Summary Of Consensus Research Articles

How to make an impact in surgical research: a consensus summary from the #SoMe4Surgery community.

Understanding and interpreting medical literature through critical thinking and applying this knowledge to evidence-based practice is an integral part of surgical training. Participating in research accelerates this process; however, young doctors' involvement in research may be suboptimal. Our aim was to provide young surgeons with recommendations on how to properly engage in surgical research. An online twitter conversation focused on recommendations about how a young physician can succeed in research was undertaken. Twitter activity for that conversation and hashtags was analyzed. A consensus based on the recommendations extracted from the discussion is summarized. Key opinion leaders were engaged to promote the conversation. Discussion was opened to all participants related to surgery or surgical research, including surgeons, medical students, nurses, patients, and healthcare workers. A total of 244 participants engaged in the Twitter conversation. The highest tweeted hashtags were #SoMe4Surgery and #SurgicalResearch with 855 and 847 tweets, respectively. Themes that came out of the conversation included 'Mentorship', which was the most essential recommendation. 'International collaboratives' and 'foreign research fellowship' were also deemed important factors for a successful path in research. Additionally, routine read of online journals, use of social media for scientific purposes, often engagement in manuscript drafting and proper time management were also recommended. Research is demanding and time consuming but an essential part of surgical education. We believe that any young surgeon can have greater chances to succeed in surgical research by following our recommendations and by academically using social media platforms.

Leptomeningeal disease in melanoma patients: An update to treatment, challenges, and future directions.

In February 2018, the Melanoma Research Foundation and the Moffitt Cancer Center hosted the Second Summit on Melanoma Central Nervous System Metastases in Tampa, Florida. The meeting included investigators from multiple academic centers and disciplines. A consensus summary of the progress and challenges in melanoma parenchymal brain metastases was published (Eroglu et al., Pigment Cell & Melanoma Research, 2019, 32, 458). Here, we will describe the current state of basic, translational, clinical research, and therapeutic management, for melanoma patients with leptomeningeal disease. We also outline key challenges and barriers to be overcome to make progress in this deadly disease.

Consensus summary report for CEPI/BC March 12–13, 2020 meeting: Assessment of risk of disease enhancement with COVID-19 vaccines

Consensus summary report for CEPI/BC March 12–13, 2020 meeting: Assessment of risk of disease enhancement with COVID-19 vaccines

2020 Consensus summary on the management of hypertension in Asia from the HOPE Asia Network.

Hypertension professionals from Asia have been meeting together for the last decade to discuss how to improve the management of hypertension. Based on these education and research activities, the Hypertension, brain, cardiovascular and renal Outcome Prevention and Evidence in Asia (HOPE Asia) Network was officially established in June 2018 and includes experts from 12 countries/regions across Asia. Among the numerous research and review papers published by members of the HOPE Asia Network since 2017, publications in three key areas provide important guidance on the management of hypertension in Asia. This article highlights key consensus documents, which relate to the Asian characteristics of hypertension, home blood pressure monitoring (HBPM), and ambulatory blood pressure monitoring (ABPM). Hypertension and hypertension-related diseases are common in Asia, and their characteristics differ from those in other populations. It is essential that these are taken into consideration to provide the best opportunity for achieving "perfect 24-hour blood pressure control", guided by out-of-office (home and ambulatory) blood pressure monitoring. These region-specific consensus documents should contribute to optimizing individual and population-based hypertension management strategies in Asian country. In addition, the HOPE Asia Network model provides a good example of the local interpretation, modification, and dissemination of international best practice to benefit specific populations.

TGF-β Signaling Promotes Tissue Formation during Cardiac Valve Regeneration in Adult Zebrafish

Cardiac valve disease can lead to severe cardiac dysfunction and is thus a frequent cause of morbidity and mortality. Its main treatment is valve replacement, which is currently greatly limited by the poor recellularization and tissue formation potential of the implanted valves. As we still lack suitable animal models to identify modulators of these processes, here we used adult zebrafish and found that, upon valve decellularization, they initiate a rapid regenerative program that leads to the formation of new functional valves. After injury, endothelial and kidney marrow-derived cells undergo cell cycle re-entry and differentiate into new extracellular matrix-secreting valve cells. The TGF-β signaling pathway promotes the regenerative process by enhancing progenitor cell proliferation as well as valve cell differentiation. These findings reveal a key role for TGF-β signaling in cardiac valve regeneration and establish the zebrafish as a model to identify and test factors promoting cardiac valve recellularization and growth.

ADHD in adult patients with substance use disorders

Attention-deficit/hyperactivity disorder (ADHD) is acommon comorbidity in adult patients with substance use disorders (SUDs). The diagnostics and treatment of ADHD with SUD are often achallenge, also with respect to the prescription of stimulants. Recently, agroup of international experts developed aconsensus paper on the diagnosis and treatment of comorbid ADHD and SUD. In addition, the German S3 guidelines on ADHD have been published, which also give advice on the treatment of ADHD in comorbid SUD. The German S3 guidelines on alcohol-related disorders and methamphetamine-related disorders also address ADHD as a comorbidity. Summary of consensus and guideline recommendations, supplemented with the most recent literature. In recent years new findings on the comorbidity of ADHD in patients with SUD have emerged. Aseries of screening and diagnostic instruments have meanwhile been evaluated in this patient group. The consensus paper and various guidelines therefore provide clinicians with specific help in detecting ADHD in patients with SUD and in conducting further diagnostics and treatment of both disorders. For example, the importance of stimulants in the treatment of patients with SUD and ADHD has significantly changed and first studies on psychotherapeutic interventions specific to this comorbidity are now available.

CCQM-K95.1 Low-polarity analytes in a botanical matrix: polycyclic aromatic hydrocarbons (PAHs) in tea

Extraction, chromatographic separation, and quantification of low-concentration organic compounds in complex matrices are core challenges for reference material producers and providers of calibration services. Evidence of successful participation in formal, relevant international comparisons is needed to document measurement capability claims made by national metrology institutes (NMIs) and designated institutes (DIs). To enable NMIs and DIs to update or establish their claims, in 2014 the Organic Analysis Working Group (OAWG) initiated CCQM-K95.1 “Low-Polarity Analytes in a Botanical Matrix: Polycyclic Aromatic Hydrocarbons (PAHs) in Tea”. This was a follow-on comparison from CCQM-K95 which was completed in 2014.The polycyclic aromatic hydrocarbons (PAHs) benz[a]anthracene (BaA) and benzo[a]pyrene (BaP) are considered priority pollutants by U.S. Environmental Protection Agency and are regulated contaminants in food, pose chromatographic separation challenges, and for which exist well-characterized measurement procedures and standard materials. BaA and BaP in a smoked tea were therefore selected as representative target measurands for CCQM-K95.1. Ten NMIs participated in CCQM-K95.1. The consensus summary mass fractions for the two PAHs are in the range of (50 to 70) ng/g with relative standard deviations of (6 to 10) %.Successful participation in CCQM K95.1 demonstrates the following measurement capabilities in determining mass fraction of organic compounds, with molar mass of 100 g/mol to 500 g/mol and having polarity pKow −2, in a botanical matrix ranging in mass fraction from 10 ng/g to 1000 ng/g: (1) value assignment of primary reference standards (if in-house purity assessment carried out), (2) value assignment of single and/or multi-component organic solutions, (3) extraction of analytes of interest from the matrix, (4) cleanup and separation of analytes of interest from interfering matrix or extract components, and (5) separation and quantification using gas chromatography or liquid chromatography.KEY WORDS FOR SEARCHbenz[a]anthracene (BaA), benzo[a]pyrene (BaP), gas chromatography(GC), isotope dilution (ID), liquid chromatography (LC), mass spectrometry (MS), polycyclic aromatic hydrocarbon (PAH), yerba mate teaMain textTo reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

CCQM-K131 Low-polarity analytes in a multicomponent organic solution: polycyclic aromatic hydrocarbons (PAHs) in acetonitrile

Solutions of organic analytes of known mass fraction are typically used to calibrate the measurement processes used to determine these compounds in matrix samples. Appropriate value assignments and uncertainty calculations for calibration solutions are critical for accurate measurements. Evidence of successful participation in formal, relevant international comparisons is needed to document measurement capability claims (CMCs) made by national metrology institutes (NMIs) and designated institutes (DIs). To enable NMIs and DIs to update or establish their claims, in 2015 the Organic Analysis Working Group (OAWG) sponsored CCQM-K131 “Low-Polarity Analytes in a Multicomponent Organic Solution: Polycyclic Aromatic Hydrocarbons (PAHs) in Acetonitrile”.Polycyclic aromatic hydrocarbons (PAHs) result from combustion sources and are ubiquitous in environmental samples. The PAH congeners, benz[a]anthracene (BaA), benzo[a]pyrene (BaP), and naphthalene (Nap) were selected as the target analytes for CCQM-K131. These targets span the volatility range of PAHs found in environmental samples and include potentially problematic chromatographic separations. Nineteen NMIs participated in CCQM-K131. The consensus summary mass fractions for the three PAHs are in the range of (5 to 25) μg/g with relative standard deviations of (2.5 to 3.5) %.Successful participation in CCQM-K131 demonstrates the following measurement capabilities in determining mass fraction of organic compounds of moderate to insignificant volatility, molar mass of 100 g/mol up to 500 g/mol, and polarity pKow < −2 in a multicomponent organic solution ranging in mass fraction from 100 ng/g to 100 μg/g: (1) value assignment of primary reference standards (if in-house purity assessment carried out), (2) value assignment of single and/or multi-component organic solutions, and (3) separation and quantification using gas chromatography or liquid chromatography.KEY WORDS FOR SEARCHbenz[a]anthracene (BaA), benzo[a]pyrene (BaP), gas chromatography(GC), isotope dilution (ID), liquid chromatography (LC), mass spectrometry (MS), naphthalene (Nap), organic calibration solution, polycyclic aromatic hydrocarbon (PAH)Main textTo reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Gliomatosis cerebri

A 21-year-old immunocompetent woman in apparent good health and without a significant past medical history presented with progressive headaches and horizontal diplopia. She was alert, oriented, and the remainder of the neurologic exam was unremarkable. Based on her brain MRI, what is the diagnosis?a)Acute viral encephalitisb)Multiple sclerosisc)Progressive multifocal leukoencephalopathyd)Gliomatosis cerebrie)Primary CNS lymphoma Stereotactic biopsy demonstrated WHO grade III astrocytoma, IDH mutant, ATRX lost. Her extensive involvement evidenced by imaging suggests a gliomatosis cerebri growth pattern. Gliomatosis cerebri refers to an extensive and invasive growth pattern that involves at least three contiguous lobes and typically resembles a low-grade lesion radiologically (e.g., non-contrast enhancing), but is associated with a poor prognosis [[1]Georgakis M.K. Spinos D. Pourtsidis A. Psyrri A. Panourias I.G. Sgouros S. et al.Incidence and survival of gliomatosis cerebri: a population-based cancer registration study.J Neurooncol. 2018; 138: 341-349Crossref PubMed Scopus (15) Google Scholar]. Until recently, it was classified separately within gliomas, but molecular studies did not warrant separation [[2]Cavenee W.K. Louis D.N. Ohgaki H. Wiestler O.D. International Agency for Research on Cancer. WHO classification of tumours of the central nervous system.Revised 4th ed. International Agency For Research On Cancer, Lyon2016Google Scholar]. It can be present in any diffuse glioma subtype, but it is especially common in anaplastic astrocytoma. Gliomatosis cerebri is generally categorized in two groups based on having a focal tumor mass: type 1 (no focal mass), and type 2 (with a focal mass). Treatment is challenging due to the extensiveness and irresectability of the lesion. Radiation therapy is especially restricted due to the extensive involvement, which often requires dosage adjusting, decreased length of therapy, and have a high likelihood of causing neurotoxicities [[3]Morales La Madrid A. Ranjan S. Warren K.E. Gliomatosis cerebri: a consensus summary report from the Second International Gliomatosis cerebri Group Meeting, June 22–23, 2017, Bethesda, USA.J Neuro-oncol. 2018; Crossref Scopus (9) Google Scholar]. Lower doses of ionizing radiation may also reduce the effectiveness of chemotherapy, as the length of concurrent radiation can be reduced. Our patient being younger, received a full dose of radiation (59.4 Gy) with concurrent temozolomide for 6 weeks, followed by maintenance temozolomide for one year. She tolerated treatment well, but unfortunately progressed soon afterwards and passed away after initiating bevacizumab. Gliomatosis cerebri remains a therapeutic challenge that warrants further investigation (Fig. 1). Dr. Garcia: Concept, design, drafting, revising, and critical revision of content. Dr. Villano: Concept, design, drafting, revising, and critical revision of content. The authors have no disclosures.

Gliomatosis cerebri: a consensus summary report from the Second International Gliomatosis cerebri Group Meeting, June 22-23, 2017, Bethesda, USA.

Gliomatosis cerebri (GC) is an aggressive glioma characterized by an invasive growth pattern and a dismal prognosis. The low incidence and non-specific symptoms at presentation pose unique challenges for early diagnosis and disease-specific research. There is no standard of care for the treatment of patients with a GC phenotype. Understanding the biology of this entity is a critical step in determining effective treatments. Toward this end, the Second International GC Group convened at National Institutes of Health, Bethesda on June 22nd-23rd 2017. This paper summarizes the main conclusions and recommendations for research priorities to fight this fatal condition.

International Consensus on the Clinical Management of Inflammatory Breast Cancer from the Morgan Welch Inflammatory Breast Cancer Research Program 10th Anniversary Conference.

National and international experts in inflammatory breast cancer (IBC) from high-volume centers treating IBC recently convened at the 10th Anniversary Conference of the Morgan Welch Inflammatory Breast Cancer Research Program at The University of Texas MD Anderson Cancer Center in Houston Texas. A consensus on the clinical management of patients with IBC was discussed, summarized, and subsequently reviewed. All participants at the conference (patients, advocates, researchers, trainees, and clinicians) were queried using the MDRing electronic survey on key management issues. A summary of the expert consensus and participant voting is presented. Bilateral breast and nodal evaluation, breast magnetic resonance imaging, positron emission tomography/computed tomography, and medical photographs were endorsed as optimal. Neoadjuvant systemic therapy, modified radical mastectomy and level I and II ipsilateral axillary node dissection, post-mastectomy radiotherapy, adjuvant targeted therapy and hormonal therapy as indicated, and delayed reconstruction were agreed-upon fundamental premises of standard non-protocol-based treatment for IBC. Consideration for local-regional therapy in de novo stage IV IBC was endorsed to provide local control whenever feasible. Variation across centers and special circumstances were discussed.

CCQM K6.2 determination of total cholesterol in human serum

Cholesterol is one of the most frequently measured substances in human blood/serum to assist in assessing the health status of individuals. Because of its clinical significance, CCQM-K6 determination of cholesterol in serum was completed in 2000 as one of the first key comparison (KC) studies performed within the Organic Analysis Working Group (OAWG). The first subsequent KC for cholesterol, CCQM-K6.1, was completed in 2001. Measurements for this second subsequent, CCQM-K6.2, were completed in 2012. These subsequent comparisons were conducted to enable CCQM members that had not participated in earlier studies to demonstrate their capabilities to measure a nonpolar (pKow < −2), low molecular mass (100 g/mol to 500 g/mol) metabolite in human serum at relatively high concentrations (1 mg/g to 3 mg/g) found in normal populations. Successful participation in CCQM-K6.2 demonstrated capabilities in analysis of complex biological matrices including sample preparation (extraction, derivatization), LC or GC separation, and quantification using an isotope dilution mass spectrometry approach.Normally in a subsequent KC, no key comparison reference value (KCRV) would be established and assessment of performance would be via the deviation of participants' results to the anchor institute's results, adjusted to account for the anchor's performance in the original comparison versus its KCRV. Due to the very long-time period since the original key comparison, the OAWG decided that this did not represent the best approach to assess performance in what is a relatively complex measurement. Given the excellent agreement between the anchor institute's results and robust consensus summary of the participants' values, the reference value for this study was taken as the anchor institute's result and treated as a 'KCRV'. Seven of the nine participants demonstrated agreement with the reference value.Main textTo reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Optimizing Nutrition in Preterm Low Birth Weight Infants-Consensus Summary.

Preterm birth survivors are at a higher risk of growth and developmental disabilities compared to their term counterparts. Development of strategies to lower the complications of preterm birth forms the rising need of the hour. Appropriate nutrition is essential for the growth and development of preterm infants. Early administration of optimal nutrition to preterm birth survivors lowers the risk of adverse health outcomes and improves cognition in adulthood. A group of neonatologists, pediatricians, and nutrition experts convened to discuss and frame evidence-based recommendations for optimizing nutrition in preterm low birth weight (LBW) infants. The following were the primary recommendations of the panel: (1) enteral feeding is safe and may be preferred to parenteral nutrition due to the complications associated with the latter; however, parenteral nutrition may be a useful adjunct to enteral feeding in some critical cases; (2) early, fast, or continuous enteral feeding yields better outcomes compared to late, slow, or intermittent feeding, respectively; (3) routine use of nasogastric tubes is not advisable; (4) preterm infants can be fed while on ventilator or continuous positive airway pressure; (5) routine evaluation of gastric residuals and abdominal girth should be avoided; (6) expressed breast milk (EBM) is the first choice for feeding preterm infants due to its beneficial effects on cardiovascular, neurological, bone health, and growth outcomes; the second choice is donor pasteurized human milk; (7) EBM or donor milk may be fortified with human milk fortifiers, without increasing the osmolality of the milk, to meet the high protein requirements of preterm infants; (8) standard fortification is effective and safe but does not fulfill the high protein needs; (9) use of targeted and adjustable fortification, where possible, helps provide optimal nutrition; (10) optimizing weight gain in preterm infants prevents long-term cardiovascular complications; (11) checking for optimal weight and sucking/swallowing ability is essential prior to discharge of preterm infants; and (12) appropriate counseling and regular follow-up and monitoring after discharge will help achieve better long-term health outcomes. This consensus summary serves as a useful guide to clinicians in addressing the challenges and providing optimal nutrition to preterm LBW infants.

Current Results and Future Research Priorities in Late Effects after Hematopoietic Stem Cell Transplantation for Children with Sickle Cell Disease and Thalassemia: A Consensus Statement from the Second Pediatric Blood and Marrow Transplant Consortium International Conference on Late Effects after Pediatric Hematopoietic Stem Cell Transplantation

Sustained donor engraftment after allogeneic hematopoietic cell transplantation (HCT) converts to healthy donor hemoglobin synthesis and halts disease symptoms in patients with sickle cell disease and thalassemia major. A disease-free survival probability that exceeds 90% has been reported when HCT using an HLA-matched sibling donor is performed in young patients with low-risk disease or treatment-related risk factors. Alternate donor HCT and HCT in adults is performed infrequently because of a higher risk profile. Transplant-specific risks include conditioning regimen-related toxicity, graft-versus-host disease, graft rejection with marrow aplasia or disease recurrence, and infections associated with immunosuppression and delayed immune reconstitution. The magnitude of risk depends on patient age, clinical status of the underlying disease (eg, organ injury from vasculopathy and iron overload), donor source, and intensity of the conditioning regimen. These risks are commonly monitored and reported in the short term. Documenting very late outcomes is important, but these data are rarely reported because of challenges imposed by patient drop-out and insufficient resources. This report summarizes long-term follow-up results after HCT for hemoglobin disorders, identifies gaps in knowledge, and discusses opportunities for future investigations. This consensus summary will be followed by a second article detailing comprehensive long-term follow-up recommendations to aid in maintaining health in these individuals and identifying late complication risks that could facilitate interventions to improve outcomes.

European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE).

This is an executive summary of the full consensus document on the management of supraventricular tachycardia (SVT) patients, published in Europace . The consensus document was prepared by a Task Force from the European Heart Rhythm Association (EHRA) with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE). It summarizes current developments in the field, and provides recommendations for the management of patients with SVT based on the principles of evidence-based medicine, with focus on new advances since the last ESC guidelines.1 It does not cover atrial fibrillation (AF), which is the subject of a separate clinical guideline. The process for evidence review has been described in the full document. Consensus statements are evidence-based and derived primarily from published …

European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE).

This is an executive summary of the full consensus document on the management of supraventricular tachycardia (SVT) patients, published in Europace . The consensus document was prepared by a Task Force from the European Heart Rhythm Association (EHRA) with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE). It summarizes current developments in the field, and provides recommendations for the management of patients with SVT based on the principles of evidence-based medicine, with focus on new advances since the last ESC guidelines.1 It does not cover atrial fibrillation (AF), which is the subject of a separate clinical guideline. The process for evidence review has been described in the full document. Consensus statements are evidence-based and derived primarily from published …

Gliomatosis cerebri: A consensus summary report from the First International Gliomatosis cerebri Group Meeting, March 26-27, 2015, Paris, France.

Gliomatosis cerebri (GC) is a universally fatal extensive and diffuse infiltration of brain parenchyma by a glial tumor. Many aspects of this phenomenon remain unknown. The First International Gliomatosis cerebri Group Meeting had the following goals: refine the clinical and radiologic diagnostic criteria for GC, suggest appropriate diagnostic procedures, standardize tissue manipulation for histologic and molecular characterization, and prioritize relevant preclinical projects. Also, general treatment recommendations were outlined for the pediatric population. Importantly, this meeting was the starting point for meaningful collaborative international research projects. This review is a consensus summary of discussions shared and conclusions derived from this meeting.

The Community Preceptor Crisis: Recruiting and Retaining Community-Based Faculty to Teach Medical Students—A Shared Perspective From the Alliance for Clinical Education

ABSTRACTIssue: Community-based instruction is invaluable to medical students, as it provides “real-world” opportunities for observing and following patients over time while refining history taking, physical examination, differential diagnosis, and patient management skills. Community-based ambulatory settings can be more conducive to practicing these skills than highly specialized, academically based practice sites. The Association of American Medical Colleges and other national medical education organizations have expressed concern about recruitment and retention of preceptors to provide high-quality educational experiences in community-based practice sites. These concerns stem from constraints imposed by documentation in electronic health records; perceptions that student mentoring is burdensome resulting in decreased clinical productivity; and competition between allopathic, osteopathic, and international medical schools for finite resources for medical student experiences. Evidence: In this Alliance for Clinical Education position statement, we provide a consensus summary of representatives from national medical education organizations in 8 specialties that offer clinical clerkships. We describe the current challenges in providing medical students with adequate community-based instruction and propose potential solutions. Implications: Our recommendations are designed to assist clerkship directors and medical school leaders overcome current challenges and ensure high-quality, community-based clinical learning opportunities for all students. They include suggesting ways to orient community clinic sites for students, explaining how students can add value to the preceptor's practice, focusing on educator skills development, recognizing preceptors who excel in their role as educators, and suggesting forms of compensation.

Hematologic Malignancies in Pregnancy: Management Guidelines From an International Consensus Meeting.

The incidence of hematologic malignancies during pregnancy is 0.02%. However, this figure is increasing, as women delay conception until a later age. Systemic symptoms attributed to the development of a hematologic cancer may overlap with physiologic changes of pregnancy. A favorable prognosis is contingent upon early diagnosis and treatment. Therefore, a high index of suspicion is required by health care providers. Although timely, accurate diagnosis followed by appropriate staging is essential and should not be delayed due to pregnancy, management guidelines are lacking due to insufficient evidence-based research. Consequently, treatment is delayed, posing significant risks to maternal and fetal health, and potential pregnancy termination. This report provides guidelines for clinical management of hematologic cancers during the perinatal period, which were developed by a multidisciplinary team including an experienced hematologist/oncologist, a high-risk obstetrics specialist, a neonatologist, and experienced nurses, social workers, and psychologists. These guidelines were developed by experts in the field during the first International Consensus Meeting of Prenatal Hematologic Malignancies, which took place in Leuven, Belgium, on May 23, 2014. This consensus summary equips health care professionals with novel diagnostic and treatment methodologies that aim for optimal treatment of the mother, while protecting fetal and pediatric health.

Behaviour and fate of metals in urban wastewater treatment plants: a review

The concerns on metals in urban wastewater treatment plants (WWTPs) are mainly related to its contents in discharges to environment, namely in the final effluent and in the sludge produced. In the near future, more restrictive limits will be imposed to final effluents, due to the recent guidelines of the European Water Framework Directive (EUWFD). Concerning the sludge, at least seven metals (Cd, Cr, Cu, Hg, Ni, Pb and Zn) have been regulated in different countries, four of which were classified by EUWFD as priority substances and two of which were also classified as hazardous substances. Although WWTPs are not designed to remove metals, the study of metals behaviour in these systems is a crucial issue to develop predictive models that can help more effectively the regulation of pre-treatment requirements and contribute to optimize the systems to get more acceptable metal concentrations in its discharges. Relevant data have been published in the literature in recent decades concerning the occurrence/fate/behaviour of metals in WWTPs. However, the information is dispersed and not standardized in terms of parameters for comparing results. This work provides a critical review on this issue through a careful systematization, in tables and graphs, of the results reported in the literature, which allows its comparison and so its analysis, in order to conclude about the state of the art in this field. A summary of the main consensus, divergences and constraints found, as well as some recommendations, is presented as conclusions, aiming to contribute to a more concerted action of future research.