SRF-rearranged cellular perivascular myoid tumor: a clinicopathological analysis of two cases / 中华病理学杂志

Objective: To investigate the clinicopathological features, immunophenotype, diagnosis and differential diagnosis of SRF-rearranged cellular perivascular myoid tumor. Methods: Two cases of SRF-rearranged cellular perivascular myoid tumor diagnosed in the Department of Pathology, Fudan University Shanghai Cancer Center from October 2021 to March 2022 were collected. Immunohistochemical staining, fluorescence in-situ hybridization (FISH) and next-generation sequencing (NGS) were performed, and the literature was reviewed. Results: Case 1, a 3-month-old boy presented with a painless tumor of the scalp, measuring about 2 cm in diameter. Case 2, a 3-year-old girl complained with a painless tumor of the knee, measuring approximately 1.5 cm in diameter. Microscopically, the tumor had a clear boundary and showed multinodular growth. The tumor was mainly composed of spindle cells arranged in long intersecting fascicles associated with thin, slit-like or branching ectatic vessels, focally forming hemangiopericytoma-like appearance. The tumor cells were abundant, but there was no obvious atypia. Mitotic figures (3-4/10 HPF) were noted. H-caldesmon and SMA were positive in both cases. Case 1 showed diffuse and strong positivity for Desmin, and focally for CKpan. Ki-67 proliferation index was 20% and 30%, respectively. FISH displayed NCOA2 gene translocation in case 1 and the RELA gene translocation in case 2. NGS detected the SRF-NCOA2 gene fusion in case 1 and the SRF-RELA gene fusion in case 2. Both patients underwent local excisions. During the follow-up of 5-14 months, case 1 had no local recurrence, while case 2 developed local recurrence 1 year post operatively. Conclusions: SRF-rearranged cellular perivascular myoid tumor is a novel variant of perivascular cell tumor, which tends to occur in children and adolescents. The tumor forms a broad morphologic spectrum ranging from a pericytic pattern to a myoid pattern, and include hybrid tumors with a mixture of pericytic and myoid patterns. Due to its diffuse hypercellularity and increased mitotic figures and smooth muscle-like immunophenotype, the tumor is easy to be misdiagnosed as myogenic sarcomas. The tumor usually pursues a benign clinical course and rare cases may locally recur.

Patients’ and caregivers’ perception of safety and accessibility of cancer care during the covid-19 pandemic: A survey in a tertiary academic cancer center in the Philippines

Background@#The COVID-19 pandemic has caused a global public health emergency. High levels of fear and limited access to cancer treatment may jeopardize the delivery of optimal oncologic care, potentially influencing treatment outcomes. This study aimed to identify patients’ and their caregivers’ perception of safety and accessibility of cancer care during the COVID-19 pandemic. @*Methods@#A cross-sectional survey of patients and caregivers at the Benavides Cancer Institute, University of Santo Tomas Hospital was performed from August to October 2020 using a 20-item investigator-developed questionnaire. @*Results@#A total of 207 participants answered the survey. Frequency of hospital visits varied from none to more than ten times in the previous month; but having multiple postponements were uncommon. Eighty-two percent, 77%, 62%, and 55% of participants reported being afraid of contracting COVID-19 from other patients, hospital surroundings, hospital staff, and doctors, respectively. Twenty-six percent and 12% had difficulty finding transportation and passing through checkpoints, respectively. Twenty-eight percent strongly expressed financial limitations in prioritizing cancer care. Participants were amenable to the use of telemedicine and stringent protocols to reduce in-hospital transmission risk, but had some reluctance to spend out of their pockets for screening tests. @*Conclusion@#The perceived safety of cancer care was influenced by fears of contracting COVID-19; and accessibility was influenced by limited transportation and financial constraints. Despite these, multiple postponements and cancelled hospital visits were uncommon. Institutional approaches targeting these concerns will be crucial to ensure safe and timely delivery of cancer care during the COVID-19 pandemic and further mitigate its impact on oncologic outcomes.

A close contact of coronavirus disease 2019 with severe imported malaria: a case report / 中国血吸虫病防治杂志

This article presents a severe cerebral malaria patient in shock with a close contact of COVID-19 that was successfully cured in a negative pressure ward during the global pandemic of COVID-19. The patient experienced a sudden onset of high fever and coma in a designated isolation hotel after returning from Africa, and was transferred to a designated hospital. Following antimalarial therapy, blood pressure elevation, increase of blood volume, bedside hemodialysis, mechanical ventilation, plasma and platelet transfusions, the case gradual recovered.

Practice and perceptions of pediatric residents in a Tertiary Government Hospital on mental healthcare as part of general practice

Objective@#This study aimed to describe mental health practice patterns, perceptions, perceived responsibility, confidence, barriers, and supports of pediatric residents in a tertiary government hospital to arrive at recommendations in enhancing their mental health competencies.@*Methodology@#As part of needs and baseline assessment within an existing collaboration, written self-administered questionnaires were distributed among pediatric residents of the hospital. Frequency of answers were tallied to see clustering and trends. RESULTS: Most of the 37 Pediatric residents had positive perceptions i.e. 78.83% - 83.78% and planned to incorporate all aspects mental healthcare in their future practice as consultants i.e. 89.19 %- 97.29 %. However, they did not get to practice or apply it as much during training. All respondents perceived that diagnosing the neurodevelopmental disorders of Autism Spectrum, Attention Deficit and Hyperactivity, Intellectual Disability and Learning was their responsibility. When it came to confidence in diagnosing other psychiatric disorders less than half to 3/5 (45.9%- 64/9%) were confident or very confident in doing so. Approximately three fifths (56.75% -67.56%) of them were confident in managing neurodevelopmental disorders. There was an even lower proportion i.e. one fourth (16.21% - 32.43%) of pediatric residents who were confident in managing other psychiatric disorders. Time was the most often perceived barrier while more exposure and training were the supportive factors for integrating mental healthcare into practice.@*Conclusion@#With such positive perceptions already in place, programs to improve knowledge and skills can be developed to increase confidence, focusing on diagnosing and managing psychiatric conditions. Target areas as guided by this research can be on how to use screening tools and psychotropics, diagnosing anxiety and behavioral addictions, and managing psychosis and trauma. These should be incorporated in a time-efficient manner into usual patient interviews. Training and added exposure can be utilized in the short-term as well as institutionalization of collaboration, liaison, and feedback systems in the future.

Delay and completion of treatment in head and neck cancer patients employing a multidisciplinary team approach: A single institution experience

Objective@#To explore possible associations of a multidisciplinary team approach compared to a non-multidisciplinary team approach on delay and completion of treatment of head and neck cancer patients.@*Methods@#Design: Historical Cohort Study Setting: Tertiary Private Training Hospital Participants: A total of 240 records of head and neck cancer patients from January 2016 and December 2018 were included in the study; 117 underwent a multidisciplinary team approach and 123 underwent a non- multidisciplinary team approach.@*Results@#Only 24.79% of head and neck cancer patients under the multidisciplinary team approach had treatment delays compared to 37.40% under the non-multidisciplinary team approach. The proportion of treatment delays was significantly higher (χ2 = 4.44, p = .035) with the non-multidisciplinary team approach. Comparative treatment completion of 77.78% and 69.11% under the multidisciplinary and non-multidisciplinary team approaches, respectively, were not significantly different (χ2 = 2.31, p = .129). @*Conclusion@#The multidisciplinary approach might be associated with decreased delay in treatment among patients with head and neck cancer compared to the non-multidisciplinary team approach. A possible trend toward better treatment completion rate was also observed, but it did not reach statistical significance.

Low-penetrance susceptibility variants and postmenopausal oestrogen receptor positive breast cancer

The risk of breast cancer (BC) in women is high and many factors including genetic factors increase the risk for the disease. It is revealed that the variations of low-penetrance susceptibility genes are important for carcinogenesis as they interact with the environmental and hereditary factors. Recently, the list of BC-associated common single nucleotide polymorphisms (SNPs) and chromosomal loci in low-penetrance susceptibility genes have been expanded in genomewide association studies. FGFR2, LSP1, MAP3K1, TGFB1, TOX3, 2q35 and 8q loci variations are some examples for these common SNPs. These SNPs and their association with BC risk was investigated in many different populations. Therefore in this study, we aimed to evaluate low-penetrance susceptibility SNPs; namely FGFR2 rs1219648, rs2981579, rs2981582; MAP3K1 rs889312; TOX3 rs3803662; LSP1 rs909116, rs3817198 and SLC4A7 rs4973768 together, for the first time in Turkish postmenopausal oestrogen receptor positive BC cases. Following the DNA isolation, multiplex PCR and matrix-assisted laser desorption/ionization mass spectrometry with time of flight measurement (MALDI-TOF) based SNP analysis were performed. MAP3K1 rs889312 SNP demonstrated the strongest association with BC risk among the other low penetrant SNPs, it was also associated with BC risk in a dominant model. Only in a ressesive model, TOX3 rs3803662 was associated with BC risk. In addition, rs4973768 CC and rs909116 CC genotypes are correlated with higher tumour size which is not reported in the literature as yet; on the other hand there are no associations between any of the other SNP genotypes and clinopathological parameters. In our opinion, MAP3K1 rs889312 may be a good BC susceptibility biomarker candidate for Turkish population.

The Antibiogram of Isolated Pathogens from Tracheal Aspirate among Intubated patients 2 months – 5 years old with very Severe Community Acquired Pneumonia Admitted in Pediatric Intensive Care Unit of a Tertiary Hospital in Cebu City from 2013-2016

Objective@#To determine the antibiogram of tracheal aspirate cultures (TACS) among intubated children aged 2 months to 5 years old with very severe community acquired pneumonia (CAP). @*Methodology@#A retrospective chart review using total enumerative sampling. @*Results@#66 out of the 343 patients had positive TACS. The top 5 most common isolates were Klebsiella pneumoniae(37.8%), Pseudomonas aeruginosa (25.7%), Acinetobacter baumanii (15.1%), Enterobacter cloacae (12.1%) and Methicillin Resistant Staphylococcus aureus (MRSA) (6%). The gram-negative isolates were highly sensitive to amikacin and carbapenems. Majority of these patients (92.42%) had history of Pentavalent immunization. Majority of patients who were TACS positive had history of antibiotic use prior to admission (92.42%), mostly second-generation cepahalosporin (cefuroxime, 32.42%). High rates of resistance to ampicillin and gentamicin were noted for patients with Klebsiella pneumoniae and Enterobacter cloacae isolates. Majority of patients with Klebsiella pneumoniae, Acinetobacter baumanii and MRSA expired. @*Conclusion/Recommendation@#Majority of those patients with positive isolates had MDR organisms thus for patients with very severe CAP who already received antibiotic as outpatient, broad spectrum antibiotics should be considered as empiric therapy and TACS be done on all patients with very severe CAP.

Relationship between fall and frailty index in elderly adults of urban community in Beijing / 中华流行病学杂志

Objective: To evaluate the frailty status and understand the relationship between the incidence of fall and frailty status in the elderly in Beijing. Methods: A cross-sectional study was conducted in old people aged ≥60 years in Longtan community of Dongcheng district in Beijing from November 2015 to January 2016. The information about any fall during the past year and frailty status of the elderly were collected with a standardized structured questionnaire in face-to-face interviews. The frailty status of elderly people was assessed with frailty index (FI) method. Logistic regression analysis was used to explore the relationship between fall and frailty status among the elderly. Results: Among 1 557 old people surveyed, the incidence of fall was 17.8% (277/1 557) during the past year. The incidence of fall in women (21.0%, 192/277) was statistically higher than that in men (13.3%, 85/277) (χ(2)=15.288, P=0.000). The median (quartile) value of FI of the elderly surveyed was 0.09 (0.08); and women had a higher FI median value than men [0.10 (0.08) versus 0.08 (0.07)](Z=5.376, P=0.000). The median FI value (quartile range) of 277 old people with history of fall in previous year was 0.12 (0.11), which was higher than the median FI value of 0.08 (0.07) of 1 280 old people without fall history (Z=7.501, P=0.000). Logistic regression analysis showed that higher FI value was associated with more risks for fall; and FI value showed the greatest impact on the incidence and frequency of fall (OR=1.093, 2.234) compared with other related factors of fall, such as age and gender. Conclusion: Frailty status has a greater impact on both incidence and frequency of fall compared with other factors in elderly people in Beijing; more attention should be paid to weak and old adults in the prevention of fall.

Current status of national free antiretroviral therapy in interprovincial migrating people living with HIV/AIDS and influencing factors, China, 2011-2015 / 中华流行病学杂志

Objective: To understand the current status of national free antiretroviral therapy in interprovincial migrating people living with HIV/AIDS (PLWHA) and influencing factors in China. Methods: Descriptive and trend test analyses were performed to evaluate the historical characteristics and trends of main descriptive indicators on national free antiretroviral therapy for the interprovincial migrating PLWHA by using the data collected from National Comprehensive HIV/AIDS Information System from 2011 to 2015. Logistic regression model was used to explore the main factors that influencing the coverage of national free antiretroviral therapy among the interprovincial migrating PLWHA in China. Results: The proportion of interprovincial migrating PLWHA gradually increased in last 5 years from 7.1% (17 784/250 645) in 2011 to 10.3% (54 596/528 226) in 2015 (Z=51.38, P<0.000 1) in China. The coverage rate of free antiretroviral therapy in interprovincial migrating PLWHA increased from 37.3% (6 641/17 784) in 2011 to 71.0% (38 783/54 596) in 2015, showing a significant rising tendency (Z=96.23, P<0.000 1), but it was slightly lower than that in non-interprovincial migrating PLWHA in 2015 (71.5%, 338 654/473 630). Multivariate logistic regression analysis showed that the PLWHA who were females, aged ≥50 years, of Han ethnic group, married or had spouse, had the educational level of high school or above, infected through homosexual intercourse, with CD(4)(+)T cells counts ≤500 cells/μl at the first visit, identified to be infected with HIV in medical setting, living in urban areas et al, were more likely to receive free antiretroviral therapy. Conclusions: The coverage rate of free antiretroviral therapy varied among the interprovincial migrating PLWHA with different characteristics. It is still necessary to take effective measures to further increase the coverage of free antiretroviral therapy in interprovincial migrating PLWHA and to include the free antiretroviral therapy in interprovincial migrating PLWHA into standardized management system as soon as possible.

Experience and understanding of sensory neuropathy in the Filipino context

@#<p style="text-align: justify;"><strong>BACKGROUND: </strong>Locally, understanding and communicating sensory neuropathy may be confounded by a "comprehension gap" during consults and limited "nerve literacy" or knowledge of patients about nerves. This may affect the effectiveness of healthcare.<br /><strong>OBJECTIVE:</strong> The study aims to describe the Filipino patients' experience of sensory neuropathy in local terms and their understanding of its causation.<br /><strong>METHODS:</strong> A cross-sectional, descriptive study among 24 patients with sensory neuropathy was done using semi-structured individual interviews. The first part elicited Filipino terms and descriptions used to explain their experience. The second part elicited perceived cause pre- and post- consult and perceived body part affected.<br /><strong>RESULTS:</strong> The most common descriptors of sensory neuropathy include "manhid", "kuryente", "tinutusuk-tusok", "ngalay", "kirot", and "naninigas". Many would initially identify "pasma" as a cause. Post-consult, many would cease to see it as part of natural ageing and would identify structural explanations such as impingement. They would however attribute it to an affectation of "ugat" which most defined as blood vessels.<br /><strong>CONCLUSION:</strong> The abovementioned terms are commonly used to describe sensory neuropathy and can be clinically useful in eliciting symptoms. There is existing confusion with regards to the nerve as a structure involved even after consultation.</p>