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* Context.--Epithelioid angiomyolipomas (eAMLs) are rare tumors of the kidney that occur in patients with tuberous sclerosis complex or in a sporadic setting; a subset of these tumors exhibit metastatic behavior. Objective.--To analyze molecular profiling data to identify pathogenic alterations in rare cases of metastatic eAML, and to identify immunohistochemistry (IHC)-based surrogate markers. Design.--Molecular profiling data from the American Association for Cancer Research GENIE registry was accessed for 23 patients with angiomyolipomas, and 9 of 16 patients with eAMLs in our institutional registry were evaluated with next-generation sequencing. IHC was performed to screen for alterations of P53, RB, and ATRX for all 16 institutional cases. Results.--Combined alterations of 5 tumor-suppressor genes (TP53, ATRX, RB1, APC, and NF1) were identified using next-generation sequencing in 7 of 8 (88%) patients with metastatic disease compared to a single patient with nonmetastatic disease (RB1 variant of uncertain significance; 1 of 24, 4%). No cases with abnormal IHC results were identified in 11 patients with nonmetastatic disease compared to 3 of 5 patients with metastatic disease. Conclusions.--Our results show that the majority of metastatic eAMLs have mutations of 5 tumor-suppressor genes (TP53, ATRX, RB1, APC, and NF1), while these are rare in patients with nonmetastatic disease. Furthermore, IHC for P53, RB, and ATRX may serve as a screen for a subset of these alterations in resource-limited settings. These findings, if validated in larger data sets, have the potential to predict metastatic behavior in eAMLs. (Arch Pathol Lab Med. 2023;147:817-825; doi: 10.5858/ arpa.2022-0127-OA), Renal angiomyolipomas (AMLs) are mesenchymal neoplasms that are typically comprised of spindle cells arising from thick-walled vessels, intermixed with variable amounts of adipose tissue; they frequently express markers such as [...]

Depression is the most common psychological challenge faced by many individuals and families following stroke. Fortunately, poststroke depression is treatable, and even preventable, if social work and other rehabilitation practitioners understand the most common risk factors and become familiar with measures for assessing for depression among patients with medical comorbidities such as stroke. The purpose of this article is to raise awareness among readers about the strong potential for depression following stroke and to provide an overview of common assessment measures. On the basis of increasing numbers of patients being cared for by informal caregivers following discharge from inpatient care facilities, growing evidence of the interconnectedness of couples' emotional well-being and the significance of couples-level factors like relationship quality and coping in the well-being of couples experiencing stroke, and current needs for effective interventions for poststroke depression, a secondary purpose of this article is to describe the importance of assessing and treating survivors in the context of their committed relationships. KEY WORDS: couples; depression; stroke, Each year, approximately 800,000 people in the United States experience stroke (American Heart Association [AHA], 2010). This works out to about one stroke every 40 seconds, less time than it [...]

Objective: To determine if personal health of spine surgeons worldwide influences perceptions, healthcare delivery, and decision-making during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A cross-sectional study was performed by distributing a multidimensional survey to spine surgeons worldwide. Questions addressed demographics, impacts and perceptions of COVID-19, and the presence of surgeon comorbidities, which included cancer, cardiac disease, diabetes, obesity, hypertension, respiratory illness, renal disease, and current tobacco use. Multivariate analysis was performed to identify specific comorbidities that influenced various impact measures. Results: Across 7 global regions, 36.8% out of 902 respondents reported a comorbidity, of which hypertension (21.9%) and obesity (15.6%) were the most common. Multivariate analysis noted tobacco users were more likely to continue performing elective surgery during the pandemic (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.46–4.72; p = 0.001) and were less likely to utilize telecommunication (OR, 0.51; 95% CI, 0.31–0.86; p = 0.011), whereas those with hypertension were less likely to warn their patients should the surgeon become infected with COVID-19 (OR, 0.57; 95% CI, 0.37–0.91; p = 0.017). Clinicians with multiple comorbidities were more likely to cite personal health as a current stressor (OR, 1.32; 95% CI, 1.07–1.63; p = 0.009) and perceived their hospital’s management unfavorably (OR, 0.74; 95% CI, 0.60–0.91; p = 0.005). Conclusion: This is the first study to have mapped global variations of personal health of spine surgeons, key in the development for future wellness and patient management initiatives. This study underscored that spine surgeons worldwide are not immune to comorbidities, and their personal health influences various perceptions, healthcare delivery, and decision-making during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Family caregivers of youth with DD and behavioral health issues experience the highest level of caregiving strain. Many must also deal with their own or another family member's chronic health condition, which may place them at additional risk for poor outcomes.Aims: (1) Provide a "snapshot" of DD family caregivers based on a national sample; (2) identify risk and protective factors among groups of DD caregivers with graduated levels of health-related stressors; (3) examine the impact of risk and protective factors on strain for DD caregivers.Methods and Procedures: We conducted a secondary analysis of data from N=600 DD caregivers recruited through sites across the United States. Risk and protective factors were compared among three groups of caregivers at study enrollment: (1) those focused on providing care for the target youth with DD, without additional health-related stressors with which to contend; (2) those contending with minor additional health-related stressors; and, (3) those contending with major additional health-related stressors. Predictors of caregiving strain at six months post-enrollment were identified.Results: 52% of the overall sample was unemployed and 71% were living at or below poverty. Differences were found among groups on a variety of risk and protective factors. With some exceptions, predictors of caregiving strain were similar to non-DD populations.Conclusions and Implications: This study provides valuable information about a population of caregivers who are highly vulnerable to poor outcomes. Findings highlight the importance of considering the needs, strengths, and outcomes of family caregivers. [ABSTRACT FROM AUTHOR]

Reports on research by the United States Academy of Sciences Institute of Medicine on the effect of sex-based differences between men and women on health. Details of the report, 'Exploring the Biological Contributions to Human Health: Does Sex Matter?'; Indication that there are differences at the cellular and molecular level between men and women, which result from genetic differences due to the sexual genotype of each cell and contribute to different patterns of illness and differences in lifespan.

Discusses a report by the United States National Academies of Science National Research Council (NRC) which states that the effects of global warming on infectious disease patterns are unknown. Refutation of other studies which predicted that global warming would lead to an increase in infectious diseases; Suggestion that the relationship between climate, human behavior, and infectious disease is too complex to predict; Criticism of the report.

Focuses on the health problems of travelers visiting friends and family. Trend of well-established immigrants contracting infectious diseases, like typhoid, cholera, and dengue, when they visit their countries of origin; Failure to receive vaccines or prophylactic measures due to a belief that they are immune; Vulnerability of children when they visit relatives in Asia, Africa, and Latin America, because they have often not acquired the immunity of their parents.

Focuses on the report 'Crossing the quality chasm: a new health system for the 21st century,' released on March 1, 2001 by the United States National Academy of Sciences Institute of Medicine. Criticism of the fragmented and inefficient quality of health care in the U.S.; Problems of equity and cost that persist despite other reforms; Guidelines which the report sets forth.

Reports on an increase in the prevalence of diabetes in the United States. Study published in the 2000 issue of 'Diabetes Care' by Michael Engelgau and coworkers of the U.S. Centers for Disease Control and Prevention suggesting a link between diabetes and obesity; Use of data collected by the Behavioral Risk Factor Surveillance System; Statistics.

Reports that the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) is calling on doctors to use their influence to persuade governments to make economic sanctions less harmful to the health of the people in targeted nations. How sanctions have caused shortages of medicine and food, and are to blame for increased rates of diseases and nutritional deficiencies; Request that sanctions should exclude medicine, food, and other materials needed to maintain health.

Reports that a judge in Eugene, Oregon, has prohibited an HIV-infected mother from breastfeeding her baby. Diagnosis of Kathleen Tyson; Treatment for the child; Terms of the court order.

Presents the results of a study that may explain why high-dose beta-carotene supplements unexpectedly increased lung cancer rates in two cancer prevention trials which included smokers. Ferrets given beta-carotene doses equivalent to those used in trials; Changes in beta-carotene metabolism were induced that may promote rather than inhibit tumorigenesis.

Describes the effectiveness of inhaled tobramycin in patients with cystic fibrosis. Improved lung function and reduced risk of hospital admission; Research by Ramsey et al, University of Washington, Seattle; Potential use of inhaled antibiotics for other diseases; Effects of Pseudomonas aeruginosa in airways; Methods and results.

States that children who are high users of sunscreen are more likely to have higher numbers of naevi than infrequent users and could be at higher risk for developing melanoma. Study by Philippe Autier et al of the European Institute of Oncology in Milan, Italy; Brief details of the study.

Discusses a report from the United States Institute of Medicine Committee on Xenograft Transplantation called `Xenotransplantation, Science, Ethics and Public Policy.' Conclusion that the potential benefits of xenotransplantation outweigh the potential risk of introducing cells, tissues, and organs from animals into human beings; Committee recommendations.

Reports on the listing of glasswool or fiberglass as potential human carcinogen in the Annual Report on Carcinogens prepared by the National Toxicology Program in the United States. Reliance on data from the World Health Organization's (WHO) International Agency for Research on Cancer; Obsolescence of source of data according to the North American Insulation Manufacturers Association.

Looks at results of a study of schoolchildren in North Carolina conducted by Joanne Harrell and co-workers. The finding that a program of education and exercise significantly lowered elevated serum cholesterol concentration in those who had multiple risk factors for cardiovascular disease; Other findings about this classroom-based intervention.

Examines the conclusion of a study which reported that United States cities with large inequalities in the distribution of income tend to have much higher death rates than cities with more homogeneous incomes. Data which was analysed; Use of three statistical methods commonly used by economists to measure income distribution; Findings; Conclusions.

Reports on the study of iodine-131 fallout from above-ground nuclear bomb tests conducted in Nevada during the Cold War. The estimates by the National Cancer Institute of expected incidence of thyroid cancer from the radioactive iodine; The National Academy of Sciences' Institute of Medicine to review the findings.

Examines the benefits of folic acid fortification for the elderly. Indication that the benefits of reducing coronary heart disease and stroke risk by reducing blood homocysteine outweigh the risk that food fortification may allow the progression of neuropsychiatric damage; Source of report; Suggestion that the potential benefits are considerable.