Intracranial extension of Schneiderian inverted papilloma: a case report and literature review

Inverted papilloma is an uncommon primary nasal tumor. Despite its benign nature, this tumor represents three typical characteristics: a high propensity of recurrence, local aggressiveness and association with malignancy. Inverted papilloma can reduce the patient’s quality of life due to compromised nasal function, extension to the orbit and brain. The authors reported the unusual case of a 72-year-old male patient with inverted papilloma, which fatally extended to the intracranial temporal fossa after multiple recurrences. To the authors’ knowledge, this is the twelfth case in the literature of inverted papilla extending into the temporal fossa. The current and pertinent literature in English, French and German was reviewed, and an algorithm for managing inverted papilloma was also proposed

Cosmic Billiards with Painted Walls in Non-Maximal Supergravities: a worked out example

The derivation of smooth cosmic billiard solutions through the compensator method is extended to non maximal supergravities. A new key feature is the non-maximal split nature of the scalar coset manifold. To deal with this, one needs the theory of Tits Satake projections leading to maximal split projected algebras. Interesting exact solutions that display several smooth bounces can thus be derived. From the analysis of the Tits Satake projection emerges a regular scheme for all non maximal supergravities and a challenging so far unobserved structure, that of the paint group G-paint. This latter is preserved through dimensional reduction and provides a powerful tool to codify solutions. It appears that the dynamical walls on which the cosmic ball bounces come actually in painted copies rotated into each other by G-paint. The effective cosmic dynamics is that dictated by the maximal split Tits Satake manifold plus paint. We work out in details the example provided by N=6,D=4 supergravity, whose scalar manifold is the special Kahlerian SO*(12)}/SU(6)xU(1). In D=3 it maps to the quaternionic E_7(-5)/ SO(12) x SO(3). From this example we extract a scheme that holds for all supergravities with homogeneous scalar manifolds and that we plan to generalize to generic special geometries. We also comment on the merging of the Tits-Satake projection with the affine Kac--Moody extensions originating in dimensional reduction to D=2 and D=1.Comment: 52 pages, 4 figures, 9 tables, paper. Few misprints correcte

The general pattern of Kac Moody extensions in supergravity and the issue of cosmic billiards

In this paper we study the systematics of the affine extension of supergravity duality algebras when we step down from D=4 to D=2. For all D=4 supergravities (with N >= 3) there is a universal field theoretical mechanism promoting the extension, which relies on the coexistence of two non locally related lagrangian descriptions. This provides a Chevalley-Serre presentation of the affine Kac Moody algebra which follows a universal pattern for all supergravities and is an extension of the mechanism considered by Nicolai for pure N=1 supergravity. There are new distinctive features in extended theories related to the presence of vector fields and to their symplectic description. The novelty is that in supergravity the so named Matzner-Missner description is structurally different from the Ehlers one with gauge 0--forms subject to SO(2n,2n) electric--magnetic duality rotations representing in D=2 the Sp(2n,R) rotations of D=4. The role played by the symplectic bundle of vectors is emphasized in view of implementing the affine extension also in N=2 supergravity, where the scalar manifold is not necessarily a homogeneous manifold U/H. We show that the mechanism of the affine extension commutes with the Tits Satake projection of the duality algebras. This is very important for the issue of cosmic billiards. We also comment on the general field theoretical mechanism of the further hyperbolic extension obtained in D=1. The possible uses of our results and their relation to outstanding problems are pointed out.Comment: 46 pages, paper. Few misprints correcte

Super-Ehlers in Any Dimension

We classify the enhanced helicity symmetry of the Ehlers group to extended supergravity theories in any dimension. The vanishing character of the pseudo-Riemannian cosets occurring in this analysis is explained in terms of Poincar\'e duality. The latter resides in the nature of regularly embedded quotient subgroups which are non-compact rank preserving.Comment: 1+55 pages; 15 Tables, 6 Figures; v2 : some clarifications added in Sec. 1 and in App.

End-user centred infrastructure operation: Towards integrated end-use service delivery

Reliable provision of water, energy and transportation, all supplied through infrastructure, is necessary for the most basic human and economic development to occur. Such development however, is not enabled by specific end-use products (e.g. litres of water, kWh of electricity, litres of diesel and petrol), or by infrastructure itself (i.e. the systems of energy, transport, digital information, water, waste and flood protection assets), but rather through the infrastructure end-use services (e.g. hygiene, thermal comfort, communication, or accessibility). The present form of infrastructure operation consists of supply systems provisioning unconstrained demand of end-use products, with larger consumption volumes corresponding to higher economic revenue. Providing infrastructure capacity to meet unmanaged growing demand is ultimately unsustainable, both in environmental and economic terms. Past research has focused on physical infrastructure assets on the one hand, and sustainable consumption and production on the other, often neglecting infrastructure end-use services. An important priority for sustainable infrastructure operation is therefore to analyse the infrastructure end-use service demands, and the variety of end-users’ wants and behaviours. This paper outlines the key aspects of an end-user and service-centred approach to infrastructure operation. It starts with an overview of relevant research areas and literature. It then describes the infrastructure end-use services provided by different infrastructure streams quantitatively, with the UK domestic sector as an illustration. Subsequently, insights into infrastructure integration at the end-user level are presented. Finally, the infrastructure end-use service perspective is described as a holistic framework for intervention: understanding technological changes in context, acting directly on end-use demand, and including social implications of service-based solutions

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy.

Purpose Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. Methods The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. Results Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. Conclusions In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques

Vision, challenges and opportunities for a Plant Cell Atlas

With growing populations and pressing environmental problems, future economies will be increasingly plant-based. Now is the time to reimagine plant science as a critical component of fundamental science, agriculture, environmental stewardship, energy, technology and healthcare. This effort requires a conceptual and technological framework to identify and map all cell types, and to comprehensively annotate the localization and organization of molecules at cellular and tissue levels. This framework, called the Plant Cell Atlas (PCA), will be critical for understanding and engineering plant development, physiology and environmental responses. A workshop was convened to discuss the purpose and utility of such an initiative, resulting in a roadmap that acknowledges the current knowledge gaps and technical challenges, and underscores how the PCA initiative can help to overcome them.</jats:p

Molecular Diagnosis for Nodal Metastasis in Endoscopically Managed Cervical Cancer: The Accuracy of the APTIMA Test to Detect High-risk Human Papillomavirus Messenger RNA in Sentinel Lymph Nodes

Study Objective: To evaluate the feasibility and accuracy of a commercially available test to detect E6/E7 mRNA of 14 subtypes of high-risk HPVs (APTIMA; Hologic, Bedford, MA) in the sentinel lymph nodes of CC patients laparoscopically operated. Design: Prospective pilot study. Setting: The study was conducted in the Department of Advanced Operative and Oncologic Gynecology, Asklepios Hospital, Hamburg, Germany. Patients: 54 women with HPV-positive CC submitted to laparoscopic sentinel node biopsy alone or sentinel node biopsy followed by systematic pelvic and/or para-aortic endoscopic lymphadenectomy. Interventions: All removed sentinel lymph nodes (SLNs) underwent sample collection by cytobrush for the APTIMA assay before frozen section. Measurements: Results obtained with the HPV mRNA test were compared with the definitive histopathological analysis of the SLNs and additional lymph nodes removed. Results: A total of 125 SLNs (119 pelvic and 6 paraaortic) were excised with a mean number of 2.3 SLNs per patient. Final histopathologic analysis confirmed nodal metastases in 10 SLNs from 10 diffeient patients (18%). All the histologically confirmed metastatic lymph nodes were also HPV E6/E7 mRNA positive, resulting in a sensitivity of 100%. Four histologically free sentinel nodes were positive for HPV E6/E7 mRNA, resulting in a specificity of 96.4%. Conclusion: The HPV E6/E7 mRNA assay in the SLNs of patients with CC is feasible and highly accurate. The detection of HPV mRNA in 4 women with negative SLNs might denote a shift from microscopic identification of metastasis to the molecular level. The prognostic value of this findings awaits further verification. (C) 2016 Published by Elsevier Inc