Leishmaniasis is a neglected tropical disease that affects 12 million people worldwide. The disease has high morbidity and mortality rates and is prevalent in over 80 countries, leaving more than 300 ...million people at risk of infection. Of all of the manifestations of this disease, cutaneous leishmaniasis (CL) is the most common form and it presents as ulcerating skin lesions that can self-heal or become chronic, leading to disfiguring scars. This review focuses on the different pathologies and disease manifestations of CL, as well as their varying degrees of severity. In particular, this review will discuss self-healing localized cutaneous leishmaniasis (LCL), leishmaniasis recidivans (LR), mucocutaneous leishmaniasis (MCL), anergic diffuse cutaneous leishmaniasis (ADCL), disseminated leishmaniasis (DL), and Post Kala-azar Dermal Leishmaniasis (PKDL), which is a cutaneous manifestation observed in some visceral leishmaniasis (VL) patients after successful treatment. The different clinical manifestations of CL are determined by a variety of factors including the species of the parasites and the host's immune response. Specifically, the balance between the pro and anti-inflammatory mediators plays a vital role in the clinical presentation and outcome of the disease. Depending upon the immune response,
infection can also transition from one form of the disease to another. In this review, different forms of cutaneous
infections and their immunology are described.
•Weekly cyanobacterial occurrence has been quantified for 2000 lakes across the US.•Satellite data confirmed a well-established pattern peaking in late summer.•In the southeast US, occurrence peaked ...in the winter rather than the summer.
Cyanobacterial harmful algal blooms are the most common form of harmful algal blooms in freshwater systems throughout the world. However, in situ sampling of cyanobacteria in inland lakes is limited both spatially and temporally. Satellite data has proven to be an effective tool to monitor cyanobacteria in freshwater lakes across the United States. This study uses data from the European Space Agency Envisat MEdium Resolution Imaging Spectrometer and the Sentinel-3 Ocean and Land Color Instrument to provide a national overview of the percentage of lakes experiencing a cyanobacterial bloom on a weekly basis for 2008–2011, 2017, and 2018. A total of 2321 lakes across the contiguous United States were included in the analysis. We examined four different thresholds to define when a waterbody is classified as experiencing a bloom. Across these four thresholds, we explored variability in bloom percentage with changes in seasonality and lake size. As a validation of algorithm performance, we analyzed the agreement between satellite observations and previously established ecological patterns, although data availability in the wintertime limited these comparisons on a year-round basis. Changes in cyanobacterial bloom percentage at the national scale followed the well-known temporal pattern of freshwater blooms. The percentage of lakes experiencing a bloom increased throughout the year, reached a maximum in fall, and decreased through the winter. Wintertime data, particularly in northern regions, were consistently limited due to snow and ice cover. With the exception of the Southeast and South, regional patterns mimicked patterns found at the national scale. The Southeast and South exhibited an unexpected pattern as cyanobacterial bloom percentage reached a maximum in the winter rather than the summer. Lake Jesup in Florida was used as a case study to validate this observed pattern against field observations of chlorophyll a. Results from this research establish a baseline of annual occurrence of cyanobacterial blooms in inland lakes across the United States. In addition, methods presented in this study can be tailored to fit the specific requirements of an individual system or region.
Uterine carcinosarcoma (UCS) is a rare type of high-grade endometrial cancer (EC) that has been understudied with population-based statistics due to its rarity. This study examined temporal trends in ...the proportion of UCS among women with EC.
This is a retrospective observational study examining The Surveillance, Epidemiology, and End Results program between 1973-2013. Primary EC cases were eligible for analysis, and a time-specific proportion of UCS was examined during the study period.
UCS was seen in 11,000 (4.7%) women among 235,849 primary EC cases. Mean age at UCS diagnosis increased from 65.9 to 71.7 years between 1973-1989 and then decreased from 71.7 to 67.0 years between 1989-2013 (both, p<0.001). Proportion of Black women significantly increased during the study period (11.9%-20.0%, p<0.001), whereas the proportion of White women decreased from 86.0% to 60.5% between 1987-2013 (p<0.001). There was a significant increase in the proportion of UCS among primary EC from 1.7% to 5.6% between 1973-2013 (p<0.001). Among type II ECs (n=76,118), the proportion of UCS also increased significantly from 6.0% to 17.5% between 1973-2013 (p<0.001). An increasing proportion of UCS was seen in both young and older women but the magnitude of interval increase was larger in the older age group between 1973-2013 (<60 years, from 1.3% to 3.3%. p<0.001; and ≥60 years, from 2.6% to 7.0%, p<0.001).
Our study demonstrated that the proportion of UCS has significantly increased among EC, accounting for more than 5% in recent years.
The role of acetylsalicylic acid (aspirin) as a chemo-preventive and adjuvant therapeutic agent for cancers is generating attention. Mounting evidence indicates that aspirin reduces the incidence and ...mortality of certain obesity-related cancers, particularly colorectal cancer. In endometrial cancer, previous studies examining the effect of aspirin remain inconsistent as to the reduction in the risk of endometrial cancer. While some evidence indicates protective effects in obese women, other studies have showed a potential deleterious effect of these medications on endometrial cancer outcomes. However, exposure measurement across studies has been inconsistent in recording dose, duration, and frequency of use; thus making comparisons difficult. In this article, we review the evidence for the association between endometrial cancer and obesity, the pharmacological differences between regular- and low-dose aspirin, as well as the potential anti-tumor mechanism of aspirin, supporting a possible therapeutic effect on endometrial cancer. A proposed mechanism behind decreased cancer mortality in endometrial cancer may be a result of inhibition of metastasis via platelet inactivation and possible prostaglandin E2 suppression by aspirin. Additionally, aspirin use in particular may have a secondary benefit for obesity-related comorbidities including cardiovascular disease in women with endometrial cancer. Although aspirin-related bleeding needs to be considered as a possible adverse effect, the benefits of aspirin therapy may exceed the potential risk in women with endometrial cancer. The current evidence reviewed herein has resulted in conflicting findings regarding the potential effect on endometrial cancer outcomes, thus indicating that future studies in this area are needed to resolve the effects of aspirin on endometrial cancer survival, particularly to identify specific populations that might benefit from aspirin use.
•Aspirin has been shown to have chemo-preventive effects on colorectal cancer.•Aspirin can suppress platelet activation.•Aspirin can indirectly inhibit prostaglandin E2, an obesity-related inflammatory marker.•Aspirin may improve the survival of women with endometrial adenocarcinoma.•Effects of aspirin on endometrial cancer risk and survival is conflicting.
Cyanobacterial harmful algal blooms (cyanoHAB) cause human and ecological health problems in lakes worldwide. The timely distribution of satellite-derived cyanoHAB data is necessary for adaptive ...water quality management and for targeted deployment of water quality monitoring resources. Software platforms that permit timely, useful, and cost-effective delivery of information from satellites are required to help managers respond to cyanoHABs. The Cyanobacteria Assessment Network (CyAN) mobile device application (app) uses data from the European Space Agency Copernicus Sentinel-3 satellite Ocean and Land Colour Instrument (OLCI) in near real-time to make initial water quality assessments and quickly alert managers to potential problems and emerging threats related to cyanobacteria. App functionality and satellite data were validated with 25 state health advisories issued in 2017. The CyAN app provides water quality managers with a user-friendly platform that reduces the complexities associated with accessing satellite data to allow fast, efficient, initial assessments across lakes.
•Cyanobacterial blooms (CyanoHAB) are a human and ecological health concern.•CyanoHABs are infrequently monitored to provide needed management information.•The CyAN mobile app provides passive access to satellite data and basic analysis.•Quantitative comparison against 2017 state advisories demonstrated app capability.•CyAN app delivers spatial and temporal information on cyanobacteria concentration.
•Method using satellite data was developed to quantify cyanobacterial extent.•Temporal assessment was used to evaluate changes in cyanoHAB extent in inland waterbodies.•WHO recreational guidance ...levels for risk were used to categorize cyanoHABs.•Quantifies cyanoHAB extent across numerous waterbodies within an entire state.
Cyanobacterial harmful algal blooms (CyanoHAB) are thought to be increasing globally over the past few decades, but relatively little quantitative information is available about the spatial extent of blooms. Satellite remote sensing provides a potential technology for identifying cyanoHABs in multiple water bodies and across geo-political boundaries. An assessment method was developed using MEdium Resolution Imaging Spectrometer (MERIS) imagery to quantify cyanoHAB surface area extent, transferable to different spatial areas, in Florida, Ohio, and California for the test period of 2008 to 2012. Temporal assessment was used to evaluate changes in satellite resolvable inland waterbodies for each state of interest. To further assess cyanoHAB risk within the states, the World Health Organization’s (WHO) recreational guidance level thresholds were used to categorize surface area of cyanoHABs into three risk categories: low, moderate, and high-risk bloom area. Results showed that in Florida, the area of cyanoHABs increased largely due to observed increases in high-risk bloom area. California exhibited a slight decrease in cyanoHAB extent, primarily attributed to decreases in Northern California. In Ohio (excluding Lake Erie), little change in cyanoHAB surface area was observed. This study uses satellite remote sensing to quantify changes in inland cyanoHAB surface area across numerous water bodies within an entire state. The temporal assessment method developed here will be relevant into the future as it is transferable to the Ocean Land Colour Instrument (OLCI) on Sentinel-3A/3B missions.
Abstract Uterine tumor resembling ovarian sex-cord tumors (UTROSCT) is an extremely rare type of uterine tumor, and its clinical characteristics are not fully understood. A systematic literature ...search was conducted in PubMed and MEDLINE using the keywords, “uterine tumors resembling ovarian sex cord tumors”, limited to case reports. Clinico-pathological characteristics and survival data were abstracted and evaluated for the analysis. Among 43 cases reporting UTROSCT, Type I (endometrial stromal tumors with sex cord-like elements, ESTSCLE) and Type II (classic UTROSCT) were reported in 5 (11.6%) and 17 (39.5%), respectively, and nearly half of reported UTROSCT did not subcategorize the histology pattern into Type I or II (unspecified, n = 21, 48.8%). Mean age was 52.2. The two most common symptoms were postmenopausal vaginal bleeding (44.2%) and abnormal menstruation (39.5%). The majority underwent total hysterectomy with adnexectomy (65.1%) followed by hysterectomy alone (18.6%) and tumor resection alone (14.0%). Mean tumor size was 6.2 cm, and extra-uterine spread was seen in 7.0%. By immunohistochemistry, calretinin expression was significantly correlated with CAM5.2, inhibin, and progesterone receptor expression (all, p < 0.05). In survival analysis, disease-free survival (DFS) rates for all 43 cases at 1, 2, and 5 years for all cases were 97.0%, 92.7%, and 69.7%, respectively. Among recurrent cases, median time to recur was 24 months (range 9–48). Decreased DFS was significantly associated with pelvic pain (2-year rate, 81.8% versus 94.7%, p = 0.006), histology subcategory (Type I versus II, 23.8% versus 100%, p = 0.006), tumor size ≥10 cm (75.0% versus 100%, p = 0.046), cervical/extra-uterine metastasis (46.7% versus 100%, p = 0.024), and lymphovascular space involvement (50% versus 100%, p = 0.002). Treatment patterns were not statistically associated with DFS (hysterectomy, p = 0.28; and adnexectomy, p = 0.38). When histology patterns were examined, Type II disease was associated with less aggressive tumor behavior when compared to Type I disease: extra-uterine spread (Type I versus II, 40% versus 5.9%, p = 0.007) and lymphovascular space invasion (50% versus 6.7%, p = 0.012). Among 17 cases of Type II disease, disease recurrence was reported in 1 (5.9%) case at 3 years after the initial treatment. In conclusion, our study showed that UTROSCT was often not subcategorized. Because classic UTROSCT has a distinct clinical outcome and characteristic histological patterns when compared to ESTSCLE, distinguishing UTROSCT from ESTSCLE is an integral component of the diagnosis. While classic UTROSCT typically has a favorable prognosis, it has been known to develop a late recurrence. If risk factors for recurrence are absent, both hysterectomy and mass resection alone are possible options for management.
To examine incidences and risk factors for metachronous vulvar, vaginal, and anal malignancies after a cervical cancer diagnosis.
This is a retrospective study examining data from the Surveillance, ...Epidemiology, and End Result Program between 1973 and 2013. Cumulative incidences of vulvar, vaginal, and anal cancers after the diagnosis of cervical cancer were assessed (n = 79,050). Multivariable analysis was performed to determine independent risk factors for these metachronous cancers.
Vaginal cancer (20-year cumulative incidence, 0.57%) was the most common type of metachronous malignancy, followed by vulvar cancer (0.33%), and anal cancer (0.16%, P < 0.001). Median time to diagnosis was 5.4 years for vaginal cancer, 6.5 years for vulvar cancer, and 13.5 years for anal cancer. On multivariable analysis, metachronous vulvar cancer was associated with older age (hazard ratio HR per year 1.04, 95% confidence interval CI 1.02–1.05, P < 0.001), squamous histology (HR 2.64, 95%CI 1.38–5.05, P = 0.003), and radiotherapy use (HR 2.52, 95%CI 1.66–3.84, P < 0.001); metachronous vaginal cancer was associated with older age (HR per year 1.03, 95%CI 1.02–1.04, P < 0.001) and Black race (HR 1.73, 95%CI 1.20–2.48, P = 0.003); and metachronous anal cancer was associated with older age (HR 1.03, 95%CI 1.01–1.05, P = 0.017). Overall survival of metachronous cancer was poor (5-year rates: 46.3% for vulvar, 43.0% for vaginal, and 47.5% for anal cancer, respectively).
Although rare, the rate of ano-genital cancers continues to increase over time after a cervical cancer diagnosis. Long-term follow-up and surveillance after cervical cancer treatment is therefore reasonable to detect these metachronous malignancies, particularly in those with risk factors.
•Metachronous ano-genital cancers after cervical cancer were examined.•The risk of metachronous cancers steadily increases over time.•Risk factors include older age, Black race, squamous histology, and radiotherapy.•The survival of metachronous cancer is poor.
This retrospective observational study examined trends, characteristics, and survival of women with synchronous endometrial and ovarian cancer (SEOC) in the Surveillance, Epidemiology, and End ...Results Program between 1973 and 2013. Among 235,454 women with primary endometrial cancer, synchronous ovarian cancer was seen in 4,082 (1.7%) women with the proportion being decreased from 2.0% to 1.6% between 1983 and 2013 (
=0.049); and the proportion of concurrent endometrioid tumors in the two cancer sites has increased from 24.2% to 49.9% among SEOC women (
<0.001). When compared to endometrial cancer without synchronous ovarian cancer, endometrioid histology in the two cancer sites was associated with improved cause-specific survival while non-endometrioid histology in the ovarian cancer was associated with decreased cause-specific survival (adjusted-
<0.01). Among 110,063 women with primary epithelial ovarian cancer, synchronous endometrial cancer was seen in 3,940 (3.6%) women with the proportion being increased from 2.2% to 4.4% between 1973 and 2013 (
<0.001); and the proportion of concurrent endometrioid tumors in the two cancer sites had increased from 24.3% to 50.2% among SEOC women (
<0.001). When compared to primary epithelial ovarian cancer without synchronous endometrial cancer, SEOC was associated with better cause-specific survival if ovarian cancer is endometrioid type or if endometrial cancer is endometrioid type (adjusted-
<0.001). Across the two cohorts, the proportion of SEOC reached to the peak in the late-40 years of age and then decreased significantly (
<0.001). In conclusion, our study suggests that synchronous ovarian cancer has decreased among endometrial cancer whereas synchronous endometrial cancer has increased among epithelial ovarian cancer.
Monitoring lake biophysical water quality is a global challenge. Satellite remote sensing offers a technology for continuous water quality information in data poor regions throughout the United ...States. Quality assurance flag data are provided for the presence of snow/ice, land-adjacency, and unresolvable waterbodies supporting water quality derived measures from Envisat MEdium Resolution Imaging Spectrometer and Sentinel-3 Ocean and Land Colour Instrument for the continental United States. In addition, an updated Waterbody Data mask that contains valid waterbody and coastal ocean delineation is provided. The quality assurance flag datasets can benefit the scientific community in processing lake water quality throughout the contiguous United States by addressing errors from snow/ice, land adjacency, and land masking. The dataset presented here will be used in the development of national scale metrics for derived biophysical water quality in the US.
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