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Concept: Second grade


OBJECTIVE: Endometrial cancer patients may benefit from systemic adjuvant chemotherapy, alone or in combination with targeted therapies. Prognostic and predictive markers are needed, however, to identify patients amenable for these therapies. METHODS: Primary endometrial tumors were genotyped for >100 hot spot mutations in genes potentially acting as prognostic or predictive markers. Mutations were correlated with tumor characteristics in a discovery cohort, replicated in independent cohorts and finally, confirmed in the overall population (n=1,063). RESULTS: PIK3CA, PTEN and KRAS mutations were most frequently detected, respectively in 172 (16.2%), 164 (15.4%) and 161 (15.1%) tumors. Binary logistic regression revealed that PIK3CA mutations were more common in high-grade tumors (OR=2.03; P=0.001 for grade 2 and OR=1.89; P=0.012 for grade 3 compared to grade 1), whereas a positive TP53 status correlated with type II tumors (OR=11.92; P<0.001) and PTEN mutations with type I tumors (OR=19.58; P=0.003). Conversely, FBXW7 mutations correlated with positive lymph nodes (OR=3.38; P=0.045). When assessing the effects of individual hot spot mutations, the H1047R mutation in PIK3CA correlated with high tumor grade and reduced relapse-free survival (HR=2.18; P=0.028). CONCLUSIONS: Mutations in PIK3CA, TP53, PTEN and FBXW7 correlate with high tumor grade, endometrial cancer type and lymph node status, whereas PIK3CA H1047R mutations serve as prognostic markers for relapse-free survival in endometrial cancer patients.

Concepts: Lymph, Second grade, Endometrial cancer, Lymph node, Mutation, Regression analysis, Oncology, Cancer


Objective: The purpose of this study was to describe computed tomography (CT) features of the ununited anconeal process and relate them with the following elbow dysplasia signs: medial coronoid disease, medial humeral condyle changes, osteoarthritis (OA), and radioulnar incongruence. Methods: Computed tomographic images of dogs older than six months with an ununited anconeal process were evaluated (n = 13). Ununited anconeal process features were described as being complete or incomplete, and the degree of displacement, volume, and presence of cysts and sclerosis were also evaluated. Medial coronoid disease was defined as an irregular medial coronoid process shape, presence of sclerosis and fragmentation. Medial humeral condyle changes were defined as subchondral bone flattening, lucencies, and sclerosis. Osteoarthritis was graded depending on the osteophytes size. Radioulnar incongruence was measured on a sagittal view at the base of the medial coronoid process. Results: Eleven elbows had a complete and two had an incomplete ununited anconeal process. All ununited anconeal processes had cystic and sclerotic lesions. Seven ununited anconeal processes were displaced and six were non-displaced. Mean ununited anconeal process volume was 1.35 cm3 (0.61 cm³ - 2.08 cm³). Twelve elbows had signs of medial coronoid disease (4 of them with a fragmented medial coronoid process), and one elbow did not show any evidence of medial coronoid disease. Ten elbows had medial humeral condyle changes. One elbow had grade 1 OA, seven elbows had grade 2, and five elbows grade 3. All elbows had radioulnar incongruence: three elbows had a negative and 10 elbows had a positive radioulnar incongruence. Mean radioulnar incongruence was 1.49 mm (0.63 mm - 2.61 mm). Computed tomographic findings were similar in the majority of the elbows studied: complete ununited anconeal processes with signs of medial coronoid disease, positive radioulnar incongruence, high grade of OA, sclerotic medial humeral condyle changes, and large ununited anconeal process volumes. Clinical significance: Incomplete small ununited anconeal process volumes could be associated with a lower incidence of medial coronoid disease or medial humeral condyle changes. We recommend performing preoperative CT of elbows with an ununited anconeal process to evaluate concurrent lesions.

Concepts: Brachioradialis, Tomographic reconstruction, Brachialis muscle, Second grade, Humerus, Tomography, Coronoid process of the ulna, Elbow


BACKGROUND: School children usually use a backpack to carry their school materials. Carrying heavy schoolbags exceeding the recommended limit may have negative health implications.OBJECTIVE: To investigate the weight of schoolbags carried by primary school pupils (aged 7-9 years) in Grades 1-3 and determine how many pupils carry backpacks in excess of the recommended limit of 10 per cent of body weight (%BW). A comparison of the schoolbag weight carried by male and female pupils will also be performed. PARTICIPANTS: One hundred and eight healthy pupils chosen at random from two participating schools from south-west Poland; 54 male and 54 female.METHODS: The personal body weight scale was used for measuring the weight. The height and weight of each participating pupil was measured, and the schoolbag weight of every participant checked over five consecutive days, from Monday to Friday. RESULTS: The mean schoolbag weight of Grade 1 pupils was 3.23 kg, (i.e.13.1%BW); of Grade 2 pupils, 3.61 kg (i.e.12.9%BW) and of Grade 3 pupils 3.37 kg (i.e. 11.1%BW).CONCLUSIONS: 78.3% of Grade 1 pupils, 43.3% of Grade 2 pupils and 40.0% of Grade 3 pupils carried backpacks exceeding 10%BW. There were no statistically significant differences between the mean schoolbag weight of males and females in particular school grades.

Concepts: High school, School, Sex, Female, Male, Primary school, Second grade, Primary education


This study examined whether the negative association between children’s attention difficulties and their academic functioning is largely confined to children whose attention problems persist across early grades and whether it depends on when attention problems emerge in children’s schooling. Children from the normative sample of the Fast Track study were classified into four attention problem groups based on the presence versus absence of attention problems in first and second grade. Those with attention problems in both grades showed a decline in reading and math achievement during the K-5 interval relative to children with attention problems in first grade only. Both groups of inattentive first graders also performed worse than comparison children. In contrast, children whose attention problems emerged in second grade did not differ from comparison children on any achievement outcome performed significantly better than inattentive first graders. The implications of these findings are discussed. (J. of Att. Dis. XXXX; XX(X) XX-XX).

Concepts: Educational years, Problem solving, Problem, Second grade, First grade, Grade


Although much research has been concerned with the development of kinematic aspects of handwriting, little is known about the development along with age of two principles that govern its rhythmic organization: Homothety and Isochrony. Homothety states that the ratio between the durations of the single motor events composing a motor act remains invariant and independent from the total duration of the movement. Isochrony refers to the proportional relationship between the speed of movement execution and the length of its trajectory. The current study shows that children comply with both principles since their first grade of primary school. The precocious adherence to these principles suggests that an internal representation of the rhythm of handwriting is available before the age in which handwriting is performed automatically. Overall, these findings suggest that despite being a cultural acquisition, handwriting appears to be shaped by more general constraints on the timing planning of the movements.

Concepts: Organization, Kindergarten, Primary education, Second grade, Primary school, Ratio, Rhythm


Background In this phase 3 trial we evaluated the efficacy and safety of the interferon-free combination of ABT-450 with ritonavir (ABT-450/r), ombitasvir (also known as ABT-267), dasabuvir (also known as ABT-333), and ribavirin for the retreatment of HCV in patients who were previously treated with peginterferon-ribavirin. Methods We enrolled patients with HCV genotype 1 infection and no cirrhosis who had previously been treated with peginterferon-ribavirin and had a relapse, a partial response, or a null response. Patients were randomly assigned in a 3:1 ratio to receive coformulated ABT-450/r-ombitasvir (at a once-daily dose of 150 mg of ABT-450, 100 mg of ritonavir, and 25 mg of ombitasvir) and dasabuvir (250 mg twice daily) with ribavirin (1000 or 1200 mg daily) or matching placebos during the 12-week double-blind period. The primary end point was the rate of sustained virologic response 12 weeks after the end of study treatment. The primary efficacy analysis compared this rate among patients assigned to the active regimen with a historical response rate (65%) among previously treated patients with HCV genotype 1 infection and no cirrhosis who had received retreatment with telaprevir and peginterferon-ribavirin. Results A total of 394 patients received at least one study-drug dose. In the active-regimen group, 286 of 297 patients had a sustained virologic response at post-treatment week 12, for an overall rate of 96.3% (95% confidence interval, 94.2 to 98.4). This rate was noninferior and superior to the historical control rate. Rates were 95.3% among patients with a prior relapse (82 of 86 patients), 100% among patients with a prior partial response (65 of 65 patients), and 95.2% among patients with a prior null response (139 of 146 patients). Pruritus occurred more frequently with the active regimen (in 13.8% of patients) than with placebo (5.2%, P=0.03). Three patients in the active-regimen group (1.0%) discontinued the study drugs owing to adverse events. Hemoglobin values of grade 2 (8.0 to <10.0 g per deciliter) and grade 3 (6.5 to <8.0 g per deciliter) occurred in 4.7% and 0.3% of patients in the active-regimen group, respectively. Conclusions Rates of response to a 12-week interferon-free combination regimen were more than 95% among previously treated patients with HCV genotype 1 infection, including patients with a prior null response. (Funded by AbbVie; SAPPHIRE-II number, NCT01715415 .).

Concepts: Medical terms, Placebo, Second grade, Statistical inference, Clinical trial, Hepatitis C


Since the last two decades, the feasibility of fertility-sparing surgery (FSS) in early-stage epithelial ovarian cancer has been explored by several teams and is reconsidered in this systematic review undertaken using the PRISMA guidelines. Borderline ovarian tumours and non-epithelial ovarian cancers were excluded. This review comprises 1150 patients and 139 relapsing patients reported by 21 teams. This conservative treatment can be safely performed for stage IA and IC grade 1 and 2 disease and stage IC1 according to the new FIGO staging system. Nevertheless the number of patients reported with grade 2 disease is too small to definitively confirm whether FSS is safe in this subgroup. For patients with “less favourable” prognostic factors (grade 3 or stage IC3 disease), the safety of FSS could not be confirmed but patients should be informed that radical treatment probably may not necessarily improve their oncological outcome, because the poorest survival observed could be related to the natural history of the disease itself and not specifically to the use of conservative therapy. FSS could probably be considered in stage I clear-cell tumours but should remain contraindicated for stage II/III disease (whatever the histologic subtype). As the disease stage and the histologic data (tumour type and grade) are crucial to patient selection for this treatment, this implies careful and mandatory complete surgical staging surgery in this context and a pathologic analysis (or review) of the tumour by an expert pathologist.

Concepts: Second grade, Metastasis, Cancer staging, Tumor, Oncology, Medicine, Ovarian cancer, Cancer


Using a longitudinal cluster-randomized controlled design, we examined whether students' reading outcomes differed when they received 1, 2, or 3 years of individualized reading instruction from first through third grade, compared with a treated control group. More than 45% of students came from families living in poverty. Following students, we randomly assigned their teachers each year to deliver individualized reading instruction or a treated control condition intervention focused on mathematics. Students who received individualized reading instruction in all three grades showed the strongest reading skills by the end of third grade compared with those who received fewer years of such instruction. There was inconsistent evidence supporting a sustained first-grade treatment effect: Individualized instruction in first grade was necessary but not sufficient for stronger third-grade reading outcomes. These effects were achieved by regular classroom teachers who received professional development, which indicates that policies that support the use of evidence-based reading instruction and teacher training can yield increased student achievement.

Concepts: School, Educational years, Profession, Reading, Education, Student, Second grade, Teacher


The present study followed 156 Finnish children (Mage  = 7.25 years) during the first grade of primary school to examine to what extent parent- and teacher-rated temperament impacts children’s math and reading skill development during the first grade, and the extent to which this impact would be mediated by teachers' interaction styles with the children. The results showed that the impact of children’s low task orientation and negative emotionality on their math skill development was mediated via teachers' behavioral control and, among girls, also by psychological control. The negative impact of children’s inhibition on math skill development, in turn, was not mediated via teachers' interaction styles. Temperament did not predict the children’s reading skill development during first grade.

Concepts: Learning, Primary school, Control theory, Second grade, Feedback, Developmental psychology, School, Psychology


The adverse effect of harsh corporal punishment on mental health and psychosocial functioning in children has been repeatedly suggested by studies in industrialized countries. Nevertheless, corporal punishment has remained common practice not only in many homes, but is also regularly practiced in schools, particularly in low-income countries, as a measure to maintain discipline. Proponents of corporal punishment have argued that the differences in culture and industrial development might also be reflected in a positive relationship between the use of corporal punishment and improving behavioral problems in low-income nations. In the present study we assessed the occurrence of corporal punishment at home and in school in Tanzanian primary school students. We also examined the association between corporal punishment and externalizing problems. The 409 children (52% boys) from grade 2 to 7 had a mean age of 10.49 (SD=1.89) years. Nearly all children had experienced corporal punishment at some point during their lifetime both in family and school contexts. Half of the respondents reported having experienced corporal punishment within the last year from a family member. A multiple sequential regression analysis revealed that corporal punishment by parents or by caregivers was positively related to children’s externalizing problems. The present study provides evidence that Tanzanian children of primary school age are frequently exposed to extreme levels of corporal punishment, with detrimental consequences for externalizing behavior. Our findings emphasize the need to inform parents, teachers and governmental organizations, especially in low-income countries, about the adverse consequences of using corporal punishment be it at home or at school.

Concepts: Second grade, Junior school, Sociology, United Kingdom, Psychology, School, Primary education, Primary school