Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

Ovo em pó na alimentação de leitões recém-desmamados Spray-dried egg for wealing pigs

Foram realizados dois experimentos para determinar a composição química, os coeficientes de digestibilidade de nutrientes e os valores de energia e proteína digestíveis do ovo em pó (OP) e avaliar o desempenho e os componentes sangüíneos e plasmáticos de leitões alimentados com dietas contendo OP. No Experimento I, foram utilizados oito leitões em um ensaio de digestibilidade. Os animais foram distribuídos em dois tratamentos e quatro repetições, sendo uma ração referência e uma teste (70% da ração referência + 30% de OP). Utilizou-se a metodologia da coleta parcial de fezes (0,5% de Cr2O3). Os coeficientes de digestibilidade aparente do OP foram de 80,81; 87,14; 82,00 e 70,55%, respectivamente, para a matéria seca, energia bruta, proteína bruta e extrato etéreo. A partir dos coeficientes de digestibilidade determinados e os valores de proteína bruta (56,53%) e energia bruta (5.897 kcal/kg), foram calculados os valores de 43,90% de proteína digestível e 5.140 kcal/kg de energia digestível para o OP. No Experimento II, foram utilizados 90 animais desmamados com 24 dias e 5,6 kg. Os tratamentos consistiram de cinco rações isonutritivas com níveis crescentes (0, 25, 50, 75 e 100%) de substituição protéica do plasma sangüíneo (PS) da dieta pelo OP. O delineamento experimental foi o de blocos casualizados, com nove repetições por tratamento. Não houve diferença entre os tratamentos para as variáveis de desempenho na fase de 1-14 dias pós-desmame. Para a fase de 15-28 dias e para o período total, foi observada redução linear do GDP e CDR, com o aumento do nível de inclusão da proteína do OP. Para as variáveis dos componentes plasmáticos e sangüíneos não foram observadas diferenças significativas entre os tratamentos. Em função dos resultados obtidos, não foi viável a substituição do plasma sangüíneo pelo ovo em pó nas dietas de leitões durante a fase de creche.<br>Two experiments were carried out to determine the chemical composition, nutrients digestibility and digestible energy and protein of spray-dried egg (OP) and to study the performance and plasma and blood components of weanling pigs fed diets containing OP. In the Experiment I, eight pigs were used for digestibility assay. The animals were assigned to two treatments and four replications/treatment. The treatments consisted of a basal diet and test diet (70% of basal diet + 30% of OP). The method was the partial faeces collection (0.5% Cr2O3). The apparent digestibility coefficients of dry matter, gross energy, crude protein and crude fat were, respectively, 80.81, 87.14, 82.00, and 70.55%. From the results of apparent digestibility coeficients and the values of crude protein (56.53%) and gross energy (5,897 kcal/kg), values of 43.90% of digestible protein and 5,140 kcal/kg of digestible energy for OP were calculated. In the Experiment II, ninety pigs were weaned at 24 days of age with 5.6 kg live weight. The treatments consisted of five dietary levels of 0, 25, 50, 75 and 100%, as a replacement of plasma (PS) protein for OP protein. Pigs were alloted to a randomized block design with nine replications per treatment. No treatment effects were observed on performance for 1-14 day post-weaning phase. For the 15-28 d phase and for the total period, linear reductions of GDP and CDR were observed, as the dietary OP levels increased. No treatment effects were observed on plasma and blood components by the inclusion of spray-dried egg. It was not recommended to replace the PS by OP in nursery diets

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies. © 2023. The Author(s). Published by IOP Publishing Ltd on behalf of the Astronomical Society of the Pacific (ASP). All rights reservedOpen access articleThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]