Bone Infarct Associated Osteosarcoma: Epidemiologic and Survival Trends

Background Bone tumors are not a frequent occurrence and bone-infarct-associated sarcomas are even rarer. The prognosis of this disease is poor and its treatment remains a challenge. Nevertheless, hardly any analyses in literature report on secondary osteosarcoma (SO) on bone infarct and most of the data available do not provide sufficient details. We evaluated whether this condition could be further characterized and if prognosis could be influenced by the chemotherapy treatment. In particular, we sought to determine (1) the main features of this rare disease; (2) the overall survival (OS) rate; (3) the OS rate associated to chemotherapy treatment; (4) the correspondence between our results and published data in terms of survival. Methods We retrospectively reviewed patients admitted at Rizzoli Orthopedic Institute of Bologna between 1992 and 2018 (1465 total cases of osteosarcoma). We identified a list of 11 cases of SO on bone infarct (cohort 1). We conferred about the epidemiology, surgical and chemotherapy (ChT) treatment and surveillance of infarct-associated osteosarcoma showing the correlation to data present in literature, corresponding to 15 case reports published within 1962-2018 (cohort 2). Results (1) cohort 1 was made of 11 patients: six females and five males, median age was 55 years. Nine (81%) were grade 4, two (19%) grade 3. Tumor predominantly arise on distal femur (64%). Most of patients had localized osteosarcoma at the diagnosis (81%); resection surgery was the elective treatment (73%) followed by amputation (18%). Of 11 patients, seven received also ChT (64%). (2) Five-years OS was 62% (95% CI: 28-84). Median OS was 74 months (95% CI: 12-not reached). The cumulative incidence of cancer-related deaths (CICRD) was 37.7% (95% CI: 11.4-64.5) at 120 months. (3) In the group treated with only surgery OS was 50% at 5 years. For patients treated with any form of ChT, OS was 71% at 5 years (p=0.4773) and hazard ratio (HR) 0.56. The CICRD was 29% (at 2 years of follow-up. Instead, it was of 50% for patients treated only with surgery. (4) Median survival was 74 months and 19 months for cohort 1 and cohort 2 respectively (p=0.09). Data analysis showed a decreased HR for cohort 1 compared to cohort 2 (HR 0.378). Results confirmed also stratifying for age and ChT administration (HR 0.355). Conclusions Based on this work, our opinion is that the choice to undergo the patients to ChT combined to surgery could improve their prognosis.

Atuação dos Agentes Comunitários de Saúde para o controle da hanseníase: uma revisão de escopo

Objetivo: Mapear e sintetizar as evidências científicas da atuação do agente comunitário de saúde para as ações de controle da hanseníase com base nos atributos da atenção primária à saúde. Metodologia: Revisão de escopo, conforme Joanna Briggs Institute e o PRISMA-ScR. A pesquisa foi realizada em bases de dados eletrônicas, na Biblioteca Virtual de Saúde, Cumulative Index to Nursing and Allied Health Literature (CINAHL), U.S National Library of Medicine National Institutes of Health (PubMed), Grey Literature Report e Google Acadêmico. A coleta de dados ocorreu em 07 de abril de 2021, com o limite temporal estabelecido entre 1991 a abril de 2021. Resultados: Foram identificadas 359 evidências científicas e após a aplicação as quatro etapas de inclusão, resultaram em 13 evidências. A maioria das pesquisas foram realizadas na região sudeste do Brasil entre os anos de 2005 a 2019. As principais evidências encontradas foram categorizadas de acordo com os atributos. Porta de entrada: Cadastramento de casos, detecção de sinais e sintomas na comunidade e visita domiciliar. Atendimento continuado: Adesão ao tratamento, verificação de reações indesejadas e supervisão da dose diária. Integralidade: vigilância dos contatos intradomiciliares. Orientação familiar: orientações sobre o tratamento contínuo e visitas domiciliares para a realização de orientações. Orientação comunitária: reuniões para grupos, sensibilizações nas escolas e produção de material didático. Orientação profissional: treinamentos. Considerações Finais: Os resultados enfatizaram a necessidade de capacitação profissional e por outro lado, foi destacada a importância da sua atuação junto ao indivíduo, família, grupos e sociedade.

Atuação dos Agentes Comunitários de Saúde para o controle da hanseníase: uma revisão de escopo

Objetivo: Mapear e sintetizar as evidências científicas da atuação do agente comunitário de saúde para as ações de controle da hanseníase com base nos atributos da atenção primária à saúde. Metodologia: Revisão de escopo, conforme Joanna Briggs Institute e o PRISMA-ScR. A pesquisa foi realizada em bases de dados eletrônicas, na Biblioteca Virtual de Saúde, Cumulative Index to Nursing and Allied Health Literature (CINAHL), U.S National Library of Medicine National Institutes of Health (PubMed), Grey Literature Report e Google Acadêmico. A coleta de dados ocorreu em 07 de abril de 2021, com o limite temporal estabelecido entre 1991 a abril de 2021. Resultados: Foram identificadas 359 evidências científicas e após a aplicação as quatro etapas de inclusão, resultaram em 13 evidências. A maioria das pesquisas foram realizadas na região sudeste do Brasil entre os anos de 2005 a 2019. As principais evidências encontradas foram categorizadas de acordo com os atributos. Porta de entrada: Cadastramento de casos, detecção de sinais e sintomas na comunidade e visita domiciliar. Atendimento continuado: Adesão ao tratamento, verificação de reações indesejadas e supervisão da dose diária. Integralidade: vigilância dos contatos intradomiciliares. Orientação familiar: orientações sobre o tratamento contínuo e visitas domiciliares para a realização de orientações. Orientação comunitária: reuniões para grupos, sensibilizações nas escolas e produção de material didático. Orientação profissional: treinamentos. Considerações Finais: Os resultados enfatizaram a necessidade de capacitação profissional e por outro lado, foi destacada a importância da sua atuação junto ao indivíduo, família, grupos e sociedade.

Directional Electromagnetic Interference Shielding Based on Step-Wise Asymmetric Conductive Networks

Some precision electronics such as signal transmitters need to not only emit effective signal but also be protected from the external electromagnetic (EM) waves. Thus, directional electromagnetic interference (EMI) shielding materials (i.e., when the EM wave is incident from different sides of the sample, the EMI shielding effectiveness (SE) is rather different) are strongly required; unfortunately, no comprehensive literature report is available on this research field. Herein, Ni-coated melamine foams (Ni@MF) were obtained by a facile electroless plating process, and multiwalled carbon nanotube (CNT) papers were prepared via a simple vacuum-assisted self-assembly approach. Then, step-wise asymmetric poly(butylene adipate-co-terephthalate) (PBAT) composites consisting of loose Ni@MF layer and compact CNT layer were successfully fabricated via a facile solution encapsulation approach. The step-wise asymmetric structures and electrical conductivity endow the Ni@MF/CNT/PBAT composites with unprecedented directional EMI shielding performances. When the EM wave is incident from Ni@MF layer or CNT layer, Ni@MF-5/CNT-75/PBAT exhibits the total EMI SE (SET) of 38.3 and 29.5 dB, respectively, which illustrates the ΔSET of 8.8 dB. This work opens a new research window for directional EMI shielding composites with step-wise asymmetric structures, which has promising applications in portable electronics and next-generation communication technologies.

Severe Adverse Toxic Effects of Low-Dose Methotrexate Treatment on an Ectopic Pregnancy Patient With Methylenetetrahydrofolate Reductase Mutations: A Case Report

Background: Low-dose methylenetetrahydrofolate (LD-MTX) has been widely used for the treatment of the ectopic pregnancy (EP) for many decades, and related severe adverse toxic effects are rare. Current studies have shown that the polymorphisms of methylenetetrahydrofolate reductase (MTHFR) gene can decrease the MTX clearance, leading to the metabolite accumulation. However, there is a lack of literature report on an MTHFR gene polymorphism associated with adverse toxic effects resulting from the use of LD-MTX in an EP.Case Presentation: We report a rare case of a 38-year-old female who developed persistent fever, grade IV myelosuppression, skin lesions, mucositis, and liver injury after single dose of LDMTX to treat EP. The personalized genetic testing showed that MTHFR TT (677C>T) and MTHFR AA (1298A>C) were detected. Gradually, the symptoms improved after calcium leucovorin (CF) rescue, continuous renal replacement therapy (CRRT), promoting blood system regeneration, and multiple supportive treatments.Conclusion: This is the first report on the serious adverse toxic effects of LD-MTX on an EP patient with MTHFR mutations. We aim to alert obstetricians and gynecologists to this rare condition. The unexpected life-threatening toxicity with LD-MTX should be highly considered and recognized early. In particular, some easily overlooked gastrointestinal, skin, and mucosal symptoms occur earlier than severe myelosuppression. When toxic effects are suspected, detecting the polymorphisms of an MTHFR gene and monitoring MTX concentration in blood could assist us to formulate individualized and active treatments.

Commercial-Scale Visible-light Trifluoromethylation of 2-Chlorothiophenol using CF3I gas.

Despite the growth of photoredox methods in academia, application of photoredox at scale in the pharmaceutical and fine chemical industries has been slow. In this report, a photoredox trifluoromethylation of a thiophenol was modified from the original literature report and the mechanism was investigated to define key scale-up parameters. The mechanistic insight was leveraged in the design and execution of two different reactor designs: an LED-based plug flow photoreactor as well as a laser-based continuous stirred tank photoreactor. In one of the first examples of commercial scale photoredox chemistry, the process was scaled to provide over 500 kilograms of the desired intermediate and amended to fully continuous manufacturing.

Lyell-Like Acute Graft-Versus-Host-Disease

Stage IV acute cutaneous graft-versus-host-disease (GVHD) is nowadays rarely seen due to tissue typing done before transplant. The first line treatment for acute GVHD grade II-IV is systemic corticosteroids. However, although there is no consensus for refractory cases, literature report diverse therapies to be effective. We report the case of a 34 year-old patient with refractory acute cutaneous graft-versus-host-disease stage IV successfully treated with etanercept

Intentional ingestion of batteries and razor blades by a prisoner: a true emergency?

Purpose Few case studies in the literature report on adult patients with intentional foreign body ingestion. Prisoners deliberately ingest foreign bodies, such as cylindrical alkaline batteries and razor blades, to achieve hospitalization or commit suicide. The purpose of this paper is to present a case of deliberate ingestion of batteries and razor blades by an inmate. Design/methodology/approach The authors present a case of an incarcerated man in Greece, who intentionally ingested three cylindrical alkaline batteries and three razor blades wrapped in aluminum foil. Findings The patient was treated conservatively with serial radiographs and was subsequently discharged without complication. This paper discusses the complications and examine the current guidelines available. Originality/value To best of authors’ knowledge, this is the first report of a simultaneous ingestion of batteries and razor blades.

Comparison of Sympathetic Skin Response (SSR) between Electrical and Acoustic Stimuli in a Healthy Pediatric Population

Data in the literature report that latency and morphology in the cutaneous sympathetic skin response (SSR) do not change according to the type of stimulus delivered, unlike the amplitude which shows greater values in relation to the intensity of the physical impact caused in patient. Since the acoustic stimulus represents a method better tolerated by the pediatric patient, the aim of this study is to evaluate the presence or absence of significant differences in SSR between electrical and acoustic stimuli. The SSR was performed for each child of 18 recruited in this study, deriving from the palm of the hand and the sole of the foot and initially delivering an electrical stimulus at the level of the median nerve at the wrist. Two acoustic stimuli were subsequently delivered with the aid of audiometric headphones. Our results show no significant differences for the amplitude values obtained (p values > 0.05). For the latency there was a statistically significant difference (p-value = 0.001) for the left hand, subsequently not confirmed by the comparison performed between the two sides (p-values = 0.28 and 0.56). If these preliminary data are confirmed by a larger sample, the acoustic stimulus could be introduced in a standardized protocol for performing SSR in pediatric patients.