A Systematic Review Including an Additional Pediatric Case Report: Pediatric Cases of Mammary Analogue Secretory Carcinoma

Importance Mammary Analogue Secretory Carcinoma (MASC) is a newly characterized salivary gland carcinoma resembling secretory carcinoma of the breast. Prior to being described, MASC was most commonly misdiagnosed as Acinic Cell Carcinoma. Though MASC is predominantly an adult neoplasm, cases have been reported in the pediatric population. Reporting and summarizing of known cases is imperative to understand the prognosis and clinical behavior of MASC. Objective (1) Report a rare case of pediatric MASC. (2) Review and consolidate the existing literature on MASC in the pediatric population. Evidence review Web of Science, Medline, EMBASE, and The Cochrane Library were searched for studies that included pediatric cases of MASC. Data on clinical presentation, diagnosis and management, and pathology were collected from all pediatric cases. Findings Case Report 14 year old with left-sided parotid mass diagnosed as MASC based on histology and immunohistochemistry. He was managed surgically with left superficial parotidectomy with selective neck dissection. Literature review The majority of MASC cases have been identified via retrospective reclassification of previously misclassified salivary gland tumors. Of all the pediatric cases (N=11) of MASC, the female-to-male ratio is 1:1.2 with an age range of 10-17 years old. The most common clinical presentation was a slowly growing, fixed, and painless mass of the parotid gland, often detected incidentally on physical examination. Common pathological features include eosinophilic vacuolated cytoplasm within cystic, tubular, and/or papillary architecture. Immunohistochemistry showed positivity for S100, mammaglobin, cytokeratin 19, and vimentin. The diagnosis was confirmed by the detection of the characteristic ETV6-NTRK6 fusion gene via fluorescent in-situ hybridization (FISH). Only 4 cases discussed treatment. Each of these underwent successful surgical resection alone with or without lymph node dissection. Conclusions and relevance Since the first case of MASC in the pediatric population was described in 2011, only 12 cases, including this one, have been described in the literature. With this paucity of information, much remains unknown regarding this new pathologic diagnosis. The collection of clinical outcomes data of children with MASC is needed to better understand the behavior of this malignancy as well as determine optimal treatment regimens

1963: Abilene Christian College Bible Lectures - Full Text

THE CHRISTIAN AND MORALITY” Being the Abilene Christian College Annual Bible Lectures 1963 Price: $3.95 Published by ABILENE CHRISTIAN COLLEGE STUDENTS EXCHANGE ACC Station Abilene, Texa

Gamma-ray Activity in the Crab Nebula: The Exceptional Flare of April 2011

The Large Area Telescope on board the Fermi satellite observed a gamma-ray flare in the Crab nebula lasting for approximately nine days in April of 2011. The source, which at optical wavelengths has a size of ~11 ly across, doubled its gamma-ray flux within eight hours. The peak photon flux was (186 +- 6) 10-7 cm-2 s-1 above 100 MeV, which corresponds to a 30-fold increase compared to the average value. During the flare, a new component emerged in the spectral energy distribution, which peaked at an energy of (375 +- 26) MeV at flare maximum. The observations imply that the emission region was likely relativistically beamed toward us and that variations in its motion are responsible for the observed spectral variability.Comment: 13 pages, 7 figures, accepted for publication in Ap

Preventable patient harm: A multidisciplinary, bundled approach to reducing clostridium difficile infections while using a glutamate dehydrogenase/toxin immunochromatographic assay/nucleic acid amplification test diagnostic algorithm

Health care facility-onset Clostridium difficile infections (HO-CDI) are an important national problem, causing increased morbidity and mortality. HO-CDI is an important metric for the Center for Medicare and Medicaid Service’s (CMS) performance measures. Hospitals that fall into the worst-performing quartile in preventing hospital-acquired infections, including HO-CDI, may lose millions of dollars in reimbursement. Under pressure to reduce CDI and without a clear optimal method for C. difficile detection, health care facilities are questioning how best to use highly sensitive nucleic acid amplification tests (NAATs) to aid in the diagnosis of CDI. Our institution has used a two-step glutamate dehydrogenase (GDH)/toxin immunochromatographic assay/NAAT algorithm since 2009. In 2016, our institution set an organizational goal to reduce our CDI rates by 10% by July 2017. We achieved a statistically significant reduction of 42.7% in our HO-CDI rate by forming a multidisciplinary group to implement and monitor eight key categories of infection prevention interventions over a period of 13 months. Notably, we achieved this reduction without modifying our laboratory algorithm. Significant reductions in CDI rates can be achieved without altering sensitive laboratory testing methods

1957: Abilene Christian College Bible Lectures - Full Text

Featuring the Theme CHRIST IN YOU -THE HOPE OF GLORY PRICE: $3.00 FIRM FOUNDATION PUBLISHING HOUSE BOX 77 AUSTIN, TEXA