Leiomyosarcoma Arising in the Pancreatic Duct: A Case Report and Review of the Current Literature

Context. Leiomyosarcomas are rare malignant smooth muscle tumors that may arise in any organ or tissue that contains smooth muscle, commonly within the gastrointestinal tract. They are most often found in the stomach, large and small intestines, and retroperitoneum. Primary pancreatic leiomyosarcoma is extremely rare, and to the best of our knowledge only 30 cases have been reported in the world literature since 1951. Our case represents the first to have a clear origin from the main pancreatic duct. Case Report. This case was diagnosed in a large, tertiary care center in Tampa, Florida. Pertinent information was obtained from chart review and interdepartmental collaboration. A mass in the tail of the pancreas was identified with large pleomorphic and spindle-shaped cells. Immunohistochemistry for vimentin, smooth muscle actin, and desmin was positive. All remaining immunohistochemical markers performed were negative. The tumor clearly originated from the pancreatic duct wall, filled and expanded the duct lumen, and was covered with a layer of benign biliary epithelium. Conclusion. Leiomyosarcoma of the pancreas is an extremely rare malignancy with few reported cases in the literature. The prognosis is poor, and treatment consists of alleviating symptoms and pain management. To our knowledge, this represents the first reported case demonstrating clear origin of a leiomyosarcoma from the pancreatic duct

Alcohol, Self-regulation, and Partner Physical Aggression: Actor-Partner Effects over a Three Year Time Frame

The question of how individual differences related to self-regulation interact with alcohol use patterns to predict intimate partner aggression (IPA) is examined. We hypothesized that excessive drinking will be related to partner aggression among those who have low self-regulation. In addition, we explored the extent to which differences in self-regulation in one partner may moderate the relationship between alcohol use and partner aggression. A sample of married or cohabitating community couples (N = 280) ages 18–45 was recruited according to their classification into four drinking groups: heavy drinking in both partners (n = 79), husband only (n = 80), wife only (n = 41), by neither (n = 80), and interviewed annually for 3 years. IPA, drinking, and scores on measures of negative affect, self-control, and Executive Cognitive Functioning (ECF) were assessed for both members of the couple. The Actor Partner Interdependence Model (APIM) was used to analyze longitudinal models predicting the occurrence of IPA from baseline alcohol use, negative affect, self-control and ECF. Actor self-control interacted with partner self-control such that IPA was most probable when both were low in self-control. Contrary to prediction, actors high in alcohol use and also high on self-control were more likely to engage in IPA. Partner alcohol use was predictive of actor IPA when the partner was also high in negative affect. Low partner ECF was associated with more actor IPA. These findings suggest that self-regulatory factors within both members of a couple can interact with alcohol use patterns to increase the risk for relationship aggression

Recognizing and Defining Occasional Constipation: Expert Consensus Recommendations

Constipation is a common problem, affects 15% of the population, and is often self-diagnosed and self-managed. Over the past 3 decades, there have been significant advances in our understanding and management of chronic constipation, with the emerging recognition that occasional constipation (OC) is another subtype that falls outside current classifications. The purpose of this review was to describe the process of developing and proposing a new definition for OC based on expert consensus and taking into consideration the multifactorial nature of the problem such as alterations in bowel habit that include stool frequency and difficulty with stool passage, perception of the sufferer, duration of symptoms, and potential responsiveness to treatment. Leading gastroenterologists from 5 countries met virtually on multiple occasions through an online digital platform to discuss the problem of OC and recommended a practical, user-friendly definition: "OC can be defined as intermittent or occasional symptomatic alteration(s) in bowel habit. This includes a bothersome reduction in the frequency of bowel movements and/or difficulty with passage of stools but without alarming features. Bowel symptoms may last for a few days or a few weeks, and episodes may require modification of lifestyle, dietary habits and/or use of over-the-counter laxatives or bulking agents to restore a satisfactory bowel habit." Prospective studies are required to validate this definition and determine OC prevalence in the community. This review highlights current knowledge gaps and could provide impetus for future research to facilitate an improved understanding of OC and development of evidence-based management guidelines

Correlatos del índice de masa corporal en los pacientes moderados y graves con el síndrome del intestino irritable

Irritable bowel syndrome (IBS) is a common and potentially disabling gastrointestinal (GI) disorder that is subject to strong psychological influences particularly among more severe IBS patients. Little is known about the role of actionable lifestyle factors (e.g., obesity) that influence the trajectory of other chronic diseases. This study examined the associations between obesity and different aspects of illness experience among more severe IBS patients. We hypothesized that Body Mass Index (BMI) would positively correlate with worse health outcomes including more severe IBS symptoms, extraintestinal complaints, and emotional distress. At pretreatment baseline in a National Institutes of Health (NIH)-funded behavioral trial, 448 Rome-diagnosed IBS patients (MAGE  = 41; MBMI = 26, Female = 8%) were administered a test battery that included a variety of clinical (IBS symptom severity, fear of GI symptoms, BMI, etc.), and sociodemographic (e.g. age, etc.) variables. BMI was positively and significantly correlated with somatization (unexplained somatic complaints) but not IBS symptom severity or emotional distress. A series of moderated multiple regression analyses showed that the associations between BMI and somatization were moderated by the interaction between BMI and age, and fear of GI symptoms. Older patients with higher BMI reported higher levels of somatization and patients who were more fearful of GI symptoms were more likely to experience somatization if they also had a high BMI. These data highlight the relationship between lifestyle factors and extraintestinal symptoms among more severe IBS patients and the impact of both sociodemographic (age) and psychosocial (fear of GI symptoms) factors on this relationship.SII es un trastorno gastrointestinal común y potencialmente incapacitante, susceptible a las influencias psicológicas fuertes, especialmente entre los pacientes más graves. Se sabe poco sobre el papel de los factores del estilo de vida (p.ej. obesidad) que influyen en la trayectoria de otras enfermedades crónicas. Este estudio ha examinado la correlación entre la obesidad y los diferentes aspectos de la experiencia de enfermedad en los pacientes más graves con el SII. Nuestra hipótesis fue que el SII se podría correlacionar positivamente con peores resultados de salud, incluyendo síntomas más graves del SII, molestias extraintestinales y angustia emocional. Durante el pretratamiento, en una prueba de comportamiento basada en NIH, 448 pacientes con el SII diagnosticados mediante los criterios de Roma (MEDAD = 41, MIMC = 26, F = 8%) fueron sometidos a una batería de prueba que incluía una variedad de variables clínicas (gravedad del SII, miedo de síntomas gastrointestinales, IMC etc.) y sociodemográficas (p. ej. edad etc.) El IMC fue positiva y significativamente correlacionado con la somatización (molestias somáticas inexplicadas), pero no con la gravedad de los síntomas del SII o angustia emocional. Una serie de múltiples análisis regresivos moderados demostró que la relación entre el IMC y la somatización fue moderada por la interacción entre el IMC, la edad y el miedo de los síntomas gastrointestinales. Los pacientes mayores con el IMC más alto mostraron niveles de somatización más altos, y los pacientes que tenían más miedo de los síntomas gastrointestinales tenían más posibilidad de sufrir la somatización si tenían también el IMC alto. Estos datos subrayan la relación entre los factores de estilo de vida y los síntomas extraintestinales entre los pacientes más graves con el SII, tanto como el impacto que tienen factores sociodemográficos (edad) y psicosociales (miedo de los síntomas gastrointestinales) en su relación

Inhibition of αvβ5 Integrin Attenuates Vascular Permeability and Protects against Renal Ischemia-Reperfusion Injury

Ischemia-reperfusion injury (IRI) is a leading cause of AKI. This common clinical complication lacks effective therapies and can lead to the development of CKD. The αvβ5 integrin may have an important role in acute injury, including septic shock and acute lung injury. To examine its function in AKI, we utilized a specific function-blocking antibody to inhibit αvβ5 in a rat model of renal IRI. Pretreatment with this anti-αvβ5 antibody significantly reduced serum creatinine levels, diminished renal damage detected by histopathologic evaluation, and decreased levels of injury biomarkers. Notably, therapeutic treatment with the αvβ5 antibody 8 hours after IRI also provided protection from injury. Global gene expression profiling of post-ischemic kidneys showed that αvβ5 inhibition affected established injury markers and induced pathway alterations previously shown to be protective. Intravital imaging of post-ischemic kidneys revealed reduced vascular leak with αvβ5 antibody treatment. Immunostaining for αvβ5 in the kidney detected evident expression in perivascular cells, with negligible expression in the endothelium. Studies in a three-dimensional microfluidics system identified a pericyte-dependent role for αvβ5 in modulating vascular leak. Additional studies showed αvβ5 functions in the adhesion and migration of kidney pericytes in vitro Initial studies monitoring renal blood flow after IRI did not find significant effects with αvβ5 inhibition; however, future studies should explore the contribution of vasomotor effects. These studies identify a role for αvβ5 in modulating injury-induced renal vascular leak, possibly through effects on pericyte adhesion and migration, and reveal αvβ5 inhibition as a promising therapeutic strategy for AKI

Quantifying injury to common bottlenose dolphins from the Deepwater Horizon oil spill using an age-, sex- and class-structured population model

Field studies documented increased mortality, adverse health effects, and reproductive failure in common bottlenose dolphins Tursiops truncatus following the Deepwater Horizon (DWH) oil spill. In order to determine the appropriate type and amount of restoration needed to compensate for losses, the overall extent of injuries to dolphins had to be quantified. Simply counting dead individuals does not consider long-term impacts to populations, such as the loss of future reproductive potential from mortality of females, or the chronic health effects that continue to compromise survival long after acute effects subside. Therefore, we constructed a sex- and agestructured model of population growth and included additional class structure to represent dolphins exposed and unexposed to DWH oil. The model was applied for multiple stocks to predict injured population trajectories using estimates of post-spill survival and reproductive rates. Injured trajectories were compared to baseline trajectories that were expected had the DWH incident not occurred. Two principal measures of injury were computed: (1) lost cetacean years (LCY); the difference between baseline and injured population size, summed over the modeled time period, and (2) time to recovery; the number of years for the stock to recover to within 95% of baseline. For the dolphin stock in Barataria Bay, Louisiana, the estimated LCY was substantial: 30 347 LCY (95% CI: 11 511 to 89 746). Estimated time to recovery was 39 yr (95% CI: 24 to 80). Similar recovery timelines were predicted for stocks in the Mississippi River Delta, Mississippi Sound, Mobile Bay and the Northern Coastal Stock.Publisher PDFPeer reviewe

Planetary Rover Simulation for Lunar Exploration Missions

When planning planetary rover missions it is useful to develop intuition and skills driving in, quite literally, alien environments before incurring the cost of reaching said locales. Simulators make it possible to operate in environments that have the physical characteristics of target locations without the expense and overhead of extensive physical tests. To that end, NASA Ames and Open Robotics collaborated on a Lunar rover driving simulator based on the open source Gazebo simulation platform and leveraging ROS (Robotic Operating System) components. The simulator was integrated with research and mission software for rover driving, system monitoring, and science instrument simulation to constitute an end-to-end Lunar mission simulation capability. Although we expect our simulator to be applicable to arbitrary Lunar regions, we designed to a reference mission of prospecting in polar regions. The harsh lighting and low illumination angles at the Lunar poles combine with the unique reflectance properties of Lunar regolith to present a challenging visual environment for both human and computer perception. Our simulator placed an emphasis on high fidelity visual simulation in order to produce synthetic imagery suitable for evaluating human rover drivers with navigation tasks, as well as providing test data for computer vision software development.In this paper, we describe the software used to construct the simulated Lunar environment and the components of the driving simulation. Our synthetic terrain generation software artificially increases the resolution of Lunar digital elevation maps by fractal synthesis and inserts craters and rocks based on Lunar size-frequency distribution models. We describe the necessary enhancements to import large scale, high resolution terrains into Gazebo, as well as our approach to modeling the visual environment of the Lunar surface. An overview of the mission software system is provided, along with how ROS was used to emulate flight software components that had not been developed yet. Finally, we discuss the effect of using the high-fidelity synthetic Lunar images for visual odometry. We also characterize the wheel slip model, and find some inconsistencies in the produced wheel slip behaviour

An expert-based system to predict population survival rate from health data

This work was supported by the Office of Naval Research Marine Mammal Biology Program [grant number N00014-17-1-2868].Timely detection and understanding of causes for population decline are essential for effective wildlife management and conservation. Assessing trends in population size has been the standard approach but we propose that monitoring population health could prove more effective. We collated data from seven bottlenose dolphin (Tursiops truncatus) populations in southeastern U.S. to develop the Veterinary Expert System for Outcome Prediction (VESOP), which estimates survival probability using a suite of health measures identified by experts as indices for inflammatory, metabolic, pulmonary, and neuroendocrine systems. VESOP was implemented using logistic regression within a Bayesian analysis framework, and parameters were fit using records from five of the sites that had a robust stranding network and frequent photographic identification (photo-ID) surveys to document definitive survival outcomes. We also conducted capture-mark-recapture (CMR) analyses of photo-ID data to obtain separate estimates of population survival rates for comparison with VESOP survival estimates. VESOP analyses found multiple measures of health, particularly markers of inflammation, were predictive of 1- and 2-year individual survival. The highest mortality risk one year following health assessment related to low alkaline phosphatase, with an odds ratio of 10.2 (95% CI 3.41-26.8), while 2-year mortality was most influenced by elevated globulin (9.60; 95% CI 3.88-22.4); both are markers of inflammation. The VESOP model predicted population-level survival rates that correlated with estimated survival rates from CMR analyses for the same populations (1-year Pearson's r = 0.99; p = 1.52e-05, 2-year r = 0.94; p = 0.001). While our proposed approach will not detect acute mortality threats that are largely independent of animal health, such as harmful algal blooms, it is applicable for detecting chronic health conditions that increase mortality risk. Random sampling of the population is important and advancement in remote sampling methods could facilitate more random selection of subjects, obtainment of larger sample sizes, and extension of the approach to other wildlife species.Publisher PDFPeer reviewe

Identification of novel subgroup a variants with enhanced receptor binding and replicative capacity in primary isolates of anaemogenic strains of feline leukaemia virus

<b>BACKGROUND:</b> The development of anaemia in feline leukaemia virus (FeLV)-infected cats is associated with the emergence of a novel viral subgroup, FeLV-C. FeLV-C arises from the subgroup that is transmitted, FeLV-A, through alterations in the amino acid sequence of the receptor binding domain (RBD) of the envelope glycoprotein that result in a shift in the receptor usage and the cell tropism of the virus. The factors that influence the transition from subgroup A to subgroup C remain unclear, one possibility is that a selective pressure in the host drives the acquisition of mutations in the RBD, creating A/C intermediates with enhanced abilities to interact with the FeLV-C receptor, FLVCR. In order to understand further the emergence of FeLV-C in the infected cat, we examined primary isolates of FeLV-C for evidence of FeLV-A variants that bore mutations consistent with a gradual evolution from FeLV-A to FeLV-C.<p></p> <b>RESULTS:</b> Within each isolate of FeLV-C, we identified variants that were ostensibly subgroup A by nucleic acid sequence comparisons, but which bore mutations in the RBD. One such mutation, N91D, was present in multiple isolates and when engineered into a molecular clone of the prototypic FeLV-A (Glasgow-1), enhanced replication was noted in feline cells. Expression of the N91D Env on murine leukaemia virus (MLV) pseudotypes enhanced viral entry mediated by the FeLV-A receptor THTR1 while soluble FeLV-A Env bearing the N91D mutation bound more efficiently to mouse or guinea pig cells bearing the FeLV-A and -C receptors. Long-term in vitro culture of variants bearing the N91D substitution in the presence of anti-FeLV gp70 antibodies did not result in the emergence of FeLV-C variants, suggesting that additional selective pressures in the infected cat may drive the subsequent evolution from subgroup A to subgroup C.<p></p> <b>CONCLUSIONS:</b> Our data support a model in which variants of FeLV-A, bearing subtle differences in the RBD of Env, may be predisposed towards enhanced replication in vivo and subsequent conversion to FeLV-C. The selection pressures in vivo that drive the emergence of FeLV-C in a proportion of infected cats remain to be established

Modeling population effects of the Deepwater Horizon oil spill on a long-lived species

This research was enabled partly by a grant from The Gulf of Mexico Research Initiative (GOMRI).The 2010 Deepwater Horizon (DWH) oil spill exposed common bottlenose dolphins (Tursiops truncatus) in Barataria Bay, Louisiana to heavy oiling that caused increased mortality and chronic disease and impaired reproduction in surviving dolphins. We conducted photographic surveys and veterinary assessments in the decade following the spill. We assigned a prognostic score (good, fair, guarded, poor, or grave) for each dolphin to provide a single integrated indicator of overall health, and we examined temporal trends in prognostic scores. We used expert elicitation to quantify the implications of trends for the proportion of the dolphins that would recover within their lifetime. We integrated expert elicitation, along with other new information, in a population dynamics model to predict the effects of observed health trends on demography. We compared the resulting population trajectory with that predicted under baseline (no spill) conditions. Disease conditions persisted and have recently worsened in dolphins that were presumably exposed to DWH oil: 78% of those assessed in 2018 had a guarded, poor, or grave prognosis. Dolphins born after the spill were in better health. We estimated that the population declined by 45% (95% CI 14–74) relative to baseline and will take 35 years (95% CI 18–67) to recover to 95% of baseline numbers. The sum of annual differences between baseline and injured population sizes (i.e., the lost cetacean years) was 30,993 (95% CI 6607–94,148). The population is currently at a minimum point in its recovery trajectory and is vulnerable to emerging threats, including planned ecosystem restoration efforts that are likely to be detrimental to the dolphins’ survival. Our modeling framework demonstrates an approach for integrating different sources and types of data, highlights the utility of expert elicitation for indeterminable input parameters, and emphasizes the importance of considering and monitoring long-term health of long-lived species subject to environmental disasters. Article impact statement: Oil spills can have long-term consequences for the health of long-lived species; thus, effective restoration and monitoring are needed.Publisher PDFPeer reviewe