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.

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.

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.

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.

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.

The basis of shooter biases: beyond cultural stereotypes.

White police officers and undergraduate students mistakenly shoot unarmed Black suspects more than White suspects on computerized shoot/don't shoot tasks. This bias is typically attributed to cultural stereotypes of Black men. Yet, previous research has not examined whether such biases emerge even in the absence of cultural stereotypes. The current research investigates whether individual differences in chronic beliefs about interpersonal threat interact with target group membership to elicit shooter biases, even when group membership is unrelated to race or cultural stereotypes about danger. Across two studies, participants with strong beliefs about interpersonal threats were more likely to mistakenly shoot outgroup members than ingroup members; this was observed for unfamiliar, arbitrarily formed groups using a minimal group paradigm (Study 1) and racial groups not culturally stereotyped as dangerous (Asians; Study 2). Implications for the roles of both group membership and cultural stereotypes in shaping decisions to shoot are discussed.

Motivated social categorization: fundamental motives enhance people's sensitivity to basic social categories.

This article presents an evolutionary framework for identifying the characteristics people use to categorize members of their social world. Findings suggest that fundamental social motives lead people to implicitly categorize social targets based on whether those targets display goal-relevant phenotypic traits. A mate-search prime caused participants to categorize opposite-sex targets (but not same-sex targets) based on their level of physical attractiveness (Experiment 1). A mate-guarding prime interacted with relationship investment, causing participants to categorize same-sex targets (but not opposite-sex targets) based on their physical attractiveness (Experiment 2). A self-protection prime interacted with chronic beliefs about danger, increasing participants' tendency to categorize targets based on their racial group membership (Black or White; Experiment 3). This work demonstrates that people categorize others based on whether they display goal-relevant characteristics reflecting high levels of perceived desirability or threat. Social categorization is guided by fundamental evolved motives designed to enhance adaptive social outcomes.

Overperceiving disease cues: the basic cognition of the behavioral immune system.

The behavioral immune system is designed to promote the detection and avoidance of potential sources of disease. Whereas previous studies of the behavioral immune system have provided insight into the types of heuristic cues used to identify disease carriers, the present research provides an understanding of the basic psychological processes involved in the detection of those cues. Across 4 studies, feeling vulnerable to disease, whether that feeling stemmed from dispositional tendencies or situational primes, facilitated a disease overperception bias--a tendency to overperceive people in the environment displaying heuristic disease cues. This disease overperception bias was observed in the outcomes of 2 cognitive processes: categorization and memory. When concerned about disease, participants set a lenient threshold for categorizing targets as displaying heuristic disease cues (e.g., obesity, old age). Additionally, concerns about disease led participants to set a lenient threshold for reporting on a recognition task that they had previously seen individuals displaying those disease cues. The present research provides insight into the basic cognitive mechanisms underlying the operation of the behavioral immune system.

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.

Ovulation as a male mating prime: subtle signs of women's fertility influence men's mating cognition and behavior.

Women's reproductive fertility peaks for a few days in the middle of their cycle around ovulation. Because conception is most likely to occur inside this brief fertile window, evolutionary theories suggest that men possess adaptations designed to maximize their reproductive success by mating with women during their peak period of fertility. In this article, we provide evidence from 3 studies that subtle cues of fertility prime mating motivation in men, thus facilitating psychological and behavioral processes associated with the pursuit of a sexual partner. In Study 1, men exposed to the scent of a woman near peak levels of fertility displayed increased accessibility to sexual concepts. Study 2 demonstrated that, among men who reported being sensitive to odors, scent cues of fertility triggered heightened perceptions of women's sexual arousal. Study 3 revealed that, in a face-to-face interaction, high levels of female fertility were associated with a greater tendency for men to make risky decisions and to behaviorally mimic a female partner. Hence, subtle cues of fertility led to a cascade of mating-related processes-from lower order cognition to overt behavior-that reflected heightened mating motivation. Implications for theories of goal pursuit, romantic attraction, and evolutionary psychology are discussed.

Self-protective biases in group categorization: threat cues shape the psychological boundary between "us" and "them".

Across 6 studies, factors signaling potential vulnerability to harm produced a bias toward outgroup categorization--a tendency to categorize unfamiliar others as members of an outgroup rather than as members of one's ingroup. Studies 1 through 4 demonstrated that White participants were more likely to categorize targets as Black (as opposed to White) when those targets displayed cues heuristically associated with threat (masculinity, movement toward the perceiver, and facial expressions of anger). In Study 5, White participants who felt chronically vulnerable to interpersonal threats responded to a fear manipulation by categorizing threatening (angry) faces as Black rather than White. Study 6 extended these findings to a minimal group paradigm, in which participants who felt chronically vulnerable to interpersonal threats categorized threatening (masculine) targets as outgroup members. Together, findings indicate that ecologically relevant threat cues within both the target and the perceiver interact to bias the way people initially parse the social world into ingroup vs. outgroup. Findings support a threat-based framework for intergroup psychology.

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.

Bilateral renal sinus myelolipomas.

Adrenal myelolipomas are benign neoplasms consisting of hematopoietic cellular elements and adipose tissue. They are uncommon, found in 0.4% to 1% of the population at autopsy. Extra-adrenal myelolipomas (EM) are extremely rare with fewer than 50 cases reported. We describe the first case of bilateral EM of the renal sinus. They are difficult to diagnose on imaging alone when arising in this location and biopsies may not yield a definitive answer. Management options include both conservative and surgical approaches depending upon the certainty of the diagnosis, progression of the patient's symptoms and evidence of growth.

Width and variation of the ENA flux ribbon observed by the Interstellar Boundary Explorer.

The dominant feature in Interstellar Boundary Explorer (IBEX) sky maps of heliospheric energetic neutral atom (ENA) flux is a ribbon of enhanced flux that extends over a broad range of ecliptic latitudes and longitudes. It is narrow (approximately 20 degrees average width) but long (extending over 300 degrees in the sky) and is observed at energies from 0.2 to 6 kilo-electron volts. We demonstrate that the flux in the ribbon is a factor of 2 to 3 times higher than that of the more diffuse, globally distributed heliospheric ENA flux. The ribbon is most pronounced at approximately 1 kilo-electron volt. The average width of the ribbon is nearly constant, independent of energy. The ribbon is likely the result of an enhancement in the combined solar wind and pickup ion populations in the heliosheath.