The impact of extent of resection in surgical outcome of pilomyxoid astrocytoma: a case study

The pilomyxoid astrocytoma (PMA) is a rare glioma that has recently been identified as a separate entity and is frequently found in the hypothalamic region. PMA is a subtype of pilocytic astrocytoma (PA), with clinical, histological, and molecular data indicating a close relationship as well as more aggressive biological behaviour in the former. There is still doubt in surgical outcome of PMA that the extent of resection, independent of location or age, is a key factor of recurrence and subsequent therapeutic choices. However, further study is needed to better understand its behaviour and, as a result, establish a consensus on its management. This research features a 2-year-6-month-old female who sought medical attention after complaining of weight loss for four weeks and vomiting for two weeks prior to her visit to the doctor. She had no additional symptoms. Only bilateral pailledema was found during the physical examination. The magnetic resonance imaging (MRI) scans revealed a tumor in the sellar area with heterogeneous enhancement. The patient had ventriculoperitoneal (VP) shunting followed by partial tumor excision twice (Extent of resection 35 percent followed by 16 percent as total 51 percent). The histology and immunohistochemical investigations revealed typical PMA characteristics. Adjuvant treatment, which included chemotherapy and radiosurgery, was initiated for the patient. She has been asymptomatic for two years and has showed no indications of progression of the disease on follow-up scans.

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Impact of extent of resection of glioblastoma multiforme (GBM) in the era of chemoradiation

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e13029 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e13029-e13029

Author(s):

B. J. Slotman ◽

W. S. Eppinga ◽

J. C. Reijneveld ◽

D. P. Noske ◽

J. Buter ◽

...

Keyword(s):

Residual Tumor ◽

Extent Of Resection ◽

Partial Resection ◽

Recurrence Time ◽

Significant Prognostic Factor ◽

Prognostic Impact ◽

Total Resection ◽

Mri Scans ◽

Major Resection ◽

The Impact

e13029 Background: Controversy remains regarding the impact of the extent of resection (EOR) on survival in patients with GBM (Sanai 2008). The main reason for this is the fact that most studies were based on the surgeon's estimate of the EOR, which is known to be unreliable, rather than early postoperative MRI scans (po-MRI). Data for the current standard of postoperative chemo-radiotherapy (CTRT) have recently been reported, but suffer from the same limitation (Gorlia 2008). We studied the prognostic impact of the EOR using early (<72 hours) po-MRI scans in a cohort of GBM patients treated with CTRT in a single center. Methods: The results of 48 consecutive patients (35 male, 13 female; age 18–73 yrs) treated with surgery, followed by concurrent CTRT (60 Gy plus temozolomide) and adjuvant temozolomide were assessed with respect to survival and relapse patterns. EOR was determined by both the surgeon's estimation and early po-MRI scans that were available in all but two patients. EOR was categorized as biopsy (N = 3), partial resection (N = 24), major resection (N = 11; i.e., total resection according to the surgeon's report, but residual tumor on po-MRI), and total resection (N = 10; i.e. no residual tumor on po-MRI). Results: Median overall survival of the entire cohort was 18.9 months, and EOR was the only significant prognostic factor (p = 0.02) on multivariate analysis, which also included age, gender, performance, and radiotherapy target volume. 2-year survival rates improved significantly with increasing EOR, with 0%, 18.9%, 68.6%, and 100% for biopsy, partial-, major-, and total resection, respectively. In-field progression was the predominant pattern of failure in 27 out of 30 patients (90%) with a recurrence. Time to neurological progression (TNP) was significantly correlated with EOR (p < 0.001). Median TNP was 3.0 months for biopsy, 7.0 months for partial resection, 20.5 months for major resection, and was not reached for total resection. Conclusions: With the use of more effective local therapy in the form of surgery and CTRT, the prognostic impact of the EOR on survival appears to be higher than previously reported. This should be accounted for in future trials. No significant financial relationships to disclose.

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Time-to-Treatment in Oral Cancer: Causes and Implications for Survival

Cancers ◽

10.3390/cancers13061321 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1321

Author(s):

Constanza Saka-Herrán ◽

Enric Jané-Salas ◽

Antoni Mari-Roig ◽

Albert Estrugo-Devesa ◽

José López-López

Keyword(s):

Oral Cancer ◽

Previous Treatment ◽

Diagnostic Procedures ◽

Original Data ◽

Primary Treatment ◽

Medical Attention ◽

Time Interval ◽

Pre Treatment ◽

The Impact ◽

Lack Of Knowledge

The purpose of this review was to identify and describe the causes that influence the time-intervals in the pathway of diagnosis and treatment of oral cancer and to assess its impact on prognosis and survival. The review was structured according to the recommendations of the Aarhus statement, considering original data from individual studies and systematic reviews that reported outcomes related to the patient, diagnostic and pre-treatment intervals. The patient interval is the major contributor to the total time-interval. Unawareness of signs and/or symptoms, denial and lack of knowledge about oral cancer are the major contributors to the process of seeking medical attention. The diagnostic interval is influenced by tumor factors, delays in referral due to higher number of consultations and previous treatment with different medicines or dental procedures and by professional factors such as experience and lack of knowledge related to the disease and diagnostic procedures. Patients with advanced stage disease, primary treatment with radiotherapy, treatment at an academic facility and transitions in care are associated with prolonged pre-treatment intervals. An emerging body of evidence supports the impact of prolonged pre-treatment and treatment intervals with poorer survival from oral cancer.

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Natural History of NAFLD

Journal of Clinical Medicine ◽

10.3390/jcm10061161 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1161

Author(s):

Raluca Pais ◽

Thomas Maurel

Keyword(s):

Liver Disease ◽

Natural History ◽

Disease Progression ◽

Specific Treatment ◽

Alcoholic Fatty Liver ◽

Individual Level ◽

Close Relationship ◽

History Of ◽

The Individual ◽

The Impact

The epidemiology and the current burden of chronic liver disease are changing globally, with non-alcoholic fatty liver disease (NAFLD) becoming the most frequent cause of liver disease in close relationship with the global epidemics of obesity, type 2 diabetes and metabolic syndrome. The clinical phenotypes of NAFLD are very heterogeneous in relationship with multiple pathways involved in the disease progression. In the absence of a specific treatment for non-alcoholic steatohepatitis (NASH), it is important to understand the natural history of the disease, to identify and to optimize the control of factors that are involved in disease progression. In this paper we propose a critical analysis of factors that are involved in the progression of the liver damage and the occurrence of extra-hepatic complications (cardiovascular diseases, extra hepatic cancer) in patients with NAFLD. We also briefly discuss the impact of the heterogeneity of the clinical phenotype of NAFLD on the clinical practice globally and at the individual level.

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Linking morphological and molecular sources to disentangle the case of Xylodon australis

Scientific Reports ◽

10.1038/s41598-020-78399-8 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Javier Fernández-López ◽

M. Teresa Telleria ◽

Margarita Dueñas ◽

Mara Laguna-Castro ◽

Klaus Schliep ◽

...

Keyword(s):

New Zealand ◽

Phylogenetic Analyses ◽

Single Species ◽

R Package ◽

Molecular Data ◽

Historical Collections ◽

Close Relationship ◽

Kinship Relations ◽

History Of ◽

Different Sources

AbstractThe use of different sources of evidence has been recommended in order to conduct species delimitation analyses to solve taxonomic issues. In this study, we use a maximum likelihood framework to combine morphological and molecular traits to study the case of Xylodon australis (Hymenochaetales, Basidiomycota) using the locate.yeti function from the phytools R package. Xylodon australis has been considered a single species distributed across Australia, New Zealand and Patagonia. Multi-locus phylogenetic analyses were conducted to unmask the actual diversity under X. australis as well as the kinship relations respect their relatives. To assess the taxonomic position of each clade, locate.yeti function was used to locate in a molecular phylogeny the X. australis type material for which no molecular data was available using morphological continuous traits. Two different species were distinguished under the X. australis name, one from Australia–New Zealand and other from Patagonia. In addition, a close relationship with Xylodon lenis, a species from the South East of Asia, was confirmed for the Patagonian clade. We discuss the implications of our results for the biogeographical history of this genus and we evaluate the potential of this method to be used with historical collections for which molecular data is not available.

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Prevalence of nocturia among community-dwelling adults: a population-based study in Malaysia

BMC Urology ◽

10.1186/s12894-021-00860-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hui-Yin Yow ◽

John Jeh Lung Tiong ◽

Chun-Wai Mai ◽

Esther van der Werf ◽

Zulkifli Md Zainuddin ◽

...

Keyword(s):

Medical Condition ◽

Population Based ◽

Community Dwelling ◽

Medical Attention ◽

Night Time ◽

Cross Sectional ◽

Population Based Study ◽

Waking Up ◽

The Impact

Abstract Background Nocturia is widely prevalent condition with detrimental effects on quality of life and general health. In Malaysia, there is a lack of up-to-date prevalence study on nocturia. This study aimed to investigate the prevalence of nocturia and awareness pertaining to nocturia among Malaysian adults. Methods A cross-sectional population-based study was conducted among Malaysian adults aged ≥ 18 years old. The data was collected by mixed mode self-administered questionnaire from May 2019 to September 2019. Nocturia was defined as one or more voids at night. Results There were a total of 4616 respondents with 74.5% of response rate. The overall prevalence of nocturia among Malaysian adults was found to be 57.3%. In multivariate analysis, respondents aged 31–40 (1.91 [1.52–2.40]) or > 60 years old (2.03 [1.48–2.71]), and those who presented with hypertension (2.84 [2.28–3.53]), diabetes mellitus (1.78 [1.42–2.25]), renal disease (3.58 [1.93–6.63]) or overactive bladder (1.61 [1.10–2.35]) were associated with higher prevalence of nocturia. A significantly lower disease prevalence (p < 0.05) was noted among those aged 41–50 (0.73 [0.59–0.91]), male (0.78 [0.69–0.88]) and Chinese (0.47 [0.30–0.74]) or Indian (0.34 [0.21–0.54]) ethnicities. A total of 37.3% of respondents with nocturia reported that they faced sleeping difficulty about half the time or more after waking up in the middle of night. Those who had ≥ 2 voids per night experienced significantly higher mean bother score than those who had 1 void per night (p < 0.001). Approximately half (56.7%) of all respondents were not aware that night time urination is a medical condition. Only 25.2% of respondents with nocturia had sought medical attention for their nocturia. Conclusions The prevalence of nocturia among Malaysian adults is high and strongly influenced by age, sex, race and comorbidities. However, the general awareness pertaining to nocturia being a health issue remains low among Malaysians. The findings also highlighted the impact of nocturia on sleep and the need for nocturia education to better address this disease.

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Validation of questionnaire-reported chest wall abnormalities with a telephone interview in Swiss childhood cancer survivors

BMC Cancer ◽

10.1186/s12885-021-08425-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rahel Kasteler ◽

Christa Lichtensteiger ◽

Christina Schindera ◽

Marc Ansari ◽

Claudia E. Kuehni ◽

...

Keyword(s):

Risk Factors ◽

Cancer Survivors ◽

Childhood Cancer ◽

Chest Wall ◽

Daily Life ◽

Well Being ◽

Childhood Cancer Survivors ◽

Thoracic Wall ◽

Medical Attention ◽

The Impact

Abstract Background Chest wall abnormalities are a poorly studied complication after treatment for childhood cancer. Chest wall abnormalities are not well-described in the literature, and little is known on the impact on daily life of survivors. Methods We investigated prevalence and risk factors of chest wall abnormalities in childhood cancer survivors in a nationwide, population-based cohort study (Swiss Childhood Cancer Survivor Study) with a questionnaire survey. We then interviewed a nested sample of survivors to validate types of chest wall abnormalities and understand their impact on the daily life of survivors. Results Forty-eight of 2382 (95%CI 2–3%) survivors reported a chest wall abnormality. Risk factors were older age at cancer diagnosis (16–20 years; OR 2.5, 95%CI 1.0–6.1), lymphoma (OR 3.8, 95%CI 1.2–11.4), and central nervous system tumors (OR 9.5, 95%CI 3.0–30.1) as underlying disease, and treatment with thoracic radiotherapy (OR 2.0, 95%CI 1.0–4.2), surgery to the chest (OR 4.5, 95%CI 1.8–11.5), or chemotherapy (OR 2.9, 95%CI 1.0–8.1). The nature of the chest wall abnormalities varied and included thoracic wall deformities (30%), deformations of the spine (5%) or both (55%), and scars (10%). Chest wall abnormalities affected daily life in two thirds (13/20) of those who reported these problems and necessitated medical attention for 15 (75%) survivors. Conclusion It is important that, during follow-up care, physicians pay attention to chest wall abnormalities, which are rare late effects of cancer treatment, but can considerably affect the well-being of cancer survivors.

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Access to MRI for patients with cardiac pacemakers and implantable cardioverter defibrillators

Open Heart ◽

10.1136/openhrt-2021-001598 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001598

Author(s):

Christopher Pieri ◽

Anish Bhuva ◽

Russell Moralee ◽

Aderonke Abiodun ◽

Deepa Gopalan ◽

...

Keyword(s):

Supply And Demand ◽

Complication Rates ◽

Cardiac Pacemakers ◽

Survey Tool ◽

Mr Conditional ◽

Mri Scans ◽

Implantation Rates ◽

The Impact

ObjectiveTo determine provision of MRI for patients with cardiac implantable electronic devices (CIEDs; pacemakers and defibrillators) in England, to understand regional variation and assess the impact of guideline changes.MethodsRetrospective data related to MRI scans performed in patients with CIED over the preceding 12 months was collected using a structured survey tool distributed to every National Health Service Trust MRI unit in England. Data were compared with similar data from 2014/2015 and with demand (estimated from local CIED implantation rates and regional population data by sustainability and transformation partnerships (STPs)).ResultsResponses were received from 212 of 223 (95%) hospitals in England. 112 (53%) MRI units’ scan patients with MR-conditional CIEDs (10% also scan non-MR conditional devices), compared with 46% of sites in 2014/2015. Total annual scan volume increased over fourfold between 2014 and 2019 (1090 to 4896 scans). There was widespread geographical variation, with five STPs (total population >3·5 million representing approximately 25 000 patients with CIED) with no local provision. There was no correlation between local demand (CIED implantation rates) and MRI provision (scan volume). Complication rates were extremely low with three events nationally in 12 months (0·06% CIED–MRI scans).ConclusionsProvision of MRI for patients with CIEDs in England increased over fourfold in 4 years, but an estimated 10-fold care gap remains. Almost half of hospitals and 1 in 10 STPs have no service, with no relationship between local supply and demand. Availability of MRI for patients with non-MR conditional devices, although demonstrably safe, remains limited.

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Routine use of immunosuppressants is associated with mortality in hospitalised patients with COVID-19

Therapeutic Advances in Drug Safety ◽

10.1177/2042098620985690 ◽

2021 ◽

Vol 12 ◽

pp. 204209862098569

Author(s):

Phyo K. Myint ◽

Ben Carter ◽

Fenella Barlow-Pay ◽

Roxanna Short ◽

Alice G. Einarsson ◽

...

Keyword(s):

Medical Attention ◽

Close Monitoring ◽

Plain Language ◽

Discharge Data ◽

Specific Patient ◽

Risk Of Death ◽

Hospitalised Patients ◽

Increased Risk ◽

The Uk ◽

The Impact

Background: Whilst there is literature on the impact of SARS viruses in the severely immunosuppressed, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study population was drawn from the COPE Study (COVID-19 in Older People), a multicentre observational cohort study, across the UK and Italy. Data were collected between 27 February and 28 April 2020 by trained data-collectors and included all unselected consecutive admissions with COVID-19. Load (name/number of medications) and dosage of immunosuppressant were collected along with other covariate data. Primary outcome was time-to-mortality from the date of admission (or) date of diagnosis, if diagnosis was five or more days after admission. Secondary outcomes were Day-14 mortality and time-to-discharge. Data were analysed with mixed-effects, Cox proportional hazards and logistic regression models using non-users of immunosuppressants as the reference group. Results: In total 1184 patients were eligible for inclusion. The median (IQR) age was 74 (62–83), 676 (57%) were male, and 299 (25.3%) died in hospital (total person follow-up 15,540 days). Most patients exhibited at least one comorbidity, and 113 (~10%) were on immunosuppressants. Any immunosuppressant use was associated with increased mortality: aHR 1.87, 95% CI: 1.30, 2.69 (time to mortality) and aOR 1.71, 95% CI: 1.01–2.88 (14-day mortality). There also appeared to be a dose–response relationship. Conclusion: Despite possible indication bias, until further evidence emerges we recommend adhering to public health measures, a low threshold to seek medical advice and close monitoring of symptoms in those who take immunosuppressants routinely regardless of their indication. However, it should be noted that the inability to control for the underlying condition requiring immunosuppressants is a major limitation, and hence caution should be exercised in interpretation of the results. Plain Language Summary Regular Use of Immune Suppressing Drugs is Associated with Increased Risk of Death in Hospitalised Patients with COVID-19 Background: We do not have much information on how the COVID-19 virus affects patients who use immunosuppressants, drugs which inhibit or reduce the activity of the immune system. There are various conflicting views on whether immune-suppressing drugs are beneficial or detrimental in patients with the disease. Methods: This study collected data from 10 hospitals in the UK and one in Italy between February and April 2020 in order to identify any association between the regular use of immunosuppressant medicines and survival in patients who were admitted to hospital with COVID-19. Results: 1184 patients were included in the study, and 10% of them were using immunosuppressants. Any immunosuppressant use was associated with increased risk of death, and the risk appeared to increase if the dose of the medicine was higher. Conclusion: We therefore recommend that patients who take immunosuppressant medicines routinely should carefully adhere to social distancing measures, and seek medical attention early during the COVID-19 pandemic.

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Fensomea setacea, gen. & sp. nov. (Cladopyxidaceae, Dinophyceae), is neither gonyaulacoid nor peridinioid as inferred from morphological and molecular data

Scientific Reports ◽

10.1038/s41598-021-92107-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Marc Gottschling ◽

Maria Consuelo Carbonell-Moore ◽

Kenneth Neil Mertens ◽

Monika Kirsch ◽

Malte Elbrächter ◽

...

Keyword(s):

Molecular Data ◽

Character Evolution ◽

Ancestral State ◽

Close Relationship ◽

Regular Configuration ◽

The Common ◽

Morphological And Molecular Data ◽

Rrna Sequences

AbstractDinophyte evolution is essentially inferred from the pattern of thecal plates, and two different labelling systems are used for the important subgroups Gonyaulacales and Peridiniales. The partiform hypotheca of cladopyxidoid dinophytes fits into the morphological concepts of neither group, although they are assigned to the Gonyaulacales. Here, we describe the thecate dinophyte Fensomea setacea, gen. & sp. nov., which has a cladopyxidoid tabulation. The cells displayed a Kofoidean plate formula APC, 3′, 4a, 7″, 7C, 6S, 6′′′, 2′′′′, and slender processes were randomly distributed over the echinate or baculate surface. In addition, we obtained rRNA sequences of F. setacea, gen. & sp. nov., but dinophytes that exhibit a partiform hypotheca did not show a close relationship to Gonyaulacales. Character evolution of thecate dinophytes may have progressed from the ancestral state of six postcingular plates, and two more or less symmetrically arranged antapical plates, towards patterns of only five postcingular plates (Peridiniales) or more asymmetrical configurations (Gonyaulacales). Based on our phylogenetic reconsiderations the contact between the posterior sulcal plate and the first postcingular plate, as well as the contact between an antapical plate and the distalmost postcingular plate, do not represent a rare, specialized gonyaulacoid plate configuration (i.e., the partiform hypotheca of cladopyxidoid dinophytes). Instead, these contacts correspond to the common and regular configuration of peridinioid (and other) dinophytes.

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Post-traumatic Growth: Longitudinal Study on Battered Women in Close Relationships after Both They and Their Partners Undergo Therapy

Journal of Interpersonal Violence ◽

10.1177/0886260521997932 ◽

2021 ◽

pp. 088626052199793

Author(s):

Dorota Dyjakon ◽

Beata Rajba

Keyword(s):

Battered Women ◽

Three Dimensions ◽

Traumatic Experiences ◽

Important Indicator ◽

Event Scale ◽

Post Traumatic Growth ◽

Polish Version ◽

Close Relationship ◽

Post Traumatic ◽

The Impact

Violence in intimate relationships is a major problem worldwide. Many women, despite having experienced violence from a partner, decide to remain in a relationship with the perpetrator. A special premise for such a decision is that the abusive partner undertakes therapy that serves to build security in the family. An important indicator of dealing with violence is post-traumatic growth (PTG), a concept introduced by Calhoun and Tedeschi (1998) to describe positive changes as a result of traumatic experiences. The purpose of the research was to assess PTG changes in the course of relationships in which the woman had experienced violence from her partner, but both her partner and she had undertaken therapy and changed their behavior ( N = 48). The conducted research used a demographic survey and two questionnaires: The Polish version of the Impact Event Scale-Revised (IES-R, Weiss, Marmara prepared by Juczyński and Ogińska-Bulik [2009]) examining three dimensions of trauma (intrusion, hyperarousal, and avoidance) and the Post-traumatic Growth Inventory ( Tedeschi & Calhoun [2004] ; Polish version prepared by Ogińska-Bulik & Juczyński [2010] ). The studies showed that over a period of one and half years, significant changes in PTG had taken place. Reportedly, changes in self-perception and changes in relating to others have decreased, while appreciation of life increased but spiritual life remained the same. The research also allowed us to distinguish several groups of corelates in changes in individual PTG categories. The studies also indicate that building a close relationship with the person who caused the harm can limit the victim’s PTG.

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