Metastatic Renal Cell Carcinoma to the Sinonasal Cavity: A Case Series

Objectives: To describe the presentation, work-up, and management of patients with metastatic renal cell carcinoma (RCC) to the sinonasal cavity and skull base, and to describe our current treatment algorithm of endoscopic surgical resection followed by radiation therapy. Design: Retrospective review of two recent cases from our institution over a 1-year period, with a relevant review of the literature. Setting: A large regional tertiary care facility. Participants: Consecutive cases of RCC with metastases to the sinonasal cavity presenting to our institution. Main Outcome Measures: Preoperative and postoperative sinonasal outcome test (SNOT)-22 scores, duration of hospital stay, complications, and local disease control Results: Patients in this series underwent preoperative embolization followed by endoscopic resection without complication. Postoperatively they were treated with radiation therapy. They experienced improvement in their SNOT-22 scores and are currently free of local disease. Conclusion: Metastatic RCC to the sinonasal cavity can be safely treated with preoperative embolization followed by endoscopic surgical resection and radiation therapy, which can result in improvement in sinonasal quality of life and is a potential adjunct for local control of disease

Src homology 2 domain containing protein 5 (SH2D5) binds the breakpoint cluster region protein, BCR, and regulates levels of Rac1-GTP

SH2D5 is a mammalian-specific, uncharacterized adaptor-like protein that contains an N-terminal phosphotyrosine binding (PTB) domain and a C-terminal Src Homology 2 (SH2) domain. We show that SH2D5 is highly enriched in adult mouse brain, particularly in purkinjie cells in the cerebellum and the cornu ammonis of the hippocampus. Despite harboring two potential phosphotyrosine (pTyr) recognition domains, SH2D5 binds minimally to pTyr ligands, consistent with the absence of a conserved pTyr-binding arginine residue in the SH2 domain. Immunoprecipitation coupled to mass spectrometry (IP-MS) from cultured cells revealed a prominent association of SH2D5 with Breakpoint Cluster Region protein (BCR), a RacGAP that is also highly expressed in brain. This interaction occurred between the PTB domain of SH2D5 and an NxxF motif located within the N-terminal region of BCR. siRNA-mediated depletion of SH2D5 in a neuroblastoma cell line, B35, induced a cell rounding phenotype correlated with low levels of activated Rac1-GTP, suggesting that SH2D5 affects Rac1-GTP levels. Taken together, our data provide the first characterization of the SH2D5 signaling protein

Longitudinal flow evolution and turbulence structure of dynamically similar, sustained, saline density and turbidity currents

Experimental results are presented concerning flow evolution and turbulence structure of sustained saline and turbidity flows generated on 0°, 3°, 6°, and 9° sloping ramps that terminate abruptly onto a horizontal floor. Two-component velocity and current density were measured with an ultrasonic Doppler velocity profiler and siphon sampler on the slope, just beyond the slope break and downstream on the horizontal floor. Three main factors influence longitudinal flow evolution and turbulence structure: sediment transport and sedimentation, slope angle, and the presence of a slope break. These controls interact differently depending on flow type. Sediment transport is accompanied by an inertial fluid reaction that enhances Reynolds stresses in turbidity flows. Thus turbidity flows mix more vigorously than equivalent saline density flows. For saline flows, turbulent kinetic energy is dependent on slope, and rapid deceleration occurs on the horizontal floor. For turbidity flows, normalized turbulent kinetic energy increases downstream, and mean streamwise deceleration is reduced compared with saline flows. The slope break causes mean bed-normal velocity of turbidity flows to become negative and have a gentler gradient compared with other locations. A reduction of peak Reynolds normal stress in the bed-normal direction is accompanied by an increase in turbulent accelerations across the rest of the flow thickness. Thus the presence of particles acts to increase Reynolds normal stresses independently of gradients of mean velocity, and sediment transport increases across the break in slope. The experiments illustrate that saline density currents may not be good dynamic analogues for natural turbidity currents

A Rare Finding of Schwannoma of the Vidian Canal: A Case Report

Background: Schwannomas of the vidian canal are an extremely rare type of intracranial tumor that can have variable clinical presentations including headache, facial pain, facial muscle paralysis, decreased lacrimation, or nasal dryness. We present an atypical case of an incidentally identified asymptomatic vidian canal schwannoma. Case Description A 49-year-old woman with a history of multiple sclerosis presented for routine surveillance magnetic resonance imaging that detected an ovoid mass originating in the vidian canal. Given the unusual location of the lesion, an endoscopic endonasal biopsy was performed and confirmed the diagnosis of a vidian canal schwannoma, for which the patient chose to receive fractionated radiation therapy. Conclusion: When a vidian canal tumor is identified, endoscopic endonasal biopsy can be used to confirm the diagnosis before pursuing either surgical or radiotherapy treatment. In particular, fractionated radiation therapy offers a radiobiologically safe means of delivering radiation when there is concern for late radiation-related side effects following treatment completion

Skull base erosion and associated complications in sphenoid sinus fungal balls

Background: Sphenoid sinus fungal balls (SSFB) are rare entities that can result in serious orbital and intracranial complications. There are few published reports of complications that result from SSFB. Objective: To review the incidence of skull base erosion and orbital or intracranial complications in patients who present with SSFB. Methods: A retrospective review was performed of all the patients with SSFB who were treated at the Massachusetts Eye and Ear Infirmary from 2006 to 2014. Presenting clinical data, radiology, operative reports, pathology, and postoperative course were reviewed. Results: Forty-three patients with SSFB were identified. Demographic data were compared between patients with (39.5%) and those without (61.5%) skull base erosion. Two patients underwent emergent surgery for acute complications of SSFB (one patient with blindness, one patient who had a seizure). Both patients with acute complications had evidence of skull base erosion, whereas no patients with an intact skull base developed an orbital or intracranial complication (p = 0.15). All the patients were surgically managed via an endoscopic approach. Conclusion: SSFBs are rare but may cause significant skull base erosion and potentially severe orbital and intracranial complications if not treated appropriately. Endoscopic sphenoidotomy is effective in treating SSFB and should be performed emergently in patients who presented with associated complications

The Vehicle, Fall 1992

Table of Contents DeconstructivismPeter F. Essigpage 5 Homecoming Pep RallyPeter F. Essigpage 6 McAfee GymnasiumWalt Howardpage 7 Morton ParkAnn Moutraypage 9 Why The Willows WeepPeter F. Essigpage 10 UntitledStephen P. Carmodypage 10 A Stranger\u27s MorningBen Hausmannpage 11 deMONSTERative pronounsJoAnna Wolaverpage 12 2.5%Jill S. Pilonpage 13 The BottleStacey Kruegerpage 14 Suppression Jean K. Graypage 15 ProgressStacey Kruegerpage 16 Daily LessonsJennifer Moropage 17 Sunset TheaterMichelle R. Hokepage 20 Eagle GT\u27sJarrod T. Shieldspage 21 New HouseRandy Lisspage 22 UntitledStephen P. Carmodypage 23 Renting Classics on a Saturday NightNancy Jamespage 24 UntitledJacqueline Hallpage 25 Alone While He SleepsSandy Beauchamppage 26 Sand and SeaThomas Schnarrepage 27 loveMichelle R. Hokepage 28 Backward Ass Junkie FunkSandy Beauchamppage 28 These Things You KeepTom McGrathpage 29 Springhill CrestRobert M. Reutherpage 30 The Pass OverLarry Irvinpage 31 The Stolen ChildTom McGrathpage 32 Before the Recycling KickWalt Howardpage 37 Authors\u27 Pagepage 38https://thekeep.eiu.edu/vehicle/1058/thumbnail.jp

Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; findings from the New Zealand multicentre stillbirth case-control study

Objective: Our objective was to test the primary hypothesis that maternal non-left, in particular supine going-to-sleep position, would be a risk factor for late stillbirth (≥28 weeks of gestation). Methods: A multicentre case-control study was conducted in seven New Zealand health regions, between February 2012 and December 2015. Cases (n=164) were women with singleton pregnancies and late stillbirth, without congenital abnormality. Controls (n=569) were women with on-going singleton pregnancies, randomly selected and frequency matched for health region and gestation. The primary outcome was adjusted odds of late stillbirth associated with self-reported going-to-sleep position, on the last night. The last night was the night before the late stillbirth was thought to have occurred or the night before interview for controls. Going to- sleep position on the last night was categorised as: supine, left-side, right-side, propped or restless. Multivariable logistic regression adjusted for known confounders. Results: Supine going-to-sleep position on the last night was associated with increased late stillbirth risk (adjusted odds ratios (aOR) 3.67, 95% confidence interval (CI) 1.74 to 7.78) with a population attributable risk of 9.4%. Other independent risk factors for late stillbirth (aOR, 95% CI) were: BMI (1.04, 1.01 to 1.08) per unit, maternal age ≥40 (2.88, 1.31 to 6.32), birthweight <10th customised centile (2.76, 1.59 to 4.80), and <6 hours sleep on the last night (1.81, 1.14 to 2.88). The risk associated with supine-going-to sleep position was greater for term (aOR 10.26, 3.00 to 35.04) than preterm stillbirths (aOR 3.12, 0.97 to 10.05). Conclusions: Supine going-to-sleep position is associated with a 3.7 fold increase in overall late stillbirth risk, independent of other common risk factors. A public health campaign encouraging women not to go-to-sleep supine in the third trimester has potential to reduce late stillbirth by approximately 9%

Polygenic susceptibility to prostate and breast cancer: implications for personalised screening

BACKGROUND: We modelled the efficiency of a personalised approach to screening for prostate and breast cancer based on age and polygenic risk-profile compared with the standard approach based on age alone.METHODS: We compared the number of cases potentially detectable by screening in a population undergoing personalised screening with a population undergoing screening based on age alone. Polygenic disease risk was assumed to have a log-normal relative risk distribution predicted for the currently known prostate or breast cancer susceptibility variants (N = 31 and N = 18, respectively).RESULTS: Compared with screening men based on age alone (aged 55-79: 10-year absolute risk >= 2%), personalised screening of men age 45-79 at the same risk threshold would result in 16% fewer men being eligible for screening at a cost of 3% fewer screen-detectable cases, but with added benefit of detecting additional cases in younger men at high risk. Similarly, compared with screening women based on age alone (aged 47-79: 10-year absolute risk >= 2.5%), personalised screening of women age 35-79 at the same risk threshold would result in 24% fewer women being eligible for screening at a cost of 14% fewer screen-detectable cases.CONCLUSION: Personalised screening approach could improve the efficiency of screening programmes. This has potential implications on informing public health policy on cancer screening. British Journal of Cancer (2011) 104, 1656 -1663. doi: 10.1038/bjc.2011.118 www.bjcancer.com Published online 5 April 2011 (C) 2011 Cancer Research U

Whole-exome sequencing and clinical interpretation of FFPE tumor samples to guide precision cancer medicine

Translating whole exome sequencing (WES) for prospective clinical use may impact the care of cancer patients; however, multiple innovations are necessary for clinical implementation. These include: (1) rapid and robust WES from formalin-fixed paraffin embedded (FFPE) tumor tissue, (2) analytical output similar to data from frozen samples, and (3) clinical interpretation of WES data for prospective use. Here, we describe a prospective clinical WES platform for archival FFPE tumor samples. The platform employs computational methods for effective clinical analysis and interpretation of WES data. When applied retrospectively to 511 exomes, the interpretative framework revealed a “long tail” of somatic alterations in clinically important genes. Prospective application of this approach identified clinically relevant alterations in 15/16 patients. In one patient, previously undetected findings guided clinical trial enrollment leading to an objective clinical response. Overall, this methodology may inform the widespread implementation of precision cancer medicine

Masculinities, affect and the (re)place(ment) of stardom in Formula One fan leisure practices

Writing from an autoethnographic perspective, this article explores male leisure practices via the mediated relationships fans enter into with stars. More specifically, my own fandom for Formula One driver Jacques Villeneuve is the locus of study, revealing how this affective investment shapes and furnishes my corresponding leisure practices. Notions of gendered 'performativity' come to the fore, with my own displays evoking, enacting and revealing oscillating performances of masculinity. Moreover, there are interesting gendered dynamics that such fan leisure practices flag in terms of the intersection of female/male relationships and the potential 'fantasy' and/or narcissistic readings that a male fan identifying with and performing as another male sport star afford. Finally, my research reveals paradoxes for contemporary masculinities, with fans reliant upon mediation and commodification to facilitate and sustain their performative roles. © 2011 Taylor & Francis