Temozolomide non-responsiveness in aggressive prolactinomas and carcinomas: management and outcomes

Purpose Temozolomide is endorsed as the treatment of choice in aggressive or malignant pituitary adenomas. Herein we describe a case of an aggressive prolactinoma which was resistant to temozolomide and performed a literature review of similar non-responsive aggressive prolactinomas. Methods A 40-year-old female presented with a giant prolactinoma which required cabergoline, transsphenoidal surgery and radiotherapy to achieve near-normal prolactin and apparently no residual tumour. A year later, she presented with multiple cranial nerve involvement due to recurrent tumour extending to the infratemporal fossa. She underwent transfrontal surgery, second radiotherapy and was started on temozolomide. Despite 8 cycles of temozolomide (200mg/m 2, 5/28 day cycle), she had progressive disease and ultimately succumbed to the disease. Pubmed/MEDLINE, Google scholar and prior review articles were searched for manuscripts with aggressive prolactinomas who had been treated with temozolomide. Data on demography, duration of therapy and management outcomes were analysed in those with progressive disease. Literature review We identified 94 cases of aggressive/malignant prolactinomas in the literature who had received temozolomide. Progressive disease despite temozolomide was present in 36 cases (38%). There was a male preponderance (65%) and 40% had aggressive prolactinomas while the rest had carcinomas. Patients received a median of 8 cycles (IQR 3.5-11.5) of temozolomide. MGMT immunostaining was negative in 35%. Overall mortality at the time of publication was 40%, at a duration varying from 2 to 20 years from diagnosis. Conclusion Temozolomide resistance in aggressive/malignant prolactinomas is challenging. Progressive disease on optimal temozolomide treatment entails the use of newer agents.

Islandscapes and Sustainable Creative Tourism: A Conceptual Framework and Guidelines for Best Practices

As strategies for the development of creative tourism multiply in contexts ranging from global cities to small communities, the need for a clearer conceptual framework, capable of better differentiating existing approaches, has become more evident. Building upon existing knowledge on cultural and creative tourism, and on a prior review of the literature on creative tourism on islands, this paper proposes a typology of creative tourism initiatives, and after examining this new categorization, develops the concept of sustainable creative tourism. Through highlighting the need for creative tourism developers, policymakers, and practitioners to deepen their engagement with more holistic and integrated approaches oriented towards sustainable development in all its dimensions (economic, environmental, social, and cultural), the authors systematize a set of international principles and policy recommendations meant to promote sustainable creative tourism development strategies, duly adjusted to different places and realities, with an emphasis on vulnerable islandscapes.

Sentiment analysis in hospitality and tourism: a thematic and methodological review

Purpose This study aims to conduct a systematic review and critically analyze the sentiment analysis literature in hospitality and tourism from methodological (data sets and analyzes) and thematic (topics, theories, key constructs and their relationships) perspectives. Design/methodology/approach Qualitative thematic review and quantitative systematic review were performed on 70 papers obtained from hospitality and tourism categories of two databases, namely, Web of Science and Scopus. Findings A total of 5 topics and 27 sub-topics were identified and the major theme is market intelligence. Sentiment variables were investigated not only as independent but also as dependent variables. The customer rating is the most investigated dependent variable, whereas moderators and mediators were rarely tested. Most reviewed studies did not use theory. The findings from the methodological review show that analysis of big data was rare. Moreover, testing the performance of sentiment analyzes was uncommon, and only one paper tested the performance of aspect/feature extraction. Research limitations/implications This study extends prior review studies by providing a comprehensive view of how knowledge and methodologies of sentiment analysis have developed. The identified themes and key constructs serve as a solid base for future knowledge advancement. Future research directions on sentiment analysis are also provided. Originality/value To the best of the authors’ knowledge, this study is the first comprehensive methodological and thematic review of sentiment analysis in hospitality and tourism. Based on the identified findings, the authors propose several directions for future research.

Are Hotel Guests Altruistic? How Positive Review Disconfirmation Affects Consumers’ Online Review Behavior

The research aims to examine how positive review disconfirmation (i.e., a positive deviance between a hotel consumer’s poststay evaluation and the average review rating by prior consumers) affects subsequent consumers’ willingness to post online reviews and their own review ratings. By employing an experimental research method, this study reveals that positive review disconfirmation increases hotel guests’ willingness to post online reviews, and increases their online review ratings through the mechanism of concern for others, demonstrating an act of altruism. In addition, comparatively the positive review disconfirmation effects are stronger when the variance of prior review ratings is smaller. This study enhances the online review social influence literature, and the consumer’s altruistic motivation of posting online reviews.

Mercury and Prenatal Growth: A Systematic Review

The intrauterine environment is critical for healthy prenatal growth and affects neonatal survival and later health. Mercury is a toxic metal which can freely cross the placenta and disrupt a wide range of cellular processes. Many observational studies have investigated mercury exposure and prenatal growth, but no prior review has synthesised this evidence. Four relevant publication databases (Embase, MEDLINE/PubMed, PsycINFO, and Scopus) were systematically searched to identify studies of prenatal mercury exposure and birth weight, birth length, or head circumference. Study quality was assessed using the NIH Quality Assessment Tool, and results synthesised in a narrative review. Twenty-seven studies met the review criteria, these were in 17 countries and used 8 types of mercury biomarker. Studies of birth weight (total = 27) involving populations with high levels of mercury exposure, non-linear methods, or identified as high quality were more likely to report an association with mercury, but overall results were inconsistent. Most studies reported no strong evidence of association between mercury and birth length (n = 14) or head circumference (n = 14). Overall, our review did not identify strong evidence that mercury exposure leads to impaired prenatal growth, although there was some evidence of a negative association of mercury with birth weight.

Severe tricuspid bioprosthetic valve stenosis as an unusual cause of pulmonary embolism: a case report

Background Bioprosthetic tricuspid valve stenosis (TS) is an uncommon and frequently under-diagnosed condition. Although the resulting right heart failure symptoms are well-known, the associated thrombogenic potential is under-recognized. Case summary A 44-year-old woman with bioprosthetic tricuspid valve (TV) replacement in 2001 was referred for urgent consultation due to acute worsening of dyspnoea and severe swelling and pain in her left arm and neck. She was diagnosed with atrial fibrillation 6 months before the presentation and was found to have right atrial (RA) thrombus with pulmonary embolism and extensive retrograde venous extension 1 month prior. Review of studies done at her local institution revealed 10 mmHg mean gradient (MG) across the bioprosthetic TV that was only reported as mild–moderate TS. Echocardiography done at our instruction confirmed suspicion of severe TS with calcified immobile leaflets. Computed tomography showed persistent RA thrombus and therefore surgical replacement of the TV was undertaken. Subsequently, patient’s dyspnoea rapidly improved. Discussion Progressive dyspnoea and symptoms of right heart failure in a patient with a history of bioprosthetic TV replacement should be investigated for prosthetic valve dysfunction. Due to its rarity, TS diagnosis can be overlooked on routine echocardiography. In our patient, despite a measured MG of 10 mmHg, the presence of critical TS was not initially recognized. As TS is associated with increased thrombogenic potential and given the rare occurrence of in situ RA thrombosis, physicians must have a high index of suspicion for TS in the appropriate clinical context.

Otolaryngology Consult Protocols in the Setting of COVID-19: The University of Pittsburgh Approach

Objective: To analyze trends in otolaryngology consultations and provide algorithms to guide management during the COVID-19 pandemic. Methods: A retrospective cohort study at a single institution tertiary care hospital. A total of 95 otolaryngology consultations were performed from March 1, 2020 to April 26, 2020 (COVID-era) and 363 were performed from September 1, 2019 to February 29, 2020 (pre-COVID-era) at the UPMC Oakland campus. Data collected included patient demographics, COVID-19 status, reason for consult, location of consult, type of consult, procedures performed, need for surgical intervention, length of hospital stay and recommended follow up. Results: Patient populations in the pre-COVID-era and COVID-era were similar in terms of their distribution of demographics and chief complaints. Craniofacial trauma was the most common reason for consultation in both periods, followed by vocal fold and airway-related consults. We saw a 21.5% decrease in the rate of consults seen per month during the COVID-era compared to the 6 months prior. Review of trends in the consult workflow allowed for development of several algorithms to safely approach otolaryngology consults during the COVID-19 pandemic. Conclusions: Otolaryngology consultations provide valuable services to inpatients and patients in the emergency department ranging from evaluation of routine symptoms to critical airways. Systematic otolaryngology consult service modifications are required in order to reduce risk of exposure to healthcare providers while providing comprehensive patient care.

A meta-analysis examining the association between maternal perfectionism and perinatal depression and anxiety

Background: Perfectionism is an important feature of adult psychopathology. In the absence of a prior review of the role of perfectionism in perinatal psychopathology, we aimed to ascertain whether perfectionism was associated with symptoms of maternal perinatal depression and anxiety. Method: We followed PRISMA guidance (PROSPERO: 42019143369 ), estimated weighted effect sizes and tested possible moderators: timing (pre or post- natal), scales used to measure constructs, infant gender, temperament and age; and rated study quality. Results: 14 studies met eligibility criteria. Perfectionism as a whole, and the perfectionistic concerns dimension, were moderately correlated with common maternal perinatal mental health difficulties r= 0.32 (95% Confidence Interval = 0.23 to 0.41). In sub-group analyses, perfectionistic concerns were associated with depression (r=.35, 95% CI = 0.26 – 0.43). We found no evidence of significant moderation of associations. Limitations: Included studies had methodological and conceptual limitations. Studies inconsistently examined both perfectionistic concerns and strivings, nor anxiety as well as depression. Conclusions: Perfectionism, especially perfectionistic concerns, appears to be an important feature of common maternal perinatal mental health problems. While further research is warranted, screening and identification of perfectionism in the perinatal period may help focus resources for intervention, reducing the prevalence of perinatal mental health difficulties.

Sleep quality in the chronic stage of concussion is associated with poorer recovery: A systematic review

Background Recovery from a concussion varies based on a multitude of factors. One such factor is sleep disturbances. In our prior review, it was observed that in the acute phase, sleep disturbances are predictive of poor outcomes following a concussion. The literature gap remains on how sleep in the chronic phase of recovery affects outcomes. Objective To examine the association between sleep quality during the chronic stage of concussion and post-concussion outcomes. Literature Survey: Literature searches were performed during 1 July to 1 August 2019 in selected databases along with searching grey literature. Out of the 733 results, 702 references were reviewed after duplicate removal. Methods Three reviewers independently reviewed and consented on abstracts meeting eligibility criteria ( n = 35). The full-text articles were assessed independently by two reviewers. Consensus was achieved, leaving four articles. Relevant data from each study was extracted using a standard data-extraction table. Quality appraisal was conducted to assess potential bias and the quality of articles. Results One study included children (18–60 months) and three studies included adolescents and/or adults (ranging 12–35 years). The association between sleep and cognition (two studies), physical activity (one study), and emotion symptoms (one study) was examined. Sleep quality was associated with decreased cognition and emotional symptoms, but not with meeting physical activity guidelines six months post-concussion injury. Conclusions The heterogeneity in age of participants and outcomes across studies and limited number of included studies made interpretations difficult. Future studies may consider if addressing sleep quality following concussion will improve outcomes.

Is the incompatibility of UK data retention law with EU law really a victory?

The Court of Justice of the European Union (ECJ) in 2014 ruled in Digital Rights Ireland that the Data Retention Directive was invalid for exceeding the limits of proportionality in light of Articles 7, 8 and 52(1) of the EU Charter of Fundamental Rights (Charter). Subsequently, preliminary references from the England and Wales Court of Appeal and the Swedish Administrative Court of Appeal sought clarification from the ECJ as to whether EU law permitted a general obligation to retain traffic data covering all persons, all means of electronic communication and all traffic data without any distinctions, limitations or exceptions for the purpose of combating crime. The ECJ in Tele2 and Watson ruled that in light of Articles 7, 8, 11 and 52(1) of the Charter, EU Member States were precluded from adopting national measures which provided general and indiscriminate retention of traffic and location data of all subscribers and registered users relating to all means of electronic communication. The ECJ also ruled that Member States were only permitted to adopt data retention measures for the purpose of fighting serious crime, and only when access to retained data was subject to prior review by a court or an independent administrative body. In 2018, the issue of the UK's data retention regime envisaged in Part 4 of the Investigatory Powers Act 2016 came before the England and Wales High Court. The High Court ruled that Part 4 was incompatible with EU law because access to retained communications data was not limited to the purpose of fighting serious crime, and it was not subject to prior review by a court or an independent administrative body. This judgment was regarded by the claimants, Liberty, as a ‘landmark victory for privacy rights’. However, this paper questions whether certain aspects of the High Court ruling are indeed a victory, by assessing its compatibility with EU law and the European Convention on Human Rights (ECHR).