Don't cancel the surgery just yet! A case report of positive preoperative pregnancy test due to a soft tissue sarcoma production of ectopic beta human chorionic gonadotropin.

Soft tissue sarcomas are a rare group of mesenchymal malignancies which can range from low to high grade. These tumors have different clinical, radiographic, and histopathological characteristics. Beta human chorionic gonadotropin is a naturally secreted hormone by placental syncytiotrophoblast cells during pregnancy. On very rare occasions, sarcomas can develop the ability to ectopically produce human chorionic gonadotropin. Very few cases exist in the literature of soft tissue sarcomas expressing this hormone. We report the case of a 55-year-old female who presented with a posterior thigh soft tissue sarcoma who on the day of surgical resection was found to have an unusually elevated serum human chorionic gonadotropin. Positive immunohistochemical staining of the resected mass confirmed the sarcoma as the source of the beta human chorionic gonadotropin

Uma revisão sobre a etiologia das recessões marginais

TCC (graduação) - Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Odontologia.A recessão marginal tecidual é um achado muito comum na prática odontológica e muitas vezes sua etiologia é de difícil compreensão, devido a sua associação com diversos fatores. Diante desta premissa, este trabalho visa compreender os fatores etiológicos associados às recessões marginais teciduais descritas na literatura, buscando sua origem e os fatores que favorecem seu desenvolvimento. Para obter estas informações, foi realizada uma busca nas bases de dados PubMED e Scientific Eletronic Library OnLine (ScieLO) pelas palavras chaves recessão, retração, gengival, tecidual, marginal, estética mucogengival, cirurgia e suas combinações. A pesquisa foi feita nos idiomas português e inglês e buscou resultados entre 1985 e o primeiro semestre de 2020. Através de uma seleção criteriosa dos artigos encontrados, foi escrita esta revisão abordando os achados mais relevantes. A partir deste trabalho foi possível concluir que existem muitos fatores associados à etiologia das recessões marginais teciduais e que dificilmente podem ser relacionadas a um único fator. A presença de fatores predisponentes como a anatomia local ou o fenótipo periodontal somados a fatores precipitantes como a escovação traumática, presença de biofilme ou doença periodontal são as associações mais comuns.Marginal tissue recession is a very common finding in dentistry and its etiology is often difficult to understand, due to its association with several factors. Given this premise, this work aims to understand the etiological factors associated with marginal tissue recessions described in the literature, looking for their origin and the factors that favor their development. To obtain this information, a search was performed in the PubMED and Scientific Electronic Library OnLine (ScieLO) databases for the keywords recession, retraction, gingival, tissue, marginal, mucogingival aesthetics, surgery and their combinations. The survey was conducted both in Portuguese and English and sought results between 1985 and the first half of 2020. Through a careful selection of the articles found, this review was written addressing the most relevant findings. From this paper it was possible to conclude that there are many factors associated with the etiology of marginal tissue recessions and that they can rarely be related to a single factor. The presence of predisposing factors such as local anatomy or the periodontal phenotype in addition to precipitating factors such as traumatic brushing, presence of biofilm or periodontal disease are the most common associations

Speciation leads to divergent methylmercury accumulation in sympatric whitefish

Central European lake whitefish (Coregonus spp.) colonized Swiss lakes following the last glacial retreat and have undergone rapid speciation and adaptive radiation. Up to six species have been shown to coexist in some lakes, and individual species occupy specific ecological niches and have distinct feeding and reproductive ecologies. We studied methylmercury (MeHg) accumulation in sympatric whitefish species from seven Swiss lakes to determine if ecological divergence has led to different rates of MeHg bioaccumulation. In four of seven lakes, sympatric species had distinctly different MeHg levels, which varied by up to a factor of two between species. Generally, species with greater MeHg levels were smaller in body size and planktivorous, and species with lower MeHg were larger and benthivorous. While modest disparities in trophic position between species might be expected a priori to explain the divergence in MeHg, δ15N of bulk tissue did not correlate with fish MeHg in five of seven lakes. Results of a nested ANCOVA analysis across all lakes indicated that only two factors (species, lake) explained substantial portions of the variance, with species accounting for more variance (52%) than inter-lake differences (32%). We suggest that differences in MeHg accumulation were likely caused by diverging metabolic traits between species, such as differences in energy partitioning between anabolism and catabolism, potentially interacting with species-specific prey resource utilization. These results indicate substantial variability in MeHg accumulation between closely related fish species, illustrating that ecological speciation in fish can lead to divergent MeHg accumulation pattern

A case of recurrent giant cell tumor of bone with malignant transformation and benign pulmonary metastases

Giant cell tumor (GCT) of bone is a locally destructive tumor that occurs predominantly in long bones of post-pubertal adolescents and young adults, where it occurs in the epiphysis. The majority are treated by aggressive curettage or resection. Vascular invasion outside the boundary of the tumor can be seen. Metastasis, with identical morphology to the primary tumor, occurs in a few percent of cases, usually to the lung. On occasion GCTs of bone undergo frank malignant transformation to undifferentiated sarcomas. Here we report a case of GCT of bone that at the time of recurrence was found to have undergone malignant transformation. Concurrent metastases were found in the lung, but these were non-transformed GCT

The role of landscape and history on the genetic structure of peripheral populations of the Near Eastern fire salamander, Salamandra infraimmaculata, in Northern Israel

Genetic studies on core versus peripheral populations have yielded many patterns. This diversity in genetic patterns may reflect diversity in the meaning of peripheral populations as defined by geography, gene flow patterns, historical effects, and ecological conditions. Populations at the lower latitude periphery of a species' range are of particular concern because they may be at increased risk for extinction due to global climate change. In this work we aim to understand the impact of landscape and ecological factors on different geographical types of peripheral populations with respect to levels of genetic diversity and patterns of local population differentiation. We examined three geographical types of peripheral populations of the endangered salamander, Salamandra infraimmaculata, in Northern Israel, in the southernmost periphery of the genus Salamandra, by analyzing the variability in 15 microsatellite loci from 32 sites. Our results showed that: (1) genetic diversity decreases towards the geographical periphery of the species' range; (2) genetic diversity in geographically disjunct peripheral areas is low compared to the core or peripheral populations that are contiguous to the core and most likely affected by a founder effect; (3) ecologically marginal conditions enhance population subdivision. The patterns we found lead to the conclusion that genetic diversity is influenced by a combination of geographical, historical, and ecological factors. These complex patterns should be addressed when prioritizing areas for conservation.Peer reviewe

DEVELOPMENT OF LOW-VOLTAGE POWER MOSFET BASED ON APPLICATION REQUIREMENT ANALYSIS

Low-voltage power MOSFETs based on charge-compensation using a field-plate offer a significant reduction of the area-specific on-resistance. Beside a further improvement of this key parameter, the new device generation takes an in-depth focus on the other device parameters which are essential to the targeted application fields. To allow a high efficiency also in light-load conditions, the power MOSFET not only needs to meet general requirements like low on-resistance, low gate charge and good avalanche capability, but must also have a low output capacitance and low reverse-recovery charge. The paper discusses how the most important of these often conflicting requirements were identified. It is shown that beside the device technology the package contributes significantly to the overall device performance. A new package solution is introduced which is especially suited for high current applications linked to high reliability requirements such as industrial motor drives or servers

Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American society of interventional pain physicians (ASIPP) guidelines

Background: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl. Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that opioids reduce pain and a smaller proportion (57%) report better quality of life. In preparation of the current guidelines, we have focused on the means to reduce the abuse and diversion of opioids without jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use. Objectives: To provide guidance for the prescription of opioids for the management of chronic non-cancer pain, to develop a consistent philosophy among the many diverse groups with an interest in opioid use as to how appropriately prescribe opioids, to improve the treatment of chronic non-cancer pain and to reduce the likelihood of drug abuse and diversion. These guidelines are intended to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique. Methods: The methodology utilized included the development of objectives and key questions. The methodology also utilized trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various specialties and groups. The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed, with a best evidence synthesis of the available literature, and utilized grading for recommendation as described by the Agency for Healthcare Research and Quality (AHRQ)

Comprehensive, Evidence-Based, Consensus Guidelines for Prescription of Opioids for Chronic Non-Cancer Pain from the American Society of Interventional Pain Physicians (ASIPP).

BACKGROUND: Opioid prescribing in the United States is decreasing, however, the opioid epidemic is continuing at an uncontrollable rate. Available data show a significant number of opioid deaths, primarily associated with illicit fentanyl use. It is interesting to also note that the data show no clear correlation between opioid prescribing (either number of prescriptions or morphine milligram equivalent [MME] per capita), opioid hospitalizations, and deaths. Furthermore, the data suggest that the 2016 guidelines from the Centers for Disease Control and Prevention (CDC) have resulted in notable problems including increased hospitalizations and mental health disorders due to the lack of appropriate opioid prescribing as well as inaptly rapid tapering or weaning processes. Consequently, when examined in light of other policies and complications caused by COVID-19, a fourth wave of the opioid epidemic has been emerging. OBJECTIVES: In light of this, we herein seek to provide guidance for the prescription of opioids for the management of chronic non-cancer pain. These clinical practice guidelines are based upon a systematic review of both clinical and epidemiological evidence and have been developed by a panel of multidisciplinary experts assessing the quality of the evidence and the strength of recommendations and offer a clear explanation of logical relationships between various care options and health outcomes. METHODS: The methods utilized included the development of objectives and key questions for the various facets of opioid prescribing practice. Also utilized were employment of trustworthy standards, and appropriate disclosures of conflicts of interest(s). The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed. The recommendations were developed after the appropriate review of text and questions by a panel of multidisciplinary subject matter experts, who tabulated comments, incorporated changes, and developed focal responses to questions posed. The multidisciplinary panel finalized 20 guideline recommendations for prescription of opioids for chronic non-cancer pain. Summary of the results showed over 90% agreement for the final 20 recommendations with strong consensus. The consensus guidelines included 4 sections specific to opioid therapy with 1) ten recommendations particular to initial steps of opioid therapy; 2) five recommendations for assessment of effectiveness of opioid therapy; 3) three recommendations regarding monitoring adherence and side effects; and 4) two general, final phase recommendations. LIMITATIONS: There is a continued paucity of literature of long-term opioid therapy addressing chronic non-cancer pain. Further, significant biases exist in the preparation of guidelines, which has led to highly variable rules and regulations across various states. CONCLUSION: These guidelines were developed based upon a comprehensive review of the literature, consensus among expert panelists, and in alignment with patient preferences, and shared decision-making so as to improve the long-term pain relief and function in patients with chronic non-cancer pain. Consequently, it was concluded - and herein recommended - that chronic opioid therapy should be provided in low doses with appropriate adherence monitoring and understanding of adverse events only to those patients with a proven medical necessity, and who exhibit stable improvement in both pain relief and activities of daily function, either independently or in conjunction with other modalities of treatments

NRF2 Activation Restores Disease Related Metabolic Deficiencies in Olfactory Neurosphere-Derived Cells from Patients with Sporadic Parkinson's Disease

Extent: 14p.Background: Without appropriate cellular models the etiology of idiopathic Parkinson’s disease remains unknown. We recently reported a novel patient-derived cellular model generated from biopsies of the olfactory mucosa (termed olfactory neurosphere-derived (hONS) cells) which express functional and genetic differences in a disease-specific manner. Transcriptomic analysis of Patient and Control hONS cells identified the NRF2 transcription factor signalling pathway as the most differentially expressed in Parkinson’s disease. Results: We tested the robustness of our initial findings by including additional cell lines and confirmed that hONS cells from Patients had 20% reductions in reduced glutathione levels and MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)- 2-(4-sulfophenyl)-2H-tetrazolium, inner salt] metabolism compared to cultures from healthy Control donors. We also confirmed that Patient hONS cells are in a state of oxidative stress due to higher production of H2O2 than Control cultures. siRNA-mediated ablation of NRF2 in Control donor cells decreased both total glutathione content and MTS metabolism to levels detected in cells from Parkinson’s Disease patients. Conversely, and more importantly, we showed that activation of the NRF2 pathway in Parkinson’s disease hONS cultures restored glutathione levels and MTS metabolism to Control levels. Paradoxically, transcriptomic analysis after NRF2 pathway activation revealed an increased number of differentially expressed mRNAs within the NRF2 pathway in L-SUL treated Patient-derived hONS cells compared to L-SUL treated Controls, even though their metabolism was restored to normal. We also identified differential expression of the PI3K/AKT signalling pathway, but only post-treatment. Conclusions: Our results confirmed NRF2 as a potential therapeutic target for Parkinson’s disease and provided the first demonstration that NRF2 function was inducible in Patient-derived cells from donors with uniquely varied genetic backgrounds. However, our results also demonstrated that the response of PD patient-derived cells was not co-ordinated in the same way as in Control cells. This may be an important factor when developing new therapeutics.Anthony L. Cook, Alejandra M. Vitale, Sugandha Ravishankar, Nicholas Matigian, Greg T. Sutherland, Jiangou Shan, Ratneswary Sutharsan, Chris Perry, Peter A. Silburn, George D. Mellick, Murray L. Whitelaw, Christine A. Wells, Alan Mackay-Sim and Stephen A. Woo