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Objective: This cross-sectional study aimed to observe the occurrence of metabolic syndrome in untreated individuals with bipolar disorders. Methods: A total of 125 untreated individuals with bipolar disorders were collected as the study group, and 201 cases from the health examination centre of our hospital were selected as the control group. The participants enrolled were assessed for general demographic data, case characteristics, and metabolic indexes including body mass index (BMI), blood pressure, triglyceride, high-density lipoprotein-cholesterol, cholesterol, low-density lipoprotein-cholesterol, and fasting plasma glucose. Results: The incidence of metabolic syndrome in the bipolar disorders group was higher compared to the control group (9.6% VS. 8.5%). After calibrating sex and age data, a significant difference between the two groups was observed (P < 0.05). Diastolic and systolic blood pressure were higher in the bipolar disorders group compared to the control group (P < 0.01). Men with bipolar disorders had a higher risk of developing metabolic syndrome than women (14.5% vs. 5.8%). Bipolar disorders, sex, age, and BMI were identified as independent risk factors for metabolic syndrome. No significant difference was found in terms of metabolic index and incidence of metabolic syndrome between individuals with depressive episodes (n = 37) and manic episodes (n = 75). Conclusion: Patients with bipolar disorders were found to have a higher risk of developing metabolic syndrome than healthy individuals. Bipolar disorders, male sex, age, and BMI may contribute to an increased risk of developing metabolic syndrome. [ABSTRACT FROM AUTHOR]

Simple Summary: This study investigates predictors influencing the growth of untreated vestibular schwannomas, a common benign brain tumor. We aim to identify predictors of tumor growth, which is crucial for making informed treatment decisions. We reviewed numerous studies and analyzed variables such as age, gender, tumor size, location, symptoms, and MRI signal characteristics. The findings reveal that larger tumor size, extra-canalicular location, cystic components, and vestibular symptoms are associated with tumor growth. These insights can guide clinicians in identifying patients who may benefit from more aggressive monitoring or intervention, potentially improving outcomes for individuals with this condition. This research contributes to better understanding the variability in vestibular schwannoma (VS) growth and emphasizes the importance of personalized treatment strategies. The growth rate of sporadic VS varies considerably, posing challenges for consistent clinical management. This systematic review examines data on factors associated with VS growth, following a protocol registered in the PROSPERO database. The analysis reveals that key predictors of tumor growth include tumor location, initial size, and specific clinical symptoms such as hearing loss and imbalance. Additionally, several studies suggest that growth observed within the first year may serve as an indicator of subsequent progression, enabling the earlier identification of high-risk cases. Emerging factors such as the posture swing test and MRI signal intensity have also been identified as novel predictors that could further refine growth assessments. Our meta-analysis confirms that tumor location, initial size, cystic components, and vestibular symptoms are closely linked to the likelihood of VS growth. This review provides valuable guidance for clinicians in identifying patients who may require closer monitoring or early intervention. By integrating these predictive factors into clinical practice, this review supports more personalized treatment and contributes to the development of more accurate prognostic models for managing untreated sporadic VS. [ABSTRACT FROM AUTHOR]

Purpose: The impact of untreated medial meniscus posterior root (MMPR) tear (MMPRT) during opening‐wedge high tibial osteotomy (OWHTO) on patient‐reported outcomes (PROs) remains poorly understood. This retrospective cohort study aimed to investigate the association between the presence of MMPRT and post‐operative PROs in patients who underwent OWHTO. Methods: A total of 83 knees that underwent OWHTO that were followed up for 6.6 years were included. Post‐operative PROs were assessed using the knee injury and osteoarthritis outcome score (KOOS) subscales. Medial meniscus extrusion (MME) was measured by magnetic resonance imaging (MRI). MMPRT was diagnosed based on preoperative MRI and intraoperative arthroscopy findings. The participants were categorized into the MMPRT and MMPR intact (MMPRI) groups, and their KOOS subscales were compared. Additionally, logistic regression analysis was conducted to explore the correlation between KOOS and MMPRT presence. Results: In total, 29 out of 80 (36.3%) knees were classified into the MMPRT group, while three knees underwent total knee arthroplasty. Preoperative MME was 3.5 ± 1.9 (range 0–8.9) mm, showing correlation with the presence of MMPRT (p = 0.004) by regression analysis. The post‐operative KOOS subscales of the MMPRT group were lower than the MMPRI group for pain (p = 0.017), activities of daily living (ADLs) (p = 0.001), sports (p < 0.001) and quality of life (QOL) (p < 0.001). Additionally, regression analysis showed the presence of MMPRT was correlated with lower KOOS subscale scores for pain (p = 0.041), ADLs (p = 0.011), sports (p < 0.001) and QOL (p = 0.002). Conclusion: Preoperative MMPRT correlated with a reduction in mid‐term post‐operative PROs, as assessed using the KOOS, among patients who underwent OWHTO. Surgeons should consider addressing an MMPRT at the time of OWHTO. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Our objectives were to ascertain the following: (1) the prevalence and socioeconomic distribution of hypertension (HTN), undiagnosed for HTN, and untreated cases of HTN‐diagnosed individuals; (2) the relationship between SES and the prevalence of HTN, undiagnosed for HTN, and untreated for HTN; and (3) whether sex moderate this association. Data from the 2017–18 Bangladesh Demographic Health Survey were used. 11,776 participants who were 18 years of age or older responded to our analysis. The age‐adjusted prevalence of HTN, undiagnosed for HTN, and untreated cases was 25.1%, 57.2%, and 12.3%. Compared to females, males were less likely to have HTN but more likely to have undiagnosed HTN. People in the rich SES groups had a higher odd of (adjusted odds ratio [aoR] 1.25; 95% confidence interval [CI] 1.08–3.45) of having HTN compared to those in the poor SES group. When compared to individuals in the poor SES group, those in the rich SES group had lower odds of undiagnosed (aoR 0.57; 95% CI 0.44–0.74) and untreated (aoR 0.56; 95% CI 0.31–0.98) for HTN. Sex moderated the association between SES and HTN prevalence, which showed that men from rich SES were more likely to suffer from HTN than men from poor SES. According to this study, the government and other pertinent stakeholders should concentrate more on developing suitable policy measures to reduce the risk of HTN, particularly for men in rich socioeconomic groups. They should also concentrate on screening and diagnosing HTN in socioeconomically disadvantaged populations, regardless of sex. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Cirugia is the property of Sociedad de Cirujanos de Chile and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article explores the use of microbial methods to remove heavy metals from industrial effluent in the pharmaceutical industry. The effluent contains metallic cations that can contaminate the soil and food chain. Traditional treatments for metal-containing waste have limitations, so researchers are investigating alternative biological methods involving bacteria and bio surfactants. The article also presents a study on the effects of microbial treated and untreated tannery effluent on the growth of green gram. The study concludes that bacteria are effective in removing heavy metals from pharmaceutical effluent. [Extracted from the article]

Background: Most people with alcohol use disorder (AUD) do not use treatment services, yet the majority ultimately resolve their AUD. As the phenomenon of untreated recovery remains poorly understood, we investigated the strategies used for recovery without treatment. Methods: We conducted semi-structured interviews with 65 adults (27 women, 37 White) with resolved AUD and no history of using specialty services (e.g., inpatient or outpatient rehabilitation, medication-assisted treatment). Using both inductive and deductive coding, we identified and elaborated themes and meanings. We verified our findings through nine member-check sessions with interviewers and interview participants. Results: Majorities of interview participants met criteria for severe lifetime AUD (84.6%), were in long-term recovery (>5 years; 81.5%), and indicated abstinence was their recovery goal (56.9%). Close to half (41.5%) had attended mutual-help groups (e.g., Alcoholics Anonymous). We identified five active strategies (Changing Contexts, Social Connections. Activities, Substitution, and Other Strategies) and four additional factors (Mutual-help Groups, Self-Reliance, Spirituality, and Aging/Maturing) that contributed to their recovery. Most participants employed multiple strategies and were intentional in adopting the ones that best suited them. By far, the two most common strategies were Changing Contexts (reported by 69.2% of participants) whereby people reduced their alcohol exposure by modifying social networks or physical settings and relying on Social Connections (reported by 67.7%), especially connections to people with similar lived experiences and struggles. Notably, Social Connections and Mutual-Help groups were the themes most often discussed jointly. Among other contributing factors mentioned, Spirituality appeared to play an important, but not universal, role as it was invoked by approximately half (49.2%) of participants. Conclusions: Our study confirms that recovery without specialty treatment is possible, and that multiple strategies and contributing factors help to achieve it. These findings may inform novel interventions to support recovery among people unwilling or unable to obtain treatment for AUD. [ABSTRACT FROM AUTHOR]

Desecrate tire is the dominating waste from the resource of rubber. These wastages are profusion from the disposal of tire material that is increasing every year. Tire wastage shall raise environmental pollution thus to a never stop and continuous progress. Hence, efforts have been taken to identify the potential application of waste rubber tires in manufacturing projects. Manufacturing is one of the ways of utilizing waste tires to resolve this disposal problem. The waste tire is one of the best alternative materials for natural aggregate. Waste tire rubber may be utilized in a variety of ways in concrete, making it both cost-effective and ecologically benign. In this focus, our current aim plan is to rubberize the mortar ratio of 1:3 and M30 Grade of concrete to use waste tire rubber powder part replacement of sand. The Tire derivate aggregate (TDA) mortar and concrete is made from 80 mesh TDA, as a partial substitute for fine aggregates that have been pre-treated with KOH solution. Compressive strength is one of the mechanical qualities of cement mortar to be evaluated with various quantities of TDA. Waste tire powder replace with (0%, 3%, 6%, 9%, 12%, and 15%) by weight of sand are casted. Compressive strength is calculated after the proper curing period of 3, 7, and 28 days, and the permeability of concrete cubes are also estimated. The results show that up to 9% of KOH-treated waste tire powder gave high compressive strength and lower permeability. It is suggested to waste rubberized mortar using non-structural manufacturing activity. [ABSTRACT FROM AUTHOR]

Copyright of Erzincan University Journal of Science & Technology is the property of Erzincan Binali Yildirim Universitesi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this study is to analyze the phase separation that occurs between treated and untreated rubber crumb particles produced by wet processes in the laboratory. The percentage of replacement used for both the treated and untreated crumb rubber-modified asphalt (CRMA) was 5%, 10%, 15%, and 20%. Tests to evaluate binder properties were performed using a rotational viscometer and a DSR, and the following properties were determined—viscosity, G*/sinδ, % recovery, and Jnr. The phase separation study was analyzed using the viscosity and G*/sinδ results. In general, the results of the study show the following. (1) The treated CRMA binders had higher viscosity values than untreated CRMA binders, although some values could not be measured due to the high viscosity values. (2) The G*/sinδ, % recovery and Jnr results also had a similar trend with viscosity results. (3) The viscosity and G*/sinδ phase separation values demonstrate that treated CRMA binders perform better than untreated CRMA binders. (4) Different experimental methods have shown variations in the calculated SI value; hence, a more improved approach should be explored to accurately assess the storage stability of asphalt binders containing various additives. [ABSTRACT FROM AUTHOR]

The years 2021 and 2022 evolved differently from a climatic point of view, one being particularly rainy and the other being relatively dry. During this period, through the ERA-Net MERIAVINO project, studies were carried out on the Sauvignon blanc variety treated and untreated variants with phytosanitary protection substances regarding the degree of attack on the main diseases - Downy Mildew, Powdery Mildew and Gray Rot, along with determinations regarding stomatal conductance and sensor recordings for leaf humidity. The determinations that were made showed that the climatic factors, especially the precipitation and the relative humidity of the air have an uneven distribution during the vegetation period; determine the occurrence of cryptogamic diseases and have a great influence over the rate of extension of grapevine diseases (GA). In 2021, the degree of pathogen attack was higher compared to 2022, being directly correlated with the value of leaf humidity and also, the stomatal conductance determined for 4 days immediately after the appearance of the first symptoms of Plasmopara viticola and Botrytis cinerea infections recorded decreasing values. [ABSTRACT FROM AUTHOR]

Background: Duration of untreated psychosis (DUP) is an important modifiable factor affecting schizophrenia outcomes. A dearth of research in India on untreated versus treated schizophrenia warrants further research. Methods: This was a longitudinal study in a tertiary hospital over 2 years. Inpatients diagnosed with schizophrenia (N = 116), aged 18–45, were divided into untreated and treated groups. Diagnostic confirmation, severity assessment, and clinical outcome were done using ICD-10 criteria, Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI) scale. Follow-up was done at 12 and 24 weeks. DUP was measured, and its association with the outcome was assessed. Results: Final analysis included 100 patients, 50 each of previously untreated and treated. Untreated patients had lower age and duration of illness (DOI), but higher DUP (p <.001). Treated patients showed much improvement on CGI-I at 12 weeks (p =.029), with no difference at 24 weeks. PANSS severity comparison showed no difference, and both groups followed a declining trend. In untreated patients, age of onset (AoO) was negatively correlated with severity (except general symptoms at baseline) at all follow-ups (' r ' range = −0.32 to –0.49, p <.05), while DOI showed a positive correlation with negative and general symptoms at 12 weeks (r ~ 0.3, p <.05). Treated patients showed inconsistent and lower negative correlation between AoO and PANSS, with no correlation between severity and DOI. The mean sample DUP was 17.9 ± 31.6 weeks; it negatively correlated with education (r = –0.25, p =.01) and positively with PANSS severity (' r ' range = 0.22 to 0.30, p <.05) at all follow-ups, especially negative symptoms. Patients with no or minimal improvement on CGI at 24 weeks had higher DUP (Quade's ANOVA F[1,98] = 6.24, p =.014). Conclusion: Illness variables in untreated schizophrenia affect severity, which has delayed improvement than treated schizophrenia. Higher DUP is associated with negative symptoms of schizophrenia. [ABSTRACT FROM AUTHOR]

This study compared some quality properties of yellow-fleshed sweet potato flour samples as affected by pretreatments (0.02% sulfite; blanching 85 °C for 3 min 30 s and steam blanching 100 °C for 2 min) and drying methods (oven, sun, and drum drying). The physicochemical composition, functional properties, pasting profile, and least gelation concentration of the flours were determined. Before pretreatment, the sweet potato tubers were sorted, weighed, rinsed, peeled, and diced. The smallest particle size (58 μm) was recorded for samples blanched at 85 °C followed by oven drying while drum-dried samples had the largest particle size (119.5 μm). The pH values (5.58 - 5.90) of the pretreated sun- and oven-dried samples were significantly (p<0.05) impacted by 0.02% sulfite. Compared to other drying methods. drum-dried samples had low bulk density (0.36 g/ml), the highest water (531%) and oil absorption capacities (168.5%,) and the least dispersibility (35%). Drum-dried samples had the highest swelling capacities at 60 – 80 °C but the values decreased at 80 – 90 °C compared to samples from other drying methods that had low swelling capacity at 60 - 70 °C but the values increased as the temperature increased from 70 – 90 °C. Results of the sample pasting profiles showed that pretreatment and drying techniques were significant on the various viscosities measured. Drum-dried samples had the lowest trough viscosity (18.13 RVU), final viscosity (24.88 RVU), setback viscosity (6.75 RVU), peak time (1.07 min), and pasting temperature (0 °C). This study concluded that the pretreatment and drying methods affected the quality properties of the yellow-fleshed sweet potato flour samples differently, consequently altering their functionality. [ABSTRACT FROM AUTHOR]

To date, there is no solid agreement on the relationship between mandibular molars, mandibular alveolar bone, and vertical facial types. Therefore, we aim to assess the buccolingual inclination of mandibular first molars and respective alveolar bones and their relationship with different vertical skeletal patterns. The CBCT data from fifty-four untreated Caucasian adult patients (12 males and 42 females, 18–65 years old) were obtained from a private orthodontic practice. We measured the inclination of the tooth and alveolar bone of the right and left mandibular first molars using CBCT. From the two-dimensional lateral cephalometric radiographic images extracted from CBCT, we assessed FMA, SN-GoGn, and PFH:AFH. All subjects showed lingual inclinations of the mandibular molars and alveolar bones which were significantly correlated with each other. However, there was no significant correlation between the inclination of alveolar bone and vertical facial types. Our study supports the conclusion that a proper curve of Wilson is physiological and should be maintained during orthodontic treatment. [ABSTRACT FROM AUTHOR]

The proportion of patients with locally advanced, unresectable or metastatic urothelial carcinoma that do not receive systemic anticancer treatment and the reasons for lack of treatment are largely unknown. The aim of this study was to investigate the prevalence and overall survival of this patient group and reasons for omission of treatment. This retrospective, single-center cohort study from Rigshospitalet, Denmark included patients diagnosed with locally advanced, unresectable or metastatic urothelial carcinoma during the study period from 1 January 2010 to 31 March 2016 who did not receive systemic anticancer treatment. Patients were identified through the Danish Pathology Register and the electronic medical records. 100 patients were included, representing 34% of all patients diagnosed with locally advanced, unresectable or metastatic urothelial carcinoma at Rigshospitalet during the study period. Lack of treatment was most often due to poor physical condition (59%), decreased renal function (15%), or patient preferences (14%). Median overall survival was 1.9 months (95% CI: 1.6–2.8 months). One in three patients diagnosed with locally advanced, unresectable or metastatic urothelial carcinoma in the pre-immunotherapy era did not receive systemic anticancer treatment. Prompt identification of advanced disease and interventions to optimize these patients for treatment are essential. Our findings underscore the compelling need for novel, better tolerated treatment regimens in this frail patient group. [ABSTRACT FROM AUTHOR]

Caregivers of cancer patients were prone to deterioration of their QOL due to the caregiving burden. A high caregiving burden and low QOL were common among CG. In India, only a few studies were done on the caregivers of cancer patients. Hence this study was undertaken. The aim: To study psychopathology, quality of life and burden in caregivers of cancer patients Materials and methods: The study was done on 100 caregivers of cancer patients attending after fulfilling the inclusion criteria. A semi-structured Proforma was administrated to collect the socio-demographic details. Following by Mini International Neuropsychiatric Interview (MINI), WHO-QOL and Burden assessment scale was administered to the caregivers. Data were analysed using SPSS. Descriptive statistics, Pearson and Spearman Correlations and ANOVA were used. Results: 31 % of caregivers suffer from generalised anxiety disorders (15 %) and depression (16 %). The environmental domain of QOL (mean-18.2, SD-15.4) was the most affected. 83 % of caregivers experienced a moderate burden, and 17 % had a severe burden. These variables are significantly associated with caregiver relation with patient and socio-economic status (<0.05). A significant correlation was found between Psychiatric morbidity, QOL and Burden in caregivers. Conclusion: psychiatric morbidity, quality of life and burden in CGs influence one another. The least attention was paid to caregivers' mental health, many of them left unidentified and untreated. These results highlight the need to educate them about mental health and counsel and treat them for their psychiatric problems [ABSTRACT FROM AUTHOR]

Copyright of Journal of Natural Fibers is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Lymph nodes with acellular mucin harvested from treated colorectal cancers (CRC) are staged as pN0. However, there is variability among pathologists while reporting the pN stage when acellular mucin is found within nodes of untreated CRCs. While the UICC guidelines suggest staging them as pN1, the AJCC and CAP do not offer any recommendations. In order to characterize their clinicopathologic features and outcome, we compared 16 untreated CRCs (study group; mean age: 68 years) harboring nodes with acellular mucin with 34 pN0 and 25 pN1 untreated CRC controls. All tumors were unifocal; 12 (75%) were right-sided lesions. Most cases (75%) showed one node with acellular mucin (range: 1–3). MMR-deficient tumors were significantly more common in the study group (83%) compared to pN0 (33%; p = 0.006) and pN1 controls (8%; p < 0.001). The overall survival of study group patients was closer to pN0 compared to pN1 controls; however, this difference was not statistically significant. In conclusion, untreated CRC that harbor acellular mucin within lymph nodes commonly present as right-sided, MMR-deficient tumors in older women that show a non-mucinous phenotype. While the limited number of cases precludes us from making any formal recommendations about staging, we suggest that the finding of acellular mucin in a node should prompt evaluation of deeper levels (with or without cytokeratin immunohistochemistry) and submission of all pericolonic fat for additional lymph node harvest. Whether acellular mucin in nodes of untreated CRCs is related to the indolent biology of the disease, a robust local immune response or MMR deficiency requires further investigation. [ABSTRACT FROM AUTHOR]

The availability of new disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) provides an opportunity for improving outcomes but makes disease management more complex. Our study aimed to describe changes in therapeutic practices over the period 2009–2018 and measure the impact of the arrival of oral DMTs on the use of injectable DMTs. Data were extracted from a representative 1/97 sample of the French population covered by the healthcare insurance system. Study period was set from 1 January 2009 to 31 December 2018. Four periods of MS identification were defined (before 2009, 2009–2011, 2012–2015, and 2016–2018). Overall, 1,508 patients with MS were included, of whom 876 (58.1%) were treated at least once over the study period. Untreated patients were older and had more comorbidities than treated ones. First-line DMTs were the most frequent initial DMT (78.5%), and a shift has operated from injectable to oral drugs over time. The proportion of patients receiving several DMTs increased with the number of available drugs. End 2018, relative parts of all DMTs were almost equal. This study provides valuable insights into the real-world use of DMTs and changes that have operated over time. [ABSTRACT FROM AUTHOR]

Previous research related to the effect of alkali treatment on mechanical properties of composite materials which generate the regression model is still rare. From the previous research, alkali treatment does not always improve the mechanical properties of composite materials. Therefore, it is necessary to research to make sure the effect of alkali treatment on coconut fiber composite. This study aims to examine the effect of alkali treatment of fiber combined with fiber weight content on the mechanical and physical properties of epoxy resin matrix composite. Mechanical properties testing is done by impact test and torsion test. The fracture surface was observed using optical microscopy. Data from the test results were analyzed to see the effect of alkali treatment on the mechanical properties of the resulting composite material by generating the regression model of impact strength and shear strength for treated and untreated fiber composites. The coefficient of determination (R2) of all models was 1. This study obtained that the untreated fibers have better impact strength and shear strength than the treated ones. The highest impact strength, 7.07 kJ.m2, and the highest shear strength, 1.81 MPa were obtained from the samples containing 4% untreated fibers. [ABSTRACT FROM AUTHOR]

This study investigated the effects of untreated oil palm-nut fibre reinforcements on the strength and durability properties of non-fired pressed mud blocks. Different proportions of untreated oil palm-nut fibre from 1% to 5% by weight of the blocks were incorporated into already characterized soil samples and used to produce blocks. Blocks containing 0% fibre were used as the control. The effects of the incorporated fibres were examined in terms of density, water absorption ratio, and compressive strength of the produced blocks. The water absorption of the blocks increased linearly with an increase in fibre content as the control exhibited the least water absorption of 7.9%. The density of the blocks decreased with an increase in fibre content. Block sample containing 5% fibre had the least density of 1644.44kg/m³ as compared to the control with density of 1866.66 kg/m³. The addition of untreated oil palm-nut fibre reinforcements to the block increased its compressive strength up to 3% fibre addition where the maximum strength (1.91N/mm2) was observed. Beyond 3% fibre addition, the compressive strength decreased. Results obtained indicate that untreated oil palm-nut fibre reinforced earth block is a sustainable building material. This study recommends 3% fibre addition to attain optimum strength results and dissuades the use of fibres to reinforce mud blocks in high humidity environments. [ABSTRACT FROM AUTHOR]

Aim: To examine the incidence of with first‐episode psychosis (FEP) in the Integrated Department of Mental Health and Pathological Addictions in Ferrara, Italy, and to examine the association between the Duration of Untreated Psychosis (DUP) and the clinical course. Methods: Participants recruited in 2013–2019 were assessed with the Health of the Nation Outcome Scale (HoNOS) every 6 months for 24 months. Hierarchical growth models analysed changes of global severity (HoNOS total scores) and symptom dimensions. Regression modelled factors associated with remission (HoNOS < 8) and clinical improvement (<12). Results: The incidence of FEP was 21.5 (95%CI: 21.2–21.9) cases per 100 000 person year. Among participants (n = 86, mean age 23, 76% males), baseline HoNOS scores were higher for those with a longer DUP. More than half subjects reached clinical remission (61.6%) or improvement (82.6%), while very few (2.3%) were re‐hospitalized. HoNOS total scores decayed with a mixed linear/quadratic trend, with a slower decay among migrants. A longer DUP was associated with reduced improvements of positive symptoms and lower likelihood of clinical improvement (OR: 0.84; 95%CI: 0.73–0.96). Conclusions: Patients from the FEP program of Ferrara reached good clinical outcomes. Nonetheless, individuals with a longer DUP may need additional clinical attention. Systematic monitoring of clinical outcomes may be an optimal strategy to improve the outcomes of FEP in the real world. [ABSTRACT FROM AUTHOR]

The dynamic nature of the SIV population during disease progression in the SIV/macaque model of AIDS and the factors responsible for its behavior have not been documented, largely owing to the lack of sufficient spatial and temporal sampling of both viral and host data from SIV-infected animals. In this study, we detail Bayesian coalescent inference of the changing collective intra-host viral effective population size (Ne) from various tissues over the course of infection and its relationship with what we demonstrate is a continuously changing immune cell repertoire within the blood. Although the relative contribution of these factors varied among hosts and time points, the adaptive immune response best explained the overall periodic dynamic behavior of the effective virus population. Data exposing the nature of the relationship between the virus and immune cell populations revealed the plausibility of an eco-evolutionary mathematical model, which was able to mimic the large-scale oscillations in Ne through virus escape from relatively few, early immunodominant responses, followed by slower escape from several subdominant and weakened immune populations. The results of this study suggest that SIV diversity within the untreated host is governed by a predator-prey relationship, wherein differing phases of infection are the result of adaptation in response to varying immune responses. Previous investigations into viral population dynamics using sequence data have focused on single estimates of the effective viral population size (Ne) or point estimates over sparse sampling data to provide insight into the precise impact of immune selection on virus adaptive behavior. Herein, we describe the use of the coalescent phylogenetic frame- work to estimate the relative changes in Ne over time in order to quantify the relationship with empirical data on the dynamic immune composition of the host. This relationship has allowed us to expand on earlier simulations to build a predator-prey model that explains the deterministic behavior of the virus over the course of disease progression. We show that sequential viral adaptation can occur in response to phases of varying immune pressure, providing a broader picture of the viral response throughout the entire course of progression to AIDS. [ABSTRACT FROM AUTHOR]

Introduction: While treatment is an effective way to resolve alcohol problems, many people resolve their alcohol problems in the absence of treatment. Just how many do so is not known and may vary based on the definition of treatment. Various estimates of untreated alcohol problem resolution were calculated in this study, and the differences between people who resolve their alcohol problems with or without treatment were explored in relation to sociodemographic variables, levels of alcohol consumption in the past 12 months and lifetime alcohol problem severity. Methods: A cross‐sectional online survey was administered to 719 people who had resolved an alcohol problem in Australia. Convenience sampling was used through a recruitment strategy targeted towards the general population via Facebook. Results: Almost half (49.8%) of all people who resolved their alcohol problem did so in the absence of alcohol treatment, whether specialist alcohol treatment, mutual‐aid services or digital support services. When accessing mental health treatment is included under the scope of 'treatment', this estimate dropped to 12.8%. The estimated odds of having accessed treatment increased with age and lifetime alcohol problem severity. Other sociodemographic variables, or levels of alcohol consumption in the past 12 months, were not significantly associated with treatment status. Discussion and Conclusions: It might be beneficial to expand the scope of 'treatment' to include mental health services and focus on the development of cost‐effective and less intrusive standalone activities, which can expedite and support alcohol problem resolution for those who choose not to access specialist treatment. [ABSTRACT FROM AUTHOR]

Background and purpose: Disease‐modifying therapies (DMTs) have an impact on relapses and disease progression. Nonetheless, many patients with multiple sclerosis (MS) remain untreated. The objectives of the present study were to determine the proportion of untreated patients with MS followed in expert centers in France and to determine the predictive factors of nontreatment. Methods: We conducted a retrospective cohort study. Data were extracted from the 38 centers participating in the European Database for Multiple Sclerosis (EDMUS) on December 15, 2018, and patients with MS seen at least once during the study period (from June 15, 2016 to June 14, 2017) were included. Results: Of the 21,189 patients with MS (age 47.1 ± 13.1 years; Expanded Disability Status Scale (EDSS) score 3.4 ± 2.4), 6,631 (31.3%; 95% confidence interval [CI] 30.7–31.9) were not receiving any DMT. Although patients with a relapsing‐remitting course (n = 11,693) were the most likely to receive DMT, 14.8% (95% CI 14.2–15.4) were still untreated (6.8% never treated). After multivariate analysis among patients with relapsing‐remitting MS, the main factors explaining never having been treated were: not having ≥9 lesions on brain magnetic resonance imaging (odds ratio [OR] 0.52 [95% CI 0.44–0.61]) and lower EDSS score (OR 0.78 [95% CI 0.74–0.82]). Most patients with progressive MS (50.4% for secondary and 64.2% for primary progressive MS) did not receive any DMT during the study period, while 11.6% of patients with secondary and 34.0% of patients with primary progressive MS had never received any DMT. Conclusion: A significant proportion of patients with MS did not receive any DMT, even though such treatments are reimbursed by the healthcare system for French patients. This result highlights the unmet need for current DMTs for a large subgroup of patients with MS. [ABSTRACT FROM AUTHOR]

Background and aims: Recovery from alcohol problems in the absence of treatment or mutual‐aid is very common, but under‐researched. This study explores the lives of people who had resolved their alcohol problems without treatment, seeking to situate experiences of recovery in social contexts and broader life narratives. Design The in‐depth qualitative interviews were aided by a life‐history methodology that invited participants to account retrospectively for their lives. A narrative analysis was undertaken. Setting: Two major cities (Sydney and Melbourne) in Australia. Participants: People who had resolved an alcohol problem in the absence of treatment (n = 12) were recruited from the general community using convenience sampling. Measurements Eligible participants had received 'minimal treatment' for an alcohol use disorder: fewer than three sessions in an outpatient treatment programme or nine sessions with mutual‐aid groups (e.g. Alcoholics Anonymous), or having accessed mental health treatment for problems other than drinking at least 2 years prior or 1 year after having resolved an alcohol problem. Participants were considered to have had an alcohol use disorder if they reported two or more symptoms (DSM‐V) within a 1‐year period prior to the past year, using questions endorsed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). People were considered to have resolved their alcohol use disorder by responding to the recruitment message calling for people who "used to have an alcohol problem but no longer do". The Alcohol Use Disorders Identification Test (AUDIT‐C) was used to understand participant's drinking behaviours in the past 12 months. Findings Four different narratives were identified in the analysis. In the emancipation narrative, identity development and major changes across the life‐curve were associated with separating oneself from an oppressive circumstance. In discovery narratives, art culture and other consciousness‐expanding experiences were sources of identity development, but sometimes a barrier to alcohol recovery. In mastery narratives, life events were understood as failures or successes, and recovery was positioned as an individual journey accomplished through increased problem awareness. Finally, in coping narratives, changes were understood as a series of continuous struggles, and recovery was made sense of through diagnostic discourses. Conclusions: People who resolve an alcohol use disorder in the absence of treatment or mutual‐aid appear to explain their recovery in terms of at least four different life narratives: emancipation, discovery, mastery or coping. Social contexts and cultures outside the treatment setting, and the various identities and narratives they provide, shape change processes. [ABSTRACT FROM AUTHOR]

There has been considerable interest in the role of synchronous brain activity abnormalities in the pathophysiology of psychotic disorders and their relevance for treatment; one index of such activity are EEG resting-state microstates. These reflect electric field configurations of the brain that persist over 60–120 ms time periods. A set of quasi-stable microstates classes A, B, C, and D have been repeatedly identified across healthy participants. Changes in microstate parameters coverage, duration and occurrence have been found in medication-naïve as well as medicated patients with psychotic disorders compared to healthy controls. However, to date, only two studies have directly compared antipsychotic medication effects on EEG microstates either pre- vs. post-treatment or between medicated and unmedicated chronic schizophrenia patients. The aim of this study was therefore to directly compare EEG resting-state microstates between medicated and medication-naïve (untreated) first-episode (FEP) psychosis patients (mFEP vs. uFEP). We used 19-channel clinical EEG recordings to compare temporal parameters of four prototypical microstate classes (A–D) within an overall sample of 47 patients (mFEP n = 17; uFEP n = 30). The results demonstrated significant decreases of microstate class A and significant increases of microstate class B in mFEP compared to uFEP. No significant differences between groups were found for microstate classes C and D. Further studies are needed to replicate these results in longitudinal designs that assess antipsychotic medication effects on neural networks at the onset of the disorder and over time during illness progression. As treatment response and compliance in FEP patients are relatively low, such studies could contribute to better understand treatment outcomes and ultimately improve treatment strategies. [ABSTRACT FROM AUTHOR]

The objective of this systematic review and meta‐analysis is to determine whether nocturnal blood pressure fall, expressed by dipping patterns according to ambulatory blood pressure monitoring (ABPM), is a risk factor for cardiovascular events (CVEs) in untreated hypertensives. Α thorough systematic literature search at MEDLINE, Embase, Cochrane Library, and gray literature was conducted through March 2020. Two reviewers screened studies and assessed dipping patterns of untreated hypertensives using ABPM with a follow‐up >6 months. Newcastle‐Ottawa scale was used for risk of bias assessment. We initially identified 463 reports; of which, seven cohort studies were eligible for meta‐analysis enrolling 10 438 untreated hypertensives. Untreated patients classified as dippers at baseline (n = 7081) had significant lower risk of CVEs and total mortality compared to non‐dippers (n = 3,357) [RR = 0.67, 95% CI (0.49, 0.92); RR = 0.71, 95% CI (0.59, 0.86)]. However, when patients were further classified into four dipping groups, only reverse dippers, yet not extreme dippers or non‐dippers, were at increased risk for CVEs compared to dippers [RR = 0.47, 95% CI (0.33, 0.66)]. Likewise, only reverse dippers had a higher stroke risk than dippers [RR = 0.39, 95% CI (0.22, 0.72)]. When compared with the whole group of dippers (including extreme dippers), non‐dipping alone (excluding reverse dipping) was not a significant risk factor for CVEs [RR = 0.84, 95% CI (0.61, 1.16)] or total mortality [RR = 0.84, 95% CI (0.61, 1.16); RR = 0.78, 95% CI (0.53, 1.13), respectively]. Untreated hypertensives may benefit more from the evaluation of reverse dipping rather than the non‐dipping phenomenon in general. [ABSTRACT FROM AUTHOR]

First line therapy of patients with marginal zone lymphomas (MZL) is not well established and various regimens with chemo‐immunotherapy can be used. Rituximab plus bendamustine (BR) is an effective and manageable treatment option for patients affected by indolent non‐Hodgkin lymphoma. The aim of this monocentric retrospective study was to analyze the effectiveness and safety of the use of BR regimen in MZL patients in first line in daily clinical practice. The treatment schedule was rituximab at the dose of 375 mg/m2 on day 1 of each cycle and bendamustine at the dose of 90 mg/m2 on day 2 and 3, every 28 days for a maximum of 6 cycles. We analyzed 65 MZL patients (28 extranodal [EMZL], 23 splenic [SMZL], and 14 nodal [NMZL]) who underwent BR regimen as first line treatment. The median time from diagnosis to therapy was 2.5 months. Final responses were: 38 complete response (CR, 58.5%), 20 partial response and 7 progressive disease, leading to an overall response rate (ORR) of 89.2%. With respect to the histology, the ORR was 89.3% for EMZL, 82.6% for SMZL and 100% for NMZL, respectively (difference not statistically significant). With a median follow‐up time of 44.6 months (range, 3.3‐175.0 months), 2 (one EMZL after 42 months and one SMZL after 10 months) of 38 (5.2%) CR patients had disease relapse, yielding an estimated disease free survival of 89.2% at 61.1 months. The estimated 6‐year progression free survival was 71.8% with 15 relapsed/progressed patients showing lymphoma recurrence within 48 months from end of treatment. The most frequently reported adverse events (any grade) were neutropenia (N = 35, 53.8%), fatigue (N = 15, 23.0%), and nausea (N = 12, 18.4%). All toxicities quickly resolved and no treatment‐related death occurred. The BR regimen is effective and feasible in MZL patients inducing prolonged disease control with manageable toxicities. [ABSTRACT FROM AUTHOR]

Background: Patient journeys for hypertensive individuals after detection at screening have not been well examined in a general population. Thus, we aimed to assess the medical treatment status and subsequent longitudinal changes in blood pressure in a middle-aged Japanese population.Methods: We conducted a cohort study using a nationwide Japanese health screening cohort, from April 2014 to March 2019. Among health screening participants aged 40-74 years who had not previously received treatment for hypertension, hypertensive patients were newly identified based on screening results, and their medical treatment status for hypertension during the year following their initial screening was assessed. The main outcomes were longitudinal changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) over 4 years after initial screening.Results: Of the 153,523 screening participants (mean age = 49.7 years), 16,720 (10.9%) and 4150 (2.7%) were newly detected as having hypertension, with baseline SBP of 140-159 mmHg (grade 1) and ≥ 160 mmHg (grade 2-3), respectively. Among them, 15.9% of the grade 1 hypertensive participants and 36.3% of the grade 2-3 hypertensive participants started receiving medical treatment during the year following initial screening. A linear generalised estimating equation with propensity score matching showed that receiving medical treatment was associated with 5.77 mmHg lower SBP (95% CI - 6.64 to - 4.90) and 3.82 mmHg lower DBP (95% CI - 4.47 to - 3.16) in the grade 1 hypertensive group, and 14.69 mmHg lower SBP (95% CI - 16.35 to - 13.04) and 8.42 mmHg lower DBP (95% CI - 9.49 to - 7.34) in the grade 2-3 hypertensive group.Conclusions: Health screenings detected hypertension in a substantial percentage of the middle-aged population in this study. However, detection was often followed by insufficient medical treatment and inappropriate blood pressure management. These findings indicate an inadequate link between health screenings and medical treatments in patients with hypertension. [ABSTRACT FROM AUTHOR]

Objectives: To study the development of dizziness, caloric function, and postural sway during long-term observation of untreated vestibular schwannoma patients.Study Design: Retrospective review of a prospectively maintained longitudinal cohort.Setting: Tertiary referral hospital.Subjects and Methods: Patients with vestibular schwannoma undergoing wait-and-scan management were included-specifically, those who did not require treatment during a minimum radiologic follow-up of 1 year. Baseline data and follow-up included magnetic resonance imaging, posturography, bithermal caloric tests, and a dizziness questionnaire. Main outcomes were prevalence of moderate to severe dizziness, canal paresis, and postural instability at baseline and follow-up, as compared with McNemar's test.Results: Out of 433 consecutive patients with vestibular schwannoma, 114 did not require treatment during follow-up and were included. Median radiologic follow-up was 10.2 years (interquartile range, 4.5 years). Age ranged from 31 to 78 years (mean, 59 years; SD, 10 years; 62% women). Median tumor volume at baseline was 139 mm3 (interquartile range, 314 mm3). This did not change during follow-up (P = .446). Moderate to severe dizziness was present in 27% at baseline and 19% at follow-up (P = .077). Postural unsteadiness was present in 17% at baseline and 21% at follow-up (P = .424). Canal paresis was present in 51% at baseline and 56% at follow-up (P = .664).Conclusions: There was no significant change in the prevalence of dizziness, postural sway, or canal paresis during conservative management of vestibular schwannoma, while tumor volume remained unchanged. This indicates a favorable prognosis in these patients with regard to vestibular symptoms. [ABSTRACT FROM AUTHOR]

Infantile hemangioma (IH) is a type of benign tumor that develops during infancy and spontaneously involutes after 1 year of age. Before the introduction of propranolol in 2008, some patients with IH were instructed to wait for the involution without treatment. This long‐term follow‐up study was conducted to assess the prognosis of East‐Asian children with untreated deep or mixed facial IH. Skin sequelae were assessed by comparing images obtained during the patients' first and last visits in our clinic. Possible factors were assessed for their association with IH prognosis. The mean follow‐up time was 7.4 years. Among the 48 patients with deep or mixed facial IH, 26 (54%) achieved complete involution without sequelae and 22 encountered various sequelae, including telangiectasia (36.3%), fibrofatty residue (68.2%), and scars (4%). The complete regression rate of deep or mixed IH occurring in the central facial region was significantly lower than for those in the perifacial region (33.3% vs 66.7%, respectively, χ2, P = 0.025). Further, the most common sequelae in this area are fibrofatty residue. [ABSTRACT FROM AUTHOR]

Background and purpose: Parkinson disease (PD) patients are classically classified according to two alternative motor subtyping methods: (i) tremor‐dominant versus postural instability and gait disorder; (ii) tremor‐dominant versus akinetic‐rigid. The degree of overlap between the two classification systems at diagnosis of PD and their temporal stability, as well as the correspondence between the two systems, were examined over a follow‐up period of 4 years. Methods: Newly diagnosed, untreated PD patients were classified as tremor‐dominant versus postural instability and gait disorder and tremor‐dominant versus akinetic‐rigid at baseline and after 2 and 4 years. Results: There was a poor overlap between the two classification systems at any time point and baseline subtype status could not predict 4‐year subtype membership. In fact, about half of our cohort shifted category during the first 2 years, regardless of the classification scheme adopted. A lower rate of shift was observed from 2‐ to 4‐year follow‐up. Conclusions: The two classical motor subtyping methods of PD poorly overlap, which implies that a patient can be categorized as tremor‐dominant in one classification system but not in the other. Moreover, their temporal instability undermines their prognostic value in the early stage of PD. [ABSTRACT FROM AUTHOR]

Background: To examine psychopathology present under prolonged antipsychotic treatment in schizophrenia and to analyse their relationship to both the duration of the prodromal stage (DPS; time between onset of first unspecific psychological symptoms and first schizophrenic symptoms) and the duration of untreated psychosis (DUP; time between the onset of psychosis and the initiation of antipsychotic treatment). Methods: The psychopathology of 93 patients was assessed cross-sectionally using the Scales for the Assessment of Negative and Positive Symptoms and the Brief Psychiatric Rating Scale. DPS and DUP were assessed by means of the patient records and the Interview for the Retrospective Assessment of the Onset and Course of Schizophrenia and Other Psychoses. A path analysis using maximum likelihood estimation was conducted with the program Analysis of Moment Structures for Windows. Results: The resulting path model indicated that DPS was predictive for a more severe negative symptomatology in schizophrenia, whereas DUP was associated with a more severe positive symptomatology in the long-term. Furthermore, DUP showed an inverse correlation with the age of the patients at the onset of both first unspecific psychological symptoms and first schizophrenic symptoms. Conclusion: A long prodromal stage suggests an increased risk of a long-term progression with negative symptoms in schizophrenia, whereas a delayed start of antipsychotic treatment could lead to an increased manifestation and severity of positive symptoms in the long term. These results underline the need to shorten the duration of the prodrome by an early detection and adequate intervention in patients with increased risk to develop psychosis. [ABSTRACT FROM AUTHOR]

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Aim: Subclinical hypothyroidism is thought to be associated with adverse pregnancy outcomes but the data is conflicting and generally depends on antibody positivity and treatment. We evaluated the pregnancy outcomes in Turkish population with untreated, antibody negative subclinical hypothyroidism for the first time. Methods: We searched for 30 015 patients between January 2016 and May 2017 retrospectively. Finally, a total of 930 pregnant women with untreated, antibody negative subclinical hypothyroidism and 7986 controls were included. Demographic characteristics, laboratory findings and pregnancy outcomes, including pregnancy loss, impaired glucose tolerance, gestational diabetes, hypertensive disorders of pregnancy, preterm birth, neonatal intensive care unit admission, placenta previa and abruption, cesarean delivery, low birthweight, Apgar score <7 and premature rupture of membranes were recorded. Results: Demographic and laboratory characteristics were similar between two groups except thyroid stimulating hormone levels and previous uterine surgery rates. Subclinical hypothyroidism group had an increased risk of pregnancy loss (odds ratio [OR] 2.583; 95% confidence interval [CI] 1.982–3.365; P < 0.001), impaired glucose tolerance (OR 1.952; 95% CI 1.450–2.627; P < 0.001), hypertensive disorders of pregnancy (OR 1.476; 95% CI 1.113–1.923; P = 0.004), neonatal intensive care unit admission (OR 1.620; 95% CI 1.084–2.420; P = 0.019), placenta previa (OR 12.581; 95% CI 5.046–31.363; P < 0.001) and cesarean delivery (OR 1.263; 95% CI 1.091–1.462; P = 0.002). Conclusion: Subclinical hypothyroidism has worse pregnancy outcomes as compared to euthyroid pregnant women even in antibody negativity. Therefore, we suggest that all pregnant women should routinely be screened in their first antenatal visits for thyroid functions. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate whether women, who reported “symptoms of depression” during pregnancy and up to 1.5 years postpartum, who reported domestic violence or not, were treated with antidepressant medication. Patients and methods: A prospective longitudinal cohort study recruited primi- and multiparous women (n=1,939). The Edinburgh Postnatal Depression Scale (EPDS), the NorVold Abuse Questionnaire, and a questionnaire about medication during pregnancy were distributed and administered three times, during early pregnancy, late pregnancy, and the postpartum period. Antidepressant medication was compared between women with EPDS scores ,13 and EPDS scores $13 as the optimal cutoff for symptoms of depression. Results: EPDS scores $13 were detected in 10.1% of the women during the whole pregnancy, of those 6.2% had depressive symptoms already in early pregnancy and 10.0 % during the post-partum period. Women with EPDS scores $13 and non-exposure to domestic violence were more often non-medicated (P,0.001). None of the women with EPDS scores $13 exposed to domestic violence had received any antidepressant medication, albeit the relationship was statistically nonsignificant. Conclusion: Pregnant women who experienced themselves as having several depressive symptoms, social vulnerability, and even a history of domestic violence, did not receive any antidepressant treatment during pregnancy nor postpartum. This study shows the importance of detecting depressive symptoms during early pregnancy and a need for standardized screening methods. [ABSTRACT FROM AUTHOR]

ABSTRACTObjective:Late life depression (LLD) confers significant morbidity and mortality but is well recognized that it often goes undetected or untreated. The objective of this study is to quantify the burden of untreated depression and death ideation (DI) at a population level.Design: Cross-sectional study ascertaining the prevalence of, and factors associated with, untreated depression and DI.Setting: This study, embedded within the Irish Longitudinal Study on Ageing, involves over 7,000 community-dwelling people aged ≥50 years.Measurements: Depression was defined as Centre for Epidemiological Studies Depression scale ≥16 indicating current clinically relevant depressive symptoms or Composite International Diagnostic Interview indicative of major depressive episode within the last year. Participants not prescribed antidepressants/antipsychotics were defined as untreated. To define DI, participants were asked "In the last month, have you felt like you would rather be dead?"Results: In total, 12% (839/7,055) met criteria for depression with 29% (241/839) on pharmacological therapy. Those with untreated depression were less likely to endorse symptoms of persistent low mood or worthlessness, but there was no difference in age or general practitioner (GP) visits compared to those on treatment. Over 3% (223/7,055) of participants had DI and less than one-third had visited their GP within the last year.Conclusions: This study demonstrates that two-thirds of depressed older people are not prescribed antidepressant/antipsychotic therapy. It is important to raise awareness of depression among older people and healthcare professionals, with particular focus on the fact that LLD is not an inevitable consequence of ageing and effective treatment is available. [ABSTRACT FROM AUTHOR]

Objective: Oral cavity cancer is the most common malignant disease of the head and neck. The natural course of the disease is poorly characterized and unavailable for patient consideration during initial treatment planning. Our primary objective was to outline this natural history, with a secondary aim of identifying predictors of treatment refusal. Study Design: Retrospective review of adult patients with oral cavity cancer who refused surgery that was recommended by their physician in the National Cancer Database. Methods: Demographic, tumor, and survival variables were included in the analyses. Multivariate Cox regressions as well as univariate Kaplan‐Meier analyses were conducted. Results: Patients who were older, uninsured, had government insurance, or had more advanced disease were more likely to go untreated. Survival among untreated patients was poor, but there was a small proportion of patients surviving long term. Five‐year survival rates ranged from 31.1% among early‐stage patients to 12.6% among stage 4 patients. Conclusion: Although the natural course of oral cavity cancer carries a poor prognosis, there are a number of patients with longer‐than‐expected survival. The survival estimates may provide supplemental information for patients deciding whether to pursue treatment. In addition to age and extent of disease, system factors such as insurance status and facility case volume are associated with a patient's likelihood of refusing treatment. Level of Evidence: 4. Laryngoscope, 128:664–669, 2018 [ABSTRACT FROM AUTHOR]

Elderly/comorbid patients with chronic lymphocytic leukemia (CLL) require low-toxicity treatments. Internationally, the standard treatment for such patients is chlorambucil and an anti-CD20 therapy; however, chlorambucil is not approved in Japan. The aim of the present study was to evaluate the safety, efficacy and pharmacokinetics of ofatumumab in combination with chlorambucil in Japanese patients with previously untreated CLL who were inappropriate for fludarabine-based therapy. Ten patients were enrolled and treated in this study, all of whom received at least one dose of the study drugs. The tolerability of the treatment was confirmed initially with three patients. The overall response rate was 50%, as determined by the Independent Review Committee (IRC) with computerized tomography. All patients were alive at follow-up, and only one patient had progressive disease. The most common treatment-related adverse events (AEs) were thrombocytopenia (n = 10), neutropenia (n = 9) and rash (n = 6). One grade 3 serious AE related to the study drug occurred (hypoxia). The results indicate that ofatumumab combined with chlorambucil is an effective treatment for Japanese CLL patients, with a manageable safety profile. [ABSTRACT FROM AUTHOR]

The 2017 annual meeting of the American Society of Clinical Oncology took place in Chicago, Illinois, 2-6 June. At the meeting, results from key studies in the first-line treatment of indolent non-Hodgkin lymphoma (iNHL) were presented. Of those studies, two were selected for oral presentations: 9-year follow-up data from the STiL NHL1 trial, which compared the efficacy and safety of bendamustine plus rituximab (BR) with those of rituximab plus cyclophosphamide-vincristine-prednisone-doxorubicin (R-CHOP); and 5-year follow-up data from the bright study, which compared BR with R-CHOP and R-CVP (rituximab plus cyclophosphamide-vincristine-prednisone) combined. Our meeting report describes the foregoing studies and includes interviews with key investigators, plus commentaries from three Quebec hematologists on the potential effects for Canadian practice. [ABSTRACT FROM AUTHOR]

Neuropsychiatric and cognitive symptoms are common in Parkinson's disease (PD) and may precede and exceed motor symptoms as major factors impacting disease course and quality of life. Neuropsychiatric symptoms (NPS) in PD are various and are attributed to pathologic changes within multiple brain regions, to psychological stress, and to adverse effects of dopamine replacement therapy. Sleep disorders and mood symptoms such as apathy, depression, and anxiety may antedate the development of motor symptoms by years, while other NPS such as impulse control disorders, psychosis, and cognitive impairment are more common in later stages of the disease. Few studies report on NPS in the early, untreated phase of PD. We reviewed the current literature on NPS in PD with a focus on the early, drug-naive stages of PD. Among these early disease stages, premotor and early motor phases were separately addressed in our review, highlighting the underlying pathophysiological mechanisms as well as epidemiological characteristics, clinical features, risk factors, and available techniques of clinical assessment. [ABSTRACT FROM AUTHOR]

The 2016 annual meeting of the American Society of Hematology took place in San Diego, California, 3-6 December. At the meeting, results from key studies on the first-line treatment of follicular lymphoma were presented. Of those studies, key oral presentations included two analyzing data from the gallium study, which evaluated the efficacy and safety of obinutuzumab plus chemotherapy (G-chemo) compared with rituximab plus chemotherapy (R-chemo), followed, in responding patients with follicular lymphoma, by obinutuzumab or rituximab maintenance; results from the sabrina study, which evaluated the efficacy and safety of subcutaneous compared with intravenous rituximab; results of a cost-effectiveness analysis of first-line treatment with bendamustine and rituximab from a Canadian perspective; and results from the SAKK 35/10 study, which evaluated the safety and efficacy of rituximab plus lenalidomide compared with rituximab monotherapy. Our meeting report describes the foregoing studies and includes interviews with the Canadian investigators, plus commentaries by those investigators about the potential impact on Canadian practice. [ABSTRACT FROM AUTHOR]

An incorporation of waste tyre particles in concrete has been established to produce a green concrete. However, despite its advantages, strength reduction is an obvious handicap. To improve the strength, pre-treatments of the waste tyre particles and addition of Oil Palm Fruit Fibre (OPFF) were chosen and reported in this study. The addition of OPFF was to influence the internal structure in order to improve shrinkage and other strength properties. Performance of the composites in compressive, split tensile and flexural strengths, as well as shrinkage and microstructure were observed. Results showed better behaviour of the treated tyre crumb mortar rather compared to the untreated tyre, with the replacement of up to 40% by volume of the treated tyre crumb particles and 0.5-1.0% OPFF addition by mass of cement content. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to investigate the association of liver fibrosis and necroinflammation with HS in untreated young patients with chronic hepatitis B (CHB). Materials and Methods: A retrospective study was conducted in a military hospital in Turkey. A total of 254 subjects with CHB were included in this study. These subjects were divided into two groups: group 1 consisted of patients with hepatic steatosis (HS) according to ultrasonography (USG) and group 2 consisted of non-HS subjects. Sociodemographic, biochemical, histopathological, virological and USG results were recorded for both groups retrospectively. Statistical analysis was performed using SPSS 22.0. Results: The prevalence of HS was found to be 11.4%. A significant statistical difference was found between group 1 and group 2 regarding the fibrosis degree (p = 0.045). No statistically significant difference was noted between two groups for age, levels of ALT, AST, HBeAg, HBV-DNA levels, HAI scores, diagnosis age and duration of CHB. No difference was noted between the grade of HS and variables. A positive correlation was found between fibrosis groups and the grade of HS (p = 0.012, r = 0.158) and between HAI groups and the grade of HS (p = 0.029, r = 0.137). Conclusion: The prevalence of steatosis was not higher in patients with CHB. HS is associated with advanced hepatic fibrosis, but not viral liver disease. [ABSTRACT FROM AUTHOR]

In this article, the different chemical modifications of natural fiber on the physical and mechanical properties of polypropylene (PP)/wood flour (WF)/nanoclay hybrid composites were studied. To meet this objective, the chemical treatments on WF, namely alkali, acetylation, and benzoylation, were carried out. Then, the composites were prepared through the melt mixing of WF and PP at 50% weight ratios, with various amounts of nanoclay (0, 3, and 6 per hundred compounds (phc)) in Haake internal mixer and the test specimens were prepared by injection molding. The amount of coupling agent was fixed at 2 phc for all formulations. The tensile strength, impact strength, and water uptake of these composites were analyzed and the reinforcing properties of the chemically treated composites were compared with those of untreated composites. The chemical modification efficiency was verified by Fourier transform infrared (FTIR) analysis, and the dispersion state of nanoclay in the composites was examined using X-ray diffractometer and transmission electron microscopy. The results showed that the tensile modulus, tensile strength, and impact strength of the composites increased by applying chemical treatments. Modified composites had lower water absorption (WA) and thickness swelling than unmodified ones. Furthermore, the highest mechanical properties and the lowest water uptake were observed in the composite modified with acetic anhydride. FTIR spectra show that the intensity of O–H bond at 3444.2 cm–1 and formation of ester bond at 1741.4 cm–1 were indications of changes in the chemical structure of the fibers. The tensile modulus and strength increased with increase of nanoclay up to 3 phc and then decreased. However, the impact strength and WA decreased with increase of nanoclay loading. The morphological findings showed that the samples containing 3 phc of nanoclay had higher order of intercalation and better dispersion. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to evaluate the long-term natural history of polypoidal choroidal vasculopathy (PCV) in untreated patients. Methods: This is a retrospective observational case series. Patients with symptomatic PCV who did not receive any treatment for at least 12 months were included from the records of three ophthalmic clinics in Asia. The medical records and imaging data were reviewed. Visual outcomes at month 12 and at last follow-up were analyzed. The influence of demographics and presenting features on visual outcome was analyzed. Results: A total of 32 eyes (32 patients) were included in this analysis. The mean follow-up was 59.9 months (range, 18-119 months), the mean age was 65.7 years and 21 (65.6 %) patients were male. The mean presenting logMAR visual acuity was 0.79 (Standard deviation [SD] 0.49). The center of the fovea was involved by the PCV complex in 25 eyes (78.1 %). The mean greatest linear dimension (GLD) of the PCV complex was 2584 μm (SD 880). Twenty-three eyes (71.9 %) had a cluster-of-grapes configuration on indocyanine green angiography. Leakage of fluorescein angiography was present in 29 eyes (90.6 %). The mean logMAR vision deteriorated from 0.79 at baseline to 0.88 at month 12 ( p = 0.11), and further to 1.14 ( p = 0.003) at the last follow-up. The proportion of eyes that improved, remained unchanged and worsened was 21.9 %, 31.3 % and 46.9 %, respectively, at month 12; and 28.1 %, 9.4 % and 62.5 %, respectively, at last follow-up. The proportion of eyes with logMAR vision worse than 1.0 was 28.1 % at presentation, and increased to 31.3 % at month 12 and further to 53.1 % at last follow-up. Reasons for poor vision were due to retinal, subretinal or vitreous hemorrhage, and retinal pigment epithelium (RPE) atrophy and scarring. None of the presenting features were found to significantly influence visual outcome. Conclusions: Half of eyes presenting with symptomatic PCV had a relatively benign course without treatment and some even had vision improvement. However, in the remaining eyes, vision deteriorated significantly, mainly due to hemorrhage and scarring. There may be subtypes of PCV with divergent natural history. [ABSTRACT FROM AUTHOR]

BACKGROUND: The use of chemotherapy in advanced metastatic breast cancer remains a subject of controversy. The thought of MicKinnon et al (early 1950s) that the course of breast cancer was unaffected by chemotherapy has been refuted by results of treatment in the developed countries. The poor result of treatment in developing centres still compares with prechemotherapy era. Consequently, The McKinnon's thought may still lurk. We compared the survival of chemotherapy treated with chemotherapy untreated cancer of breast patients. METHOD: Records of breast cancer patients who presented and died between January 2010 and May 2014 were reviewed. The primary outcome was overall survival. Records of patients that received chemotherapy with or without other tumor directed specific therapy were compared with records of patients who did not receive any tumor directed therapy. RESULT: Thirty-one patients received chemotherapy while 25 patients did not. All were females, more than 90% were of the patients had advanced or metastatic disease. Treatments were not biologically directed and treatment plans were largely compromised and suboptimal. The overall mean survival was 19.2 ±9.2 months, and the median duration was 17.5 months(range 6-44months). The overall survival was not statistically different between the two groups (p= 0.230, unequal variance assumed). The objective of using neoadjuvant chemotherapy for fungating lesions was not achieved. CONCLUSION: In advanced and metastatic breast cancer, outcomes of patients who receive suboptimal regimen of cytotoxic chemotherapy do not differ from chemotherapy untreated patients. [ABSTRACT FROM AUTHOR]

Immunomodulatory drugs have been shown to be of benefit in relapsed/refractory immunoglobulin light-chain ( AL) amyloidosis. We designed a prospective, multicentre phase II trial of lenalidomide, dexamethasone and cyclophosphamide for newly diagnosed patients with AL amyloidosis not eligible for autologous stem-cell transplantation. Twenty-eight patients were included in the study. Cardiac involvement was present in 23 patients; 14 of them had cardiac stage III. The overall haematological response rate was 46%, including complete and very good partial responses in 25% and 18% of patients respectively. Haematological response was mainly associated with absence of cardiac stage III and lower tumour burden. Organ response was observed in 46% of patients. After a median follow-up of 24 months, median progression-free and overall survival have not been reached, both being significantly longer in responders ( P < 0·001 and P = 0·001 respectively). Seventeen patients have discontinued treatment, mostly due to amyloid-related death, disease progression or lack of response. Only 14% of the patients discontinued treatment due to therapy-related adverse events. Our results support the efficacy of this regimen, with high quality responses and prolonged survival, as well as its tolerability, in patients with AL amyloidosis not eligible for stem cell transplant and without advanced cardiac involvement (clinicaltrials.gov identifier: NCT01194791). [ABSTRACT FROM AUTHOR]

Indolent non-follicular lymphomas (inFLs) are generally regarded as incurable, apart from extranodal mucosa-associated lymphatic tissue lymphomas, which can be partially cured by surgery, local radiotherapy, or antibiotic treatment. The aim of the present study was to test the degree of effectiveness and the safety of the regimen containing fludarabine, mitoxantrone, and rituximab (FMR) in inFL patients considering all the different entities belonging to this group. An observational retrospective study was conducted on 143 inFL patients providing that their first chemoimmunotherapy performed was FMR regimen and diagnosis from September 2000 to March 2011. There were 32 small lymphocytic lymphomas and 111 marginal zone lymphomas. At the end of treatment, overall response rate was 96.5% with 88% of complete responses (CR) and 8.5% of partial responses. With a median follow-up of 48 months, 10 out of 125 (8%) CR patients had disease relapse, yielding an estimated 9-year disease-free survival (DFS) of 74.9% and an estimated 10-year overall survival of 92.8%. The estimated 9-year progression free survival was 70.5%. The 10 relapsed patients showed lymphoma recurrence within 52 months: after this time, the DFS curve presented a plateau configuration. Only two (1.4%) patients developed a secondary hematological neoplasia. This study showed promising findings for the use of a fludarabine-based regimen in combination with rituximab in the front-line treatment of symptomatic inFL with a noteworthy high percentage of CR associated to an interesting long-term DFS and favorable acute and long-term safety profile. [ABSTRACT FROM AUTHOR]