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Key Clinical Message Early and complete surgical resection is the most important therapeutic and diagnostic measure. Adjuvant radiation is suggested for malign phyllode tumors, phyllode tumors larger than 10 cm or those with a low distance to the resection margins. Abstract Phyllodes tumors are rare fibroepithelial tumors of the breast. Histologically, they are usually classified as benign, borderline or malignant, though these classifications do not necessarily reflect the clinical course of the disease. These tumors may stay undetected for years, or show sudden and rapid progression. There is currently no consistent therapy recommendation based upon histological findings, the localization of the tumor and/or whether it is recurrent. Using the examples of three patients, we show how courses and therapy may differ widely, and discuss this in the context of the current state of the literature.

Background: Prenatal ethylene oxide exposure may have adverse effects on fetal development. We examined the relationships between ethylene oxide hemoglobin (Hb) adduct levels and offspring's size at birth in a prospective European mother--child study. Methods: This study included 1106 singletons from the NewGeneris project (2006-2010) with ethylene oxide Hb adducts measured in cord blood. We examined the relationships between adduct levels and offspring's size at birth among all infants and separately among infants of nonsmokers, using linear regression models for birth weight and birth head circumference and logarithmic binomial regression models for small for gestational age. We examined potential interactions between CYP2E1 single nucleotide polymorphisms in cord blood and the effects of ethylene oxide Hb adduct levels on offspring birth size. Results: Higher quartiles of adduct levels as a measure of exposure were associated with decreasing birth weight and head circumference in the overall population. Compared to infants in the lowest quartile, those in the highest quartile exhibited lower birth weight (-70.73 g, 95% confidence interval = -141.16, -0.30) and reduced head circumference (-0.30 cm, 95% confidence interval = -0.58, -0.02). We observed similar, albeit less pronounced, patterns among infants of nonsmokers. There was no evidence of an association between ethylene oxide Hb adducts and risk of small for gestational age, nor consistent evidence of an interaction with CYP2E1 polymorphisms on the association between EO Hb adduct levels and offspring's size at birth. Conclusion: Results suggest that higher ethylene oxide Hb adduct levels in cord blood are associated with a reduction in offspring birth size. [ABSTRACT FROM AUTHOR]

The aim of the present review is to discuss the roles of vitamin K (phylloquinone or menaquinones) and vitamin K-dependent proteins, and the combined action of the vitamins K and D, for the maintenance of bone health. The most relevant vitamin K-dependent proteins in this respect are osteocalcin and matrix Gla-protein (MGP). When carboxylated, these proteins appear to have the ability to chelate and import calcium from the blood to the bone, thereby reducing the risk of osteoporosis. Carboxylated osteocalcin appears to contribute directly to bone quality and strength. An adequate vitamin K status is required for the carboxylation of MGP and osteocalcin. In addition, vitamin K acts on bone metabolism by other mechanisms, such as menaquinone 4 acting as a ligand for the nuclear steroid and xenobiotic receptor (SXR). In this narrative review, we examine the evidence for increased bone mineralization through the dietary adequacy of vitamin K. Summarizing the evidence for a synergistic effect of vitamin K and vitamin D3, we find that an adequate supply of vitamin K, on top of an optimal vitamin D status, seems to add to the benefit of maintaining bone health. More research related to synergism and the possible mechanisms of vitamins D3 and K interaction in bone health is needed. [ABSTRACT FROM AUTHOR]

Collaborative professional development of science and special educators leads to improved access and inclusion of students with disabilities. Yet, despite poor science achievement of students with disabilities, their increasing presence in general education science classrooms, and research that demonstrates effective teaching strategies for students with special education needs, there have been few reports of joint professional development in the literature. The purpose of the study was to examine changes in the teaching practices of science and special educators, grades 4 to 8, as they completed an intense year-long professional development program designed to promote hands-on, inquiry-based science in their classrooms and expand their instructional repertoires to better serve students with disabilities and other learning problems. Quantitative and qualitative measures, including pre and post ratings of teacher classroom performance, action research projects, and teacher self-reports were used to determine changes in teaching practices. Findings indicated all teachers showed improvement in the classroom on many elements related to classroom culture, instructional content, and lesson design and implementation, and the ability to adjust instruction.

The prevalence of choroidal naevi is common and has been found to be up to 10%. Little is known regarding the optical properties of choroidal naevi. A novel hyperspectral eye fundus camera was used to investigate choroidal naevi's optical density spectra in the retina. In an ophthalmology clinic setting, patients with choroidal naevi were included in the study. Visual acuity and pressure were tested. Following mydriatics, optical coherence tomography and fundus photography were taken as a reference, after which a hyperspectral image with 12 nm spectral resolution at 450–700 nm was taken. The optical density spectra was measured across the area of the naevus. Nine patients with 11 naevi were examined. The visual acuity was not affected by any of the naevi. All the naevi were flat as measured either with the optical coherence tomography and/or on inspection, and only one naevi had a risk factor (orange pigmentation). The Wasserstein distance between the background and the naevi was higher at 695 nm compared to 555 nm (p =.002). The naevi could be grouped into three clusters based on the extracted optical density spectra. Choroidal naevi are better visible in longer wavelengths compared to shorter wavelengths. This finding can be used to contour and follow choroidal naevi. Choroidal naevi expose different optical density spectra that can be grouped into three different clusters. One of these clusters has an optical density spectra resembling the absorption spectra of lipofuscin, which may indicate the content of this pigment. [ABSTRACT FROM AUTHOR]

Background: Selenium-dependent deiodinases play a central role in thyroid hormone regulation and metabolism. In many European countries, insufficient selenium intake may consequently lead to adverse effects on thyroid function. In this randomised placebo-controlled double-blind study, we examined the effect of supplementation with selenium and coenzyme Q10 on thyroid hormonal status, cardiovascular (CV) mortality and health-related quality of life (Hr-QoL). Methods: Free T3, free T4, reverse T3, and TSH were determined in 414 individuals at baseline, and the effect of selenium yeast (200 µg/day) and coenzyme Q10 (200 mg/day) supplementation on hormone concentrations, CV mortality and Hr-QoL was evaluated after 48 months using Short Form 36 (SF-36). Pre-intervention plasma selenium was low, mean 67 µg/L, corresponding to an estimated intake of 35 µg/day. Changes in concentrations of thyroid hormones following the intervention were assessed using T-tests, repeated measures of variance, and ANCOVA analyses. Results: In the total population, the group with the lowest selenium concentration at baseline presented with significantly higher levels of TSH and lower levels of fT3 as compared to subjects with the highest selenium concentration. Supplementation with selenium and coenzyme Q10 for 4 years significantly increased fT3 and rT3, decreased fT4, and diminished the increase in TSH levels compared with placebo treatment (p = 0.03, all). In the placebo group, TSH and fT4 values above the median were associated with an increase in 10-year CV mortality, as compared with the mortality rate among those with TSH and fT4 below the median (p < 0.04, both), with no difference in mortality rate according to TSH and fT4 levels in the active intervention group. Similarly, TSH > median and fT3 < median were associated with a decline in mental Hr-QoL measures vs. TSH < and fT3 > median in the placebo group during 4 years of follow-up, but this was wiped out in the active group. Conclusions: Supplementation with selenium and coenzyme Q10 had a beneficial effect on thyroid hormones with respect to CV mortality and Hr-QoL outcomes. The initial deficient selenium status was associated with an impaired thyroid function and the changes in thyroid hormone levels can be explained by increased activity of deiodinases. We conclude that a substantial part of the elderly study population might suffer from suboptimal thyroidal function with adverse clinical implications due to selenium deficiency. Trial registration: This study was registered at ClinicalTrials.gov and has the identifier NCT01443780. Since it was not mandatory to register at the time the study began, the study has been registered retrospectively. [ABSTRACT FROM AUTHOR]

Disasters do and have happened throughout human existence. Their traces are found in the environmental record, archaeological evidence, and historical chronicles. Societal responses to these events vary and depend on ecological and cultural constraints and opportunities. These elements are being discovered more and more on a global scale. When looking at disasters in antiquity, restoring the environmental and geographical context on both the macro- and microscale is necessary. The relationships between global climatic processes and microgeographical approaches ought to be understood by examining detailed societal strategies conceived in response to threatening natural phenomena. Architectural designs, human geography, political geography, technological artefacts, and textual testimony are linked to a society’s inherited and real sense of natural threats, such as floods, earthquakes, fires, diseases, etc. The Shang and Mycenaean cultures are prime examples, among others, of Bronze Age societies with distinctive geographical, environmental, and cultural features and structures that defined their attitudes and responses to dangerous natural phenomena, such as floods, earthquakes, landslides, and drought. By leaning on two well-documented societies with little to no apparent similarities in environmental and cultural aspects and no credible evidence of contact, diffusion, or exchange, we can examine them free of the onus of diffused intangible and tangible cultural features. Even though some evidence of long-distance networks in the Bronze Age exists, they presumable had no impact on local adaptive strategies. The Aegean Sea and Yellow River cultural landscapes share many similarities and dissimilarities and vast territorial and cultural expansions. They have an apparent contemporaneity, and both recede and collapse at about the same time. Thus, through the microgeography of a few select Shang and Mycenaean sites and their relevant environmental, archaeological, and historical contexts, and through environmental effects on a global scale, we may understand chain events of scattered human societal changes, collapses, and revolutions on a structural level.

BackgroundMobile health (mHealth) interventions can increase physical activity (PA); however, their long-term impact is not well understood. ObjectiveThe primary aim of this study is to understand the immediate and long-term effects of mHealth interventions on PA. The secondary aim is to explore potential effect moderators. MethodsWe performed this study according to the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, the Cochrane Library, SCOPUS, and PsycINFO in July 2020. Eligible studies included randomized controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and energy expenditure. Where reported, we extracted data for 3 time points (ie, end of intervention, follow-up ≤6 months, and follow-up >6 months). To explore effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration tool. ResultsOf the 2828 identified studies, 117 were included. These studies reported on 21,118 participants with a mean age of 52.03 (SD 14.14) years, of whom 58.99% (n=12,459) were female. mHealth interventions significantly increased PA across all the 4 outcome measures at the end of intervention (walking standardized mean difference [SMD] 0.46, 95% CI 0.36-0.55; P