Phosphaturic mesenchymal tumor: management and outcomes of ten patients treated at a single institution.

BACKGROUND: Phosphaturic mesenchymal tumor (PMT) is a rare tumor that causes tumor-induced osteomalacia. Patients present with non-specific symptoms secondary to renal phosphate wasting and decreased bone mineralization. We sought to assess: (1) What are the common presenting features, laboratory and imaging findings, histologic findings of phosphaturic mesenchymal tumors? (2) What are the available treatment strategies for phosphaturic mesenchymal tumors and their long-term outcomes in terms of local recurrence and symptom control after treatment? METHODS: We retrospectively identified patients with a histologic diagnosis of PMT located in the axial or appendicular skeleton, or surrounding soft tissues. A total of 10 patients were finally included in our study. RESULTS: Median tumor size was 1.9 cm (range, 1.1 to 6.1) and median time from symptom onset to diagnosis was 3 years (range, 0.5 to 15 years). All patients but one presented with hypophosphatemia (median 1.9 mg/dL, range 1.2 to 3.2). Pre-operative FGF-23 was elevated in all cases (median 423.5 RU/mL, range 235 to 8950). Six patients underwent surgical resection, three were treated percutaneously (radiofrequency ablation or cryoablation), and one refused treatment. Only one patient developed local recurrence and no patients developed metastatic disease. At last follow-up, nine patients showed no evidence of disease and one was alive with disease. CONCLUSION: Phosphaturic mesenchymal tumor is a rare tumor presenting with non-specific symptoms. Surgery is the standard treatment when negative margins can be achieved without significant morbidity. In patients with small tumors in surgically-inaccessible areas, radiofrequency ablation or cryoablation can be performed successfully.

Design of a novel multifunction decision support/alerting system for in-patient acute care, ICU and floor (AlertWatch AC).

BACKGROUND: Multifunction surveillance alerting systems have been found to be beneficial for the operating room and labor and delivery. This paper describes a similar system developed for in-hospital acute care environments, AlertWatch Acute Care (AWAC). RESULTS: A decision support surveillance system has been developed which extracts comprehensive electronic health record (EHR) data including live data from physiologic monitors and ventilators and incorporates them into an integrated organ icon-based patient display. Live data retrieved from the hospitals network are processed by presenting scrolling median values to reduce artifacts. A total of 48 possible alerts are generated covering a broad range of critical patient care concerns. Notification is achieved by paging or texting the appropriated member of the critical care team. Alerts range from simple out of range values to more complex programing of impending Ventilator Associated Events, SOFA, qSOFA, SIRS scores and process of care reminders for the management of glucose and sepsis. As with similar systems developed for the operating room and labor and delivery, there are green, yellow, and red configurable ranges for all parameters. A census view allows surveillance of an entire unit with flashing or text to voice alerting and enables detailed information by windowing into an individual patient view including live physiologic waveforms. The system runs via web interface on desktop as well as mobile devices, with iOS native app available, for ease of communication from any location. The goal is to improve safety and adherence to standard management protocols. CONCLUSIONS: AWAC is designed to provide a high level surveillance view for multi-bed hospital units with varying acuity from standard floor patients to complex ICU care. Alerts are generated by algorithms running in the background and automatically notify the selected member of the patients care team. Its value has been demonstrated for low acuity patients, further study is required to determine its effectiveness in high acuity patients.

Triterpenoids.

Covering 2015. Previous review: Nat. Prod. Rep., 2018, 35, 1294-1329This review covers the isolation and structure determination of triterpenoids reported during 2015 including squalene derivatives, lanostanes, holostanes, cycloartanes, cucurbitanes, dammaranes, euphanes, tirucallanes, tetranortriterpenoids, quassinoids, lupanes, oleananes, friedelanes, ursanes, hopanes, serratanes, isomalabaricanes and saponins; 320 references are cited.

The Asian cyclopoid copepod Mesocyclops pehpeiensis reported from the western basin of Lake Erie.

The Asian cyclopoid copepod Mesocyclops pehpeiensis Hu, 1943 has been reported as an introduced species at several locations in the western hemisphere. In the United States, reports of this exotic species are restricted to localities in Louisiana, Mississippi, and Washington D.C. This report documents a new record of occurrence for M. pehpeiensis from the western basin of Lake Erie. The detection of M. pehpeiensis in Lake Erie constitutes the first record of this species from the Laurentian Great Lakes, and the northernmost record in the western hemisphere. The species was found in 2016, 2017 and 2018, including females with egg sacks, and can therefore be considered established in the area. The occurrence of M. pehpeiensis in Lake Erie suggests that this Asian copepod may be more widely distributed in North America than is currently understood.

Triterpenoids.

Covering 2014. Previous review: Nat. Prod. Rep., 2017, 34, 90-122 This review covers the isolation and structure determination of triterpenoids reported during 2014 including squalene derivatives, lanostanes, holostanes, cycloartanes, cucurbitanes, dammaranes, euphanes, tirucallanes, tetranortriterpenoids, quassinoids, lupanes, oleananes, friedelanes, ursanes, hopanes, serratanes, isomalabaricanes and saponins; 374 references are cited.

Triterpenoids.

Covering: 2013. Previous review: Nat. Prod. Rep., 2015, 29, 1028-1065This review covers the isolation and structure determination of triterpenoids reported during 2013 including squalene derivatives, lanostanes, holostanes, cycloartanes, cucurbitanes, dammaranes, euphanes, tirucallanes, tetranortriterpenoids, quassinoids, lupanes, oleananes, friedelanes, ursanes, hopanes, serratanes, isomalabaricanes and saponins; 350 references are cited.

Triterpenoids.

This review covers the isolation and structure determination of triterpenoids reported during 2012 including squalene derivatives, lanostanes, holostanes, cycloartanes, cucurbitanes, dammaranes, euphanes, tirucallanes, tetranortriterpenoids, quassinoids, lupanes, oleananes, friedelanes, ursanes, hopanes, serratanes, isomalabaricanes and saponins; 348 references are cited.

Update on the Epidemiology of Concussion/Mild Traumatic Brain Injury.

Mild traumatic injuries to the brain (e.g., concussion) are common and have been recognized since antiquity, although definitions have varied historically. Nonetheless, studying the epidemiology of concussion helps clarify the overall importance, risk factors, and at-risk populations for this injury. The present review will focus on recent findings related to the epidemiology of concussion including definition controversies, incidence, and patterns in the population overall and in the military and athlete populations specifically. Finally, as this is an area of active research, we will discuss how future epidemiologic observations hold promise for gaining greater clarity about concussion and mild traumatic brain injury.

Wound-Healing Effects of Common Antineoplastic Agents and Perioperative Considerations for the Orthopaedic Surgeon.

In oncologic patients, optimal postoperative wound healing is crucial for the maintenance of systemic therapies and improved survival. Although several risk factors for postoperative wound complications have been identified, the clinical effect of new antineoplastic agents on wound healing remains uncertain. The available literature on the effect of antineoplastic agents in wound healing is complex to analyze because of other confounding risk factors such as radiation therapy and certain patient-specific variables. Available perioperative drug recommendations are based on database opinion and case reports from adverse event alerts. This review highlights the characteristics of old and new antineoplastic agents commonly used in the treatment of sarcoma, carcinoma, and other cancers and their potential effects on the wound-healing process. It also aims to provide perioperative treatment cessation recommendations to guide orthopaedic surgeons and prevent drug-related wound complications to the fullest extent possible.

Triterpenoids.

This review covers the isolation and structure determination of triterpenoids including squalene derivatives, lanostanes, holostanes, cycloartanes, cucurbitanes, dammaranes, euphanes, tirucallanes, tetranortriterpenoids, quassinoids, lupanes, oleananes, friedelanes, ursanes, hopanes, onoceranes and saponins; 308 references are cited.

Triterpenoids.

This review covers the isolation and structure determination of triterpenoids, including squalene derivatives, protostanes, lanostanes, holostanes, cycloartanes, dammaranes, euphanes, tirucallanes, tetranortriterpenoids, quassinoids, lupanes, oleananes, friedelanes, ursanes, hopanes, serratanes and saponins; 305 references are cited.

Reevaluation of the genus Cyclops Mller, 1776 (Cyclopoida: Cyclopidae) in the Laurentian Great Lakes basin: first report of the Palearctic species Cyclops divergens Lindberg, 1936 from Lake Erie and documentation of Cyclops sibiricus Lindberg, 1949 in the St. Marys River.

Large cyclopoid copepods of the genus Cyclops Mller, 1776 are seldom collected in the Laurentian Great Lakes, with only Cyclops scutifer Sars, 1863 and Cyclops strenuus Fischer, 1851 reported from the region. Rare reports of the species C. strenuus date back to 1972 within the Great Lakes basin. The first specimens reported as C. strenuus were collected from the St. Marys River, and additional specimens have been collected from western Lake Erie since 2013. We examined all available archived materials of C. strenuus from the Great Lakes and determined that specimens from the two localities belong to two separate species, neither of which refer to C. strenuus. Archived specimens collected from the St. Marys River in 1972 and 1995 were reidentified as Cyclops sibiricus Lindberg, 1949, a Holarctic species known from Siberia, Russian Federation, Alaska, USA, and northern regions of Canada. The occurrences of C. sibiricus from the St. Marys River extend the known distribution of the species southward some 1,688 km in the Nearctic region. Cyclops specimens collected from the western basin of Lake Erie in 2013, 2014, and 2019 were identified as the Palearctic species Cyclops divergens Lindberg, 1936 using both conventional taxonomy and genetic barcoding. C. divergens is known from localities across much of Europe and eastward into Central Asia. The occurrences of the species from western Lake Erie constitute the first detection of C. divergens in the Great Lakes and the Nearctic region. Therefore, we expect C. strenuus does not occur in the Great Lakes basin and is likely restricted to the Palearctic region.

Triterpenoids.

This review covers the isolation and structure determination of triterpenoids, including squalene derivatives, protostanes, lanostanes, holostanes, cycloartanes, dammaranes, euphanes, tirucallanes, tetranortriterpenoids, quassinoids, lupanes, oleananes, friedelanes, ursanes, hopanes, serratanes and saponins; 278 references are cited.

Triterpenoids.

This review covers the isolation and structure determination of triterpenoids including squalene derivatives, protostanes, lanostanes, holostanes, cycloartanes, dammaranes, euphanes, tirucallanes, tetranortriterpenoids, lupanes, oleananes, friedelanes, ursanes, hopanes, isomalabaricanes and saponins; 574 references are cited.

Okundoperoxide, a bicyclic cyclofarnesylsesquiterpene endoperoxide from Scleria striatinux with antiplasmodial activity.

Okundoperoxide (1) was isolated by bioassay-guided fractionation of extracts from Scleria striatinux (syn. S. striatonux). The compound contains a cyclic endoperoxide structural moiety and possesses moderate antimalarial activity.

First record of the Neotropical cladoceran Diaphanosoma fluviatile in the Great Lakes basin.

The ctenopod Diaphanosoma fluviatile has been reported primarily from the Neotropical region and occasionally from the southern United States. D. fluviatile was collected in the Great Lakes basin (the Maumee River, Western Lake Erie, and Lake Michigan) in 2015 and 2018, far north from its previously known distribution. The occurrence of this southern species in the Maumee River and Great Lakes may be the result of an anthropogenic introduction, although a natural range expansion cannot be excluded. This report documents the northernmost record of D. fluviatile in the Nearctic region, extending the known distribution of the species to 42°N, which is a notable increase of 11 degrees latitude. Our detection of D. fluviatile is the first record of this southern species from the Laurentian Great Lakes drainage.

Bacillus anthracis secretome time course under host-simulated conditions and identification of immunogenic proteins.

BACKGROUND: The secretion time course of Bacillus anthracis strain RA3R (pXO1+/pXO2-) during early, mid, and late log phase were investigated under conditions that simulate those encountered in the host. All of the identified proteins were analyzed by different software algorithms to characterize their predicted mode of secretion and cellular localization. In addition, immunogenic proteins were identified using sera from humans with cutaneous anthrax. RESULTS: A total of 275 extracellular proteins were identified by a combination of LC MS/MS and MALDI-TOF MS. All of the identified proteins were analyzed by SignalP, SecretomeP, PSORT, LipoP, TMHMM, and PROSITE to characterize their predicted mode of secretion, cellular localization, and protein domains. Fifty-three proteins were predicted by SignalP to harbor the cleavable N-terminal signal peptides and were therefore secreted via the classical Sec pathway. Twenty-three proteins were predicted by SecretomeP for secretion by the alternative Sec pathway characterized by the lack of typical export signal. In contrast to SignalP and SecretomeP predictions, PSORT predicted 171 extracellular proteins, 7 cell wall-associated proteins, and 6 cytoplasmic proteins. Moreover, 51 proteins were predicted by LipoP to contain putative Sec signal peptides (38 have SpI sites), lipoprotein signal peptides (13 have SpII sites), and N-terminal membrane helices (9 have transmembrane helices). The TMHMM algorithm predicted 25 membrane-associated proteins with one to ten transmembrane helices. Immunogenic proteins were also identified using sera from patients who have recovered from anthrax. The charge variants (83 and 63 kDa) of protective antigen (PA) were the most immunodominant secreted antigens, followed by charge variants of enolase and transketolase. CONCLUSION: This is the first description of the time course of protein secretion for the pathogen Bacillus anthracis. Time course studies of protein secretion and accumulation may be relevant in elucidation of the progression of pathogenicity, identification of therapeutics and diagnostic markers, and vaccine development. This study also adds to the continuously growing list of identified Bacillus anthracis secretome proteins.

Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery.

STUDY DESIGN: A population-based retrospective cohort study. OBJECTIVE: The aim of this study was to examine risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults. SUMMARY OF BACKGROUND DATA: Opioid prescription rates for the management of low back pain have more than doubled in the US over the past decade. Although opioids are commonly used for the management of pain following lumbar spinal fusion surgery, to date, no large-scale nationally representative studies have examined the risk factors for long-term opioid use following such surgical intervention. METHODS: Using one of the nation's largest commercial insurance databases, we conducted a retrospective cohort study of 8377 adults, aged 21 to 63 years, who underwent lumbar spinal fusion surgery between January 1, 2009, and December 31, 2012. Long-term opioid use was defined as ≥365 days of filled opioid prescriptions in the 24 months following lumbar fusion. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for the risk of long-term opioid use following lumbar fusion. RESULTS: After adjusting for covariates, the following factors were associated with an increased risk of long-term opioid use following surgery: duration of opioid use in the year before lumbar surgery [Referent (0 days); Quartile 1 (1-22 days) OR = 2.27, 95% CI = 1.48-3.49; Quartile 2 (23-72 days): OR = 5.94, 95% CI = 4.00-8.83; Quartile 3: (73-250 days) OR = 25.31, 95% CI = 17.26-37.10; Quartile 4 (≥250 days) OR = 219.95, 95% CI = 148.53-325.71)], refusion surgery (OR = 1.32, 95% CI = 1.02-1.72), and diagnosis of depression (OR = 1.43, 95% CI = 1.18-1.74). Receipt of anterior fusion was associated with a modest decrease in the risk of long-term opioid use (OR = 0.79, 95% CI = 0.63-0.99). CONCLUSION: These findings may provide clinically relevant information to physicians, patients, and their families regarding the risk factors for opioid dependence following lumbar fusion surgery. LEVEL OF EVIDENCE: 3.