conducted. Fifteen articles were identified for inclusion. Seven addressed all symptoms of PES, and 8 studies focused on individual symptoms of PES. Interventions identified are intra-arterial lidocaine, oral and intravenous analgesics, steroids, wrist-ankle acupuncture, antibiotics, and 5-HT3 receptor antagonists. Findings are explicated according to individual symptoms of PES. Intra-arterial lidocaine, steroids, and a 5-HT3 receptor antagonist are found to offer potential benefit in the management of PES symptoms. A number of interventions have shown potential benefit in the management of PES. A systemic approach using combination therapy is necessary to effectively manage characterizing symptoms. Further research is needed to determine the impact of primary disease site, TACE technique, and chemotherapeutic agent on PES. Oncology nurses are uniquely placed to undertake thorough patient assessment after TACE and implement early intervention to effectively manage PES.

[Posttraumatic primary cutaneous aspergillosis with Candida guilliermondii infection in a healthy host].

PubMed

Türkşen, Zeynep; Yağcı, Server; Karadağ, Ayşe Serap; Tezer, Ayla; Taner, Omer Faruk; Tekin, Fatih; Arıkan Akdağlı, Sevtap

2010-10-01

Opportunistic fungal infections are usually seen in immunocompromised patients. While Candida is the most prevalent agent in such infections, Aspergillus is at the second order. Primary cutaneous aspergillosis is most common in immunocompromised patients but can rarely be seen in healthy hosts as well. We report a case of posttraumatic primary cutaneous aspergillosis and Candida guilliermondii coinfection in a 70-years-old healthy man. The patient had an ulcerous lesion which developed in the site of a trauma on the middle finger of the right hand. Histopathological examination of the biopsy specimens revealed septate hyphae with dichotomous branching small circular blastospores. The cultures of the biopsy specimen yielded yellow-green colored, granular mold colonies and creamy white yeast colonies. Microscopic examination of the lactophenol cotton blue stained mold colonies indicated long conidiophores with vesicles surrounded by uniseriate phialides, compatible with Aspergillus flavus. Yeast colonies were identified as Candida guilliermondii by ID32C (BioMerieux, France) and by their microscopical morphology detected in corn meal-Tween 80 agar incubated at 25°C for 72 hours. The patient was treated properly with surgical debridement and itraconazole therapy. Since the immune system is compressed as a consequence of aging, cutaneous opportunistic fungal infections should be considered in the differential diagnosis of posttraumatic necrotic ulcers and black eschar in aged patients.

Breast cancer brain metastases show increased levels of genomic aberration based homologous recombination deficiency scores relative to their corresponding primary tumors.

PubMed

Diossy, M; Reiniger, L; Sztupinszki, Z; Krzystanek, M; Timms, K M; Neff, C; Solimeno, C; Pruss, D; Eklund, A C; Tóth, E; Kiss, O; Rusz, O; Cserni, G; Zombori, T; Székely, B; Tímár, J; Csabai, I; Szallasi, Z

2018-06-18

Based on its mechanism of action, PARP inhibitor therapy is expected to benefit mainly tumor cases with homologous recombination deficiency (HRD). Therefore, identification of tumor types with increased HRD is important for the optimal use of this class of therapeutic agents. HRD levels can be estimated using various mutational signatures from next generation sequencing data and we used this approach to determine whether breast cancer brain metastases show altered levels of HRD scores relative to their corresponding primary tumor. We used a previously published next generation sequencing dataset of twenty-one matched primary breast cancer/brain metastasis pairs to derive the various mutational signatures/HRD scores strongly associated with HRD. We also performed the myChoice HRD analysis on an independent cohort of seventeen breast cancer patients with matched primary/brain metastasis pairs. All of the mutational signatures indicative of HRD showed a significant increase in the brain metastases relative to their matched primary tumor in the previously published whole exome sequencing dataset. In the independent validation cohort the myChoice HRD assay showed an increased level in 87.5% of the brain metastases relative to the primary tumor, with 56% of brain metastases being HRD positive according to the myChoice criteria. The consistent observation that brain metastases of breast cancer tend to have higher HRD measures may raise the possibility that brain metastases may be more sensitive to PARP inhibitor treatment. This observation warrants further investigation to assess whether this increase is common to other metastatic sites as well, and whether clinical trials should adjust their strategy in the application of HRD measures for the prioritization of patients for PARP inhibitor therapy.

Misdiagnosis of primary immune thrombocytopenia and frequency of bleeding: lessons from the McMaster ITP Registry

PubMed Central

Nazy, Ishac; Clare, Rumi; Jaffer, Anushka M.; Aubie, Brandon; Li, Na; Kelton, John G.

2017-01-01

Nonspecific diagnostic criteria and uncertain estimates of severe bleeding events are fundamental gaps in knowledge of primary immune thrombocytopenia (ITP). To address these issues, we created the McMaster ITP Registry. In this report, we describe the methodology of the registry, the process for arriving at the diagnosis, and the frequency of bleeding. Consecutive patients with platelets <150 × 109/L from a tertiary hematology clinic in Canada were eligible. Patients completed a panel of investigations and were managed per clinical need. Two hematologists initially determined the cause of the thrombocytopenia using standard criteria and reevaluated the diagnosis over time, which was adjudicated at regular team meetings. Bleeding was graded from 0 (none) to 2 (severe) prospectively using an ITP-specific tool. Data were validated by duplicate chart review and source verification. Between 2010 and 2016, 614 patients were enrolled. Median follow-up for patients with >1 visit was 1.7 years (interquartile range, 0.8-3.4). At registration, 295 patients were initially diagnosed with primary ITP; of those, 36 (12.2%) were reclassified as having a different diagnosis during follow-up. At registration, 319 patients were initially diagnosed with another thrombocytopenic condition; of those, 10 (3.1%) were ultimately reclassified as having primary ITP. Of 269 patients with a final diagnosis of primary ITP, 56.5% (95% confidence interval [CI], 50.4-62.5] experienced grade 2 bleeding at 1 or more anatomical site, and 2.2% (95% CI, 0.8-4.8) had intracranial hemorrhage. Nearly 1 in 7 patients with primary ITP were misdiagnosed. Grade 2 bleeding was common. Registry data can help improve the clinical and laboratory classification of patients with ITP. PMID:29296891

Comparative Profiling of Primary Colorectal Carcinomas and Liver Metastases Identifies LEF1 as a Prognostic Biomarker

PubMed Central

Lin, Albert Y.; Chua, Mei-Sze; Choi, Yoon-La; Yeh, William; Kim, Young H.; Azzi, Raymond; Adams, Gregg A.; Sainani, Kristin; van de Rijn, Matt; So, Samuel K.; Pollack, Jonathan R.

2011-01-01

Purpose We sought to identify genes of clinical significance to predict survival and the risk for colorectal liver metastasis (CLM), the most common site of metastasis from colorectal cancer (CRC). Patients and Methods We profiled gene expression in 31 specimens from primary CRC and 32 unmatched specimens of CLM, and performed Significance Analysis of Microarrays (SAM) to identify genes differentially expressed between these two groups. To characterize the clinical relevance of two highly-ranked differentially-expressed genes, we analyzed the expression of secreted phosphoprotein 1 (SPP1 or osteopontin) and lymphoid enhancer factor-1 (LEF1) by immunohistochemistry using a tissue microarray (TMA) representing an independent set of 154 patients with primary CRC. Results Supervised analysis using SAM identified 963 genes with significantly higher expression in CLM compared to primary CRC, with a false discovery rate of <0.5%. TMA analysis showed SPP1 and LEF1 protein overexpression in 60% and 44% of CRC cases, respectively. Subsequent occurrence of CLM was significantly correlated with the overexpression of LEF1 (chi-square p = 0.042), but not SPP1 (p = 0.14). Kaplan Meier analysis revealed significantly worse survival in patients with overexpression of LEF1 (p<0.01), but not SPP1 (p = 0.11). Both univariate and multivariate analyses identified stage (p<0.0001) and LEF1 overexpression (p<0.05) as important prognostic markers, but not tumor grade or SPP1. Conclusion Among genes differentially expressed between CLM and primary CRC, we demonstrate overexpression of LEF1 in primary CRC to be a prognostic factor for poor survival and increased risk for liver metastasis. PMID:21383983

Natrelle Silicone Breast Implant Follow-Up Study: Demographics, Lifestyle, and Surgical Characteristics of More Than 50,000 Augmentation Subjects

PubMed Central

Picha, George J.; Murphy, Diane K.

2016-01-01

Background: A large, multicenter, 10-year observational study is being conducted to compare the long-term safety and effectiveness of Natrelle silicone breast implants with saline implants or national norms. Study baseline data and surgical characteristics are reported here. Methods: Women seeking primary augmentation, revision-augmentation, primary reconstruction, or revision-reconstruction participated. Eligible subjects had completed surgery and received one implant or matching implants. Baseline demographics, health, lifestyle, and surgical characteristics were recorded. Data are presented here for subjects (≥22 years old) who underwent primary augmentation or revision-augmentation. Results: Of 50,979 subjects who underwent augmentation procedures, 35,756 received silicone implants and 15,223 received saline implants. Of these, 86.3 percent underwent primary augmentation, and 13.7 percent underwent revision-augmentation; nearly all subjects (99.3 percent) received bilateral implants. In the primary augmentation group, 67.6 percent of subjects received silicone implants versus 86.1 percent in the revision-augmentation group. Median age was lower in the primary augmentation group compared with the revision-augmentation group (33 versus 42 years old, respectively). Most subjects were white nonsmokers and had attended college. Hispanic subjects and subjects with a body mass index of 25 kg/m2 or greater were more likely to receive saline versus silicone implants. Across groups, the most common characteristics by procedure or implant type included inframammary incision site (54.6 percent), partial (58.2 percent) or complete (31.9 percent) submuscular placement, smooth surface implants (93.1 percent), and implant size of 300 to 399 cc. Incision size was larger for silicone versus saline implants. Conclusion: These data add to the body of knowledge on women undergoing augmentation procedures by providing an unprecedented look at a large number of subjects. PMID:26710009

Current Treatments Available for Scleroderma Patients

MedlinePlus

... from infection from bacteria at the site of infusion, the most common include edema (swelling); accumulation of ... irritated skin and/or hardening of skin at infusion site; flushing, faintness, dizziness or lightheadedness. Less common ...

T-tube drainage versus primary closure after laparoscopic common bile duct exploration.

PubMed

Gurusamy, Kurinchi Selvan; Koti, Rahul; Davidson, Brian R

2013-06-21

T-tube drainage may prevent bile leak from the biliary tract following bile duct exploration and it offers post-operative access to the bile ducts for visualisation and exploration. Use of T-tube drainage after laparoscopic common bile duct (CBD) exploration is controversial. To assess the benefits and harms of T-tube drainage versus primary closure after laparoscopic common bile duct exploration. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2013. We included all randomised clinical trials comparing T-tube drainage versus primary closure after laparoscopic common bile duct exploration. Two of four authors independently identified the studies for inclusion and extracted data. We analysed the data with both the fixed-effect and the random-effects model meta-analyses using Review Manager (RevMan) Analysis. For each outcome we calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis. We included three trials randomising 295 participants: 147 to T-tube drainage versus 148 to primary closure. All trials had a high risk of bias. No one died during the follow-up period. There was no significant difference in the proportion of patients with serious morbidity (17/147 (weighted percentage 11.3%) in the T-tube drainage versus 9/148 (6.1%) in the primary closure group; RR 1.86; 95% CI 0.87 to 3.96; three trials), and no significant difference was found in the serious morbidity rates (weighted serious morbidity rate = 97 events per 1000 patients) in participants randomised to T-tube drainage versus serious morbidity rate = 61 events per 1000 patients in the primary closure group; RR 1.59; 95% CI 0.66 to 3.83; three trials). Quality of life was not reported in any of the trials. The operating time was significantly longer in the T-tube drainage group compared with the primary closure group (MD 21.22 minutes; 95% CI 12.44 minutes to 30.00 minutes; three trials). The hospital stay was significantly longer in the T-tube drainage group compared with the primary closure group (MD 3.26 days; 95% CI 2.49 days to 4.04 days; three trials). According to one trial, the participants randomised to T-tube drainage returned to work approximately eight days later than the participants randomised to the primary closure group (P < 0.005). T-tube drainage appears to result in significantly longer operating time and hospital stay as compared with primary closure without any evidence of benefit after laparoscopic common bile duct exploration. Based on currently available evidence, there is no justification for the routine use of T-tube drainage after laparoscopic common bile duct exploration in patients with common bile duct stones. More randomised trials comparing the effects of T-tube drainage versus primary closure after laparoscopic common bile duct exploration may be needed. Such trials should be conducted with low risk of bias, assessing the long-term beneficial and harmful effects including long-term complications such as bile stricture and recurrence of common bile duct stones.

VARIABILITY IN NET PRIMARY PRODUCTION AND CARBON STORAGE IN BIOMASS ACROSS OREGON FORESTS - AN ASSESSMENT INTEGRATING DATA FROM FOREST INVENTORIES, INTENSIVE SITES, AND REMOTE SENSING. (R828309)

EPA Science Inventory

We used a combination of data from USDA Forest Service inventories, intensive
chronosequences, extensive sites, and satellite remote sensing, to estimate biomass
and net primary production (NPP) for the forested region of western Oregon. The
study area was divided int...

A model-data comparison of gross primary productivity: Results from the North American Carbon Program site synthesis

Treesearch

Kevin Schaefer; Christopher R. Schwalm; Chris Williams; M. Altaf Arain; Alan Barr; Jing M. Chen; Kenneth J. Davis; Dimitre Dimitrov; Timothy W. Hilton; David Y. Hollinger; Elyn Humphreys; Benjamin Poulter; Brett M. Raczka; Andrew D. Richardson; Alok Sahoo; Peter Thornton; Rodrigo Vargas; Hans Verbeeck; Ryan Anderson; Ian Baker; T. Andrew Black; Paul Bolstad; Jiquan Chen; Peter S. Curtis; Ankur R. Desai; Michael Dietze; Danilo Dragoni; Christopher Gough; Robert F. Grant; Lianhong Gu; Atul Jain; Chris Kucharik; Beverly Law; Shuguang Liu; Erandathie Lokipitiya; Hank A. Margolis; Roser Matamala; J. Harry McCaughey; Russ Monson; J. William Munger; Walter Oechel; Changhui Peng; David T. Price; Dan Ricciuto; William J. Riley; Nigel Roulet; Hanqin Tian; Christina Tonitto; Margaret Torn; Ensheng Weng; Xiaolu Zhou

2012-01-01

Accurately simulating gross primary productivity (GPP) in terrestrial ecosystem models is critical because errors in simulated GPP propagate through the model to introduce additional errors in simulated biomass and other fluxes. We evaluated simulated, daily average GPP from 26 models against estimated GPP at 39 eddy covariance flux tower sites across the United States...

77 FR 30208 - Approval and Promulgation of Air Quality Implementation Plans; Maryland; Baltimore Nonattainment...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-22

... completeness criteria for 2010 is incorrect. As explained in the TSD, the missing data from the primary monitor..., appendix N. Missing data from a primary monitor at a site does not necessarily mean that the data at the monitoring site is incomplete. When data from a collocated monitor is used to substitute for missing data at...

Issues in the Development of Children's Centres on Nursery and Primary School Sites

ERIC Educational Resources Information Center

Lewis, Jane; Finnegan, Cathy; West, Anne

2011-01-01

This paper explores the development of children's centres in England between 2004 and 2008, focusing on the newly created centres that have been located on primary and nursery school sites. Using both an analysis of policy documents and interview data from three urban local authorities, we examine the use of premises and the differing priorities…

Outcomes among chronically ill adults in a medical home prototype.

PubMed

Liss, David T; Fishman, Paul A; Rutter, Carolyn M; Grembowski, David; Ross, Tyler R; Johnson, Eric A; Reid, Robert J

2013-10-01

To compare quality, utilization, and cost outcomes for patients with selected chronic illnesses at a patient-centered medical home (PCMH) prototype site with outcomes for patients with the same chronic illnesses at 19 nonintervention control sites. Nonequivalent pretest-posttest control group design. PCMH redesign results were investigated for patients with preexisting diabetes, hypertension, and/or coronary heart disease. Data from automated databases were collected for eligible enrollees in an integrated healthcare delivery system. Multivariable regression models tested for adjusted differences between PCMH patients and controls during the baseline and follow-up periods. Dependent measures under study included clinical processes and, outcomes, monthly healthcare utilization, and costs. Compared with controls over 2 years, patients at the PCMH prototype clinic had slightly better clinical outcome control in coronary heart disease (2.20 mg/dL lower mean low-density lipoprotein cholesterol; P <.001). PCMH patients changed their patterns of primary care utilization, as reflected by 86% more secure electronic message contacts (P <.001), 10% more telephone contacts (P = .003), and 6% fewer in-person primary care visits (P <.001). PCMH patients had 21% fewer ambulatory care-sensitive hospitalizations (P <.001) and 7% fewer total inpatient admissions (P = .002) than controls. During the 2-year redesign, we observed 17% lower inpatient costs (P <.001) and 7% lower total healthcare costs (P <.001) among patients at the PCMH prototype clinic. A clinic-level population-based PCMH redesign can decrease downstream utilization and reduce total healthcare costs in a subpopulation of patients with common chronic illnesses.

The site of primary T cell activation is a determinant of the balance between intrahepatic tolerance and immunity.

PubMed

Bowen, David G; Zen, Monica; Holz, Lauren; Davis, Thomas; McCaughan, Geoffrey W; Bertolino, Patrick

2004-09-01

Hepatic immunobiology is paradoxical: although the liver possesses unusual tolerogenic properties, it is also the site of effective immune responses against multiple pathogens and subject to immune-mediated pathology. The mechanisms underlying this dichotomy remain unclear. Following previous work demonstrating that the liver may act as a site of primary T cell activation, we demonstrate here that the balance between immunity and tolerance in this organ is established by competition for primary activation of CD8+ T cells between the liver and secondary lymphoid tissues, with the immune outcome determined by the initial site of activation. Using a transgenic mouse model in which antigen is expressed within both liver and lymph nodes, we show that while naive CD8+ T cells activated within the lymph nodes were capable of mediating hepatitis, cells undergoing primary activation within the liver exhibited defective cytotoxic function and shortened half-life and did not mediate hepatocellular injury. The implications of these novel findings may pertain not only to the normal maintenance of peripheral tolerance, but also to hepatic allograft tolerance and the immunopathogenesis of chronic viral hepatitis.

Selection of summer roosting sites by Indiana bats (Myotis sodalis) in Missouri

USGS Publications Warehouse

Callahan, E.V.; Drobney, R.D.; Clawson, R.L.

1997-01-01

Summer roosting sites were studied at four maternity colonies of Indiana bats (Myotis sodalis) in northern Missouri. Colonies of Indiana bats used two types of roosts, primary and alternate, that differed in intensity of use, number, and probable function. Primary roosts were denned as roosts where use by >30 bats on more than one occasion was observed. The number of primary roosts per colony ranged from one to three. All primary roosts were in standing dead trees situated in trees exposed to direct sunlight. Alternate roosts were used by smaller numbers of bats. These roosts included both living and dead trees that typically were located within the shaded forest interior. Differences in patterns of use between types of roosts seemed to be influenced by weather conditions in that use of alternate roost trees increased during periods of elevated temperature and precipitation. Indiana bats have specific requirements for roost sites, but also must be able to relocate when loss of bark, tree fall, or other events render their current roost sites unusable. Practices of forest management within the summer range of Indiana bats should favor retention of large-diameter, mature, and senescent trees.

Integrating a suicide prevention program into the primary health care network: a field trial study in Iran.

PubMed

Malakouti, Seyed Kazem; Nojomi, Marzieh; Poshtmashadi, Marjan; Hakim Shooshtari, Mitra; Mansouri Moghadam, Fariba; Rahimi-Movaghar, Afarin; Afghah, Susan; Bolhari, Jafar; Bazargan-Hejazi, Shahrzad

2015-01-01

To describe and evaluate the feasibility of integrating a suicide prevention program with Primary Health Care services and evaluate if such system can improve screening and identification of depressive disorder, reduce number of suicide attempters, and lower rate of suicide completion. This was a quasi-experimental trial in which one community was exposed to the intervention versus the control community with no such exposure. The study sites were two counties in Western Iran. The intervention protocol called for primary care and suicide prevention collaboration at different levels of care. The outcome variables were the number of suicides committed, the number of documented suicide attempts, and the number of identified depressed cases. We identified a higher prevalence of depressive disorders in the intervention site versus the control site (χ (2) = 14.8, P < 0.001). We also found a reduction in the rate of suicide completion in the intervention region compared to the control, but a higher prevalence of suicide attempts in both the intervention and the control sites. Integrating a suicide prevention program with the Primary Health Care network enhanced depression and suicide surveillance capacity and subsequently reduced the number of suicides, especially in rural areas.

Does Social Belonging to Primary Groups Protect Young People From the Effects of Pro-Suicide Sites?

PubMed

Minkkinen, Jaana; Oksanen, Atte; Näsi, Matti; Keipi, Teo; Kaakinen, Markus; Räsänen, Pekka

2016-01-01

The Internet has facilitated the existence of extreme and pathological communities that share information about ways to complete suicide or to deliberately harm or hurt oneself. This material is user-generated and easily accessible. The present study analyzed the buffering effect of social belonging to a primary group in the situation of pro-suicide site exposure. Cross-national data were collected from the US, UK, Germany, and Finland in spring 2013 and 2014 from respondents aged 15-30 years (N = 3,567). Data were analyzed by using linear regression separately for women and men for each country. A higher level of belonging to a primary group buffered the negative association of pro-suicide site exposure with mental health, measured as happiness, although the results were not consistent in the subgroups. US male subjects showed a significant buffering effect of the sense of belonging to family while the belonging to friends had a buffering effect among four other subgroups: British female and male subjects and Finnish female and male subjects. The results underline the positive potential of primary groups to shield young people's mental health in the situation of pro-suicide site exposure.

Assessing Antiretroviral Use During Gaps in HIV Primary Care Using Multisite Medicaid Claims and Clinical Data.

PubMed

Monroe, Anne K; Fleishman, John A; Voss, Cindy C; Keruly, Jeanne C; Nijhawan, Ank E; Agwu, Allison L; Aberg, Judith A; Rutstein, Richard M; Moore, Richard D; Gebo, Kelly A

2017-09-01

Some individuals who appear poorly retained by clinic visit-based retention measures are using antiretroviral therapy (ART) and maintaining viral suppression. We examined whether individuals with a gap in HIV primary care (≥180 days between HIV outpatient clinic visits) obtained ART during that gap after 180 days. HIV Research Network data from 5 sites and Medicaid Analytic Extract eligibility and pharmacy data were combined. Factors associated with having both an HIV primary care gap and a new (ie, nonrefill) ART prescription during a gap were evaluated with multinomial logistic regression. Of 6892 HIV Research Network patients, 6196 (90%) were linked to Medicaid data, and 4275 had any Medicaid ART prescription. Over half (54%) had occasional gaps in HIV primary care. Women, older people, and those with suppressed viral load were less likely to have a gap. Among those with occasional gaps (n = 2282), 51% received a new ART prescription in a gap. Viral load suppression before gap was associated with receiving a new ART prescription in a gap (odds ratio = 1.91, 95% confidence interval: 1.57 to 2.32), as was number of days in a gap (odds ratio = 1.04, 95% confidence interval: 1.02 to 1.05), and the proportion of months in the gap enrolled in Medicaid. Medicaid-insured individuals commonly receive ART during gaps in HIV primary care, but almost half do not. Retention measures based on visit frequency data that do not incorporate receipt of ART and/or viral suppression may misclassify individuals who remain suppressed on ART as not retained.

Final results of a phase 2 study using continuous 5% Imiquimod cream application in the primary treatment of high-grade vulva intraepithelial neoplasia.

PubMed

Le, Tien; Menard, Chantal; Hicks-Boucher, Wendy; Hopkins, Laura; Weberpals, Johanne; Fung-Kee-Fung, Michael

2007-09-01

To investigate the activity of 5% Imiquimod cream in the primary treatment of vulva intraepithelial neoplasia (VIN) grade 2/3. Patients with histologically confirmed VIN 2/3 were recruited from regional colposcopy units. A Simon two-stage phase 2 study design was used. Imiquimod cream was applied over the abnormal VIN areas by the patients, using an escalating dose regimen for a total treatment duration of 16 weeks. Colposcopy assessments were performed every 2 weeks to evaluate for response. A historical cohort of VIN 2/3 patients treated with primary surgical ablation was used to compare recurrence patterns. Thirty-nine patients enrolled in the study. Six patients dropped out due to side effects and non-compliance with study protocol. Thirty-six patients (92%) had VIN 3. Therapy was well tolerated with the most common observed side effects being only minor skin irritation at the application site. Histologic complete response was observed in 21 patients with partial response in another nine patients. The overall response rate was 77% using intention to treat principle. No VIN progression or cancer was diagnosed. At a median follow-up of 16 months in the whole study cohort, eight recurrences (20.5%) were observed. In comparison, the recurrence rate for primary surgically treated patients was 53.5% (p=0.013). Imiquimod cream was well tolerated and resulted in the regression in a majority of high-grade VIN lesions. The recurrence rate appeared to be comparable to primary surgical ablation.

Safety and benefit of curative surgical resection for esophageal squamous cell cancer associated with multiple primary cancers.

PubMed

Otowa, Y; Nakamura, T; Takiguchi, G; Yamamoto, M; Kanaji, S; Imanishi, T; Oshikiri, T; Suzuki, S; Tanaka, K; Kakeji, Y

2016-03-01

Enhancements in surgical techniques have led to improved outcomes for esophageal cancer. Recent findings have showed that esophageal cancer is frequently associated with multiple primary cancers, and surgical resection is usually complicated in such cases. The aim of this study was to clarify the clinical significance of surgery for patients with esophageal squamous cell cancer associated with multiple primary cancers. The clinical outcomes of surgical resection for esophageal cancer were compared among 79 patients with antecedent and/or synchronous cancers (Multiple cancer group) and 194 patients without antecedent and/or synchronous cancers (Single cancer group). The most common site of multiple primary cancers was the pharynx (36 patients; 29.7%), followed by the stomach (24 patients; 19.8%). The reconstruction method was more complicated in the Multiple cancer group as a result of the prolonged surgery time and increased blood loss. However, postoperative morbidity and overall survival (OS) did not differ between the two groups. After esophagectomy, metachronous cancers were observed in 26 patients, with 30 regions in total, and 93.1% were found to be curable. Sex was the only independent risk factors for developing metachronous cancer after esophagectomy. The presence of antecedent and synchronous cancers complicates the surgical resection of esophageal cancer; however, no differences were found in the OS and postoperative morbidity between the two groups. Therefore, surgical intervention should be selected as a first-line treatment. Because second primary cancers are often observed in esophageal cancer, we recommend a close follow-up using esophagogastroduodenoscopy and contrast-enhanced computed tomography. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prevention of Common Mental Disorders in Employees. Perspectives on Collaboration from Three Health Care Professions

PubMed Central

Michaelis, Martina; Jarczok, Marc N.; Balint, Elisabeth M.; Lange, Rahna; Zipfel, Stephan; Gündel, Harald; Junne, Florian

2018-01-01

Collaboration among occupational health physicians, primary care physicians and psychotherapists in the prevention and treatment of common mental disorders in employees has been scarcely researched. To identify potential for improvement, these professions were surveyed in Baden-Württemberg (Germany). Four hundred and fifty occupational health physicians, 1000 primary care physicians and 700 resident medical and psychological psychotherapists received a standardized questionnaire about their experiences, attitudes and wishes regarding activities for primary, secondary and tertiary prevention of common mental disorders in employees. The response rate of the questionnaire was 30% (n = 133) among occupational health physicians, 14% (n = 136) among primary care physicians and 27% (n = 186) among psychotherapists. Forty percent of primary care physicians and 33% of psychotherapists had never had contact with an occupational health physician. Psychotherapists indicated more frequent contact with primary care physicians than vice versa (73% and 49%, respectively). Better cooperation and profession-specific training on mental disorders and better knowledge about work-related stress were endorsed. For potentially involved stakeholders, the importance of interdisciplinary collaboration for better prevention and care of employees with common mental disorders is very high. Nevertheless, there is only little collaboration in practice. To establish quality-assured cooperation structures in practice, participants need applicable frameworks on an organizational and legal level. PMID:29415515

Prevention of Common Mental Disorders in Employees. Perspectives on Collaboration from Three Health Care Professions.

PubMed

Rothermund, Eva; Michaelis, Martina; Jarczok, Marc N; Balint, Elisabeth M; Lange, Rahna; Zipfel, Stephan; Gündel, Harald; Rieger, Monika A; Junne, Florian

2018-02-06

Collaboration among occupational health physicians, primary care physicians and psychotherapists in the prevention and treatment of common mental disorders in employees has been scarcely researched. To identify potential for improvement, these professions were surveyed in Baden-Württemberg (Germany). Four hundred and fifty occupational health physicians, 1000 primary care physicians and 700 resident medical and psychological psychotherapists received a standardized questionnaire about their experiences, attitudes and wishes regarding activities for primary, secondary and tertiary prevention of common mental disorders in employees. The response rate of the questionnaire was 30% ( n = 133) among occupational health physicians, 14% ( n = 136) among primary care physicians and 27% ( n = 186) among psychotherapists. Forty percent of primary care physicians and 33% of psychotherapists had never had contact with an occupational health physician. Psychotherapists indicated more frequent contact with primary care physicians than vice versa (73% and 49%, respectively). Better cooperation and profession-specific training on mental disorders and better knowledge about work-related stress were endorsed. For potentially involved stakeholders, the importance of interdisciplinary collaboration for better prevention and care of employees with common mental disorders is very high. Nevertheless, there is only little collaboration in practice. To establish quality-assured cooperation structures in practice, participants need applicable frameworks on an organizational and legal level.

Biomechanical evaluation of oversized drilling technique on primary implant stability measured by insertion torque and resonance frequency analysis

PubMed Central

Santamaría-Arrieta, Gorka; Brizuela-Velasco, Aritza; Fernández-González, Felipe J.; Chávarri-Prado, David; Chento-Valiente, Yelko; Solaberrieta, Eneko; Diéguez-Pereira, Markel; Yurrebaso-Asúa, Jaime

2016-01-01

Background This study evaluated the influence of implant site preparation depth on primary stability measured by insertion torque and resonance frequency analysis (RFA). Material and Methods Thirty-two implant sites were prepared in eight veal rib blocks. Sixteen sites were prepared using the conventional drilling sequence recommended by the manufacturer to a working depth of 10mm. The remaining 16 sites were prepared using an oversize drilling technique (overpreparation) to a working depth of 12mm. Bone density was determined using cone beam computerized tomography (CBCT). The implants were placed and primary stability was measured by two methods: insertion torque (Ncm), and RFA (implant stability quotient [ISQ]). Results The highest torque values were achieved by the conventional drilling technique (10mm). The ANOVA test confirmed that there was a significant correlation between torque and drilling depth (p<0.05). However, no statistically significant differences were obtained between ISQ values at 10 or 12 mm drilling depths (p>0.05) at either measurement direction (cortical and medullar). No statistical relation between torque and ISQ values was identified, or between bone density and primary stability (p >0.05). Conclusions Vertical overpreparation of the implant bed will obtain lower insertion torque values, but does not produce statistically significant differences in ISQ values. Key words:Implant stability quotient, overdrilling, primary stability, resonance frequency analysis, torque. PMID:27398182

Common mutation underlying primary hyperoxaluria type1 in three Indian children

PubMed Central

Chanchlani, R.; Sinha, A.; Gulati, A.; Agarwal, V.; Bagga, A.

2012-01-01

Primary hyperoxaluria is an autosomal recessive disorder caused by deficiency of alanine-glyoxylate aminotransferase, which is encoded by the AGXT gene. We report three Indian children with primary hyperoxaluria type1 having a common mutation in this gene. All patients had evidence of chronic kidney disease at the time of diagnosis, with subsequent progression to end-stage renal disease. The detection of an identical mutation in the AGXT gene suggests that specific genetic screening for this mutation may be useful when considering the diagnosis of primary hyperoxaluria type1. PMID:23439734

Common mutation underlying primary hyperoxaluria type1 in three Indian children.

PubMed

Chanchlani, R; Sinha, A; Gulati, A; Agarwal, V; Bagga, A

2012-11-01

Primary hyperoxaluria is an autosomal recessive disorder caused by deficiency of alanine-glyoxylate aminotransferase, which is encoded by the AGXT gene. We report three Indian children with primary hyperoxaluria type1 having a common mutation in this gene. All patients had evidence of chronic kidney disease at the time of diagnosis, with subsequent progression to end-stage renal disease. The detection of an identical mutation in the AGXT gene suggests that specific genetic screening for this mutation may be useful when considering the diagnosis of primary hyperoxaluria type1.

Occupancy rates of primary burrowing crayfish in natural and disturbed large river bottomlands

USGS Publications Warehouse

Loughman, Zachary J.; Welsh, Stuart A.; Simon, Thomas P.

2012-01-01

Among crayfish, primary burrowing species are the least understood ecologically. Many primary burrowing crayfish inhabit floodplains where forested landscapes have been fragmented by agricultural, industrial, or residential uses. In this study, site occupancy rates (ψ) were modeled for two primary burrowing crayfish, Fallicambarus fodiens (Cottle, 1863) and Cambarus thomai Jezerinac, 1993, from Ohio and Kanawha river floodplains in West Virginia, U.S.A. Fallicambarus fodiens is one of West Virginia’s rarest crayfish, while C. thomai is prevalent in most wetlands along both river floodplains. Occupancy rate modeling incorporated four environmental covariates (forest age, soil type, tree frequency, and land use). Based on presence/absence data, forests with tree ages >100 years (ΔQAICc = 0) and sites with loam soils (ΔQAICc = 1.80) were most likely to harbor F. fodiens populations. For C. thomai, several models were supported owing to model selection uncertainty, but those with the land use covariate had more total model weight (total w i = 0 . 54 ) than all other covariate models. Cambarus thomai rarely occupied industrial/agricultural sites, but were often present in forested and residential sites. Although the influence of covariates on site occupancy differed between species, both taxa readily utilized mature forested habitats when available. Conservation actions for F. fodiens and C. thomai should focus on preserving forested tracts along large river floodplains

Site scientific mission plan for the Southern Great Plains CART site, January-June 1995

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schneider, J.M.; Lamb, P.J.; Sisterson, D.L.

1994-12-01

The Southern Great Plains (SGP) Cloud and Radiation Testbed (CART) site is designed to help satisfy the data needs of the Atmospheric Measurement (ARM) Program Science Team. This document defines the scientific priorities for site activities during the six months beginning on January 1, 1995, and also looks forward in lesser detail to subsequent six-month periods. The primary purpose of this Site Scientific Mission Plan is to provide guidance for the development of plans for site operations. It also provides information on current plans to the ARM functional teams (Management Team, Experiment Support Team [EST], Operations Team, Data Management Teammore » [DMT], Instrument Team [IT], and Campaign Team) and serves to disseminate the plans more generally within the ARM Program and among the members of the Science Team. This document includes a description of the operational status of the site and the primary envisaged site activities, together with information concerning approved and proposed Intensive Observation Periods (IOPs). Amendments will be prepared and distributed whenever the content changes by more than 30% within a six-month period. The primary users of this document are the site operator, the site scientist, the Science Team through the ARM Program Science Director, The ARM Program Experiment Center, and the aforementioned ARM Program functional teams. This plan is a living document that will be updated and reissued every six months as the observational facilities are developed, tested, and augmented and as priorities are adjusted in response to developments in scientific planning and understanding.« less

Approaches to systematic assessment of environmental exposures posed at hazardous waste sites in the developing world: the Toxic Sites Identification Program.

PubMed

Ericson, Bret; Caravanos, Jack; Chatham-Stephens, Kevin; Landrigan, Philip; Fuller, Richard

2013-02-01

In the developing world, environmental chemical exposures due to hazardous waste sites are poorly documented. We describe the approach taken by the Blacksmith Institute's Toxic Sites Identification Program in documenting environmental chemical exposures due to hazardous waste sites globally, identifying sites of concern and quantifying pathways, populations, and severity of exposure. A network of local environmental investigators was identified and trained to conduct hazardous waste site investigations and assessments. To date, 2,095 contaminated sites have been identified within 47 countries having an estimated population at risk of 71,500,000. Trained researchers and investigators have visited 1,400 of those sites. Heavy metals are the leading primary exposures, with water supply and ambient air being the primary routes of exposure. Even though chemical production has occurred largely in the developed world to date, many hazardous waste sites in the developing world pose significant hazards to the health of large portions of the population. Further research is needed to quantify potential health and economic consequences and identify cost-effective approaches to remediation.

Percutaneous coronary intervention with off-site cardiac surgery backup for acute myocardial infarction as a strategy to reduce door-to-balloon time.

PubMed

Peels, Hans O; de Swart, Hans; Ploeg, Tjeerd V D; Hautvast, Raymond W; Cornel, Jan H; Arnold, Alf E; Wharton, Thomas P; Umans, Victor A

2007-11-01

We investigated whether primary percutaneous coronary intervention (PCI) for patients admitted with an acute ST-segment elevation myocardial infarction could be performed more rapidly and with comparable outcomes in a community hospital versus a tertiary center with cardiac surgery. We started the first PCI with an off-site surgery program in The Netherlands in 2002 and report the results of 439 consecutive patients. In the safety phase, 199 patients presenting with ST-segment elevation myocardial infarction were randomly assigned to treatment at our off-site center versus a more distant cardiac surgery center. In the confirmation phase, 240 consecutive patients were treated in the off-site hospital. Safety and efficacy end points were the rate of an angiographically successful PCI procedure (diameter stenosis <50% and Thrombolysis In Myocardial Infarction grade 3 flow) in the absence of major adverse cardiac and cerebrovascular events at 30 days. The randomization phase showed a 37-minute decrease in door-to-balloon time (p <0.001) with comparable procedural and clinical successes (91% Thrombolysis In Myocardial Infarction grade 3 flow in the 2 groups). In the confirmation phase, the 30-day rate without major adverse cardiac and cerebrovascular events was 95%. None of the 439 patients in the study required emergency surgery for failed primary PCI. In conclusion, time to treatment with primary PCI can be significantly shortened when treating patients in a community hospital setting with off-site cardiac surgery backup compared with transport for PCI to a referral center with on-site surgery. PCI at hospitals with off-site cardiac surgery backup can be considered a needed strategy to improve access to primary PCI for a larger segment of the population and can be delivered with a very favorable safety profile.

Expanding rural primary care training by employing information technologies: the need for participation by medical reference librarians.

PubMed

Coggan, J M; Crandall, L A

1995-01-01

The use of rural sites to train badly needed primary care providers requires access to sophisticated medical information not traditionally available outside of academic health centers. Medical reference librarians can play a key role in the development of primary care training sites in rural settings. Electronic information technologies, with proactive support from medical reference librarians, can provide current and detailed information without concern for distance from the health science center library. This paper discusses recent developments in technology, describes current challenges to the application of this technology in rural settings, and provides policy recommendations for medical reference librarians to enhance rural primary care training.

ErbB receptors in the biology and pathology of the aerodigestive tract

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morgan, Sarah; Suite 500, Pittsburgh, PA 15213; Grandis, Jennifer R.

2009-02-15

The most common sites of malignancies in the aerodigestive tract include the lung, head and neck and the esophagus. Esophageal adenocarcinomas (EA), esophageal squamous cell carcinomas (ESCC), and squamous cell carcinomas of the head and neck (SCCHN) are the primary focus of this review. Traditional treatment for aerodigestive tract cancers includes primary chemoradiotherapy (CRT) or surgical resection followed by radiation (or CRT). Recent developments in treatment have focused increasingly on molecular targeting strategies including cetuximab (a monoclonal antibody against epidermal growth factor receptor (EGFR)). Cetuximab was FDA approved in 2006 for treatment of SCCHN, underscoring the importance of understanding themore » biology of these malignancies. EGFR is a member of the ErbB family of growth factor receptor tyrosine kinases. The major pathways activated by ErbB receptors include Ras/Raf/MAPK; PI3K/AKT; PLC{gamma} and STATs, all of which lead to the transcription of target genes that may contribute to aerodigestive tumor progression. This review explores the expression of ErbB receptors in EA, ESCC and SCCHN and the signaling pathways of EGFR in SCCHN.« less