KEY POINTS A patient treated with dual anti-PD1 and anti-CTLA4 therapy developed Raynaud's-like signs and symptoms more than 18 months after starting therapy. In this case, autoantibody changes became apparent shortly before onset of clinical toxicity. This case highlights the potential for late-onset immune-related adverse events checkpoint inhibitors, requiring continuous clinical vigilance. The optimal duration of checkpoint inhibitor therapy in patients with profound and prolonged responses remains unclear. © 2020 The Authors. The Oncologist published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.Insecure attachment is widely accepted to be a risk factor for suicidal thoughts and behaviour. https://www.selleckchem.com/products/benzylpenicillin-potassium.html To increase our understanding of this distal association, the current systematic review aimed to evaluate empirical evidence that has investigated the role of psychosocial mechanisms within this relationship. Sixteen original research articles were identified, with the majority carrying out mediational analyses to test their hypotheses. Substantial heterogeneity was found across studies with regards to their theoretical approach to assessing attachment, suicide-related outcomes, sample population, statistical analyses and the psychological factors under investigation. Nevertheless, this emergent evidence base indicates that a range of predisposing, precipitating and crisis-state factors may mediate the association between attachment security and suicidality. Studies that investigated moderating factors did not report significant findings, and the mediating role for psychiatric diagnoses remains unclear. Furthermore, this emerging research base is limited by an over-reliance on cross-sectional designs and self-reported data. Longitudinal and experimental designs are required to verify causal pathways, and to investigate whether trait vulnerabilities interact with acute stressors to increase suicide risk. Finally, disorganised attachment has been overlooked so far and should be given greater consideration going forward. This article is protected by copyright. All rights reserved.Children with attention-deficit and hyperactivity disorder (ADHD) are more likely to experience peer problems compared to their non-ADHD peers, though ADHD-specific symptoms only partially explain this association. This study examined whether sleep difficulties and motor coordination problems are additional predictors of peer problems in an ADHD population. An ADHD sample of 72 participants aged 6-14 years (M = 9.86 years, SD = 1.79 years) was evaluated for an association of peer problems with measures of motor coordination, sleep difficulties as well as ADHD and comorbidity symptoms. Hierarchical multiple regression analysis (HMRA) was used to test the current study aims. Motor coordination, but not sleep difficulties, predicted additional variance in peer problems after controlling for inattention, hyperactivity/impulsivity, internalizing problems, oppositionality, and conduct problems. Poor motor coordination predicts peer problems beyond ADHD symptoms. Clinicians seeking to improve peer functioning in chims of the disorder. Internalizing symptomatology, conduct problems, oppositionality, motor coordination, and sleep difficulties were added to a regression model already including inattention and hyperactivity symptoms. These factors explained 51% of the variability in peer problems. In this sample of 72 ADHD children, the results of the final model highlighted that only motor coordination and conduct problems remained significant predictors of peer problems - highlighting two potentially important target areas for screening and intervention. © 2020 The British Psychological Society.Infections related to orthopedic procedures are considered particularly severe when implantation materials are used, because effective treatments for biofilm removal are lacking. In this study, the relatively new approach for infection control by using an erbiumyttrium-aluminum-garnet (ErYAG) laser was tested. This laser vaporizes all water containing cells in a very effective, precise, and predictable manner and results in only minimal thermal damage. For preliminary testing, 42 steel plates and 42 pins were seeded with mixed cultures. First, the minimally necessary laser energy for biofilm removal was determined. Subsequently, the effectiveness of biofilm removal with the ErYAG laser and the cleansing of the metal implants with octenidine-soaked gauze was compared. Then, we compared the effectiveness of biofilm removal on 207 steel pins from 41 patients directly after explantation. Sonication and scanning electron microscopy were used for analysis. Laser fluences exceeding 2.8  J/cm2 caused a complete extinction of all living cells by a single-laser impulse. Cleansing with octenidine-soaked gauze and irradiation with the ErYAG laser are both thoroughly effective when applied to seeded pins. In contrast, when explanted pins with fully developed biofilms were analyzed, we found a significant advantage of the laser procedure. The ErYAG laser offers a secure, complete, and nontoxic eradication of all kinds of pathogens from metal implants without damaging the implant and without the possible development of resistance. The precise noncontact removal of adjacent tissue is a decisive advantage over conventional disinfectants. Therefore, laser irradiation could become a valuable method in every debridement, antibiotics, and implant retention procedure. © 2020 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.INTRODUCTION One-year post-transplant survival is a significant quality measure for solid organ transplant programs in the United States. It is not known whether the use of this metric is associated with changes in life-sustaining clinical practices that would delay mortality for solid organ recipients until just beyond the one-year time point. METHODS We compared trends in mortality in the time period immediately preceding the one-year post-transplant mark compared to the period immediately after using second-order Cox proportional hazard regression models. RESULTS Among recipients of heart, liver, and lung transplantation, mortality did not decrease significantly in the period immediately before day 365 or increase in the 14 days thereafter. There was an increased adjusted hazard of mortality in the 30 days following day 365 among lung transplant recipients (HR 1.33, 95% CI 1.03 - 1.72, p=0.03) with a 0.76% absolute mortality rate (94 deaths) in month 12 following lung transplantation and a 1.14% absolute mortality rate in month 13 (113 deaths).