Institutional arthroplasty registry: what is the minimum acceptable dataset to be included in your hospital? Recommendations from a single-country national consensus using the Delphi method.

PURPOSE: Institutional arthroplasty registries are very popular nowadays; however, very few efforts have been made in order to standardize the information to be collected, thus limiting the possibility of inter-institutional data interpretation. This manuscript reports the results of a single-country consensus designed to define the minimum standardized dataset to be recorded within an institutional arthroplasty registry. METHODS: A national consensus was carried out among all members of the Colombian Society of Hip and Knee Surgeons using the Delphi method. Eleven questions and answers comprising every potential domain of an institutional registry of hip and knee arthroplasty were defined. According to the methodology, anonymous voting and multiple discussion rounds were performed. Three levels of agreement were defined: Strong consensus: equal to or greater than 80%, weak consensus between 70 and 79.9%, and no consensus below 70%. RESULTS: All of the questions reached consensus level. The minimum dataset was defined to include demographic and clinical information, intraoperative and implant details, follow-up and early complications, implant survival, and functional outcome scores, as well as the validation model to assess information quality within the database. Currently, this dataset is being implemented voluntarily by the members of our national society. DISCUSSION: A national consensus is a feasible method to build homogeneous arthroplasty registries. We recommend such an exercise since it establishes the basis to compare and add data between institutions and the joint analysis of said information in a national registry.

Low-grade serous carcinoma (LGSC): A Canadian multicenter review of practice patterns and patient outcomes.

OBJECTIVE: Patients with advanced low-grade serous carcinoma (LGSC) have poor long-term survival rates. As a rare histotype, there are uncertainties regarding the use of current therapies. Thus, we studied practice patterns and treatment outcomes as part of a national initiative to better understand and improve the care of women with advanced LGSC. METHODS: This retrospective cohort study was conducted in 5 Canadian referral institutions from 2000 to 2016. Data collection and pathology reporting were standardized. Outcome measures included overall survival (OS), progression-free survival (PFS), progression-free intervals (PFI), and time to next treatment (TTNT). Cox regression analysis was used to evaluate the effects of clinical and pathologic factors on outcomes and prognosis. RESULTS: There were 134 patients (stage II-IV) with a median follow-up of 32.4 months (range 1.6-228). Four primary treatments were compared across institutions: 1) surgery followed by chemotherapy (56%), 2) neoadjuvant chemotherapy (NACT) followed by surgery (27%), 3) surgery alone (9%), and 4) surgery followed by anti-hormone therapy (4%). Primary platinum/paclitaxel chemotherapy was used in 81%. Patients treated with NACT had worse PFS. Multivariable Cox regression analysis identified lesser residual disease, younger age, and primary peritoneal origin as variables significantly associated with better OS/PFS (p < 0.03). One institution had significantly better PFS than the others (p = 0.025), but this finding could be related to a higher frequency of primary peritoneal LGSC. PFI and TTNT intervals in patients with relapsed disease were not significantly different after the first relapse irrespective of treatment type. CONCLUSIONS: There are notable differences in practice patterns across Canada. This underscores the need for ongoing strategies to measure, evaluate and achieve optimal patient outcomes for women with advanced LGSC.

An immunologically relevant rodent model demonstrates safety of therapy using a tumour-specific IgE.

BACKGROUND: Designing biologically informative models for assessing the safety of novel agents, especially for cancer immunotherapy, carries substantial challenges. The choice of an in vivo system for studies on IgE antibodies represents a major impediment to their clinical translation, especially with respect to class-specific immunological functions and safety. Fcε receptor expression and structure are different in humans and mice, so that the murine system is not informative when studying human IgE biology. By contrast, FcεRI expression and cellular distribution in rats mirror that of humans. METHODS: We are developing MOv18 IgE, a human chimeric antibody recognizing the tumour-associated antigen folate receptor alpha. We created an immunologically congruent surrogate rat model likely to recapitulate human IgE-FcεR interactions and engineered a surrogate rat IgE equivalent to MOv18. Employing this model, we examined in vivo safety and efficacy of antitumour IgE antibodies. RESULTS: In immunocompetent rats, rodent IgE restricted growth of syngeneic tumours in the absence of clinical, histopathological or metabolic signs associated with obvious toxicity. No physiological or immunological evidence of a "cytokine storm" or allergic response was seen, even at 50 mg/kg weekly doses. IgE treatment was associated with elevated serum concentrations of TNFα, a mediator previously linked with IgE-mediated antitumour and antiparasitic functions, alongside evidence of substantially elevated tumoural immune cell infiltration and immunological pathway activation in tumour-bearing lungs. CONCLUSION: Our findings indicate safety of MOv18 IgE, in conjunction with efficacy and immune activation, supporting the translation of this therapeutic approach to the clinical arena.

AllergoOncology - the impact of allergy in oncology: EAACI position paper.

Th2 immunity and allergic immune surveillance play critical roles in host responses to pathogens, parasites and allergens. Numerous studies have reported significant links between Th2 responses and cancer, including insights into the functions of IgE antibodies and associated effector cells in both antitumour immune surveillance and therapy. The interdisciplinary field of AllergoOncology was given Task Force status by the European Academy of Allergy and Clinical Immunology in 2014. Affiliated expert groups focus on the interface between allergic responses and cancer, applied to immune surveillance, immunomodulation and the functions of IgE-mediated immune responses against cancer, to derive novel insights into more effective treatments. Coincident with rapid expansion in clinical application of cancer immunotherapies, here we review the current state-of-the-art and future translational opportunities, as well as challenges in this relatively new field. Recent developments include improved understanding of Th2 antibodies, intratumoral innate allergy effector cells and mediators, IgE-mediated tumour antigen cross-presentation by dendritic cells, as well as immunotherapeutic strategies such as vaccines and recombinant antibodies, and finally, the management of allergy in daily clinical oncology. Shedding light on the crosstalk between allergic response and cancer is paving the way for new avenues of treatment.

Chronic urticaria due to autoreactivity to progesterone.

A 23-year-old, regularly menstruating woman presented with recurrent urticarial eruptions, which occurred premenstrually. A skin prick test was positive for progesterone, but the urticaria was unresponsive to standard treatments. The patient was treated with goserelin (Zoladex), which suppressed her menstrual cycle, leading to the resolution of her symptoms. Subsequent flares were controlled by further goserelin injections, and the urticaria is currently in remission. However, the risks of inducing menopause artificially are significant, and alternative long-term solutions may need to be considered in the event of a relapse.

Uterine Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy).

We report a unique case of Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) involving the uterus. A 63-yr-old female with a history of parathyroid adenoma and cavernous sinus meningioma underwent total abdominal hysterectomy for a possible uterine malignancy. The histologic findings consisted of a nodular, mass-like infiltration of the myometrium by clusters, cords, and sheets of CD163-positve, S100-positive histiocytes with lymphocytophagocytosis (emperipolesis). The cells were negative for CD1a and langerin. Occasional plasma cells and erythrocytes were also present. Most of the histiocytes had pale, vacuolated, or foamy cytoplasm. In all cases, the nuclei were small and eccentric. No mitotic figures were identified. Two prior cases of Rosai-Dorfman disease have been reported in the female genital tract: 1 in the cervix and 1 in the bilateral ovaries. Rosai-Dorfman disease should be added to the differential diagnosis of histiocyte-rich lesions in the female genital tract. The diagnosis should be strongly considered in the presence of the characteristic histology with lymphocytophagocytosis (emperipolesis). A limited immunohistochemical panel consisting of CD163, S100, and CD1a and/or langerin will confirm the diagnosis in most cases.

Clear cell carcinoma of the female genital tract (not everything is as clear as it seems).

Clear cell carcinoma has a storied history in the female genital tract. From the initial designation of ovarian clear cell adenocarcinoma as "mesonephroma" to the linkage between vaginal clear cell carcinoma and diethylstilbestrol exposure in utero, gynecologic tract clear cell tumors have puzzled investigators, posed therapeutic dilemmas for oncologists, and otherwise presented major differential diagnostic challenges for pathologists. One of the most common errors in gynecologic pathology is misdiagnosis of clear cell carcinoma, on both frozen section and permanent section. Given the poor response to platinum-based chemotherapy for advanced-stage disease and increased risk of thromboembolism, accurate diagnosis of clear cell carcinoma is important in the female genital tract. This review (1) presents the clinical and pathologic features of female genital tract clear cell carcinomas; (2) highlights recent molecular developments; (3) identifies areas of potential diagnostic confusion; and (4) presents solutions for these diagnostic problems where they exist.

Sick body, vigilant mind: the biological immune system activates the behavioral immune system.

Activation of the behavioral immune system has been shown to promote activation of the biological immune system. The current research tested the hypothesis that activation of the biological immune system (as a result of recent illness) promotes activation of the behavioral immune system. Participants who had recently been ill, and had therefore recently experienced activation of their biological immune system, displayed heightened attention to (Study 1) and avoidance of (Study 2) disfigured individuals--cognitive and behavioral processes reflecting activation of the behavioral immune system. These findings shed light on the interactive nature of biological and psychological mechanisms designed to help people overcome the threat of disease.

Age-related memory impairment associated with loss of parietal deactivation but preserved hippocampal activation.

The neural underpinnings of age-related memory impairment remain to be fully elucidated. Using a subsequent memory face-name functional MRI (fMRI) paradigm, young and old adults showed a similar magnitude and extent of hippocampal activation during successful associative encoding. Young adults demonstrated greater deactivation (task-induced decrease in BOLD signal) in medial parietal regions during successful compared with failed encoding, whereas old adults as a group did not demonstrate a differential pattern of deactivation between trial types. The failure of deactivation was particularly evident in old adults who performed poorly on the memory task. These low-performing old adults demonstrated greater hippocampal and prefrontal activation to achieve successful encoding trials, possibly as a compensatory response. Findings suggest that successful encoding requires the coordination of neural activity in hippocampal, prefrontal, and parietal regions, and that age-related memory impairment may be primarily related to a loss of deactivation in medial parietal regions.

Scent of a woman: men's testosterone responses to olfactory ovulation cues.

Adaptationist models of human mating provide a useful framework for identifying subtle, biologically based mechanisms influencing cross-gender social interaction. In line with this framework, the current studies examined the extent to which olfactory cues to female ovulation--scents of women at the peak of their reproductive fertility--influence endocrinological responses in men. Men in the current studies smelled T-shirts worn by women near ovulation or far from ovulation (Studies 1 and 2) or control T-shirts not worn by anyone (Study 2). Men exposed to the scent of an ovulating woman subsequently displayed higher levels of testosterone than did men exposed to the scent of a nonovulating woman or a control scent. Hence, olfactory cues signaling women's levels of reproductive fertility were associated with specific endocrinological responses in men--responses that have been linked to sexual behavior and the initiation of romantic courtship.

The endocrinology of exclusion: rejection elicits motivationally tuned changes in progesterone.

Social exclusion can have profound effects on a vast array of motivated psychological processes, from social withdrawal and aggression to prosocial behavior and social affiliation. The current studies examined motivationally tuned endocrinological consequences of exclusion by measuring the release of progesterone, a hormone that reflects an individual's level of social-affiliative motivation. Results from two experiments indicate that release of progesterone following social exclusion depends on people's levels of social anxiety and rejection sensitivity. Individuals high in social anxiety displayed a drop in progesterone in response to exclusion, a pattern consistent with a lack of affiliative motivation. In contrast, individuals high in rejection sensitivity displayed an increase in progesterone when given an opportunity to reaffiliate, a change consistent with a desire for compensatory social contact. These findings provide new insight into the immediate biological changes precipitated by social exclusion--changes that could initiate a range of motivated social responses.

Nonlinear dimensionality reduction by locally linear embedding.

Many areas of science depend on exploratory data analysis and visualization. The need to analyze large amounts of multivariate data raises the fundamental problem of dimensionality reduction: how to discover compact representations of high-dimensional data. Here, we introduce locally linear embedding (LLE), an unsupervised learning algorithm that computes low-dimensional, neighborhood-preserving embeddings of high-dimensional inputs. Unlike clustering methods for local dimensionality reduction, LLE maps its inputs into a single global coordinate system of lower dimensionality, and its optimizations do not involve local minima. By exploiting the local symmetries of linear reconstructions, LLE is able to learn the global structure of nonlinear manifolds, such as those generated by images of faces or documents of text.

Intrasexual vigilance: the implicit cognition of romantic rivalry.

Four experiments tested the hypothesis that concerns about infidelity would lead people, particularly those displaying high chronic levels of romantic jealousy, to display a functionally coordinated set of implicit cognitive biases aimed at vigilantly processing attractive romantic rivals. Priming concerns about infidelity led people with high levels of chronic jealousy (but not those low in chronic jealousy) to attend vigilantly to physically attractive same-sex targets at an early stage of visual processing (Study 1), to strongly encode and remember attractive same-sex targets (Study 2), and to form implicit negative evaluations of attractive same-sex targets (Studies 3 and 4). In each case, effects were observed only for same-sex targets who were physically attractive-individuals who can pose especially potent threats to a person's own romantic interests. These studies reveal a cascade of implicit, lower order cognitive processes underlying romantic rivalry and identify the individuals most likely to display those processes. At a broader conceptual level, this research illustrates the utility of integrating social cognitive and evolutionary approaches to psychological science.

Submitting to defeat: social anxiety, dominance threat, and decrements in testosterone.

Although theory suggests a link between social anxiety and social dominance, direct empirical evidence for this link is limited. The present experiment tested the hypothesis that socially anxious individuals, particularly men, would respond to a social-dominance threat by exhibiting decrements in their testosterone levels, an endocrinological change that typically reflects pronounced social submission in humans and other animals. Participants were randomly assigned to either win or lose a rigged face-to-face competition with a confederate. Although no zero-order relationship between social anxiety and level of testosterone was observed, testosterone levels showed a pronounced drop among socially anxious men who lost the competition. No significant changes were observed in nonanxious men or in women. This research provides novel insight into the nature and consequences of social anxiety, and also illustrates the utility of integrating social psychological theory with endocrinological approaches to psychological science.

Signet Ring Stromal Cell Tumor: A Legitimate (Benign) Mimic of Krukenberg Tumor.

Signet ring stromal cell tumor is a rare, benign ovarian neoplasm thought to arise from ovarian stromal cells. The pathophysiology of these tumors is poorly understood. They present in women in a wide age range, often with nonspecific symptoms including lower abdominal or pelvic pain. Their morphologic appearance raises a critical differential diagnosis of Krukenberg tumor, an aggressive malignancy with significant implications for patient management. For this reason, it is important for the pathologist to be aware of signet ring stromal cell tumor and its differentiating features, including useful histochemical and immunohistochemical ancillary tests. These tumors are curable with surgical excision, and there have been no recurrences or metastases among reported cases.

Alterations in memory networks in mild cognitive impairment and Alzheimer's disease: an independent component analysis.

Memory function is likely subserved by multiple distributed neural networks, which are disrupted by the pathophysiological process of Alzheimer's disease (AD). In this study, we used multivariate analytic techniques to investigate memory-related functional magnetic resonance imaging (fMRI) activity in 52 individuals across the continuum of normal aging, mild cognitive impairment (MCI), and mild AD. Independent component analyses revealed specific memory-related networks that activated or deactivated during an associative memory paradigm. Across all subjects, hippocampal activation and parietal deactivation demonstrated a strong reciprocal relationship. Furthermore, we found evidence of a nonlinear trajectory of fMRI activation across the continuum of impairment. Less impaired MCI subjects showed paradoxical hyperactivation in the hippocampus compared with controls, whereas more impaired MCI subjects demonstrated significant hypoactivation, similar to the levels observed in the mild AD subjects. We found a remarkably parallel curve in the pattern of memory-related deactivation in medial and lateral parietal regions with greater deactivation in less-impaired MCI and loss of deactivation in more impaired MCI and mild AD subjects. Interestingly, the failure of deactivation in these regions was also associated with increased positive activity in a neocortical attentional network in MCI and AD. Our findings suggest that loss of functional integrity of the hippocampal-based memory systems is directly related to alterations of neural activity in parietal regions seen over the course of MCI and AD. These data may also provide functional evidence of the interaction between neocortical and medial temporal lobe pathology in early AD.

Can't take my eyes off you: Attentional adhesion to mates and rivals.

In 3 experiments, mating primes interacted with functionally relevant individual differences to guide basic, lower order social perception. A visual cuing method assessed biases in attentional adhesion--a tendency to have one's attention captured by particular social stimuli. Mate-search primes increased attentional adhesion to physically attractive members of the opposite sex (potential mates) among participants with an unrestricted sociosexual orientation but not among sexually restricted participants (Studies 1 and 2). A mate-guarding prime increased attentional adhesion to physically attractive members of one's own sex (potential rivals) among participants who were concerned with threats posed by intrasexual competitors but not among those less concerned about such threats (Study 3). Findings are consistent with a functionalist approach to motivation and social cognition and highlight the utility of integrating evolutionary and social cognitive perspectives.

A Psychophysiological Mechanism Underlying Women's Weight-Management Goals: Women Desire and Strive for Greater Weight Loss Near Peak Fertility.

Three studies demonstrated that conception risk was associated with increased motivations to manage weight. Consistent with the rationale that this association is due to ovulatory processes, Studies 2 and 3 demonstrated that it was moderated by hormonal contraceptive (HC) use. Consistent with the rationale that this interactive effect should emerge when modern appearance-related concerns regarding weight are salient, Study 3 used a 14-day diary to demonstrate that the interactive effects of conception risk and HC use on daily motivations to restrict eating were further moderated by daily motivations to manage body attractiveness. Finally, providing evidence that this interactive effect has implications for real behavior, daily fluctuations in the desire to restrict eating predicted daily changes in women's self-reported eating behavior. These findings may help reconcile prior inconsistencies regarding the implications of ovulatory processes by illustrating that such implications can depend on the salience of broader social norms.

The safety of automatic versus manual blood pressure cuffs for patients receiving thrombolytic therapy.

BACKGROUND: Patients receiving thrombolytic therapy for acute myocardial infarction require frequent monitoring of blood pressure. Historically, many nurses have been reluctant to use automatic blood pressure cuffs during thrombolytic therapy because of concern that the automatic cuffs might increase risk of bleeding. This concern is not based on research findings but on case reports, anecdotal observations, and possible myths in clinical practice. OBJECTIVE: To determine the safety of using automatic blood pressure cuffs during thrombolytic therapy in patients with acute myocardial infarction. METHODS: Ninety-six patients with acute myocardial infarction who received thrombolytic therapy (streptokinase or tissue plasminogen activator) were randomized to have blood pressure measurements obtained with either automatic or manual blood pressure cuffs. Patients were checked at least every 2 hours for purpuric lesions (petechiae, ecchymoses, or hematomas). The study ended after 24 hours of measurements or when a purpuric lesion was noted. RESULTS: We found no significant difference in frequency of purpuric lesions between patients who had blood pressure measured with a manual cuff and patients who had blood pressure measured with an automatic cuff. The most common purpuric lesions noted were ecchymoses. A significant difference was noted in the frequency of purpuric lesions depending on which thrombolytic agent was used, regardless of cuff type. CONCLUSIONS: Automatic blood pressure cuffs are as safe as manual blood pressure cuffs in patients with acute myocardial infarction who are receiving thrombolytic therapy.