Oncologic Outcomes for Squamous Cell Carcinoma In Situ With a Clinically Resolved Biopsy Site Managed by Watchful Waiting.

BACKGROUND: Treatment option decisions for low-risk squamous cell carcinoma in situ (SCCIS) are hampered by a paucity of management-type-specific outcomes data. OBJECTIVE: Describe SCCIS tumor outcomes managed by watchful waiting and risk factors associated with poor cancer outcomes. MATERIALS AND METHODS: Retrospective cohort study. Setting: Single academic hospital in a rural setting. Patients: Adults with SCCIS diagnosed between January 01, 2014, and December 31, 2016. Main Outcomes and Measures: Hazard ratios (HRs) for local recurrence (LR), nodal metastases (NM), distant metastases (DM), and disease-specific death (DSD). RESULTS: A total of 411 consecutive SCCIS tumors that were considered clinically resolved at follow-up and managed with watchful waiting were included. Seventeen tumors recurred locally. No instances of NM, DM, or DSD were identified. Multivariate analysis found that solid-organ transplant recipient status conferred the highest risk of local recurrence [HR, 9.979 (95% CI, 2.249-39.69)]. Additional risk factors predicting LR include anatomic location on the vermilion lip or ear [HR, 9.744 (95% CI, 1.420-69.28)], anatomic location on the head and neck [HR, 6.687 (95% CI, 1.583-36.15)], and a biopsy with tumor extending to the deep edge [HR, 6.562 (95% CI, 1.367-39.04)]. CONCLUSION: Watchful waiting for SCCIS with a clinically resolved biopsy site has a local recurrence rate of 4%.

A case of mevalonate kinase deficiency, neonatal Sweet syndrome, and inflammatory bowel disease.

Mevalonate kinase deficiency is a group of rare metabolic autoinflammatory disorders that present with recurrent fevers, abdominal pain, arthralgias, adenopathy, and a variety of cutaneous manifestations. The skin findings may mimic cellulitis, erythema elevatum diutinum, IgA vasculitis, and Sweet syndrome, and there is often a morbilliform or urticarial rash and aphthous stomatitis. Mevalonate kinase deficiency is one of the identified monogenic variants that can cause very early onset inflammatory bowel disease (IBD). We present a rare case of a patient with mevalonate kinase deficiency, neonatal Sweet syndrome, and infantile-onset IBD, who has been successfully treated with canakinumab therapy.

Cross-sectional survey exploring current intake practices for dogs admitted to animal shelters in Texas: a descriptive study.

Introduction: Entering an animal shelter is a stressful experience for dogs that can impair their welfare, adoptability, and shelter staff safety; thus, it is crucial to reduce the stress experienced during intake. This study investigated the current intake practices for dogs admitted in animal shelters in Texas, United States. Methods: To gather data, an online survey was designed and distributed to shelter employees responsible for intake at animal shelters. The survey collected information about examination procedures, the type of information collected from owner-surrenders, as well as the housing environment for the dogs. Results: Survey participants (n = 64) were shelter staff from municipal (59%, 38/64) and private shelters (23%, 15/64) in 47 counties. Handling techniques reported to be used during intake exams varied depending on the dog's behavior, with participants reporting higher restraint for aggressive dogs and lower restraint for calm dogs. If the dog was displaying fear, participants reported offering food and attention (89%, 47/53), using towel restraint (64%, 34/53) and conducting the exam on someone's lap (49%, 26/53). In cases of aggression, it was commonly reported to use muzzles (81%, 42/52) and catch poles (77%, 40/52), and shorten the exam (71%, 37/52). After the exam, most reported placing dogs on the adoption floor (45%, 27/60) or placing them wherever space was available (20%, 12/60). Discussion: Results provide descriptive information on current intake procedures and routine handling techniques used in Texas shelters. Future research should explore shelter dog responses to routine handling techniques to support the development of evidence-based protocols during routine intake examinations and procedures.

Willingness to pay for and willingness to vaccinate with the COVID-19 vaccine booster dose in China.

Objective: The present study aims to assess the willingness to pay (WTP) for and willingness to vaccinate (WTV) with the Coronavirus (COVID-19) vaccine booster dose in China when the pandemic is under adequate control and the majority of the population is vaccinated. This study is also to identify significant factors associated with the WTP. Methods: This was a cross-sectional study on adults with no past or present COVID-19 infection. An online questionnaire was distributed to collect data on vaccination status, quarantine experience, and factors related to health beliefs on vaccination. The WTV was assessed through the vaccination preference. The WTP was examined by payment scale (PS) and iterative bidding game (IBG) administered in random order. Three IBG algorithms with different starting-price were presented randomly. The average WTP of PS and IBG were analyzed as primary outcomes using univariate and multivariate analyses. Multivariate ordered logistic regression was performed to identify significant factors for the WTP. Results: The survey recruited 543 participants with a mean age of 32 years and 57.80% being female. The WTV rate was 86.74%, while 94.66% of participants completed full-schedule or enhanced vaccination. The mean WTP was CNY 149 (±CNY 197) and the median WTP was CNY 80. Regarding significant factors for the WTP, urban residents were 57% more likely (95% CI: 1.11-2.22) to pay for a high-priced vaccine than rural residents. Respondents who completed full-schedule vaccination were 46% more likely (95% CI: 1.03-2.07) to pay for a high-priced vaccine than those who completed enhanced vaccination. Respondents with a low household income of CNY 40k or lower were 62% less likely (95% CI: 0.21-0.66) to pay for a high-priced vaccine than those with a middle household income of CNY 110k-210k. Other significant factors associated with the WTP included the perceived benefit of vaccination and peer environmental pressure in the health belief model. Conclusion: The WTV with the COVID-19 vaccine booster dose was high in China. The WTP was influenced by the place of residence, vaccination status, household income, perceived benefit of vaccination, and environmental peer pressure. Study findings can inform policymakers to better design vaccination programs and financial schemes involving out-of-pocket payments.

A Likely Case of Abemaciclib-Induced Hyperpigmentation in a Patient With Metastatic Breast Cancer.

We report a case of a 64-year-old female with a past medical history of invasive right breast adenocarcinoma presented with diffuse hyperpigmentation of her skin after admission to the hospital for an infected breast implant. She had no recollection of a similar cutaneous reaction in her past. The patient had been on a chronic regimen of anastrozole and abemaciclib for her metastatic breast cancer. A punch biopsy revealed results were highly suspicious for a drug-induced hyperpigmentation reaction. After a thorough review of the patient's current and past medication lists, it was determined that her abemaciclib was the most likely culprit of her hyperpigmentation. This case is significant because of the rarity of this possible specific cutaneous reaction to abemaciclib. The literature that exists on cyclin-dependent kinase 4 and 6 inhibitors (CDK 4/6) is minimal. And so, the importance of shedding light on its possible cutaneous side effects is not only helpful for clinician diagnosis but also essential for patients to make informed decisions. To our knowledge, there is no other published literature on likely abemaciclib-induced hyperpigmentation.

Dog Owner Perceptions of Veterinary Handling Techniques.

Veterinary care can be a source of stress for domestic dogs and their owners. If a dog owner is not satisfied with the veterinary experience, this may reduce the frequency of veterinary visits and negatively impact a dog's health and welfare. Allowing dog owners to offer their perspectives on aspects of the veterinary appointment may help improve owner satisfaction. We assessed owner agreement towards 13 recommended handling techniques used on dogs during routine veterinary appointments, when the participants' dog was calm, fearful, or aggressive. An online cross-sectional survey targeting current dog owners, residing in Canada and the United States, was used to examine the influence of participant's pet attachment (using the Lexington Attachment to Pets Scale (LAPS)) and demographic information (age, gender, experience working in the veterinary field) on owner agreement towards the handling techniques. The majority of participants (N = 1176) disagreed with higher restraint techniques (e.g., full body restraint, muzzle hold) and tools (e.g., dog mask), and agreed with lower restraint techniques (e.g., minimal restraint) regardless of dog demeanor. Logistic regression models revealed that for medium/large dog owners, having previous veterinary work experience resulted in lower agreement with the use of minimal restraint (p < 0.0001) and higher agreement with the use of full body restraint on fearful dogs (p = 0.01). Small dog owners were more likely to agree with the use of minimal restraint on fearful dogs if they had a higher pet attachment score (p < 0.001), and were more likely to agree with full body restraint if they had previous veterinary work experience (p < 0.0001) or were male (p = 0.02). Owner perspectives align with current handling recommendations and provide further support for the use of low stress handling methods to improve owner satisfaction and dog welfare during routine veterinary care.

Cerebral Blood Flow and Brain Functional Connectivity Changes in Older Adults Participating in a Mindfulness-Based Stress Reduction Program.

There is a growing interest in the potential beneficial effects of mindfulness meditation training in protecting against age-related physical, emotional, and cognitive decline. The current prospective, single-center, single-arm study investigated if functional magnetic resonance imaging-based changes in cerebral blood flow and brain functional connectivity could be observed in 11 elderly adults (mean age 79) after participation in a Mindfulness-Based Stress Reduction (MBSR) program. The results showed significantly (p < 0.05) altered cerebral blood flow and functional connectivity in the cingulate gyrus, limbic structures, and subregions of the temporal and frontal lobes, similar to findings of other meditation-related studies in younger populations. Furthermore, these changes were also associated with significant improvements in depression symptoms. This study suggests that the MBSR program can potentially modify cerebral blood flow and connectivity in this population.

Association Between Household Food Environment and Excessive Gestational Weight Gain.

BACKGROUND: Understanding the role of home food environment on gestational weight gain (GWG) may provide a useful weight management strategy to help reduce excessive GWG. MATERIALS AND METHODS: Pregnant women recruited between 2011 and 2014 (N = 165; normal weight N = 65, overweight N = 62, obese N = 38) in Arkansas completed measures of high-fat food availability, low-fat food availability, and food storage practices at baseline (4-10 weeks) and 30 weeks gestation. GWG was calculated as the difference between weight at the first (4-10 weeks) and final (36 weeks) prenatal visit, and based on each participant's baseline body mass index (BMI) category, GWG was classified as being above or within the 2009 Institute of Medicine's GWG guidelines. Multivariable models were adjusted for mother's age, race, marital status, and household income. RESULTS: There were no significant relationships between gaining above the guidelines and the home food environment variables. At baseline, after adjusting for covariates, overweight and obese pregnant women stored significantly more foods visibly in their home compared to normal weight women (overweight: ß: 0.30, standard error [SE]: 0.13, p = 0.01; obese: ß: 0.28, SE: 0.14, p = 0.04). At 30 weeks, obese pregnant women had significantly fewer low-fat foods in the home (ß: -0.17; SE: 0.08, p = 0.04), although after adjusting for covariates, this relationship became a nonsignificant trend (p = 0.08). There were no significant relationships between BMI category and number of high-fat foods in the home. CONCLUSIONS: These findings are consistent with other studies in nonpregnant populations that demonstrate that home food environment may influence weight status of overweight and obese pregnant women, although we did not find a significant relationship between the home food environment and GWG.