Рак почки при центральной локализации диагностическая дилемма

Centrally Located renal tumor poses a diagnostic challenge to differentiate between renal cell carcinoma and transitional cell carcinoma. Imaging alone is not sufficient to make the diagnosis, some invasive diagnostic investigations are required to ascertain the diagnosis. We present a 60 years old gentleman, who presented dyspepsia and further investigation by contrasted CT kidney revealed a centrally located right renal tumor. Before making a management decision, we performed the right renal biopsy of the tumor which turns out to be a renal cell carcinoma. Henceforth, we performed a robotic-assisted laparoscopic right nephrectomy. A renal biopsy, in this case, assisted to decide only radical nephrectomy instead of radical nephroureterectomy which has higher associated morbidity. Thus, it is important to make confirm by tissue biopsy before deciding on surgery in case of the central renal tumor as this prevents subjecting a patient to under-or overtreatment.Опухоль почки с центральной локализацией представляет собой проблему для дифференциальной диагностики почечно-клеточной карциномы и переходно-клеточного (уротелиального) рака. Применения только методов визуализации недостаточно для постановки диагноза, требуются определенные инвазивные диагностические исследования. В статье описан пациент, 60 лет, с диспепсией. При обследовании по данным компьютерной томографии почек с контрастированием была выявлена опухоль правой почки с центральной локализацией. Перед принятием решения о лечении была выполнена биопсия опухоли почки, по результатам которой диагностирована почечноклеточная карцинома. Пациенту выполнили операцию - робот-ассистированную лапароскопическую нефрэктомию справа. В данном клиническом случае биопсия почки помогла принять решение в пользу радикальной нефрэктомии вместо радикальной нефруретерэктомии, последняя ассоциирована с большей частотой послеоперационных осложнений. Таким образом, в случае опухоли почки с центральной локализацией важно выполнять биопсию ткани перед принятием решения о хирургическом вмешательстве, так как это предотвращает неполное (undertreament) или излишнее (overtreatment) лечение пациента

Aneuploidy in oocytes is prevented by sustained CDK1 activity through degron masking in cyclin B1

Successful mitosis requires that cyclin B1:CDK1 kinase activity remains high until chromosomes are correctly aligned on the mitotic spindle. It has therefore been unclear why, in mammalian oocyte meiosis, cyclin B1 destruction begins before chromosome alignment is complete. Here, we resolve this paradox and show that mouse oocytes exploit an imbalance in the ratio of cyclin B1 to CDK1 to control CDK1 activity; early cyclin B1 destruction reflects the loss of an excess of non-CDK1-bound cyclin B1 in late prometaphase, while CDK1-bound cyclin B1 is destroyed only during metaphase. The ordered destruction of the two forms of cyclin B1 is brought about by a previously unidentified motif that is accessible in free cyclin B1 but masked when cyclin B1 is in complex with CDK1. This protects the CDK1-bound fraction from destruction in prometaphase, ensuring a period of prolonged CDK1 activity sufficient to achieve optimal chromosome alignment and prevent aneuploidy

A Simple Separable Exact C*-Algebra not Anti-isomorphic to Itself

We give an example of an exact, stably finite, simple. separable C*-algebra D which is not isomorphic to its opposite algebra. Moreover, D has the following additional properties. It is stably finite, approximately divisible, has real rank zero and stable rank one, has a unique tracial state, and the order on projections over D is determined by traces. It also absorbs the Jiang-Su algebra Z, and in fact absorbs the 3^{\infty} UHF algebra. We can also explicitly compute the K-theory of D, namely K_0 (D) = Z[1/3] with the standard order, and K_1 (D) = 0, as well as the Cuntz semigroup of D.Comment: 16 pages; AMSLaTeX. The material on other possible K-groups for such an algebra has been moved to a separate paper (1309.4142 [math.OA]

Gravitational lensing as a contaminant of the gravity wave signal in CMB

Gravity waves (GW) in the early universe generate B-type polarization in the cosmic microwave background (CMB), which can be used as a direct way to measure the energy scale of inflation. Gravitational lensing contaminates the GW signal by converting the dominant E polarization into B polarization. By reconstructing the lensing potential from CMB itself one can decontaminate the B mode induced by lensing. We present results of numerical simulations of B mode delensing using quadratic and iterative maximum-likelihood lensing reconstruction methods as a function of detector noise and beam. In our simulations we find the quadratic method can reduce the lensing B noise power by up to a factor of 7, close to the no noise limit. In contrast, the iterative method shows significant improvements even at the lowest noise levels we tested. We demonstrate explicitly that with this method at least a factor of 40 noise power reduction in lensing induced B power is possible, suggesting that T/S=10^-6 may be achievable in the absence of sky cuts, foregrounds, and instrumental systematics. While we do not find any fundamental lower limit due to lensing, we find that for high-sensitivity detectors residual lensing noise dominates over the detector noise.Comment: 6 pages, 2 figures, submitted to PR

Cadherin-11 Provides Specific Cellular Adhesion between Fibroblast-like Synoviocytes

Cadherins are integral membrane proteins expressed in tissue-restricted patterns that mediate homophilic intercellular adhesion. During development, they orchestrate tissue morphogenesis and, in the adult, they determine tissue integrity and architecture. The synovial lining is a condensation of fibroblast-like synoviocytes (FLS) and macrophages one to three cells thick. These cells are embedded within the extracellular matrix, but the structure is neither an epithelium nor an endothelium. Previously, the basis for organization of the synovium into a tissue was unknown. Here, we cloned cadherin-11 from human rheumatoid arthritis (RA)-derived FLS. We developed L cell transfectants expressing cadherin-11, cadherin-11 fusion proteins, and anti–cadherin-11 mAb. Cadherin-11 was found to be expressed mainly in the synovial lining by immunohistologic staining of human synovium. FLS adhered to cadherin-11–Fc, and transfection of cadherin-11 conferred the formation of tissue-like sheets and lining-like structures upon fibroblasts in vitro. These findings support a key role for cadherin-11 in the specific adhesion of FLS and in synovial tissue organization and behavior in health and RA

International Consortium for Health Outcomes Measurement (ICHOM): Standardized Patient-Centered Outcomes Measurement Set for Heart Failure Patients

Whereas multiple national, international, and trial registries for heart failure have been created, international standards for clinical assessment and outcome measurement do not currently exist. The working group's objective was to facilitate international comparison in heart failure care, using standardized parameters and meaningful patient-centered outcomes for research and quality of care assessments. The International Consortium for Health Outcomes Measurement recruited an international working group of clinical heart failure experts, researchers, and patient representatives to define a standard set of outcomes and risk-adjustment variables. This was designed to document, compare, and ultimately improve patient care outcomes in the heart failure population, with a focus on global feasibility and relevance. The working group employed a Delphi process, patient focus groups, online patient surveys, and multiple systematic publications searches. The process occurred over 10 months, employing 7 international teleconferences. A 17-item set has been established, addressing selected functional, psychosocial, burden of care, and survival outcome domains. These measures were designed to include all patients with heart failure, whether entered at first presentation or subsequent decompensation, excluding cardiogenic shock. Sources include clinician report, administrative data, and validated patient-reported outcome measurement tools: the Kansas City Cardiomyopathy Questionnaire; the Patient Health Questionnaire-2; and the Patient-Reported Outcomes Measurement Information System. Recommended data included those to support risk adjustment and benchmarking across providers and regions. The International Consortium for Health Outcomes Measurement developed a dataset designed to capture, compare, and improve care for heart failure, with feasibility and relevance for patients and clinicians worldwide

Orthostatic hypotension and novel blood pressure-associated gene variants: Genetics of Postural Hemodynamics (GPH) Consortium

Aims Orthostatic hypotension (OH), an independent predictor of mortality and cardiovascular events, strongly correlates with hypertension. Recent genome-wide studies have identified new loci influencing blood pressure (BP) in populations, but their impact on OH remains unknown. Methods and resultsA total of 38 970 men and women of European ancestry from five population-based cohorts were included, of whom 2656 (6.8) met the diagnostic criteria for OH (systolic/diastolic BP drop <20/10 mmHg within 3 min of standing). Thirty-one recently discovered BP-associated single nucleotide polymorphisms (SNPs) were examined using an additive genetic model and the major allele as referent. Relations between OH, orthostatic systolic BP response, and genetic variants were assessed by inverse variance-weighted meta-analysis. We found Bonferroni adjusted (P < 0.0016) significant evidence for association between OH and the EBF1 locus (rs11953630, per-minor-allele odds ratio, 95 confidence interval: 0.90, 0.850.96; P=0.001), and nominal evidence (P < 0.05) for CYP17A1 (rs11191548: 0.85, 0.750.95; P=0.005), and NPR3-C5orf23 (rs1173771: 0.92, 0.870.98; P=0.009) loci. Among subjects not taking BP-lowering drugs, three SNPs within the NPPA/NPPB locus were nominally associated with increased risk of OH (rs17367504: 1.13, 1.021.24; P=0.02, rs198358: 1.10, 1.011.20; P=0.04, and rs5068: 1.22, 1.041.43; P=0.01). Moreover, an ADM variant was nominally associated with continuous orthostatic systolic BP response in the adjusted model (P=0.04). ConclusionThe overall association between common gene variants in BP loci and OH was generally weak and the direction of effect inconsistent with resting BP findings. These results suggest that OH and resting BP share few genetic components

Towards an Airframe Noise Prediction Methodology: Survey of Current Approaches

In this paper, we present a critical survey of the current airframe noise (AFN) prediction methodologies. Four methodologies are recognized. These are the fully analytic method, CFD combined with the acoustic analogy, the semi-empirical method and fully numerical method. It is argued that for the immediate need of the aircraft industry, the semi-empirical method based on recent high quality acoustic database is the best available method. The method based on CFD and the Ffowcs William- Hawkings (FW-H) equation with penetrable data surface (FW-Hpds ) has advanced considerably and much experience has been gained in its use. However, more research is needed in the near future particularly in the area of turbulence simulation. The fully numerical method will take longer to reach maturity. Based on the current trends, it is predicted that this method will eventually develop into the method of choice. Both the turbulence simulation and propagation methods need to develop more for this method to become useful. Nonetheless, the authors propose that the method based on a combination of numerical and analytical techniques, e.g., CFD combined with FW-H equation, should also be worked on. In this effort, the current symbolic algebra software will allow more analytical approaches to be incorporated into AFN prediction methods