Can A Funny Story about Tooth Brushing Decrease Plaque Scores in Children? A Longitudinal Field Experiment.

Dental caries is the most common chronic condition among children, it is thus a necessity to develop health communication tools to increase children's dental hygiene. Prior research among adults indicates that entertaining narrative communication can promote health behaviors, but knowledge on narrative effects on children's health outcomes is limited. In a repeated measures field experiment (N = 94, 4-10 years) we examined the long-term effects of repeated exposure to a humorous tooth brushing narrative about an orange monkey, versus an expository text on dental care, on children's self-reported and biomedical dental hygiene (plaque scores). We also explored narrative, affective and cognitive processes. Findings showed that the humorous narrative increased character engagement, enjoyment, and moral judgment compared with the expository condition. Enjoyment and moral judgment, in turn, predicted increases and decreases in plaque scores, respectively. We conclude that effectiveness of humorous narrative approach crucially depends on whether the child understands it when a story character is violating the rule.

Corrigendum: Watching More Closely: Shot Scale Affects Film Viewers' Theory of Mind Tendency But Not Ability.

[This corrects the article on p. 2349 in vol. 8, PMID: 29387032.].

Region Specific Differences of Claudin-5 Expression in Pediatric Intracranial Ependymomas: Potential Prognostic Role in Supratentorial Cases.

Ependymomas are common pediatric brain tumors that originate from the ependyma and characterized by poor prognosis due to frequent recurrence. However, the current WHO grading system fails to accurately predict outcome. In a retrospective study, we analyzed 54 intracranial pediatric ependymomas and found a significantly higher overall survival in supratentorial cases when compared to infratentorial tumors. Next we performed region-specific immunohistochemical analysis of the ependyma in neonatal and adult ependyma from the central canal of spinal cord to the choroid plexus of lateral ventricles for components of cell-cell junctions including cadherins, claudins and occludin. We found robust claudin-5 expression in the choroid plexus epithelia but not in other compartments of the ependyma. Ultrastructural studies demonstrated distinct regional differences in cell-cell junction organization. Surprisingly, we found that 9 out of 20 supratentorial but not infratentorial ependymomas expressed high levels of the brain endothelial tight junction component claudin-5 in tumor cells. Importantly, we observed an increased overall survival in claudin-5 expressing supratentorial ependymoma. Our data indicates that claudin-5 expressing ependymomas may follow a distinct course of disease. The assessment of claudin-5 expression in ependymoma has the potential to become a useful prognostic marker in this pediatric malignancy.

Watching More Closely: Shot Scale Affects Film Viewers' Theory of Mind Tendency But Not Ability.

Recent research debates the effects of exposure to narrative fiction on recognition of mental states in others and self, referred to as Theory of Mind. The current study explores the mechanisms by which such effects could occur in fictional film. Using manipulated film scenes, we conducted a between subject experiment (N = 136) exploring how film shot-scale affects viewers' Theory of Mind. Specifically, in our methods we distinguish between the trait Theory of Mind abilities (ToM ability), and the state-like tendency to recognize mental states in others and self (ToM tendency). Results showed that close-up shots (compared to long shots) of a character was associated with higher levels of Theory of Mind tendency, when the facial expression was sad but not when it was neutral. And this effect did not transfer to other characters in the film. There was also no observable effect of character depiction on viewers' general Theory of Mind ability. Together the findings suggest that formal and content features of shot scale can elicit Theory of Mind responses by directing attention toward character mental states rather than improving viewers' general Theory of Mind ability.

A needle in the haystack--the dire straits of needle exchange in Hungary.

BACKGROUND: The two largest needle exchange programs (NEPs) in Hungary were forced to close down in the second half of 2014 due to extreme political attacks and related lack of government funding. The closures occurred against a background of rapid expansion in Hungary of injectable new psychoactive substances, which are associated with very frequent injecting episodes and syringe sharing. The aim of our analysis was to predict how the overall Hungarian NEP syringe supply was affected by the closures. METHODS: We analyzed all registry data from all NEPs in Hungary for all years of standardized NEP data collection protocols currently in use (2008-2014) concerning 22 949 client enrollments, 9,211 new clients, 228,167 client contacts, 3,160,560 distributed syringes, and 2,077,676 collected syringes. RESULTS: We found that while the combined share of the two now closed NEPs decreased over time, even in their partial year 2014 they still distributed and collected about half of all syringes, and attended to over half of all clients and client contacts in Hungary. The number of distributed syringes per PWID (WHO minimum target = 100) was 81 in 2014 in Hungary, but 39 without the two now closed NEPs. CONCLUSIONS: There is a high probability that the combination of decreased NEP coverage and the increased injection risk of new psychoactive substances may lead in Hungary to a public health disaster similar to the HIV outbreaks in Romania and Greece. This can be avoided only by an immediate change in the attitude of the Hungarian government towards harm reduction.

Expression of proliferation markers Ki67, cyclin A, geminin and aurora-kinase A in primary breast carcinomas and corresponding distant metastases.

AIMS: To assess the expression of the following cell cycle regulatory proteins in primary metastatic breast carcinomas (MBCs) and on availability in matched distant metastases (DMs): Ki67, cyclin A, geminin and aurora-kinase A (aurkA); and to compare the expression of these markers in early MBC (EMBC) and late MBC separated into groups according to median time point on metastatic event occurred (28 months). METHODS: The expression of the above mentioned markers was analysed in a total of 47 primary MBCs and 59 DMs (out of which 37 were pairs) by immunohistochemistry. Fourteen breast carcinomas with no relapse over a 10-year follow-up period were utilised as control cases (CBC). RESULTS: Among the MBCs, 22 metastasised to the bone, 4 to the lung and 21 to the central nervous system (CNS). Geminin (p<0.001) and Ki67 (p=0.001) were increased in the MBCs while aurkA and cyclin A showed no difference when compared with CBCs. There were no differences between aurkA, cyclin A and geminin expression in MBCs and DMs in general. Expression of Ki67 was, however, elevated (p=0.027) in DMs. In CNS metastases all markers showed elevated expression as compared to MBCs. In bone metastases, geminin was lower (p<0.001) compared with primary MBCs. In the metastases of the lung, the evaluated markers did not show different expression. According to the median follow-up until the metastatic event, Ki67 was found to be significantly elevated in EMBC (p=0.018). CONCLUSIONS: Ki67 index and geminin distinguish a fraction of MBC with worse prognosis, showing increased levels in the latter in comparison to CBC being tumour-free over a 10-year follow-up period. Ki67 could possibly identify a group of MBCs that develop early DMs.

The effect of patient-centeredness and gender of professional role models on trainees' mentalization responses. Implications for film-aided education.

OBJECTIVE: To examine how certain characteristics of film-presented practitioner role-models influence trainees' mentalization. METHODS: In an experimental setting, psychology students watched four film clips presenting a patient-practitioner session; the clips varied in the practitioner's patient-centeredness (positive vs. negative) and gender. Participants commented on the practitioner's thoughts, emotions and intentions through the session. Analysis of 116 comments focused on the effect of patient-centeredness and gender variables on mentalization and judgment utterances. RESULTS: Negative role-models and female role-models induced higher levels of mentalization compared to positive and male role-models. There was no gender difference in the level of mentalization; however male participants gave more judgmental responses than female participants. The patient-centeredness had a larger effect on mentalization when trainees described the opposite gender role-model. CONCLUSION: In a systematic comparison, students' capacity for mentalization differed according to role-models' patient-centeredness and gender, as well as the gender-match of students with role-models. PRACTICE IMPLICATIONS: When working with film-presented role-models, educators should be aware of the differences in the level of mentalization elicited by positive and male role-models, as opposed to negative and female role-models. Educators should also consider the gender-match between trainees and role-models, therefore students should be exposed to both cross- and same-gender role-models.

Angiogenesis and angiogenic tyrosine kinase receptor expression in pediatric brain tumors.

Tumor angiogenesis and receptor tyrosine kinases (RTK) are major novel targets in anticancer molecular therapy. Accordingly, we characterized the vascular network and the expression pattern of angiogenic RTK in the most frequent pediatric brain tumors. In a retrospective collection of 44 cases (14 astrocytoma, 16 ependymoma and 14 medulloblastoma), immunohistochemistry for VEGFR1, VEGFR2, PDGFRα, PDGFRß, and c-Kit as well as microvessel labeling with CD34 and SMA were conducted on surgical specimens. We found a significantly higher vascular density in ependymoma. Glomeruloid formations were abundant in medulloblastoma but rare or almost absent in astrocytoma and ependymoma, respectively. C-Kit and VEGFR2 labeled blood vessels were more abundant in ependymoma than in the other two types of tumors. In contrast, medulloblastoma contained higher number of PDGFRα expressing vessels. In tumor cells, we found no VEGFR2 but VEGFR1 expression in all three tumor types. PDGFRα was strongly expressed on the tumor cells in all three malignancies, while PDGFRß tumor cell expression was present in the majority of medulloblastoma cases. Interestingly, small populations of c-Kit expressing cancer cells were found in a number of medulloblastoma and ependymoma cases. Our study suggests that different angiogenic mechanisms are present in ependymoma and medulloblastoma. Furthermore ependymoma patients may benefit from anti-angiogenic therapies based on the high vascularization as well as the endothelial expression of c-kit and VEGFR2. The expression pattern of the receptors on tumor cells also suggests the targeting of specific angiogenic tyrosine kinase receptors may have direct antitumor activity. Further preclinical and biomarker driven clinical investigations are needed to establish the application of tyrosine kinase inhibitors in the treatment of pediatric brain tumors.

[The role of the pathologist in the diagnosis and therapy planning of central nervous system tumors. Prognostic and predictive markers]. / A patológus szerepe a központi idegrendszer tumorainak diagnosztikájában, a terápiatervezésben. Prognosztikus és prediktív markerek vizsgálata.

Despite advances in imaging methods, the standard of diagnosis and treatment of the tumours of the nervous system remains the histological report issued by a neuropathologist. For reliable, definitive diagnosis, close collaboration with other medical professions is essential, correlation of histological findings with clinical and imaging results is necessary. Neuropathology became a subspecialty because of the specific knowledge and experience it requires. In more complex cases consultation with neuropathologists is important to ensure adequate diagnosis and subsequent treatment. In both establishing the diagnosis and treatment planning, the molecular testing of brain tumors becomes more and more important. These tests are reliably available only in larger centers. Out of the molecular markers, in current practice the investigation of codeletion at 1p/19q, IDH mutations, ß-katenin nuclear positivity and MGMT methylation gained acceptance. Besides these tests already in practice, a vast array of potential diagnostic and prognostic markers are being investigated, which in the future may assist in delivering better and more individualized therapy.

Gliosarcoma of the pineal region with cerebellar metastasis: case illustration.

A very rare case of gliosarcoma of the pineal region with cerebellar metastasis is presented. A few cases of glioblastoma and fibrosarcoma have already been published however there was no reported case with gliosarcoma at the pineal region even with cerebellar metastases.

[Shrinkage dynamics of cystic craniopharyngeomas after Yttrium-90 colloid brachytherapy]. / Cystás craniopharyngeomák zsugorodásának dinamikája 90ittrium-brachytherapia után.

OBJECTIVE: The aim of this study is to reveal the long-term effect of Yttrium-90 colloid radioisotope brachytherapy applied for the treatment of cystic craniopharyngiomas. To provide a mathematical expression that can describe the cyst reduction as a function of time in an accurate matter. METHODS: Fourteen cystic craniopharyngiomas were selected for intracavital irradiation with stereotactically implanted beta-emitting radioisotope Yttrium-90 silicate colloid. The cumulative dose aimed at the inner surface of the cyst wall was ranging between 180-300 Gy. Volumes of the cysts were measured on image-fused control CT/MRI images for a 28-month period. Dose planning was done with our own software, while stereotactic calculations, volume calculations and image fusion were done with the BrainLab Target 1.19 software. Mathematical and statistical computations were carried out with the Matlab numeric computation and visualization software. To determine the volumes, the control images were fused with the planning images. RESULTS: Relative volumes normalized with respect to the volume of cysts before irradation were determined from the patients' measured data, the mean values of volumes were calculated, then a polynomial was fitted to the mean values using the polynomial curve fitting method. We have found that the dynamics describing the reduction of cysts can be expressed mathematically by the polynomial V=93.627-18.091t + 1.473t2 - 0.054t3 + 0.0007t4, where "t" denotes the time in months passed after irradiation. The accuracy of our results was verified by correlating the predicted data with the measured ones. CONCLUSIONS: Our long-term results support the view, that intracavitary Yttrium-90 irradiation is a non invasive and very effective method for treatment of craniopharyngioma cysts. The derived polynomial helps to 1. design the best treatment, 2. follow up patients' condition and 3. plan a reirradiation if necessary.

Down-regulation of Wee1 kinase by a specific subset of microRNA in human sporadic pituitary adenomas.

CONTEXT: The tumorigenic mechanisms involved in pituitary adenomas, especially of nonfunctional pituitary adenomas (NFAs), remains unclear. Various cell cycle inhibitors have been found to be underexpressed in pituitary tumors; however, Wee1 kinase, a nuclear protein that delays mitosis and was recently recognized as a tumor suppressor gene, has not been previously investigated in pituitary tumors. OBJECTIVE: Our objective was to examine the expression of Wee1 in pituitary tumors and to identify microRNAs (miRs) that can regulate its expression. DESIGN: Expression of Wee1 was examined by immunohistochemistry and quantitative real-time PCR (qRT-PCR). Identification of miRs targeting the Wee1 3'-untranslated region was performed by miR array followed by expression analysis of identified miRs using qRT-PCR. Dual-luciferase assay and transient transfection of miRs into Hela cells followed by immunoblot analysis of Wee1 protein and cell proliferation analysis were carried out. PATIENTS: A total of 57 pituitary tissue samples including 27 NFAs, 15 GH-producing adenomas with or without prolactin overproduction, and 15 normal pituitary glands were analyzed. RESULTS: Wee1 protein expression was decreased in NFAs and GH-producing tumors with or without prolactin production, but no change in mRNA expression was observed with qRT-PCR. A specific subset of five miRNAs revealed by in silico target prediction was significantly overexpressed in NFA samples; three miRs (miR-128a, miR-155, and miR-516a-3p) targeted the 3'-untranslated region of the Wee1 transcript, and exogenous overexpression of these miRs inhibited Wee1 protein expression and HeLa cell proliferation. CONCLUSIONS: To our knowledge, this is the first report suggesting that regulation of Wee1 kinase by miRs may be linked to pituitary tumorigenesis.

Ependymoma in adults: surgery, reoperation and radiotherapy for survival.

PURPOSE: to retrospectively determine the long-term outcome of adult intracranial ependymoma patients treated with surgery, reoperation, and postoperative radiation therapy. MATERIAL AND METHODS: 61 patients were treated at our institution between 1980 and 2004. Forty patients had World Health Organization (WHO) Grade II ependymoma, and 21 patients had Grade III ependymoma. The median age was 34 years. The majority of patients were female (59%), and 35 had gross total resections (60%). Eighteen patients were reoperated, 15 only once but 2 twice and one six times. Survival times following reoperation was mostly short but some of them reached more than 5 or 10 years. Postoperative radiation therapy was delivered to 31 patients postoperative (55.4%) and to 5 after reoperation, a median total dose of 54 Gy. RESULTS: The median follow-up of surviving patients was 10.6 years. The 5-year and 10-year disease free survival rates for all patients were 50% and 32.9% respectively. The 5-year and 10-year overall survival rates for all patients were 57.1% and 39.4%, respectively. A statistically significant effect on prognosis was observed with WHO tumour grade as well as with MIB-1 labelling index. Subtotal resection predicted a worse overall survival, but this failed to reach statistical significance. No statistically significant effect on prognosis was observed with tumour location and radiation therapy. CONCLUSION: In our experience the use of radiotherapy in adult, intracranial WHO Grade II ependymoma patients had no significant effect on prognosis. Radical surgery and eventual reoperation seems to be more favorable.

Cervical juxtafacet cyst combined with spinal dysraphism.

Juxtafacet cysts of the cervical and thoracic spine are rare and often cause radiculopathy or myelopathy. We present a case of a patient with radicular pain and early onset myelopathy. A juxtafacet cyst at the cervico-thoracic junction combined with discal herniation and spina bifida occulta was diagnosed with computed tomography (CT) and magnetic resonance imaging (MRI). Laminectomy with removal of the cyst was the treatment and the patient recovered rapidly.

Long-term results and late complications after intracavitary yttrium-90 colloid irradiation of recurrent cystic craniopharyngiomas.

OBJECTIVE: Data were analyzed to assess the value of stereotactically applied intracystic colloidal yttrium-90 (YTx) for the treatment of recurrent cystic craniopharyngiomas during a 30-year period. METHODS: This article compares data from 73 YTx procedures in 60 patients between 1975 and 2006. The cumulative beta dose aimed at the inner surface of the cyst wall was 300 Gy. RESULTS: After YTx, the initial cyst volumes decreased an average of 79%. In 47, the reduction was more than 80%; in 27 of them, the cyst disappeared completely within 1 year. The mean survival after YTx was 9.4 years (range, 0.7-30 yr). Actuarial survival rates at 5, 10, 15, 20, 25, and 30 years were 81, 61, 45, 18, 2, and 0%, respectively. Late complications of YTx were related to the anatomic localization of the cyst, either presellar and retrosellar, e.g., a presellar (prechiasmatic/suprasellar) localization caused neuro-ophthalmological complications in 5.8% and internal carotid artery injury in 1.6%. The treatment of retrosellar (retrochiasmatic, suprasellar) tumors occasionally induced hypothalamic and/or pontomesencephalothalamic damage obviously by untoward radiation to the so-called perforating arteries. This occurred in 3.2% of these latter patients. CONCLUSION: Despite sporadic complications, intracavitary YTx irradiation is a valuable treatment alternative for craniopharyngioma cysts, sometimes as part of a multimodality management in these tumors, especially in precarious surgical cases.

Temporal extradural ectopic craniopharyngioma. Case report.

A rare case of histologically confirmed primary craniopharyngioma at an ectopic location is presented. This cystic tumor, which had a small solid portion, was located extradurally at the right temporobasal region, and pyramidal bone erosion was observed. No evidence of involvement of the sellar or suprasellar region was found. The neuroimaging findings, surgical intervention, and histopathological features of the tumor are discussed. The authors' hypothesis regarding the extradural location of the tumor is that mismigration of squamous epithelial cell remnants of the obliterated craniopharyngeal canal had occurred.

The role of microglia/macrophage system in the tissue response to I-125 interstitial brachytherapy of cerebral gliomas.

OBJECTIVE: To study histopathologic changes and the role of the microglia/macrophage cell in the therapeutic effect of I-125 interstitial brachytherapy on the cerebral gliomas. METHODS: Out of a series of 60 cases with cerebral astrocytomas and other brain tumors treated with I-125 interstitial brachytherapy, autopsy materials were available in ten cases 0.75 and 60 months after irradiation. The patients were treated with the maximum dosage (60 Gy) on the tumor periphery. Besides the routine hematoxylin-eosine and Mallory's PTAH trichrome staining, immunohistochemical reactions were carried out for CD15, CD31, CD34, CD45, CD68, CPM, HAM56 and HLR-DR antigens on paraffin sections to study immunologic phenotypic characteristics of the reaction cell population around gliomas after I-125 treatment. RESULT: One month after irradiation, a necrotic zone developed around the I-125 seeds within the 72 Gy isodose curve. Histologically, there was a fresh coagulation necrosis in the center of the lesion. Reactive zone has not yet developed but scattered interstitial and perivascular CD68 positive macrophages were present in the surrounding brain tissues. Six months after the I-125 isotope treatment, a reactive zone developed: a microglial rim around the necrosis tissue, and a broad area of proliferating vessels and glial fibrillary acidic protein (GFAP) positive astroglial cells which contained CD68 positive activated microglial and macrophage cells. Fifty-four months after I-125 interstitial irradiation, the necrotic center became colliquative and cystic. The microglial rim was replaced by round end stage (HLR-DR and CD31 positive) macrophages. The reactive zone was characterized by astrocytic gliosis but vascular proliferation and macrophages were lacking. CONCLUSION: Results of the present immunohistochemical study suggest that the early lesions are characterized by migrating macrophages apparently concerned with the removal of necrotic debris. The established phase of reactive zone around the necrotic center is characterized by a narrow inner rim of microglial accumulation and a broad outer area characterized by astrocytic gliosis, vascular proliferation, activated microglia and infiltration by macrophages. In the burned-out phases of I-125 interstitial brachytherapy of gliomas, the necrosis undergoes liquefaction and the microglial rim is replaced by astrocytic gliosis which can be considered as equivalent to the scar tissue formed around necrosis outside the central nervous system.

Stereotactic intracavitary irradiation of cystic craniopharyngiomas with yttrium-90 isotope.

The authors analyzed data from nearly 30-year follow-up period to assess the value of intracavitary irradiation with stereotactically implanted beta-emitting radioisotope yttrium- 90 (90Y) silicate colloid for the treatment of cystic craniopharyngiomas. Seventy-three cysts in 60 patients were selected for retrospective analysis. The cumulative dose aimed at the inner surface of the cyst wall was 300 Gy. An average of 79% (mean 88.3%) shrinkage of the initial cyst volume was observed. In 47 cysts, the reduction was more than 80%, and the cyst disappeared totally in 29 out of those 47 cases, usually within a year. Mean survival duration after intracavitary irradiation was 9.4 years. Neuroophthalmological prognosis was only favorable when the optic disc was normal or nearly normal at the time of the treatment. In the presence of preexisting optic atrophy, visual damage proved to be irreversible. The long-term results support the view that intracavitary 90Y irradiation is a noninvasive and effective method for the treatment of craniopharyngioma cysts. Because of the mean penetration pathway of beta irradiation is 3.6mm in the soft tissues (maximum 11 mm) it cannot influence the solid part of the tumor; therefore, the best result can be expected in solitary cysts.

Pathological findings in cystic craniopharyngiomas after stereotactic intracavitary irradiation with yttrium-90 isotope.

Histopathological, ultrastructural and polyacrylamide gel electrophoretic examinations were carried out on biopsy, cyst fluid, surgical pathology and autopsy specimens obtained from 7 cystic craniopharyngioma cases before and after yttrium-90 silicate colloid (90Y) irradiation. Light microscopy revealed that the lining epithelial tumor cell layer of the cyst wall was destroyed, and scar tissue containing large amount of hyaline degenerated collagen bundles replaced it. Proliferative postirradiation vasculopathy was also demonstrated in the cyst wall following 90Y installation. Electrophoretic property of cyst fluid was similar to the normal human serum. Considering that scar tissue has a certain propensity to shrink, the fibrosis in the cyst wall together with destruction of neoplastic epithelium and vascular changes might explain diminished fluid production and cyst volume reduction after 90Y treatment.

Image fusion-guided stereotactic iodine-125 interstitial irradiation of inoperable and recurrent gliomas.

Between 1996 and 2004, 27 patients with low grade gliomas (WHO grade I-II), 10 patients with WHO grade III gliomas and 6 patients with glioblastoma multiforme (WHO grade IV) were treated with stereotactic brachytherapy using low-dose rate iodine-125 (125I) isotope seeds at the Department of Neurosurgery, St. John's Hospital, Budapest, Hungary. In all 43 cases, brachytherapy was used for surgically inoperable gliomas: in 32 cases for recurrent gliomas and in 11 cases as a primary treatment. Results of this study suggest that 125I brachytherapy for inoperable and recurrent gliomas is an effective method and offers a chance for longer-term survival.