Follow-up Status Research Articles

BIOM-63. DIAGNOSIS AND PROGNOSTIC SIGNIFICANCE OF CIRCULATING miR-2276-5p IN PLASMA OF GLIOMA PATIENTS

Abstract Circulating microRNAs (miRNAs) in plasma have the potential to become diagnostic and prognostic biomarkers for various cancers. This study hopes to use plasma circulating miRNAs as biomarkers for diagnosis and prognosis of glioma patients. METHOD: In this study, the plasma circulating miRNAs of 124 patients with glioma and 36 controls was collected to detect the relative expression of miR-2276-5p, and the specificity and sensitivity of the diagnosis were verified by ROC curve. The follow-up survival status was analyzed by cox regression analysis. RESULT: In the GSE 139031 database, it was found that the expression of circulating miR-2276-5p in plasma of glioma patients was significantly lower than that of patients with non-gliomas. Using our plasma samples, and it is indicated that the expression of circulating miR-2276-5p in plasma is lower than that of healthy patients, and compared with low-grade gliomas, patients with high-grade gliomas have a lower expression of circulating miR-2276-5p. ROC curve analysis found that the AUC value was 0.851. The low expression of circulating miR-2276-5p in plasma of glioma patients indicates a poor prognosis of glioma patients, After univariate and multifactorial cox regression analysis, which can be used as an independent prognostic risk factor for glioma patients (P< 0.05). CONCLUSION: The expression of circulating miR-2276-5p in plasma of glioma patients was significantly lower than that of the control group, compared with low-grade gliomas, patients with high-grade gliomas have a lower expression of circulating miR-2276-5p. The lower the relative expression of circulating miR-2276-5p indicated that glioma patients had a worse prognosis.

Status and related factors of depression, perceived stress, and distress of women at home rest with threatened preterm labor and women with healthy pregnancy in Taiwan

Background: Women with threatened preterm labor (TPTL) resting at home face several life challenges, but their psychological well-being has been ignored. This study aimed to explore the status and related factors of the psychological status of women with TPTL resting at home, and to compare the psychological status differences between TPTL and healthy pregnant women. Methods: A cross-sectional, multiple time-point study was conducted to repeatedly assess depression, perceived stress, and distress in 49 TPTL women and 62 healthy pregnant women during pregnancy in Taiwan. Mann-Whitney U tests were used to compare the psychological status differences between these women and the generalized estimating equation was used to identify the factors related to their psychological status. Results: The TPTL women's perceived stress at 24–27 weeks (p=0.047) and 32–35 weeks (p=0.04) and distress at each time point was significantly greater than that of healthy pregnant women (p<0.001). The common distress experienced by TPTL women was the inability to provide self-care and family care, the baby's health and safety, and to request leave from work for bed rest. Positive personalities, gestational age, preterm birth history, follow-up status and employment have been shown to be related to the psychological status of TPTL women. LimitationsThe major limitation of this study is the small sample size. Conclusion: This study contributed to a better understanding of the emotional burdens of women with TPTL resting at home. Such findings highlight the need for constructing effective interventions to alleviate the psychological burden of these women.

Adolescent and Young Adult Hodgkin Lymphoma: Is More Better?

Background: There is a lack of a uniform approach in the treatment of Classical Hodgkin lymphoma (CHL) in adolescents and young adults (AYA). Age cutoffs are arbitrary and based on institutional experience. Chemotherapy using ABVD (Adriamycin Bleomycin Vinblastine Dacarbazine) is the standard of care in most centers for the management of adult CHL. Children and adolescents have been managed with more chemo intense approaches like the EURONET protocol, with better Event-free survival (EFS) outcomes while reducing the need for radiation therapy (RT). There is a knowledge gap regarding the optimum treatment in the AYA group and this pertains to strategies to improve EFS while addressing increasing concerns of acute toxicities and long-term complications of therapy, RT especially. We share the retrospective experience of our center where young adults and adolescents received two different strategies based on an age cutoff alone, resulting in different outcomes. Methodology: A retrospective chart review of patients aged 10-30 years with newly diagnosed CHL between January 2014 to Dec, 2019 was undertaken. The demographic and clinical profile, treatment details, treatment related complications, RT requirement, and follow-up status for the entire cohort and for each of ABVD and EURONET treatment subsets were analysed. EURONET treatment strategy used 2 cycles of OEPA (Vincristine + Etoposide + Prednisone + Adriamycin) followed by 1-4 cycles of COPDAC (Cyclophosphamide + Vincristine + Dacarbazine + Prednisone), based on the risk level. ABVD protocol used 2 cycles of ABVD followed by 2 - 4 cycles of AVD/ABVD, or intensified chemotherapy based on the interim PET-CT scan response. RT was reserved for inadequate responders during interim assessment in both protocols. Events calculated were death, progression, refractory disease and relapse. Results: 470 patients with CHL were registered at our centre in the study period. 156 patients were in the 10-30yrs age group. 30 adolescents between ≥10 and &amp;lt;18 years of age (with median age 15.9 years) received the EURONET treatment strategy and 126 patients between ≥18 and ≤30 years (median age 22.7 years) received ABVD protocol. Median follow-up for the entire cohort was 28 months. The patient characteristics are shown in the Table 1. Advanced disease (Stage IIB-IV, and Bulky disease) was seen in 67.4% and 63.3% of patients treated with ABVD and EURONET treatment protocols, respectively. RT was administered in 37.7% of the patients on ABVD and 3.3 % patients on EURONET treatment protocol (Figure 1). 23% of the patients receiving the ABVD therapy had an event compared to 3.3% of the patients in the EURONET treatment group. The EURONET treatment group experienced more grade 3 or 4 acute toxicities (46.6%) when compared to ABVD (8%), the majority being neutropenic fever episodes. There was no treatment related mortality. The 3 year estimated EFS was 93.1% (Std.error=0.04) for the EURONET treated group whereas it was 71.9% (Std.error=0.044) for the ABVD group (Figure 2). Conclusions: This large single centre retrospective study of CHL in AYA patients shows better EFS and lesser requirement of RT in the EURONET treated group, at the cost of increased acute hematological toxicity. Though an age-matched direct comparison between the treatment groups was not feasible, this study suggests that chemotherapy intensification in the AYA group is possible and may potentially improve EFS while reducing the need for Radiotherapy. Disclosures Radhakrishnan: Pfizer, India: Honoraria, Speakers Bureau; Roche, India: Research Funding; Bristol Myers Squibb, India: Research Funding; Astra Zeneca, India: Honoraria, Speakers Bureau; Novartis, India: Honoraria, Speakers Bureau; NATCO pharmaceuticals: Research Funding; Emcure pharmaceuticals: Research Funding, Speakers Bureau; Dr. Reddys Laboratories: Speakers Bureau; Aurigene: Honoraria; Cipla: Honoraria, Research Funding, Speakers Bureau; Intas: Research Funding, Speakers Bureau. Chandy:NATCO Pharmaceuticals: Research Funding; Intas Pharmaceuticals: Research Funding. Nair:Intas Pharmaceuticals: Research Funding, Speakers Bureau; Cipla: Speakers Bureau; Dr Reddys Laboratories: Honoraria, Research Funding, Speakers Bureau.

Percutaneous vertebroplasty for the treatment of symptomatic vertebral hemangioma with long-term follow-up

There is a paucity of literature on vertebroplasty in hemangioma. The effectiveness with short-term and long-term follow-up is an important insight for research. This study aims to evaluate the effectiveness and the long-term efficacy of vertebroplasty in the treatment of the patient with symptomatic vertebral hemangioma. Materials and methodsThis is a retrospective cohort study. The outcome was evaluated by immediate post-procedure and 3 months, 1 year, and 5 years of follow-up clinical status of the patients. The significance was determined by using a paired t-test between the pre-procedure and post-procedure severity of pain, activity score, and analgesic. The P-value < 0.05 indicated statistical significance. ResultsA total of 38 vertebroplasties were performed in 34 patients. Additionally, the embolization of residual soft tissue was performed in 4 patient and Percutaneous alcohol injection for posterior elements involvement was performed in 9 patients. Immediate after the procedure, 44.12% of patients became asymptomatic, 38.23% of patients showed significant improvement, 11.77% of patients remained static and 2.94% of patients deteriorated and needed laminectomy. The complication rate was 29.4%, but only 2 patients were symptomatic and needed surgical decompression. There was significant relief of pain (P < 0.05), reduced analgesic intake (P < 0.05), and increased activity (P < 0.05) immediately after the procedure, 3 months, 1 year, and 5 years follow-up. ConclusionPVP is an effective therapeutic option for the treatment of VH with fewer complications. The additional procedures like preprocedural embolization and percutaneous alcohol injection enhance the outcome and avoid complicated surgical interventions.

Surgical Management of Multifocal Trigeminal Schwannomas.

Isolated trigeminal schwannomas occur in 0.07% to 0.3% of intracranial tumors and account for 0.8% to 8% of intracranial schwannomas and 1/3 of Meckel cave tumors. The presence of multisegmental schwannoma is rare, resulting in a limited understanding of its optimal management. To describe potential surgical options to manage this rare entity. A 2-institution retrospective review of all patients with pathologically confirmed trigeminal schwannoma managed with resection from January 2009 through January 2019 was conducted. A manual chart review was performed to verify patients' inclusion and collect data about age, sex, tumor size, tumor site, treatment modality, surgical approach, complications, and follow-up duration and status. A total of 4 patients (age range 12-50 yr) who underwent a variety of cranial and orbitocranial approaches for tumor resection were identified. Patients achieved good outcomes with improvement of visual outcomes. One case of infection and 1 case of partial tumor recurrence requiring reresection were identified. Multisegmental trigeminal schwannoma is a rare and unique entity, often associated with trigeminal schwannomatosis. Interdisciplinary management has been shown to be the most effective method for improving patient outcomes with these complex and poorly understood diseases.

Retinoblastoma in Children Older than 6 Years of Age

Objective: The aim of this work was to study the clinical and histopathology features and treatment outcome in retinoblastoma cases presenting at an older age (>6 years). Design: This was a retrospective study. We recruited 48 retinoblastoma patients who were treated at our institute over 7 consecutive years and were older than 6 years at presentation. Methods: Medical records were reviewed for data, including age at diagnosis, gender, laterality, family history, lag time, first symptom, misdiagnosis, clinical findings, grade and stage of disease at diagnosis, treatment, outcome, and follow-up status. Histopathology slides were reviewed and assessed for the presence of histopathological high-risk features (HRF) for metastasis. The main outcome measures were the frequency of atypical clinical features like hyphema, pseudohypopyon, glaucoma, cataract, vitreous hemorrhage, and phthisis, and misdiagnosis, prior intervention, stage of disease at presentation, and treatment outcome. Results: In total, 48/610 (7.8%) patients were older than 6 years, with a median age of 7 years (range 6–31). Retinoblastoma was bilateral in 7 cases. The most common initial symptom was white reflex followed by a decrease in vision. The median lag time was 9 months. Fourteen cases (29.2%) were misdiagnosed, with endophthalmitis the most common misdiagnosis. Twenty-six (54%) patients had intraocular disease, 12 (25%) had locally advanced disease, and 10 (21%) had metastatic disease at presentation. Overall, 67% (14/21) of the eyes that were enucleated upfront for presumed intraocular disease had histopathological HRF. At last follow-up, 31/36 (86%) who were treated were alive and healthy, while 5 (14%) patients had disease progression. Conclusions: This is the largest study of older age retinoblastoma and shows that it forms a significant percentage of retinoblastoma in developing countries, is misdiagnosed in one-third of cases, and may present at an advanced stage in 46% of cases.

\u2018Mothers moving towards empowerment\u2019 intervention to reduce stigma and improve treatment adherence in pregnant women living with HIV in Botswana: study protocol for a pragmatic clinical trial

BackgroundWith high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children’s lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the “What Matters Most” stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the “Mothers Moving towards Empowerment” (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period.MethodsThis study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at < 16 weeks), birth weight, vaccination record, and HIV status).DiscussionOur trial will evaluate MME, a culturally based HIV stigma reduction intervention using the “What Matters Most” framework, to reduce stigma and improve treatment adherence among pregnant women and their infants. This study will help inform further refinement of MME and preparation for a future large-scale, multisite, randomized controlled trial (RCT) in Botswana.Trial registrationClinicalTrials.gov NCT03698981. Registered on October 8, 2018

Guillain-Barre syndrome: demographics, clinical features, and outcome in a single tertiary care hospital, Oman.

Objectives:Guillain–Barre syndrome (GBS) is an acute autoimmune-mediated peripheral nervous system disease. Different studies from various geographical regions have reported considerable variability regarding its epidemiology, clinical features, and outcome. Our study aimed to document demographics, clinical features, and outcomes among GBS patients admitted to a single tertiary care hospital in Muscat, Oman.Methods:A retrospective data analysis of 44 GBS patients, who were admitted during a two-year period from January 2016 to December 2018 at Khoula hospital, was carried out. Demographics, antecedent illness, duration of symptoms, muscle power graded by the Medical Research Council scale (MRCs), sensory & autonomic involvements, nerve conduction study results, CSF study, need for ventilation, condition at discharge and subsequent follow-up status were obtained.Results:Ninety-one percent of the patients were Omanis, with male predominant 63.6% and the average age was 42.69 years. Quadriparesis was the predominant presenting complaint (61.3%) and AIDP was the commonest variant (52%). All patients received a single cycle of IVIg and (13.6%) patients admitted to the ICU for mechanical ventilation. The study showed good outcome and recovery in 18 months follow up.Conclusion:The clinical presentation of GBS in the majority of patients in Oman is similar to those reported in previous studies, and most patients had favorable prognoses. Our results can be used as baseline data for understanding the characteristics of GBS in Oman and, consequently, for better management.

Neighborhood Matters For Transitional Care and Heart Failure Hospital Readmission

Introduction The social and economic conditions of where people live has been associated with HF hospital readmission. Multidisciplinary transitional care is effective to decrease HF readmission, but the impact of neighborhood disadvantage on transitional care is unknown. Early provider follow-up and nursing care coordination have unique contributions to transitional care and HF outcomes. The purposes of this study were to examine the relationship between early provider follow-up, nursing care coordination, and hospital readmission in a population of older adults with HF, and determine if an interaction exists with neighborhood disadvantage. Hypothesis There is a direct relationship between early provider follow-up and decreased HF readmission and an indirect relationship through nursing care coordination intensity that is moderated by neighborhood disadvantage. Methods A retrospective, correlational design utilized existing data. Data were from medical records and billing databases. Home addresses from index admissions were geocoded to census block groups and linked to the 2015 Area Deprivation Index database. Logistic regression was used to compare patients by readmission and early provider follow-up status. Moderated mediation analysis included ordinary least squares regression, logistic regression, and bootstrap confidence intervals to test the hypothesis. Results Of 1280 subjects, mean (SD) age was 79 (8.66) years, 50.7% were female, and 25.9% were non-white. In multivariable analysis, early provider follow up decreased the odds of readmission (OR 0.70 [CI, 0.50, 0.97], p=.032) and having 2 care coordination contacts increased the odds of readmission (OR 1.67 [1.07, 2.60], p=.024). Neighborhood disadvantage decreased the odds of having an early provider visit (OR 0.67 [0.49, 0.93], p=.015) and having a care coordination contact within 3 days of hospital discharge increased the odds of a provider visit two-fold (OR 2.13 [1.67, 2.72], p Conclusions Neighborhood disadvantage influences participation in transitional care interventions for the elderly HF population. An interventional study that examines the combined effect of care coordination and provider follow-up on HF readmission, using innovative processes to reach the most disadvantaged populations is needed.

Clinicopathologic Study of Gleason Pattern 5 Prostatic Adenocarcinoma With "Single-cell" Growth Reveals 2 Distinct Types, One With "Plasmacytoid" Features.

Each Gleason score category of prostatic adenocarcinoma (or Grade Group) may encompass a diverse group of architectural patterns such as well-formed glands, poorly formed glands, cribriform structures, single cells, and/or solid sheets. We have noted heterogeneity within the single-cell subtype of Gleason pattern 5 prostatic adenocarcinoma that has not been fully addressed. Therefore, we retrospectively reviewed a series of radical prostatectomies with high-grade prostatic adenocarcinoma (Grade Group 4 or 5), identifying tumors with a component of single-cell infiltration. Additional cases identified prospectively were also included. TNM status, association with other histologic patterns, and clinical follow-up status were determined. Immunohistochemistry for NKX3.1, E-cadherin, p120 catenin, and prostate-specific antigen (PSA) were performed in each case. Eighteen cases with a component of well-developed Gleason pattern 5 characterized by single infiltrative cells that comprised ≥5% of the tumor were identified (15/202 retrospective radical prostatectomies with the high-grade disease [7.5%]). The single-cell pattern ranged from 5% to 50% of the tumor volume, with 5 cases containing ≥40%, and variable secondary architecture included diffuse infiltrating single cells with targetoid growth pattern around benign glands, solid expansive nests of noncohesive cells, and corded/single file growth pattern. Further morphologic analysis demonstrated 2 distinct histologic subtypes: (1) (subtype 1; n=9) monomorphic "plasmacytoid" tumor cells with eccentrically placed nuclei and variable intracytoplasmic vacuoles with bland cytology and discohesion and (2) (subtype 2; n=9) more cohesive tumor cells with greater cytologic atypia characterized by prominent nucleoli, greater variability in nuclear size/shape, occasional mitotic figures, and more irregular infiltration. By immunohistochemistry, NKX3.1 nuclear expression and PSA cytoplasmic expression was retained in all cases. Concomitant membranous E-cadherin loss and strong cytoplasmic p120 catenin expression were present in 5 of the 18 (28%) cases, all in subtype 1 (5/9, 56%). Overall, 56% (10/18) of patients had advanced-stage disease (≥pT3b), and 70% (7/10) of these patients had associated lymphovascular invasion. All patients had concomitant cribriform patterns of carcinoma. The outcome was available for 14 patients: 4 died of unknown cause; 6 had biochemical recurrence with distant bone metastasis in 5 of the 6; and 4 patients with <3 years of follow-up currently have undetectable serum PSA levels (2 patients received salvage radiotherapy with androgen deprivation and 2 remain on routine follow-up). In summary, the single-cell pattern of Gleason pattern 5 prostatic adenocarcinoma is uniformly associated with other high-risk histologic patterns (eg, cribriform growth), and high-stage disease with distant metastasis is not uncommon. Our data suggest that the "single-cell" Gleason pattern 5 prostatic adenocarcinoma contains 2 distinct subtypes. Somatic CDH1 alterations may play a role in the development of the "plasmacytoid" pattern characterized by monomorphic cytology with concomitant E-cadherin loss and aberrant p120 catenin expression.

Mesenteric Cyst in 22 Cases.

The aim of this study is to retrospectively and multi-centerly examine the clinicopathological features of patients who were operated with the diagnosis of mesenteric cyst, which is a rare cause of intra-abdominal mass in the last 9 years, in the light of the literature. The patients were operated due to mesenteric cysts in the general surgery clinics of two Training and Research Hospital between 2010 and 2019; age, gender, preoperative clinical findings, computed tomography (CT) findings, localization of the mass, surgical procedure, morbidity, histopathological results, and follow-up period status were analyzed and reported electronically. The patients generally applied with the complaints of abdominal pain, palpable abdominal mass, and abdominal distention. Fourteen (63.7%) of the cases were male and 8 (36.3%) were female. The mesenteric cysts were located in the small intestine in 18 cases and colon in 4 cases. In the histopathological examination of the surgical materials, simple cyst was detected in 17 cases, lymphangioma in 4 cases, colon adenocarcinoma, and simple cyst in 1 case. In the postoperative period, superficial surgical site infection developed in 3 patients and morbidity developed in 1 patient due to anastomotic leakage. Although mesenteric cysts are rarely seen, although most of them are not histopathologically malignant, they can reach large sizes and require extensive surgical operation, and related morbidities can be seen. Therefore, mesenteric cysts should be followed carefully in the postoperative period as well as during the diagnosis and surgical treatment process.

Quality of Care in Patients With Cirrhosis: Trends in Recommended Adult Vaccination Coverage.

ObjectiveTo assess the proportion of patients with cirrhosis up to date with vaccinations and associations of vaccination with age, sex, race, ethnicity, marital status, and type of provider follow-up.Patients and MethodsPatients with cirrhosis diagnosed at Mayo Clinic in Rochester and Mayo Clinic Health System in Minnesota from January 1, 2007, to December 31, 2009, were followed up from diagnosis until May 31, 2015. Data were abstracted from Mayo Clinic and Minnesota State records. Factors determining vaccination coverage were assessed.ResultsAt the end of the study period (8 years follow-up), 26.4% (95 of 360), 24.7% (82 of 332), 63.2% (180 of 285), and 25.5% (54 of 212) of patients with cirrhosis were up to date with hepatitis A virus (HAV), hepatitis B virus, pneumococcal pneumonia (PN), and herpes zoster vaccinations, respectively. Influenza (FLU) vaccine coverage increased from 36.1% (57 of 158) in 2007 to 2008 to 65.8% (106 of 161) in 2014 to 2015. Of those unvaccinated for HAV and hepatitis B virus before cirrhosis diagnosis, 18.6% (59 of 318) and 23.4% (71 of 304) completed vaccination. For HAV, more whites than nonwhites (28.3% [91 of 322] vs 10.5% [4 of 38]; odds ratio [OR], 3.35; 95% CI, 1.29 to 11.45; P=.02) and more non-Hispanics than Hispanics (27.4% [95 of 347] vs 0% [0 of 13]; OR, 0.00; 95% CI, 0.00 to 0.43; P=.03) were vaccinated. For PN, more younger than elderly people (66.8% [135 of 202] vs 54.2% [45 of 83]; OR, 1.70; 95% CI, 1.01 to 2.87; P=.04) and married vs single people (56.8% [100 of 176] vs 73.4% [80 of 109]; OR, 2.10; 95% CI, 1.26 to 3.56; P=.005) were vaccinated. For FLU, in 2013 to 2014, more elderly (72.0% [54 of 75] vs 58.0% [69 of 119]; OR, 0.54; 95% CI, 0.28 to 0.99; P=.05); in 2008 to 2009, more Hispanics (100% [4 of 4] vs 41.6% [116 of 279]; OR, ∞; 95% CI, 2.25 to ∞; P=.02); and in 2011 to 2012, more married people (62.4% [101 of 162] vs 50.5% [56 of 111]; OR, 1.63; 95% CI, 0.1.0 to 2.66; P=.05) were vaccinated. For FLU in 2008 to 2009, coverage was higher in the primary care than the specialist setting (55.8% [48 of 86] vs 36.6% [72 of 197]; P=.003).ConclusionExcept for PN and FLU, vaccination coverage in patients with cirrhosis falls short of Healthy People 2020 target. Specific interventions are needed to improve vaccination coverage in patients with cirrhosis.

Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: A living systematic review and meta-analysis.

There is disagreement about the level of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We conducted a living systematic review and meta-analysis to address three questions: (1) Amongst people who become infected with SARS-CoV-2, what proportion does not experience symptoms at all during their infection? (2) Amongst people with SARS-CoV-2 infection who are asymptomatic when diagnosed, what proportion will develop symptoms later? (3) What proportion of SARS-CoV-2 transmission is accounted for by people who are either asymptomatic throughout infection or presymptomatic? We searched PubMed, Embase, bioRxiv, and medRxiv using a database of SARS-CoV-2 literature that is updated daily, on 25 March 2020, 20 April 2020, and 10 June 2020. Studies of people with SARS-CoV-2 diagnosed by reverse transcriptase PCR (RT-PCR) that documented follow-up and symptom status at the beginning and end of follow-up or modelling studies were included. One reviewer extracted data and a second verified the extraction, with disagreement resolved by discussion or a third reviewer. Risk of bias in empirical studies was assessed with an adapted checklist for case series, and the relevance and credibility of modelling studies were assessed using a published checklist. We included a total of 94 studies. The overall estimate of the proportion of people who become infected with SARS-CoV-2 and remain asymptomatic throughout infection was 20% (95% confidence interval [CI] 17-25) with a prediction interval of 3%-67% in 79 studies that addressed this review question. There was some evidence that biases in the selection of participants influence the estimate. In seven studies of defined populations screened for SARS-CoV-2 and then followed, 31% (95% CI 26%-37%, prediction interval 24%-38%) remained asymptomatic. The proportion of people that is presymptomatic could not be summarised, owing to heterogeneity. The secondary attack rate was lower in contacts of people with asymptomatic infection than those with symptomatic infection (relative risk 0.35, 95% CI 0.10-1.27). Modelling studies fit to data found a higher proportion of all SARS-CoV-2 infections resulting from transmission from presymptomatic individuals than from asymptomatic individuals. Limitations of the review include that most included studies were not designed to estimate the proportion of asymptomatic SARS-CoV-2 infections and were at risk of selection biases; we did not consider the possible impact of false negative RT-PCR results, which would underestimate the proportion of asymptomatic infections; and the database does not include all sources. The findings of this living systematic review suggest that most people who become infected with SARS-CoV-2 will not remain asymptomatic throughout the course of the infection. The contribution of presymptomatic and asymptomatic infections to overall SARS-CoV-2 transmission means that combination prevention measures, with enhanced hand hygiene, masks, testing tracing, and isolation strategies and social distancing, will continue to be needed.

Evolution of serum Anti-Müllerian Hormone (AMH) level in young women treated with chemotherapy for breast cancer according to basal AMH level

ObjectiveSerum AMH level has been shown to decrease in women treated for breast cancer in several studies. However, whether basal AMH status affects AMH dynamics during chemotherapy remains to be clarified. The objective of this study was to compare serum AMH dynamics in young women with either low, normal or high basal serum AMH level at diagnosis, during and after treatment with chemotherapy for breast cancer. Study designIn this secondary analysis of a prospective cohort study, serum AMH was measured during and after chemotherapy in 239 women of reproductive age diagnosed with breast cancer and treated with chemotherapy. The association between AMH dynamics throughout chemotherapy and during follow-up and basal AMH status, i.e. low AMH (<1 μg/l, <7 pmol/l), normal AMH (1–4.9 μg/l, 7−36 pmol/l) and high AMH (≥5 μg/l, >36 pmol/l), was evaluated. Menses occurrence was also recorded. ResultsA total of 21 women had low, 154 had normal and 64 had high basal AMH level. Serum AMH rapidly decreased during chemotherapy in all groups, and its variation during chemotherapy and follow-up was not significantly different between the 3 groups. ConclusionNo association was found between AMH variation during chemotherapy and follow-up, and basal AMH level at diagnosis. However, women with high basal AMH levels have significantly higher AMH levels throughout chemotherapy and follow-up than women with normal or low basal AMH levels at diagnosis.

Postinflammatroy pulmonary fibrosis of COVID-19: the current status and perspective

The novel coronavirus pneumonia (COVID-19) has been well controlled in China. Most of the COVID-19 patients were having postinflammatory pulmonary fibrosis (PPF) on the follow-up CT scan when discharged, and complaining about exertional dyspnea of different levels, presenting with an UIP (usual interstitial pneumonia) pattern or NSIP (non-specific interstitial pneumonia) pattern on the CT scans. Will the PPF get improved or stay stable, or progress? Such questions could only be answered by follow-up and monitoring of the pulmonary function. At the same time, we should learn from the lessons on pulmonary function loss of the SARS patients and MERS patients, some of whom had persistent impaired lung function after discharge. Pirfenidone and Nintedanib had been approved for the treatment of idiopathic pulmonary fibrosis(IPF), showing effectiveness on non-IPF pulmonary fibrosis as well. However, there are no studies about the application on PPF resulting from viral pneumonia. Given the follow-up status of SARS patients and MERS patients, and the PPF of COVID-19 patients, we should be careful about the discharged patients with a close follow-up, and further studies on PPF of COVID-19 are needed.

Body mass index at diagnosis and prognostic significance on head and neck carcinoma survival

Abstract Background Previous findings suggest there might be an inverse association between body mass index (BMI) and overall (OS) and Head and Neck-specific survival. The aim of this study was to investigate the prognostic role of BMI in the largest available cohort of HNC patients. Methods We performed a pooled analysis of studies participating at the INHANCE consortium. Cases were adults with HNCs of the oral cavity, oropharynx, hypopharynx and larynx. We used cox's proportional hazards models to estimate the relationship between BMI and overall and HNC-specific mortality. Sensitivity analysis were performed according to tumour location, smoking status and length of follow-up. Results The study included 9484 patients from 10 centres worldwide for a median follow-up of 48 months (IQR: 18-69). Overall 3623 patients (38.2%) died from all-causes and 1493 (15.7%) from HNC. Compared to patients with a normal weight, overweight or obese was associated with a longer HNC-specific survival (HR = 0.58, 95% CI: 0.35-0.95, HR = 0.37, 95% CI: 0.17-0.78, respectively), while underweight was associated to a shorter survival (HR = 1.73, 95% CI: 1.36-2.21). Results were heterogeneous according to tumour site, with the strongest effect among oropharynx and oral cavity cancer sites. When we restricted the analysis among patients with a follow-up longer than 5 years, underweight (HR = 5.17, 95% CI: 3.02-8.86) was associated with shorter HNC-specific survival. Conclusions Our findings suggest low BMI values are at diagnosis increase mortality in HNC patients. The protective effect of high BMI might be partially explained by residual confounding and reverse causality, so that further research is needed to clarify the potential role in tertiary prevention of BMI. Key messages BMI at diagnosis is a prognostic factor of HNC. Low BMI values predict unfavourable outcomes.

A cut above? Inferior vena cava resection without reconstruction: a dual-centre experience

Objectives: To evaluate outcomes in our patients undergoing inferior vena cava (IVC) resection without reconstruction, as part of an adrenal/renal cell cancer (RCC) operation. Methods: British Association of Urological Surgeons (BAUS) Data and Audit System records were obtained for two operating surgeons, each at geographically separate urological cancer centres. Retrospectively reviewed case notes of patients who had undergone IVC resection without reconstruction as part of an adrenal/RCC operation, assessing operative parameters, length of stay, complications and follow-up status. Results: A total of Twenty-eight patients (20 right-sided tumours, 8 left sided) underwent IVC resection without reconstruction in May 2013–February 2017. No perioperative or early deaths occurred. Fourteen patients (50%) had complications: sepsis; pneumonia; congestive cardiac failure; acute kidney injury; symptomatic peripheral deep venous thrombosis; splenectomy; and significant chyle leak. At a median follow-up of 21 months (range 1–55 months) six patients (21.4%) have died and two patients (7.1%) progressed to metastatic disease, giving a 71.4% progression-free survival in this series. Conclusions: This case series illustrates our experience of IVC resection without reconstruction as an acceptably safe procedure. This should be considered as an alternative to graft reconstruction, particularly as minimal invasive approaches are being adopted. Level of Evidence: 3

Different surgical outcome and follow-up status between dMMR and pMMR colorectal cancer patients who fulfilled with Amsterdam-II criteria

BackgroundAlthough hereditary non-polyposis colorectal cancer (HNPCC) could be subtyped into proficient or deficient mismatch repair gene expression (pMMR or dMMR), distinct clinical features between these two subgroups patients were rarely reported.MethodsWe retrospectively analyzed 175 hereditary non-polyposis colorectal cancer (HNPCC) patients between January 1995 and December 2012. Cox proportional hazards model was used to compare the differences between two subgroups.ResultsSignificant differences of disease free survival (DFS) and overall survival (OS) exist between dMMR and pMMR. In addition to other factors including younger mean age of diagnosis for dMMR patients (48.6 years vs. 54.3 years), operation type (more extended colectomy for dMMR 35.8% vs. 14.5%), tumor location (right colon predominance for dMMR 61.7% vs. 27.3% and more rectum cases for pMMR 41.8% vs. 11.7%), tumor differentiation (more poor differentiation for dMMR 23.3% vs. 9.0%), N staging (more N0 cases for dMMR 70.8% vs. 50.9%), more frequently presence of extra-colonic tumors for dMMR (16.7% vs.1.8%), and lower recurrence rates (9.1% vs.35.3%). Significantly different cumulative incidences of developing metachronous colorectal cancer were observed with 6.18 for pMMR patients and 20.57 person-years for dMMR patients (p < 0.001).ConclusionsDistinct clinicopathological features significantly exist between dMMR and pMMR subtypes patient, MMR status should be consider to tailor operation types and follow up surveillance between these two subgroups patients who all fulfilled with Amsterdam-II criteria.

Oral Amelanotic Melanomas: Clinicopathologic Features of 8 Cases and Review of the Literature.

Mucosal melanomas are aggressive tumors, rarely observed in the oral cavity. The diagnosis is based on the clinical and microscopical features. Often these tumors had variable amounts of melanin pigmentation. However, when melanin is absent, the tumors are denominated amelanotic, presenting a tendency to misdiagnosis and delayed treatment. The aim of this study was to describe the clinicopathologic features of a series of oral amelanotic melanomas (OAM). Records of all cases of OAM were retrospectively retrieved from oral pathology services from January 2002 to January 2019. Data regarding the clinical features, morphological aspects, immunohistochemical reactions, treatment, and follow-up status were collected. Eight cases of OAM were included, 6 in men and 2 in women (ratio of 3:1) ranging in age from 33 to 77 years (mean 53.6 years). Clinically, the tumors presented as masses or ulcerated swellings. The most common intraoral locations of the tumors were gingiva and palate. Cervical lymph node metastasis was detected in 3 patients at the first examination. All but one patient died from complications of the tumors after a mean follow-up period of 8.5 months. In conclusion, OAM is a very aggressive malignant tumor, and when melanin is absent, an immunohistochemical panel comprising S100, melan A, HMB45, and SOX10 should be performed.

SOSYAL BİLGİLER ÖĞRETMEN ADAYLARININ SOSYOBİLİMSEL KONULARA YÖNELİK TUTUM VE GÖRÜŞLERİ

Bu araştırmanın amacı, sosyal bilgiler öğretmen adaylarının sosyobilimsel konulara yönelik tutum ve görüşlerini incelemektir. Küresel ısınma, nükleer santraller, organ bağışı, klonlama gibi tartışmalara neden olan sosyobilimsel konuların günlük yaşamda karşılaşılan problemlere uygun stratejik yaklaşımların geliştirilmesinde önemi bulunmaktadır. Karma yöntem (mixed-method research) yaklaşımına göre tasarlanan araştırma 2018-2019 eğitim-öğretim yılının bahar yarıyılında açıklayıcı ardışık desen ile gerçekleştirilmiştir. Nicel veriler, Topçu (2010) tarafından geliştirilen “Sosyobilimsel Konulara Yönelik Tutum Ölçeği ’ne” göre, nitel veriler ise “Yarı Yapılandırılmış Görüşme Formu” ile elde edilmiştir. Nicel verilerin analizinde bağımsız t testi, tek yönlü varyans analizi ve kruskal wallis testlerinden yararlanılmıştır. Nitel verilerin analizinde ise içerik analizi kullanılmıştır. Araştırmanın değişkenlerinden sınıf düzeyi, akademik not ortalaması, lise türü, bilimsel yayın takip durumu ve anne eğitim durumunun öğretmen adaylarının sosyobilimsel konulara yönelik tutumlarını etkilediği belirlenmiştir. Öte yandan cinsiyet, öğrenim gördüğü üniversite, yerleşim birimi, sosyal medya kullanımı, en fazla izlenilen televizyon programı ve baba eğitim durumu değişkenlerinin ise tutumları etkilemediği belirlenmiştir. Nitel bulgulara göre ise öğretmen adaylarının sosyobilimsel konuların öğretiminde kendilerini yeterli donanıma sahip olarak görmedikleri, bu konuları sosyal ve fen bilimleri alanındaki derslerle ilişkilendirdikleri ayrıca toplumsal-ahlaki ve tartışmalı konular şeklinde özetledikleri belirlenmiştir. Araştırmanın nitel bulgularının nicel bulguları büyük ölçüde desteklediği tespit edilmiş ve araştırmadan elde edilen bulgular ışığında bazı öneriler sunulmuştur.