Oral amelanotic melanoma: a case report

Objectives. Primary oral melanoma is a very rare malignancy, representing about 0.5% of all melanomas, characterized by a wide clinical-histological variability and a very aggressive behavior. Aim of the present study is to describe a case of oral amelanotic melanoma, an infrequent variant with a poorer prognosis than that of pigmented melanomas for a more aggressive biological behavior and frequent delays for the correct diagnosis and for starting the treatment. Case report. A 53-year-old white man referred at the Department Surgical, Oncological and Oral Sciences for a macular, scarsely pigmented lesion with irregular margins, located on anterior region of hard palate. The lesion, completely asymptomatic and without any history of trauma or injury, was observed by his dentist some months ago. The patient was a smoker (about 20 cigarettes a day for 30 years) and his anamnesis was negative for any systemic diseases and drug assumption. Histological examination, following the incisional biopsy, showed the hyperplasia of the junctional melanocytes with occasionally dendritic appearance and light atypia; on the recommendation of pathologist, a second incisional biopsy was performed, and a definitive diagnosis of “amelanotic melanoma in situ” was confirmed. After diagnosis, the patient was referred to the unit of Head and Neck Surgery for staging and surgical approach of the lesion. Conclusions. This case report underlines the importance to perform biopsy of all lesions of the oral cavity to rule out malignancy, even when slightly colored, asymptomatic and with a clinically harmless presentation. Besides benign diseases (e.g melanotic macules, nevi, extravasation of blood pigments, amalgam tattoos and deposition of other exogenous/endogenous pigments), rare variant of non-pigmented melanoma should be considered in order to avoid a dangerous diagnostic and therapeutic delay

Longitudinal tear protein changes correlate with ocular chronic gvhd development in allogeneic hematopoietic stem cell transplant patients

Ocular graft-versus-host disease (oGVHD) is a manifestation of chronic GVHD, frequently occurring in patients after allogeneic hematopoietic stem cell transplant (HSCT). We analyzed tear protein changes before and after allogeneic HSCT, and correlated their levels with the oGVHD development. This retrospective study included 102 patients, and data were recorded before the conditioning treatment, and after 3 to 6 months postoperatively. Tear protein analysis was performed with the Agilent-2100 Bioanalyzer on individual tears sampled by aspiration. Total protein (TP), Lysozyme-C (LYS-C), Lactoferrin (LACTO), Lipocalin-1 (LIPOC-1), Transferrin (TRANSF), Albumin (ALB), and Zinc-alpha-2-glycoprotein (ZAG-2) levels were retrieved and statistically analyzed. Following HSCT forty-three patients developed oGVHD. TP, LACTO, LYS-C, and ZAG-2 levels significantly decreased post-HSCT as compared to pre HSCT levels. In univariate analysis, TP, LACTO, and ZAG-2 decrease was associated with an increased development of oGVHD (OR = 4.49; 95% CI, 1.9 to 10.5; p < 0.001; OR = 3.08; 95% CI 1.3 to 7.6; p = 0.01; OR = 11.1; 95% CI 2.7 to 46.6; p < 0.001, respectively). TRANSF post-HSCT levels significantly increased (OR 15.7; 95% CI, 4.1 to 52.2; p = 0.0001). No pre-post-HSCT changes were shown in ALB and LIPOC-1 levels. Data suggest that TP content, LACTO, TRANSF, and ZAG-2 pre-post changes might be significant predictors of oGVHD development

Upgrade of the HadGEM3-A based attribution system to high resolution and a new validation framework for probabilistic event attribution

We present a substantial upgrade of the Met Office system for the probabilistic attribution of extreme weather and climate events with higher horizontal and vertical resolution (60 km mid-latitudes and 85 vertical levels), the latest Hadley Centre atmospheric and land model (ENDGame dynamics with GA6.0 science and JULES at GL6.0) as well as an updated forcings set. A new set of experiments designed for the evaluation and implementation of an operational attribution service are described which consist of pairs of multi-decadal stochastic physics ensembles continued on a season by season basis by large ensembles that are able to sample extreme at- mospheric states possible in the recent past. Diagnostics from these experiments form the HadGEM3-A contribution to the international Climate of the 20th Century Plus (C20Cþ) project and were analysed under the European Climate and Weather Events: Interpretation and Attribution (EUCLEIA) event attribution project as well as contributing to the Climate Science for Service Partnership (CSSP)-China programme. After discussing the framing issues surrounding questions that can be asked with our system we construct a novel approach to the evaluation of atmosphere-only ensembles intended for event attribution, in the process highlighting and clarifying the distinction between hindcast skill and model performance. A framework based around assessing model representation of predictable components and ensuring exchangeability of model and real world statistics leads to a form of detection and attribution to boundary condition forcing as a means of quantifying one degree of freedom of potential model error and allowing for the bias correction of event probabilities and resulting probability ratios. This method is then applied systematically across the globe to assess contributions from anthropogenic influence and specific boundary conditions to the changing probability of observed and record seasonal mean temperatures of four recent 3-month seasons from March 2016–February 2017

Unusual past dry and wet rainy seasons over Southern Africa and South America from a climate perspective

Southern Africa and Southern South America have experienced recent extremes in dry and wet rainy seasons which have caused severe socio-economic damages. Selected past extreme events are here studied, to estimate how human activity has changed the risk of the occurrence of such events, by applying an event attribution approach (Stott et al., 2004)comprising global climate models of Coupled Model Intercomparison Project 5 (CMIP5). Our assessment shows that models' representation of mean precipitation variability over Southern South America is not adequate to make a robust attribution statement about seasonal rainfall extremes in this region. Over Southern Africa, we show that unusually dry austral summers as occurred during 2002/2003 have become more likely, whereas unusually wet austral summers like that of 1999/2000 have become less likely due to anthropogenic climate change. There is some tentative evidence that the risk of extreme high 5-day precipitation totals (as observed in 1999/2000) have increased in the region. These results are consistent with CMIP5 models projecting a general drying trend over SAF during December–January–February (DJF) but also an increase in atmospheric moisture availability to feed heavy rainfall events when they do occur. Bootstrapping the confidence intervals of the fraction of attributable risk has demonstrated estimates of attributable risk are very uncertain, if the events are very rare. The study highlights some of the challenges in making an event attribution study for precipitation using seasonal precipitation and extreme 5-day precipitation totals and considering natural drivers such as ENSO in coupled ocean–atmosphere models

Giant magnons and non-maximal giant gravitons

We produce the open strings on $\mathbb{R}\times S^{2}$ that correspond to the solutions of integrable boundary sine-Gordon theory by making use of the $N$-magnon solutions provided in \cite{KPV} together with explicit moduli. Relating the two boundary parameters in a special way we describe the scattering of giant magnons with non-maximal $Y=0$ giant gravitons and calculate the leading contribution to the associated magnon scattering phase.Comment: 34 pages, 8 figure

Survival analysis in single N2 station lung adenocarcinoma: The prognostic role of involved lymph nodes and adjuvant therapy

Background: Prognostic factors in patients with single mediastinal station (sN2) involvement continues to be a debated issue. Methods: Data on 213 adenocarcinoma patients with sN2 involvement and who had undergone complete anatomical lung resection and lymphadenectomy, were retrospectively reviewed. Clinical and pathological characteristics together with adjuvant therapy (AD) and node (N) status classifications (number of resected nodes (#RN), number of metastatic nodes (#MN), and node ratio (#MN/#RN = NR) were analyzed. Results: Univariable analysis confirmed that age (0.009), #MN (0.009), NR (0.003), #N1 involved stations (p = 0.003), and skip metastases (p = 0.005) were related to overall survival (OS). Multivariable analysis confirmed, as independent prognostic factors, age <66 years and NR with a three-year OS (3YOS) of 78.7% in NR < 10% vs. 46.6% in NR > 10%. In skip metastases, NR (HR 2.734, 95% CI 1.417–5.277, p = 0.003) and pT stage (HR2.136, 95% CI 1.001–4.557, p = 0.050) were confirmed as independent prognostic factors. AD did not influence the OS of patients with singular positive lymph nodes (p = 0.41), while in patients with multiple lymph nodes and AD, a significantly better 3YOS was demonstrated, i.e., 49.1% vs. 30% (p = 0.004). In patients with N2 + N1 involvement, age (p = 0.002) and AD (p = 0.022) were favorable prognostic factors. Conclusions: Adenocarcinoma patients with single N2 station involvement had a favorable outcome in the case of skip metastases and low NR. Adjuvant therapy improves survival with multiple nodal involvement, while its role in single node involvement should be clarified

Detectable Anthropogenic Shift toward Heavy Precipitation over Eastern China

Changes in precipitation characteristics directly affect society through their impacts on drought and floods, hydro-dams, and urban drainage systems. Global warming increases the water holding capacity of the atmosphere and thus the risk of heavy precipitation. Here, daily precipitation records from over 700 Chinese stations from 1956 to 2005 are analyzed. The results show a significant shift from light to heavy precipitation over eastern China. An optimal fingerprinting analysis of simulations from 11 climate models driven by different combinations of historical anthropogenic (greenhouse gases, aerosols, land use, and ozone) and natural (volcanic and solar) forcings indicates that anthropogenic forcing on climate, including increases in greenhouse gases (GHGs), has had a detectable contribution to the observed shift toward heavy precipitation. Some evidence is found that anthropogenic aerosols (AAs) partially offset the effect of the GHG forcing, resulting in a weaker shift toward heavy precipitation in simulations that include the AA forcing than in simulations with only the GHG forcing. In addition to the thermodynamic mechanism, strengthened water vapor transport from the adjacent oceans and by midlatitude westerlies, resulting mainly from GHG-induced warming, also favors heavy precipitation over eastern China. Further GHG-induced warming is predicted to lead to an increasing shift toward heavy precipitation, leading to increased urban flooding and posing a significant challenge for mega-cities in China in the coming decades. Future reductions in AA emissions resulting from air pollution controls could exacerbate this tendency toward heavier precipitation

Alteration of the perception of cold, heat and texture of food in association with taste dysfunction in COVID-19

COVID19 is characterized by alteration of smell and taste perception. It was investigated the presence of alteration for cold, heat, and food consistency perception in COVID-19 patients and the possible correlation with the most commonly used biomarkers in a routine way (CRP, IL-6, IL-1, PSP, PCT) to show if the local inflammatory process may induce alteration of cold, heat, and food consistency perception in COVID-19. From March 2020 to April 2021, a survey about taste and oral tactile/thermal sensitivity dysfunction was carried out on 1155 patients with mild or moderate COVID-19, while patients admitted to intensive care were excluded because they could not answer questions from health professionals. Positive RT-PCR confirmed all diagnoses. CRP, IL-6, IL-1, PSP, and PCT were detected for each patient. Taste and Smell Questionnaire Section of the US NHANES 2011−2014 protocol (CDC 2013b) was used for gustatory function assessment. The study was approved by the Ethics committee of AOU Policlinico Consorziale di Bari (No. 6388 COVID19 DOM-protocol number 0034687/12-05-2020), and written informed consent was obtained. A total of 208 patients referred only to alteration to taste (208/821). 75/208 ageusia, 71/208 ipoageusia, 21/208 fantageusia, 19/208 dysgeusia, 22/208 parageusia. Significant correlations between CRP, IL-6, IL-1, PSP, PCT levels and type of dysfunctions about the perception of heat, cold and food consistency have not been found (P>0.05). Loss of taste can be due to the action of inflammatory mediators on gustatory buds, while alteration of cold, heat and food consistency perception may be due to direct damage of filiform papillae, allowing virus binding through the spike protein to ACE2 receptors of filiform papillae cells

Surgical site infection after caesarean section. Space for post-discharge surveillance improvements and reliable comparisons

Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive