Objectives
Individuals with hoarding disorder are more likely to be overweight or obese than the general population for unknown reasons.
Methods
One hundred and twenty‐nine individuals (Hoarding ...Group: n = 63; Control Group: n = 66) completed self‐report measures and were offered snacks in a tidy and a cluttered environment in a counterbalanced order. Groups were based on the self‐reporting of high or low hoarding symptoms.
Results
The hoarding group reported being less able to use their kitchen and prepare food at home and experiencing more impulsivity, distress intolerance and problematic eating beliefs than did the control group. The hoarding group consumed more cookies in the tidy room, whereas the control group consumed more cookies in the cluttered room. Greater impulsivity, distress intolerance and problematic body and eating beliefs were related to greater cookie consumption for the hoarding group.
Conclusions
Early interventions that help individuals to tolerate distress and to engage in goal‐directed behaviour regardless of their emotional state may have benefits for both hoarding and eating behaviour. We encourage future researchers to examine this hypothesis.
Abstract Background Wire-localized breast biopsy (WLBB) remains the standard method for the surgical excision of nonpalpable breast lesions. Because of many of its shortcomings, most important a high ...microscopic positive margin rate, alternative approaches have been described, including radioactive seed localization (RSL). This review highlights the literature regarding RSL, including safety, the ease of the procedure, billing, and oncologic outcomes. Methods Medline and PubMed were searched using the terms “radioactive seed” and “breast.” All peer-reviewed studies were included in this review. Conclusions RSL is a promising approach for the resection of nonpalpable breast lesions. It is a reliable and safe alternative to WLBB. RSL is at least equivalent compared with WLBB in terms of the ease of the procedure, removing the target lesion, the volume of breast tissue excised, obtaining negative margins, avoiding a second operative intervention, and allowing for simultaneous axillary staging.
Objectives/Hypothesis
Balloon dilation (BD) represents a minimally invasive alternative to endoscopic sinus surgery (ESS). Although BD was introduced in 2006, distinct Current Procedural Terminology ...(CPT) codes were not available until 2011, making prior analysis of population‐based trends difficult. Our objectives were to evaluate these trends and compare any changes to the use of traditional ESS techniques. Geographic trends also were evaluated.
Methods
Medicare Part B national datasets encompassing procedures from 2011 to 2015 were obtained. ESS CPT codes (frontal sinusotomy, maxillary antrostomy with/without tissue removal, sphenoidotomy) and BD codes were searched to determine temporal trends in their use. Additionally, state carriers were individually evaluated for geographic trends.
Results
National use of BD increased greater than five‐fold (39,193 from 7,496 among Medicare patients), whereas the use of ESS increased by only 5.9%. This increase in BD was observed across all sites, including the sphenoid (7.0x), maxillary (5.1x), and frontal (4.7x) sinuses. In the most recent year for which data was available (2015), a significantly greater portion of sinus procedures in these sites utilized BD in the South (42.1%) compared to the Northeast (30.6%), West (29.5%), and Midwest (25.3%) regions (P < 0.0001).
Conclusion
The performance of BD has increased markedly in recent years. Because the use of ESS codes remain stable, observed BD trends are unlikely to be due simply to greater familiarity with newer CPT coding. The reasons for the striking increase in BD popularity are speculative and beyond the scope of this analysis, but further study may be needed.
Level of Evidence
NA. Laryngoscope, 128:1299–1303, 2018
Radioactive seed localization (RSL) is an alternative to wire localization. We compared the rate of positive margins for evidence of a learning curve in implementing RSL.
A retrospective review of ...RSL by three surgeons at a single institution from 2002 to 2016. Positive margins were defined as ink on tumor.
Surgeon experience with RSL for ranged from 142 to >500 cases. The positive margin rate among the first 100 of each surgeons' experience (n = 300) was 2.3% and the rate during the most recent up to 100 cases after experience with at least 100 RSL procedures (n = 242) was 4.1% (p = 0.32). Individual surgeon's positive margin rates ranged from 2 to 5% in the early experience and 2–7% in the later experience (p = NS).
RSL for breast conservation surgery has a low rate of positive margins even early in a surgeon's experience. Implementation of RSL can be done with no evidence of a learning curve.
Summary Background & aims There is a sparsity of data on the impact of cachexia on human muscle function. This study examined the relationship between cachexia, quality of life and the ...mass/function/mechanical quality of lower limb skeletal muscle in gastrointestinal cancer patients. Methods Quadriceps strength and lower limb power were measured in 54 patients with gastrointestinal cancer ( n = 24 ≥ 10% weight-loss) and 18 healthy controls. Quadriceps cross-sectional area was measured in 33/54 patients and in all controls using MRI. Muscle mechanical quality was defined as quadriceps strength/unit quadriceps cross-sectional area. Quality of life was assessed using the EORTC QLQ-C30. Patients with weight-loss ≥10% were classified as cachectic. Results In male cachectic patients, quadriceps strength ( p = 0.003), lower limb power ( p = 0.026), quadriceps cross-sectional area ( p = 0.019) and muscle quality ( p = 0.008) were reduced compared with controls. In female cachectic patients, quadriceps strength ( p = 0.001) and muscle quality ( p = 0.001) were reduced compared with controls. Physical function ( p = 0.013) and fatigue ( p = 0.004) quality of life scores were reduced in male cachectic compared with non-cachectic patients, but not in females. Conclusions Muscle quality is reduced in cancer patients. The degree of impairment of lower limb muscle mass, quality and function and the impact on quality of life varies with weight-loss and sex.
Nipple-sparing mastectomy (NSM) use is increasing. We investigated the relationships between body mass index (BMI), operative time (OT), and ischemic complications.
A single center, retrospective ...review was performed of NSMs from 2006 to 2018. Analysis included descriptive statistics, Wilcoxon rank-sum test and logistic regression.
Among 294 patients, 510 breast reconstructions were performed (216 bilateral). Median OTs in the prosthetic-based (266 patients, 90.5%) and autologous tissue groups (28 patients, 9.5%) were 266 and 529 min, respectively. Median OTs ranged from 236 to 358 min for those with BMI <20 and ≥ 40, respectively. Increasing BMI correlated with OT (r = 0.33, p < 0.001) and was associated with slightly higher odds of major NAC ischemic complications (OR = 1.09, p = 0.02).
Higher BMI is associated with up to 50% longer OT, but is not a contraindication to NSM with reconstruction. Surgeons should recognize increased time and resource utilization.
•BMI and operative time have a positive correlation for nipple-sparing mastectomy.•Higher BMI marginally increased risk of nipple-areola ischemic complications.•Longer operative time did not impact morbidity.•Other patient factors did not impact ischemic complications.
In this study we compared three different microbubble-based approaches to the delivery of a widely used chemotherapy drug, gemcitabine: (i) co-administration of gemcitabine and microbubbles (Gem+MB); ...(ii) conjugates of microbubbles and gemcitabine-loaded liposomes (GemlipoMB); and (iii) microbubbles with gemcitabine directly bound to their surfaces (GembioMB). Both in vitro and in vivo investigations were carried out, respectively, in the RT112 bladder cancer cell line and in a murine orthotopic muscle-invasive bladder cancer model. The in vitro (in vivo) ultrasound exposure conditions were a 1 (1.1) MHz centre frequency, 0.07 (1.0) MPa peak negative pressure, 3000 (20,000) cycles and 100 (0.5) Hz pulse repetition frequency. Ultrasound exposure produced no significant increase in drug uptake either in vitro or in vivo compared with the drug-only control for co-administered gemcitabine and microbubbles. In vivo, GemlipoMB prolonged the plasma circulation time of gemcitabine, but only GembioMB produced a statistically significant increase in cleaved caspase 3 expression in the tumor, indicative of gemcitabine-induced apoptosis.
Abstract Background Many surgical options exist for breast cancer, including breast conserving therapy (BCT), mastectomy with reconstruction (MAST+RECON) or without reconstruction (MAST). Long-term ...results regarding oncologic outcomes are few and primarily retrospective studies. Methods A retrospective review of a prospectively collected database of patients undergoing breast surgery for breast cancer from 2002 to 2014 was performed. Patients were separated into 3 time periods for analysis: 2002 to 2005, 2006 to 2009, and 2010 to 2014. Recurrence outcomes were compared at 4 years between MAST+RECON patients. Results Two thousand seventy-six patients were identified: 61.2% underwent BCT, 19.7% had MAST, and 19.1% had MAST+RECON. BCT patients were older and had smaller tumors. MAST+RECON increased in prevalence, whereas BCT decreased. Implant-based reconstruction and conservative mastectomy rates increased over the study period. Four-year local recurrence–free rates were similar in nipple-sparing and skin-sparing mastectomy groups. Conclusions BCT usage has decreased, trending toward immediate, nipple-sparing mastectomy, implant-based reconstruction. Surgeons should be aware of trends to optimally offer patients their surgical options.
Organisms on islands provide a revealing window into the process of adaptation. Populations that colonize islands often evolve substantial differences in body size from their mainland relatives. ...Although the ecological drivers of this phenomenon have received considerable attention, its genetic basis remains poorly understood. We use house mice (subspecies: Mus musculus domesticus) from remote Gough Island to provide a genetic portrait of rapid and extreme size evolution. In just a few hundred generations, Gough Island mice evolved the largest body size among wild house mice from around the world. Through comparisons with a smaller-bodied wild-derived strain from the same subspecies (WSB/EiJ), we demonstrate that Gough Island mice achieve their exceptional body weight primarily by growing faster during the 6 weeks after birth. We use genetic mapping in large F(2) intercrosses between Gough Island mice and WSB/EiJ to identify 19 quantitative trait loci (QTL) responsible for the evolution of 16-week weight trajectories: 8 QTL for body weight and 11 QTL for growth rate. QTL exhibit modest effects that are mostly additive. We conclude that body size evolution on islands can be genetically complex, even when substantial size changes occur rapidly. In comparisons to published studies of laboratory strains of mice that were artificially selected for divergent body sizes, we discover that the overall genetic profile of size evolution in nature and in the laboratory is similar, but many contributing loci are distinct. Our results underscore the power of genetically characterizing the entire growth trajectory in wild populations and lay the foundation necessary for identifying the mutations responsible for extreme body size evolution in nature.
In the subduction-related Catalina Schist, reaction zones or ‘rinds’ developed at contacts of metamorphosed mafic blocks with chemically distinct mélange matrix. These rinds exhibit complex chemical ...compositions that defy simple, single-process explanations. A comparison of high-grade and low-grade reaction rinds, including field observations, bulk-rock geochemistry, thin section textural observations, mineral compositional analyses, and thermodynamic modeling provides constraints on the nature and timing of the rind-forming processes. Bulk-rock variations in the highly siderophile elements (HSE, including Os, Ir, Ru, Pt, Pd and Re) and MgO, Cr, and Ni provide insight into the physical processes of mixing of ultramafic material of the mélange matrix, rich in these elements, with mafic material derived from the blocks. Enrichments in the concentrations of these elements are found in both low-grade and high-grade reaction rinds suggesting that the processes that enrich these elements and create the reaction rinds occur over a wide range of P–T conditions in subduction zones. Differences in the chemical composition of garnets in an amphibolite-grade metamafic block, compared with garnets in the associated reaction rind, suggest that at least some of the mixing occurred before the growth of garnet in the blocks, perhaps at P–T conditions different from those producing the garnet. Bulk-rock variations in elements commonly considered fluid-mobile, such as K2O, Ba and Rb, are observed in all reaction rinds. At high-grade, enrichments of K2O, Ba and Rb are associated with replacement of garnet and amphibole by phengite and chlorite. Because phengite is the major host for K, Ba and Rb, the addition of these elements by fluids appears to have been a post-garnet growth phenomenon. This study highlights the significance of processes of metasomatism and mechanical mixing in mélange zones for influencing the geochemical evolution of the slab–mantle interface. Any “fluids” (hydrous or silicate melts) emanating from subducting slabs and entering the mantle wedge and arc lava source regions would necessarily reflect the hybrid compositions created by these processes.
•Low and high-grade reaction rinds are enriched in HSE consistent with physical mixing of ultramafic with mafic material.•Rind garnets have different chemical compositions from block garnets; mixing occurred prior to garnet growth.•Enrichment of fluid-mobile LILE in rinds associated with mineral replacement textures involving LILE-rich minerals•Mélange capable of influencing the transfer of slab signal into arc source regions
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