Most children with intermediate-risk rhabdomyosarcoma (RMS) have gross disease (group III) at the initiation of chemotherapy. Delayed primary excision (DPE) after induction chemotherapy allows for a reduction in adjuvant radiation dose, but with the risk of potential surgical morbidity. The objectives of this study were to compare outcomes in children with group III RMS who did and did not undergo DPE and to assess surgical morbidity.
 
  The study included 369 patients who had clinical group III RMS at sites amenable to DPE from intermediate-risk Children's Oncology Group studies D9803 (encouraged DPE) and ARST0531 (discouraged DPE).
 
  The primary tumor site was bladder/prostate (136 patients; 37%), extremity (97 patients; 26%), trunk (24 patients; 7%), retroperitoneum (91 patients; 25%), or intrathoracic/perineum/perianal (21 patients; 6%). In total, 112 patients (53.9%) underwent DPE in D9803, and 26 patients (16.2%) underwent DPE in ARST0531 (P < .001), with loss of vital organ or function in 30 of 138of higher dose irradiation.Performing a heterogeneous catalysis with proteins is still a challenge. Herein, we demonstrate the importance of cross-linked crystals for sulfoxide oxidation by an artificial enzyme. The biohybrid consists of the insertion of an iron complex into a NikA protein crystal. The heterogeneous catalysts displays a better efficiency-with higher reaction kinetics, a better stability and expand the substrate scope compared to its solution counterpart. Designing crystalline artificial enzymes represents a good alternative to soluble or supported enzymes for the future of synthetic biology.Handcycling performance is dependent on the physiological economy of the athlete; however, handbike configuration and the biomechanical interaction between the two are also vital. The purpose of this study was to examine the effect of crank length manipulations on physiological and biomechanical aspects of recumbent handcycling performance in highly trained recumbent handcyclists at a constant linear handgrip speed and sport-specific intensity. Nine competitive handcyclists completed a 3-minute trial in an adjustable recumbent handbike in four crank length settings (150, 160, 170 & 180 mm) at 70% peak power output. Handgrip speed was controlled (1.6 m·s-1 ) across trials with cadences ranging from 102 to 85 rpm. Physiological economy, heart rate, and ratings of perceived exertion were monitored in all trials. Handcycling kinetics were quantified using an SRM (Schoberer Rad Messtechnik) powermeter, and upper limb kinematics were determined using a 10-camera VICON motion capture system. Physiological responses were not significantly affected by crank length.  https://www.selleckchem.com/products/tulmimetostat.html  However, greater torque was generated (P less then .0005) and peak torque occurred earlier during the push and pull phase (P ≤ .001) in longer cranks. Statistical parametric mapping revealed that the timing and orientation of shoulder flexion, shoulder abduction, and elbow extension were significantly altered in different crank lengths. Despite the biomechanical adaptations, these findings suggest that at constant handgrip speeds (and varying cadence) highly trained handcyclists may select crank lengths between 150 and 180 mm without affecting their physiological performance. Until further research, factors such as anthropometrics, comfort, and self-selected cadence should be used to facilitate crank length selection in recumbent handcyclists.
  Lymphedema is an adverse effect of breast cancer treatment that causes swelling and pain in the arm and hand. We tested 2 lymphedema prevention interventions and their impact on health-related quality of life (HRQOL) in a group-randomized trial at 38 cooperative group sites within the United States.
 
  Patients were recruited before breast surgery. Sites were randomly assigned to education-only (EO) lymphedema prevention or education plus exercise and physical therapy (LEAP). Lymphedema was defined as a ≥10% difference in arm volume at any time from baseline to 18 months postsurgery. HRQOL was assessed using the Functional Assessment of Cancer Therapy-Breast plus 4 lymphedema items (FACT-B+4). Longitudinal mixed model regression analysis, adjusting for key demographic and clinical variables, examined participants' HRQOL by intervention group and lymphedema status.
 
  A total of 547 patients (56% LEAP) were enrolled and completed HRQOL assessments. The results revealed no differences between the interventions n HRQOL outcomes. African American women reported greater HRQOL impacts due to lymphedema symptoms than women of other races or ethnicities.Over the last decade, spontaneous coronary artery dissection (SCAD) has garnered much attention as a significant cause of acute coronary syndrome (ACS) and sudden cardiac death in women without classic cardiovascular risk factors. SCAD has been mostly studied in the West, with little recognition in Asia leading to under-diagnosis and under-representation. In this review, we highlight two distinct cases occurring at our center in Singapore, affecting two Singaporean women of Malay and Chinese descent. These 2 cases highlight that pregnancy-associated SCAD is neither the most common nor only manifestation of SCAD. Through review of the literature, we emphasize the heterogeneity in case presentation paying particular attention to SCAD and its association with connective tissue disorders such as fibromuscular dysplasia. SCAD remains a diagnostic challenge for many cardiologists, here we shed light and dispel myths surrounding coronary angiography and review the use of intracoronary imaging. The successful treatment of this unique group of patients requires a high index of suspicion, and management within a multidisciplinary team. The development of a recovery program with access to support groups, allied health, and cardiac rehabilitation is paramount in improving outcomes for these patients in the long term. Further research and studies in our Asian population will help to enhance our understanding of this disease and develop practices to best manage our patients.Storm events lead to agricultural and urban runoff, to mobilization of contaminated particulate matter, and to input from combined sewer overflows into rivers. We conducted time-resolved sampling during a storm event at the Ammer River, southwest Germany, which is representative of small river systems in densely populated areas with a temperate climate. Suspended particulate matter (SPM) and water from 2 sampling sites were separately analyzed by a multi-analyte liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for 97 environmentally relevant organic micropollutants and with 2 in vitro bioassays. Oxidative stress response (AREc32) may become activated by various stressors covering a broad range of physicochemical properties and induction of aryl hydrocarbon receptor-chemical-activated luciferase gene expression (AhR-CALUX) by hydrophobic compounds such as dioxins and dioxin-like molecules. Compound numbers, concentrations, their mass fluxes, and associated effect fluxes increased substantially during the storm event.