Renal Neoplasia in Tuberous Sclerosis: A Study of 41 Patients

ObjectiveTo study the clinical features and identify unique renal neoplasia subtypes and their prognostic implications in individuals with tuberous sclerosis complex (TSC).Patients and MethodsThe Mayo Clinic nephrectomy registry included 37 patients with TSC diagnosed between 1970 and 2018. Four additional patients were identified from the pathology consultation and autopsy files. All available renal tumors were further characterized using immunohistochemistry and fluorescence in situ hybridization. Clinicopathologic features and follow-up were obtained from the medical record. The American Association for Cancer Research Project GENIE registry was accessed using cBioPortal for molecular profiling of angiomyolipoma (AML).ResultsA total of 276 renal tumors from 41 patients were analyzed. Renal tumors were classified into 9 distinct morphological subtypes, with AML predominating (238 [86%]). Interestingly, all these tumors acted in a benign fashion except one renal cell carcinoma with clear cells and fibromyomatous stroma and one epithelioid AML that metastasized. Molecular profiling studies revealed that epithelioid AMLs were enriched for alterations of TP53, RB1, and ATRX. Eight patients died of direct complications of TSC, including 3 of end-stage renal disease. To date, none have died of a renal epithelial neoplasm.ConclusionThe identification of unique renal neoplasia subtypes may provide important clues to establish a diagnosis of TSC, and in the somatic setting, this finding has important implications for accurate prognostication. These tumors tend to be indolent, and only 2 of 276 tumors in our study exhibited metastatic behavior. Our results support multidisciplinary management with a focus on preservation of renal function.     

Diversity and distribution of Maize-associated totivirus strains from Tanzania

Virus Genes - Typically associated with fungal species, members of the viral family Totiviridae have recently been shown to be associated with plants, including important crop species, such as...     

Time-varying coefficient of determination to quantify the explanatory power of biomarkers on longitudinal GFR among children with chronic kidney disease

Purpose

Coefficients of determination (R²) for continuous longitudinal data are typically reported as time constant, if they are reported at all. The widely used mixed model with random intercepts and slopes yields the total outcome variance as a time-varying function. We propose a generalized and intuitive approach based on this variance function to estimate the time-varying predictive power (R²) of a variable on outcome levels and changes.

Exploring MEST: a new universal teaching strategy for school health services to promote positive mental health literacy and mental wellbeing among Norwegian adolescents

Background

Mental health among adolescents is an important public health challenge. School health services perform central public health functions in Norwegian municipalities, where school nurses are uniquely positioned to educate and promote mental health among adolescents. MEST (MEST is not an acronym; MEST is a short version of the Norwegian word for coping) is a newly developed universal working strategy for school health services that aims to promote positive mental health literacy (MHL) and mental wellbeing in the adolescent population. The aim of this study was to investigate the potential outcome mean differences in positive MHL and mental wellbeing between adolescents who participated and those who did not participate in MEST over a school year.

Methods

This study is based on cohort data collected from 357 adolescents (aged 15–21?years) in five Norwegian upper secondary schools at the beginning and end of the 2016/2017 school year. The data were analyzed by describing mean scores and estimating the average treatment effect (ATE) of MEST on positive MHL and mental wellbeing.

Results

Positive MHL increased significantly more among the MEST participants compared to the non-MEST participants (p?=?.02). No significant change in mental wellbeing was found between MEST and non-MEST participants (p?=?.98). Estimating the ATE of MEST on positive MHL, the MEST participants showed a significant 2.1% increase (p?=?.04) in the potential outcome mean of positive MHL compared to the nonparticipants. Estimating the ATE of MEST on mental wellbeing, the girls who attended MEST exhibited a significant 9.7% increase (p?=?.03) in the potential outcome mean of mental wellbeing compared with the girls who did not attend MEST, while no significant change (p?=?.99) was detected among boys or the entire sample of both genders combined (p?=?.12).

Conclusion

This study found a significant ATE of MEST on positive MHL and on mental wellbeing among girls. The results support further investments in studying MEST as a promising work strategy for school health services to promote adolescent mental health. This initial study of MEST may be used as a foundation for investing in future evaluations of MEST.

     

The Development of a Decision Tool for the Empiric Treatment of Suspected Urinary Tract Infection in Frail Older Adults: A Delphi Consensus Procedure

Objectives

Nonspecific signs and symptoms combined with positive urinalysis results frequently trigger antibiotic therapy in frail older adults. However, there is limited evidence about which signs and symptoms indicate urinary tract infection (UTI) in this population. We aimed to find consensus among an international expert panel on which signs and symptoms, commonly attributed to UTI, should and should not lead to antibiotic prescribing in frail older adults, and to integrate these findings into a decision tool for the empiric treatment of suspected UTI in this population.

Investigating the JD‐R occupational stress model with Australian direct‐care workers: A focus group approach

This study aimed to explore the use of a contemporary workplace stress model, the Job Demands‐Resources model, with direct‐care workers using a qualitative approach. The JD‐R model has successfully been used to predict health outcomes across different occupations using quantitative methods. However, the use of the generic questionnaire developed for this model may not always be appropriate. Direct‐care workers (n = 19) attended two focus groups and reported on their job demands, job resources and personal resources. Six themes relating to demands across the two groups: funding insecurity, time pressure, hindrance demands, poor systems, emotional engagement and dealing with client crises were identified. Participants identified clinical supervision, social support and progressive workplace resources as job resources. Finally, the personal resources identified by participants were professional behaviours, disposition and self‐care. The JD‐R model and its standard questionnaire captures some of these aspects of direct‐care work, but many were not assessed. As such, future investigations with direct‐care workers should ensure items related to poor systems, progressive workplace resources, disposition and professional behaviours are included. Alternatively, a qualitative approach should be used as a first step in the development of valid questionnaires when investigating workplace stress with this group to ensure their experience is accurately quantified.