ABSTRACT
BACKGROUND: Renewable materials made using environmentally friendly processes are in high demand as a solution to reduce the pollution created by the fashion industry. In recent years, there has been a growing trend in research on renewable materials focused on bio-based materials derived from fungi. RESULTS: Recently, fungal cell wall material of a chitosan producing fungus has been wet spun to monofilaments. This paper presents a modification for the fungal monofilament spinning process, by the development of a benign method, dry gel spinning, to produce continuous monofilaments and twisted multifilament yarns, from fungal cell wall, that can be used in textile applications. The fungal biomass of Rhizopus delemar, grown using bread waste as a substrate, was subjected to alkali treatment with a dilute sodium hydroxide solution to isolate alkali-insoluble material (AIM), which mainly consists of the fungal cell wall. The treatment of AIM with dilute lactic acid resulted in hydrogel formation. The morphology of the hydrogels was pH dependent, and they exhibited shear thinning viscoelastic behavior. Dry gel spinning of the fungal hydrogels was first conducted using a simple lab-scale syringe pump to inject the hydrogels through a needle to form a monofilament, which was directly placed on a rotating receiver and left to dry at room temperature. The resulting monofilament was used to make twisted multifilament yarns. The process was then improved by incorporating a heated chamber for the quicker drying of the monofilaments (at 30°C). Finally, the spinning process was scaled up using a twin-screw microcompounder instead of the syringe pump. The monofilaments were several meters long and reached a tensile strength of 63 MPa with a % elongation at break of 14. When spinning was performed in the heated chamber, the tensile strength increased to 80 MPa and further increased to 103 MPa when a micro-compounder was used for spinning. CONCLUSION: The developed dry gel spinning method shows promising results in scalability and demonstrates the potential for renewable material production using fungi. This novel approach produces materials with mechanical properties comparable to those of conventional textile fibers.
ABSTRACT
Oncology is a field of medicine projected to face provider shortages as cancer prevalence rises. Moreover, the diversity of oncologists remains subpar compared to that of the general population despite initiatives to increase the number of students from underrepresented backgrounds (UIM). Thus, first-year UIM medical students interested in oncology were invited to participate in a 4-week oncology summer internship (OSI) to gain clinical exposure and mentorship experiences. The OSI connected students with oncologists for mentorship, provided tours of oncologic facilities, and coordinated shadowing opportunities. The impact of the OSI was assessed via a mixed-methods approach. Pre- and post-survey data were collected from eight of the nine OSI students. Quantitative data demonstrated improvement of students' understanding of oncology as a discipline, for example its training pathways (p = .02), and awareness of patient experiences in oncology, for example socioeconomic challenges (p = .008). Students reported an increased ability to identify with those in oncology and identify mentors in the field (p = .03 and p = .05, respectively). Qualitative data demonstrated continued interest in oncology with increased commentary on the patient experience and social determinants of health. Post-survey, students provided more commentary on the need for diversity in the field and possible increased professional connections in medicine. The OSI improved students' understanding of oncology and oncology patient experiences with potentially increased identification of and connection with others in the field. Further work will focus on assessing the impact of future OSIs on professional identity formation.
ABSTRACT
INTRODUCTION: Docetaxel can cause fluid retention reactions (FRRs) and hypersensitivity reactions (HSRs). The manufacturer recommends a multi-day oral dexamethasone premedication to prevent these toxicities, but steroid related side effects and regimen compliance remain a concern. This study aimed to determine if modified dexamethasone premedication regimens resulted in differences in HSRs or FRRs to docetaxel. We also examined side effects of dexamethasone and delays in chemotherapy. METHODS: A retrospective chart review was conducted on 82 early breast cancer patients treated with docetaxel. Three steroid regimens were examined: IV 20â mg single-dose dexamethasone, or IV 12â mg dexamethasone with either dexamethasone 8â mg BID for three days starting the day before chemotherapy or dexamethasone 4â mg BID for three days following chemotherapy. Adverse effects, delays in chemotherapy, and reasons for delays in chemotherapy were recorded. RESULTS: The incidence and severity of FRRs and HSRs was low, with less than 10% incidence of HSRs or FRRs in any group. Delays were most common in the group receiving dexamethasone 8â mg BID for 3 days starting the day before chemotherapy (63.3%) (p < 0.05) and were most commonly due to patient noncompliance (26%). CONCLUSION: A single dose of intravenous dexamethasone alone or followed by lower doses of oral dexamethasone may improve patient compliance and avoid delays in chemotherapy, without an increase in docetaxel toxicity.
ABSTRACT
Mosaic mutations in genes GNAQ or GNA11 lead to a spectrum of diseases including Sturge-Weber syndrome and phakomatosis pigmentovascularis with dermal melanocytosis. The pathognomonic finding of localized "tramlining" on plain skull radiography, representing medium-sized neurovascular calcification and associated with postnatal neurological deterioration, led us to study calcium metabolism in a cohort of 42 children. In this study, we find that 74% of patients had at least one abnormal measurement of calcium metabolism, the commonest being moderately low serum ionized calcium (41%) or high parathyroid hormone (17%). Lower levels of ionized calcium even within the normal range were significantly associated with seizures, and with specific antiepileptics despite normal vitamin D levels. Successive measurements documented substantial intrapersonal fluctuation in indices over time, and DEXA scans were normal in patients with hypocalcemia. Neurohistology from epilepsy surgery in five patients revealed not only intravascular, but perivascular and intraparenchymal mineral deposition and intraparenchymal microvascular disease in addition to previously reported findings. Neuroradiology review clearly demonstrated progressive calcium deposition in individuals over time. These findings and those of the adjoining paper suggest that calcium deposition in the brain of patients with GNAQ/GNA11 mosaicism may not be a nonspecific sign of damage as was previously thought, but may instead reflect the central postnatal pathological process in this disease spectrum.
Subject(s)
Calcinosis , Neurocutaneous Syndromes , Child , Humans , GTP-Binding Protein alpha Subunits/genetics , GTP-Binding Protein alpha Subunits, Gq-G11/genetics , Calcium/metabolism , Mosaicism , Neurocutaneous Syndromes/diagnosis , Neurocutaneous Syndromes/genetics , Calcinosis/geneticsABSTRACT
INTRODUCTION: Extended endocrine therapy (EET) benefits select patients with early-stage hormone-receptor positive (HR+) breast cancer (BC) but also incurs side effects and cost. The Clinical Treatment Score at Five Years (CTS5) is a free tool that estimates risks of late relapse in estrogen-receptor positive (ER+) BC using clinicopathologic factors. The Breast Cancer Index (BCI) incorporates 2 genomic assays to estimate late relapse risk and likelihood of benefit from EET. This retrospective study assesses the utility of BCI in selecting EET candidates in a safety net hospital. MATERIALS AND METHODS: We performed a retrospective chart review on 69 women with early-stage HR+, HER2- BC diagnosed at our institution from December 2009 to February 2016 on whom BCI was submitted. The CTS5 score was also calculated to assess clinical risk of late relapse. RESULTS: Median age was 53 years. All patients included in our analysis had early ER+ HER2-negative BC. Roughly half of the patients (55%) were postmenopausal and 61% were of Hispanic origin. A total of 34 patients (49%) were deemed high-risk (>5%) for late relapse by CTS5, compared to 42 (61%) by BCI. BCI identified 31 (45%) patients that would benefit from EET and of those, 74%% were advised EET. 16 (47%) clinical high-risk patients were advised against EET due to low benefit predicted by BCI. In the clinical low risk group, 9 (26%) were recommended EET based on high benefit predicted by BCI. CONCLUSION: BCI is reasonable to consider in early-stage HR+ BC and offered clinically relevant information over clinical pathologic information alone.
Subject(s)
Brain-Computer Interfaces , Breast Neoplasms , Humans , Female , Middle Aged , Prognosis , Tamoxifen/therapeutic use , Breast Neoplasms/diagnosis , Breast Neoplasms/drug therapy , Breast Neoplasms/genetics , Antineoplastic Agents, Hormonal/adverse effects , Retrospective Studies , Receptors, Estrogen , Safety-net Providers , Neoplasm Recurrence, Local/pathology , RecurrenceABSTRACT
Patients with recalcitrant facial port wine stains (rfPWS) can be challenging to manage, often leaving the clinician with difficult decisions for treatment options. 'Triple therapy' consists of using three different laser wavelengths at each treatment setting. The evidence on outcomes is limited as this treatment approach has not been previously reported to the best of our knowledge. Children who received triple therapy at least once for rfPWS, and for whom SIAscopy readings had been taken, were retrospectively identified. SIAscope readings were compared before the first triple therapy treatment and at final the most recent clinical follow-up. The clinical appearance was also assessed using a Visual Analogue Scale comparing clinical photographs taken before triple therapy to those taken at the most recent clinical follow-up. A total of 47 children were identified and included in our review. The SIAscope readings showed an overall significant (p < 0.001) lightening with 39 (83%) showing lightening and 8 (17%) patients showing a darkening. Scores using the VAS also showed improvement with 55% experiencing an improvement in their clinical appearance, 38% showing no visible change and 6% appearing to have worsened. Triple therapy can offer improvement of rfPWS which have failed to respond to single wavelength laser therapy. SIAscopy and VAS scores correlate well in assessing clinical response; however, the added clinical benefit of SIAscopy in vascular laser clinics remains uncertain.
Subject(s)
Laser Therapy , Low-Level Light Therapy , Port-Wine Stain , Child , Humans , Port-Wine Stain/radiotherapy , Port-Wine Stain/surgery , Retrospective Studies , Treatment OutcomeSubject(s)
Neutropenia/diagnosis , Neutropenia/etiology , Rothmund-Thomson Syndrome/diagnosis , Rothmund-Thomson Syndrome/etiology , Skin Abnormalities/diagnosis , Skin Abnormalities/etiology , Alleles , Diagnosis, Differential , Genetic Association Studies , Genetic Predisposition to Disease , Genotype , Humans , Mutation , PhenotypeABSTRACT
INTRODUCTION: The moderate-penetrance germline mutations ATM, CHEK2, and PALB2 are implicated in an increased risk of the development of breast cancer. Whether these mutations provide clinical utility to guide treatment strategies and prognosis remains unknown. METHODS: A retrospective case-control study from a tertiary institution compared patients with stage 0-III breast cancer, and positive for ATM, CHEK2, or PALB2 mutations, with a matched cohort selected by randomization and negative for mutations. Data acquisition included demographics, histopathologic, treatment, and clinical outcome variables. RESULTS: A total of 145 patients with breast cancer (144 female and 1 male) were analyzed-74 mutation-positive patients (24 ATM, 26 CHEK2, 24 PALB2) and 71 mutation-negative patients. Mutation-positive patients compared with mutation-negative patients had increased family history of breast cancer (79.7 vs. 52.9%, p < 0.001) and tumor size > 2.0 cm (63.1% vs. 42.3%, p = 0.015). Patients with prior knowledge of mutational status were more likely to proceed with total mastectomy and prophylactic mastectomy (74.5% vs. 25.5%, p < 0.02; and 65.5% vs. 34.5%, p < 0.001, respectively). The unadjusted recurrence rate was higher in mutation-positive patients compared with mutation-negative patients (24.3 vs. 8.5%, p = 0.01), although mutation status was not predictive for recurrence in Cox regression analysis. CONCLUSIONS: Patients positive for ATM, CHEK2, or PALB2 mutations had increased tumor size and were more likely to undergo extensive surgeries. Mutation status was not predictive of recurrence, although this lack of effect may have been mitigated by lower rates of recurrence in those who pursued total mastectomy. Further studies are needed to confirm these findings.
Subject(s)
Breast Neoplasms , Ataxia Telangiectasia Mutated Proteins/genetics , Breast Neoplasms/genetics , Case-Control Studies , Checkpoint Kinase 2/genetics , Fanconi Anemia Complementation Group N Protein/genetics , Female , Genetic Predisposition to Disease , Germ-Line Mutation , Humans , Male , Mastectomy , Mutation , Neoplasm Recurrence, Local/genetics , Retrospective StudiesSubject(s)
Antibiotics, Antineoplastic/adverse effects , Bicarbonates/metabolism , Breast Neoplasms/drug therapy , Doxorubicin/adverse effects , Heart Diseases/chemically induced , Mitochondria, Heart/drug effects , Myocytes, Cardiac/drug effects , Neoadjuvant Therapy/adverse effects , Pyruvate Dehydrogenase Complex/metabolism , Adult , Carbon-13 Magnetic Resonance Spectroscopy , Cardiotoxicity , Chemotherapy, Adjuvant/adverse effects , Early Diagnosis , Feasibility Studies , Female , Heart Diseases/diagnostic imaging , Heart Diseases/enzymology , Humans , Lactic Acid/metabolism , Middle Aged , Mitochondria, Heart/enzymology , Myocytes, Cardiac/enzymology , Predictive Value of Tests , Pyruvic Acid/metabolism , Time FactorsSubject(s)
GTP-Binding Protein alpha Subunits/genetics , Genotype , Mutation/genetics , Protein Domains/genetics , Skin/metabolism , Sturge-Weber Syndrome/genetics , Capillaries/abnormalities , Child , Child, Preschool , Cohort Studies , Female , Genetic Association Studies , Humans , Infant , Infant, Newborn , Male , Mosaicism , Phenotype , Prospective Studies , Skin/pathology , Skin Pigmentation , Sturge-Weber Syndrome/diagnosis , Vascular MalformationsABSTRACT
BACKGROUND: Gastric cancer treatment initiation is a complex process. Inefficiencies in care coordination can lead to significant delays, which are often more prominent at safety net hospitals. Multidisciplinary teams (MDTs) have been proposed as an effective solution. METHODS: A retrospective review of sequential gastric cancer patients receiving treatment at Parkland Hospital (Dallas, TX) between 2013 and 2015 was performed before (n = 50) and after (n = 50) creation of a MDT and standardized care pathways. Patients undergoing urgent resection were excluded. Time to treatment (TTT) from initial endoscopy to initiation of chemotherapy was evaluated. The number of diagnostic tests performed and treatment variability also were compared. RESULTS: Groups were similar in terms of age, sex, stage distribution, tumor location, and type of presentation (outpatient vs. emergency room). Post-intervention, TTT decreased from 84.1 ± 12.3 to 32.5 ± 15.2 days (p < 0.02). This decrease was primarily related to parallel performance of subspecialty evaluations, staging studies, and procedures. MDT review reduced the number of unnecessary staging tests performed, leading to a decrease in the average number of studies from 3.8 per patient to 2.2 (p < 0.05). Use of diagnostic laparoscopy in patients with clinically locally advanced disease increased from 18 to 94% (p < 0.05). CONCLUSIONS: Creation of a gastric cancer MDT and uniform care pathways at a large safety net hospital expedited initiation of treatment, reduced unnecessary tests, and promoted consistent patient management.
Subject(s)
Hospitals/standards , Interdisciplinary Communication , Patient Care Team/statistics & numerical data , Quality of Health Care , Safety-net Providers/statistics & numerical data , Stomach Neoplasms/therapy , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Retrospective Studies , Stomach Neoplasms/pathology , Survival Rate , Time-to-TreatmentABSTRACT
Capillary malformation-arteriovenous malformation syndrome (CM-AVM) is a rare condition associated with mutations in the genes RASA1 and EPHB4. We present a challenging case of CM-AVM in a 17-month-old boy with permanent diplegia from an undiagnosed arteriovenous malformation underlying a large atypical capillary malformation over the lower thoracic spine. This case demonstrates that clinicians should have a low threshold for neuroimaging in the context of new neurologic symptoms in patients with atypical capillary malformations.
Subject(s)
Arteriovenous Fistula/diagnosis , Arteriovenous Malformations/diagnosis , Capillaries/abnormalities , Cerebral Palsy/diagnosis , Missed Diagnosis/adverse effects , Port-Wine Stain/diagnosis , Spinal Cord Diseases/diagnosis , p120 GTPase Activating Protein/genetics , Arteriovenous Fistula/diagnostic imaging , Arteriovenous Fistula/etiology , Arteriovenous Fistula/genetics , Arteriovenous Malformations/complications , Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/genetics , Capillaries/diagnostic imaging , Cerebral Palsy/diagnostic imaging , Cerebral Palsy/etiology , Humans , Infant , Male , Port-Wine Stain/complications , Port-Wine Stain/diagnostic imaging , Port-Wine Stain/genetics , Spinal Cord Diseases/diagnostic imaging , Spinal Cord Diseases/etiology , Spinal Cord Diseases/genetics , Thoracic VertebraeABSTRACT
BACKGROUND: Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare, severe, sporadically occurring disorder characterized by multiple venous malformations. AIMS: To present and analyze a case series of pediatric patients with BRBNS and to describe diagnostic approaches and management options applied. PATIENTS AND METHODS: Multicenter, retrospective study, evaluating the diagnosis and management of children with BRBNS. RESULTS: Eighteen patients diagnosed with BRBNS were included. Cutaneous venous malformations were observed in 78% and gastrointestinal venous malformations in 89%. Lesions were also found in other organs including muscles, joints, central nervous system, eyes, parotid gland, spine, kidneys and lungs. Gastrointestinal lesions were more common in the small intestine than in stomach or colon. The management varied significantly among centers. Endoscopic therapy and surgical therapy alone failed to prevent recurrence of lesions. In younger children and in patients with musculoskeletal or other organ involvement, sirolimus was used with 100% success rate in our series (5 patients treated) although poor compliance with subtherapeutic sirolimus trough levels led to recurrence in a minority. CONCLUSIONS: Considering the multi-organ involvement in BRBNS, diagnosis and management requires a multidisciplinary approach. The treatment includes conservative, medical, endoscopic and surgical options. Prospective multicenter studies are needed to identify the optimal management of this rare condition.
Subject(s)
Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Neoplasms/therapy , Nevus, Blue/diagnosis , Nevus, Blue/therapy , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , Child , Child, Preschool , Diagnosis, Differential , Endoscopy, Digestive System , Female , Humans , Infant , Interdisciplinary Communication , Male , Neoplasm Recurrence, Local , Retrospective Studies , Sclerotherapy , Sirolimus/therapeutic use , Vascular Malformations/diagnosis , Vascular Malformations/therapySubject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Carcinoma, Neuroendocrine/diagnostic imaging , Carcinoma, Neuroendocrine/pathology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/metabolism , Carcinoma, Neuroendocrine/drug therapy , Carcinoma, Neuroendocrine/metabolism , Cisplatin/administration & dosage , Contrast Media , Etoposide/administration & dosage , Female , Humans , Magnetic Resonance Imaging/methods , Middle Aged , Receptors, Estrogen/metabolism , Receptors, Progesterone/metabolism , Ultrasonography, MammarySubject(s)
Biomarkers/blood , Fasting/blood , Glucagon/blood , Glucose/administration & dosage , Pancreatic Neoplasms/diagnosis , Aged , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Female , Glucose Tolerance Test , Humans , Hypoglycemic Agents/therapeutic use , Insulin/blood , Male , Middle Aged , Pancreatic Neoplasms/blood , Pancreatic Neoplasms/complications , Pioglitazone/therapeutic useABSTRACT
BACKGROUND: We describe a case of elastosis perforans serpiginosa and its successful management with PDL laser. CASE PRESENTATION: A 15-year-old male presented with a history of itchy, raised, red and unsightly lesions on the back of his neck. He was diagnosed with Elastosis Perforans Serpiginosa on tissue biopsy and underwent pulse dye laser therapy over four years with excellent results. CONCLUSIONS: Our results show that pulse dye laser therapy is a safe and effective treatment for elastosis perforans serpiginosa.
ABSTRACT
OBJECTIVES: There is interest in improving the tumoricidal effects of preoperative radiotherapy for rectal carcinoma by studying new radiosensitizers. The safety and toxicity profile of these combination regimens needs rigorous clinical evaluation. The primary objective of this study was to evaluate the toxicity of combining bavituximab, an antibody that targets exposed phosphatidylserine, with capecitabine and radiation therapy. MATERIALS AND METHODS: Patients with stage II or III rectal adenocarcinoma were enrolled on a phase I study combining radiation therapy, capecitabine, and bavituximab. A standard 3+3 trial designed was used. RESULTS: In general, bavituximab was safe and well tolerated in combination with radiation therapy and capecitabine in the treatment of rectal adenocarcinoma. One patient at the highest dose level experienced a grade III infusion reaction related to the bavituximab. One tumor demonstrated a complete pathologic response to the combination treatment. CONCLUSIONS: Bavituximab is safe in combination with capecitabine and radiation therapy at the doses selected for the study. Further clinical investigation would be necessary to better define the efficacy of this combination.
Subject(s)
Adenocarcinoma/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemoradiotherapy , Neoplasm Recurrence, Local/therapy , Rectal Neoplasms/therapy , Adenocarcinoma/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal/administration & dosage , Capecitabine/administration & dosage , Cohort Studies , Dose Fractionation, Radiation , Female , Follow-Up Studies , Humans , Male , Maximum Tolerated Dose , Middle Aged , Neoplasm Recurrence, Local/pathology , Prognosis , Rectal Neoplasms/pathology , Survival Rate , Young AdultSubject(s)
Nevus, Sebaceous of Jadassohn/diagnosis , Child , Diagnosis, Differential , Female , Foot , Groin , Humans , Nevus, Sebaceous of Jadassohn/pathologyABSTRACT
Blue rubber bleb nevus syndrome (Bean syndrome) is a rare, severe disorder of unknown cause, characterized by numerous cutaneous and internal venous malformations; gastrointestinal lesions are pathognomonic. We discovered somatic mutations in TEK, the gene encoding TIE2, in 15 of 17 individuals with blue rubber bleb nevus syndrome. Somatic mutations were also identified in five of six individuals with sporadically occurring multifocal venous malformations. In contrast to common unifocal venous malformation, which is most often caused by the somatic L914F TIE2 mutation, multifocal forms are predominantly caused by double (cis) mutations, that is, two somatic mutations on the same allele of the gene. Mutations are identical in all lesions from a given individual. T1105N-T1106P is recurrent in blue rubber bleb nevus, whereas Y897C-R915C is recurrent in sporadically occurring multifocal venous malformation: both cause ligand-independent activation of TIE2, and increase survival, invasion, and colony formation when expressed in human umbilical vein endothelial cells.