Peritoneal lesions caused by Enterobius vermicularis suspected to be metastases of ovarian malignancy.

Enterobius vermicularis, also known as pinworm, is a helminth that commonly causes intestinal parasitic infestation. E. vermicularis can also cause extraintestinal infestations. We report a case of lower abdominal pain and intermittent vaginal bleeding in a 45-year-old woman who was referred to our gynaecology department. On investigation, a transvaginal ultrasound showed a multilocular cyst in the left ovary, along with elevated levels of cancer antigen 125. Consequently, a laparoscopic salpingo-oophorectomy was performed. A biopsy of atypical peritoneal lesions revealed remains of E. vermicularis Peritoneal lesions are a rare complication of enterobiasis, and the diagnosis of this complication is usually delayed by limitations in diagnostic options. Although extraintestinal enterobiasis does not require treatment because it is the last stage of the parasitic cycle, primary intestinal infestation requires treatment with mebendazole.

International Perspectives on Understanding and Improving Teachers' Data-Based Instruction and Decision Making: Introduction to the Special Series.

This article serves as an introduction to the special series, Data-Based Instruction and Decision-Making: An International Perspective. In this series, we bring together international researchers from both special and general education to address teachers' use (or non-use) of data for instructional decision making. Via this special series, we aim to increase understanding of the challenges involved in teachers' data-based instructional decision making for students with or at-risk for learning disabilities, and to further the development of approaches for improving teachers' ability to plan, adjust, and adapt instruction in response to data.

Fetal and Perinatal Brain Autopsy: Useful Macroscopic Techniques Including Agar In-situ and Pre-Embedding Methods.

Fragile perinatal and fetal brains are the rule rather than the exception for developmental neuropathologists. Retrieving the fresh brain from the skull and examining early fetal, macerated or severely hydrocephalic brains after fixation can be a challenge. Textbooks on neurodevelopmental pathology mention these challenges to macroscopic examination of the developing central nervous system only in passing, but many perinatal pathologists recognize this diagnostic problem. We reviewed protocols and publications on the removal, fixation, slicing and sampling of these fetal- and perinatal brains. In addition, we describe a technique to facilitate the removal of severely hydrocephalic brains with very thin cerebral walls from the skull by replacing the intraventricular fluid with agar in-situ. Furthermore, we present a method for post-fixation pre-embedding in agar to facilitate slicing, macroscopic examination and sampling of fragile and macerated brains.

A Systematic Review of CBM Professional Development Materials: Are Teachers Receiving Sufficient Instruction in Data-Based Decision-Making?

The purpose of this study was to examine the amount of attention devoted to data-based decision-making in Curriculum-Based Measurement (CBM) professional development materials. Sixty-nine CBM instructional sources were reviewed, including 45 presentations, 22 manuals, and two books. The content of the presentations and manuals/books was coded into one of four categories: (a) general CBM information, (b) conducting CBM, (c) data-based decision-making, and (d) other. Results revealed that only a small proportion of information in the CBM instructional materials was devoted to data-based decision-making (12% for presentations and 14% for manuals/books), and that this proportion was significantly smaller than (a) that devoted to other instructional topics, (b) that expected were information to be equally distributed across major instructional topics, and (c) that recommended by experienced CBM trainers. Results suggest a need for increased attention to data-based decision-making in CBM professional development.

Histological subtypes in triple negative breast cancer are associated with specific information on survival.

Much research has focused on finding novel prognostic biomarkers for triple negative breast cancer (TNBC), whereas only scattered information about the relation between histopathological features and survival in TNBC is available. This study aims to explore the prognostic value of histological subtypes in TNBC. A multicenter retrospective TNBC cohort was established from five Dutch hospitals. All non-neoadjuvantly treated, stage I-III patients with estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 negative breast cancer diagnosed between 2006 and 2014 were included. Clinical and follow-up data (overall survival; OS, relapse free survival; RFS) were retrieved and a central histopathological review was performed. Of 597 patients included (median follow up 62.8 months, median age at diagnosis 56.0 years), 19.4% developed a recurrence. The most prevalent histological subtypes were carcinoma of no special type (NST) (88.4%), metaplastic carcinoma (4.4%) and lobular carcinoma (3.4%). Collectively, tumors of special type were associated with a worse RFS and OS compared to carcinoma NST (RFS HR 1.89; 95% CI 1.18-3.03; p = 0.008; OS HR 1.94; 95% CI 1.28-2.92; p = 0.002). Substantial differences in survival, however, were present between the different histological subtypes. In the presented TNBC cohort, special histological subtype was in general associated with less favorable survival. However, within the group of tumors of special type there were differences in survival between the different subtypes. Accurate histological examination can provide specific prognostic information that may potentially enable more personalized treatment and surveillance regimes for TNBC patients.

Identification of novel GNAS mutations in intramuscular myxoma using next-generation sequencing with single-molecule tagged molecular inversion probes.

BACKGROUND: Intramuscular myxoma (IM) is a hypocellular benign soft tissue neoplasm characterized by abundant myxoid stroma and occasional hypercellular areas. These tumors can, especially on biopsy material, be difficult to distinguish from low-grade fibromyxoid sarcoma or low-grade myxofibrosarcoma. GNAS mutations are frequently involved in IM, in contrast to these other malignant tumors. Therefore, sensitive molecular techniques for detection of GNAS aberrations in IM, which frequently yield low amounts of DNA due to poor cellularity, will be beneficial for differential diagnosis. METHODS: In our study, a total of 34 IM samples from 33 patients were analyzed for the presence of GNAS mutations, of which 29 samples were analyzed using a gene-specific TaqMan genotyping assay for the detection of GNAS hotspot mutations c.601C > T and c602G > A in IM, and 32 samples using a novel next generation sequencing (NGS)-based approach employing single-molecule tagged molecular inversion probes (smMIP) to identify mutations in exon 8 and 9 of GNAS. Results between the two assays were compared for their ability to detect GNAS mutations with high confidence. RESULTS: In total, 23 of 34 samples were successfully analyzed with both techniques showing GNAS mutations in 12 out of 23 (52%) samples. The remaining 11 samples were analyzed with either TaqMan assay or smMIP assay only. The TaqMan assay revealed GNAS mutations in 16 out of 29 samples (55%), with six samples c.601C > T (p.R201C; 38%) and ten samples c.602G > A (p.R201H; 62%) missense mutations. The smMIP assay identified mutations in 16 out of 28 samples (57%), with five samples c.601C > T (p.R201C; 31%) and seven samples c.602G > A (p.R201H; 44%) missense mutations. In addition, four samples (25%) revealed novel IM-associated mutations, including c.601C > A (p.R201S), c.602G > T (p.R201L), c.602G > C (p.R201P) and c.680A > G (p.Q227R). Combining the results of both tests, 23 out of 34 sporadic IM samples (68%) showed a GNAS mutation. CONCLUSIONS: Both the TaqMan and the smMIP assay a show a high degree of concordance in detecting GNAS hotspot mutations in IM with comparable sensitivity. However, since the NGS-based smMIP assay permits mutation detection in whole exons of GNAS, a broader range of GNAS mutations can be identified by the smMIP approach.

Whole-Slide Mitosis Detection in H&E Breast Histology Using PHH3 as a Reference to Train Distilled Stain-Invariant Convolutional Networks.

Manual counting of mitotic tumor cells in tissue sections constitutes one of the strongest prognostic markers for breast cancer. This procedure, however, is time-consuming and error-prone. We developed a method to automatically detect mitotic figures in breast cancer tissue sections based on convolutional neural networks (CNNs). Application of CNNs to hematoxylin and eosin (H&E) stained histological tissue sections is hampered by: (1) noisy and expensive reference standards established by pathologists, (2) lack of generalization due to staining variation across laboratories, and (3) high computational requirements needed to process gigapixel whole-slide images (WSIs). In this paper, we present a method to train and evaluate CNNs to specifically solve these issues in the context of mitosis detection in breast cancer WSIs. First, by combining image analysis of mitotic activity in phosphohistone-H3 (PHH3) restained slides and registration, we built a reference standard for mitosis detection in entire H&E WSIs requiring minimal manual annotation effort. Second, we designed a data augmentation strategy that creates diverse and realistic H&E stain variations by modifying the hematoxylin and eosin color channels directly. Using it during training combined with network ensembling resulted in a stain invariant mitosis detector. Third, we applied knowledge distillation to reduce the computational requirements of the mitosis detection ensemble with a negligible loss of performance. The system was trained in a single-center cohort and evaluated in an independent multicenter cohort from The Cancer Genome Atlas on the three tasks of the Tumor Proliferation Assessment Challenge (TUPAC). We obtained a performance within the top-3 best methods for most of the tasks of the challenge.

Reading Pictures for Story Comprehension Requires Mental Imagery Skills.

We examined the role of mental imagery skills on story comprehension in 150 fifth graders (10- to 12-year-olds), when reading a narrative book chapter with alternating words and pictures (i.e., text blocks were alternated by one- or two-page picture spreads). A parallel group design was used, in which we compared our experimental book version, in which pictures were used to replace parts of the corresponding text, to two control versions, i.e., a text-only version and a version with the full story text and all pictures. Analyses showed an interaction between mental imagery and book version: children with higher mental imagery skills outperformed children with lower mental imagery skills on story comprehension after reading the experimental narrative. This was not the case for both control conditions. This suggests that children's mental imagery skills significantly contributed to the mental representation of the story that they created, by successfully integrating information from both words and pictures. The results emphasize the importance of mental imagery skills for explaining individual variability in reading development. Implications for educational practice are that we should find effective ways to instruct children how to "read" pictures and how to develop and use their mental imagery skills. This will probably contribute to their mental models and therefore their story comprehension.

Is SLN Biopsy Alone Safe in SLN Positive Breast Cancer Patients?

The Z0011 trial demonstrated no difference in overall survival (OS) and locoregional recurrence in breast cancer patients with a positive sentinel lymph node (SLN) randomized to axillary lymph node dissection (ALND) or no further surgery. The aim of this study was to evaluate locoregional recurrence in a nonrandomized group of SLN positive patients, in whom cALND was not performed, that were retrospectively categorized by the Z0011 eligibility criteria. From two hospital breast cancer databases consisting of 656 consecutive SLN positive breast cancer patients, 88 patients, who did not undergo cALND, were identified. This population was categorized by the Z0011 inclusion criteria (e.g., eligible versus ineligible) and the groups were compared. Thirty-four patients (38.6%) were retrospectively eligible for omitting cALND according to the Z0011 criteria and 54 (61.4%) were not. The median number of SLNs removed in both groups was 1 (range 1-5). The number of positive SLNs did not differ between the groups. Tumor size was slightly larger in the ineligible group (21 mm versus 19 mm) and 76% of patients in the ineligible group underwent a mastectomy. At a median follow-up of 26 months (range 1-84 months), one axillary recurrence was observed in the ineligible group versus 0 in the eligible group. Axillary recurrence was low, even in patients who did not meet the Z0011 inclusion criteria. Future trials that randomize Z0011 ineligible patients are needed to investigate long-term results.

Reading enjoyment amongst non-leisure readers can affect achievement in secondary school.

This study aimed to evaluate determinants of differences in leisure reading behavior and school achievement. We specifically examined reading enjoyment, mental imagery, and sex as predictors in a large, age-homogeneous sample of Dutch secondary school students (N = 1,071). Results showed that the prevalence of leisure reading was low in both the lower, pre-vocational track (19.5%) and the higher, pre-academic track (32.5%). Boys read even less than girls. Almost all leisure readers enjoyed reading and engaged in mental imagery, i.e., the propensity "to see images" of a written story in the mind's eye. Overall, boys who did not like to read for leisure had the poorest school performance. Non-leisure readers who reported that they enjoyed reading got higher school grades in the higher educational track. In the lower track, this was the case for girls. Our study findings imply that reading promotion programs should take into account individual differences in sex, achievement level, and reading enjoyment when aiming to decrease the academic achievement gap.

Early presentation of cystic kidneys in a family with a homozygous INVS mutation.

Nephronophthisis (NPHP) is an autosomal recessive cystic kidney disease that is the most frequent monogenic cause of end-stage renal disease in children. Infantile NPHP, often in combination with other features like situs inversus, are commonly caused by mutations in the INVS gene. INVS encodes the ciliary protein inversin, and mutations induce dysfunction of the primary cilia. In this article, we present a family with two severely affected fetuses that were aborted after discovery of grossly enlarged cystic kidneys by ultrasonography before 22 weeks gestation. Exome sequencing showed that the fetuses were homozygous for a previously unreported nonsense mutation, resulting in a truncation in the IQ1 domain of inversin. This mutation induces nonsense-mediated RNA decay, as suggested by a reduced RNA level in fibroblasts derived from the fetus. However, a significant amount of mutant INVS RNA was present in these fibroblasts, yielding mutant inversin protein that was mislocalized. In control fibroblasts, inversin was present in the ciliary axoneme as well as at the basal body, whereas in the fibroblasts from the fetus, inversin could only be detected at the basal body. The phenotype of both fetuses is partly characteristic of infantile NPHP and Potter sequence. We also identified that the fetuses had mild skeletal abnormalities, including shortening and bowing of long bones, which may expand the phenotypic spectrum associated with INVS mutations.

Pelvic floor muscle training for urinary incontinence: a comparison of outcomes in premenopausal versus postmenopausal women.

OBJECTIVES: Previous studies examining the effectiveness of pelvic floor muscle training (PFMT) for urinary incontinence in premenopausal and postmenopausal women have shown ambiguous results. The aim of this study was to compare subjective PFMT outcome in premenopausal versus postmenopausal women. METHODS: This is a retrospective study including premenopausal and postmenopausal women after PFMT for urodynamically proven stress urinary incontinence, mixed urinary incontinence, or urgency urinary incontinence from January 2003 to December 2008, with assessment of the need of an incontinence surgery in a follow-up time of least 24 months. Patients evaluated the change of their urinary incontinence on a 4-point Likert scale (1, no improvement; 2, slightly better; 3, no relevant incontinence; 4, excellent outcome; no incontinence at all) and their goal attainment on a 3-point Likert scale (1, less than expected; 2, as expected; and 3, more than expected). RESULTS: Successful outcome was reported by 59% of the premenopausal patients and 70% of the postmenopausal patients (P = 0.16), the attainment of the subjective goal by 68% and 81% (P = 0.09), and the need of an incontinence operation in a follow-up of 30 to 102 months by 15% and 14% (P = 1.0), respectively. None of the outcome parameters reached significance. CONCLUSIONS: In comparing premenopausal to postmenopausal women, we could not detect any statistically significant difference with regard to patients' satisfaction for the outcome of PFMT.

To read or not to read: a meta-analysis of print exposure from infancy to early adulthood.

This research synthesis examines whether the association between print exposure and components of reading grows stronger across development. We meta-analyzed 99 studies (N = 7,669) that focused on leisure time reading of (a) preschoolers and kindergartners, (b) children attending Grades 1-12, and (c) college and university students. For all measures in the outcome domains of reading comprehension and technical reading and spelling, moderate to strong correlations with print exposure were found. The outcomes support an upward spiral of causality: Children who are more proficient in comprehension and technical reading and spelling skills read more; because of more print exposure, their comprehension and technical reading and spelling skills improved more with each year of education. For example, in preschool and kindergarten print exposure explained 12% of the variance in oral language skills, in primary school 13%, in middle school 19%, in high school 30%, and in college and university 34%. Moderate associations of print exposure with academic achievement indicate that frequent readers are more successful students. Interestingly, poor readers also appear to benefit from independent leisure time reading. We conclude that shared book reading to preconventional readers may be part of a continuum of out-of-school reading experiences that facilitate children's language, reading, and spelling achievement throughout their development.