Synchronous clear cell renal cell carcinoma and tubulocystic carcinoma: genetic evidence of independent ontogenesis and implications of chromosomal imbalances in tumor progression

Seven percent of renal cell carcinoma (RCC) cases are diagnosed as "unclassified" RCC by morphology. Genetic profiling of RCCs helps define renal tumor subtypes, especially in cases where morphologic diagnosis is inconclusive. This report describes a patient with synchronous clear cell RCC (ccRCC) and a tubulocystic renal carcinoma (TCRC) in the same kidney, and discusses the pathologic features and genetic profile of both tumors. A 67 year-old male underwent CT scans for an unrelated medical event. Two incidental renal lesions were found and ultimately removed by radical nephrectomy. The smaller lesion had multiple small cystic spaces lined by hobnail cells with high nuclear grade separated by fibrous stroma. This morphology and the expression of proximal (CD10, AMACR) and distal tubule cell (CK19) markers by immunohistochemistry supported the diagnosis of TCRC. The larger lesion was a typical ccRCC, with Fuhrman's nuclear grade 3 and confined to the kidney. Molecular characterization of both neoplasms using virtual karyotyping was performed to assess relatedness of these tumors. Low grade areas (Fuhrman grade 2) of the ccRCC showed loss of 3p and gains in chromosomes 5 and 7, whereas oncocytic areas displayed additional gain of 2p and loss of 10q; the high grade areas (Fuhrman grade 3) showed several additional imbalances. In contrast, the TCRC demonstrated a distinct profile with gains of chromosomes 8 and 17 and loss of 9. In conclusion, ccRCC and TCRC show distinct genomic copy number profiles and chromosomal imbalances in TCRC might be implicated in the pathogenesis of this tumor. Second, the presence of a ccRCC with varying degrees of differentiation exemplifies the sequence of chromosomal imbalances acquired during tumor progression

Comments on: Implications of structural variations in the human sacrum: why is an anatomical classification crucial?

We sincerely appreciate the work done by Mahato [1] in which a qualitative classification of the sacrum is done to determine the number of segments, position of auricular surfaces, symmetry and abnormalities. This work is of the utmost importance since it is crucial for several surgical interventions and at the same time correlates certain pathologies with the morphology, mostly low back pai

Modifications to the delivery of a gross anatomy course during the COVID-19 pandemic at a Mexican medical school

The Coronavirus disease was declared a pandemic this year, causing an impact on medical education. Following the World Health Organization’s (WHO) recommendations, Universities around the world implemented social distancing and the use of online platforms. Anatomists lead medical students, most of which are part of Generation Z. Different technological tools have been used in the gross anatomy course in combination with face-toface classes, but now are forced to move exclusively online. The Human Anatomy Department in the Medical School of the Universidad Autonoma de Nuevo León (UANL) implemented asynchronous sessions as a short-term resolution, transformed to synchronous sessions as the pandemic progressed. It is important to consider the adaptability of the student, the near-peer teacher, and academic staff, with the creation of innovative ideas to facilitate the learning for the student and to maintain the quality of the course. Their role in this modality should be assessed, as it may change medical education and the way to teach in the future for the new generation of medical students. Professors’ roles are changing and it is necessary to adapt to new situations

Neurovascular Structures at Risk During Anterolateral and Medial Arthroscopic Approaches of the Hip

To describe the safety areas for placement of 5 anterolateral portals (anterior, anterior lateral, posterior lateral, proximal anterior medial and distal anterior medial portals) and 3 recently described medial portals (anterior medial, posterior medial and distal posterior medial portals) to provide topographical description of the safety of each. A descriptive, observational and crosssectional study in which femoral triangle dissection was performed in 12 hips. 5 lateral portals and the 3 medial portals were placed. Clinically relevant neurovascular structures associated with each portal, were identified measured and documented. The lateral portal with the highest risk of injury to a nearby neurovascular structure was the anterior portal, the most adjacent to the femoral cutaneous nerve, 1.42 cm (±0.85) lateral to the portal. In the medial portals, the anterior medial portal has the narrowest margin in relation to the femoral artery, 2.14 cm (±0.35) lateral to the portal and medial to the obturator nerve by 0.87 cm (±0.62). The lateral portals have a higher safety margin; the portal with the most proximity to a neurovascular structure is the anterior portal, associated laterally with the femoral cutaneous nerve, presenting a higher risk of injury. Medial portals have a higher risk of injuring the femoral neurovascular bundle as well as the obturator nerve

Morphometry of the aortic arch and its branches. A computed tomography angiography-based study

Background: The current study aims to determine the prevalence of variations of the aortic arch using computed tomography angiography (CTA), as well as morphometries and gender correlations.Materials and methods: A retrospective, transverse, observational and descriptive study of 220 CTA was performed. The branching pattern, most cranial vertebral level of the aortic arch, area of the proximal, middle and distal segments of the arch, area of each branch, and the path of atypical arteries were recorded. Results were analysed and stratified by gender.Results: The typical aortic arch branching pattern was present in 77.7% without statistical significance between genders. The most common variant was a two-branch pattern with a common trunk and a left subclavian (13.6%), followed by a typical branching pattern with an added left vertebral artery (7.3%). T3 was the most frequent cranial level (32.3%), followed by T2–T3 (26.8%), and T3–T4 (23.2%). The mean areas of the aortic arch were 685.5 ± 183.9, 476.1 ± 124.1, and 445.0 ± 145.1 mm2 for the proximal, middle and distal segments, with statistical difference between men and women in the middle and distal segments. Three paths of atypical arteries were identified: bifurcated vertebral artery (0.5%), aberrant right subclavian artery (0.5%), and left subclavian ostium obstruction (0.5%).Conclusions: Mexican population has one of the highest prevalence of variations in the aortic arch branching pattern. The high probability of finding these should be taken into consideration when assessing patients. A standardised classification method would contemplate future un-reported findings, without causing confusion by the different numbers assigned by each author

Environmental flows in the Rio Grande - Rio Bravo basin

The Rio Grande/Bravo is an arid river basin shared by the United States and Mexico, the fifth-longest river in North America, and home to more than 10.4 million people. By crossing landscapes and political boundaries, the Rio Grande/Bravo brings together cultures, societies, ecosystems, and economies, thereby forming a complex social-ecological system. The Rio Grande/Bravo supplies water for the human activities that take place within its territory. While there have been efforts to implement environmental flows (flows necessary to sustain riparian and aquatic ecosystems and human activities), a systematic and whole-basin analysis of these efforts that conceptualizes the Rio Grande/Bravo as a single, complex social-ecological system is missing. Our objective is to address this research and policy gap and shed light on challenges, opportunities, and success stories for implementing environmental flows in the Rio Grande/Bravo. We introduce the physical characteristics of the basin and summarize the environmental flows studies already done. We also describe its water governance framework and argue it is a distributed and nested governance system across multiple political jurisdictions and spatial scales. We describe the environmental flows legal framework and argue that the authority over different aspects of environmental flows is divided across different agencies and institutions. We discuss the prioritization of agricultural use within the governance structure without significant provisions for environmental flows. We introduce success stories for implementing environmental flows that include leasing of water rights or voluntary releases for environmental flow purposes, municipal ordinances to secure water for environmental flows, nongovernmental organizations representing the environment in decision-making processes, and acquiring water rights for environmental flows, among others initiatives. We conclude that environmental flows are possible and have been implemented but their implementation has not been systematic and permanent. There is an emerging whole-basin thinking among scientists, managers, and citizens that is helping find common-ground solutions to implementing environmental flows in the Rio Grande/Bravo basin

Psychometric Comparisons of Benevolent and Corrective Humor across 22 Countries: The Virtue Gap in Humor Goes International

Recently, two forms of virtue-related humor, benevolent and corrective, have been introduced. Benevolent humor treats human weaknesses and wrongdoings benevolently, while corrective humor aims at correcting and bettering them. Twelve marker items for benevolent and corrective humor (the BenCor) were developed, and it was demonstrated that they fill the gap between humor as temperament and virtue. The present study investigates responses to the BenCor from 25 samples in 22 countries (overall N = 7,226). The psychometric properties of the BenCor were found to be sufficient in most of the samples, including internal consistency, unidimensionality, and factorial validity. Importantly, benevolent and corrective humor were clearly established as two positively related, yet distinct dimensions of virtue-related humor. Metric measurement invariance was supported across the 25 samples, and scalar invariance was supported across six age groups (from 18 to 50+ years) and across gender. Comparisons of samples within and between four countries (Malaysia, Switzerland, Turkey, and the UK) showed that the item profiles were more similar within than between countries, though some evidence for regional differences was also found. This study thus supported, for the first time, the suitability of the 12 marker items of benevolent and corrective humor in different countries, enabling a cumulative cross-cultural research and eventually applications of humor aiming at the good

The environmental flows implementation challenge: Insights and recommendations across water‐limited systems

Environmental flows (e-flows) are powerful tools for sustaining freshwater biodiversity and ecosystem services, but their widespread implementation faces numerous social, political, and economic barriers. These barriers are amplified in water-limited systems where strong trade-offs exist between human water needs and freshwater ecosystem protection. We synthesize the complex, multidisciplinary challenges that exist in these systems to help identify targeted solutions to accelerate the adoption and implementation of environmental flows initiatives. We present case studies from three water-limited systems in North America and synthesize the major barriers to implementing environmental flows. We identify four common barriers: (a) lack of authority to implement e-flows in water governance structures, (b) fragmented water governance in transboundary water systems, (c) declining water availability and increasing variability under climate change, and (d) lack of consideration of non-biophysical factors. We then formulate actionable recommendations for decision makers facing these barriers when working towards implementing environmental flows: (a) modify or establish a water governance framework to recognize or allow e-flows, (b) strive for collaboration across political jurisdictions and social, economic, and environmental sectors, and (c) manage adaptively for climate change in e-flows planning and recommendations