Losing a part of life: experiences of cancer survivors accessing treatment and sheltering in place during the COVID-19 pandemic

PURPOSE

To explore experiences of sheltering in place and accessing treatment during the initial stages of the COVID-19 pandemic among survivors with cancer receiving tyrosine kinase inhibitor (TKI) therapy.

METHODS

Participants from two pilot studies evaluating TKI therapy use in the Southeastern United States during the start of the COVID-19 pandemic (March 2020) were interviewed. Identical interview guides were used across both studies to assess participants' experiences accessing cancer treatment, sheltering in place, and coping during the COVID-19 pandemic. Digitally recorded sessions were transcribed professionally and checked for accuracy. Descriptive statistics were used to summarize participant sociodemographics, and a six-step thematic approach was used to analyze interview data and identify salient themes. Dedoose qualitative research software was used to manage and organize qualitative codes, themes, and memos.

RESULTS

Participants (n = 15) ranged from 43 to 84 years of age, and were mostly female (53.3%), married (60%), and survivors with hematologic malignancies (86.7%). The research team identified five salient themes: Participants followed pandemic guidelines, Variable impact on well-being, Common feelings of fear, anxiety and anger, No barriers to accessing therapy and medical care, and Faith and God as powerful forces for coping.

CONCLUSIONS

The conclusions of the study provide several implications for survivorship programs or clinics for supporting survivors who are taking chronic TKI therapy during COVID-19, including enhancement of current psychosocial support efforts for cancer survivors or development of new programs tailored to the unique needs of a survivor during a pandemic, such as focused coping strategies, modified physical activity programs, family/professional role changes, and access to safe public spaces.

Bacterascites confers poor patient prognosis beyond MELD prediction

Spontaneous bacterial peritonitis (SBP) is a well-recognized clinical entity with a poor prognosis. In comparison, the prevalence, microbiological flora, and prognostic significance of bacterascites (BA) (the presence of organism on culture but ascitic PMN <250 cells/mm³) is largely unknown. We, therefore, assessed the prognosis and predictors of outcome in patients with BA in comparison with those with SBP. Ascitic fluid cultures from consecutive patients with cirrhosis from 2008 to 2018 were reviewed retrospectively, and patients with SBP and BA were identified. Baseline demographic, laboratory, and microbiological data were collated and analyzed as prognostic indicators, and clinical outcomes were recorded. Patients were censored at the time of LT, death, or last follow-up. For this study 176 and 213 cases of SBP and BA, respectively, were identified and included. Patients with SBP had significantly higher Model for End-Stage Liver Disease (MELD) ( p =<0.01), peripheral blood WCC ( p < 0.01), and higher rates of Enterobacteriaceae ( p < 0.01) and multi-drug resistant pathogens ( p < 0.01). Survival at 1 and 3 months was lower in patients with SBP ( p < 0.01) when compared with BA but at 6 months and beyond, no significant difference remained. After the exclusion of deaths within 30 days of presentation, survival between SBP and BA was equivocal at all time points. Mortality was substantially higher across all MELD groupings for both SBP and BA when compared with the predicted mortality calculated by the MELD score alone. BA has a negative impact on patient survival above that predicted by the MELD score. It has similar impact to SBP on patient survival beyond 1 month suggesting it should be seen as a poor prognostic marker and prompt consideration of LT where appropriate. Further studies evaluating the role of secondary prophylaxis in this group are required.

How common are acromial and scapular spine fractures after reverse shoulder arthroplasty?: A systematic review

AIMS

Acromial fractures following reverse shoulder arthroplasty (RSA) have a wide range of incidences in reported case series. This study evaluates their incidence following RSA by systematically reviewing the current literature.

MATERIALS AND METHODS

A systematic review using the search terms "reverse shoulder", "reverse total shoulder", or "inverted shoulder" was performed using PubMed, Web of Science, and Cochrane databases between 1 January 2010 and 31 March 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Studies were included if they reported on RSA outcomes and the incidence rate of acromial and/or scapular spine fractures. The rate of these fractures was evaluated for primary RSA, revision RSA, RSA indications, and RSA implant design.

RESULTS

The review included 90 articles out of 686 identified after exclusions. The incidence rate of acromial and/or scapular spine fractures was 2.8% (253/9048 RSAs). The fracture rate was similar for primary and revision RSA (2.8% vs 2.1%; p = 0.4). Acromial fractures were most common after RSA for inflammatory arthritis (10.9%) and massive rotator cuff tears (3.8%). The incidence was lowest in RSA for post-traumatic arthritis (2.1%) and acute proximal humerus fractures (0%). Lateralized glenosphere design had a significantly higher rate of acromial fractures compared with medial glenosphere designs.

CONCLUSION

Based on current English literature, acromial and/or scapular spine fractures occur at a rate of 2.8% after RSA. The incidence is slightly more common after primary compared with revision arthroplasty. Also, higher rates of acromial fractures are reported in RSA performed for inflammatory arthritis and in the lateralized glenoid design. Cite this article: Bone Joint J 2019;101-B:627-634.

An eDNA assay for Irish Petromyzon marinus and Salmo trutta and field validation in running water

This pilot study presents an environmental DNA (eDNA) assay for sea lamprey Petromyzon marinus and brown trout Salmo trutta, two species of economic and conservation importance in the Republic of Ireland. The results demonstrate the effectiveness of eDNA for assessing presence of low-abundance taxa (here, P. marinus) for environmental managers, and they highlight the potential for assessing relative abundance of rare or invasive freshwater species.

A highly permeable species boundary between two anadromous fishes

Meristic identification, mitochondrial DNA and a suite of microsatellite markers were employed to estimate the incidence of hybridization in wild populations of anadromous Allis shad Alosa alosa and twaite shad Alosa fallax in southern Irish riverine and estuarine waters. It was shown that 16% of the fishes examined were misclassified using meristic count of gill rakers. Next, a significant proportion of fishes that were robustly assigned to a species using nuclear markers were shown to possess the mtDNA of the other. The genomes of A. alosa and A. fallax in Ireland are extensively introgressed, which suggests a complex history of hybridization between these species, which can only partially be explained by recent man-made habitat changes.

Chemical characterization of synthetic soil from composting coal combustion and pharmaceutical by-products

Land application of coal combustion by-products (CCBs) mixed with solid organic wastes (SOWs), such as municipal sewage sludge, has become increasingly popular as a means of productively using what were once considered waste products. Although bulk chemical and physical properties of several of these CCB-SOW materials have been reported, detailed information about their synthesis and mineralogy of the CCB-SOW materials has not been reported. In this paper, chemical and mineralogical properties of a soil-like material obtained from composting a mixture of CCBs with a pharmaceutical fermentation by-product (FB) were investigated at the laboratory and field scale. All starting materials and products were characterized by X-ray diffraction (XRD), fourier transform infrared (FFIR) spectroscopy, and elemental analyses. The results showed that the FB was strongly bound to the CCBs and could not be removed by washing. Within 2 wk of the start of a composting study, there was a rapid drop in pH from 12 to 8, an increase in temperature to 70 degrees C, and a reduction in the dissolved oxygen content, attributed to the rapid establishment of a highly active microbial population. Composting produced a soil-like material with high levels of plant nutrients, a high nutrient retention capacity, and metal contents similar to median levels of those metals reported for soils. The levels of boron and soluble salts are such that sensitive plants may initially show toxicity symptoms. However, with adequate rainfall, leaching should rapidly remove most of the B and soluble salts. With care, the material produced is safe for use as a synthetic topsoil.

Production of leptin in Escherichia coli: a comparison of methods

A procedure is described for gram-scale refolding of Escherichia coli-derived human leptin inclusion bodies. Refolding was achieved by gradually reducing denaturant using a diafiltration method. Refolded leptin is characterized by in vivo modulation of food intake, reduction in body weight, and lowering of insulin and glucose levels in ob/ob mice. In addition, refolded leptin is characterized by radioimmunoassay (RIA) and activation of the leptin receptor in a cell-based assay. For comparison we also refolded leptin by a simple dilution method and produced periplasmic derived leptin, which did not require ex vivo folding. Leptin produced by these three methods and leptin obtained from commercial sources were compared using the RIA and the cell-based assay and appeared to be of comparable quality and potency.

Genetic analysis of variation for auxin-induced adventitious root formation among eighteen ecotypes of Arabidopsis thaliana L. Heynh

Eighteen ecotypes and two inbred lines of Arabidopsis thaliana L. Heynh. were analyzed for variation in the number of adventitious roots formed (hereafter referred to as rooting) on seedling hypocotyls in response to auxin treatment. Mean root counts varied from 1.7 to 23.1. Stable high (HA) and low (LA) rooting lines selected from ecotype Columbia, a low rooting ecotype (Mt-0), and unselected Columbia populations were evaluated for vegetative and reproductive growth parameters to determine correlated phenotypic effects of selection for rooting response. High rooting in HA correlated with compact, highly branched shoot growth. Genetic analysis of HA, Mt-0, and their F1, F2, and reciprocal backcross generations indicated that high and low rooting responses in this population may be controlled by several genes acting independently in additive-dominance fashion. Genetic variance partitioned into principally additive effects, with dominance favoring low rooting.

Recent advances in the large scale fermentation of Neisseria meningitidis group B for the production of an outer membrane protein complex

The Outer Membrane Protein Complex (OMPC) of the bacterium Neisseria meningitidis group B has been used successfully as a protein carrier in a Haemophilus influenza type b (Hib) polysaccharide conjugate vaccine and a Streptococcus pneumoniae (Pn) polysaccharide conjugate vaccine to elicit antipolysaccharide immune responses in young infants. The OMPC carrier is derived by detergent extraction of whole cells and, thus, the consistent generation of suitable biomass is central to an effective production process. Therefore, we have developed a large-scale, high-cell density (5 g/L dry cell weight) fermentation process for the cultivation of N. meningitidis B11. Since current requirements for the production of human biologics mandate strict control of all aspects of the manufacturing process, several key features of the process, including a chemically defined medium and a rational event-based harvest criterion, support current good manufacturing practice (cGMP) and increased productivity.

Post-translational control of alcohol dehydrogenase levels in Drosophila melanogaster

A trans-acting regulatory gene that alters in vivo protein levels of alcohol dehydrogenase (ADH) has been mapped to a region of the third chromosome of Drosophila melanogaster. The gene has been found to affect the in vivo stability of ADH protein. It was not found to alter levels of total protein of two other enzymes assayed. The action of the gene over development and its possible mode of control are discussed.

GENETIC LOCALIZATION AND BIOCHEMICAL CHARACTERIZATION OF A TRANS-ACTING REGULATORY EFFECT IN DROSOPHILA

A region-specific, trans-acting regulatory gene that alters in vivo protein levels of α-glycerophosphate dehydrogenase (α-GPDH) has been mapped to position 55.4 on the third chromosome of Drosophila melanogaster. The gene has been found to affect the in vivo stability of α-GPDH in adult thoracic tissue but has no effect on α-GPDH levels in the abdomen. Although no other thoracic proteins were found to be influenced by the locus, it appears to modify the level of one additional abdominal protein. The action of the gene over development and its possible mode of control are discussed.

Platinum analogs of clinical interest

Eight platinum analogs including complexes containing two isomeric forms of 1,2-diaminocyclohexane have received preliminary clinical trials. Dosage and limiting toxicity have been identified for racemic malonato-1,2-diaminocyclohexaneplatinum(II) (PHM) and its trans(-)-1,2-diaminocyclohexane isomer (neo-PHM). Dosage and toxicity for racemic sulfato-1,2-diaminocyclohexaneplatinum(II) have been identified and preliminary dosage data for the trans(-)-1,2-diaminocyclohexane isomer are presented. Of the four remaining compounds, three have been abandoned due to toxicity or lack of promise as antitumor agents and the fourth is not being pursued actively at the present time. Further trials of PHM, and especially the neo-PHM isomer, in combination with standard agents seem indicated and are underway. The search for platinum analogs of clinical interest may yet identify analogs significantly superior in effectiveness and safety to cis-dichlorodiammineplatinum(II).

Studies on the chemical composition of lipopolysaccharide from Neisseria meningitidis group B

A lipopolysaccharide was isolated from Neisseria meningitidis group B by phenol/water extraction and purified by differential ultracentrifugation. This preparation exhibited endotoxic properties as shown by the limulus-lysate assay. Mild acid hydrolysis of the lipopolysaccharides yielded a lipid A fraction and a polysaccharide fraction. The lipid A fraction contained fatty acids, phosphorus and glucosamine. Analysis of the polysaccharide fraction revealed the presence of glucose, galactose, glucosamine, 2-keto-3-deoxyoctonic acid and phosphorus. There was no heptose.

Influence of Pasteurization Before and After Separation of Cream on the Oxidative Stability of Ripened Cream Butter

Ripened cream butter manufactured from cream separated from pasteurized milk (80 C for 15 sec) was more susceptible to oxidative changes than the corresponding butter manufactured from cream which was separated from milk at 50 C and the cream subsequently pasteurised (80 C for 15 sec). The propensity to oxidation is related to changes in copper distribution between the serum and fat globule phases and also to the relative ratio of serum to fat at the time of pasteurization.

Influence of Pasteurization and Homogenization Treatments on Photocatalyzed Oxidation of Cream

Heat treatment within the temperature range of 60 to 94 C promoted photocatalyzed lipid oxidation of cream. The sulfhydryl compounds cysteine hydrochloride, glutathione, thioglycolic acid, and mercapto-ethanol at concentrations of 0.1 to 0.001% acted as antioxidants. Copper migrated from the serum phase to the fat globule surfaces when cream was heated and acted as an oxidation catalyst. The latter influence predominates over the antioxidant effect of the free sulfhydryl groups in heat treated cream. Homogenization of pasteurized cream inhibits lipid oxidation depending on the pressure used.

Clinical studies of Platinum Coordination compounds in the treatment of various malignant diseases

Following the prior work of Rosenberg et al, Rosenberg and VanCamp, and Speer et al, we started clinical trials with cis-dichlorodiammineplatinum(II) in April 1971. Marked tumor regression was noted in several malignant diseases in these initial clinical studies which were reported at the Chemotherapy Congress in Prague, August 1971. At the present time over 178 patients have been treated wihhis durg for a variety of malignant conditions. Approximately half of these patients received the platinum compound alone and the other half received it in combination with four other chemotherapeutic agents...

Dark repair of ultraviolet-irradiated deoxyribonucleic acid by bacteriophage T4: purification and characterization of a dimer-specific phage-induced endonuclease

The purification and properties of an ultraviolet (UV) repair endonuclease are described. The enzyme is induced by infection of cells of Escherichia coli with phage T4 and is missing from extracts of cells infected with the UV-sensitive and excision-defective mutant T4V(1). The enzyme attacks UV-irradiated deoxyribonucleic acid (DNA) containing either hydroxymethylcytosine or cytosine, but does not affect native DNA. The specific substrate in UV-irradiated DNA appears to be pyrimidine dimer sites. The purified enzyme alone does not excise pyrimidine dimers from UV-irradiated DNA. However, dimer excision does occur in the presence of the purified endonuclease plus crude extract of cells infected with the mutant T4V(1).