An atypical presentation of Liposarcoma: Primary involvement of the liver with secondary metastatic seeding

A 61-year old male with PMH significant for gastric bypass, anxiety/depression, and previous alcohol abuse, presented to the ED with 10-day history of SOB and abdominal distention. He endorsed difficulty taking deep breaths, urinating, and bowel movements. He denied any unexplained weight loss, night sweats, or history of ascites. Physical exam revealed abdominal distension and tenderness. Hepatitis screen, AFP, CEA, and CA19-9 were negative. AST, ALT, total bilirubin, and alkaline phosphatase were all WNL. CT imaging demonstrated pleural effusion with atelectasis, large amounts of ascites with mesenteric stranding, and a 7cm mass of unknown etiology adjacent/medial to the liver. CT-guided biopsy of the perihepatic mass was consistent with well-differentiated liposarcoma. IR-guided biopsy of the omental mass demonstrated de-differentiated liposarcoma, FNCLCC grade 2. Colonoscopy to assess second primary tumor found three polyps demonstrating tubular adenoma. The patient was diagnosed metastatic primary liposarcoma of the liver. Soft tissue sarcomas comprise ~1% of all malignancies in adults. The majority of these arise from primary soft tissue, with bone as the next closest site of involvement. Liposarcomas are a subclass of soft-tissue sarcomas, arising from precursor adipocytes. Their primary focus is in the retroperitoneum and extremities. A liposarcoma with primary involvement of the liver is very rare. If the liver is involved it is usually from distant metastasis rather than a primary focus, though that is also rare. With only about a dozen cases of primary liver liposarcoma reported in the literature, the knowledge of the clinical course, management, and prognosis are limited.https://scholarlycommons.henryford.com/merf2020caserpt/1055/thumbnail.jp

Unusual Etiology of Chronic Cough and Syncope as Chiari Malformation Type 1

Chronic cough is a common chief complaint in ambulatory clinics. Unlike most cases that are caused by upper airway cough syndrome, gastroesophageal reflux disease, asthma, and non-asthmatic eosinophilic bronchitis, chronic cough can also be the presenting feature of a Chiari malformation. Our case is that of a 39-year-old female who had a chronic cough associated with shortness of breath, and when severe, associated with loss of consciousness. Her cough was refractory to conventional management. Further workup including pulmonary functions tests (PFT), laryngoscopy, high-resolution CT of the chest, an upper GI series, and esophageal pH manometry study were all normal. An MRI of her brain was obtained due to her syncopal episodes and revealed findings concerning a type 1 Chiari malformation. She subsequently underwent a Chiari decompression with patchy duraplasty and tonsilloplasty with cervical vertebrae 1 and 2 (C1-C2) laminectomy with a resolution of her symptoms. Chiari malformations are sometimes inherited but are often sporadic in nature, and, thus, appropriate diagnosis is key. Our patient is unique in that she presented at an older age, suggesting that atypical etiologies of a chronic cough refractory to conventional treatments must be considered

Expansive and Diverse Phenotypic Landscape of Field Aedes aegypti (Diptera: Culicidae) Larvae with Differential Susceptibility to Temephos: Beyond Metabolic Detoxification

Arboviruses including dengue, Zika, and chikungunya are amongst the most significant public health concerns worldwide. Arbovirus control relies on the use of insecticides to control the vector mosquito Aedes aegypti (Linnaeus), the success of which is threatened by widespread insecticide resistance. The work presented here profiled the gene expression of Ae. aegypti larvae from field populations of Ae. aegypti with differential susceptibility to temephos originating from two Colombian urban locations, Bello and Cúcuta, previously reported to have distinctive disease incidence, socioeconomics, and climate. We demonstrated that an exclusive field-to-lab (Ae. aegypti strain New Orleans) comparison generates an over estimation of differential gene expression (DGE) and that the inclusion of a geographically relevant field control yields a more discrete, and likely, more specific set of genes. The composition of the obtained DGE profiles is varied, with commonly reported resistance associated genes including detoxifying enzymes having only a small representation. We identify cuticle biosynthesis, ion exchange homeostasis, an extensive number of long noncoding RNAs, and chromatin modelling among the differentially expressed genes in field resistant Ae. aegypti larvae. It was also shown that temephos resistant larvae undertake further gene expression responses when temporarily exposed to temephos. The results from the sampling triangulation approach here contribute a discrete DGE profiling with reduced noise that permitted the observation of a greater gene diversity, increasing the number of potential targets for the control of insecticide resistant mosquitoes and widening our knowledge base on the complex phenotypic network of the Ae. aegypti response to insecticides

Inappropriate statin therapy according to ASCVD risk: Can we do better?

Background: Statin therapy targeted at reducing 10-year risk of ASCVD has become a cornerstone of preventative health in the outpatient setting. Appropriate statin prescription can lead to improved morbidity and mortality as outlined by current American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Methods: In this empiric observational study performed in August 2018, we calculated the 10-year ASCVD risk for patients visiting the Henry Ford Hospital Academic Internal Medicine Clinic between January and December 2017, and compared the ACC/AHA guideline recommended statin intensity with the one currently prescribed. Our aim was to assess appropriateness of statin therapy based on ASCVD risk calculation and ACC/AHA guidelines. Results: Of the 2994 patients assessed, approximately 1548 patients were prescribed an inappropriate intensity of statin based on 10-year ASCVD risk calculation (p \u3c 0.001). For female patients, the odds of appropriate statin dose prescription increased by approximately 81.9% (odds ratio 1-1.819) when compared to male patients (95% CI 1.559-2.124). For black patients, the odds of appropriate statin prescription decreased by 32.2% (odds ratio 1-0.678) when compared to white patients (95% CI 0.532-0.864). Approximately 1245 patients currently taking high-intensity statin did not qualify for one as compared to 484 patients (p \u3c 0.001). Conclusion: Calculation of 10-year ASCVD risk is an integral part of guiding statin prescription and preventative health therapy in the outpatient setting, However, an increasing percentage of patients are not managed adequately according to ACC/AHA guidelines. Race, gender, and income disparities appear to be major factors influencing appropriateness of statin prescription. This demonstrates a major opportunity for potential intervention to improve statin prescription and patient health outcomes.https://scholarlycommons.henryford.com/merf2019hcd/1000/thumbnail.jp

Diltiazem Induced Bullous Leukocytoclastic Vasculitis

Diltiazem is a calcium ion cellular influx inhibitor approved by the U.S. Food and Drug Administration for the management of hypertension and chronic stable angina. Diltiazem is commonly used off label for chronic ventricular rate control in atrial fibrillation. Very few cases of widespread cutaneous vasculitis have been described in association with diltiazem since 1988. We report on a patient developing diffuse petechiae with overlying palpable purpura and tense bullae in both lower extremities, which progressed to the thighs, buttocks, abdomen, and upper extremities 6 days after starting diltiazem for management of atrial fibrillation. Skin biopsy revealed leukocytoclastic vasculitis.https://scholarlycommons.henryford.com/merf2020caserpt/1009/thumbnail.jp

Knowledge and skill requirements for marketing positions: the gap between employers' and undergraduate marketing students' expectations in Kuching, Sarawak / Margaret Lucy Gregory, Jasmine Vivienne Andrew and Noraida Omar

Marketing education has seen a tremendous growth over the years. Thus, marketing education has a responsibility of preparing marketers of the future with the relevant knowledge and skills essential for subsequent organizational and career success. However, there is little research done on the effectiveness of marketing education in Malaysia focusing on purely marketing elements. Our research attempts to identify what undergraduate marketing students in Sarawak expect of their jobs and how these expectations can be compared to the needs of the job markets and identifying areas of commonality and difference. This study will use qualitative and the quantitative method. Data will be analyzed using the SPSS 17.0 software and descriptive analysis will be used extensively in this study. With a greater insight into the expectations of employers and students alike, we hope to draw some conclusion about the effectiveness of the current degree program in encouraging students to develop the capability required if they are to be employed as fresh graduates. Furthermore, the findings would provide suggestions for how courses offered by the universities and institutions of higher learning could be adapted to reflect employers' needs

Rapid Evaporative Ionization Mass Spectrometry (REIMS): a Potential and Rapid Tool for the Identification of Insecticide Resistance in Mosquito Larvae

Insecticide resistance is a significant challenge facing the successful control of mosquito vectors globally. Bioassays are currently the only method for phenotyping resistance. They require large numbers of mosquitoes for testing, the availability of a susceptible comparator strain, and often insectary facilities. This study aimed to trial the novel use of rapid evaporative ionization mass spectrometry (REIMS) for the identification of insecticide resistance in mosquitoes. No sample preparation is required for REIMS and analysis can be rapidly conducted within hours. Temephos resistant Aedes aegypti (Linnaeus) larvae from Cúcuta, Colombia and temephos susceptible larvae from two origins (Bello, Colombia, and the lab reference strain New Orleans) were analyzed using REIMS. We tested the ability of REIMS to differentiate three relevant variants: population source, lab versus field origin, and response to insecticide. The classification of these data was undertaken using linear discriminant analysis (LDA) and random forest. Classification models built using REIMS data were able to differentiate between Ae. aegypti larvae from different populations with 82% (±0.01) accuracy, between mosquitoes of field and lab origin with 89% (±0.01) accuracy and between susceptible and resistant larvae with 85% (±0.01) accuracy. LDA classifiers had higher efficiency than random forest with this data set. The high accuracy observed here identifies REIMS as a potential new tool for rapid identification of resistance in mosquitoes. We argue that REIMS and similar modern phenotyping alternatives should complement existing insecticide resistance management tools

The impact of tourist attractions and accessibility on tourists' satisfaction: The moderating role of tourists' age

Age has frequently been recognized as one of the key attributes and indicators in creating an advertising system. In any case, it has been infrequently discovered the moderating effects of age on the links between attractions and accessibility as well as tourist satisfaction. Particularly, in the context of Bangladesh, this sort of study has not ever been considered. Hence, this study fulfils the gap by examining the moderating role of age in the relationship of these constructs. The questionnaire survey was directed for gathering data from international tourists in the Hazrat Shahjalal International Airport in Bangladesh. The outcomes got from Structural Equation Modeling (SEM) using the SmartPLS v3 uncovered that age significantly moderated the relationship between attraction and tourist satisfaction as well as accessibility and tourist satisfaction

Determinants of technology adoption among Malaysian SMES: An IDT perspective

Traditional competitive advantages such as raw material availability, inexpensive labour and proximity to local markets are fast losing their importance to other factors such as technology adoption. In order to survive, it is imperative that organizations incorporate technology into their daily operations. Still, technological adoption and information and communications technology penetration among the Malaysian SME industry is yet to reach a much desired level. Hence, this paper aims to reveal the factors that drive technology adoption among SMEs in Malaysia using the perceived innovation characteristics outlined in the Innovation Diffusion Theory (IDT). Data was gathered from manufacturing and manufacturing-related services; SMEs scattered throughout the country and analyzed using the partial least squares technique. The analysis revealed that innovation characteristics such as perceived relative advantage, observability and image are positively-related to the adoption of a technology while compatibility and ease of use do not influence adoption. Interestingly, though trialability was found to have a significant impact on adoption, its effect turned out to be a negative one instead of a positive hypothesized relationship. The findings are further discussed and elaborated

Zerumbone alleviates chronic constriction injury-induced allodynia and hyperalgesia through serotonin 5-HT receptors

Zerumbone, a bioactive sesquiterpene isolated from Zingiber zerumbet (Smith), has shown to exert antiallodynic and antihyperalgesic effects in neuropathic pain mice model in our recent study. The mechanism through which zerumbone alleviates neuropathic pain has yet to be elucidated. Thus, this study aimed to determine whether the serotonergic system, part of the descending pain modulation pathway, contributes to the antineuropathic effect of zerumbone. Participation of the serotonergic system in zerumbone-induced antiallodynia and antihyperalgesia was assessed using Dynamic Plantar Aesthesiometer von Frey test and Hargreaves plantar test respectively in chronic-constriction injury mice model. Administration of ρ-chlorophenylalanine (PCPA, 100 mg/kg, i.p.) for four consecutive days to deplete serotonin (5-HT) prior to zerumbone administration blocked the antiallodynic and antihyperalgesic effects of zerumbone. Further investigation with 5-HT receptor antagonists methiothepin (5-HT 1/6/7 receptor antagonist, 0.1 mg/kg), WAY-100635 (5-HT 1A receptor antagonist, 1 mg/kg), isamoltane (5-HT 1B receptor antagonist, 2.5 mg/kg), ketanserin (5-HT 2A receptor antagonist, 0.3 mg/kg) and ondansetron (5-HT 3 receptor antagonist, 0.5 mg/kg) managed to significantly attenuate antiallodynic and antihyperalgesic effects of zerumbone (10 mg/kg). These findings demonstrate that zerumbone alleviates mechanical allodynia and thermal hyperalgesia through the descending serotonergic system via 5-HT receptors 1A, 1B, 2A, 3, 6 and 7 in chronic constriction injury neuropathic pain mice