The impact of p16(ink4a) positivity in invasive vulvar cancer on disease-free and disease-specific survival, a retrospective study

Purpose To evaluate HPV and p16(ink4a) status as prognostic factors in patients with invasive vulvar cancer. Methods Retrospective analysis of disease-free (DFS) and disease-specific survival (DSS) of patients with invasive vulvar cancer at a single tertiary care center. Histology, HPV and p16(ink4a) status were evaluated in the context of a global multicenter trial. Logistic regression models were performed to identify the impact of p16(ink4a) positivity. Results 135 patients were included in the analysis. 32 (23.7%) showed a p16(ink4a) expression of over 25%. Disease-free and disease-specific survival was longer in p16(ink4a) positive patients (23 vs. 10 months, p = 0.004, respectively, 29 vs. 21 months, p = 0.016). In multivariate analysis, p16(ink4a) positivity was an independent parameter for DFS (p = 0.025, HR: 2.120 (1.100-4.085)), but not for DSS (p = 0.926, HR: 1.029 (0.558-1.901), in contrast to age and tumor stage. Conclusions Age and tumor stage negatively affect survival. However, disease-free survival is significantly longer in patients with p16(ink4a) positive invasive vulvar cancer

Gensthaler: How Many Small Libraries Can Be a Large Library

The success of the Internet has caused a significant change in the way of literature supply. Not only traditional libraries, booksellers and publishing houses have begun to enter the new digital world and offer their services world-wide, completely new information providers have been developed such as digital libraries, delivery services, citation services, and bibliographic databases. The amount of knowledge and information available world-wide grows every day. However, very few people will be able to access all the information that is available, since the information is distributed among a large number of computers and databases. People need assistance to gain the whole utility from the new situation. The idea presented in this paper is to integrate library and information services worldwide, so that they build a large virtual library with different services, offering the user a uniform access to the system.

Characteristics of person, place, and activity that trigger failure to speak in children with selective mutism

Selective Mutism (SM) is an anxiety disorder with predictable and circumscribed situations in which children remain silent while they speak unaffectedly in others. However, core features of anxiety inducing stimuli have rarely been studied so far. Parents of children with elevated SM symptomatology participated in an online-based study and answered open ended questions about specific characteristics of a person, place, and activity that elicit failure to speak in their child. The final sample consisted of n = 91 parents with children aged between 3 and 17 years (M = 8.02 years, SD = 3.94). Answers were analyzed by qualitative content analysis. Characteristics of a person were assigned to five categories with lack of distance as the most frequently reported feature. With respect to a place, the majority of parents mentioned unknown places as a silence trigger. The most frequently mentioned feature of an activity that was designated to be associated to silence was new activity. There were only few associations between the designation of these features, age, and gender. For the first time, anxiety inducing triggers related to person, place, and activity were comprehensively assessed in children with SM. This allows a differentiated and deeper understanding of an understudied disorder. The majority of characteristics can be associated with proposed etiological factors such as increased behavioral inhibition, conditioning processes, social anxiety, and a strong need for control. Implications for effective treatments are discussed

Evaluation of a novel p-rated scale for selective mutism

Assessment of selective mutism (SM) is hampered by the lack of diagnostic measures. The Frankfurt Scale of Selective Mutism was developed for kindergarteners, schoolchildren, and adolescents, including the diagnostic scale (DS) and the severity scale (SS). The objective of this study was to evaluate this novel, parent-rated questionnaire among individuals aged 3 to 18 years (n = 334) with SM, social phobia, internalizing disorders, and a control group. Item analysis resulted in high item-total correlations, and internal consistency in both scales was excellent with Cronbach’s α = .90-.98. Exploratory factor analysis of the SS consistently yielded a one-factor solution. Mean sum scores of the DS differed significantly between the diagnostic groups, and the receiver operating characteristic analysis resulted in optimal cutoffs for distinguishing SM from all other groups with the area under the curves of 0.94-1.00. The SS sum scores correlated significantly with SM’s clinician-rated symptom severity

HPV prevalence in vulvar cancer in Austria

Background Even if vulvar cancer is not common, over one hundred women are affected in Austria per year. There is strong evidence that basaloid and warty variants are associated with types of human papillomavirus (HPV). Methods The aim of this study is to analyze the types of HPV in vulvar cancer in Austria. This cross-sectional period-prevalence international collaborative study on archival specimens was performed in cooperation with the Institut Catalan di Oncologia in Barcelona, Spain. A total of 177 consecutive samples of Austrian women were analyzed to detect the presence of various HPV types using the SPF10 PCR/DEIA/LiPA25 system. Furthermore, the expression of the tumor suppressor protein p16INK4a was analyzed by immunohistochemistry (CINtec histology kit, ROCHE). A tumor was considered HPV-driven if an overexpression of p16INK4a was detected. Results In all, 41 cases of vulvar cancer tested positive for HPV DNA (23%) and 32 (18%) were p16 positive. Patients with warty and basaloid squamous cell cancer were significantly younger than those with keratinizing squamous cell cancer (63.3 years vs. 71.0 years, p = 0.021). In addition, 77.4% of all cases suffering from warty or basaloid squamous cell cancer tested positive for HPV, compared to 9.5% of the keratinizing squamous cell cancer cases (p < 0.001). The most commonly detected HPV strain was type 16, followed by 31 and 33. Conclusion Infection with HPV type 16 appears to be strongly correlated to the development of warty or basaloid squamous cell cancer. Vaccination against HPV can be expected to prevent this type of vulvar cancer.(VLID)356917

Bariatric Surgery–How Much Malabsorption Do We Need?—A Review of Various Limb Lengths in Different Gastric Bypass Procedures

The number of obese individuals worldwide continues to increase every year, thus, the number of bariatric/metabolic operations performed is on a constant rise as well. Beside exclusively restrictive procedures, most of the bariatric operations have a more or less malabsorptive component. Several different bypass procedures exist alongside each other today and each type of bypass is performed using a distinct technique. Furthermore, the length of the bypassed intestine may differ as well. One might add that the operations are performed differently in different parts of the world and have been changing and evolving over time. This review evaluates the most frequently performed bariatric bypass procedures (and their variations) worldwide: Roux-en-Y Gastric Bypass, One-Anastomosis Gastric Bypass, Single-Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy, Biliopancreatic Diversion + Duodenal Switch and operations due to weight regain. The evaluation of the procedures and different limb lengths focusses on weight loss, remission of comorbidities and the risk of malnutrition and deficiencies. This narrative review does not aim at synthesizing quantitative data. Rather, it provides a summary of carefully selected, high-quality studies to serve as examples and to draw tentative conclusions on the effects of the bypass procedures mentioned above. In conclusion, it is important to carefully choose the procedure and small bowel length excluded from the food passage suited best to each individual patient. A balance has to be achieved between sufficient weight loss and remission of comorbidities, as well as a low risk of deficiencies and malnutrition. In any case, at least 300 cm of small bowel should always remain in the food stream to prevent the development of deficiencies and malnutrition