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Scarpa, M., Scarpa, M., Castagliuolo, I., Erroi, F., Kotsafti, A., Basato, S., et al. (2016). Aberrant gene methylation in non-neoplastic mucosa as a predictive marker of ulcerative colitis-associated CRC. Oncotarget, 7(9), 10322–10331.
Abstract: UNLABELLED: BACKGROUND PROMOTER: hypermethylation plays a major role in cancer through transcriptional silencing of critical genes. The aim of our study is to evaluate the methylation status of these genes in the colonic mucosa without dysplasia or adenocarcinoma at the different steps of sporadic and UC-related carcinogenesis and to investigate the possible role of genomic methylation as a marker of CRC. RESULTS: The expression of Dnmts 1 and 3A was significantly increased in UC-related carcinogenesis compared to non inflammatory colorectal carcinogenesis. In non-neoplastic colonic mucosa, the number of methylated genes resulted significantly higher in patients with CRC and in those with UC-related CRC compared to the HC and UC patients and patients with dysplastic lesion of the colon. The number of methylated genes in non-neoplastic colonic mucosa predicted the presence of CRC with good accuracy either in non inflammatory and inflammatory related CRC. METHODS: Colonic mucosal samples were collected from healthy subjects (HC) (n = 30) and from patients with ulcerative colitis (UC) (n = 29), UC and dysplasia (n = 14), UC and cancer (n = 10), dysplastic adenoma (n = 14), and colon adenocarcinoma (n = 10). DNA methyltransferases-1, -3a, -3b, mRNA expression were quantified by real time qRT-PCR. The methylation status of CDH13, APC, MLH1, MGMT1 and RUNX3 gene promoters was assessed by methylation-specific PCR. CONCLUSIONS: Methylation status of APC, CDH13, MGMT, MLH1 and RUNX3 in the non-neoplastic mucosa may be used as a marker of CRC: these preliminary results could allow for the adjustment of a patient's surveillance interval and to select UC patients who should undergo intensive surveillance.
Keywords: Adenocarcinoma/*genetics/pathology; Adenomatous Polyposis Coli Protein/genetics; Adolescent; Adult; Aged; Biomarkers, Tumor/*genetics; Cadherins/genetics; Carcinogenesis/genetics; Colitis, Ulcerative/*genetics/pathology; Colon/*pathology; Colonic Neoplasms/*genetics/pathology; Core Binding Factor Alpha 3 Subunit/genetics; DNA (Cytosine-5-)-Methyltransferase/biosynthesis/genetics; DNA Methylation/*genetics; DNA Modification Methylases/genetics; DNA Repair Enzymes/genetics; Female; Humans; Intestinal Mucosa/*pathology; Male; Middle Aged; MutL Protein Homolog 1/genetics; Promoter Regions, Genetic/genetics; RNA, Messenger/biosynthesis; Tumor Suppressor Proteins/genetics; Young Adult; Apc; biomarker; colorectal cancer; promoter methylation; ulcerative colitis
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Rosenbluth, G., Garritson, S., Green, A. L., Milev, D., Vidyarthi, A. R., Auerbach, A. D., et al. (2016). Achieving Hand Hygiene Success With a Partnership Between Graduate Medical Education, Hospital Leadership, and Physicians. Am J Med Qual, 31(6), 577–583.
Abstract: Engaging physicians in hand hygiene programs is a challenge faced by many academic medical centers. Partnerships between education and academic leaders present opportunities for effective collaboration and improvement. The authors developed a robust hand hygiene quality improvement program, with attention to rapid-cycle improvements, including all levels of staff and health care providers. The program included a defined governance structure, clear data collection process, educational interventions, rapid-cycle improvements, and financial incentive for staff and physicians (including residents and fellows). Outcomes were measured on patients in all clinical areas. Run charts were used to document compliance in aggregate and by subgroups throughout the project duration. Institutional targets were achieved and then exceeded, with sustained hand hygiene compliance >90%. Physician compliance lagged behind aggregate compliance but ultimately was sustained at a level exceeding the target. Successfully achieving the institutional goal required collaboration among all stakeholders. Physician-specific data and physician champions were essential to drive improvement.
Keywords: hand hygiene; infection control; quality improvement; residents and fellows
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Carkovic, A. B., Calcagni, M. S., Vega, A. S., Coquery, M., Moya, P. M., Bonilla, C. A., et al. (2016). Active and legacy mining in an arid urban environment: challenges and perspectives for Copiapo, Northern Chile. Environ Geochem Health, 38(4), 1001–1014.
Abstract: Urban expansion in areas of active and legacy mining imposes a sustainability challenge, especially in arid environments where cities compete for resources with agriculture and industry. The city of Copiapo, with 150,000 inhabitants in the Atacama Desert, reflects this challenge. More than 30 abandoned tailings from legacy mining are scattered throughout its urban and peri-urban area, which include an active copper smelter. Despite the public concern generated by the mining-related pollution, no geochemical information is currently available for Copiapo, particularly for metal concentration in environmental solid phases. A geochemical screening of soils (n = 42), street dusts (n = 71) and tailings (n = 68) was conducted in November 2014 and April 2015. Organic matter, pH and elemental composition measurements were taken. Notably, copper in soils (60-2120 mg/kg) and street dusts (110-10,200 mg/kg) consistently exceeded international guidelines for residential and industrial use, while a lower proportion of samples exceeded international guidelines for arsenic, zinc and lead. Metal enrichment occurred in residential, industrial and agricultural areas near tailings and the copper smelter. This first screening of metal contamination sets the basis for future risk assessments toward defining knowledge-based policies and urban planning. Challenges include developing: (1) adequate intervention guideline values; (2) appropriate geochemical background levels for key metals; (3) urban planning that considers contaminated areas; (4) cost-effective control strategies for abandoned tailings in water-scarce areas; and (5) scenarios and technologies for tailings reprocessing. Assessing urban geochemical risks is a critical endeavor for areas where extreme events triggered by climate change are likely, as the mud flooding that impacted Copiapo in late March 2015.
Keywords: Chile; *Cities; Desert Climate; Dust/analysis; Environmental Monitoring/statistics & numerical data; Metallurgy; Metals, Heavy/*analysis; *Mining; Soil/chemistry; Soil Pollutants/*analysis; Heavy metals; Mining tailings; Risk assessment; Soils; Street dust; Urban geochemistry
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Cochereau, J., Herbet, G., Rigau, V., & Duffau, H. (2016). Acute progression of untreated incidental WHO Grade II glioma to glioblastoma in an asymptomatic patient. J Neurosurg, 124(1), 141–145.
Abstract: WHO Grade II glioma (low-grade glioma [LGG]) is increasingly diagnosed as an incidental finding in patients undergoing MRI for many conditions. Recent data have demonstrated that such incidental LGGs are progressive tumors that undergo clinical transformation and ultimately become malignant. Although asymptomatic LGG seems to represent an earlier step in the natural course of a glioma than the symptomatic LGG, it is nonetheless impossible to predict at the individual level when the tumor will become malignant. The authors report the case of a 43-year-old woman with a right operculo-insular LGG that was incidentally diagnosed because of headaches. No treatment was proposed, and repeated MRI scans were performed for 6 years in another institution. Due to a slow but continuous growth of the lesion, the patient was finally referred to our center to undergo surgery. Interestingly, objective calculation of the velocity of the tumor's diametric expansion demonstrated a sudden acceleration of the growth rate within the 5 months preceding surgery, with the development of contrast enhancement. Remarkably, the patient was still asymptomatic. An awake resection was performed with intraoperative electrical mapping. There was no functional worsening following surgery, as assessed on postoperative neuropsychological examination. Removal of 92% of signal abnormality on FLAIR MRI was achieved, with complete resection of the area of contrast enhancement. Neuropathological examination revealed a glioblastoma, and the patient was subsequently treated with concomitant radiotherapy and chemotherapy. Although a “wait and see” attitude has been advocated by some authors with respect to incidental LGG, our original case demonstrates that acute transformation to glioblastoma may nonetheless occur, even before the onset of any symptoms. Therefore, because the lack of symptoms does not protect from malignant transformation, we propose consideration of earlier resection in a more systematic manner in cases of incidental LGG.
Keywords: Adult; Brain Neoplasms/*pathology/psychology/surgery; Disease Progression; Female; Glioblastoma/*pathology/psychology/surgery; Glioma/*pathology/psychology/surgery; Headache/etiology; Humans; Magnetic Resonance Imaging; Neuropsychological Tests; Neurosurgical Procedures/methods; Treatment Outcome; Watchful Waiting; EOR = extent of resection; FLAIR = fluid attenuation inversion recovery; LGG = low-grade glioma; WHO = World Health Organization; iLGG = incidental LGG; incidental tumor; low-grade glioma; malignant transformation; oncology; surgery
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Mantha, A., Coggins, N. L., Mahadevan, A., Strehlow, R. N., Strehlow, M. C., & Mahadevan, S. V. (2016). Adaptive leadership curriculum for Indian paramedic trainees. Int J Emerg Med, 9(1), 9.
Abstract: BACKGROUND: Paramedic trainees in developing countries face complex and chaotic clinical environments that demand effective leadership, communication, and teamwork. Providers must rely on non-technical skills (NTS) to manage bystanders and attendees, collaborate with other emergency professionals, and safely and appropriately treat patients. The authors designed a NTS curriculum for paramedic trainees focused on adaptive leadership, teamwork, and communication skills critical to the Indian prehospital environment. METHODS: Forty paramedic trainees in the first academic year of the 2-year Advanced Post-Graduate Degree in Emergency Care (EMT-paramedic equivalent) program at the GVK-Emergency Management and Research Institute campus in Hyderabad, India, participated in the 6-day leadership course. Trainees completed self-assessments and delivered two brief video-recorded presentations before and after completion of the curriculum. RESULTS: Independent blinded observers scored the pre- and post-intervention presentations delivered by 10 randomly selected paramedic trainees. The third-party judges reported significant improvement in both confidence (25 %, p < 0.01) and body language of paramedic trainees (13 %, p < 0.04). Self-reported competency surveys indicated significant increases in leadership (2.6 vs. 4.6, p < 0.001, d = 1.8), public speaking (2.9 vs. 4.6, p < 0.001, d = 1.4), self-reflection (2.7 vs. 4.6, p < 0.001, d = 1.6), and self-confidence (3.0 vs. 4.8, p < 0.001, d = 1.5). CONCLUSIONS: Participants in a 1-week leadership curriculum for prehospital providers demonstrated significant improvement in self-reported NTS commonly required of paramedics in the field. The authors recommend integrating focused NTS development curriculum into Indian paramedic education and further evaluation of the long term impacts of this adaptive leadership training.
Keywords: International emergency medicine; Interpersonal skills; Prehospital education
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