A rare case of invasive mucinous adenocarcinoma of fallopian tube fimbria with metastasis to ipsilateral ovary, uterine serosa, myometrium and pelvis: Case report and review of literature

Mucinous adenocarcinoma of the fallopian tube is exceptionally rare and the detailed clinicopathologic features of these tumors have not yet been reported in English literature. Here we report a moderately differentiated mucinous adenocarcinoma arising in the tubal fimbria in a 70-year-old woman. Patient had a history of cholecystectomy for gallstones and gastric banding who presented with gastrointestinal discomfort and was found to have a large adnexal mass on imaging studies. Serum CA-125 was moderately elevated. Recent mammography, upper endoscopy and colonoscopy were completely normal. She underwent surgical staging for the adnexal mass. Frozen section and final pathology diagnosis revealed moderately differentiated adenocarcinoma arising in the left fimbria. Carcinoma had spread to the ipsilateral ovary and pelvic soft tissue at the time of her presentation. Tumor was strongly immunoreactive to CK7 and CEA, and was negative for CK20, CDX-2, PAX-8, WT-1, p16, ER, and vimentin. TP53 showed wild-type phenotype by immunohistochemistry. Molecular studies showed no mutation in codon 12 and 13 of the k-ras gene, and no mutation was detected in the BRAF and EGFR genes. In addition, the non-tumorous fimbria epithelium showed a spectrum of mucinous alterations with variable nuclear atypia: cytologically bland areas that were reminiscent of mucinous metaplasia were positive for p53 and showed minimal proliferation as assessed by Ki-67, and cytologically atypical stratified mucinous epithelium that was positive for p53 and Ki-67. The patient received 3 cycles of Folfox and was regularly followed at a 3–6 month interval. Her carcinoma recurred in abdomen at 32 months post surgery. After excluding the possibility of an extra-gynecologic tract primary through extensive clinical investigations and post-surgical follow-up, we concluded that this tumor most likely represented a mucinous adenocarcinoma of tubal origin

Cytokines levels, Severity of acute mucositis and the need of PEG tube installation during chemo-radiation for head and neck cancer - a prospective pilot study

<p>Abstract</p> <p>Background</p> <p>The purpose of this pilot study was to detect a correlation between serum cytokine levels and severity of mucositis, necessitating installation of a percutaneous endoscopic gastrostomy tube (PEG) in head and neck (H&N) cancer patients receiving combined chemo-radiation therapy.</p> <p>Patients and Methods</p> <p>Fifteen patients with H&N epithelial cancer were recruited to this study. All patients received radiotherapy to the H&N region, with doses ranging from 50-70 Gy. Chemotherapy with cisplatin, carboplatin, 5-fluorouracil and taxanes was given to high-risk patients, using standard chemotherapy protocols. Patients were evaluated for mucositis according to WHO common toxicity criteria, and blood samples were drawn for inflammatory (IL-1, IL-6, IL-8, TNF-α) and anti-inflammatory (IL-10) cytokine levels before and during treatment.</p> <p>Results</p> <p>A positive correlation was found between IL-6 serum levels and severity of mucositis and dysphagia; specifically, high IL-6 levels at week 2 were correlated with a need for PEG tube installation. A seemingly contradictory correlation was found between low IL-8 serum levels and a need for a PEG tube.</p> <p>Conclusion</p> <p>These preliminary results, indicating a correlation between IL-6 and IL-8 serum levels and severity of mucositis and a need for a PEG tube installation, justify a large scale study.</p

Deep Bribe: Predicting the Rise of Bribery in Blockchain Mining with Deep RL

Blockchain security relies on incentives to ensure participants, called miners, cooperate and behave as the protocol dictates. Such protocols have a security threshold – a miner whose relative computational power is larger than the threshold can deviate to improve her revenue. Moreover, blockchain participants can behave in a petty compliant manner: usually follow the protocol, but deviate to increase revenue when deviation cannot be distinguished externally from the prescribed behavior. The effect of petty compliant miners on the security threshold of blockchains is not well understood. Due to the complexity of the analysis, it remained an open question since Carlsten et al. identified it in 2016. In this work, we use deep Reinforcement Learning (RL) to analyze how a rational miner performs selfish mining by deviating from the protocol to maximize revenue when petty compliant miners are present. We find that a selfish miner can exploit petty compliant miners to increase her revenue by bribing them. Our method reveals that the security threshold is lower when petty compliant miners are present. In particular, with parameters estimated from the Bitcoin blockchain, we find the threshold drops from the known value of 25% to only 21% (or 19%) when 50% (or 75%) of the other miners are petty compliant. Hence, our deep RL analysis puts the open question to rest; the presence of petty compliant miners exacerbates a blockchain’s vulnerability to selfish mining and is a major security threat

Gross motor proficiency deficits among children and adolescents post posterior fossa brain tumor removal vs. traumatic brain injury in the chronic phase of recovery: a cross-sectional study

IntroductionAcquired brain injury (ABI) is a prevalent diagnosis in pediatric rehabilitation. Gross motor skills are often affected by ABI and limit the ability to participate in various physical activities. However, as ABI injury location is diverse, children and adolescents (youth) with localized ABI, such as ABI in the posterior fossa (ABI-PF) may present unique and different motor disabilities than youth with ABI on account of traumatic brain injury (TBI).AimsThe aims of the study were: (1) to compare gross motor deficits in youth with TBI vs. ABI-PF; and (2) to compare two methods on scoring BOT2 to determine which is better for identifying motor deficits.MethodsParticipated in this study youth with TBI (N = 50) and ABI-PF (N = 30). Participants were tested on Bruininks-Oseretsky Test of Motor Proficiency-2nd Edition (BOT2) Upper-Limb Coordination, Balance, Strength, Running Speed and Agility, and Bilateral-Coordination subtests. Motor performance deficits were established using two-standard deviations (2SD) and age-equivalent methods. Between-group differences were assessed via independent t-tests and receiver operating characteristic curves (ROC).ResultsAccording to the 2SD method, motor deficits in the ABI-PF group ranged from 20% to 66.66%, whereas in the TBI group 8%–16%. According to the age-equivalent method, in the TBI and ABI-PF groups 40%–66.0% and 46.66%–76.66% of the youth presented motor deficits, respectively. Moreover, ROC analysis showed that motor performance deficits of both groups in all sub-scales except for Bilateral Coordination differed enough to result in medium area under the curve.ConclusionsMotor deficits post-pediatric ABI are prevalent. In comparison to the TBI group, deficits are greater in the ABI-PF group. Moreover, compared to the 2SD method, the extent of motor deficiency is greater in the age-equivalent method. Therefore, using the later might provide a more valid classification of deficits in gross motor proficiency for youth post-ABI

Neural traces of stress: cortisol related sustained enhancement of amygdala-hippocampal functional connectivity

Stressful experiences modulate neuro-circuitry function, and the temporal trajectory of these alterations, elapsing from early disturbances to late recovery, heavily influences resilience and vulnerability to stress. Such effects of stress may depend on processes that are engaged during resting-state, through active recollection of past experiences and anticipation of future events, all known to involve the default mode network (DMN). By inducing social stress and acquiring resting-state functional magnetic resonance imaging (fMRI) before stress, immediately following it, and 2 h later, we expanded the time-window for examining the trajectory of the stress response. Throughout the study repeated cortisol samplings and self-reports of stress levels were obtained from 51 healthy young males. Post-stress alterations were investigated by whole brain resting-state functional connectivity (rsFC) of two central hubs of the DMN: the posterior cingulate cortex (PCC) and hippocampus. Results indicate a ’recovery’ pattern of DMN connectivity, in which all alterations, ascribed to the intervening stress, returned to pre-stress levels. The only exception to this pattern was a stress-induced rise in amygdala-hippocampal connectivity, which was sustained for as long as 2 h following stress induction. Furthermore, this sustained enhancement of limbic connectivity was inversely correlated to individual stress-induced cortisol responsiveness (AUCi) and characterized only the group lacking such increased cortisol (i.e., non-responders). Our observations provide evidence of a prolonged post-stress response profile, characterized by both the comprehensive balance of most DMN functional connections and the distinct time and cortisol dependent ascent of intra-limbic connectivity. These novel insights into neuro-endocrine relations are another milestone in the ongoing search for individual markers in stress-related psychopathologies

Normative positions towards COVID-19 contact-tracing apps: findings from a large-scale qualitative study in nine European countries

Mobile applications for digital contact tracing have been developed and introduced around the world in response to the COVID-19 pandemic. Proposed as a tool to support ‘traditional’ forms of contact-tracing carried out to monitor contagion, these apps have triggered an intense debate with respect to their legal and ethical permissibility, social desirability and general feasibility. Based on a large-scale study including qualitative data from 349 interviews conducted in nine European countries (Austria, Belgium, France, Germany, Ireland, Italy, the Netherlands, German-speaking Switzerland, the United Kingdom), this paper shows that the binary framing often found in surveys and polls, which contrasts privacy concerns with the usefulness of these interventions for public health, does not capture the depth, breadth, and nuances of people’s positions towards COVID-19 contact-tracing apps. The paper provides a detailed account of how people arrive at certain normative positions by analysing the argumentative patterns, tropes and (moral) repertoires underpinning people’s perspectives on digital contact-tracing. Specifically, we identified a spectrum comprising five normative positions towards the use of COVID-19 contact-tracing apps: opposition, scepticism of feasibility, pondered deliberation, resignation, and support. We describe these stances and analyse the diversity of assumptions and values that underlie the normative orientations of our interviewees. We conclude by arguing that policy attempts to develop and implement these and other digital responses to the pandemic should move beyond the reiteration of binary framings, and instead cater to the variety of values, concerns and expectations that citizens voice in discussions about these types of public health interventions

Normative positions towards COVID-19 contact-tracing apps: findings from a large-scale qualitative study in nine European countries

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