Gone with the Wind.

OBJECTIVE: If the narrative of "coronavirus" has an underlying theme, it may perhaps for some be one of survival, whilst for others, the theme might be suffering. The recurring motif of survival has continued throughout history, yet for the first time the sum of all fears has amounted to a run on the bare essentials. This paper seeks to offer an alternative formulation of "panic buying," with references to literature, philosophy, and contemporary neurobiology. CONCLUSION: The bare essentials disappeared perhaps as part of some self-fulfilling prophecy: the supermarkets became bare because others inadvertently lead us to believe they would become bare. The contagion model of emotional propagation provides a psychological model of how "panic buying" by an individual might lead to the replication of panic in an observer. The Polyvagal Theory further informs us of how the threat posed by the pandemic primes our limbic system to perceive danger, and explains how witnessing others engaging in fight-flight responses might evoke a fearful affect in an observer. In the end, it is perhaps through Nietzsche's study of classical tragedy that we may find some meaning to the pandemic, allowing our collective lived experience to serve as a template for growth.

Love in the time of Corona.

OBJECTIVE: As the world struggles to come to terms with "corona," we find our collective experience to be entirely alien, struggling to find meaning in the forms of feeling being evoked. When words cannot provide meaning to experience, metaphor is often utilized. CONCLUSIONS: Words like "love" are informed autobiographically as "growing words," with no rules defining their use. The significance of "love" to an individual is created through personal history, such that sophisticated understanding is only constructed following a lifetime of experience. "Corona" is perhaps a growing word; we cannot yet grasp its meaning in the face of cólera (passion) and pati (suffering) informing our collective traumatic script. Psychiatrists should aim to focus on the positive forms of feeling emerging during the pandemic, in order to be better equipped to meet the impending "second wave" of mental health complications.

Risk factors for Gleason Score upgrading following radical prostatectomy.

INTRODUCTION: Gleason Score discordance can confound optimal treatment allocation of patients diagnosed with prostate cancer and place these patients at risk of worse oncological outcomes. Its prevalence remains endemic; its exact causation remains unknown. The objective of this review was to examine the observational studies of patient cohorts who have undergone radical prostatectomy with the aim of identifying any preoperative variables that may be associated with an upgrade in final prostatectomy Gleason Score. EVIDENCE ACQUISITION: A non-systematic review of English articles from 2010 to present was performed through a MEDLINE search. Search terms included "Gleason Score," "pathological," "upgrade," and "radical prostatectomy." EVIDENCE SYNTHESIS: All studies included for review were retrospective analyses of radical prostatectomy series that examined factors associated with Gleason Score discordance. CONCLUSIONS: The various studies found that Gleason Score upgrading remains highly prevalent, and that some association can be seen with greater percent positive cores, longer biopsy core lengths, smaller prostate glands, higher percent tumor volume per gland, prostate-specific antigen density and visible lesions on multiparametric magnetic resonance imaging.

Predicting the risk of positive surgical margins following robotic-assisted radical prostatectomy.

INTRODUCTION: The number of men receiving radical prostatectomy (RP) in Victoria, Australia, increased seven-fold in the period 1993-2010, and increasingly robotic-assisted radical prostatectomy (RARP) is being utilized over the open and laparoscopic approaches. The longer-term oncological outcomes of RARP are beginning to be reported in the literature. The objective of this review was to determine whether any preoperative variables may be associated with the occurrence of positive surgical margins (PSMs) following RARP and how these may translate into subsequent risk of biochemical recurrence (BCR). EVIDENCE ACQUISITION: A systematic review of English articles from 2005 to present was performed through a MEDLINE search. Search terms included "positive surgical margins", "biochemical recurrence", "radical prostatectomy" and "prostate cancer". EVIDENCE SYNTHESIS: All studies included for review were retrospective analyses of series that reported on rates of PSM and BCR achieved with RARP, and considered potential factors that may influence the rates observed. CONCLUSIONS: RARP appears to confer lower rates of PSM when compared to the established approaches. Recent reports included in this review indicate that RARP should be able to provide excellent oncological outcomes as a result.

What Are the Predictive Factors for Gleason Score Upgrade following RP?

The Gleason score is one of a number of factors used in staging patients diagnosed with prostate cancer and in determining the treatment path such patients will ultimately follow. However, discrepancies in the Gleason scores obtained through biopsy compared with the final pathological staging of specimens following radical prostatectomy are not uncommon. Incorrect Gleason scoring can potentially influence treatment decisions and therefore, it is imperative that research is undertaken to elucidate factors that may be able to predict whether a patient's Gleason score might need to be reconsidered. A literature review was undertaken in late 2014 to highlight some of these factors that require further investigation.

Ingenol mebutate: a succinct review of a succinct therapy.

BACKGROUND: Ingenol mebutate is a newly approved topical field therapy for actinic keratosis (AK). It has a dual mechanism of action comprising of a rapid induction of necrosis that specifically targets dysplastic cells, as well as neutrophil-mediated immunostimulatory effects. Such a dual mechanism allows for this agent to clear AK lesions in as little as two to three daily applications, thus providing for improved treatment outcomes and patient satisfaction. REVIEW: Given that this is a new dermatologic therapy, this review summarizes the key literature surrounding this agent. This review covers the indications for use, mechanisms of action, method of administration, efficacy and safety profile and important drug interactions of ingenol mebutate. CONCLUSIONS: Ingenol mebutate should be considered a highly relevant field therapy for AK and the prevention of progression to squamous cell carcinoma.

Sarcopenia: describing rather than defining a condition.

BACKGROUND: Traditional definitions of sarcopenia have described an aging-associated disorder roughly defined as muscle mass two standard deviations below the young adult demographic. In an effort to clear the ambiguity pertaining to such descriptions, two international bodies have put forth working definitions of sarcopenia, namely The Society of Sarcopenia, Cachexia and Wasting Disorders in 2011, and The European Working Group on Sarcopenia in Older People in 2009. REVIEW: This paper will look at the current zeitgeist of sarcopenia through a range of studies and will argue that what we have is an amalgamated and often conflicted description, rather than a definition, of the sarcopenic condition. Herein, we will consider whether such descriptions of sarcopenia should center on the consideration of the neuromuscular junction (NMJ) rather than describing the condition more in terms of muscular pathology. CONCLUSION: Consideration was given to studies of the NMJ to advance the idea that present notions of the sarcopenic condition are incomplete and that at its' core, sarcopenia is an age-related disorder of the NMJ.

HIV vaccine development: an exploratory review of the trials and tribulations.

While advances have been made in some areas, more often than not attempts at vaccine development against the human immunodeficiency virus only serve to highlight gaps in our knowledge of host immunity. While numerous approaches have been explored, to control infection, an HIV vaccine will need to be able to induce production of neutralizing antibodies and a cytotoxic T cell response in order to prevent the formation of the CD4+ T cell viral reservoir. However, challenges still remain for the development of an HIV vaccine. Incomplete knowledge of host immunity lies at the core of the tribulations lying in the face of effective vaccine development.