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tcomes.Background The National Comprehensive Cancer Network (NCCN) recommends germline testing for pathogenic BRCA1/2 mutations identified by somatic tumor sequencing. The aim of this study was to explore whether patients at Stanford with somatic BRCA1/2 mutations were recommended germline testing in accordance with NCCN guidelines. Methods We retrospectively collected all Stanford patients with BRCA1/2 mutations found by tumor sequencing. Medical records were reviewed for each patient to identify those recommended germline testing. A multivariable logistic regression model was fit associating baseline characteristics with whether or not a recommendation was made. Results Of 164 participants, 51 (31.1%) had no recommendation for germline testing. Of the 97 available germline-testing results, 54 (55.7%) were positive for pathogenic BRCA1/2 mutations. After adjusting for possible confounders, patients with genitourinary cancer (odds ratio [OR] = 0.03, 95% confidence interval [CI] = 0.00 to 0.03; P = .003), lung cancer (OR = 0.04, 95% CI = 0.01 to 0.21; P  less then  .001), sarcoma (OR = 0.02, 95% CI = 0.00 to 0.14; P  less then  .001), skin cancer (OR = 0.01, 95% CI = 0.98 to 1.03; P = .002), or "other" diagnoses (OR = 0.01, 95% CI = 0.00 to 0.16; P  less then  .001) were statistically significantly less likely to be recommended germline testing compared with patients with breast or gynecological cancers. Conclusions Our study highlights the importance of provider education outside of the oncologic specialties typically associated with BRCA-related cancers and continued exploration of referrals to genetics for germline testing on the basis of somatic findings. © The Author(s) 2019. Published by Oxford University Press.Background Diabetes is a prognostic factor for some malignancies, but its association with outcome in patients with advanced or metastatic colorectal cancer (CRC) is less clear. Methods This cohort study was nested within a randomized trial of first-line chemotherapy and bevacizumab and/or cetuximab for advanced or metastatic CRC. Patients were enrolled at 508 community and academic centers throughout the National Clinical Trials Network. The primary exposure was physician-documented diabetes at the time of enrollment. The primary endpoint was overall survival (OS); secondary endpoints were progression-free survival (PFS) and adverse events. Tests of statistical significance were two-sided. Results Among 2326 patients, 378 (16.3%) had diabetes. The median follow-up time was 6.0 years. We observed 1973 OS events and 2173 PFS events. The median time to an OS event was 22.7 months among those with diabetes and 27.1 months among those without diabetes (HR = 1.27, 95% CI = 1.13 to 1.44; P  less then  .001). The median time to a PFS event was 9.7 months among those with diabetes and 10.8 months among those without diabetes (HR = 1.16, 95% CI = 1.03 to 1.30; P = .02). Patients with diabetes were more likely to experience no less than grade 3 hypertension (8.1% vs 4.4%; P = .054) but were not more likely to experience other adverse events, including neuropathy. Conclusions Diabetes is associated with an increased risk of mortality and tumor progression in patients with advanced or metastatic CRC. Patients with diabetes tolerate first-line treatment with chemotherapy and monoclonal antibodies similarly to patients without diabetes. © The Author(s) 2020. Published by Oxford University Press.In our physical environment as well as in many experimental paradigms, we need to decide whether an occurring stimulus is relevant to us or not; further, stimuli have uneven probabilities to emerge. Both, decision making and the difference between rare and frequent stimuli (oddball effect) are described to affect pupil dilation. Surprisingly though, conjoint systematic pupillometric investigations into both factors are still rare. In two experiments, both factors as well as their interplay were investigated. Participants completed a sequential letter matching task. In this task, stimulus probability and letter matching (decision making) were manipulated independently. AdipoRon research buy As dependent variables, pupil dilation and reaction time were assessed. Results suggest a clearly larger pupil dilation for target than for distractor letters, even when targets were frequent and distractors rare. When considering the data structure best, no main effect of stimulus probability was found, instead, oddball effects only emerged when stimuli were goal-relevant to participants. The results are discussed in the light of common theoretical concepts of decision making and stimulus probability. Finally, relating theories of each factor, we propose an integrated framework for effects of decision making and stimulus features on pupil dilation. We assume a sequential mechanism during which incoming stimuli are decided upon regarding their goal relevance and, about 200 ms later, relevant stimuli are appraised regarding their value. Copyright © 2020 The Author(s).Book reading shows large individual variability and correlates with better language ability and more empathy. This makes reading exposure an interesting variable to study. Research in English suggests that an author recognition test is the most reliable objective assessment of reading frequency. In this article, we describe the efforts we made to build and test a Dutch author recognition test (DART for older participants and DART_R for younger participants). Our data show that the test is reliable and valid, both in the Netherlands and in Belgium (split-half reliability over .9 with university students, significant correlations with language abilities) and can be used with a young, non-university population. The test is free to use for research purposes. Copyright © 2020 The Author(s).Background Fulminant myocarditis secondary to leptospirosis is rare and associated with poor outcomes. Case summary We describe a 60-year-old gentleman with fulminant leptospiral myocarditis and profound cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenator (VA-ECMO) support. He was given high-dose pulse steroids early on post-VA-ECMO implantation and achieved full recovery. To our knowledge, this is the first reported case of leptospiral myocarditis with multiorgan dysfunction successfully managed by VA-ECMO and high-dose pulse steroids. Discussion This case report highlights the potential benefits of steroids in the management of leptospiral myocarditis which requires further validation. Early aggressive supportive management with ECMO should be considered in patients with fulminant leptospiral myocarditis. © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.