Leukocytoclastic Vasculitis in a 66-Year-Old Woman After Fusion of the Second Right Metatarsocuneiform Joint Using Titanium Plate and Screws: A Case Report

Metallic orthopaedic implants are known to instigate cutaneous reactions; however, the mechanism by which this occurs is not fully understood. Contact dermatitis after implantation of stainless steel fracture plates was first described in 1966, and similar reactions to various implants have been documented subsequently. Leukocytoclastic vasculitis (LCV) is an inflammatory condition of small dermal blood vessels resulting from neutrophil invasion, degranulation, and cell death caused by a type III hypersensitivity reaction. No studies have reported use of titanium orthopaedic implants resulting in LCV. We describe a 66-year-old woman who developed LCV after the fusion of her second right metatarsocuneiform joint with a titanium plate and screws. At 4 months after removal of the titanium plate and screws, the LCV symptoms had resolved without further intervention. Although this rash might be a rare complication associated with orthopaedic implants, it is an important differential diagnosis for orthopaedic surgeons to consider when assessing and treating postoperative rashes

A Case of Metastatic Atypical Neuroendocrine Tumor with ALK Translocation and Diffuse Brain Metastases.

A challenge in precision medicine requires identification of actionable driver mutations. Critical to such effort is the deployment of sensitive and well-validated assays for mutation detection. Although identification of such alterations within the tumor tissue remains the gold standard, many advanced non-small cell lung cancer cases have only limited tissue samples, derived from small biopsies or fine-needle aspirates, available for testing. More recently, noninvasive methods using either circulating tumor cells or tumor DNA (ctDNA) have become an alternative method for identifying molecular biomarkers and screening patients eligible for targeted therapies. In this article, we present a case of a 52-year-old never-smoking male who presented with widely metastatic atypical neuroendocrine tumor to the bones and the brain. Molecular genotyping using DNA harvested from a bone metastasis was unsuccessful due to limited material. Subsequent ctDNA analysis revealed an ALK translocation. The clinical significance of the mutation in this particular cancer type and therapeutic strategies are discussed.Key pointsTo our knowledge, this index case represents the first reported ALK translocation identified in an atypical carcinoid tumor.Liquid biopsy such as circulating tumor DNA is a feasible alternative platform for identifying sensitizing genomic alterations.Second-generation ALK inhibitors represent a new paradigm for treating ALK-positive patients with brain metastases

Characteristics of U.S. Agricultural Communications Undergraduate Programs

This study characterized agricultural communications undergraduate programs nationwide. A total of 40 undergraduate agricultural communications programs were identified via the National Agricultural Communicators of Tomorrow database, Internet searches, and previous academic program research, and their existences were verified via multiple sources. Objectives included creating an accounting of existing programs, describing the programs’ demographics, and identifying top programs. This study employed a census approach and used a descriptive survey design, including both quantitative and structured qualitative questions. The quantitative data were analyzed via descriptive statistics. A total of 26 respondents — faculty representing U.S. undergraduate agricultural communications programs — participated in this study. An increase in the number of academic programs across the U.S. was observed, compared to the last similar study published in 2000, suggesting an increase in popularity and student demand, which is most likely a result of an increase in industry demand for agricultural communications graduates. While programs varied in size and age, most faculty respondents projected an increase in enrollment in their undergraduate programs. Future studies characterizing the discipline should be conducted on a more frequent, standardized schedule, and improved participation in the study should be a goal. National curriculum studies also should be conducted to tie program characteristics and instructional methodologies to program success and to correlate program characteristics and demographics

Have Gender Gaps in Math Closed? Achievement, Teacher Perceptions, and Learning Behaviors Across Two ECLS-K Cohorts

Studies using data from the Early Childhood Longitudinal Study–Kindergarten Class of 1998–1999 (ECLS-K:1999) revealed gender gaps in mathematics achievement and teacher perceptions. However, recent evidence suggests that gender gaps have closed on state tests, raising the question of whether such gaps are absent in the ECLS-K:2011 cohort. Extending earlier analyses, this study compares the two ECLS-K cohorts, exploring gaps throughout the achievement distribution and examining whether learning behaviors might differentially explain gaps more at the bottom than the top of the distribution. Overall, this study reveals remarkable consistency across both ECLS-K cohorts, with the gender gap developing early among high achievers and spreading quickly throughout the distribution. Teachers consistently rate girls’ mathematical proficiency lower than that of boys with similar achievement and learning behaviors. Gender differences in learning approaches appear to be fairly consistent across the achievement distribution, but girls’ more studious approaches appear to have more payoff at the bottom of the distribution than at the top. Questions remain regarding why boys outperform girls at the top of the distribution, and several hypotheses are discussed. Overall, the persistent ECLS-K patterns make clear that girls’ early mathematics learning experiences merit further attention

Impact of primary breast cancer therapy on energetic capacity and body composition

PURPOSE: This observational study was designed to measure baseline energy parameters and body composition in early-stage breast cancer patients, and to follow changes during and after various modalities of treatment. This will provide information to aid in the development of individualized physical activity intervention strategies. METHODS: Patients with newly diagnosed stage 0-III breast cancer were enrolled into three cohorts: A (local therapy alone), B (endocrine therapy), or C (chemotherapy with or without endocrine therapy). At baseline, 6 months, and 12 months, subjects underwent a stationary bicycle protocol to assess power generation and DEXA to assess body composition. RESULTS: Eighty-three patients enrolled. Patients had low and variable levels of power generation at baseline (mean power per kilogram lean mass 1.55 W/kg, SD 0.88). Power normalized to lean body mass (W/kg) decreased significantly, and similarly, by 6 months in cohorts B (1.42-1.04 W/kg, p = 0.008) and C (1.53-1.18 W/kg, p < 0.001). In all cohorts, there was no recovery of power generation by 12 months. Cohort C lost lean body mass (- 1.5 kg, p = 0.007), while cohort B maintained lean body mass (- 0.2 kg, p = 0.68), despite a similar trajectory in loss of power. Seven patients developed sarcopenia during the study period, including four patients who did not receive any chemotherapy (cohort B). CONCLUSIONS: The stationary bike protocol was feasible, easy, and acceptable to patients as a way to measure energetic capacity in a clinical setting. Early-stage breast cancer patients had low and variable levels of power generation, which worsened following primary therapy and did not show evidence of 'spontaneous recovery' by 12 months. Effective physical activity interventions will need to be personalized, accounting for both baseline ability and the effect of treatment

Glycolytic requirement for NK cell cytotoxicity and cytomegalovirus control

NK cell activation has been shown to be metabolically regulated in vitro; however, the role of metabolism during in vivo NK cell responses to infection is unknown. We examined the role of glycolysis in NK cell function during murine cytomegalovirus (MCMV) infection and the ability of IL-15 to prime NK cells during CMV infection. The glucose metabolism inhibitor 2-deoxy-ᴅ-glucose (2DG) impaired both mouse and human NK cell cytotoxicity following priming in vitro. Similarly, MCMV-infected mice treated with 2DG had impaired clearance of NK-specific targets in vivo, which was associated with higher viral burden and susceptibility to infection on the C57BL/6 background. IL-15 priming is known to alter NK cell metabolism and metabolic requirements for activation. Treatment with the IL-15 superagonist ALT-803 rescued mice from otherwise lethal infection in an NK-dependent manner. Consistent with this, treatment of a patient with ALT-803 for recurrent CMV reactivation after hematopoietic cell transplant was associated with clearance of viremia. These studies demonstrate that NK cell-mediated control of viral infection requires glucose metabolism and that IL-15 treatment in vivo can reduce this requirement and may be effective as an antiviral therapy

The prevention of lower urinary tract symptoms (PLUS) research consortium: A transdisciplinary approach toward promoting bladder health and preventing lower urinary tract symptoms in women across the life course

Lower urinary tract symptoms (LUTS) are highly prevalent in women, and are expected to impose a growing burden to individuals and society as the population ages. The predominance of research related to LUTS has focused on underlying pathology, disease mechanisms, or the efficacy of treatments for women with LUTS. Although this research has been vital for helping to reduce or ameliorate LUTS conditions, it has done little to prevent the onset of LUTS. Health promotion and prevention require an expansion of scientific inquiry beyond the traditional paradigm of studying disease mechanisms and treatment to the creation of an evidence base to support recommendations for bladder health promotion and, in turn, prevention of LUTS. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) introduced the concept of prevention as an important priority for women's urologic research as a prelude to supporting the formation of the Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium. In this article, we introduce the PLUS research consortium to the scientific community; share the innovative paradigms by which the consortium operates; and describe its unique research mission: to identify factors that promote bladder health across the life course and prevent the onset of LUTS in girls and women

Echinococcus across the north : Current knowledge, future challenges

Foodborne Parasites in Cold ClimatesAbstract Zoonotic Echinococcus spp. cestodes are present in almost all circumpolar nations, and have historically posed a risk to health of indigenous as well as other northern residents. However, surveillance data on both alveolar (AE) and cystic (CE) echinococcosis remains incomplete throughout the circumpolar region: Russia, Fennoscandia, Iceland, Greenland, Canada and Alaska (USA). Prevalence of Echinococcus spp. varies considerably in definitive canid hosts, animal intermediate hosts and accidental hosts like humans. Yet despite the high prevalence reported in canids in some geographic locations, human AE and CE are much less common than in endemic Asian and central European countries. This paper explores knowledge gaps and future challenges posed by Echinococcus spp. in eight circumpolar countries, a region where rapid environmental and social change are rewriting the boundaries, transmission, and impact of many pathogens, including zoonotic Echinococcus spp. Genotypes G6, G8 and G10 of Echinococcus canadensis are causative agents of human CE and have been identified in sylvatic (wild animal) and synanthropic (ecological association with humans) cervid-canine life cycles in the following northern regions: Alaska and northern Canada - G8 and G10; northern Russia - G6, G8, G10; and Fennoscandia - G10 in Finland - with no recent reports from Norway or Sweden. Echinococcus multilocularis, which causes AE, has been identified in a sylvatic arvicoline rodent-canine lifecycle in Alaska, Canada, Russia, Sweden and Svalbard (Norway). Asian, Mongolian, European and North American strains of E. multilocularis are found in Russia, with the North American N1 strain predominating in the north. The N1 strain is also found in Alaska, as well as Svalbard, whilst Asian strains have been identified in western Alaska. Central North American (N2) strain and European-type strains of E. multilocularis are present in Canada. Typing of the strain in Sweden is still pending. Individual human cases of AE with N2 and European-type strains are reported in North America, as well as multiple cases with Asian strains in Russia and historically on St Lawrence Island, Alaska (although genotyping of human cases was not available at the time). Echinococcus spp. have not been detected in Greenland and have been eliminated from Iceland. The predominance of E. multilocularis N1 strain and E. canadensis genotypes, in regions with high prevalence in definitive hosts yet low incidence of human AE and CE, suggests that these genotypes have lower zoonotic potential and pathogenicity than European and Asian strains of E. multilocularis and livestock genotypes of E granulosus sensu stricto. The continued monitoring of the emergence of Echinococcus genotypes within definitive and intermediate hosts, as well as people, is needed to assess the impact on public health risk, since the introduction of other genotypes could have serious repercussions. Lastly, determining risk factors and source attribution for human cases, including the possibility of food and waterborne transmission and the likelihood of autochthonous transmission, remain challenges.Peer reviewe

Additive drug-specific and sex-specific risks associated with co-use of marijuana and tobacco during pregnancy: Evidence from 3 recent developmental cohorts (2003-2015).

BACKGROUND: Methodologic challenges related to the concomitant use (co-use) of substances and changes in policy and potency of marijuana contribute to ongoing uncertainty about risks to fetal neurodevelopment associated with prenatal marijuana use. In this study, we examined two biomarkers of fetal neurodevelopmental risk-birth weight and length of gestation-associated with prenatal marijuana use, independent of tobacco (TOB), alcohol (ALC), other drug use (OTH), and socioeconomic risk (SES), in a pooled sample (N = 1191) derived from 3 recent developmental cohorts (2003-2015) with state-of-the-art substance use measures. We examined differential associations by infant sex, and multiplicative effects associated with co-use of MJ and TOB. METHODS: Participants were mother-infant dyads with complete data on all study variables derived from Growing Up Healthy (n = 251), Behavior and Mood in Babies and Mothers (Cohorts 1 and 2; n = 315), and the Early Growth and Development Study (N = 625). We estimated direct effects on birth weight and length of gestation associated with MJ, TOB, and co-use (MJ x TOB), using linear regression analysis in the full sample, and in male (n = 654) and female (n = 537) infants, separately. RESULTS: Mean birth weight and length of gestation were 3277 g (SD = 543) and 37.8 weeks (SD = 2.0), respectively. Rates of prenatal use were as follows: any use, n = 748 (62.8%); MJ use, n = 273 (22.9%); TOB use, n = 608 (51.0%); co-use of MJ and TOB, n = 230 (19.3%); ALC use, n = 464 (39.0%); and OTH use n = 115 (9.7%.) For all infants, unique effects on birth weight were observed for any MJ use [B(SE) = -84.367(38.271), 95% C.I. -159.453 to -9.281, p = .028], any TOB use [B(SE) = -0.99.416(34.418), 95% C.I. -166.942 to -31.889, p = .004], and each cigarette/day in mean TOB use [B(SE) = -12.233(3.427), 95% C.I. -18.995 to -5.510, p \u3c .001]. Additional effects of co-use on birth weight, beyond these drug-specific effects, were not supported. In analyses stratified by sex, while TOB use was associated with lower birth weight in both sexes, MJ use during pregnancy was associated with lower birth weight of male infants [B(SE) = -153.1 (54.20); 95% C.I. -259.5 to -46.7, p = .005], but not female infants [B(SE) = 8.3(53.1), 95% C.I. -96.024 to 112.551, p = .876]. TOB, MJ, and their co-use were not associated with length of gestation. CONCLUSIONS: In this sample, intrauterine co-exposure to MJ and TOB was associated with an estimated 18% reduction in birth weight not attributable to earlier delivery, exposure to ALC or OTH drugs, nor to maternal SES. We found evidence for greater susceptibility of male fetuses to any prenatal MJ exposure. Examination of dose-dependence in relationships found in this study, using continuous measures of exposure, is an important next step. Finally, we underscore the need to consider (a) the potential moderating influence of fetal sex on exposure-related neurodevelopmental risks; and (b) the importance of quantifying expressions of risk through subtle alterations, rather than dichotomous outcomes