The diagnostic workup for systemic mastocytosis differs from consensus recommendations: Results of a worldwide survey

Objective: Mastocytosis is a complex disorder affecting various organs. The diagnostic workup can be challenging and requires a multidisciplinary approach including the use of uncommon tests. To assess mastocytosis management around the globe, we conducted the first worldwide online survey for physicians. Methods: A 21-item questionnaire was sent out to the members of the World Allergy Organization (WAO), the Global Allergy and Asthma European Network (GA2LEN), the Urticaria (UCARE) and Angioedema (ACARE) Centers of Reference and Excellence, the German Society of Allergology and Clinical Immunology (DGAKI), and the European Mast Cell and Basophil Research Network (EMBRN) in April–June 2021. Results: Across 628 respondents from 79 countries 87.7% and 9.7% of physicians were allergists/clinical immunologists and/or dermatologists. Participating physicians were from all regions of the world (Europe, EU: 41.6%; North America, NA: 24.8%; Latin America, LA: 14.5%; Asia-Pacific, AP: 12.6%; and Africa/Middle East, AME: 6.5%). Only 2.2% of respondents worked at Specialized Mastocytosis Centers (SMCs) in North America or European Union. Physicians reported caring for 4 patients with mastocytosis per year, with higher numbers in European Union and Asia Pacific (5/year) compared to Latin America (2/year). Dermatologists and physicians who work at SMCs reported higher patient numbers (15/year and 80/year, respectively). Suspicion of mastocytosis in the allergology and dermatology community is commonly driven by anaphylaxis (82.9%), mastocytosis skin lesions (82.1%), or elevated tryptase levels (76.6%). Osteoporosis and gastrointestinal symptoms less often prompted suspicion of mastocytosis (21.4% and 49.9%, respectively). World Health Organisation (WHO)-diagnostic criteria and classification, regardless of the region, are only used by about 50% of physicians, with higher rates for SMCs (83.3%). Serum tryptase, bone marrow biopsy, and KIT D816V mutation analysis are included in the diagnostic workup by 90.9%, 61.5%, and 58.4% of physicians, respectively. The biggest challenges for the management of mastocytosis are the lack of more effective treatment options (51.1%), missing multidisciplinary networks (47.1%), and the lack of experience of specialists from other disciplines (39.0%). Conclusions: The diagnostic workup for mastocytosis differs from consensus recommendations and varies between regions. This may be improved by establishing active multidisciplinary networks, increasing access to diagnostic procedures, consistently applying WHO criteria, and developing new Mastocytosis Centers of Reference and Excellence

Pre-Fracture Functional Status and Early Functional Recovery are Significant Predictors of Instrumental Activities of Daily Living After Hip Fracture: A Prospective Cohort Study

Introduction Although the overall quality of medicine has improved in recent decades, the functional capacity in many hip fracture patients remains insufficient. The goal of the present study was to identify significant predictors of Instrumental Activities of Daily Living (IADL) measured by the Lawton-Brody scale at 3- and 6-month follow-up in patients with hip fractures admitted to a hospital. Methods This observational cohort study included 191 patients with acute hip fractures. IADL was measured at baseline and after 3 and 6 months using the Lawton-Brody scale. Multivariable logistic regression analysis was carried out using pre-fracture functional status, sociodemographic variables, hand grip strength (HGS), surgical procedure, complications, and length of hospital stay, Short Physical Performance Battery, and Barthel Index (BI) on the fifth postoperative day as potential predictors for IADL after a hip fracture surgery. Results The mean age of the participants was 80.3 ± 6.8 years, and 77.0% of our cohort were women. Multivariate regression analysis revealed that pre-fracture functional status and early functional recovery were independent predictors of IADL after hip fracture surgery. Conclusions Clinicians should take steps to improve functional outcomes by changing how patients are rehabilitated in the first days after hip fracture surgery, especially for the group of patients with a lower functional status before the fracture

Determination of changes in heavy metal accumulation depending on plant species, plant organism, and traffic density in some landscape plants

The level of pollution has reached the dimensions that threaten human health, with the rapid urbanization and the increase of energy consumption especially in developing countries. Every year in the world, millions of people lose their lives because of air pollution. Heavy metals have a separate precaution in pollutants, especially in terms of human health, because they can remain intact in nature for long periods of time, they tend to bioaccumulate and some are toxic or carcinogenic even at low concentrations. Therefore, monitoring of heavy metal pollution and determination of risky areas is very important. Biomonitors are the most commonly used methods for monitoring heavy metal pollution. However, determining which plants and organelles are more suitable for monitoring the metal is essential in order to ensure that the monitoring is reliable. In this study, it was aimed to determine the variations of the concentration of Ni, Pb, and Cd elements depending on the traffic density in leaves, seeds, and branches of Ailanthus altissima, Biota orientalis, Platanus orientalis, and Pyracantha coccinea which are grown in areas with heavy, low dense, and non-traffic areas. As a result of the study, it was determined that concentrations of Ni, Pb, and Cd increased depending on traffic density. According to the results obtained, it was determined that seeds and branches of Biota orientalis were the most suitable species and organelles to determine Ni pollution. The leaves of Ailanthus altissima are very suitable for monitoring the pollution of Pb and Cd. © 2018, Springer Nature B.V

Alpine thermal events in the central Serbo‑Macedonian Massif (southeastern Serbia)

The Serbo-Macedonian Massif (SMM) represents a crystalline belt situated between the two diverging branches of the Eastern Mediterranean Alpine orogenic system, the northeast-vergent Carpatho-Balkanides and the southwest-vergent Dinarides and the Hellenides. We have applied fission-track analysis on apatites and zircons, coupled with structural field observations in order to reveal the low-temperature evolution of the SMM. Additionally, the age and geochemistry of the Palaeogene igneous rocks (i.e. Surdulica granodiorite and dacitic volcanic rocks) were determined by the LA-ICPMS U–Pb geochronology of zircons and geochemical analysis of main and trace elements in whole-rock samples. Three major cooling stages have been distinguished from the late Early Cretaceous to the Oligocene. The first stage represents rapid cooling through the partial annealing zones of zircon and apatite (300–60 °C) during the late Early to early Late Cretaceous (ca. 110–ca. 90 Ma). It is related to a post-orogenic extension following the regional nappe-stacking event in the Early Cretaceous. Middle to late Eocene (ca. 48–ca. 39 Ma) cooling is related to the formation of the Crnook–Osogovo–Lisets extensional dome and its exhumation along low-angle normal faults. The third event is related to regional cooling following the late Eocene magmatic pulse. During this pulse, the areas surrounding the Surdulica granodiorite (36 ± 1 Ma) and the slightly younger volcanic bodies (ca. 35 Ma) have reached temperatures higher than the apatite closure temperature (120 °C) but lower than ca. 250 °C. The geochemistry of the igneous samples reveals late- to post-orogenic tectonic setting during magma generation