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2021 ◽  
Yu-Jung Ko ◽  
Aini Putkonen ◽  
Ali Selman Aydin ◽  
Shirin Feiz ◽  
Yuheng Wang ◽  

Eric Chong ◽  
Bathiya Ratnayake ◽  
Bobby V. M. Dasari ◽  
Benjamin P. T. Loveday ◽  
Ajith K. Siriwardena ◽  

Abstract Background The present systematic review aimed to compare survival outcomes of invasive intraductal papillary mucinous neoplasms (IIPMNs) treated with adjuvant chemotherapy versus surgery alone and to identify pathologic features that may predict survival benefit from adjuvant chemotherapy. Method A systematic search of MEDLINE, PubMed, Scopus, and EMBASE was performed using the PRISMA framework. Studies comparing adjuvant chemotherapy and surgery alone for patients with IIPMNs were included. Primary endpoint was overall survival (OS). A narrative synthesis was performed to identify pathologic features that predicted survival benefits from adjuvant chemotherapy. Results Eleven studies and 3393 patients with IIPMNs were included in the meta-analysis. Adjuvant chemotherapy significantly reduced the risk of death in the overall cohort (HR 0.57, 95% CI 0.38–0.87, p = 0.009) and node-positive patients (HR 0.29, 95% CI 0.13–0.64, p = 0.002). Weighted median survival difference between adjuvant chemotherapy and surgery alone in node-positive patients was 11.6 months (95% CI 3.83–19.38, p = 0.003) favouring chemotherapy. Adjuvant chemotherapy had no impact on OS in node-negative patients (HR 0.53, 95% CI 0.20–1.43, p = 0.209). High heterogeneity (I2 > 75%) was observed in pooled estimates of hazard ratios. Improved OS following adjuvant chemotherapy was reported for patients with stage III/IV disease, tumour size > 2 cm, node-positive status, grade 3 tumour differentiation, positive margin status, tubular carcinoma subtype, and presence of perineural or lymphovascular invasion. Conclusion Adjuvant chemotherapy was associated with improved OS in node-positive IIPMNs. However, the findings were limited by marked heterogeneity. Future large multicentre prospective studies are needed to confirm these findings and explore additional predictors of improved OS to guide patient selection for adjuvant chemotherapy.

Stroke ◽  
2021 ◽  
Gabriel Broocks ◽  
Andre Kemmling ◽  
Svenja Teßarek ◽  
Rosalie McDonough ◽  
Lukas Meyer ◽  

Background and Purpose: Patients presenting in the extended time window may benefit from mechanical thrombectomy. However, selection for mechanical thrombectomy in this patient group has only been performed using specialized image processing platforms, which are not widely available. We hypothesized that quantitative lesion water uptake calculated in acute stroke computed tomography (CT) may serve as imaging biomarker to estimate ischemic lesion progression and predict clinical outcome in patients undergoing mechanical thrombectomy in the extended time window. Methods: All patients with ischemic anterior circulation stroke presenting within 4.5 to 24 hours after symptom onset who received initial multimodal CT between August 2014 and March 2020 and underwent mechanical thrombectomy were analyzed. Quantitative lesion net water uptake was calculated from the admission CT. Prediction of clinical outcome was assessed using univariable receiver operating characteristic curve analysis and logistic regression analyses. Results: One hundred two patients met the inclusion criteria. In the multivariable logistic regression analysis, net water uptake (odds ratio, 0.78 [95% CI, 0.64–0.95], P =0.01), age (odds ratio, 0.94 [95% CI, 0.88–0.99]; P =0.02), and National Institutes of Health Stroke Scale (odds ratio, 0.88 [95% CI, 0.79–0.99], P =0.03) were significantly and independently associated with favorable outcome (modified Rankin Scale score ≤1), adjusted for degree of recanalization and Alberta Stroke Program Early CT Score. A multivariable predictive model including the above parameters yielded the highest diagnostic ability in the classification of functional outcome, with an area under the curve of 0.88 (sensitivity 92.3%, specificity 82.9%). Conclusions: The implementation of quantitative lesion water uptake as imaging biomarker in the diagnosis of patients with ischemic stroke presenting in the extended time window might improve clinical prognosis. Future studies could test this biomarker as complementary or even alternative tool to CT perfusion.

2021 ◽  
Itai Yanai ◽  
Bo Xia ◽  
Weimin Zhang ◽  
Aleksandra Wudzinska ◽  
Emily Huang ◽  

Abstract The loss of the tail is one of the main anatomical evolutionary changes to have occurred along the lineage leading to humans and to the “anthropomorphous apes”1,2. This morphological reprogramming in the ancestral hominoids has been long considered to have accommodated a characteristic style of locomotion and contributed to the evolution of bipedalism in humans3–5. Yet, the precise genetic mechanism that facilitated tail-loss evolution in hominoids remains unknown. Primate genome sequencing projects have made possible the identification of causal links between genotypic and phenotypic changes6–8, and enable the search for hominoid-specific genetic elements controlling tail development9. Here, we present evidence that tail-loss evolution was mediated by the insertion of an individual Alu element into the genome of the hominoid ancestor. We demonstrate that this Alu element – inserted into an intron of the TBXT gene (also called T or Brachyury10–12) – pairs with a neighboring ancestral Alu element encoded in the reverse genomic orientation and leads to a hominoid-specific alternative splicing event. To study the effect of this splicing event, we generated a mouse model that mimics the expression of human TBXT products by expressing both full-length and exon-skipped isoforms of the mouse TBXT ortholog. We found that mice with this genotype exhibit the complete absence of a tail or a shortened tail, supporting the notion that the exon-skipped transcript is sufficient to induce a tail-loss phenotype, albeit with incomplete penetrance. We further noted that mice homozygous for the exon-skipped isoforms exhibited embryonic spinal cord malformations, resembling a neural tube defect condition, which affects ~1/1000 human neonates13. We propose that selection for the loss of the tail along the hominoid lineage was associated with an adaptive cost of potential neural tube defects and that this ancient evolutionary trade-off may thus continue to affect human health today.

2021 ◽  
pp. 1357633X2110410
Brian Z Chin ◽  
Nazrul Nashi ◽  
Shuxun Lin ◽  
Kevin Yik ◽  
Gamaliel Tan ◽  

Introduction With a recent resurgence of the 2019 coronavirus disease (COVID-19) cases globally, an increasing number of healthcare systems are adopting telemedicine as an alternative method of healthcare delivery in a bid to decrease disease transmission. Continued care of orthopaedic patients in the outpatient setting during the coronavirus disease of 2019 era can prove challenging without a systematic workflow, adequate logistics, and careful patient selection for teleconsultation. The aim of this paper is to describe our single-centre experience with the application of telemedicine in our orthopaedic practice, and its effectiveness in maintaining outpatient follow-up of orthopaedic patients. Methodology We describe our centre's telemedicine model of care for orthopaedic patients on the outpatient follow-up – which includes workforce assembly, population health and target patients, logistics and communications, and overall workflow – with roles and responsibilities of involved people portrayed in detail. Results Feedback from both patients and orthopaedic surgeons reflected high satisfaction rates with care provided, noting minimal communication and clinical barriers compared to face-to-face consultations. Whilst not without limitations, our protocol allowed for rapid adoption of telemedicine in line with a national-wide initiative to digitize healthcare. Discussion The implementation of teleconsultation services at our orthopaedic centre has provided an effective method of healthcare delivery while enforcing social distancing measures – which proves vital in combating the spread of COVID-19 and ushering in a new normal.

2021 ◽  
Vol 6 (15) ◽  
pp. 86-99
Neşe ŞEKERCİ ◽  
Deniz ACUNER ◽  
Şevval Nur AYDOĞAN ◽  
Yağmur DOĞAN ◽  

The main purpose of this research is to examine the relationship between children and their parents' gender stereotype judgments and toy choices. The study is descriptive and relationship-seeking research using quantitative methods. The universe of the study is that of children aged 3-8 and their parents living in Istanbul. The sample was composed of 360 parents and 360 children selected by the purpose-built sampling method. The study was conducted by researchers through online platforms with a literature review and a survey created with expert opinion. In accordance with the purpose of the study, two forms were created, aimed at parents and aimed at Children. There are 21 Questions in the parent question form and 14 questions in the child question form. Consent was obtained from the participants at the beginning of the survey. The question form includes questions about parents' perceptions of toy choices, gender stereotypes, children's gender stereotypes, and children's toy choices. Research data was collected in April 2021. Data on sociodemographic features were obtained by frequency, number and percentage analysis. It was found using the Kolmogorov Smirnov test whether gender stereotype judgment score and toy selection scores showed normal distribution. It was found that the scores did not show normal distribution, and non-parametric tests were used. Difference analyses between the groups were obtained using the Mann Whitney U test, and the existence of a relationship between the data was obtained using the Spearman correlation analysis. As a result of this research, it was found that sociodemographic characteristics that parents have influence on gender stereotypes, as well as on their and their children's toy choices. It was concluded that the children of parents with high educational status have more egalitarian gender stereotypes and non-gender-specific toy choices compared to children of parents with low educational status. In parents who had a profession and a job where they worked, the results were found to have more egalitarian gender stereotypes than in those who did not have a profession, similar to educational status. On the other hand, parents who have a job, have more egalitarian gender stereotypes than non-working parents. Gender stereotypes for parents with low educational status and non-working and the importance of toy selection for children should be organized.

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