Metastatic Uterine Leiomyosarcoma in the Upper Buccal Gingiva Misdiagnosed as an Epulis

Uterine leiomyosarcoma (LMS) is a rare tumor constituting 1% of all uterine malignancies. This sarcoma demonstrates an aggressive growth pattern with an high rate of recurrence with hematologic dissemination; the most common sites are lung, liver, and peritoneal cavity, head and neck district being rarely interested. Only other four cases of metastasis in the oral cavity have been previously described. The treatment of choice is surgery and the use of adjuvant chemotherapy and radiation has limited impact on clinical outcome. In case of metastases, surgical excision can be performed considering extent of disease, number and type of distant lesions, disease free interval from the initial diagnosis to the time of metastases, and expected life span. We illustrate a case of uterine LMS metastasis in the upper buccal gingiva that occurred during chemotherapy in a 63-year-old woman that underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy for a diagnosis of LMS staged as pT2bN0 and that developed lung metastases eight months after primary treatment. Surgical excision of the oral mass (previously misdiagnosed as epulis at a dental center) and contemporary reconstruction with pedicled temporalis muscle flap was performed in order to improve quality of life. Even if resection was achieved in free margins, "local" relapse was observed 5 months after surgery

Sustainable and Resistant Road Infrastructures: The Role of the Envision Framework as a Guide to a New Design Approach

In Italy, resilience and sustainability concepts are generally applied to road infrastructures (mainly in terms of pavements) in order to minimize the environmental impacts of their construction and maintenance. In this paper the Envision framework has been adopted to evaluate the sustain-ability of a road project, optimizing its resilience for both short-term and long-term impacts. The rating approach has been applied considering not only pavements analysis but also the complete project process. The authors have upgraded the original Envision framework to road infrastructures, in compliance with the Italian regulatory framework. Four scenarios have been considered. The first allowed us to understand which credits can be evaluated with the available project documentation. The second represents a snapshot of the state of the project. The third evaluates the effect of the improvement in the performance level obtained by analyzing the potential increases. Finally, the last considers also for “pending” credits

Seasonal oxygen, nitrogen and phosphorus benthic cycling along an impacted Baltic Sea estuary: regulation and spatial patterns

The regulatory roles of temperature, eutrophication and oxygen availability on benthic nitrogen (N) cycling and the stoichiometry of regenerated nitrogen and phosphorus (P) were explored along a Baltic Sea estuary affected by treated sewage discharge. Rates of sediment denitrification, anammox, dissimilatory nitrate reduction to ammonium (DNRA), nutrient exchange, oxygen (O-2) uptake and penetration were measured seasonally. Sediments not affected by the nutrient plume released by the sewage treatment plant (STP) showed a strong seasonality in rates of O-2 uptake and coupled nitrification-denitrification, with anammox never accounting for more than 20 % of the total dinitrogen (N-2) production. N cycling in sediments close to the STP was highly dependent on oxygen availability, which masked temperature-related effects. These sediments switched from low N loss and high ammonium (NH4 (+)) efflux under hypoxic conditions in the fall, to a major N loss system in the winter when the sediment surface was oxidized. In the fall DNRA outcompeted denitrification as the main nitrate (NO3 (-)) reduction pathway, resulting in N recycling and potential spreading of eutrophication. A comparison with historical records of nutrient discharge and denitrification indicated that the total N loss in the estuary has been tightly coupled to the total amount of nutrient discharge from the STP. Changes in dissolved inorganic nitrogen (DIN) released from the STP agreed well with variations in sedimentary N-2 removal. This indicates that denitrification and anammox efficiently counterbalance N loading in the estuary across the range of historical and present-day anthropogenic nutrient discharge. Overall low N/P ratios of the regenerated nutrient fluxes impose strong N limitation for the pelagic system and generate a high potential for nuisance cyanobacterial blooms

Actions and Potential Therapeutic Applications of Growth Hormone-Releasing Hormone Agonists.

Abstract In this article, we briefly review the identification of GHRH, provide an abridged overview of GHRH antagonists, and focus on studies with GHRH agonists. Potent GHRH agonists of JI and MR class were synthesized and evaluated biologically. Besides the induction of the release of pituitary GH, GHRH analogs promote cell proliferation and exert stimulatory effects on various tissues, which express GHRH receptors (GHRH-Rs). A large body of work shows that GHRH agonists, such as MR-409, improve pancreatic β-cell proliferation and metabolic functions and facilitate engraftment of islets after transplantation in rodents. Accordingly, GHRH agonists offer a new therapeutic approach to treating diabetes. Various studies demonstrate that GHRH agonists promote repair of cardiac tissue, producing improvement of ejection fraction and reduction of infarct size in rats, reduction of infarct scar in swine, and attenuation of cardiac hypertrophy in mice, suggesting clinical applications. The presence of GHRH-Rs in ocular tissues and neuroprotective effects of GHRH analogs in experimental diabetic retinopathy indicates their possible therapeutic applications for eye diseases. Other effects of GHRH agonists, include acceleration of wound healing, activation of immune cells, and action on the central nervous system. As GHRH might function as a growth factor, we examined effects of GHRH agonists on tumors. In vitro, GHRH agonists stimulate growth of human cancer cells and upregulate GHRH-Rs. However, in vivo, GHRH agonists inhibit growth of human cancers xenografted into nude mice and downregulate pituitary and tumoral GHRH-Rs. Therapeutic applications of GHRH analogs are discussed. The development of GHRH analogs should lead to their clinical use

Role of extracellular vesicle-based cell-to-cell communication in multiple myeloma progression

Multiple myeloma (MM) progression closely depends on the bidirectional crosstalk between tumor cells and the surrounding microenvironment, which leads to the creation of a tumor supportive niche. Extracellular vesicles (EVs) have emerged as key players in the pathological interplay between the malignant clone and near/distal bone marrow (BM) cells through their biologically active cargo. Here, we describe the role of EVs derived from MM and BM cells in reprogramming the tumor microenvironment and in fostering bone disease, angiogenesis, immunosuppression, drug resistance, and, ultimately, tumor progression. We also examine the emerging role of EVs as new therapeutic agents for the treatment of MM, and their potential use as clinical biomarkers for early diagnosis, disease classification, and therapy monitoring

Problematising international placements as a site of intercultural learning

This paper theorises some of the learning outcomes of a three-year project concerning student learning in international social work placements in Malaysia. The problematic issue of promoting cultural and intercultural competence through such placements is examined, where overlapping hegemonies are discussed in terms of isomorphism of social work models, that of the nation state, together with those relating to professional values and knowledge, and the tyrannies of received ideas. A critical discussion of cultural competence as the rationale for international placements is discussed in terms of the development of the graduating social worker as a self-reflexive practitioner. The development of sustainable international partnerships able to support student placement and the issue of non-symmetrical reciprocation, typical of wide socio-economic differentials across global regions, is additionally discussed

Prospective Study on Several Urinary Biomarkers as Indicators of Renal Damage in Children with CAKUT

Purpose The aim of the study was to investigate urinary levels of monocyte chemotactic protein-1 (MCP-1), epidermal growth factor (EGF), β-2-microglobulin (β2M), and FAS-ligand (FAS-L) in children with congenital anomalies of kidney and urinary tract (CAKUT) disease at risk of developing glomerular hyperfiltration syndrome. For this reason, we selected patients with multicystic kidney, renal agenesia and renal hypodysplasia, or underwent single nephrectomy. Materials and Methods This prospective, multicentric study was conducted in collaboration between the Pediatric Surgery Unit in Foggia and the Pediatric Nephrology Unit in Bari, Italy. We enrolled 80 children with CAKUT (40 hypodysplasia, 22 agenetic; 10 multicystic; 8 nephrectomy) who underwent extensive urological and nephrological workup. Exclusion criteria were recent urinary tract infections or pyelonephritis, age > 14 years, presence of systemic disease, or hypertension. A single urine sample was collected in a noninvasive way and processed for measuring by enzyme-linked immunosorbent assay urine levels of MCP-1, EGF, β2M, and FAS-L. As control, urine samples were taken from 30 healthy children. Furthermore, we evaluated the urinary ratios uEGF/uMCP-1 (indicator of regenerative vs inflammatory response) and uEGF/uβ2M (indicator of regenerative response vs. tubular damage). Results These results suggest that urinary levels of MCP-1 are overexpressed in CAKUT patients. Furthermore, our findings clearly demonstrated that both uEGF/uMCP-1 and uEGF/uβ2M ratios were significantly downregulated in all patient groups when compared with the control group. Conclusion These findings further support that CAKUT patients may, eventually, experience progressive renal damage and poor regenerative response. The increased urinary levels of MCP-1 in all groups of CAKUT patients suggested that the main factor responsible for the above effects is chronic renal inflammation mediated by local monocytes

Polarization effects in the reaction e++e−→ρ++ρ−e^++e^-\to \rho^+ +\rho^- and determination of the ρ−\rho - meson form factors in the time--like region

The electron positron annihilation reaction into four pion production has been studied, through the channel $e^++e^-\to \bar \rho+\rho$. The differential (and total) cross sections and various polarization observables for this reaction have been calculated in terms of the electromagnetic form factors of the corresponding $\gamma^*\rho\rho$ current. The elements of the spin--density matrix of the $\rho -$meson were also calculated. Numerical estimations have been done, with the help of phenomenological form factors obtained in the space--like region of the momentum transfer squared and analytically extended to the time-like region.Comment: 19 pages, 2 figures, to appear in Phys Rev

Clinical Characteristics and Management of Children with Ureteropelvic Junction Obstruction and Severe Vesicoureteral Reflux: Preliminary Results

Objective: The aim of this study was to investigate the physiopathology of isolated or coexisting ureteropelvic junction obstruction (UPJ-O) and high-grade vesicoureteral reflux (VUR), including the clinical characteristics and management.Summary background data: The association between UPJ-O and VUR was reported more frequently in boys with high-grade VUR; however, the physiopathology of concomitant UPJ-O and VUR is still unknown. Primary pyeloplasty, followed by ureteral reimplantation, if needed, has been widely accepted, although VUR should be treated first (most often by endoscopic treatment) in the presence of a functional obstruction.Methods: We reviewed the charts of 78 children with isolated or coexisting high-grade VUR/UPJ-O. Among the children, 14 had isolated UPJ-O, 16 had high-grade VUR/ UPJ-O, and 48 had high-grade VUR. Children with other urological or extrarenal conditions were excluded.Results: Patients with isolated UPJ-O showed significantly different clinical characteristics compared with the other two groups of patients with high-grade VUR. Among the patients of group 2, 3/13 (23%) showed progression from functional to obstructive UPJ-O after endoscopic treatment. All of them underwent secondary pyeloplasty, which was complicated at follow-up by VUR recurrence needing further endoscopic injection.Conclusion: We suggest that UPJ-O in high-grade VUR patients is just a complication of severe VUR that produces structural changes in predisposed children. The treatment of children with associated high-grade VUR/UPJ-O may be complicated by the progression of urinary flow obstruction or VUR recurrence after pyeloplasty. Endoscopic treatment of high-grade VUR is associated with a high rate of VUR recurrence in children requiring subsequent pyeloplasty.Keywords: Children, Endoscopic Treatment, Ureteropelvic Junction Obstruction, Vesicoureteral Reflu

Field-Dependent Tilt and Birefringence of Electroclinic Liquid Crystals: Theory and Experiment

An unresolved issue in the theory of liquid crystals is the molecular basis of the electroclinic effect in the smectic-A phase. Recent x-ray scattering experiments suggest that, in a class of siloxane-containing liquid crystals, an electric field changes a state of disordered molecular tilt in random directions into a state of ordered tilt in one direction. To investigate this issue, we measure the optical tilt and birefringence of these liquid crystals as functions of field and temperature, and we develop a theory for the distribution of molecular orientations under a field. Comparison of theory and experiment confirms that these materials have a disordered distribution of molecular tilt directions that is aligned by an electric field, giving a large electroclinic effect. It also shows that the net dipole moment of a correlated volume of molecules, a key parameter in the theory, scales as a power law near the smectic-A--smectic-C transition.Comment: 18 pages, including 9 postscript figures, uses REVTeX 3.0 and epsf.st