bluuebunny/crossref_metadata_2025 huggingface dataset:
Demographic and Functional Characteristics of National Veterans Wheelchair Games Participants: A Cross-sectional Study
Authors: Lee-Hauser Cecelia Rose , Schein Richard M , Schiappa Vince J , Pruziner Alison L , Tostenrude Dave , Goedhard Kristine E , Nelson Leif M , Schmeler Mark R
Published: December 2020

Introduction

Although many studies report the impact of adaptive sports and recreation on quality of life for people with disabilities across several age groups, few have focused on the Veteran population. The purpose of this study was to establish a baseline of common characteristics of the Veteran population that participated in the National Veterans Wheelchair Games (NVWG) in 2017 and 2018, including their perception on how their participation is associated with function and social factors.

Materials and methods

A cross-sectional study was implemented as part of a quality assurance collaboration between the University of Pittsburgh and the Veterans Administration National Veterans Sports Programs and Special Events. Demographic and quality-of-life data were collected through the Functional Mobility Assessment (FMA) and associated Uniform Dataset as well as the Sports Participation Outcome Research Tool and Comprehensive Uniform Survey (SPORTACUS). This report provides and discusses the descriptive analyses that were performed on the data and establishes a framework to assess the impact of sports and exercise for Veterans with disabilities.

Results

A sample of 426 Veterans, 87% who were male and an average population age of 56 years old, reported high FMA scores on each of 10 items (daily routine, comfort, health, operate, reach, transfer, personal care, indoor mobility, outdoor mobility, and transportation) along with SPORTACUS scores scoring above 5, based on a 1-6 scoring scale (1 being “completely disagree” and 6 being “completely agree”), on each domain indicating sports participation is associated with their ability to function and participate in the community.

Conclusion

Based on these results, it can be concluded for this military Veteran population that participation in a large, organized adaptive sports programs such as the NVWG has a positive association with daily function, quality of life, community participation, and use of higher quality assistive technology.
Unusual Case of Acute Decompensated Maple Syrup Urine Disease in the Emergency Department
Authors: Tobin Michael R , Grisham Justin , Brigg Andrew , Kinder Bradley
Published: December 2020

A case report of an army soldier presenting to the emergency department with acute metabolic derangement resulting in encephalopathy, cerebral edema, and death is presented. The patient had no medical diagnoses before entering military service and was triaged in the emergency department with the common complaint of presyncope. However, as encephalopathy worsened, the patient experienced altered mental status, lethargy, emesis, and seizure. This patient ultimately died because of rapid decompensation. Maple syrup urine disease pathophysiology and treatment recommendations are reviewed.
Advancing Prehospital Combat Casualty Evacuation: Patients Amenable to Aeromedical Evacuation via Unmanned Aerial Vehicles
Authors: Maddry Joseph K , Arana Allyson A , Mora Alejandra G , Perez Crystal A , Cutright Julie E , Kester Braden M , Ng Patrick C , Schauer Steven G , Bebarta Vikhyat S
Published: December 2020

Introduction

The U.S. military currently utilizes unmanned aerial vehicles (UAVs) for reconnaissance and attack missions; however, as combat environment technology advances, there is the increasing likelihood of UAV utilization in prehospital aeromedical evacuation. Although some combat casualties require life-saving interventions (LSIs) during medical evacuation, many do not. Our objective was to describe patients transported from the point of injury to the first level of care and characterize differences between patients who received LSIs en route and those who did not.

Materials and Methods

We conducted a retrospective review of the records of traumatically injured patients evacuated between January 2011 and March 2014. We compared patient characteristics, complications, and outcomes based on whether they had an LSI performed en route (LSI vs. No LSI). We also constructed logistic regression models to determine which characteristics predict uneventful flights (no en route LSI or complications).

Results

We examined 1,267 patient records; 47% received an LSI en route. Most patients (72%) sustained a blast injury and injuries to the extremities and head. Over 78% experienced complications en route; the LSI group had higher rates of complications compared to the No LSI group. Logistic regression showed that having a blunt injury or the highest abbreviated injury scale (AIS) severity score in the head/neck region are significant predictors of having an uneventful flight.

Conclusion

Approximately half of casualties evaluated in our study did not receive an LSI during transport and may have been transported safely by UAV. Having a blunt injury or the highest AIS severity score in the head/neck region significantly predicted an uneventful flight.
Forward Surgical Teams as a Model for Humanitarian Orthopedic Surgical Care: A Review of Current Literature
Authors: Recker Andrew J , Danelson Kerry , Coates Kevin E
Published: December 2020

Introduction

Orthopedic trauma is a significant portion of global burden of disease in low- and middle-income countries (LMICs). This has led the World Health Organization to advocate for increased surgical intervention in LMICs. The two largest barriers to orthopedic surgical care for LMICs are cost of procedure and geographic access to centers with appropriate surgical capabilities. There is no current consensus on how to structure surgical interventional teams. The overall objective of this study is to describe the composition of a forward surgical team (FST), including its abilities and limitations. It is hypothesized that an FST is an effective model for orthopedic surgical relief efforts in LMICs.

Methods

A narrative literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis standards published by the National Academies of Medicine. Studies were evaluated by structured review procedures to identify an FST’s capacity for orthopedic surgery, as well as applicability for humanitarian care. Articles detailing FST logistics, types of orthopedic treatment provided, and instances of humanitarian care while deployed in austere environments were included for review.

Results

The FST is a military surgical unit operating with a small crew of surgeons and supporting staff who use tents or trailers that can be positioned near points of conflict, often in remote or austere environments. FSTs were designed to treat traumatic injuries, including orthopedic trauma from RTIs. If used as a sponsored humanitarian aid mission, FSTs can provide surgical care at free or greatly reduced costs. Because FSTs carry limited supplies and personnel, they are highly mobile surgical units that can be transported via truck.

Conclusion

FSTs are effective models for humanitarian orthopedic surgery in LMICs. FSTs were designed to treat orthopedic trauma, the largest burden of orthopedic care in LMICs. Efficient use of limited equipment allows FSTs to be cost effective for funding sources and highly mobile to reduce the geographic barrier to care. Further research is needed to determine the cost to operate an FST and ethical consideration for military intervention for foreign humanitarian aid.
A Rare Case of Rib Fractures During Centrifuge Training
Authors: Tu Min-Yu , Chu Hsin , Huang Yi-Jhih , Chiang Kwo-Tsao , Tong Pao-Tsung , Lai Chung-Yu
Published: December 2020

There are several injuries potentially related to high-G exposure, including neck and back pain, spinal fractures, and pneumomediastinum. We present a young military pilot diagnosed with isolated fractures of the right 9th and 10th ribs via X-ray after high-G exposure (maximum G level: 9G). This patient presented with progressive and localized pain in the right anterior chest and flank region. After conservative treatment with rest and pain management, he recovered from the rib fractures and completed all profile challenges in the advanced high-G training program. A review of the annual health examination of the pilot did not show any rib lesions or other related illnesses. He was qualified for flying class II and considered fit for flight training. His medication history was unremarkable, and he did not have a family history of malignancy, osteoporosis, or osteopenia. He also denied having previously experienced trauma of the rib cage or participated in any strenuous military training program or exercise before centrifuge training. The potential explanations for the multiple rib fractures are repetitive stress from the anti-G straining maneuver and anti-G suit compression of the abdominal bladder. To our knowledge, consecutive rib fractures related to high-G exposure have never been documented. This report may increase the awareness of flight surgeons and training units regarding the risk of chest wall injuries during high-G exposure and encourage them to use multiple diagnostic tools to determine the correct diagnosis.
Assessing Uncertainty in the Rooting of the SARS-CoV-2 Phylogeny
Authors: Pipes Lenore , Wang Hongru , Huelsenbeck John P , Nielsen Rasmus
Published: December 2020

The rooting of the SARS-CoV-2 phylogeny is important for understanding the origin and early spread of the virus. Previously published phylogenies have used different rootings that do not always provide consistent results. We investigate several different strategies for rooting the SARS-CoV-2 tree and provide measures of statistical uncertainty for all methods. We show that methods based on the molecular clock tend to place the root in the B clade, whereas methods based on outgroup rooting tend to place the root in the A clade. The results from the two approaches are statistically incompatible, possibly as a consequence of deviations from a molecular clock or excess back-mutations. We also show that none of the methods provide strong statistical support for the placement of the root in any particular edge of the tree. These results suggest that phylogenetic evidence alone is unlikely to identify the origin of the SARS-CoV-2 virus and we caution against strong inferences regarding the early spread of the virus based solely on such evidence.
Genetics-first approach improves diagnostics of ESKD patients <50 years old
Authors: Snoek Rozemarijn , van Jaarsveld Richard H , Nguyen Tri Q , Peters Edith D J , Elferink Martin G , Ernst Robert F , Rookmaaker Maarten B , Lilien Marc R , Spierings Eric , Goldschmeding Roel , Knoers Nine V A M , van der Zwaag Bert , van Zuilen Arjan D , van Eerde Albertien M
Published: December 2020

Background

Often only chronic kidney disease (CKD) patients with high likelihood of genetic disease are offered genetic testing. Early genetic testing could obviate the need for kidney biopsies, allowing for adequate prognostication and treatment. To test the viability of a ‘genetics-first’ approach for CKD, we performed genetic testing in a group of kidney transplant recipients aged <50 years, irrespective of cause of transplant.

Methods

From a cohort of 273 transplant patients, we selected 110 that were in care in the University Medical Center Utrecht, had DNA available and were without clear-cut non-genetic disease. Forty patients had been diagnosed with a genetic disease prior to enrollment; in 70 patients, we performed a whole-exome sequencing-based 379 gene panel analysis.

Results

Genetic analysis yielded a diagnosis in 51%. Extrapolated to the 273 patient cohort, who did not all fit the inclusion criteria, the diagnostic yield was still 21%. Retrospectively, in 43% of biopsied patients, the kidney biopsy would not have had added diagnostic value if genetic testing had been performed as a first-tier diagnostic.

Conclusions

The burden of monogenic disease in transplant patients with end-stage kidney disease (ESKD) of any cause prior to the age of 50 years is between 21% and 51%. Early genetic testing can provide a non-invasive diagnostic, impacting prognostication and treatment, and obviating the need for an invasive biopsy. We conclude that in patients who expect to develop ESKD prior to the age of 50 years, genetic testing should be considered as first mode of diagnostics.
The brain tumor not-for-profit and charity experience of COVID-19: reacting and adjusting to an unprecedented global pandemic in the 21st century
Authors: Amidei Christina , Arzbaecher Jean , Maher Mary Ellen , Mungoshi Christine , Cashman Rosemary , Farrimond Stuart , Kruchko Carol , Tse Chris , Daniels Maureen , Lamb Sharon , Granero Anita , Lovely Mary , Baker Jenifer , Payne Sally , Oliver Kathy
Published: December 2020

Background

The Coronavirus Disease 2019 (COVID-19) pandemic has affected individuals as well as disease-specific brain tumor organizations. These organizations around the world exist to address unmet needs for patients and caregivers they serve. The direct impact of the pandemic on these organizations constitutes significant collateral damage. In order to better understand the effects of the COVID-19 pandemic on brain tumor organizations, the International Brain Tumour Alliance (IBTA) carried out an international survey to identify organizational changes induced by the virus and approaches adopted to address challenges.

Methods

A 37-question online survey consisting of categorical and qualitative questions was developed and circulated to 130 brain tumor organizations across the world. Seventy-seven organizations from 22 countries completed the survey (59% return rate). Descriptive statistics and content analysis were used to present the results.

Results

Responses fell into the following 3 categories: (1) organizational characteristics, (2) impact of COVID-19 on services, and (3) COVID-19 impact on financial and human resources within organizations. Although organizational characteristics varied, common concerns reported were activity disruption which impacted organizations’ abilities to offer usual services and challenges to sustaining funding. Both financial and human resources were stressed, but integral adaptations were made by organizations to preserve resources during the pandemic.

Conclusions

Although brain tumor organizations have been impacted by the COVID-19 pandemic, organizations quickly adjusted to this unprecedented global healthcare crisis. Nimble reactions and flexibility have been vital to organization sustainability. Innovative approaches are required to ensure organizations remain viable so that needs of brain tumor community at large are met.
Multidisciplinary management of metastatic spine disease: initial symptom-directed management
Authors: Steinberger Jeremy M , Yuk Frank , Doshi Amish H , Green Sheryl , Germano Isabelle M
Published: December 2020

In the past 2 decades, a deeper understanding of the cancer molecular signature has resulted in longer longevity of cancer patients, hence a greater population, who potentially can develop metastatic disease. Spine metastases (SM) occur in up to 70% of cancer patients. Familiarizing ourselves with the key aspects of initial symptom-directed management is important to provide SM patients with the best patient-specific options. We will review key components of initial symptoms assessment such as pain, neurological symptoms, and spine stability. Radiographic evaluation of SM and its role in management will be reviewed. Nonsurgical treatment options are also presented and discussed, including percutaneous procedures, radiation, radiosurgery, and spine stereotactic body radiotherapy. The efforts of a multidisciplinary team will continue to ensure the best patient care as the landscape of cancer is constantly changing.
An overview of the tumors affecting the spine—inside to out
Authors: Kumar Naresh , Tan Wei Loong Barry , Wei Wei , Vellayappan Balamurugan A
Published: December 2020

Spine tumors may arise within or surrounding the spinal cord and/or vertebral column. Spinal tumors can be benign or malignant. Based on their epicenter, they may be classified as intradural-intramedullary, intradural-extramedullary, or extradural. Of these, extradural lesions are the most common, and are typically metastatic. Primary bone tumors of the spinal column comprise 5% of all primary skeletal tumors. The majority of primary spinal column tumors are benign, with malignant tumors comprising only 20%. Overall, spine metastases are the most common malignant spine tumor, and these usually arise from primaries such as lung, breast, and prostate cancers. The advent of improved systemic therapies leading to improved survival and the frequent use of imaging has positioned metastatic spine disease as the new epidemic in oncology. For spine tumors, establishing the correct diagnosis is heavily reliant on magnetic resonance imaging and histological confirmation. In this review, we will provide an overview of the epidemiology, radiological and histopathological features, and the natural history of key primary (benign and malignant) spinal cord and column tumors and metastatic spine tumors. Treatment principles for primary spinal cord or column tumors are aimed toward curative resection, whereas palliative resection forms the treatment principle for most metastatic tumors.
Reusable sanitary napkins—time to revisit
Authors: Mehta Sumita , Grover Anshul , Mittal Nalini , Nanda Pratibha , Khatuja Ritu , Naseem Azra
Published: December 2020

Background

To assess knowledge, attitude and practices (KAP) of women regarding menstrual hygiene and to evaluate the use of reusable sanitary napkins as an alternative to disposable sanitary napkins.

Methods

A community-based cross-sectional study was done in two phases. In the first phase, 50 married women attending Gynecology OPD were asked to use reusable sanitary napkins for 2 months. A pre- and post-usage vaginal swab testing was done to rule out genital infection. This study was extended in the second phase to another 534 women after confirming that reusable sanitary napkins do not cause genital infection and are acceptable. KAP analysis regarding menstrual hygiene was done for all women.

Results

In phase 1 of the study, the microbiological evaluation revealed no pathological organisms on vaginal swab culture after 2 months of usage. KAP analysis of 584 women revealed that only 26% women had awareness about menstruation before attaining menarche; in 51.88%, the primary source of information was their mother; 76.54% women in the study used disposable sanitary pads of which 15% were disposing of them unhygienically; 80.49% women found the reusable napkins comfortable and easy to use and 83.6% women confirmed recommending these napkins to others.

Conclusion

Reusable sanitary pads are an effective, environment friendly, and cost-effective alternative to disposable napkins.
DIAGNOSTIC REFERENCE LEVELS FOR PAEDIATRIC HEAD COMPUTED TOMOGRAPHY IN MOROCCO: A NATIONWIDE SURVEY
Authors: Benmessaoud M , Dadouch A , Talbi M , Tahiri M , El-ouardi Y
Published: December 2020

The purpose of this study was to establish the diagnostic reference levels (DRLs) for paediatric head computed tomography (CT) in Morocco and to assess the effective doses received during head CT examinations. The data of 1007 patients were collected retrospectively from Moroccan university children’s hospitals. The sample was classified per age group:<1, 1–5, 5–10 and 10–15 years. The proposed DRLs were defined as 75th percentile of the distributions, which were in terms of CT dose index of 26.98, 28.88, 34.00 and 38.20 mGy and dose length product of 461.64, 540.06, 627.20 and 705.98 mGy.cm, respectively. The effective doses estimated were 3.6, 2.9, 2 and 1.79 mSv, respectively. The DRLs reported in Morocco were compared with those of other countries, which were based on the same age grouping method, including Thailand, Switzerland, Japan and the international DRLs. Our initiative via the determination of the first Moroccan diagnostic reference levels for paediatric head CT must be a starting point to spread this investigation towards other examinations and imaging modalities.
Elderly hip fracture patients: surgical timing and factors to consider
Authors: Wenk Manuel , Frey Sönke
Published: December 2020

Purpose of review

Hip fractures of the elderly population are a common trauma and numbers are increasing due to ageing societies. Although this is an ordinary low energy impact injury and surgical repair techniques show good results, the perioperative course is characterized by an unparalleled disproportionate perioperative morbidity and mortality.

Recent findings

Most studies focus on outcome-related data. Little is known on how to prevent and treat adverse sequelae, ranging from mild physical challenges to neurobiological disorders and death.

Although the contribution of the anaesthetic technique per se seems to be small, the role of the anaesthesiologist as a perioperative physician is undisputed. From focusing on comorbidities and initiating preoperative optimization to intraoperative and postoperative care, there is a huge area to be covered by our faculty to ensure a reasonable outcome defined as quality of postoperative life rather than merely in terms of a successful surgical repair. Protocol-driven perioperative approaches should be employed focusing on pre, intraoperative and postoperative optimization of the patient to facilitate early repair of the fracture that may then translate into better outcomes and hence alleviate the individual patient's burden as well as the socioeconomic load for society.
Checkpoint Blockade in Melanoma Patients With Underlying Chronic Lymphocytic Leukemia
Authors: Smithy James W. , Pianko Matthew J. , Maher Colleen , Postow Michael A. , Shoushtari Alexander N. , Momtaz Parisa , Chapman Paul B. , Wolchok Jedd D. , Park Jae H. , Callahan Margaret K.
Published: December 2020

Chronic lymphocytic leukemia (CLL) is associated with immune dysfunction and an increased risk of melanoma. For patients with metastatic melanoma, immunotherapy with checkpoint blocking antibodies is a standard of care. In patients with concomitant CLL and metastatic melanoma, it is not known whether CLL might influence the antimelanoma efficacy or immune-related toxicities of immune checkpoint blockade. Fifteen patients with locally advanced or metastatic melanoma and a concomitant diagnosis of CLL who received pembrolizumab or ipilimumab with or without nivolumab for the treatment of their melanoma at Memorial Sloan Kettering Cancer Center between January 1, 2010, and January 1, 2017, were retrospectively identified. Clinical characteristics including absolute lymphocyte counts during therapy were recorded along with a response to treatment (objective radiographic response, progression-free survival, and adverse events) for each patient. Of 9 response-evaluable patients treated with ipilimumab, 3 (33%) had a partial response, 1 (11%) had stable disease, and 5 (56%) developed progressive disease. Objective tumor responses were also observed with single-agent therapy pembrolizumab and with combination therapy of nivolumab and ipilimumab. Grade 3 or 4 toxicity was observed in 6 of 15 patients (40%), including diarrhea, transaminitis, rash, and hemolytic anemia. Although our retrospective assessment was limited, there was no evidence that CLL responded to the checkpoint blockade. This case series demonstrates that ipilimumab, pembrolizumab, and combined ipilimumab and nivolumab therapies show clinical activity in patients with melanoma and concomitant CLL, at rates consistent with those previously reported. This population may warrant closer surveillance for hematologic immune-related toxicities such as autoimmune hemolytic anemia.
Follow-up Findings in Postconservative Treatment Surveillance for Women With Cervical Adenocarcinoma In Situ
Authors: Upadhyay Baskota Swikrity , Wang Tiannan , Zhao Chengquan
Published: December 2020

Objectives

The risks of adenocarcinoma in situ (AIS) recurrence or progression after conservative treatment are uncertain. The aim of this study was to examine the role of high-risk human papillomavirus (hrHPV) and cytology in the posttreatment surveillance of AIS patients.

Materials and Methods

Follow-up results of hrHPV status, cytology results, and clinicopathological features of 207 patients were retrospectively analyzed, in whom AIS was initially treated by loop electrosurgical excision procedure (LEEP)/cone biopsy between September 2009 and June 2018.

Results

Among 207 patients diagnosed AIS on LEEP/cone biopsy, 30.9% (64/207) had positive margins. Persistent/recurrent AIS rate was substantially higher in the patients with positive margins than in those with negative margins (47.2% vs 9.3%, p < .001). Of 74 patients with hrHPV surveillance, 17 (17/74, 23.0%) were found to have positive hrHPV and 4 (4/17, 23.5%) had the persistent/recurrent AIS regardless of margin status. On the contrast, no AIS were found in negative surveillant hrHPV patients (23.5% vs 0%, p < .001). Lastly, 27.8% patients (22/79) were reported atypical glandular cells on surveillant cytology, and 9 persistent/recurrent AIS cases were further identified on second biopsy or hysterectomy with a positive detection rate of 40.9%.

Conclusions

In this study, we concluded the positive margin on LEEP/cone biopsy in AIS patients was associated with a significantly greater risk of disease persistence or recurrence. The posttreatment surveillance by cytology and adjunct hrHPV would be an ideal strategy in predicting AIS persistence and recurrence, which will warrant further treatments.
Symptom Clusters and Influencing Factors in Family Caregivers of Individuals With Cancer
Authors: Lee Lena J. , Wehrlen Leslie , Wallen Gwenyth R. , Ding Ya , Ross Alyson
Published: December 2020

Background

A symptom cluster is a group of 2 or more symptoms that occur together and are related to each other. Although family caregivers of individuals with cancer experience multiple concurrent symptoms, the majority of symptom research has focused on assessing and managing individual, isolated symptoms.

Objective

The study purpose was to investigate symptom clusters in cancer caregivers and to explore factors that influence symptom clusters.

Methods

Cluster analysis was performed using cross-sectional survey data from 129 family caregivers of individuals receiving cancer treatment at the National Institutes of Health Clinical Center. PROMIS (Patient-Reported Outcomes Measurement Information System) measures of 5 common symptoms in caregivers (fatigue, sleep disturbance, depression, anxiety, impaired cognition) were used to identify symptom clusters.

Results

Two symptom cluster groups were identified: low symptom burden (n = 106, 82.2%) and high symptom burden (n = 23, 17.8%). Individuals who reported higher levels of caregiving burden (impact on health subscale) (β = 1.31, P = .005) and loneliness (β = 0.18, P = .024) were significantly more likely to be in the high symptom burden group.

Conclusions

This study provides evidence that 5 key symptoms among cancer caregivers appear to cluster into 2 groups, those with low symptom burden and those with high symptom burden. Caregiving burden (impact of health) and loneliness were significant factors differentiating symptom cluster membership.

Implications for Practice

Identifying symptom clusters may lead to better prevention and treatment strategies that target symptoms in cancer caregivers. Identifying factors that place a group at high risk of symptom burden can be used to guide individualized and tailored interventions.
Some Morphology Frontiers of Dysplasia in the Tubular Gastrointestinal Tract
Authors: Montgomery Elizabeth A. , Arnold Christina A. , Lam-Himlin Dora M. , McDonald Oliver G. , Poveda Julio C. , Salimian Kevan J. , Voltaggio Lysandra , Waters Kevin M. , Wood Laura D. , Singhi Aatur D.
Published: December 2020

This review, based on the content of the 2020 US Gastrointestinal Pathology Society’s Rodger Haggitt Lecture, concerns an array of tubular gastrointestinal tract dysplastic or possible “predysplastic lesions” with an almost purely morphologic focus based on our collaborative efforts over the past few years. These processes include esophageal epidermoid metaplasia, Barrett esophagus-associated dysplasia, polypoid gastric dysplastic lesions, small intestinal dysplasia, and the ability of metastases to mimic it, the controversial “serrated epithelial change” encountered in the setting of long-standing ulcerative and Crohn colitis, and recently described anal columnar human papilloma virus-associated neoplasms.
HER2 Testing and Reporting in Endometrial Serous Carcinoma: Practical Recommendations for HER2 Immunohistochemistry and Fluorescent In Situ Hybridization: Proceedings of the ISGyP Companion Society Session at the 2020 USCAP Annual Meeting
Authors: Buza Natalia
Published: December 2020

Anti-HER2 therapy has recently emerged as an effective targeted treatment approach for patients with advanced stage and recurrent endometrial serous carcinoma, resulting in significantly prolonged progression-free and overall survival when combined with the standard chemotherapy regimen. Consequently, there is an increasing clinical demand in pathology laboratories for HER2 testing of these tumors. This article provides an overview of the unique characteristics of HER2 protein expression and gene amplification in endometrial serous carcinoma and summarizes the HER2 scoring criteria used for patient enrollment in the recent clinical trial. Following the experience of guideline-development in other tumor types, the trial criteria should serve as the basis for future endometrial carcinoma-specific HER2 testing and scoring recommendations, to ensure therapeutic response in new patient cohorts. Thus, based on the clinical trial, the author proposes a specific HER2 testing algorithm for endometrial serous carcinoma to guide the current clinical practice. Future studies are necessary to refine and adjust these criteria to allow for appropriate triaging of patients and maximize the clinical benefit from HER2-targeted therapy.
The Many Uses of p53 Immunohistochemistry in Gynecological Pathology: Proceedings of the ISGyP Companion Society Session at the 2020 USCAP Annual9 Meeting
Authors: Köbel Martin , Kang Eun Young
Published: December 2020

Ancillary immunohistochemistry (IHC) has become a reliable adjunct for subclassification of gynecological neoplasms. An important recent development was optimization and validation of p53 IHC, where 3 abnormal IHC patterns (nuclear overexpression, complete absence, cytoplasmic) were shown to predict underlying TP53 mutations with high accuracy in ovarian carcinomas. p53 IHC now helps in distinguishing high-grade serous from low-grade serous carcinomas. Thereafter, the new interpretation of p53 IHC was quickly adapted for other purposes and similar accuracies were shown in endometrial carcinomas, vulvar squamous cell carcinomas, and ovarian mucinous tumors. However, it required further refinement of the p53 IHC interpretation criteria for each tumor site. A proportion of endometrial endometrioid carcinomas shows an ultramutated or hypermutated genotype due to underlying POLE mutations or mismatch repair deficiency sometimes causing subclonal TP53 mutations, and their distribution can be visualized by p53 IHC. Squamous cell carcinomas and ovarian mucinous tumors show a phenomenon called terminal differentiation where basal cells demonstrate an abnormal pattern of p53 IHC but apical cells do not despite an underlying TP53 mutation. High-grade progression of adult granulosa cell tumors due to a subclonal TP53 mutation has been recently described. Another use of p53 IHC is triaging gynecological sarcomas for molecular testing based on the assumption that TP53-mutated gynecological sarcomas do not harbor cancer driving translocations. Therefore, familiarity with interpretation of p53 IHC is becoming increasingly important for the practicing gynecological pathologist. Furthermore, local optimization of the p53 IHC assay using validated protocols including appropriate low expressing control tissues (eg, tonsil) is vital in order to achieve high diagnostic accuracy, especially for abnormal staining patterns such as complete absence or cytoplasmic, and interlaboratory concordance. p53 IHC is a reliable diagnostic adjunct for histotyping and molecular subtyping of ovarian and endometrial carcinomas, and it paves the way for large-scale studies to validate the prognostic value of p53 IHC in several gynecological tumor types. The technical advances, validated interpretation criteria, and its growing versatility in identifying high-risk neoplasms paired with its widespread availability in pathology departments make p53 IHC perhaps the single most useful IHC stain in gynecological pathology.
Predictive Biomarkers for Immune Checkpoint Inhibitors in Advanced Non–Small Cell Lung Cancer
Authors: Bhalla Sheena , Doroshow Deborah Blythe , Hirsch Fred R.
Published: December 2020

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment paradigm for advanced non–small cell lung cancer (NSCLC). Although certain patients achieve significant, long-lasting responses from checkpoint blockade, the majority of patients with NSCLC do not and may be unnecessarily exposed to inadequate therapies and immune-related toxicities. Therefore, there is a critical need to identify biomarkers predictive of immunotherapy response. While tumor and immune cell expression of programmed death ligand-1 and, more recently, tumor mutational burden are used in clinical practice and may correlate with immunotherapy response in selected circumstances, neither consistently predicts an individual patient's likelihood of clinical benefit from ICI therapy. More recently, innovative approaches such as blood-based assays and combination biomarker strategies are under active investigation. This review will focus on the current role and challenges of programmed death ligand-1 and tumor mutational burden as predictive biomarkers for immunotherapy response in advanced NSCLC and explore promising novel biomarker strategies.
Mechanical detection and pain thresholds: comparability of devices using stepped and ramped stimuli
Authors: Pfau Doreen B. , Haroun Omer , Lockwood Diana N. , Maier Christoph , Schmitter Marc , Vollert Jan , Rice Andrew S.C. , Treede Rolf-Detlef
Published: December 2020

Introduction:

Quantitative sensory testing is used to assess somatosensory function in humans. The protocol of the German Research Network on Neuropathic Pain (DFNS) provides comprehensive normative values using defined tools; however, some of these may not be feasible in low-resource settings.

Objectives:

To compare the standard DFNS devices for assessment of mechanosensory function to a low resource tool, the Sorri-Bauru-monofilaments.

Methods:

Mechanical detection thresholds (MDT), pain thresholds (MPT), and suprathreshold pinprick ratings (pain sensitivity: MPS) were measured over cheek, hand dorsum, and fingertip in 13 healthy subjects (7 female, aged 21–44 years). Mechanical detection threshold was assessed with DFNS standard glass monofilaments (0.25–512 mN, 0.5 mm tip) and nylon monofilaments (Sorri-Bauru; 0.5–3000 mN). MPT was assessed with DFNS standard cylindrical probes (8–512 mN, 0.25 mm tip), Sorri-Bauru monofilaments, and with ramped stimuli using an electronic von Frey aesthesiometer (10 mN/s or 100 mN/s, 0.20 mm tip). MPS was measured in response to stepped and ramped pinpricks (128 and 256 mN).

Results:

Mechanical detection thresholds were the same for DFNS and Sorri-Bauru monofilaments. For MPT, Sorri-Bauru filaments yielded lower values than PinPricks over face but not hand. Pain thresholds were higher at all test sites for ramped than stepped pinpricks (P < 0.01). Suprathreshold ratings were lower for ramped than stepped pinpricks (P < 0.05).

Conclusion:

Sorri-Bauru filaments are acceptable substitutes for DFNS standards in estimating tactile sensitivity, but are not consistent with standard probes for pinprick sensitivity because of their nonstandardized tips. Ramped stimuli overestimated MPT and underestimated MPS due to reaction time artefacts and therefore need their own normative values.
Mental Health and Psychological Responses During the Coronavirus Disease 2019 Epidemic: A Comparison Between Wuhan and Other Areas in China
Authors: Wang Qunfeng , Feng Hongliang , Wang Meiyao , Xie Yu , Hou Botong , Lu Xuanzhen , Liu Zhenxing , Ouyang Keni , Zhang Renwei , Cai Qi , Xu Zhipeng , Li Huagang , Chao Hao , Yang Xiaohua , Hong Yan , Hu Xiaohua , Liu Zhigang , Liu Yumin
Published: December 2020

Objective

This study aimed to compare the mental health and psychological responses in Wuhan, a severely affected area, and other areas of China during the coronavirus disease 2019 (COVID-19) epidemic.

Methods

This cross-sectional study was conducted on February 10–20, 2020. A set of online questionnaires was used to measure mental health and responses. A total of 1397 participants from Wuhan (age, 36.4 ± 10.7 years; male, 36.1%) and 2794 age- and sex-matched participants from other areas of China (age, 35.9 ± 9.9 years; male, 39.0%) were recruited.

Results

Compared with their counterparts, participants from Wuhan had a significantly higher prevalence of any mental health problems (46.6% versus 32.2%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.65–2.17), anxiety (15.2% versus 6.2%; adjusted OR = 2.65, 95% CI = 2.14–3.29), depression (18.3% versus 9.7%; adjusted OR = 2.11, 95% CI = 1.74–2.54), suicidal ideation (10.5% versus 7.1%; adjusted OR = 1.60, 95% CI = 1.28–2.02), and insomnia (38.6% versus 27.6%; adjusted OR = 1.70, 95% CI = 1.48–1.96). Participants from Wuhan had a slightly higher rate of help-seeking behavior (7.1% versus 4.2%; adjusted OR = 1.76, 95% CI = 1.12–2.77) but similar rate of treatment (3.5% versus 2.7%; adjusted OR = 1.23, 95% CI = 0.68–2.24) for mental problems than did their counterparts. In addition, compared with their counterparts, participants from Wuhan gave higher proportions of responses regarding “fearful” (52% versus 36%, p < .001), “discrimination against COVID-19 cases” (64% versus 58%, p = .006), “strictly comply with preventive behaviors” (98.7% versus 96%, p = .003), and “fewer living and medical supplies” (<2 weeks: 62% versus 57%, p = .015).

Conclusions

The COVID-19 epidemic has raised enormous challenges regarding public mental health and psychological responses, especially in the highly affected Wuhan area. The present findings provide important information for developing appropriate strategies for the prevention and management of mental health problems during COVID-19 and other epidemics.
Cognitive Versus Magnetic Resonance-Ultrasound Fusion Prostate Biopsy: Which One Is Worthier to Perform?
Authors: Turkay Rustu , Inci Ercan , Yildiz Omer , Ozgur Eren , Taşci Ali İhsan
Published: December 2020

The aim of our study is to compare 2 prostate fusion biopsy models in terms of accurate target sampling. One hundred patients who had Prostate Imaging-Reporting and Data System score 3, 4, or 5 lesions (lesion diameter, >5 mm in long axis) in multiparametric-magnetic resonance imaging and prostate-specific antigen levels between 3 and 10 ng/mL were enrolled in the study. All patients were biopsy naive. Two groups were composed with 50 patients each. Group 1 patients had cognitive fusion (CF) biopsy, and group 2 had magnetic resonance-ultrasound fusion platform biopsy. After fusion biopsy, standard biopsy was also performed. Outcomes of histopathologic and demographic data were evaluated statistically. There were no statistical differences between the 2 groups in terms of age, prostate-specific antigen levels, prostate volume, and lesion length (P > 0.05). There was no statistically significant difference in sampling targeted lesions (P > 0.05). Also, no difference was found between the 2 groups in terms of random biopsy cancer detection rates (P > 0.05). There was no statistically significant difference between CF and magnetic resonance-ultrasound fusion in terms of cancer detection rates. For the experienced operators, we recommend lesions that are longer than 5 mm can be sampled using CF, an inexpensive and faster technique.
Diagnostic Efficiency of Gynecologic Imaging Reporting and Data System Combined With 3-dimensional Contrast-enhanced Ultrasound Scoring System in Evaluating Ovarian Tumor
Authors: Yang Lin , Lv Guorong , Chen Huie , Yang Shuping , Liao Jianmei , Zhang Weina , Ke Linfang
Published: December 2020

To estimate the value of gynecologic imaging reporting and data system (GI-RADS) combined with 3-dimensional contrast-enhanced ultrasound (3D-CEUS) scoring system in the differential diagnosis of ovarian tumor. Both of 2-dimensional ultrasound (2D-US) and 3D-CEUS were performed on 114 patients with ovarian masses by Voluson E8 with SonoVue (Bracco, Italy). Besides, dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) (Siemens Magneton Verio 3.0T, Germany) was performed on the patients. There were totally 62 benign and 52 malignant ovarian tumors in all patients. The ability of GI-RADS combined with 3D-CEUS scoring system to distinguish benign and malignant ovarian tumors was superior to conventional ultrasound GI-RADS classification. The sensitivity, specificity, and accuracy of GI-RADS combined with 3D-CEUS scoring system were 96.2% and 98.1%, 87.10%, whereas those of MRI were 87.10%, 91.23%, and 92.11% respectively, indicating that there was high concordance in ovarian tumors assessment between the 2 diagnostic methods. The new scoring system has a good correlation with microvessel density (P = 0.000, r = 0.73), estrogen receptor (P = 0.000, r = 0.59), progesterone receptor (P = 0.000, r = 0.56), and matrix metalloproteinase-9 (P = 0.000, r = 0.61). The GI-RADS combined with 3D-CEUS scoring system was valuable in clinical diagnosis and differential diagnosis of ovarian tumor and show good agreement with MRI.
Efficacy and feasibility of amniotic membrane for the treatment of burn wounds: A meta-analysis
Authors: Yang Chao , Xiong Ai Bing , He Xiao Chuan , Ding Xiao Bin , Tian Xin Li , Li Ying , Yan Hong
Published: December 2020

BACKGROUND

Burns cause a huge economic burden to society, and the wounds can be very difficult to manage. Clinical experience suggests that amniotic membrane (AM) is an economical and effective biological dressing for burns. However, few systematic reviews or meta-analyses have been published on such use. We aimed to evaluate the role of AM dressings in burn wounds.

METHODS

A systematic search of the PubMed, Cochrane, Embase, and Web of Science databases was conducted in March 2020. The search was conducted to identify randomized control trials that compared selected features of AM with those of other dressings, such as silver sulfadiazine, polyurethane membrane, and honey. For skin-grafted wounds, we compared AM-covered skin grafts and traditional staple-fixed skin grafts. Outcomes of interest for the efficacy analysis included wound infection, pain, itching, scarring, and healing time. The number of adverse events in each treatment group, the rate of withdrawal because of adverse effects, the cost of treatment, and patient acceptability were assessed for the feasibility analysis.

RESULTS

Eleven randomized controlled trials with 816 participants total were identified in our review. Amniotic membrane treatment was more effective than conventional methods, silver sulfadiazine, and polyurethane membrane in treating burn wounds, but AM appears to be less effective than honey. No reports of AM-related disease transmission or adverse reactions were described in the included articles.

CONCLUSION

Amniotic membrane has beneficial effects in treating burn wounds; however, the evidence needs to be strengthened by further robust randomized controlled trials.

LEVEL OF EVIDENCE

Systematic Review/Meta-analysis, level III.
Preparations for a European R&D roadmap for an inertial fusion demo reactor
Authors: Norreys P. A. , Ceurvorst L. , Sadler J. D. , Spiers B. T. , Aboushelbaya R. , Mayr M. W. , Paddock R. , Ratan N. , Savin A. F. , Wang R. H. W. , Glize K. , Trines R. M. G. M. , Bingham R. , Hill M. P. , Sircombe N. , Ramsay M. , Allan P. , Hobbs L. , James S. , Skidmore J. , Fyrth J. , Luis J. , Floyd E. , Brown C. , Haines B. M. , Olson R. E. , Yi S. A. , Zylstra A. B. , Flippo K. , Bradley P. A. , Peterson R. R. , Kline J. L. , Leeper R. J.
Published: December 2020

A European consortium of 15 laboratories across nine nations have worked together under the EUROFusion Enabling Research grants for the past decade with three principle objectives. These are: (a) investigating obstacles to ignition on megaJoule-class laser facilities; (b) investigating novel alternative approaches to ignition, including basic studies for fast ignition (both electron and ion-driven), auxiliary heating, shock ignition, etc.; and (c) developing technologies that will be required in the future for a fusion reactor. A brief overview of these activities, presented here, along with new calculations relates the concept of auxiliary heating of inertial fusion targets, and provides possible future directions of research and development for the updated European Roadmap that is due at the end of 2020.

This article is part of a discussion meeting issue ‘Prospects for high gain inertial fusion energy (part 2)’.
The inadequacy of a magnetohydrodynamic approach to the Biermann battery
Authors: Ridgers C. P. , Arran C. , Bissell J. J. , Kingham R. J.
Published: December 2020

Magnetic fields can be generated in plasmas by the Biermann battery when the electric field produced by the electron pressure gradient has a curl. The commonly employed magnetohydrodynamic (MHD) model of the Biermann battery breaks down when the electron distribution function is distorted away from Maxwellian. Using both MHD and kinetic simulations of a laser-plasma interaction relevant to inertial confinement fusion we have shown that this distortion can reduce the Biermann-producing electric field by around 50%. More importantly, the use of a flux limiter in an MHD treatment to deal with the effect of the non-Maxwellian electron distribution on electron thermal transport leads to a completely unphysical prediction of the Biermann-producing electric field and so results in erroneous predictions for the generated magnetic field.

This article is part of a discussion meeting issue ‘Prospects for high gain inertial fusion energy (part 2)’.
Recent progress in quantifying hydrodynamics instabilities and turbulence in inertial confinement fusion and high-energy-density experiments
Authors: Casner A.
Published: December 2020

Since the seminal paper of Nuckolls triggering the quest of inertial confinement fusion (ICF) with lasers, hydrodynamic instabilities have been recognized as one of the principal hurdles towards ignition. This remains true nowadays for both main approaches (indirect drive and direct drive), despite the advent of MJ scale lasers with tremendous technological capabilities. From a fundamental science perspective, these gigantic laser facilities enable also the possibility to create dense plasma flows evolving towards turbulence, being magnetized or not. We review the state of the art of nonlinear hydrodynamics and turbulent experiments, simulations and theory in ICF and high-energy-density plasmas and draw perspectives towards in-depth understanding and control of these fascinating phenomena.

This article is part of a discussion meeting issue ‘Prospects for high gain inertial fusion energy (part 2)’.