Duodenal GI stromal tumors: Is radical resection necessary?

BACKGROUND AND OBJECTIVES: Duodenal gastrointestinal stromal tumors (GISTs) are rare tumors that pose a surgical challenge, and long-term outcomes after resection have not been detailed outside of small case series. This study uses the National Cancer Database (NCDB) to examine the determinants of radical resection for duodenal GISTs as well as the impact of local vs radical resection on overall survival (OS). METHODS: The NCDB was queried for nonmetastatic duodenal GISTs from 2004 to 2014. Predictors of radical resection were determined using multivariate logistic regression stratified by extent of tumor involvement. Factors associated with OS were identified with Cox proportional regression analysis. RESULTS: Treatment at an academic center, size \u3e5 cm, and extra-duodenal extension were associated with radical resection. On multivariate analysis, radical resection was associated with decreased OS (HR, 1.93; P \u3c .03). Systemic therapy, extra-duodenal extension, grade, stage, mitoses, and receipt of systemic therapy did not impact OS. CONCLUSION: Local resection of duodenal GISTs is associated with improved OS compared to radical resection after controlling for tumor factors and systemic treatment. Traditional indicators of tumor aggressiveness were associated with radical resection, but not OS. When feasible, local resection should be considered for resection of duodenal GISTs

Absence of intestinal PPARγ aggravates acute infectious colitis in mice through a lipocalin-2-dependent pathway.

To be able to colonize its host, invading Salmonella enterica serovar Typhimurium must disrupt and severely affect host-microbiome homeostasis. Here we report that S. Typhimurium induces acute infectious colitis by inhibiting peroxisome proliferator-activated receptor gamma (PPARγ) expression in intestinal epithelial cells. Interestingly, this PPARγ down-regulation by S. Typhimurium is independent of TLR-4 signaling but triggers a marked elevation of host innate immune response genes, including that encoding the antimicrobial peptide lipocalin-2 (Lcn2). Accumulation of Lcn2 stabilizes the metalloproteinase MMP-9 via extracellular binding, which further aggravates the colitis. Remarkably, when exposed to S. Typhimurium, Lcn2-null mice exhibited a drastic reduction of the colitis and remained protected even at later stages of infection. Our data suggest a mechanism in which S. Typhimurium hijacks the control of host immune response genes such as those encoding PPARγ and Lcn2 to acquire residence in a host, which by evolution has established a symbiotic relation with its microbiome community to prevent pathogen invasion

Instrument Selection and Application Used to Probe Dental Implants.

PURPOSE: The purpose of this study is to survey clinicians\u27 choice of peri-implant instrument selection and the application used to probe dental implants as well as to evaluate peri-implant probing force and pressure applied as compared to that reported in current literature. MATERIALS AND METHODS: 48 clinicians (16 periodontists/periodontal residents, 16 restorative dentists and 16 hygienists) participated in the study. A questionnaire to determine the frequency and method of probing dental implants was provided and subject to the Chi-square test. Each participant was given a choice of three periodontal probes (Marquis, UNC15, Plastic) to use on the typodont and probing force was recorded blindly. Probing force and pressure data were analyzed with ANOVA among subject groups as well as probe types per site; where statistical differences (p \u3c .05) were detected, Tukey\u27s posthoc test was applied. RESULTS: The questionnaire resulted in a variety of answers although the majority demonstrated an agreement on probing implants in everyday practice. There was no significant difference among provider groups in regard to instrument selection, probing forces and pressure in both maxilla and mandible although the mean probing forces and pressures in all provider groups were higher than the suggested value reported in the literature. CONCLUSION: This study indicates that there are variations among clinical provider groups with regard to peri-implant probe instrument type used and forces applied, though these are not statistically significant. Probe tip diameter should be considered to avoid BOP false positives when probing dental implants especially as the forces generally used by the clinicians may be higher than advised

60 GHz Mikrowellentechnik fuer die Breitband-Mobilkommunikation mit optischer Mikrowellenerzeugung Schlussbericht

We have worked on a project 'optical microwave generation for mobile communications' in the context of the BMBF Project line 'PHOTONIK II' together with the Heinrich Hertz Institut (HHI). The task of Bosch were in the area of microwave engineering. For the estimation of the results and for promotion issues we have built working demonstrator systems at 18 GHz and 60 GHz. We have estimated the characteristics of the mobile radiofrequency channel at 60 GHz and have analyzed suitable modulation methods. An optical path which is built with laser diodes, glass fiber and photodetector has been integrated in a radio relay system from Bosch. With this system we have realized a bidirectional data transmission at 155 MBit/s with an OQPSK modulation at 18 GHz. For the Demonstrator at 60 GHz we have created a radio basestation and radio mobile station with waveguide components. Based on a power budget for a cellular radio communication network we have developed a hemisspherical antenna. The measurements of the antenna match the simulations very well and show the suitability for a cellular network at 60 GHz. (orig.)SIGLEAvailable from TIB Hannover: DtF QN1(66,60) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman

A simplified pneumonia severity index (PSI) for clinical outcome prediction in COVID-19.

BackgroundThe Pneumonia Score Index (PSI) was developed to estimate the risk of dying within 30 days of presentation for community-acquired pneumonia patients and is a strong predictor of 30-day mortality after COVID-19. However, three of its required 20 variables (skilled nursing home, altered mental status and pleural effusion) are not discreetly available in the electronic medical record (EMR), resulting in manual chart review for these 3 factors. The goal of this study is to compare a simplified 17-factor version (PSI-17) to the original (denoted PSI-20) in terms of prediction of 30-day mortality in COVID-19.MethodsIn this retrospective cohort study, the hospitalized patients with confirmed SARS-CoV-2 infection between 2/28/20-5/28/20 were identified to compare the predictive performance between PSI-17 and PSI-20. Correlation was assessed between PSI-17 and PSI-20, and logistic regressions were performed for 30-day mortality. The predictive abilities were compared by discrimination, calibration, and overall performance.ResultsBased on 1,138 COVID-19 patients, the correlation between PSI-17 and PSI-20 was 0.95. Univariate logistic regression showed that PSI-17 had performance similar to PSI-20, based on AUC, ICI and Brier Score. After adjusting for confounding variables by multivariable logistic regression, PSI-17 and PSI-20 had AUCs (95% CI) of 0.85 (0.83-0.88) and 0.86 (0.84-0.89), respectively, indicating no significant difference in AUC at significance level of 0.05.ConclusionPSI-17 and PSI-20 are equally effective predictors of 30-day mortality in terms of several performance metrics. PSI-17 can be obtained without the manual chart review, which allows for automated risk calculations within an EMR. PSI-17 can be easily obtained and may be a comparable alternative to PSI-20

Maintaining human milk bank services throughout the COVID-19 pandemic: A global response

If maternal milk is unavailable, the World Health Organization recommends that the first alternative should be pasteurised donor human milk (DHM). Human milk banks (HMBs) screen and recruit milk donors, and DHM principally feeds very low birth weight babies, reducing the risk of complications and supporting maternal breastfeeding where used alongside optimal lactation support. The COVID-19 pandemic has presented a range of challenges to HMBs worldwide. This study aimed to understand the impacts of the pandemic on HMB services and develop initial guidance regarding risk limitation. A Virtual Collaborative Network (VCN) comprising over 80 HMB leaders from 36 countries was formed in March 2020 and included academics and nongovernmental organisations. Individual milk banks, national networks and regional associations submitted data regarding the number of HMBs, volume of DHM produced and number of recipients in each global region. Estimates were calculated in the context of missing or incomplete data. Through open-ended questioning, the experiences of milk banks from each country in the first 2 months of the pandemic were collected and major themes identified. According to data collected from 446 individual HMBs, more than 800,000 infants receive DHM worldwide each year. Seven pandemic-related specific vulnerabilities to service provision were identified, including sufficient donors, prescreening disruption, DHM availability, logistics, communication, safe handling and contingency planning, which were highly context-dependent. The VCN now plans a formal consensus approach to the optimal response of HMBs to new pathogens using crowdsourced data, enabling the benchmarking of future strategies to support DHM access and neonatal health in future emergencies