Association between Hashimoto's thyroiditis and melanoma: a retrospective matched cohort study.

An inflammatory microenvironment has been shown to increase risk for malignant melanoma, suggesting that melanoma may be related to a pro-inflammatory state. Though Hashimoto's thyroiditis is one of the most common autoimmune diseases, there are no investigations of its relationship with melanoma. We aim to determine if Hashimoto's increases risk of developing melanoma. A retrospective, validated cohort of patients with a diagnosis of Hashimoto's between 2005 and 2020 were identified using the Olmsted County database. Patients were age and sex matched to controls without a Hashimoto's diagnosis. The primary outcomes were development of melanoma and time to first melanoma diagnosis. 4805 patients were included in the study, with 1726 (36%) having a diagnosis of Hashimoto's. Hashimoto's patients had no significant difference in risk of melanoma (relative risk 0.96, 95% CI 0.78-1.17) or nonmelanoma skin cancer (relative risk 0.95, 95% CI 0.86-1.06) compared with matched controls. This suggests that the local proinflammatory environment present in Hashimoto's does not contribute significantly to melanoma risk. Larger studies may be needed to further characterize the relationship between these diseases.

The impact of coronavirus disease 2019 on suspected head and neck cancer two-week-wait referrals.

BACKGROUND: The impact of coronavirus disease 2019 extends far beyond the immediate burden on healthcare systems caused by hospitalisation of patients with the disease itself. OBJECTIVE: To investigate the impact of the coronavirus disease 2019 pandemic on the referral rate of patients to the suspected head and neck cancer two-week-wait clinic. METHODS: A multicentre retrospective study was performed investigating data collected for all patients attending the suspected head and neck cancer two-week-wait clinic in ENT departments in the West Midlands. RESULTS: A total of 509 fast-track referrals were received from February to April in 2019, compared to 399 referrals in 2020. April 2020 saw a 62.4 per cent reduction in referral rate compared to April 2019. CONCLUSION: The coronavirus disease 2019 pandemic has resulted in changes to health-seeking behaviours, and healthcare provision and delivery. Urgent policy interventions may be required to compensate for the hidden impact that the coronavirus disease 2019 pandemic has had on those with cancer.

Diabetic gastroparesis alters the biomagnetic signature of the gastric slow wave.

BACKGROUND: Gastroparesis is characterized by delayed gastric emptying without mechanical obstruction, but remains difficult to diagnose and distinguish from other gastrointestinal (GI) disorders. Gastroparesis affects the gastric slow wave, but non-invasive assessment has been limited to the electrogastrogram (EGG), which reliably characterizes temporal dynamics but does not provide spatial information. METHODS: We measured gastric slow wave parameters from the EGG and magnetogastrogram (MGG) in patients with gastroparesis and in healthy controls. In addition to dominant frequency (DF) and percentage power distribution (PPD), we measured the propagation velocity from MGG spatiotemporal patterns and the percentage of slow wave coupling (%SWC) from EGG. KEY RESULTS: No significant difference in DF was found between patients and controls. Gastroparesis patients had lower percentages of normogastric frequencies (60 ± 6% vs 78 ± 4%, p < 0.05), and higher brady (9 ± 2% vs 2 ± 1%, p < 0.05) and tachygastric (31 ± 2% vs 19 ± 1%, p < 0.05) frequency content postprandial, indicative of uncoupling. Propagation patterns were substantially different in patients and longitudinal propagation velocity was retrograde at 4.3 ± 2.9 mm/s vs anterograde at 7.4 ± 1.0 mm/s for controls (p < 0.01). No difference was found in %SWC from EGG. CONCLUSIONS & INFERENCES: Gastric slow wave parameters obtained from MGG recordings distinguish gastroparesis patients from controls. Assessment of slow wave propagation may prove critical to characterization of underlying disease processes. Future studies should determine pathologic indicators from MGG associated with other functional gastric disorders, and whether multichannel EGG with appropriate signal processing also reveals pathology.

Stacking of 2D electron gases in Ge probed at the atomic level and its correlation to low-temperature magnetotransport.

Stacking of two-dimensional electron gases (2DEGs) obtained by δ-doping of Ge and patterned by scanning probe lithography is a promising approach to realize ultrascaled 3D epitaxial circuits, where multiple layers of active electronic components are integrated both vertically and horizontally. We use atom probe tomography and magnetotransport to correlate the real space 3D atomic distribution of dopants in the crystal with the quantum correction to the conductivity observed at low temperatures, probing if closely stacked δ-layers in Ge behave as independent 2DEGs. We find that at a separation of 9 nm the stacked-2DEGs, while interacting, still maintain their individuality in terms of electron transport and show long phase coherence lengths (∼220 nm). Strong vertical electron confinement is crucial to this finding, resulting in an interlayer scattering time much longer (∼1000 × ) than the scattering time within the dopant plane.

Field-directed sputter sharpening for tailored probe materials and atomic-scale lithography.

Fabrication of ultrasharp probes is of interest for many applications, including scanning probe microscopy and electron-stimulated patterning of surfaces. These techniques require reproducible ultrasharp metallic tips, yet the efficient and reproducible fabrication of these consumable items has remained an elusive goal. Here we describe a novel biased-probe field-directed sputter sharpening technique applicable to conductive materials, which produces nanometer and sub-nanometer sharp W, Pt-Ir and W-HfB(2) tips able to perform atomic-scale lithography on Si. Compared with traditional probes fabricated by etching or conventional sputter erosion, field-directed sputter sharpened probes have smaller radii and produce lithographic patterns 18-26% sharper with atomic-scale lithographic fidelity.

Prenatal diagnosis of supernumerary ring chromosome 1: case report and review of the literature.

A supernumerary ring chromosome was found on amniocentesis performed for advanced maternal age. A review of the literature found 34 reports of supernumerary ring chromosome I which are compared to our case.

In situ site-specific specimen preparation for atom probe tomography.

Techniques for the rapid preparation of atom-probe samples extracted directly from a Si wafer are presented and discussed. A systematic mounting process to a standardized microtip array allows approximately 12 samples to be extracted from a near-surface region and mounted for subsequent focused-ion-beam sharpening in a short period of time, about 2h. In addition, site-specific annular mill extraction techniques are demonstrated that allow specific devices or structures to be removed from a Si wafer and analyzed in the atom-probe. The challenges presented by Ga-induced implantation and damage, particularly at a standard ion-beam accelerating voltage of 30 keV, are shown and discussed. A significant reduction in the extent of the damaged regions through the application of a low-energy "clean-up" ion beam is confirmed by atom-probe analysis of the damaged regions. The Ga+ penetration depth into {100} Si at 30 keV is approximately 40 nm. Clean-up with either a 5 or 2 keV beam reduces the depth of damaged Si to approximately 5 nm and <1 nm, respectively. Finally, a NiSi sample was extracted from a Si wafer, mounted to a microtip array, sharpened, cleaned up with a 5 keV beam and analyzed in the atom probe. The current results demonstrate that specific regions of interest can be accessed and preserved throughout the sample-preparation process and that this preparation method leads to high-quality atom probe analysis of such nano-structures.

Poverty, insurance, and well-baby care among mainland Puerto Rican children.

Using data from the Puerto Rican Maternal and Infant Health Study, we investigate the implications of family income and insurance status for well-baby care among mainland Puerto Ricans. Given the socioeconomic disadvantage of Puerto Ricans, it is critical to understand the extent to which low income and lack of health insurance create barriers to well-baby care and result in low utilization. The analysis shows that the income-to-needs ratio is related to barriers to well-baby care, and a key intervening factor is insurance status. The odds of reporting any barriers to care are lowest among those with both adequate income and private health insurance. Access to insurance is also vital in achieving adequate well-baby care. Uninsured children receive inadequate care more often than children with public or private insurance, especially when their income is also low. Children with public insurance are as likely as children with private insurance to receive an adequate number of well-baby visits, despite the fact that their mothers report more barriers to care.

Prenatal care among Puerto Ricans on the United States mainland.

Recent public health initiatives in the USA identify the improvement of maternal and infant health outcomes among ethnic minorities as a national priority. Prenatal care is emphasized in these initiatives as a crucial intervention for reducing the risks of adverse outcomes. We investigate the barriers to prenatal care and the adequacy of prenatal care among mainland Puerto Ricans using data from a follow-back survey of a representative sample of mothers. The results show that barriers to prenatal care and the adequacy of prenatal care cannot be reduced solely to financial problems or problems associated with migration. Rather, attention to the social and the psychological circumstances surrounding the pregnancy (e.g. pregnancy wantedness) is required.

Comparison of tissue harmonic imaging with conventional US in abdominal disease.

Harmonic waves are generated from nonlinear distortion of an acoustic signal as an ultrasound wave insonates tissues in the body. These beams are integer multiples of a fundamental transmitted frequency. Potential advantages of harmonic imaging include improved axial resolution due to higher frequencies and better lateral resolution due to narrower beams. Decreased noise from side lobes improves signal-to-noise ratios and reduces artifacts. Deleterious effects of the body wall are also reduced. The authors prospectively studied ultrasonographic (US) findings in 100 adult patients with 202 abdominal lesions by comparing harmonic US images with conventional US images. The results were subjected to statistical analysis. Harmonic imaging was superior to conventional US in regard to lesion visibility and diagnostic confidence. Harmonic imaging was particularly useful for depicting cystic lesions and those containing echogenic tissues such as fat, calcium, or air. In patients with a body mass index of 30 or more, harmonic imaging was clearly better for lesion visibility and confidence of diagnosis. The authors recommend routine use of harmonic imaging for abdominal US studies in all adult patients.

Focal intracavitary masses recognized with the hyperechoic line sign at endovaginal US and characterized with hysterosonography.

In 42 women, endovaginal ultrasonography (US) was performed because of an abnormal central endometrial complex. Retrospective review of the endovaginal US scans and subsequently obtained hysterosonograms with histopathologic correlation showed a hyperechoic line surrounding the central endometrial complex in 25 patients, all of whom had focal intracavitary processes. Cystic spaces within the central endometrial complex in 17 of these patients reflected polyps; this finding was associated with a hyperechoic line in 15. At hysterosonography, all polyps (n = 29) had a narrow attachment to the endometrium. All five fibroids were broadly attached and had a rim of overlying endometrium. These focal abnormalities were easily distinguished from global endometrial processes amenable to a blind biopsy procedure. This initial experience showed that a hyperechoic line circumscribing the central endometrial complex at endovaginal US allows prediction of focal intracavitary disease, particularly when the line is associated with cystic spaces within the central endometrial complex. The presence of a hyperechoic line can be used to direct the patient to a visually guided hysteroscopic procedure rather than a potentially unsuccessful blind biopsy procedure. Alternatively, absence of a hyperechoic line can prompt management appropriately directed by hysterosonographic characterization of the uterine contents as focal or diffuse.

Racial and ethnic variation in low birthweight in the United States: individual and contextual determinants.

Using the Linked Birth and Death data set for 1990, the County-City Plus for 1993, and Summary Tape Files (STF) for 1990, a multilevel model is utilized to examine the influence of county and individual-level characteristics on low birthweight risk for white, black, Mexican, Cuban and Puerto Rican infants in the United States. Logistic regression results show that the racial and ethnic differences in low birthweight are not only the result of the individual-level characteristics of the mother, but also are a function of the characteristics of the county where the mother resides. Support for the contention that contextual factors work directly and indirectly to affect low birthweight risk was found. Separate racial/ethnic models indicate that the specific contextual variables that account for low birthweight risk vary across racial/ethnic groups.

Facilitated communication: rejected in science, accepted in court-a case study and analysis of the use of FC evidence under Frye and Daubert.

This article traces the phenomenon of facilitated communication (FC) from its introduction to the United States in 1990 to its use in recent court proceedings. FC is an alleged breakthrough technique that enables nonverbal individuals with developmental disabilities to communicate via a form of assisted typing. Widespread use of FC resulted in miraculous communications and surprising allegations of abuse. The growing importance and notoriety of FC attracted the interest of the scientific community which rejected the technique after numerous controlled studies were undertaken. Despite the rejection of FC by the scientific community, however, some courts have accepted this unproven technique by evading their state's test of scientific admissibility. It is asserted that court decisions admitting FC evidence are pretextural, and it is argued that FC should not be admitted into court proceedings. In addition, this report analyzes the future of FC in those states that have adopted the newer Daubert standard for scientific evidence.

Chemotherapy-related hepatotoxicity causing imaging findings resembling cirrhosis.

In this article, we describe three women in whom changes in the liver resembling cirrhosis occurred during systemic chemotherapy for metastatic breast carcinoma. All three patients were treated with tamoxifen as part of their chemotherapeutic regimen. Abnormalities of biochemical liver tests were associated with the development of a cirrhosis-like appearance of the liver on computed tomography. In two of the patients, hepatic metastases were proved at biopsy. The third patient had no radiologic evidence of metastatic disease. Chemotherapy for metastatic breast carcinoma may cause striking morphologic changes in the liver that resemble cirrhosis. Of importance, these changes should not be mistaken for the development or progression of liver metastases. Alternatively, because of the changes produced by chemotherapeutic agents, detection of metastases on computed tomography alone may be more difficult. Supplementary magnetic resonance imaging may be helpful in selected cases.

Intraocular metallic-appearing foreign bodies after phacoemulsification.

Intraocular metallic-appearing foreign bodies in the anterior segment were seen in six eyes after cataract extraction by two-handed phacoemulsification. These fragments produced no symptoms and had no clinically significant effect on visual function. Similar-appearing foreign bodies were experimentally produced by applying ultrasound power with a phacoemulsification handpiece to the surface of a cyclodialysis spatula in vitro. Microscopic examination of the phaco handpiece tip and cyclodialysis spatulas revealed numerous surface irregularities, suggesting a possible source of these fragments. These results suggest that instrument touch during phacoemulsification may be the cause of the fragments. Long-term follow-up of these patients is required to determine the overall effect of the fragments.

Publication bias in obesity treatment trials?

OBJECTIVE: The present investigation examined the extent of publication bias (namely the tendency to publish significant findings and file away non-significant findings) within the obesity treatment literature. DESIGN: Quantitative literature synthesis of four published meta-analyses from the obesity treatment literature. Interventions in these studies included pharmacological, educational, child, and couples treatments. METHODS: To assess publication bias, several regression procedures (for example weighted least-squares, random-effects multi-level modeling, and robust regression methods) were used to regress effect sizes onto their standard errors, or proxies thereof, within each of the four meta-analysis. A significant positive beta weight in these analyses signified publication bias. RESULTS: There was evidence for publication bias within two of the four published meta-analyses, such that reviews of published studies were likely to overestimate clinical efficacy. The lack of evidence for publication bias within the two other meta-analyses might have been due to insufficient statistical power rather than the absence of selection bias. CONCLUSIONS: As in other disciplines, publication bias appears to exist in the obesity treatment literature. Suggestions are offered for managing publication bias once identified or reducing its likelihood in the first place.

Hepatic adenomatosis.

This case report describes a 41-year-old woman with hepatic adenomatosis (multiple hepatic adenomas) associated with acute hemorrhage. She had no history of oral contraceptive use or corticosteroid therapy. Ultrasonography showed multiple masses in the right lobe of the liver. The clinical associations and potential complications of hepatocellular adenomas are discussed, and the histologic characteristics are provided. Their typical appearance on computed tomography, ultrasonography, magnetic resonance imaging, and nuclear scintigraphy is described. The differential diagnosis of hepatic adenomatosis and multiple solid liver masses is discussed.

Imaging of gastrointestinal neuroendocrine tumors.

Gastrointestinal neuroendocrine tumors are rare neoplasms that cause classic clinical syndromes because of the excess secretion of specific gastrointestinal hormones. The two most important tumors clinically are insulinomas and gastrinomas. The clinical management of patients with these disorders usually involves the localization and surgical removal of the responsible tumor. Many radiological techniques can be used for tumor localization, including preoperative and intraoperative ultrasound, endoscopic ultrasound, CT, MRI, radionuclide scanning, angiography, and venous sampling. However, there are conflicting claims as to the relative accuracy of these procedures, and many of these investigations are difficult to justify because of their high cost, degree of invasiveness, or lack of precise anatomic information that is obtained. If surgical resection of a neuroendocrine tumor is planned, intraoperative sonography should always be used to detect occult nonpalpable tumors and to discern the relationship of the tumor to vital adjacent pancreatic ductal anatomy. The choice of preoperative imaging is more controversial, and depends on the clinical problem, local expertise, and availability of imaging techniques. Sonography and contrast-enhanced helical CT are the most commonly used preoperative imaging methods, because of their relatively low cost and widespread availability. Radionuclide scanning with a somatostatin analogue, which is a relatively new procedure, may be valuable in patients with symptoms of tumor recurrence.

Linking in-session change to overall outcome in short-term cognitive therapy.

To better understand the mechanisms of change in psychotherapy, it is important to validate suboutcome measures that represent intermediate links between more molecular in-session changes and ultimate outcome. The present study involved the collection of pre- and postsession ratings from 53 patients in a 20-session protocol of cognitive therapy, which yielded 5 suboutcome measures: Anxiety Shift, Depression Shift, Cognitive Shift, Optimism Shift, and Therapeutic Alliance. From a series of regression analyses of repeated measures with a generalized estimating equations approach, results regarding the predictive relationship of these variables to a number of patient and therapist-rated outcome criterion variables indicated that change in cognition and quality of the therapeutic alliance were the strongest predictors.

The smallest gene of the orbivirus, epizootic hemorrhagic disease, is expressed in virus-infected cells as two proteins and the expression differs from that of the cognate gene of bluetongue virus.

The smallest gene (S10) of the virus of epizootic hemorrhagic disease of deer (EHD, serotype 2) is expressed as two proteins in virus-infected cells. By contrast, the non-structural proteins (NS3 and NS3A) encoded in the smallest gene of bluetongue (BT) viruses are difficult to detect in virus-infected cells. The nucleotide sequence of S10 of EHDV-2 contains two in-frame initiation codons which allow for translation of proteins of mol. wt. 25503 and 23921 analogous to NS3 and NS3A of BT viruses. The S10 genes of BT viruses are highly conserved (82%-99%); the nucleotide sequence similarity of S10 of EHDV-2 and BT viruses is about 64%. Some structural features of NS3 and NS3A are conserved in the two viruses, despite the divergence in the amino acid sequences of the proteins. The hydrophobic domains of the proteins and the putative transmembrane sequences are conserved, as are potential glycosylation sites in the proteins. A cluster of proline residues, which is conserved at residues 36-50 in all of the published sequences of NS3 of BT viruses, is conserved exactly in the alignment of the sequence of NS3 of EHDV-2 with that of the BT viruses. An explanation for the differences in expression of NS3/NS3A in EHD and BT viruses was not evident in comparing the nucleotide sequences of S10 of the viruses.