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Dunn G.P.,Pennsylvania | Miller N.,The American College
Journal of Surgical Oncology | Year: 2014

Surgeons can more effectively meet the public's increased expectation of patient-centered care by directing attention to pain, non-pain symptoms, including depression and anxiety, in addition to the patient's personal preferences, resources, and support needs. Patient navigation and palliative care, both pioneered by surgeons, provide complementary frameworks for the screening, assessment and intervention needed to achieve enhanced patient outcomes including adherence to care, improved quality of life and patient satisfaction. © 2014 Wiley Periodicals, Inc.

Garakani A.,New Hill | Jaffe R.J.,The New School | Savla D.,The New School | Welch A.K.,The New School | And 2 more authors.
American Journal on Addictions | Year: 2016

Background/Objectives: Nitrous oxide (N2O) is known to have abuse potential, although debate regarding the toxic effects of such abuse continues. Our objective was to review the case literature and present the neurologic, psychiatric and medical consequences of N2O abuse. Methods: A systematic literature review was completed for case reports using keywords "nitrous oxide" with "abuse/abusing" or "misuse/misusing" or "overuse/overusing" or "addiction." Non-English-language cases and cases not involving direct toxic effects of N2O were excluded as were commentaries or personal essays. Clinical presentation, frequency of N2O abuse, laboratory studies, imaging, ancillary tests, treatments and outcomes were collected from case reports. Results: Our review returned 335 Pubmed, 204 Web of Science, 73 PsycINFO, 6 CINAHL, 55 EMBASE and 0 Grey Literature results, and after exclusion and removal of duplicates, 91 individual cases across 77 publications were included. There were also 11 publications reporting 29 cases of death related to N2O abuse. The majority of cases (N=72) reported neurologic sequelae including myeloneuropathy and subacute combined degeneration, commonly (N=39) with neuroimaging changes. Psychiatric (N=11) effects included psychosis while other medical effects (N=8) included pneumomediastinum and frostbite. Across all cases N2O abuse was correlated with low or low-normal Vitamin B12 (cyanocobalamin) levels (N=52) and occasionally elevated homocysteine and methylmalonic acid. Conclusions/Scientific Significance: N2O abuse represents a significant problem because of the difficulty involved with identification and the toxicity related to chronic abuse including possible death. Health professionals should be aware of the toxic effects of N2O and be able to identify potential N2O abuse. © 2016 American Academy of Addiction Psychiatry.

Biegel J.A.,Pennsylvania
American Journal of Medical Genetics, Part A | Year: 2015

We report a patient with a constitutional missense mutation in SMARCB1, Coffin-Siris Syndrome (CSS), and schwannomatosis. CSS is a rare congenital syndrome with characteristic clinical findings. This thirty-three-year-old man was diagnosed early in life with the constellation of moderate intellectual disability, hypotonia, mild microcephaly, coarse facies, wide mouth with full lips, hypoplasia of the digits, and general hirsutism. At age 26, he was found to have schwannomatosis after presenting with acute spinal cord compression. Blood and tissue analysis of multiple subsequent schwannoma resections revealed a germline missense mutation of SMARCB1, acquired loss of 22q including SMARCB1 and NF2 and mutation of the remaining NF2 wild-type allele-thus completing the four-hit, three-event mechanism associated with schwannomatosis. Variations in five genes have been associated with the Coffin-Siris phenotype: ARID1A, ARID1B, SMARCA4, SMARCB1, and SMARCE1. Of these genes, SMARCB1 has a well-established association with schwannomatosis and malignancy. This is the first report of a patient with a constitutional missense mutation of SMARCB1 resulting in CSS and subsequent development of schwannomatosis. This finding demonstrates that a SMARCB1 mutation may be the initial "hit" (constitutional) for a genetic disorder with subsequent risk of developing schwannomas and other malignancies, and raises the possibility that other patients with switch/sucrose non-fermenting (SWI/SNF) mutations may be at increased risk for tumors. © 2015 Wiley Periodicals, Inc.

Westneat D.F.,University of Kentucky | Hatch M.I.,Pennsylvania | Wetzel D.P.,University of Kentucky | Ensminger A.L.,University of Kentucky
American Naturalist | Year: 2011

Personality (consistent differences between individuals in behavior) and plasticity (changes within individuals in behavior) are often viewed as separate and opposing phenomena. We tested this idea by analyzing parental care reaction norms in a bird that exhibits biparental care. Personality in provisioning behavior existed (r IC = 0.11) and persisted despite being reduced after accounting for IC individual differences in environment. Plasticity was also evident and differed between the sexes. Male visit rate was associated with changes in brood size and time of day, but female visit rate was associated with changes in nestling age and date. In both sexes changes in visit rate were positively correlated with changes in their partner's visit rate. Both sexes also exhibited multidimensional reaction norms; interaction terms revealed that within-individual visit rates increased more steeply with brood size when nestlings were older, and the effect of the partner's visit rate was sensitive to variation in date, precipitation, and the focal bird's age. Individuals also varied in how they responded (reaction norm slope) to changes in nestling age and partner visits. Moreover, parental personality was interdependent with individual plasticity in several ways. Individuals of both sexes with a high visit rate also responded more positively to changes in nestling age, and males also showed this pattern with changes in partner visit rate. Explicit use of the behavioral reaction norm integrated personality and plasticity, revealed that these are not opposing concepts, and stimulated new hypotheses about sexual conflict over care and provisioning as a life-history trait. © 2011 by The University of Chicago.

Mateo A.M.,Pennsylvania | Pezzi T.A.,Texas College | Sundermeyer M.,Pennsylvania | Kelley C.A.,Pennsylvania | Pezzi C.M.,Pennsylvania
Journal of Surgical Oncology | Year: 2016

Backgrounds and Objectives: Medullary breast carcinoma (MBC) is a subtype with a more favorable prognosis. Tumors with some, but not all, characteristics of MBC are classified as atypical medullary carcinoma of the breast (AMCB). Methods: Patients with invasive MBC and AMCB reported to the National Cancer Data Base (NCDB) from 2004 to 2013 were compared for tumor characteristics and overall survival, using infiltrating ductal carcinoma (IDC) as a reference. Results: Patients with MBC (n=3,688), AMCB (n=288), and IDC (n=918,870) met inclusion criteria. Comparing MBC with AMCB, the mean age at diagnosis (52.9 vs. 53.9 years), mean tumor size (2.4 vs. 2.5cm), lymph node positivity (22.8% vs. 22.4%), estrogen receptor (ER) positivity (22% vs. 25%), progesterone receptor (PR) positivity (14% vs. 15%), HER2 positivity (11% vs. 14%), rate of breast conserving surgery (67% vs. 68%), use of chemotherapy (76% vs. 75%), and use of hormonal therapy (19% vs. 18%), respectively, were not clinically or statistically different. Five-year (92% vs. 89%) and 10-year survival rates (85% vs. 87%) were not significantly different (P=0.46). Conclusions: There does not appear to be any reason to differentiate between AMCB and MBC given the similarities in presentation, treatment and prognosis. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.

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