Risk of malignancy in resected pancreatic mucinous cystic neoplasms.

BACKGROUND: Pancreatic mucinous cystic neoplasms (MCNs) are rare mucin-producing cystic tumours defined by the presence of ovarian-type stroma. MCNs have a malignant potential and thus surgery is frequently performed. The aim of this cohort study was to define better the criteria for surgical resection in patients with MCN. METHODS: This multicentre retrospective study included all resected MCNs between 2003 and 2015 in participating centres. Lesions without ovarian-type stroma were excluded. Patient characteristics, preoperative findings, histopathology findings and follow-up data were recorded. RESULTS: The study included 211 patients; their median age was 53 (range 18-82) years, and 202 (95·7 per cent) were women. Median preoperative tumour size was 55 (range 12-230) mm. Thirty-four of the 211 (16·1 per cent) were malignant, and high-grade dysplasia (HGD) was found in a further 13 (6·2 per cent). One-third of MCNs in men were associated with invasive cancer, compared with 15·3 per cent in women. Five cases of malignant transformation occurred in MCNs smaller than 4 cm. All cases of malignancy or HGD were associated with symptoms or features of concern on preoperative cross-sectional imaging. In multivariable analysis, raised carbohydrate antigen 19-9 (odds ratio (OR) 10·54, 95 per cent c.i. 2·85 to 218·23; P < 0·001), tumour size (OR 4·23, 3·02 to 11·03; P = 0·001), mural nodules (OR 3·55, 1·31 to 20·55; P = 0·002) and weight loss (OR 3·40, 2·34 to 12·34; P = 0·034) were independent factors predictive of malignant transformation. CONCLUSIONS: Small indeterminate MCNs with no symptoms or features of concern may safely be observed as they have a low risk of malignant transformation.

Single and mixture per- and polyfluoroalkyl substances accumulate in developing Northern leopard frog brains and produce complex neurotransmission alterations.

Per- and polyfluoroalkyl substances (PFAS) are present in water and >99% of human serum. They are found in brains of wildlife; however, little is known about effects on the developing brain. To determine the effects of PFAS on brain and cardiac innervation, we conducted an outdoor mesocosm experiment with Northern leopard frog larvae (Rana pipiens) exposed to control, 10 ppb perfluorooctane sulfonate (PFOS), or a PFAS mixture totaling 10 ppb that mimicked aqueous film forming foam-impacted surface water (4 ppb PFOS, 3 ppb perfluorohexane sulfonate, 1.25 ppb perfluorooctanoate, 1.25 ppb perfluorohexanoate, and 0.5 ppb perfluoro-n-pentanoate). Water was spiked with PFAS and 25 larvae (Gosner stage (GS) 25) added to each mesocosm (n = 4 mesocosms per treatment). After 30 days, we harvested eight brains per mesocosm and remaining larvae developed to GS 46 (i.e. metamorphosis) before brains and hearts were collected. Weight, length, GS, and time to metamorphosis were recorded. Brain concentrations of all five PFAS were quantified using LC/MS/MS. Dopamine and metabolites, serotonin and its metabolite, norepinephrine, γ-aminobutyric acid, and glutamate were quantified using High Performance Liquid Chromatography with electrochemical detection while acetylcholine and acetylcholinesterase activity were quantified with the Invitrogen Amplex Red Acetylcholine Assay. PFOS accumulated in the brain time- and dose-dependently. After 30 days, the mixture decreased serotonin while both PFAS treatments decreased glutamate. Interestingly, acetylcholine increased in PFAS treatments at GS 46. This research shows that developmental environmentally relevant exposure to PFAS changes neurotransmitters, especially acetylcholine.

EB virus antibody and infectious mononucleosis in a boarding school for boys.

A study of EB virus antibody was undertaken in a boarding school for boys between 11 and 18 years of age; 35% of boys had EBV antibody when first sampled and a small number acquired antibody each year. Some of these boys had had no recorded illness during the period before the first positive sample and some developed classic infectious mononucleosis which was accompainied by a positive heterophil antibody test and detection of EB virus specific IgM. In a school of 800 boys there were 13 cases of infectious mononucleosis in four years.

Cardiac rehabilitation. An overview.

The paper is intended to acquaint physical therapists with the theory and practice of cardiac rehabilitation, which is often prescribed for patients who have coronary heart disease, and the therapists' responsibilities in this effort. The related exercise physiology literature is reviewed, and physiological, psychological, physical, and prognostic advantages of cardiac rehabilitation are described. Cardiac rehabilitation is presented in three phases: acute care, outpatient, and further conditioning programs. The protocols for exercise testing and programs of progressive activity are discussed, with emphasis upon the role of physical therapists. Data collected at Tufts New England Medical Center demonstrating the measurable effects of cardiovascular training for patients with coronary heart disease ar presented.

Physical conditioning and altered self-concept in rehabilitated hemipelegic patients.

Level of physical conditioning and self-concept are two factors important to all functions of physically disabled persons, both during and after formal rehabilitation. The level of physical conditioning as a determinant of physical fitness and functional status and the measure of self-concept as a determinant of behavior were studied in seven hemiplegic patients who had completed a formal rehabilitation program. Before the rehabilitation program, subjects were physically deconditioned and had altered self-concepts, including lowered self-esteem and other devaluations of the self. Following a 12-week physical conditioning program, subjects demonstrated improvements in physical fitness and functional status and a return to more normal values in some aspects of self-concept.

Concurrent outbreaks of influenza and parvovirus B19 in a boys' boarding school.

In the spring term of 1985 there was a protracted outbreak of upper respiratory tract febrile illness consistent with a clinical diagnosis of influenza in a boys' boarding school, which lasted from 23 January to 29 March. Although influenza virus infection was confirmed in 89% of cases in the first half of the term, 53% of the cases which occurred in the second half of the term had no evidence of infection with influenza virus. Between 5 February and 31 March 28 boys presented with skin rashes consistent with a clinical diagnosis of erythema infectiosum; 68% of these were associated with parvovirus B19. Investigation of the cases of clinical influenza with no identified respiratory pathogen revealed a 58% infection rate with B19. B19 DNA was identified in either throat swabs or acute stage bloods of nine pupils with influenza-like symptoms. Cohort studies revealed that 44% of pupils aged 15-16 years were immune before the outbreak compared with only 17% of pupils aged 11-12 years. Infection in the younger group was common and was associated with influenza-like illnesses as well as rashes. Forty-eight per cent of those who did not report any symptoms were also infected with B19.

A review of outbreaks of infectious disease in schools in England and Wales 1979-88.

In this review of 66 outbreaks of infectious disease in schools in England and Wales between 1979-88, 27 were reported from independent and 39 from maintained schools. Altogether, over 8000 children and nearly 500 adults were affected. Most of the outbreaks investigated were due to gastrointestinal infections which affected about 5000 children: respiratory infections affected a further 2000 children. Fifty-two children and seven adults were admitted to hospital and one child with measles died. Vaccination policies and use of immunoglobulin for control and prevention of outbreaks in schools have been discussed.

Prophylactic use of amantadine in a boarding school outbreak of influenza A.

Amantadine was used in a boarding school to control an outbreak of influenza A H3N2. Of 859 pupils 79% took amantadine and almost all of them completed the course (100 mg per day for 15 days). While amantadine was being taken the number of clinical cases of influenza was considerably fewer than that predicted on the basis of previous outbreaks of influenza A at the school. However, during the month following the course of amantadine, the outbreak continued with many clinical cases confirmed by virus isolation. The advantages and limitations of amantadine prophylaxis are discussed.

Investigation of an outbreak of adenovirus type 3 infection in a boys' boarding school.

An outbreak of pharyngoconjunctival fever caused by adenovirus type 3 was studied in a boarding school for 800 boys aged 11-18 years. A total of 96 clinical cases were confirmed by laboratory tests. Clinical infection rates were higher in the younger boys but total infection rate did not vary with age. Previous infection provided 88% protection against reinfection. The techniques of virus isolation, complement fixation and neutralization were compared in the diagnosis of cases. Virus isolation diagnosed 86% of confirmed cases. Where acute sera (collected at onset) and convalescent sera (collected within one month) were available complement fixation and neutralization tests each diagnosed 96% of cases.

Assessment of inactivated influenza-A vaccine after three outbreaks of influenza A at Christ's Hospital.

The boys of Christ's Hospital experienced outbreaks of influenza A in 1972 (A/England/42/72), in 1974 (A/Port Chalmers), and in 1976 (A/Victoria). In each outbreak, the protective effect of inactivated influenza-A vaccine was limited to those boys, not already immune, who were vaccinated for the first time with the most up-to-date strain. Revaccination with the same strain did not increase the degree of protection, and revaccination with a later strain did not afford protection against subsequent challenge. The cummulative attack-rate in the three outbreaks was similar in all groups irrespective of vaccination history. These observations suggest that annual revaccination with inactivated influenza-A vaccine confers no long-term advantage.

The spread of Coxsackie B1 infection.

During June and July 1977 5 junior boys in a boarding school for 800 pupils became ill with a mild infection caused by Coxsackie B1. The school had been taking part in a vaccine trial, and paired blood samples had been taken from new entrants in October 1976 and October 1977. 18% of the boys susceptible to the infection developed antibodies. The results suggest that dormitories are more important than the day-to-day contacts in the spread of infection. The advisability of nursing children with known or suspected enterovirus infections in open wards in hospital is questioned.

Influenza at Christ's Hospital: March, 1974.

Boys in a boarding-school given inactivated influenza-A or influenza-B vaccine have been observed during a simultaneous outbreak of influenza due to A/Port Chalmers, B/Hong Kong, and B/Intermediate strains. Influenza-B vaccine conferred substantial protection, the attack-rates in boys given B vaccine being 24% compared with 45% in a control group. A/Hong Kong vaccine, by preventing infection during the previous influenza A/England outbreak, left the boys vulnerable to influenza A/Port Chalmers. Influenza-A haemagglutination-inhibiting (H.I.) antibody acquired by natural infection was associated with more protection than H.I. antibody induced by vaccination. This difference was not seen with influenza-B H.I. antibody.