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Background and study aims Neuroendocrine neoplasms (NEN) account for a small number of colorectal neoplasms. Endoscopic detection is essential for diagnosis, treatment and follow-up. Little is known about incidence of NENs in colonoscopy populations or the relationship between clinical, endoscopic and histopathologic features. We evaluated epidemiology, endoscopic and clinical characteristics of colorectal NENs in a population-based cohort. Patients and methods Medical records of NEN cases were cross-linked with the national pathology database from January 2001 to December 2015, in South Limburg County, the Netherlands, covering four endoscopy units. Senior pathologists reviewed and classified NENs using World Health Organization 5th edition (2019) guidelines. Results The number of colorectal NEN diagnoses was stable over time with 0.6 NEN per 1,000 patients. A total of NENs were detected in 85 patients: 65 neuroendocrine tumors (NETs) and 20 poorly differentiated neuroendocrine carcinomas (NECs). Rectal NETs were usually small sessile/submucosal lesions with yellowish (lipoma-like) color. Colonic NETs were larger sessile/submucosal lesions with darker color compared to background. Colorectal NECs presented as large, dark-colored lesions with ulcerated/necrotizing areas. Conclusions Our population-based data point to a stable and low incidence of 0.6 NEN per 1,000 patients in the Netherlands. Rectal NETs mainly present as small sessile yellowish lesions. Colonic NETs present as larger and darker lesions than background mucosa and NECs as darker lesions than background with ulceration/necrosis. Standardized endoscopic characterization of colorectal NENs is necessary to improve recognition of these lesions and provide a basis for evidence-based treatment and surveillance recommendations.

A study on the type and frequency of injuries in preschool-age children was conducted in a sample of households representing population of Purworejo district. A two stages cluster (wilcah) method was used to select 4.354 preschool-age children living in 12,721 households in the district. The mother or other child caretakers provided responses about injuries occurring during the 3 months period to interview. Injuries among these preschool-age children included trauma by cutting or sharp object (6.5%), falls (5.7%), bums (0.6%), bites (0.4%), traffic accident (0.4%), unconsciousness (0.2%) and poisoning (0 .1 %). The typical injury in under the 12 months olds was falls. Children aged 12 to 23 month accounted for 18% of the injury episodes which were typical fall and trauma. Children aged 24 to 59 months accounted for 76.6% of injury episodes which were typically trauma, falls, bums, bites and traffic accident. No statistical differences in the frequency and type on injuries were observed between urban and rural areas. The relative frequency in age-grouped and type of injuries from this population-based study can be used in planning injury prevention especially for family health education program.

Background: One of the most important factors in providing health services is communication. Effective communication between patient-physician will have an impact on health outcomes. Nevertheless, a gap still occurs in patient-physician communication. Objective: This study aimed to determine the correlation between the core concepts of the well-established Health Belief Model: perceived susceptibility, perceived severity, perceived benefits, perceived barriers and cues to action with the concept of self-efficacy in applying the newly developed Indonesian Model of Assertive Communication called "CERDAS”. Methods: A cross sectional study was conducted with 202 eligible women of the Family Welfare Programme in Yogyakarta, Indonesia. The samples were selected using quota sampling. Data were analyzed using Pearson correlation test. Results: Results of the Pearson correlation tests between self efficacy and perceived susceptibiliy showed r: 0.191, perceived severity r: 0.239, perceived benefits r: 0.256, perceived barriers r: 0.272, and cues to action r: 229; with all values p

Background: Derogation of professional behavior (PB) increased in education, even in medical education revealed cheating during in educational process as best predictor when the students at work placed in the future. The aim of this study is to know the students’ perspective on cheating, altruism and plagiarism. Method: This study was conducted using a qualitative approach. Sampling technique was purposeful sampling with criterion reference. Fifty-two year-one students of medical school of faculty of medicine and health sciences (FMHS) divided into 5 groups, each group consists of 10 to 11 students. The students received teaching learning of PB (three times tutorial with trigger film, reflection and expert panel). Qualitative data from students’ reflection analized using constant comparative method. Results: The results of this study indicated the presence of 6 final themes (i.e., learning value, learning approach, student preparedness, examination strategy, learning spiritual, study plan. Students who had the ability to understand various learning events would have a good study plan, and then could choose appropriate examination strategy to reach success and could avoid blamable event such as cheating. The students who had good learning spiritual and learning value to dilemmatic event, they would be motivated and their heart would be touched, so in their future plan they would try to be altruistic and professional doctor in all situation. There would be influence on positive study plan, make more effort and pried to God, also respect others work, so plagiarism could be avoided. Conclusion: There were 6 final themes of students’ reflection on cheating, altruism and plagiarism after they exposure by teaching learning of PB. They were learning value, learning approach, student preparedness, examination strategy, learning spiritual and study plan.

Background: Educational institutions must promote the learning of professional behavior as early as possible and conduct evaluation of the implementation, including evaluation of the academic integrity implementation. This study aims to determine the academic integrity perception, behavior and intention of students and their relation to mental capacity and basic personality of students based on the MMPI-2 measurements. Method: This was a non-experimental, conducting quantitative survey involving 209 medical students from one of Faculty of Medicine in Indonesia. Results: The relationship between mental capacity and basic personality based on the measurement of MMPI-2 and the perceptions, attitude and intentions of academic integrity were found. On mental capacity, a correlation was found between potential performance and perceptions (r = 0.169 and p = 0.014) and academic integrity behavior (r = 0.170 and p = 0.014), between adaptability and perception of academic integrity of fellow students (r = 0.149 and p = 0.032), between psychological constraints and academic integrity behavior score (r = 0.137 and p = 0.049) and between moral integrity and perception score of academic integrity (r = - 0.220 and p = 0.001). On the basic personality, there was a correlation between openness to pressure and perceptions of academic integrity of fellow students (r = 0.141 and p = 0.041), as well as between basic personality and perception (r = 0.169 and p = 0.014) and academic integrity behavior (r = 0.154 and p = 0.026). Conclusion: There is a correlation in some variables of mental capacity and basic personality based on MMPI-2 to perception and academic integrity behavior.

Objective: To study the effects of COX-2 on colonic surgical wound healing. Background: Cyclooxygenase-2 (COX-2) is a key enzyme in gastrointestinal homeostasis. COX-2 inhibitors have been associated with colonic anastomotic leakage. Methods: Wildtype, COX-2 knockout and COX-2 heterozygous mice were subjected to a model of colonic anastomotic leakage, and were treated with vehicle, diclofenac, or prostaglandin E2 (PGE2), the most important COX-2 product in the intestine. We assessed anastomotic leakage, mortality, angiogenesis, and inflammation. Furthermore, we investigated the association between anastomotic leakage and a human polymorphism of the COX-2 gene resulting in low COX-2 levels. Results: Diclofenac, a nonsteroidal anti-inflammatory drug inhibiting COX-2, increased anastomotic leakage compared to vehicle-treated mice (100% vs 25%, respectively). Similarly, 92% of COX-2-deficient mice developed anastomotic leakage (P = 0.003) compared to WT. PGE2 partly rescued this severe phenotype because only 46% of PGE2-administered COX-2 knockout mice developed anastomotic leakage (P = 0.02). This may be related to decreased neovascularization, because decreased CD31 staining, indicating less blood vessels, was observed in COX-2-/- mice (2 vessels/mm2 vs 6 vessels/mm2 in controls (P = 0.03)). This effect could partly be reversed by administration of PGE2 to COX-2-/- mice. No significant differences in inflammation were found. PTGS2-765G>C polymorphism in humans, associated with reduced COX-2 expression, was associated with higher anastomotic leakage rates. Conclusions: COX-2-induced PGE2 production is essential for intestinal wound healing after colonic surgery, possibly via its effects on angiogenesis. These data emphasize that COX-2 inhibitors should be avoided after colonic surgery, and administration of PGE2 might be favorable for a selection of patients. [ABSTRACT FROM AUTHOR]

Summary Cervical intraepithelial neoplasia (CIN) is historically viewed as a progressive biologic continuum leading to cervical cancer. However, it has been questioned whether CIN1 lesions ever progress. To this end, we evaluated the number of patients with a CIN3 and a previous CIN1 diagnosis. Subsequently, metachronous CIN1 and CIN3 lesions were reviewed and human papillomavirus (HPV) genotyping was performed to evaluate whether CIN1 lesions do progress. The medical records of 1819 patients diagnosed with a CIN3 lesion were retrieved from the archives, and prior Pap smear surveillance was available for 1474 patients. Forty-four CIN3 patients (3.0%) had a previous CIN1 lesion, and review of the biopsies confirmed 43 out of 44 CIN3 lesions and 37 out of 44 CIN1 lesions (78%). Three cases were not available for analysis, and in another three cases the quality of the isolated DNA was insufficient for further analysis. Out of the 30 remaining patients, 19 patients had different HPV genotypes in their CIN1 and CIN3 lesion. The cytological diagnosis leading to the CIN1 biopsy showed high-grade squamous intraepithelial lesion in 11 out of 19 patients with a different HPV genotype in the metachronous CIN1 and CIN3 lesions. High-grade squamous intraepithelial lesion was detected in 7 out of 11 patients with the same HPV genotype. Our results show that CIN3 lesions are rarely preceded by a CIN1 lesion. The majority of metachronous CIN1 and CIN3 lesions are caused by different HPV genotypes, indicating that the presence of CIN1 seems not to determine the risk for subsequent detection of CIN3. [ABSTRACT FROM AUTHOR]

Prader–Willi syndrome (PWS) is a complex condition with many medical and psychological features. In individuals with this syndrome, causes of death were studied. Data of 27 case reports were collected. Ages at death ranged from neonatal to 68 years. None of the individuals were treated with growth hormone (GH). Most cases were not completely documented and autopsy was performed in a minority of cases only. In five cases, death was considered not to be causally related to PWS. Hypotonia with hypoventilation was noted in the babies, and acute respiratory illness with unexpected sudden death was experienced in young children with PWS. Two young children died after a short period of fever and gastroenteritis. Obesity and its complications leading to death were pronounced in the adult group. One (possibly two) adult(s) died from gastric dilatation and shock. Based on these data, some cautious conclusions can be drawn. In babies with PWS hypoventilation is a risk factor; upper airway infection may be more serious than anticipated and any other clinical features pointing to an infection should be taken very seriously. Therefore, young infants with PWS hospitalized with an upper airway infection and/or hypoventilation or gastroenteritis symptoms, should be closely monitored. Early diagnosis and prevention of overweight is a major factor in preventing early causes of death in individuals with PWS. In the adult group, weight reduction is important but difficult to manage. Sleep apnea should be recognized and treated. Pain in the upper stomach and/or vomiting should be taken as a possible sign of acute intestinal dilatation; intravenous support may be life saving. © 2003 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Background and study aims  Neuroendocrine neoplasms (NEN) account for a small number of colorectal neoplasms. Endoscopic detection is essential for diagnosis, treatment and follow-up. Little is known about incidence of NENs in colonoscopy populations or the relationship between clinical, endoscopic and histopathologic features. We evaluated epidemiology, endoscopic and clinical characteristics of colorectal NENs in a population-based cohort. Patients and methods  Medical records of NEN cases were cross-linked with the national pathology database from January 2001 to December 2015, in South Limburg County, the Netherlands, covering four endoscopy units. Senior pathologists reviewed and classified NENs using World Health Organization 5th edition (2019) guidelines. Results  The number of colorectal NEN diagnoses was stable over time with 0.6 NEN per 1,000 patients. A total of NENs were detected in 85 patients: 65 neuroendocrine tumors (NETs) and 20 poorly differentiated neuroendocrine carcinomas (NECs). Rectal NETs were usually small sessile/submucosal lesions with yellowish (lipoma-like) color. Colonic NETs were larger sessile/submucosal lesions with darker color compared to background. Colorectal NECs presented as large, dark-colored lesions with ulcerated/necrotizing areas. Conclusions  Our population-based data point to a stable and low incidence of 0.6 NEN per 1,000 patients in the Netherlands. Rectal NETs mainly present as small sessile yellowish lesions. Colonic NETs present as larger and darker lesions than background mucosa and NECs as darker lesions than background with ulceration/necrosis. Standardized endoscopic characterization of colorectal NENs is necessary to improve recognition of these lesions and provide a basis for evidence-based treatment and surveillance recommendations., Competing Interests: Competing interests The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

We identified the proportion of positive sentinel lymph node biopsies (SNBs) in patients treated for thin melanoma (Breslow thickness

Prader-Willi syndrome (PWS) is a complex condition with many medical and psychological features. In individuals with this syndrome, causes of death were studied. Data of 27 case reports were collected. Ages at death ranged from neonatal to 68 years. None of the individuals were treated with growth hormone (GH). Most cases were not completely documented and autopsy was performed in a minority of cases only. In five cases, death was considered not to be causally related to PWS. Hypotonia with hypoventilation was noted in the babies, and acute respiratory illness with unexpected sudden death was experienced in young children with PWS. Two young children died after a short period of fever and gastroenteritis. Obesity and its complications leading to death were pronounced in the adult group. One (possibly two) adult(s) died from gastric dilatation and shock. Based on these data, some cautious conclusions can be drawn. In babies with PWS hypoventilation is a risk factor; upper airway infection may be more serious than anticipated and any other clinical features pointing to an infection should be taken very seriously. Therefore, young infants with PWS hospitalized with an upper airway infection and/or hypoventilation or gastroenteritis symptoms, should be closely monitored. Early diagnosis and prevention of overweight is a major factor in preventing early causes of death in individuals with PWS. In the adult group, weight reduction is important but difficult to manage. Sleep apnea should be recognized and treated. Pain in the upper stomach and/or vomiting should be taken as a possible sign of acute intestinal dilatation; intravenous support may be life saving., (Copyright 2003 Wiley-Liss, Inc.)

We describe a 20-week-old fetus with multiple congenital anomalies exposed to acitretin in the first trimester of pregnancy. Acitretin and its ethylester etretinate are both vitamin A congeners; drugs of this group are well-known teratogenic agents. Since the marketing of acitretin only one report on human teratogenicity associated with acitretin has been published. The present male fetus showed severe symmetric anomalies of upper and lower limbs, craniofacial anomalies, ear anomalies, and an atrioventricular septal defect (ASD). Although the craniofacial anomalies resemble the abnormalities described in classical "retinoic acid embryopathy," limb anomalies were seldomly reported after maternal use of vitamin A congeners. However, in laboratory animals limb defects were frequently observed after retinoid exposure in utero. This case emphasizes again that extreme care and precaution are needed before prescribing a potentially teratogenic drug to a fertile woman.