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Today's constrained healthcare environment can make it very difficult for nurses to provide compassionate, competent, and ethical care, and yet their continued commitment to care is viewed as requisite. Nurses' commitment to care of patients, enmeshed with professional identity, may be understood as heroic. A few nursing scholars have advanced the concept of a nurse‐patient covenant to explain or inspire nurses' commitment to care. Covenant describes an enduring relationship characterised by mutual promises and generous responsiveness. However, recent critique has revealed a general misunderstanding and misuse of the term covenant in much of the nursing literature whereby individual nurses are improperly and impossibly idealised as holding sole responsibility in the commitment to care. Such an interpretation obscures society's responsibilities in caring for both patients and nurses and contributes to the idealisation of nurses' commitment to extend themselves to fill in healthcare system gaps. Yet, the concept of a covenant relationship, when reframed as occurring between society and the profession of nursing, may lead us toward solutions to the very problems the originally misused concept sustained. Evidence within healthcare systems globally suggests that nurses' commitments are fragile or fragmented under duress due to increasing pressure, demands, and even risks. A reframing of covenant has the common good for society and nursing at its core and, we argue, may lead to a more sustainable nursing identity. We present the results of an exploratory project, undertaken to examine the utility and suitability of covenant as a relational framework for nursing. We explore a reframing of a covenant of care as a relationship between nursing and society, which may provide a fruitful path toward a sustainable, shared commitment for healthcare. This covenant of care re‐centres shared work—a joint responsibility between society and nursing—as necessary for the common good. [ABSTRACT FROM AUTHOR]

Background: Relapse and refractory (R/R) rates after first‐line R‐CHOP in diffuse large B cell lymphomas (DLBCL) are ~40% and ~15% respectively. Aims: We conducted a retrospective real‐world analysis aimed at evaluating clinical outcomes of R/R DLBCL patients. Material and Methods: Overall, 403 consecutive DLBCL patients treated in two large hematological centers in Torino, Italy were reviewed. Results: At a median follow up of 50 months, 5‐year overall survival from diagnosis (OS‐1) was 66.5%, and 2‐year progression free survival (PFS‐1) was 68%. 134 (34.4%) patients relapsed (n = 46, 11.8%) or were refractory (n = 88, 22.6%) to R‐CHOP. Most employed salvage treatments included platinum salt‐based regimens in 38/134 (28.4%), lenalidomide in 14 (10.4%). Median OS and PFS after disease relapse or progression (OS‐2 and PFS‐2) were 6.7 and 5.1 months respectively. No significant difference in overall response rate, OS‐2 or PFS‐2 in patients treated with platinum‐based regimens versus other regimens was observed. By multivariate analysis, age between 60 and 80 years, germinal center B cell type cell of origin and extranodal involvement of <2 sites were associated with better OS‐2. Discussion: Our findings confirm very poor outcomes of R/R DLBCL in the rituximab era. Widespread approval by national Medicine Agencies of novel treatments such as CAR‐T cells and bispecific antibodies as second‐line is eagerly awaited to improve these outcomes. [ABSTRACT FROM AUTHOR]

Herein, the design, optimization, fabrication, and characterization of a highly efficient selective emitter (SE) for solar thermophotovoltaic systems is presented. An SE consisting of three layers (SiNx–SiO2–TiO2) deposited on a tungsten substrate is optimized for use with photovoltaic (PV) cells based on III–V semiconductors, such as GaSb, InGaAs, and InGaAsSb. The fabricated SE shows an emitter efficiency (ηSE) of 50% when coupled with a PV cell having an energy bandgap of 0.63 eV. After thermal treatment carried out at 1000 °C for 8 h in a vacuum environment, ηSE of 46% is recorded, demonstrating the thermal stability of the proposed SE. Its behavior at high temperatures has also been studied using simulations based on the transfer matrix method and on refractive indices experimentally measured at different temperatures (up to 1000 °C). The results show ηSE of 44% in the energy bandgap range of 0.55–0.63 eV, proving that the proposed structure is promising and can operate at high temperatures. In addition, the behavior of a real PV cell is simulated, and calculations show a maximum PV cell efficiency of 15% at 1000 °C and 25% at 1600 °C, exceeding the Shockley–Queisser limit. [ABSTRACT FROM AUTHOR]

Objective: Cardio‐facio‐cutaneous syndrome (CFC) is a genetic disorder due to variants affecting genes coding key proteins of the Ras/MAPK signaling pathway. Among the different features of CFC, neurological involvement, including cerebral malformations and epilepsy, represents a common and clinically relevant aspect. Status epilepticus (SE) is a recurrent feature, especially in a specific subgroup of CFC patients with developmental and epileptic encephalopathy (DEE) and history of severe pharmacoresistant epilepsy. Here we dissect the features of SE in CFC patients with a particular focus on longitudinal magnetic resonance imaging (MRI) findings to identify clinical‐radiological patterns and discuss the underlying physiopathology. Methods: We retrospectively analyzed clinical, electroencephalogram (EEG), and MRI data collected in a single center from a cohort of 23 patients with CFC carrying pathogenic BRAF variants who experienced SE during a 5‐year period. Results: Seven episodes of SE were documented in 5 CFC patients who underwent EEG and MRI at baseline. MRI was performed during SE/within 72 hours from SE termination in 5/7 events. Acute/early post‐ictal MRI findings showed heterogenous abnormalities: restricted diffusion in 2/7, focal area of pcASL perfusion change in 2/7, focal cortical T2/FLAIR hyperintensity in 2/7. Follow‐up images were available for 4/7 SE. No acute changes were detected in 2/7 (MRI performed 4 days after SE termination). Significance: Acute focal neuroimaging changes concomitant with ictal EEG focus were present in 5/7 episodes, though with different findings. The heterogeneous patterns suggest different contributing factors, possibly including the presence of focal cortical malformations and autoinflammation. When cytotoxic edema is revealed by MRI, it can be followed by permanent structural damage, as already observed in other genetic conditions. A better understanding of the physiopathology will provide access to targeted treatments allowing to prevent long‐term adverse neurological outcome. Plain Language Summary: Cardio‐facio‐cutaneous syndrome is a genetic disorder that often causes prolonged seizures known as status epilepticus. This study has a focus on electroclinical and neuroimaging patterns in patients with cardio‐facio‐cutaneous syndrome. During these status epilepticus episodes, we found different abnormal brain imaging patterns in patients, indicating various causes like brain malformations and inflammation. Understanding these patterns could help doctors find specific treatments, protecting cardio‐facio‐cutaneous syndrome patients from long‐term brain damage. [ABSTRACT FROM AUTHOR]

Objective: Variants in GABRA1 have been associated with a broad epilepsy spectrum, ranging from genetic generalized epilepsies to developmental and epileptic encephalopathies. However, our understanding of what determines the phenotype severity and best treatment options remains inadequate. We therefore aimed to analyze the electroclinical features and the functional effects of GABRA1 variants to establish genotype–phenotype correlations. Methods: Genetic and electroclinical data of 27 individuals (22 unrelated and 2 families) harboring 20 different GABRA1 variants were collected and accompanied by functional analysis of 19 variants. Results: Individuals in this cohort could be assigned into different clinical subgroups based on the functional effect of their variant and its structural position within the GABRA1 subunit. A homogenous phenotype with mild cognitive impairment and infantile onset epilepsy (focal seizures, fever sensitivity, and electroencephalographic posterior epileptiform discharges) was described for variants in the extracellular domain and the small transmembrane loops. These variants displayed loss‐of‐function (LoF) effects, and the patients generally had a favorable outcome. A more severe phenotype was associated with variants in the pore‐forming transmembrane helices. These variants displayed either gain‐of‐function (GoF) or LoF effects. GoF variants were associated with severe early onset neurodevelopmental disorders, including early infantile developmental and epileptic encephalopathy. Interpretation: Our data expand the genetic and phenotypic spectrum of GABRA1 epilepsies and permit delineation of specific subphenotypes for LoF and GoF variants, through the heterogeneity of phenotypes and variants. Generally, variants in the transmembrane helices cause more severe phenotypes, in particular GoF variants. These findings establish the basis for a better understanding of the pathomechanism and a precision medicine approach in GABRA1‐related disorders. Further studies in larger populations are needed to provide a conclusive genotype–phenotype correlation. ANN NEUROL 2024;95:27–41 [ABSTRACT FROM AUTHOR]

Patients affected by multiple myeloma (MM) have an increased risk of severe acute respiratory syndrome coronavirus type 2 (SARS‐CoV‐2) infection and subsequent coronavirus (20)19 disease (COVID‐19)‐related death. The changing epidemiological and therapeutic scenarios suggest that there has been an improvement in severity and survival of COVID‐19 during the different waves of the pandemic in the general population, but this has not been investigated yet in MM patients. Here we analyzed a large cohort of 1221 patients with MM and confirmed SARS‐CoV‐2 infection observed between February 2020, and August 2022, in the EPICOVIDEHA registry from 132 centers around the world. Median follow‐up was 52 days for the entire cohort and 83 days for survivors. Three‐hundred and three patients died (24%) and COVID‐19 was the primary reason for death of around 89% of them. Overall survival (OS) was significantly higher in vaccinated patients with both stable and active MM versus unvaccinated, while only a trend favoring vaccinated patients was observed in subjects with responsive MM. Vaccinated patients with at least 2 doses showed a better OS than those with one or no vaccine dose. Overall, according to pandemic waves, mortality rate decreased over time from 34% to 10%. In multivariable analysis, age, renal failure, active disease, hospital, and intensive care unit admission, were independently associated with a higher number of deaths, while a neutrophil count above 0.5 × 109/L was found to be protective. This data suggests that MM patients remain at risk of SARS‐CoV‐2 infection even in the vaccination era, but their clinical outcome, in terms of OS, has progressively improved throughout the different viral phases of the pandemic. [ABSTRACT FROM AUTHOR]

TNFRSF13B mutations are widely associated with common variable immunodeficiency. TNFRSF13B was recently counted among relevant genes associated with childhood‐onset of hematological malignancies; nonetheless, its role in acute myeloid leukemia (AML) remains unexplored. We report the study of a family with two cases of AML, sharing a germline TNFRSF13B mutation favoring the formation of a more stable complex with its ligand TNFSF13: a positive regulator of AML‐initiating cells. Our data turn the spotlight onto the TNFRSF13B role in AML onset, inserting a new fragment into the complex scenario of a hereditary predisposition to myeloid neoplasms. [ABSTRACT FROM AUTHOR]

Introduction: Health care in Manitoba, Canada is divided into five regions, each with unique geographies, demographics, health care access, and health status. COVID‐19‐related restrictions and subsequent responses also differed by region. To understand the impact of the pandemic on cancer incidence in the context of these differences, we examined age‐standardized cancer incidence rates by region over time before and after the COVID‐19 pandemic. Methods: We used a population‐based quasi‐experimental study design, population‐based data, and an interrupted time series analysis to examine the rate of new cancer diagnoses before (January 2015 until December 2019) and after the start of COVID‐19 and the interventions implemented to mitigate its impact (April 2020 until December 2021) by region. Results: Overall cancer incidence differed by region and remained lower than expected in Winnipeg (4.6% deficit, 447 cases), Prairie Mountain (6.9% deficit, 125 cases), and Southern (13.0% deficit, 238 cases). Southern was the only region that had a significantly higher deficit in cases compared to Manitoba (ratio 0.92, 95% CI 0.86, 0.99). Breast and colorectal cancer incidence decreased at the start of the pandemic in all regions except Northern. Lung cancer incidence decreased in the Interlake‐Eastern region and increased in the Northern region. Prostate cancer incidence increased in Interlake‐Eastern. Conclusions: The impact of the COVID‐19 pandemic on cancer incidence differed by region. The deficit in the number of cases was largest in the southern region and was highest for breast and prostate cancers. Cancer incidence did not significantly decrease in the most northern, remote region. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this paper was to review and synthesize published research articles that have utilized yoga nidra as an intervention. Background: Yoga nidra is a form of guided meditation that has emerged in the literature in the past two decades as an intervention for a variety of medical conditions such as stress and mental health. It differs from traditional yoga, in that it does not require yoga poses. It is a noninvasive, cost‐effective approach that is also easily accessible so it can be done in the privacy and comfort of the home. Design: The integrative review methodology by Whittemore and Knafl (2005) provided the framework for this review. Methods: The databases CINAHL, PubMed, SCOPUS, and PsycINFO were used to search for articles. Inclusion criteria consisted of journal articles in English with no limitations on dates of publication. Studies were excluded if any form of traditional yoga requiring poses was used as an intervention. Also excluded were all types of meditation that were not yoga nidra, systematic reviews, studies that utilized multiple intervention types (i.e., traditional yoga and yoga nidra), and commentaries/brief reports. Twenty‐nine studies met the inclusion criteria. Quality appraisal was completed for each study. Results: The 29 studies that were reviewed consisted of 12 randomized controlled trials, 13 quasi‐experimental studies, 3 mixed‐methods studies, and 1 qualitative study. Outcome variables were categorized according to themes and results were systemically synthesized and reported by theme: (a) stress, (b) mood, (c) well‐being, (d) psychologic dysfunction, (e) biomarkers, (f) sleep, and (g) miscellaneous. Conclusion: Yoga nidra was found to be effective in most of these studies. However, there was some clinical heterogeneity in the sample populations and intervention session lengths, frequencies, and durations, making it difficult to draw conclusions about yoga nidra intervention based solely on the findings presented in this review. More studies are needed overall, particularly ones with larger sample sizes and stronger experimental designs. Clinical Relevance: Yoga nidra has the potential to be a useful, noninvasive, nonpharmacologic treatment or adjunct for a variety of conditions, particularly mental health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Aflatoxin B1 (AFB1) and ochratoxin A (OTA) are among the most important mycotoxins with common presence in bread and bakery products. Biological detoxification of mould food spoilage and mycotoxin contamination by lactic acid bacteria (LABs) exhibits high potential on a cost‐effective and large scale. In this work, the effect of Lactobacillus strains isolated from goat milk whey on reducing AFB1 and OTA during bread making was evaluated by the determination of mycotoxin reduction potential of 12 LAB strains after 72 h incubation in De Man–Rogosa–Sharpe (MRS) broth (37 °C). The most effective LABs were lyophilized and added as ingredient in bread formulation, analysing mycotoxins by high‐performance liquid chromatography coupled with quadrupole time‐of‐flight mass spectrometry after bread fermentation and baking. RESULTS: AFB1 was reduced in MRS broth by seven LABs (11–35%), highlighting Lactobacillus plantarum B3 activity; while all LABs reduced OTA (12–40%) with L. plantarum B3 and Lactobacillus paracasei B10 as the most active strains. Both LABs were lyophilized and added in contaminated bread with and without yeast, reaching AFB1 and OTA reductions up to 27% and 32% respectively in dough and up to 55% and 34% respectively in bread. CONCLUSION: The selected strains significantly reduced AFB1 and OTA during bread fermentation, pointing to a potential biocontrol strategy for mycotoxins detoxification in bread and bakery products. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

We conducted a post hoc analysis of the FOLL12 trial to determine the impact of different initial immunochemotherapy (ICT) regimens on patient outcomes. Patients were selected from the FOLL12 trial, which included adults with stage II–IV follicular lymphoma (FL) grade 1–3a and high tumor burden. Patients were randomized 1:1 to receive either standard ICT followed by rituximab maintenance (RM) or the same ICT followed by a response‐adapted approach. ICT consisted of rituximab‐bendamustine (RB) or rituximab, cyclophosphamide, doxorubicin, and prednisone (R‐CHOP), per physician's decision. A total of 786 patients were included in this analysis, 341 of whom received RB and 445 R‐CHOP. RB was more frequently prescribed to older subjects, females, patients without bulky disease, and those with grade 1–2 FL. After a median of 56 months of follow‐up, R‐CHOP and RB had similar progression‐free survival (PFS) (Hazard Ratio for RB 1.11, 95% CI 0.87–1.42, p = 0.392). Standard RM was associated with improved PFS compared to response‐adapted management both after R‐CHOP and RB. Grade 3–4 hematologic adverse events were more frequent with R‐CHOP during induction treatment and more frequent with RB during RM. Grade 3–4 infections were more frequent with RB. RB was also associated with a higher incidence of transformed FL. R‐CHOP and RB showed similar activity and efficacy, but with different safety profiles and long‐term events, suggesting that the treating physician should carefully select the most appropriate chemotherapy regimen for each patient based on patient's individual characteristics, choices, and risk profile. [ABSTRACT FROM AUTHOR]

High rates of lung failure have been reported in haematological patients after SARS‐CoV2 infection. An early administration of monoclonal antibodies or anti‐virals may improve the prognosis. Oral anti‐virals may have a wider use independently of the genetic variations of the virus. Prospective data on anti‐virals in haematological malignancies (HMs) are still lacking. Outpatients diagnosed with HM and early COVID‐19 infection were prospectively treated with the oral anti‐virals nirmatrelvir/ritonavir and molnupiravir. Incidence of lung failure, deaths and adverse events was analysed. Long‐term outcome at third month was evaluated. Eighty‐two outpatients were evaluable for the study objectives. All patients had been treated for their HM within 12 months. COVID‐19‐related lung failure was 23.1%. Active HM (aOR = 4.42; p = 0.038) and prolonged viral shedding (aOR = 1.04; p = 0.022) resulted independent predictors of severe infection. The vaccination with three to four doses (aOR = 0.02; p = 0.001) and with two doses (aOR = 0.06; p = 0.006) resulted protective. COVID‐19‐related deaths at 28 days were 6.1%. All‐cause mortality at 90‐day follow‐up was 13.4% (n. 11) and included opportunistic infections and cardiovascular events. In conclusion, this approach reduced the incidence of lung failure and specific mortality compared to previous cohorts, but patients remain at high risk of further complications. [ABSTRACT FROM AUTHOR]

Summary: Idelalisib, a reversible inhibitor of PI3Kδ (phosphoinositide‐3 kinase delta), showed remarkable activity in the phase II DELTA trial, leading to its approval by the European Medicines Agency (EMA) in patients with relapsed/refractory (R/R) follicular lymphoma (FL). However, real‐life data on idelalisib are scarce. We treated 55 double‐refractory FL patients with idelalisib in a real‐life setting. With a median exposure to idelalisib of 10 months (range 1–43), overall response rate was 73%, the highest ever reported. Non‐haematological toxicities were mild and manageable. At 12 months, 80% of patients were alive, and 72% disease‐free. The efficacy and safety of idelalisib was confirmed in a real‐life setting. [ABSTRACT FROM AUTHOR]

Summary: COVID‐19 continues to be a relevant issue among patients with haematological malignancies (HM). Vaccines are frequently not effective in subjects on active treatment. In this multicentre retrospective study of Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), we collected data from 91 paucisymptomatic HM patients treated with anti‐spike neutralizing monoclonal antibodies (nMoAbs) to determine time to viral clearance, referencing it to the expected value of 28 days from an historical group of untreated paucisymptomatic patients. Secondary endpoints included rate of hospitalization, intensive care unit (ICU) admission, COVID‐19 related death and safety. SARS‐CoV‐2 molecular swab negativity was obtained in 86 patients (95%), with a median time of 18 days (IQR 13–26; p < 0.0001). We did not find significant variations according to age, diagnosis, treatment type, vaccination status or nMoAbs type. Rate of hospitalization due to COVID‐19 progression was 12% (11/91), with 2 patients (2.2%) requiring ICU admission. With a median follow‐up of 2.33 months, the overall mortality was 5.5% (5/91), with 3 deaths due to COVID‐19. Side effects were rare and self‐limiting. Our data suggest that nMoAbs can limit the detrimental effect of immunosuppressive treatments on COVID‐19 clinical progression and time to viral clearance. The original trial was registered at www.clinicaltrials.gov as #NCT04932967. [ABSTRACT FROM AUTHOR]

Myopericytoma is a rare tumor generally arising from skin and soft tissues of extremities, trunk, head, and neck regions, rarely from visceral sites. An intrathoracic visceral localization may carry a broad differential diagnosis including primary lung, pleura and chest wall lesions, or metastatic lesions. To date, any radiological features have been recognized and diagnosis of myopericytoma with intrathoracic localization remains still challenging. Here, we describe the case of a subpleural lesion incidentally diagnosed in an older adult affected by gastric cancer. Radiological features did not allow a differential diagnosis between a benign lesion, a primary tumor, or a metastasis. After resection, the histological examination showed histopathological features congruent with the diagnosis of myopericytoma. This unusual presentation reflects the need to share clinical, radiological, and histopathological data about this uncommon but frequently misdiagnosed disease. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) progression and drug resistance depend on the crosstalk between MM cells and bone marrow (BM) fibroblasts (FBs). During monoclonal gammopathy of undetermined significance (MGUS) to MM transition, MM cell‐derived exosomes (EXOs) reprogram the miRNA (miR) profile of FBs, inducing the overexpression miR‐23b‐3p, miR‐27b‐3p, miR‐125b‐5p, miR‐214‐3p, and miR‐5100. Here, we demonstrate that the miR content of MM FB‐derived EXOs (FB‐EXOs) overlaps the miR profile of parental FBs by overexpressing comparable levels of miR‐23b‐3p, miR‐27b‐3p, miR‐125b‐5p, miR‐214‐3p, and miR‐5100. Recipient MM cells co‐cultured with MM FB‐EXOs selectively overexpress only miR‐214‐3p and miR‐5100 but not miR‐23b‐3p, miR‐27b‐3p, and miR‐125b‐5p, suggesting a putative selective transfer. MM cells express HOTAIR, TOB1‐AS1, and MALAT1 lncRNAs. Transient transfection of MM cells with lnc·siRNAs demonstrates that HOTAIR, TOB1‐AS1, and MALAT1 lncRNAs are sponges for miR‐23b‐3p, miR‐27b‐3p, and miR‐125b‐5p. Indeed, lncRNA knockdown significantly increased miR levels in U266 MM cells co‐cultured with MM FB‐EXOs. Selective miR‐214‐3p and miR‐5100 overexpression modulates MAPK, PI3K/AKT/mTOR, and p53 pathways in MM cells. Interrogation using the DIANA tools algorithm and transient overexpression using miR mimic probes confirmed the involvement of miR‐214‐3p and miR‐5100 and their target genes, PTEN and DUSP16, respectively, in the modulation of these intracellular pathways. Finally, the uptake of EXOs as well as miR‐214‐3p and miR‐5100 overexpression increase MM cell proliferation and resistance to bortezomib‐induced apoptosis by switching the balance between pro‐/anti‐apoptotic proteins. Overall, these data show that MM cells are not simply a container into which EXOs empty their cargo. On the contrary, tumour cells finely neutralize exosomal miRs via lncRNA expression to ensure their survival. © 2021 The Pathological Society of Great Britain and Ireland. [ABSTRACT FROM AUTHOR]

In G1, all patients, allogeneic recipients and autologous recipients had significantly lower antibody levels than HC, whereas no differences were found in G2. Among the patients vaccinated >5 years after HSCT, allogeneic recipients had antibody titres comparable to HC; in contrast, autologous recipients had significantly lower titres than HC. Keywords: stem cell transplantation; severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination; seroconversion EN stem cell transplantation severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination seroconversion 928 931 4 02/14/22 20220215 NES 220215 Adult patients with haematological malignancies (HM) and coronavirus disease 2019 (COVID-19) have a higher mortality than healthy subjects.1-3 In particular, haematopoietic stem-cell transplantation (HSCT) recipients have a poor prognosis,4,5 strongly supporting the role of vaccination. Serological response following BNT162b2 anti-SARS-CoV-2 mRNA vaccination in haematopoietic stem cell transplantation patients. [Extracted from the article]

Subcutaneous (SC) rituximab may be beneficial in terms of convenience and tolerability, with potentially fewer and less severe administration-related reactions (ARRs) compared to the intravenous (IV) form. This report presents the results of a phase IIIb study conducted in Italy. The study included adult patients with CD20+ DLBCL or FL having received at least one full dose of IV RTX 375 mg/m2 during induction or maintenance. Patients on induction received ≥4 cycles of RTX SC 1400 mg plus standard chemotherapy and FL patients on maintenance received ≥6 cycles of RTX SC. Overall, 159 patients (73 DLBCL, 86 FL) were enrolled: 103 (54 DLBCL, 49 FL) completed induction and 42 patients with FL completed 12 maintenance cycles. ARRs were reported in 10 patients (6.3%), 3 (4.2%) with DLBCL and 7 (8.1%) with FL, all of mild severity, and resolved without dose delay/discontinuation. Treatment-emergent adverse events (TEAEs) and serious adverse events occurred in 41 (25.9%) and 14 patients (8.9%), respectively. Two patients with DLBCL had fatal events: Klebsiella infection (related to rituximab) and septic shock (related to chemotherapy). Neutropenia (14 patients, 8.9%) was the most common treatment-related TEAE. Two patients with DLBCL (2.8%) and 6 with FL (7.0%) discontinued rituximab due to TEAEs. 65.2% and 69.7% of patients with DLBCL and 67.9% and 73.6% of patients with FL had complete response (CR) and CR unconfirmed, respectively. The median time to events (EFS, PFS, and OS) was not estimable due to the low rate of events. At a median follow-up of 29.5 and 47.8 months in patients with DLBCL and FL, respectively, EFS, PFS, and OS were 70.8%, 70.8%, and 80.6% in patients with DLBCL and 77.9%, 77.9%, and 95.3% in patients with FL, respectively. The switch from IV to SC rituximab in patients with DLBCL and FL was associated with low risk of ARRs and satisfactory response in both groups. This trial was registered with NCT01987505. [ABSTRACT FROM AUTHOR]

Summary: The outcome of patients with Hodgkin lymphoma (HL) has improved significantly in recent years, and now attention is increasingly being focused on the well‐being of these young patients. This study aimed to analyse the influence of HL and its treatment on the spermatogenic status of 46 male HL patients with available spermiograms, treated between 2008 and 2016. Analysing prognostic factors at diagnosis, we found that the number of spermatozoa was reduced in stage III–IV; motility and vitality were reduced in stage III–IV and in the presence of B symptoms; and abnormal forms were increased in patients with elevated erythrocyte sedimentation rate (ESR) and low albumin. Furthermore, we found that haematopoietic stem cell transplantation (HSCT) was associated with a severe impairment of fertility in terms of sperm motility. In HL‐treated patients who did not undergo HSCT we found a statistically significantly improved fertility in terms of motility. In this study, we found that HSCT induced infertility in the majority of male patients with HL, but that first‐line treatment could improve the impaired fertility status caused by disease. Further studies are needed in larger case series to investigate risk factors for impaired fertility at HL diagnosis and after treatment. [ABSTRACT FROM AUTHOR]

Personality disorders (PDs) have a prevalence of approximately 10% in the United States, translating to over 30 million people affected in just one country. The true prevalence of these disorders may be even higher, as the paucity of objective diagnostic criteria could be leading to underdiagnosis. Because little is known about the underlying neuropathologies of these disorders, patients are diagnosed using subjective criteria and treated nonspecifically. To better understand the neural aberrancies responsible for these patients' symptoms, a review of functional MRI literature was performed. The findings reveal that each PD is characterized by a unique set of activation changes corresponding to individual structures or specific neural networks. While unique patterns of neural activity are distinguishable within each PD, aberrations of the limbic/paralimbic structures and default mode network are noted across several of them. In addition to identifying valuable activation patterns, this review reveals a void in research pertaining to paranoid, schizoid, histrionic, narcissistic, and dependent PDs. By delineating patterns in PD neuropathology, we can more effectively direct future research efforts toward enhancing objective diagnostic techniques and developing targeted treatment modalities. Furthermore, understanding why patients are manifesting certain symptoms can advance clinical awareness and improve patient outcomes. [ABSTRACT FROM AUTHOR]

The article discusses that Italian Cytometry Society (GIC) endorsement of consensus recommendations for measurable residual disease in chronic lymphocytic leukemia. It mentions that measurable residual disease (MRD) in chronic lymphocytic leukemia (CLL) has moved from a predictor of prognosis to a laboratory parameter strictly correlated to progression-free survival (PFS) and used in clinical trials.

An emerging body of evidence demonstrates that defects in antileukemic effector cells in patients with acute myeloid leukemia (AML) can contribute to the development and/or persistence of the disease. In particular, immune suppressive regulatory T cells (Tregs) may contribute to this defective antileukemic immune response, being recruited by bone marrow leukemic cells to evade immune surveillance. We evaluated Tregs (CD4+/CD45RA-/CD25high/CD127low), performing multiparametric flow cytometry on freshly collected bone marrow aspirate (BMA), in addition to the usual molecular and cytogenetic work-up in newly diagnosed AML patients to look for any correlation between Tregs and the overall response rate (ORR). We studied 39 AML younger patients (<65 years), all treated with standard induction chemotherapy. ORR (complete remission (CR)+CR with incomplete hematologic recovery (CRi)) was documented in 21 out of 39 patients (54%); two partial responder patients were also recorded. Apart from the expected impact of the molecular-cytogenetic group (p = 0.03) and the NPM mutation (p = 0.05), diagnostic BMA Tregs did not show any correlation with ORR. However, although BMA Tregs did not differ in the study population after treatment, their counts significantly decreased in responder patients (p = 0.039), while no difference was documented in nonresponder ones. This suggested that the removal of Treg cells is able to evoke and enhance anti-AML immune response. However, the role of BMA Tregs in mediating immune system-AML interactions in the diagnostic and posttreatment phase should be confirmed in a greater number of patients. [ABSTRACT FROM AUTHOR]

The votes that come with equities barely figure in retail investment decisions, especially the decisions aided by robo‐advisors. This low profile is consistent with the tiny effect a retail investor's votes would have, if she took them seriously. But despite this disinterest in voting implications, or possibly because of it, recent trends in retail investment decisions are reshaping the corporate‐governance landscape by creating new and different blocks of voting power. In this paper I review the relevant trends and consider the implications for public corporations. [ABSTRACT FROM AUTHOR]

Cutis verticis gyrata (CVG) is a neurocutaneous syndrome characterized by the formation of folds in the scalp that resembles the cerebral cortex. We present two cases of CVG and intellectual disability with drug‐resistant epilepsy. Recognizing CVG is necessary to provide interdisciplinary support for the treatment of comorbidities associated with this entity. [ABSTRACT FROM AUTHOR]

We report a case of a 43-year-old patient with a monochorionic triamniotic triplet pregnancy after IVF with donor oocytes. After failed IVF attempts, the patient chose to undergo treatment with donor oocytes. Her 22-year-old oocyte donor underwent standard controlled ovarian hyperstimulation. The retrieved oocytes were fertilized in vitro, and one embryo was transferred at the blastocyst stage. At 6 weeks and 5 days of gestation, an ultrasound revealed monochorionic triamniotic (MCTA) triplets. The risk of monozygotic twinning in women undergoing in vitro fertilization (IVF) is reported to be higher than that in natural conception, although the causes of the phenomenon have not yet been clarified. Efforts still must be made in order to prevent monozygotic multiple pregnancies, associated with much greater chances of obstetric and perinatal morbidity and mortality. [ABSTRACT FROM AUTHOR]

The standard analysis of corporate governance assumes that shareholders vote in ratios that firms choose, such as one share-one vote. However, if the cost of unbundling and trading votes is sufficiently low, then shareholders choose the ratios. We document an active market for votes within the U.S. equity loan market, where the average vote sells for zero. We hypothesize that asymmetric information motivates the vote trade and find support in the cross section. More trading occurs for higher-spread and worse-performing firms, especially when voting is close. Vote trading corresponds to support for shareholder proposals and opposition to management proposals. [ABSTRACT FROM AUTHOR]

The literature documents a convex relation between past returns and fund flows of mutual funds. We show this to be consistent with fund incentives, because funds discard exactly those strategies which underperform. Past returns tell less about the future performance of funds which discard, so flows are less sensitive to them when they are poor. Our model predicts that strategy changes only occur after bad performance, and that bad performers who change strategy have dollar flow and future performance that are less sensitive to current performance than those that do not. Empirical tests support both predictions. [ABSTRACT FROM AUTHOR]

We present evidence that fund managers inflate quarter-end portfolio prices with last-minute purchases of stocks already held. The magnitude of price inflation ranges from 0.5 percent per year for large-cap funds to well over 2 percent for small-cap funds. We find that the cross section of inflation matches the cross section of incentives from the flow/performance relation, that a surge of trading in the quarter's last minutes coincides with a surge in equity prices, and that the inflation is greatest for the stocks held by funds with the most incentive to inflate, controlling for the stocks' size and performance. [ABSTRACT FROM AUTHOR]

The article presents case study of 33-year-old White male with occurrence of chronic myeloid leukemia in a patient with CDC73 gene deletion. It mentions diagnosis of familial isolated hyperparathyroidism (FIHP); and also mentions pathogenicity of CDC73 whole-gene deletions indicates that inactivation of one allele and haploinsufficiency is the cause of the phenotype.

A weekly database of retail money fund portfolio statistics is uneconomical for retail investors to observe, so it allows direct comparison of disclosed and undisclosed portfolios. This makes possible a more direct and unambiguous test for "window dressing" than elsewhere in the literature. The analysis shows that funds allocating between government and private issues hold more in government issues around disclosures than at other times, consistent with the theory that intermediaries prefer to disclose safer portfolios. Cross-sectional comparisons locate the most intense rebalancing in the worst recent performers. [ABSTRACT FROM AUTHOR]

Stress adapted steel folding's for self‐supporting spatial structures The use of folds in civil engineering is limited to longitudinal folds (trapezoidal sheets) and regular folds. Spatial folding structure and foldcoreplates, spatially curved and three‐dimensional shell structures are desiderata of lightweight construction with steel sheets. Spatial fold structures consist mainly of regular folding patterns based on tessellation with primitive faces (triangles and squares). In order to improve the efficiency of these lightweight structures, it makes sense to use folding patterns in accordance with the stresses or stress distribution instead of regular folding patterns based on geometric principles. For this purpose a form finding process has to be developed, which is based on the generation of a trajectory mesh, which is derived from the formative load case. The comparison of the mass input and the load bearing capacity of the folds, which were generated on a geometric basis, with a fold developed on the basis of the trajectory mesh shows the change in efficiency. [ABSTRACT FROM AUTHOR]

Background: Swallowing is a complex physiologic function developing mostly in the first years of life. After 6 years old, if mature deglutition is not achieved, swallowing persists as "atypical swallowing" (AS). Objective: The aim of this study was to detect any electromyographical differences in the muscular activation pattern in patients with and without AS. Materials and methods: 38 adolescents and young adults were selected for this study: 20 with atypical swallowing (AS group) and 18 without (C group). Standardised surface electromyographic analysis was performed by the same operator to detect the activity of masseter (MM), temporalis (TA) and submental (SM) muscles. A Student t test for unpaired data was carried out to detect differences between the AS and C groups. A 1‐way ANOVA was performed to detect any differences between the three couples of muscles. Results: When compared to controls, AS patients showed a significantly longer duration of activity for each couple of muscles and for the whole duration of swallowing act (P < 0.0001) as well as lower intensity of the SM activity (P < 0.05) than controls. Within the AS and C groups, masticatory muscles (MM and TA) showed lower duration of activation (P < 0.01) and lower intensity of the spike (P < 0.0001) than SM. Within the C group, masticatory muscles also reached their activation spike earlier (1‐way ANOVA, P < 0.01) than SM. Conclusion: Two different muscular performance models have been defined: patients with AS showed a longer activity of all the muscles involved with a lower intensity of SM activity than that of controls. [ABSTRACT FROM AUTHOR]

Commercial paper sells at an extra discount if it matures in the next calendar year but Treasury bills do not. The discount is apparent in downward price shifts before the year-end, and upward price shifts at the turn of the year that are significantly correlated with the simultaneous returns to small stocks, and that cannot reflect tax-loss selling. Cross-sectional and time-series tests on prices, as well as flow of funds evidence on trades by institutional investors, indicate that both the debt and equity patterns reflect agency problems related to portfolio disclosures. [ABSTRACT FROM AUTHOR]

This photo demonstrates two papulonodular lesions on the upper labial mucosa consistent with MEH lesions gl Histopathologic Findings Excisional biopsy of two nodules was consistent with fibroepithelial hyperplasia (Figs. Discussion Multifocal epithelial hyperplasia (also known as Heck disease) is a proliferative condition characterized by multifocal nodules of the oral squamous mucosa. A 77-year-old Caucasian female complained of multiple asymptomatic oral lesions of 3 months' duration intermittently traumatized with function. [Extracted from the article]

CD200, a transmembrane type Ia glycoprotein belonging to the immunoglobulin superfamily, has been shown to have a differential expression in B-cell neoplasms. Here, we retrospectively assessed the diagnostic relevance of CD200 on 427 patients with B-cell chronic neoplasms in leukemic phase (median age, 69 y; range, 35-97 y). The final diagnosis based on the investigator's assessment was chronic lymphocytic leukaemia (CLL) in 75% of cases and non-CLL in 25% of cases. Sensitivity and specificity for the diagnosis of CLL (vs non-CLL) were calculated for the following markers: CD200, CD5, CD22, CD23, CD79b, FMC7, and SmIg. CD23 was the only marker without a statistically significant difference between the investigator assessment and the flowcytometric analysis. The other markers were unable-when individually evaluated-to discriminate between CLL and non-CLL, requiring the integration into a scoring system. The modified score no. 1 (addition of CD200) showed superimposable sensitivity and specificity compared with the Matutes score. The substitution of CD79b (modified score no. 2), surface membrane immunoglobulins (SmIg) (modified score no. 3), and CD79b and FMC7 (modified score no. 4) with CD200 showed that only the modified score no. 4 had both higher sensitivity and higher specificity compared with standard Matutes score. In conclusion, this work defines a simplified score, compared with the classical Matutes score, for the differential diagnosis of chronic B-cell leukaemia-which only requires 4 markers instead of 5 (CD5, CD23, CD200, and SmIg). [ABSTRACT FROM AUTHOR]