Abstract Familial forms of monoclonal gammopathy, defined as multiple myeloma (MM) or Monoclonal Gammopathy of Undetermined Significance (MGUS), are relatively infrequent and most series reported in ...the literature describe a limited number of families. MM rarely occurs in a familial context. MGUS is observed much more commonly, which can in some cases evolve toward full‐blown MM. Although recurrent cytogenetic abnormalities have been described in tumor cells of sporadic cases of MM, the pathogenesis of familial MM remains largely unexplained. In order to identify genetic factors predisposing to familial monoclonal gammopathy, the Intergroupe Francophone du Myélome identified 318 families with at least two confirmed cases of monoclonal gammopathy. There were 169 families with parent/child pairs and 164 families with cases in at least two siblings, compatible with an autosomal transmission. These familial cases were compared with sporadic cases who were matched for age at diagnosis, sex and immunoglobulin isotype, with 10 sporadic cases for each familial case. The gender distribution, age and immunoglobulin subtypes of familial cases were unremarkable in comparison to sporadic cases. With a median follow‐up of 7.4 years after diagnosis, the percentage of MGUS cases having evolved to MM was 3%. The median overall survival of the 148 familial MM cases was longer than that of matched sporadic cases, with projected values of 7.6 and 16.1 years in patients older and younger than 65 years, respectively. These data suggest that familial cases of monoclonal gammopathy are similar to sporadic cases in terms of clinical presentation and carry a better prognosis.
Abstract Background The association between SARS-CoV-2 commercial serological assays and virus neutralization test (VNT) has been poorly explored in mild patients with COVID-19. Methods 439 serum ...specimens were longitudinally collected from 76 healthcare workers with RT-PCR-confirmed COVID-19. The clinical sensitivity (determined weekly) of 9 commercial serological assays were evaluated. Clinical specificity was assessed using 69 pre-pandemic sera. Correlation, agreement, and concordance with the VNT were also assessed on a subset of 170 samples. Area under the ROC curve (AUC) was estimated at 2 neutralizing antibody titers. Results The Wantai Total Ab assay targeting the receptor binding domain (RBD) within the S protein presented the best sensitivity at different times during the course of disease. The clinical specificity was greater than 95% for all tests except for the Euroimmun IgA assay. The overall agreement with the presence of neutralizing antibodies ranged from 62.2% (95%CI; 56.0–68.1) for bioMérieux IgM to 91.2% (87.0–94.2) for Siemens. The lowest negative percent agreement (NPA) was found with the Wantai Total Ab assay (NPA 33% (21.1–48.3)). The NPA for other total Ab or IgG assays targeting the S or the RBD was 80.7% (66.7–89.7), 90.3% (78.1–96.1), and 96.8% (86.8–99.3) for Siemens, bioMérieux IgG, and DiaSorin, respectively. None of the commercial assays have sufficient performance to detect a neutralizing titer of 80 (AUC < 0.76). Conclusions Although some assays show a better agreement with VNT than others, the present findings emphasize that commercialized serological tests, including those targeting the RBD, cannot substitute a VNT for the assessment of functional antibody response.
The water footprint of humanity Hoekstra, Arjen Y.; Mekonnen, Mesfin M.
Proceedings of the National Academy of Sciences - PNAS,
02/2012, Letnik:
109, Številka:
9
Journal Article
Recenzirano
Odprti dostop
This study quantifies and maps the water footprint (WF) of humanity at a high spatial resolution. It reports on consumptive use of rainwater (green WF) and ground and surface water (blue WF) and ...volumes of water polluted (gray WF). Water footprints are estimated per nation from both a production and consumption perspective. International virtual water flows are estimated based on trade in agricultural and industrial commodities. The global annual average WF in the period 1996-2005 was 9,087 Gm³ /y (74% green, 11% blue, 15% gray). Agricultural production contributes 92%. About one-fifth of the global WF relates to production for export. The total volume of international virtual water flows related to trade in agricultural and industrial products was 2,320 Gm³ /y (68% green, 13% blue, 19% gray). The WF of the global average consumer was 1,385 m³ /y. The average consumer in the United States has a WF of 2,842 m³ /y, whereas the average citizens in China and India have WFs of 1,071 and 1,089 m³ /y, respectively. Consumption of cereal products gives the largest contribution to the WF of the average consumer (27%), followed by meat (22%) and milk products (7%). The volume and pattern of consumption and the WF per ton of product of the products consumed are the main factors determining the WF of a consumer. The study illustrates the global dimension of water consumption and pollution by showing that several countries heavily rely on foreign water resources and that many countries have significant impacts on water consumption and pollution elsewhere.
Prior efforts to characterize disparities in radiation therapy access and receipt have not comprehensively investigated interplay between race, socioeconomic status, and geography relative to ...oncologic outcomes. This study sought to define these complex relationships at the US county level for prostate cancer (PC) and invasive breast (BC) cancer to build a tool that facilitates identification of “radiotherapy deserts”—regions with mismatch between radiation therapy resources and oncologic need.
An ecologic study model was constructed using national databases to evaluate 3,141 US counties. Radiation therapy resources and use densities were operationalized as physicians to persons at risk (PPR) and use to persons at risk (UPR): the number of attending radiation oncologists and Medicare beneficiaries per 100,000 persons at risk, respectively. Oncologic need was defined by “hot zone” counties with ≥2 standard deviations (SDs) above mean incidence and death rates. Univariable and multivariable logistic regressions examined links between PPR and UPR densities, epidemiologic variables, and hot zones for oncologic outcomes. Statistics are reported at a significance level of P < .05.
The mean (SD) PPR and UPR densities were 2.1 (5.9) and 192.6 (557.6) for PC and 1.9 (5.3) and 174.4 (501.0) for BC, respectively. Counties with high PPR and UPR densities were predominately metropolitan (odds ratio OR, 2.9-4.4), generally with a higher percentage of Black non-Hispanic constituents (OR, 1.5-2.3). Incidence and death rate hot zones were largely nonmetropolitan (OR, 0.3-0.6), generally with a higher percentage of Black non-Hispanic constituents (OR, 3.2-6.3). Lower PPR density was associated with death rate hot zones for both types of cancer (OR, 0.8-0.9); UPR density was generally not linked to oncologic outcomes on multivariable analysis.
The study found that mismatch between oncologic need with PPR and UPR disproportionately affects nonmetropolitan communities with a higher percentage of Black non-Hispanic constituents. An interactive web platform (bit.ly/densitymaps) was developed to visualize “radiotherapy deserts” and drive targeted investigation of underlying barriers to care in areas of highest need, with the goal of reducing health inequities in this context.
The representation of minorities among medical students has increased over the past two decades, but diversity among orthopaedic residents lags behind. This phenomenon has occurred despite a recent ...focus by the American Academy of Orthopaedic Surgeons on the recruitment of minorities and women.
To analyze the impact of recent efforts on diversity in orthopaedic residents in comparison with other surgical specialties from 2006 to 2015.
Data from the American Association of Medical Colleges on residents in surgical specialty programs in the years 2006 to 2015 were analyzed. Linear regression models were used to estimate trends in diversity among orthopaedic residents and residents in other surgical specialties. A mixed model analysis of variance was used to compare rates of diversification among different specialties over time.
Female representation in orthopaedic programs increased from 10.9% to 14.4% between 2006 and 2015. However, the rate of increase was significantly lower compared with other specialties (all P < 0.05) studied, except for urology (P = 0.64). Minority representation in orthopaedics averaged 25.6% over the 10-year period. Residents of Hispanic origin in orthopaedic programs increased (P = 0.0003) but decreased for Native Hawaiian/Pacific Islander (P < 0.0001). During the same period, white representation increased (P = 0.004). No significant changes were found in African Americans or Asian American representation. Diversity decreased among orthopaedic residents over the period studied (P = 0.004).
Recruitment efforts have not reversed the sex, racial, and ethnic disparities in orthopaedic residents. Orthopaedics has the lowest representation of women and minorities among residencies studied. The rate of increase in women lags behind all surgical subspecialties, except for urology.
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