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In 2016, the Society of Surgical Oncology released a Choosing Wisely guideline recommending sentinel lymph node biopsy (SLNB) omission in females ≥70years of age with early-stage, hormone-positive, clinically node-negative invasive breast cancer. This study investigated the impact of this guideline on SLNB and radiotherapy rates, in addition to assessing temporal trends of nodal biopsy and factors associated with recurrence.
The study involved a retrospective review of women who met the guideline criteria and underwent partial mastectomy at a single institution between 2009 and 2018. Using the same inclusion criteria, the National Cancer Database was queried to obtain a separate dataset. Statistical analyses included univariate comparisons, and multivariate logistic regression modeling to predict radiotherapy delivery.
In our institutional series, 487 patients were included, 274 (56.3%) of whom received radiotherapy. There were 414 patients (85.0%) who underwent SLNB, with a nodal positivity rate of 11%n should continue.
To evaluate the total, and direct effects of vitamin D, measured by circulating 25-hydroxyvitamin D [25(OH)D] levels, on GWG after adjustment for confounding variables, and then assess the indirect effects by demonstrating the role of gestational age at birth as a mediator in this association.
Data collected in "Khuzestan Vitamin D Deficiency Screening Program in Pregnancy" were used for the present study; it included the data of 900 pregnant women referred to the health centers of Shushtar (Khuzestan Province, Iran), whose vitamin D status during the third trimester of pregnancy was available. A mediation analysis was applied to detect the causal relationship between serum level of 25(OH)D, covariates (maternal age, parity, education level, and baseline maternal weight), mediator (gestational age), and outcome (GWG).
Of 900 pregnant women referred to the health centers, a total of 726 eligible participants were analyzed for the study. The adjusted total effect of vitamin D on GWG was estimated 0.07 (95ent of gestational age. Therefore, the detection and treatment of women with vitamin D inadequacy can directly improve the trend of their weight gain in addition to its indirect effect on reducing the risk of preterm delivery.Parkinson's disease (PD) patients with impulse control disorders (ICD) frequently report hypersensitivity to rewards. However, a few studies have explored the effectiveness of modulation techniques on symptoms experienced by these patients. In this study, we assessed the effect of anodal tDCS over the DLPFC on reward responsiveness and valuation in PD patients with ICD. 43 participants (15 PD patients with ICD, 13 PD without ICD, and 15 healthy matched controls) were asked to perform a reward-craving test employing both explicit (self-ratings of liking and wanting) and implicit (heart rate and skin conductance response) measures, as well as two temporal discounting tasks with food and money rewards. Each participant performed the experimental tasks during active anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC), anodal tDCS of the primary motor cortex (M1), and sham tDCS. Results showed increased wanting and a steeper temporal discounting of rewards in PD with ICD compared to the other groups. Moreover, we found that PD without ICD exhibit reduced liking for rewards. tDCS results capable to modulate the altered intensity of PD patients' liking, but not wanting and temporal discounting of rewards in PD patients with ICD. These findings confirm that alterations in reward responsiveness and valuation are characteristics of impulse control disorders in patients with PD but suggest that anodal tDCS over the left DLPFC is not capable to influence these processes. At the same time, they provide new insight into affective experience of rewards in PD.
We have demonstrated in a multicenter cohort that the COVID-19 pandemic has led to a delay in intravenous thrombolysis (IVT) among stroke patients. Whether this delay contributes to meaningful short-term outcome differences in these patients warranted further exploration.
We conducted a nested observational cohort study of adult acute ischemic stroke patients receiving IVT from 9 comprehensive stroke centers across 7 U.S states. Patients admitted prior to the COVID-19 pandemic (1/1/2019-02/29/2020) were compared to patients admitted during the early pandemic (3/1/2020-7/31/2020). Multivariable logistic regression was used to estimate the effect of IVT delay on discharge to hospice or death, with treatment delay on admission during COVID-19 included as an interaction term.
Of the 676 thrombolysed patients, the median age was 70 (IQR 58-81) years, 313 were female (46.3%), and the median NIHSS was 8 (IQR 4-16). Longer treatment delays were observed during COVID-19 (median 46 vs 38min, p = 0.01) and were asbilitation facility. There was no effect modification of treatment delay on admission during the pandemic, indicating that treatment delay at any time contributes similarly to these short-term outcomes.A set of three Al13+ clusters, one perfectly planar, and two quasi-planar structures, have been recently reported by our group (Guin et al. Journal of Molecular Graphics and Modeling, 2020, 97, 107544). All three clusters possess bilateral symmetry with identical structural features-a set of ten aluminum atoms encircle a triangular core. The symmetry axis passes through one of the Al atoms of the central triangular core and two Al atoms located on the periphery at two opposite ends of the cluster. This set of three aluminum clusters is an example of a rare metallo-aromatic system where highly anti-aromatic islands are embedded within an aromatic sea. In the present study, we have explored the effect of doping alkali atoms (Li, Na, and K) at the positions of the Al atoms that lie on the symmetry axis of the cluster intending to understand the structural stability and the effect on the aromatic character as compared to the undoped parent clusters. Besides the electronic structural analysis, NICS and ELF studies have also been carried out to characterize the aromatic nature of the doped clusters. Interestingly, it has been found that even with the incorporation of the alkali atoms, the bilateral symmetry of the clusters remains intact, but the alkali atoms are pushed out of the original location toward the edge of the cluster, whereas the aluminum atoms remain grouped. The dipole moment of the clusters systematically increases, and the overall aromaticity of the cluster systematically decreases with the increase in the atomic number of the doped alkali atoms. Effect of alkali atom doping to Al13+ cluster.
This article reports findings from a demonstration project funded by the Center for Medicare and Medicaid Innovation (CMMI). The purpose of the project was to test a supportive care program on the outcomes of quality of care and quality of life, and costs in patients with advanced cancer.
The project was conducted between February 2015 and February 2018, enrolling adult, Medicare or Medicaid beneficiaries with advanced or progressed solid tumor malignancy. A comparative longitudinal comparison of the program with both a concurrent control and an historic control was used to evaluate outcomes. The intervention included routine electronic biopsychosocial screening, early access to specialty palliative care, and nurse care coordination. Quality of life, aggressiveness of care, and healthcare utilization were measured.
A total of 1340 people were enrolled, with 71% of the total sample being Caucasian; 41.4% had stage IV cancer, and 20% utilized Medicaid only. Significant differences in the enrolled patients and the comparison group were controlled for through statistical analysis. There were significantly fewer ED visits, unplanned admissions, and fewer total hospitalization days in the intervention group. In the last 30days of life, hospital and ICU admissions were less and a greater proportion of patients were enrolled in hospicein the intervention group. Quality of life had a marked improvement for enrolled patients. Average cost per member per month was not less in the enrolled group.
This pragmatic demonstration project confirmed the clinical benefits of an integration of supportive care for patients with advanced cancer, although no reduction in costs was found.
This pragmatic demonstration project confirmed the clinical benefits of an integration of supportive care for patients with advanced cancer, although no reduction in costs was found.A Gram-stain negative, non-motile, brilliant yellow and non-spore forming, coccoid- or short rod-shaped bacterium, designated strain KSK16Y-1T, was isolated from surface-sterilised leaf of Rhizophora stylosa collected from Shankou Mangrove Nature Reserve, Guangxi Zhuang Autonomous Region, China. Genome of strain KSK16Y-1T is 4.93 Mb with 68.1% DNA G + C content and encoded 4359 predicted proteins, 4 rRNAs, 45 tRNAs and 4 ncRNA. Comparative 16S rRNA gene sequence analysis showed that the strain KSK16Y-1T has 98.1%, 97.9% and 96.9% 16S rRNA gene similarities with Jiella aquimaris JCM 30119T, J. endophytica CBS5Q-3T and J. pacifica 40Bstr34T, respectively. Whole-genome comparisons between strain KSK16Y-1T and J. aquimaris 22II-16-19i, J. endophytica CBS5Q-3T, J. pacifica 40Bstr34T, using average nucleotide identity (ANI) values ( less then 82.0%) and digital DNA-DNA hybridization (dDDH) values ( less then 25.1%), confirmed low genome relatedness. selleck Strain KSK16Y-1T grew at 20-30 °C (optimum, 30 °C), pH 6.0-11.0 (optimum, pH 6.0-7.0) and with 0-10% (w/v) NaCl (optimum, 0-2%). Cell wall contained meso-diaminopimelic acid and the major fatty acid was C181ω7c. The polar lipid profile consists of phosphatidylcholine, phosphatidylglycerol, diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylmonomethylethanolamine, one unknown phospholipid, one unknown aminolipid, one unknown aminophospholipid and four unidentified lipids. The predominant respiratory quinone is ubiquinone-10 (Q-10). The polyphasic characterization indicated that strain KSK16Y-1T represents a novel Jiella species. The name Jiella mangrovi sp. nov., type strain KSK16Y-1T (= CGMCC 1.18745T = JCM 34332T) is proposed.A common marker for inhibition processes in task switching are n - 2 repetition costs. The present study aimed at elucidating effects of no-go trials on n - 2 repetition costs. In contrast to the previous studies, no-go trials were associated with only one of the three tasks in the present two experiments. High n - 2 repetition costs occurred if the no-go task had to be executed in trial n - 2, irrespective of whether a response had to be withheld or not. In contrast, no n - 2 repetition costs were visible if the other two tasks were relevant in n - 2. Whereas this n - 2 effect was unaffected by whether participants could reliably exclude a no-go trial or not, effects of no-gos in trial n were determined by this knowledge. The results differ from effects of no-go trials that are not bound to a specific task. It is assumed that the present no-go variation exerted its effect not on the response level, but on the level of task sets, resulting in enhanced salience of the no-go task that leads to higher activation and, as a consequence, to stronger inhibition.
