Publications by authors named "Wong J"

8,129 Publications

Radiation and Androgen Deprivation Therapy With or Without Docetaxel in the Management of Nonmetastatic Unfavorable-Risk Prostate Cancer: A Prospective Randomized Trial.

J Clin Oncol 2021 Jul 1:JCO2100596. Epub 2021 Jul 1.

Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.

Purpose: Although docetaxel is not recommended when managing men with unfavorable-risk prostate cancer (PC) given negative or inconclusive results from previous randomized trials, unstudied benefits may exist.

Methods: Between September 21, 2005, and January 13, 2015, we randomly assigned 350 men 1:1 with T1c-4N0M0 unfavorable-risk PC to receive radiation therapy (RT) and androgen deprivation therapy (ADT) plus docetaxel (60 mg/m once every 3 weeks for three cycles before RT and 20 mg/m once weekly during RT) versus ADT + RT. We evaluated the treatment effect of adding docetaxel to ADT + RT on the primary end point of overall survival (OS) and the incidence of RT-induced cancers and explored whether the impact of the treatment effect on OS differed within prostate-specific antigen (PSA) subgroups (< 4, > 20 4-20 ng/mL) using the interaction test for heterogeneity adjusted for age and PC prognostic factors.

Results: After a median follow-up of 10.2 years, 89 men died (25.43%); of these, 42 from PC (47.19%). Although OS was not significantly increased in the docetaxel arm (the restricted mean survival time over 10 years was 9.11 8.82 years; = .22), significantly fewer RT-induced cancers were observed (10-year estimates: 0.61% 4.90%; age-adjusted hazard ratio of 0.13; 95% CI, 0.02 to 0.97; = .046). The treatment effect of adding docetaxel to ADT + RT on OS significantly differed in men with a PSA < 4 ng/mL versus 4-20 ng/mL (adjusted hazard ratio: 0.27 and 1.51, respectively) because of less PC-specific mortality on the docetaxel arm (0.00% 28.57%) among men with PSA < 4 ng/mL.

Conclusion: Adding docetaxel to ADT + RT did not prolong OS in men with unfavorable-risk PC, but decreased RT-induced cancer incidence, and may prolong OS in the subgroup of men with a PSA < 4 ng/mL by reducing PC-specific mortality.
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http://dx.doi.org/10.1200/JCO.21.00596DOI Listing
July 2021

Comparison of Multimodal Therapies and Outcomes Among Patients With High-Risk Prostate Cancer With Adverse Clinicopathologic Features.

JAMA Netw Open 2021 Jul 1;4(7):e2115312. Epub 2021 Jul 1.

Department of Urology, Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland.

Importance: The optimal management strategy for high-risk prostate cancer and additional adverse clinicopathologic features remains unknown.

Objective: To compare clinical outcomes among patients with high-risk prostate cancer after definitive treatment.

Design, Setting, And Participants: This retrospective cohort study included patients with high-risk prostate cancer (as defined by the National Comprehensive Cancer Network [NCCN]) and at least 1 adverse clinicopathologic feature (defined as any primary Gleason pattern 5 on biopsy, clinical T3b-4 disease, ≥50% cores with biopsy results positive for prostate cancer, or NCCN ≥2 high-risk features) treated between 2000 and 2014 at 16 tertiary centers. Data were analyzed in November 2020.

Exposures: Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy (ADT), or EBRT plus brachytherapy boost (BT) with ADT. Guideline-concordant multimodal treatment was defined as RP with appropriate use of multimodal therapy (optimal RP), EBRT with at least 2 years of ADT (optimal EBRT), or EBRT with BT with at least 1 year ADT (optimal EBRT with BT).

Main Outcomes And Measures: The primary outcome was prostate cancer-specific mortality; distant metastasis was a secondary outcome. Differences were evaluated using inverse probability of treatment weight-adjusted Fine-Gray competing risk regression models.

Results: A total of 6004 men (median [interquartile range] age, 66.4 [60.9-71.8] years) with high-risk prostate cancer were analyzed, including 3175 patients (52.9%) who underwent RP, 1830 patients (30.5%) who underwent EBRT alone, and 999 patients (16.6%) who underwent EBRT with BT. Compared with RP, treatment with EBRT with BT (subdistribution hazard ratio [sHR] 0.78, [95% CI, 0.63-0.97]; P = .03) or with EBRT alone (sHR, 0.70 [95% CI, 0.53-0.92]; P = .01) was associated with significantly improved prostate cancer-specific mortality; there was no difference in prostate cancer-specific mortality between EBRT with BT and EBRT alone (sHR, 0.89 [95% CI, 0.67-1.18]; P = .43). No significant differences in prostate cancer-specific mortality were found across treatment cohorts among 2940 patients who received guideline-concordant multimodality treatment (eg, optimal EBRT alone vs optimal RP: sHR, 0.76 [95% CI, 0.52-1.09]; P = .14). However, treatment with EBRT alone or EBRT with BT was consistently associated with lower rates of distant metastasis compared with treatment with RP (eg, EBRT vs RP: sHR, 0.50 [95% CI, 0.44-0.58]; P < .001).

Conclusions And Relevance: These findings suggest that among patients with high-risk prostate cancer and additional unfavorable clinicopathologic features receiving guideline-concordant multimodal therapy, prostate cancer-specific mortality outcomes were equivalent among those treated with RP, EBRT, and EBRT with BT, although distant metastasis outcomes were more favorable among patients treated with EBRT and EBRT with BT. Optimal multimodality treatment is critical for improving outcomes in patients with high-risk prostate cancer.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.15312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251338PMC
July 2021

What difference might retractions make? An estimate of the potential epistemic cost of retractions on meta-analyses.

Account Res 2021 Jul 14:1-18. Epub 2021 Jul 14.

Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.

The extent to which a retraction might require revising previous scientific estimates and beliefs - which we define as the epistemic cost - is unknown. We collected a sample of 229 meta-analyses published between 2013 and 2016 that had cited a retracted study, assessed whether this study was included in the meta-analytic estimate and, if so, re-calculated the summary effect size without it. The majority (68% of N = 229) of retractions had occurred at least one year prior to the publication of the citing meta-analysis. In 53% of these avoidable citations, the retracted study was cited as a candidate for inclusion, and only in 34% of these meta-analyses (13% of total) the study was explicitly excluded because it had been retracted. Meta-analyses that included retracted studies were published in journals with significantly lower impact factor. Summary estimates without the retracted study were lower than the original if the retraction was due to issues with data or results and higher otherwise, but the effect was small. We conclude that meta-analyses have a problematically high probability of citing retracted articles and of including them in their pooled summaries, but the overall epistemic cost is contained.
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http://dx.doi.org/10.1080/08989621.2021.1947810DOI Listing
July 2021

Rapid training of non-intensivists using an online critical care course during COVID-19.

Ann Acad Med Singap 2021 06;50(6):503-507

Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.

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June 2021

Patient disease knowledge, attitudes and behaviours related to non-alcoholic fatty liver disease: a qualitative study.

BMJ Open Gastroenterol 2021 Jun;8(1)

Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.

Objective: Despite clear evidence that weight loss via nutritional and physical activity changes improves histological outcomes in non-alcoholic fatty liver disease (NAFLD), many patients struggle to implement and maintain these health behaviour changes. The aim of this study was to characterise disease knowledge, attitudes and behaviours among persons with NAFLD and to identify the factors driving these health behaviours and perceptions.

Design: We conducted semistructured interviews among patients with NAFLD. We used purposeful sampling to enroll equivalent percentages based on age and sex, and enrolled approximately one-third of patients with cirrhosis to capture those perspectives. Interviews were conducted until thematic saturation was achieved. Transcripts were coded using NVivo software to identify themes and subthemes.

Results: A total of 29 patient interviews were completed. Ambiguity about the diagnosis and aetiology of their liver disease was a key theme, though the vast majority of patients were aware that weight loss via nutrition and exercise was the primary therapy. Most patients were asymptomatic, diagnosed incidentally, and reported low level of concern regarding their diagnosis. The primary barriers and facilitators to health behaviour change were the presence of social support, competing medical comorbidities and low motivation to change behaviours.

Conclusions: Although patients are aware that lifestyle interventions are the primary therapy for NAFLD, there is a gap in knowledge about the condition. The presence of social support and competing medical comorbidities were the most consistent facilitators and barriers to lifestyle change. Tailoring treatment recommendations to provide relevant disease education, specific nutrition and exercise regimens, and personalised approaches based on specific individual barriers and facilitators will likely aid in uptake and maintenance of first-line therapy for NAFLD.
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http://dx.doi.org/10.1136/bmjgast-2021-000634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246278PMC
June 2021

A reasoned approach towards administering COVID-19 vaccines to pregnant women.

Prenat Diagn 2021 Jun 15. Epub 2021 Jun 15.

Department of Obstetrics and Gynaecology, National University Hospital Singapore, Singapore.

There are over 50 SARS-CoV-2 candidate vaccines undergoing Phase II and III clinical trials. Several vaccines have been approved by regulatory authorities and rolled out for use in different countries. Due to concerns of potential teratogenicity or adverse effect on maternal physiology, pregnancy has been a specific exclusion criterion for most vaccine trials with only two trials not excluding pregnant women. Thus, other than limited animal studies, gradually emerging development and reproductive toxicity data, and observational data from vaccine registries, there is a paucity of reliable information to guide recommendations for the safe vaccination of pregnant women. Pregnancy is a risk factor for severe COVID-19, especially in women with comorbidities, resulting in increased rates of preterm birth and maternal morbidity. We discuss the major SARS-CoV-2 vaccines, their mechanisms of action, efficacy, safety profile and possible benefits to the maternal-fetal dyad to create a rational approach towards maternal vaccination while anticipating and mitigating vaccine-related complications. Pregnant women with high exposure risks or co-morbidities predisposing to severe COVID-19 infection should be prioritised for vaccination. Those with risk factors for adverse effects should be counselled accordingly. It is essential to support patient autonomy by shared decision-making involving a risk-benefit discussion with the pregnant woman.
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http://dx.doi.org/10.1002/pd.5985DOI Listing
June 2021

Race-Related Differences in the Clinical Presentation and Histopathologic Features of Phyllodes Tumor.

Am Surg 2021 Jun 30:31348211029841. Epub 2021 Jun 30.

Department of Surgery, 12278East Carolina University Brody School of Medicine, Greenville, NC, USA.

Background: Phyllodes tumor (PT) is a rare fibroepithelial lesion of the breast with variable malignant potential. Black women have a higher incidence of a related benign tumor, fibroadenoma, but there are limited epidemiological data on PT. The aim of our study was to evaluate race-related differences in the clinicopathologic features and outcomes of PT.

Methods: Our institutional pathology database was queried for breast specimen reports from 01/2009 to 10/2019 to identify patients with a pathologic diagnosis of PT. Chart review and detailed slide review were performed to obtain clinical and histopathologic variables, respectively.

Results: Among twelve patients, two had malignant PT, three had borderline PT, and seven had benign PT. All patients with malignant and borderline PT were black, compared with 29% of those with benign PT. There were no apparent race-related differences in specific histopathologic features among black vs. non-black women with benign PT. Malignant and borderline PT were relatively larger than benign PT, with mean tumor sizes of 9.0 cm (standard deviation [SD] 4.7 cm), 12.2 cm (SD 9.4 cm), and 5.4 cm (SD 5.8 cm), respectively. Two women had a local recurrence, both of whom were black.

Discussion: In this single-institution retrospective study, we observed disproportionate rates of aggressive histopathologic features and disparate outcomes among black women with PT. A multi-institutional PT registry would facilitate improved knowledge about race-related differences in the presentation and outcomes of this rare tumor.
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http://dx.doi.org/10.1177/00031348211029841DOI Listing
June 2021

Promoting anaerobic co-digestion of sewage sludge and food waste with different types of conductive materials: Performance, stability, and underlying mechanism.

Bioresour Technol 2021 Jun 16;337:125384. Epub 2021 Jun 16.

Institute of Bioresource and Agriculture, Sino-Forest Applied Research Centre for Pearl River Delta Environment, Department of Biology, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China; School of Technology, Huzhou University, Huzhou 311800, China. Electronic address:

In this research, we investigated and compared the effects of three widely used conductive materials, e.g., zero-valent iron (Fe), magnetite (FeO), and biochar on the performance, stability, and in-depth mechanism during the anaerobic co-digestion process of sewage sludge and food waste. Among the three conductive materials, Fe could achieve the highest cumulative methane production of 394.0 mL/g volatile solids (VS) , which was 1.24-fold and 1.17-fold higher than that receiving FeO and biochar. The mechanistic studies indicated that compared to the FeO and biochar groups, Fe could significantly enhance the release of soluble protein, polysaccharide, and dissolved organic matters, the degradation of volatile fatty acids and VS, and the activities of key enzymes and direct interspecies electron transfer (DIET). Consequently, the methane yield and digestate dewaterability were notably improved. Collectively, these findings will offer suggestions of the preferable conductive materials in the anaerobic co-digestion process for decision makers.
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http://dx.doi.org/10.1016/j.biortech.2021.125384DOI Listing
June 2021

Can the complete blood count be used as a reliable screening tool for obstructive sleep apnea?

Sleep Breath 2021 Jun 29. Epub 2021 Jun 29.

Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.

Purpose: Since hypoxia increases erythropoietin production and inflammation, the complete blood count (CBC) has been proposed as an inexpensive alternative for obstructive sleep apnea (OSA) screening. The objective of this study was to determine whether or not intermittent hypoxia and OSA severity, as measured by the mean oxygen saturation (SpO) and apnea-hypopnea index (AHI), affect parameters measured by the CBC.

Methods: This retrospective study included a total of 941 surgical patients who had a pre-operative home sleep study. The pre-operative CBC was extracted from the electronic patient records. Patients were stratified according to their AHI scores, into mild (AHI ≥ 5 - < 15), moderate (AHI ≥ 15 - < 30), and severe (AHI ≥ 30) OSA groups.

Results: There were 244 patients without OSA, 294 with mild, 223 with moderate, and 180 with severe OSA. Our analysis showed that hemoglobin (P = 0.010), hematocrit (P = 0.027), and basophils (P = 0.006) showed significant changes among the different severities of OSA. For mean SpO, there were negative associations with body mass index (r =  - 0.287; P < 0.001), age (r =  - 0.077; P = 0.021), hemoglobin (r =  - 0.208; P < 0.001), hematocrit (r =  - 0.220; P < 0.001), red blood cells (r =  - 0.107; P = 0.001), mean corpuscular volume (MCV) (r =  - 0.159; P < 0.001), mean corpuscular hemoglobin (r =  - 0.142; P < 0.001), and basophils (r =  - 0.091; P = 0.007). All analyzed parameters remained within normal clinical range. Multivariable regression identified hemoglobin, MCV, and basophils to be independent predictors of mean SpO and AHI.

Conclusion: Hemoglobin, MCV, and basophils were independently associated with intermittent hypoxia defined by mean SpO and AHI. Adding CBC parameters to other screening tools for OSA may have additional value due to its association with changes in mean SpO
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http://dx.doi.org/10.1007/s11325-021-02383-3DOI Listing
June 2021

Outcomes of eyes with retinal vein occlusion that are lost to follow-up after antivascular endothelial growth factor therapy.

Br J Ophthalmol 2021 Jun 28. Epub 2021 Jun 28.

The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA

Background/aims: To evaluate the outcomes of eyes with macular oedema due to retinal vein occlusion (RVO) that are lost to follow-up (LTFU) after antivascular endothelial growth factor (VEGF) injections.

Method: A retrospective, single-centre, consecutive case series of RVO patients receiving injections who were LTFU >6 months was conducted. Data were collected from the visit before LTFU; return visit; 3 months, 6 months and 12 months after return; and the final visit.

Results: Ninety eyes of 83 patients were included. Fifty (55.5%) eyes had branch RVO and 40 (44.5%) had central RVO. Mean LTFU duration was 277.8 days with additional mean follow-up for 748.1 days after return. Mean logarithm of the minimum angle of resolution visual acuity (VA) (Snellen) at the visit before LTFU was 0.72 (20/105) which worsened on return [1.04 (20/219), p<0.001) and remained worse at all timepoints after return: 0.92 (20/166) at 3 months (p<0.001), 0.97 (20/187) at 6 months (p<0.001), 0.94 (20/174) at 12 months (p<0.001) and 1.01 (20/205) at final visit (p<0.001). Mean central foveal thickness (CFT) increased from 252 µm at the visit before LTFU to 396 µm at the return visit (p<0.001). No difference in CFT was noted by 3 months (258 µm, p=0.71), 6 months (241 µm, p=0.54) or 12 months after return (250 µm, p=0.95). CFT was thinner at the final visit (215 µm, p=0.018).

Conclusion: RVO patients receiving anti-VEGF injections who were LTFU experienced a decline in VA that did not return to the levels seen before LTFU despite improvement in CFT after restarting therapy, underscoring the importance of ongoing treatment.
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http://dx.doi.org/10.1136/bjophthalmol-2021-319180DOI Listing
June 2021

Excluder Stent Graft-Related Outcomes in Patients with Aortic Neck Anatomy Outside of Instructions For Use (IFU) within the Global Registry for Endovascular Aortic Treatment (GREAT): Mid-term Follow-Up Results.

Ann Vasc Surg 2021 Jun 25. Epub 2021 Jun 25.

Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia; School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia.

Background: The utilisation rate of endovascular aortic aneurysm repair (EVAR) has increased continuously over the past two decades. EVAR is still performed frequently in patients with an unfavourable proximal seal zone, despite the associated late complications.

Purpose: We aimed to evaluate the mid-term durability of the GORE® EXCLUDER® AAA Endoprosthesis, featuring the C3 delivery system, in patients with a proximal neck anatomy outside the instructions for use (IFU).

Procedures: A retrospective sub-analysis of the Global Registry for Endovascular Aortic Treatment including patients treated for abdominal aortic aneurysms with the GORE® EXCLUDER® AAA Endoprosthesis (W.L. Gore & Associates, Inc, Flagstaff, Arizona) was performed. A "challenging neck" was defined as those treated outside the IFU with an aortic neck length <15 mm and/or aortic neck angle >60°. Cox proportional analyses were used to test for time-to-event differences between those treated within and outside the IFU while accounting for covariates, specifically proximal neck length and neck angle. The main outcomes assessed were 5-year all-cause mortality, 5-year endoleak development (type I or III), and 5-year device-related reinterventions.

Findings: Of the 3,324 patients included in the analysis, 411 (12.4%) had a challenging neck and 2,913 (87.6%) did not. The patients in the challenging neck group were significantly older (74.9 years vs. 73.2 years, p=<0.0001) and had a significantly larger aortic aneurysm diameter at the time of the intervention than those treated within the IFU (61.2 mm vs 56.4 mm, p<0.0001), shorter proximal neck length (18 mm vs 30 mm, p<0.0001) and larger infrarenal neck angle (60.8° vs 25.8°, p<0.0001). In the multivariate analysis, brachial access site and challenging neck were not independent risk factors; increased age was associated with a shorter time to mortality (hazard ratio 1.051, 95% confidence interval 1.039-1.062, p<0.0001), as was the use of tobacco (hazard ratio 1.329, 95% confidence interval 1.124-1.571, p=0.0009). The 5-year all-cause mortality (36.2% vs. 27.5%, p=0.002) and aorta-related mortality (3.8% vs 1.1%, p=0.002) were significantly higher in the challenging neck group. The risk of death within 5 years also increased significantly at 1.1% per millimetre increase in the abdominal aortic aneurysm diameter (p=0.0005). Furthermore, the rates of type Ia endoleak development (7% vs. 1.2%, p<0.001) and requirement for reintervention (13.3% vs. 9.7%, p<0.001) were higher in those treated outside the IFU (challenging neck group).

Conclusions: Treatment with the Excluder AAA Endograft outside the IFU was associated with higher 5-year mortality values, increased type Ia endoleak development rates, and a greater need for reintervention compared with treatment within the IFU. This reiterates that fenestrated and open treatments should be strongly considered in cases with aortic neck anatomies outside the IFU. Infrarenal endovascular intervention outside the IFU should only be used when there is no alternative, with meticulous procedural planning and intervention to promote satisfactory outcomes.
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http://dx.doi.org/10.1016/j.avsg.2021.04.032DOI Listing
June 2021

The differential importation risks of COVID-19 from inbound travellers and the feasibility of targeted travel controls: A case study in Hong Kong.

Lancet Reg Health West Pac 2021 Aug 21;13:100184. Epub 2021 Jun 21.

WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.

Background: Many countries/regions implemented strict border measures (e.g., 14-day quarantines) as a blanket policy to prevent COVID-19 importations, while proposed "travel bubbles" as an alternative to reduce the impact of border controls. We aim to examine the differential importation risks with departure origins and post-arrival controls.

Methods: We developed a Bayesian framework to model disease progress of COVID-19 and the effectiveness of travel measures and inferred the origin-specific disease prevalence among inbound travellers, using data on passengers arriving in Hong Kong and laboratory-confirmed imported cases. We estimated the origin-specific risks of releasing infectious travellers under different control strategies and traveller volumes. We also estimated the risk of having released infectious travellers when a resurgence occurs in departure locations with no imported cases during a certain period.

Findings: Under the then strict controls of 14-day quarantine and testing on day 12, the Philippines imposed the greatest importation risk among the studied countries/regions (95.8% of releasing at least one infectious traveller, 95% credible interval (CrI), 94.8-96.6%). This was higher than that from low prevalence countries/regions (e.g., 23.4%, 95% CrI, 21.6-25.3% for Taiwan) if controls relaxed (i.e., 7-day quarantine and test on day 5). Increased traveller volumes and resurgence in departure locations with low prevalence under relaxed controls did not impose a greater importation risk than high prevalence locations under stricter controls.

Interpretation: Moderate relaxation of control measures for travellers arriving from low prevalence locations did not impose higher risks of community outbreaks than strict controls on travellers from high prevalence locations.

Funding: Health and Medical Research Fund, Hong Kong.
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http://dx.doi.org/10.1016/j.lanwpc.2021.100184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214928PMC
August 2021

Intimate Partner Aggression During the Early Parenting Years: The Role of Dissatisfaction with Division of Labor and Childcare.

Couple Family Psychol 2021 Mar 8;10(1):1-16. Epub 2020 Oct 8.

The Pennsylvania State University.

The high rates of intimate partner aggression (IPA) among new parents may be partly due to changes in couples' division of household labor and childcare, which disproportionately negatively impact women. This is the first study to examine the association between division of labor dissatisfaction and IPA perpetration across genders, while also examining whether such dissatisfaction is specifically associated with IPA during conflicts about division of labor issues. Quarterly for one year, 109 women and 94 men from 111 couples with a first-born child approximately 32 months of age at study commencement described each incident of IPA that occurred during the quarter, including conflict topics and number of aggressive acts perpetrated. Division of labor and childcare comprised the largest portion (30%) of IPA conflict topics. Division of labor dissatisfaction at child age 24 months was positively associated with women's, but not men's, IPA perpetration during conflicts about division of labor issues, but not other topics. A similar pattern of results emerged in the examination of division of childcare dissatisfaction and conflicts about childcare vs. other topics. The discovery that the impact of division of labor and childcare dissatisfaction on IPA perpetration is context- and gender-specific suggests that, among women, a history of dissatisfaction may impair appropriate conflict resolution skills specifically when addressing domains of dissatisfaction. These findings support prevention of women's IPA via nonaggressive strategies for addressing division of labor concerns and promotion of equal opportunities for women and men at home and in the workplace during the early parenting years.
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http://dx.doi.org/10.1037/cfp0000156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220595PMC
March 2021

Factors Associated with Intention to Donate Hematopoietic Stem Cells among Blood Donors.

Transfus Med Hemother 2021 May 11;48(3):188-195. Epub 2020 Dec 11.

Blood Transfusion Services and Blood Bank Department, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia.

Introduction: Past studies pay little attention to the intention to donate hematopoietic stem cells (HSC) among blood donors. This study investigated the level of and the influence of socio-demographic characteristics, knowledge, attitude, subjective norm and self-efficacy on the intention to donate HSC among blood donors.

Methods: This cross-sectional study recruited blood donors at selected public hospitals in the Malaysian State of Sarawak in 2019. A structured questionnaire was developed based on the review of relevant literature. It gathered information on socio-demographic characteristics, knowledge, attitude, subjective norm and self-efficacy on the intention to donate HSC. Variables with a value <0.200 in bivariate analysis were included in the variable selection for regression modeling to examine their associations with the intention to donate HSC.

Results: A total of 569 blood donors participated (94.5% response rate). Overall, 87.1% reported a positive intention to donate HSC. In the regression model, the factor with the greatest association with intention to donate HSC was subjective norms about HSC donation (β = 0.35, 95% CI 0.27-0.42), followed by attitude about regulations of HSC donation (β= 0.21, 95% CI 0.13-0.35), self-efficacy on HSC donation (β = 0.15, 95% CI 0.09-0.32), attitude about the potential side effects of HSC donation (β = 0.14, 95% CI 0.02-0.10) and highest education level (β = 0.10, 95% CI 0.03-0.44).

Conclusions: The findings can be used to formulate a better strategy in promoting HSC donation among blood donors in the region.
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http://dx.doi.org/10.1159/000512197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215939PMC
May 2021

A critical review on various feedstocks as sustainable substrates for biosurfactants production: a way towards cleaner production.

Microb Cell Fact 2021 Jun 26;20(1):120. Epub 2021 Jun 26.

Faculty of Environment and Natural Resources, Ho Chi Minh City University of Technology (HCMUT), Ho Chi Minh City, 700000, Vietnam.

The quest for a chemical surfactant substitute has been fuelled by increased environmental awareness. The benefits that biosurfactants present like biodegradability, and biocompatibility over their chemical and synthetic counterparts has contributed immensely to their popularity and use in various industries such as petrochemicals, mining, metallurgy, agrochemicals, fertilizers, beverages, cosmetics, etc. With the growing demand for biosurfactants, researchers are looking for low-cost waste materials to use them as substrates, which will lower the manufacturing costs while providing waste management services as an add-on benefit. The use of low-cost substrates will significantly reduce the cost of producing biosurfactants. This paper discusses the use of various feedstocks in the production of biosurfactants, which not only reduces the cost of waste treatment but also provides an opportunity to profit from the sale of the biosurfactant. Furthermore, it includes state-of-the-art information about employing municipal solid waste as a sustainable feedstock for biosurfactant production, which has not been simultaneously covered in many published literatures on biosurfactant production from different feedstocks. It also addresses the myriad of other issues associated with the processing of biosurfactants, as well as the methods used to address these issues and perspectives, which will move society towards cleaner production.
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http://dx.doi.org/10.1186/s12934-021-01613-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236176PMC
June 2021

Balancing the dental boards.

Br Dent J 2021 06 25;230(12):804-806. Epub 2021 Jun 25.

School of Clinical Dentistry, 19 Claremont Crescent, University of Sheffield, S10 2TA, UK.

The gender balance on boards is an important issue because any imbalance represents gender inequality and is not acceptable. We describe data that we have gathered on the current balance of the UK dental boards and then outline potential ways forward to address any imbalance.
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http://dx.doi.org/10.1038/s41415-021-3126-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232984PMC
June 2021

Anaerobic digestion beyond biogas.

Bioresour Technol 2021 Jun 2;337:125378. Epub 2021 Jun 2.

State Institute of Agricultural Engineering and Bioenergy, University of Hohenheim, Garbenstraße 9, 70599 Stuttgart, Germany.

Anaerobic digestion (AD) is a matured technology for waste (water) remediation/stabilization and bioenergy generation in the form of biogas. AD technology has several inherent benefits ranging from generating renewable energy, remediating waste (water), and reducing greenhouse gas emission to improving health/hygiene and the overall socio-economic status of rural communities in developing nations. In recent years, there has been a paradigm shift in applications of AD technology beyond biogas. This special issue (SI) entitled, "Anaerobic Digestion Beyond Biogas (ADBB-2021)," was conceptualized to incorporate some of the recent advances in AD in which the emphasis is beyond biogas, such as anaerobic biorefinery, chain elongation, treatment of micropollutants, toxicity and system stability, digestate as biofertilizer, bio-electrochemical systems, innovative bioreactors, carbon sequestration, biogas upgrading, microbiomes, waste (water) remediation, residues/waste pre-treatment, promoter addition, and modeling, process control, and automation, among others. This VSI: ADBB-2021 contains 53 manuscripts (14 critical reviews and 39 research). The key findings of each manuscript are briefly summarized here, which can serve as a valuable resource for AD researchers to learn of major advances in AD technology and identify future research directions.
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http://dx.doi.org/10.1016/j.biortech.2021.125378DOI Listing
June 2021

Training and Validation of Deep Learning-Based Auto-Segmentation Models for Lung Stereotactic Ablative Radiotherapy Using Retrospective Radiotherapy Planning Contours.

Front Oncol 2021 7;11:626499. Epub 2021 Jun 7.

Medical Physics/Radiation Oncology, British Columbia Cancer - Kelowna, Kelowna, BC, Canada.

Purpose: Deep learning-based auto-segmented contour (DC) models require high quality data for their development, and previous studies have typically used prospectively produced contours, which can be resource intensive and time consuming to obtain. The aim of this study was to investigate the feasibility of using retrospective peer-reviewed radiotherapy planning contours in the training and evaluation of DC models for lung stereotactic ablative radiotherapy (SABR).

Methods: Using commercial deep learning-based auto-segmentation software, DC models for lung SABR organs at risk (OAR) and gross tumor volume (GTV) were trained using a deep convolutional neural network and a median of 105 contours per structure model obtained from 160 publicly available CT scans and 50 peer-reviewed SABR planning 4D-CT scans from center A. DCs were generated for 50 additional planning CT scans from center A and 50 from center B, and compared with the clinical contours (CC) using the Dice Similarity Coefficient (DSC) and 95% Hausdorff distance (HD).

Results: Comparing DCs to CCs, the mean DSC and 95% HD were 0.93 and 2.85mm for aorta, 0.81 and 3.32mm for esophagus, 0.95 and 5.09mm for heart, 0.98 and 2.99mm for bilateral lung, 0.52 and 7.08mm for bilateral brachial plexus, 0.82 and 4.23mm for proximal bronchial tree, 0.90 and 1.62mm for spinal cord, 0.91 and 2.27mm for trachea, and 0.71 and 5.23mm for GTV. DC to CC comparisons of center A and center B were similar for all OAR structures.

Conclusions: The DCs developed with retrospective peer-reviewed treatment contours approximated CCs for the majority of OARs, including on an external dataset. DCs for structures with more variability tended to be less accurate and likely require using a larger number of training cases or novel training approaches to improve performance. Developing DC models from existing radiotherapy planning contours appears feasible and warrants further clinical workflow testing.
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http://dx.doi.org/10.3389/fonc.2021.626499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215371PMC
June 2021

Factors Associated With Mental Health Symptoms During the COVID-19 Pandemic in Hong Kong.

Front Psychiatry 2021 7;12:617397. Epub 2021 Jun 7.

School of Public Health, University of Hong Kong, Hong Kong, China.

The COVID-19 pandemic has led to an increasing mental health burden. We examined the factors associated with mental health symptoms in Chinese general adults in Hong Kong. We conducted a dual-frame (landline and mobile) survey on Chinese adults aged 18 years or older in April 2020. Shortage of preventive materials, perceptions of the outbreak (each item range 1-5), and reduction in income were assessed. Mental health symptoms measured included stress (Perceived Stress Scale-4, range 0-16), anxiety (General Anxiety Disorders-2, range 0-6, cutoff >2), and depressive symptoms (Patient Health Questionnaire-2, range 0-6, cutoff >2). Results were weighted by the general population distribution. Associations were analyzed by multivariable linear (for stress) and logistic (for anxiety and depressive symptoms) regression adjusting for sociodemographic and health-related covariates, including confirmed or in close contacts of confirmed cases, chronic disease, self-rated health, and smoking and alcohol drinking behavior. Of the 1,501 participants (52.5% female, 55.0 aged 30-59 years), the average stress score was 7.20 (SD 2.12). 218 (15.8%) and 206 (14.8%) participants had anxiety and depressive symptoms, respectively. Shortage in facemasks (20.8%), alcohol-based hand sanitizers (13.9%), and cleaning products (7.3%) was reported. Participants generally disagree with the perception of at risk of getting infected in the coming 6 months (mean 2.2, SD 1.1), but tended to agree with the perception of worry that the people around pose a threat to them (mean 3.6, SD 0.9) and the outbreak has greatly affected their daily life (mean 3.7, SD 0.9). 59.3% employed participants had income reduction and 6.2% had become unemployed since the outbreak. Stress, anxiety, and depressive symptoms were more prevalent in those with shortages of preventive materials and negative perceptions of the outbreak (all < 0.05). Reduction in income and unemployment were associated with more mental health symptoms (all < 0.05). Shortage of preventive materials, negative perceptions, financial loss, and unemployment were prevalent during the outbreak and found in association with higher stress and more anxiety and depressive symptoms. Further research and urgent actions are warranted to relieve stress and promote mental health, targeting the many risk factors identified by our study.
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http://dx.doi.org/10.3389/fpsyt.2021.617397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215194PMC
June 2021

Relationship between Infant Tongue-Tie and Maternal Wellbeing.

MCN Am J Matern Child Nurs 2021 Jun 18. Epub 2021 Jun 18.

Dr. Rebecca R. Hill is an Associate Professor, MGH Institute of Health Professions School of Nursing, Boston, MA. Dr. Hill can be reached via email at Dr. John Wong is an Associate Professor, MGH Institute of Health Professions School of Nursing, Boston, MA. Gayatri S. Parikh is a graduate of MGH Institute of Health Professions School of Nursing, Boston, MA.

Abstract: Background: Tongue-tie is a mild oral anomaly that can cause feeding challenges, especially for breastfeeding mothers and infants. Delayed diagnosis may place mothers at increased risk of stress and impaired mother-infant bonding when feeding does not go as planned. The purpose of this study was to explore the risk for altered maternal wellbeing (e.g., stress and maternal-infant bonding) in mothers of infants with tongue-tie using a mixed-methods, cross-sectional study.Methods: We recruited mothers from two sites to participate in a survey about their experiences with tongue-tie: FacebookTM tongue-tie support group and a local pediatric dental office where frenotomy is commonly performed. Inclusion criteria were mothers 18 or older; able to read, write, and understand English. Infants were under the age of 1 year when diagnosed with tongue-tie. The survey contained both selection and open-text entry questions. Maternal-infant bonding was assessed using the Postpartum Bonding Questionnaire and maternal stress was measured using the Parental Stress Scale.Results:N = 113 mothers participated. Findings suggest that mothers of infants with tongue-tie report increased stress, especially when a diagnosis of tongue-tie is delayed. After correction, maternal wellbeing, the breastfeeding relationship, and maternal report of infant temperament improved.Clinical Implications: Early assessment, diagnosis, and management of tongue-tie are important. Partner support is helpful in fostering the mother-infant relationship. Future research is needed to understand barriers to appropriate referrals and delay in treatment of tongue-tie.
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http://dx.doi.org/10.1097/NMC.0000000000000739DOI Listing
June 2021

Increasing the gradient of energetic cost does not initiate adaptation in human walking.

J Neurophysiol 2021 06 23. Epub 2021 Jun 23.

Biomedical Physiology and Kinesiology, Simon Fraser University, Canada

When in a new situation, the nervous system may benefit from adapting its control policy. In determining whether or not to initiate this adaptation, the nervous system may rely on some features of the new situation. Here we tested whether one such feature is salient cost savings. We changed cost saliency by manipulating the gradient of participants' energetic cost landscape during walking. We hypothesized that steeper gradients would cause participants to spontaneously adapt their step frequency to lower costs. To manipulate the gradient, a mechatronic system applied controlled fore-aft forces to the waist of participants as a function of their step frequency as they walked on a treadmill. These forces increased the energetic cost of walking at high step frequencies and reduced it at low step frequencies. We successfully created three cost landscapes of increasing gradients, where the natural variability in participants' step frequency provided cost changes of 3.6% (shallow), 7.2% (intermediate) and 10.2% (steep). Participants did not spontaneously initiate adaptation in response to any of the gradients. Using metronome-guided walking-a previously established protocol for eliciting initiation of adaptation-participants next experienced a step frequency with a lower cost. Participants then adapted by -1.41±0.81 (p=0.007) normalized units away from their originally preferred step frequency obtaining cost savings of 4.80±3.12% That participants would adapt under some conditions, but not in response to steeper cost gradients, suggests that the nervous system does not solely rely on the gradient of energetic cost to initiate adaptation in novel situations.
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http://dx.doi.org/10.1152/jn.00311.2020DOI Listing
June 2021

Associations of COVID-19 online information sources and information overload with psychological distress symptoms: a population-based study.

Transl Behav Med 2021 Jun 23. Epub 2021 Jun 23.

School of Nursing, University of Hong Kong, Hong Kong, China.

Using information communication technologies as information sources of COVID-19 was associated with psychological problems, but mechanisms remain uncertain. We examined associations of COVID-19 information sources and information overload with psychological distress symptoms and explored the mediating effect of information overload in Hong Kong. A random sample of Chinese adults (N = 1501; 52.6% females; 55.0% aged 30-59) from dual landline and online surveys in April 2020 reported frequency of using traditional media, internet websites, social networking sites, instant messaging, and online discussion forums as COVID-19 information sources. Psychological distress symptoms were measured using the Patient Health Questionnaire 4-item ([PHQ-4]; 0-12). Information overload defined as a perception of being overwhelmed was measured (1-6). Linear regressions were performed to analyze the associations, and the mediating effect of information overload was examined. Greater PHQ-4 score was observed for frequent use of internet websites (adjusted b = 0.58, 95% CI 0.29, 0.87, adjusted β = 0.12) and online discussion forums (adjusted b = 0.39, 95% CI 0.08, 0.70, adjusted β = 0.08) and information overload (adjusted b = 0.54, 95% CI 0.44, 0.63, adjusted β = 0.28). Information overload mediated 44.9% and 36.9% of associations of frequent use of internet websites and online discussion forums with PHQ-4 score, respectively. Frequent use of social networking sites was associated with lower PHQ-4 score (adjusted b = -0.37, 95% CI -0.69, -0.04, adjusted β = -0.07) partially through lower information overload (37.5%). Psychological distress symptoms were associated with frequent use of internet websites and online discussion forums as COVID-19 information sources, which were mediated through information overload.
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http://dx.doi.org/10.1093/tbm/ibab086DOI Listing
June 2021

Pdcd10-Stk24/25 complex controls kidney water reabsorption by regulating Aqp2 membrane targeting.

JCI Insight 2021 Jun 22;6(12). Epub 2021 Jun 22.

Department of Pharmacology, School of Basic Medical Sciences, Tianjin Medical University, China.

PDCD10, also known as CCM3, is a gene found to be associated with the human disease cerebral cavernous malformations (CCMs). PDCD10 forms a complex with GCKIII kinases including STK24, STK25, and MST4. Studies in C. elegans and Drosophila have shown a pivotal role of the PDCD10-GCKIII complex in maintaining epithelial integrity. Here, we found that mice deficient of Pdcd10 or Stk24/25 in the kidney tubules developed polyuria and displayed increased water consumption. Although the expression levels of aquaporin genes were not decreased, the levels of total and phosphorylated aquaporin 2 (Aqp2) protein in the apical membrane of tubular epithelial cells were decreased in Pdcd10- and Stk24/25-deficient mice. This loss of Aqp2 was associated with increased expression and membrane targeting of Ezrin and phosphorylated Ezrin, Radixin, Moesin (p-ERM) proteins and impaired intracellular vesicle trafficking. Treatment with Erlotinib, a tyrosine kinase inhibitor promoting exocytosis and inhibiting endocytosis, normalized the expression level and membrane abundance of Aqp2 protein, and partially rescued the water reabsorption defect observed in the Pdcd10-deficient mice. Our current study identified the PDCD10-STK-ERM signaling pathway as a potentially novel pathway required for water balance control by regulating vesicle trafficking and protein abundance of AQP2 in the kidneys.
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http://dx.doi.org/10.1172/jci.insight.142838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8262504PMC
June 2021

Spatiotemporal Imaging of Thickness-Induced Band-Bending Junctions.

Nano Lett 2021 07 21;21(13):5745-5753. Epub 2021 Jun 21.

Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States.

van der Waals materials exhibit naturally passivated surfaces and an ability to form versatile heterostructures to enable an examination of carrier transport mechanisms not seen in traditional materials. Here, we report a new type of homojunction termed a "band-bending junction" whose potential landscape depends solely on the difference in thickness between the two sides of the junction. Using MoS on Au as a prototypical example, we find that surface potential differences can arise from the degree of vertical band bending in thin and thick regions. Furthermore, by using scanning ultrafast electron microscopy, we examine the spatiotemporal dynamics of charge carriers generated at this junction and find that lateral carrier separation is enabled by differences in the band bending in the vertical direction, which we verify with simulations. Band-bending junctions may therefore enable new optoelectronic devices that rely solely on band bending arising from thickness variations to separate charge carriers.
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http://dx.doi.org/10.1021/acs.nanolett.1c01481DOI Listing
July 2021

Systematic review of Meckel's diverticulum in pregnancy.

ANZ J Surg 2021 Jun 21. Epub 2021 Jun 21.

Western Sussex Hospitals NHS Trust, Chichester, UK.

Introduction: Meckel's diverticulum (MD) is the most common congenital malformation in the gastrointestinal tract. Limited up-to-date evidence is available regarding MD in pregnancy. We aim to review the available pertinent literature to help support clinical decision making and patient management in the future.

Materials And Methods: The search term 'Meckel's diverticulum' was combined with 'pregnant' or 'pregnancy'. Database searches of EMBASE, Medline and PubMed were conducted. All papers published in English from 01/01/1990 to 01/01/2021 were included. Simple statistical analysis (t-test) was performed.

Results: Twenty-seven cases were included. Average age = 26.9 years. Average gestation = 25.1 weeks. Occurrence: first trimester = 3.7%; second trimester = 48.1% and third trimester = 48.1%. Presenting symptoms: abdominal pain 88.9%; nausea/vomiting 59.3%; fever 18.5%; abdominal distension 18.5%; haematochezia 11.1%; constipation 11.1%; haematemesis 3.7%, diarrhoea 3.7% and asymptomatic 3.7%. Mean duration of preceding symptoms = 3.4 days. Diagnostic imaging modalities utilised: ultrasound = 40.7%; CT = 25.9%; MRI = 14.8%; abdominal X-ray = 11.1% and endoscopy = 7.4%. All cases required definite surgical management: laparotomy = 65.4%; laparoscopy = 15.4%; C-section = 19.2% and unreported = 3.8%. Main intra-operative findings: perforated MD = 40.7%; intussusception with MD as a lead point = 11.1%; bleeding MD = 11.1%, inflamed MD = 11.1%; small bowel obstruction = 11.1%; gangrenous MD = 3.7%; volvulus = 3.7% and unspecified = 7.4%. Mean length from ileocolic junction = 51.7 cm. Average length of stay was 7.1 days. T-test (p-value = 0.12) when comparing management strategy. Three maternal complications and two foetal mortalities.

Conclusion: MD and associated pathology are difficult to diagnose in the pregnant cohort. Current imaging demonstrates low diagnostic accuracy and a deviation away from recognised nuclear medicine investigations. Surgery appears the definitive management with both open and laparoscopic approaches utilised. Significant maternal morbidity and foetal mortality are associated with this condition.
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http://dx.doi.org/10.1111/ans.17014DOI Listing
June 2021

Pigmented nodule on the dorsum of the foot.

JAAD Case Rep 2021 Jul 12;13:49-51. Epub 2021 May 12.

Division of Dermatology, National University Hospital, Singapore.

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http://dx.doi.org/10.1016/j.jdcr.2021.05.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190128PMC
July 2021

Positive margins after mastectomy in patients with invasive lobular carcinoma of the breast: Incidence and management strategies.

Am J Surg 2021 Jun 10. Epub 2021 Jun 10.

Division of General Surgery, Department of Surgery, University of California, San Francisco, CA, USA. Electronic address:

Background: Surgical treatment of invasive lobular carcinoma (ILC) is challenging due to its diffuse growth pattern, and the positive margin rate after mastectomy is poorly described.

Methods: We retrospectively determined the positive margin rate in those with stage I-III ILC undergoing mastectomy. We evaluated the relationship between management strategy and recurrence free survival (RFS).

Results: In 357 patients, the positive margin rate was 10.6% overall and 18.7% in those with T3 tumors. Having a positive margin was associated with significantly shorter RFS on multivariate analysis (p = 0.01). Undergoing additional local treatment (radiation or re-excision) for a positive margin was significantly associated with improved RFS (p = 0.004). Older women with positive margins were significantly less likely to undergo additional local therapy.

Conclusions: Even mastectomy fails to clear margins in a high proportion of patients with large ILC tumors, a finding which may warrant testing neoadjuvant strategies even prior to planned mastectomy.
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http://dx.doi.org/10.1016/j.amjsurg.2021.05.021DOI Listing
June 2021

The Quest to Reduce Stroke Treatment Delays at A Melbourne Metropolitan Primary Stroke Centre over the Last Two Decades.

Intern Med J 2021 Jun 18. Epub 2021 Jun 18.

Department of Neurosciences, Box Hill Hospital, Eastern Health, Victoria, Australia.

Background: Reducing door-to-needle time (DNT) for intravenous thrombolysis in acute ischaemic stroke can lead to improved patient outcomes. Long-term reports on DNT trends in Australia are lacking in the setting of extension of the thrombolysis time window, addition of mechanical thrombectomy and increasing presentations.

Aims: To examine 17-year trends of DNT and identify factors associated with improved DNT at a high-volume, metropolitan primary stroke centre.

Method: Retrospective study between 2003 and 2019 of all thrombolysis cases using departmental stroke database. Since most strategies were implemented from 2012 onwards, intervention period has been defined as period 2012-2019. Factors associated with DNT reduction were examined by regression modelling.

Results: 15 strategies were identified including alterations to 'Code Stroke' processes. 1250 patients were thrombolysed, with 737 (58.8%) treated during the intervention period. The proportion of DNT ≤60- minutes rose from average of 22.5% during 2003-2012 to 63% during 2015-2018 and 71% in 2019. However, median DNT has only marginally improved from 58 to 51 minutes between 2015 and 2019. Faster DNT was independently associated with two modifiable workflow factors, 'Direct-to-CT' protocol (P < 0.001) and acute stroke nurse presence (P < 0.005). Over time, treated patients were older and less independent (P < 0.001), and the number of annual stroke admissions and 'Code Stroke' activations have risen by 4- and 10-fold to 748 and 1298 by 2019, respectively.

Conclusions: Targeted quality improvement initiatives are key to reducing thrombolysis treatment delays in the Australian metropolitan setting. Relative stagnation in DNT improvement is concerning and needs further investigation. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/imj.15429DOI Listing
June 2021

Commute patterns, residential traffic-related air pollution, and lung cancer risk in the prospective UK Biobank cohort study.

Environ Int 2021 Oct 15;155:106698. Epub 2021 Jun 15.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA.

Introduction: Commuting exposes millions of people to carcinogens from traffic-related air pollution (TRAP) but is seldomly considered in epidemiologic studies of lung cancer. In the prospective United Kingdom (UK) Biobank cohort study, we investigated associations between commute patterns, residential nitrogen dioxide concentrations (NO; a surrogate for TRAP), and lung cancer risk.

Methods: We analyzed 234,124 employed participants at baseline (2006-2010). There were 493 incident lung cancer cases diagnosed over an average 7-year follow-up. Subjects were cross-classified into exclusive categories of commute mode (automobile, public transportation, walking, cycling, active mixture, and other mixture) and frequency (regular: 1-4, often: ≥5 work-bound trips/week). Annual average residential NO concentrations in 2005-2007 were estimated with land use regression. Multivariable Cox regression was used to estimate associations between commute patterns, NO quartiles, and incident lung cancer. We conducted analyses stratified by NO (>, ≤median = 28.3 µg/m) and potential confounders such as sex and smoking.

Results: Compared to regular automobile use, commuting often by public transportation was associated with increased lung cancer risk (hazard ratio (HR) = 1.58, 95% confidence intervals (CI):1.08-2.33). Additionally, we found a positive exposure-response relationship with residential NO (HR = 1.21, 95 %CI: 0.90-1.62; HR = 1.48, 95 %CI: 1.10-1.99; HR = 1.58, 95 %CI: 1.13-2.23; p-trend = 3.1 × 10). The public transportation association was observed among those with higher NO (p-interaction = 0.02). Other commute categories were not associated with risk.

Conclusions: Commuters residing in high-NO areas who often use public transportation could have elevated lung cancer risk compared to regular automobile users. These results warrant investigations into which component(s) of public transportation contribute to the observed association with increased lung cancer risk.
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http://dx.doi.org/10.1016/j.envint.2021.106698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292218PMC
October 2021

In situ and ex situ bioassays with Cantareus aspersus for environmental risk assessment of metal(loid) and PAH contaminated soils.

Integr Environ Assess Manag 2021 Jun 17. Epub 2021 Jun 17.

UMR CNRS 6249 Department Chrono-Environment, University of Bourgogne Franche-Comté, 16 route de Gray, 25030, Besançon Cedex, France.

Environmental risk assessment of contaminated soils requires bioindicators that allow the assessment of bioavailability and toxicity of chemicals. Although many bioassays can determine the ecotoxicity of soil samples in the laboratory, few are available and standardized for on-site application. Bioassays based on specific threshold values that assess the in situ and ex situ bioavailability and risk of metal(loid)s and polycyclic aromatic hydrocarbons (PAHs) in soils to the land snail Cantareus aspersus have never been simultaneously applied to the same soils. The aims of this study were to compare the results provided by in situ and ex situ bioassays and to determine their respective importance for environmental risk assessment. The feasibility and the reproducibility of the in situ bioassay were assessed thanks to an international ring test. This study used five plots located at a former industrial site, and six laboratories participated in the ring test. The results revealed the impact of environmental parameters on the bioavailability of metal(loid)s and PAHs to snails exposed in the field to structured soils and vegetation compared to those exposed under laboratory conditions to soil collected from the same field site (excavated soils). The risk coefficients were generally higher ex situ than in situ with some exceptions (mainly due to Cd and Mo), which might be explained by the in situ contribution of plants and humus layer as sources of exposure of snails to contaminants and by climatic parameters. The ring test showed good agreement among laboratories, which determined the same levels of risk in most of the plots. Comparison of the bioavailability to land snails and the subsequent risk estimated in situ or ex situ highlighted the complementarity between both approaches in the ERA of contaminated soils, namely, to guide decisions on the fate and future use of the sites (e.g., excavation, embankments, land restoration). This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1002/ieam.4480DOI Listing
June 2021