Metastatic Adenocarcinoma of Mandible with Unknown Primary Origin (CUP Syndrome): A Rare Case Report

Metastatic lesions of the jaws are a diagnostic challenge because of their scarcity and uncharacteristic clinical-radiographic features. Carcinoma of unknown primary origin (CUP) is characterized by the existence of metastatic disease with no recognized primary neoplasm after a comprehensive work-up. CUP shows a poor prognosis with limited treatment choices. This paper presents a 64-year-old male with a chief complaint of paresthesia of the chin and lower lip. Panoramic radiography showed an ill-defined radiolucency in the left mandibular molar area and the residue of the first molar root. Microscopic examination demonstrated features of mucin-producing adenocarcinoma and was not similar to common neoplasms of the jaw. The whole-body scan revealed multiple osseous uptakes. CDX2 was diffusely positive. However, in the end, the origin of the primary tumor was not determined. Considering the aforementioned data, the diagnosis of metastatic adenocarcinoma with unknown primary origin was made. CUP of the oral cavity is an extremely rare event. The possibility of metastasis should be raised in a patient who complains of paresthesia. Awareness of the clinical and histopathologic features of these malignancies is crucial for clinicians and pathologists to have a proper diagnosis

Comparison of antifungal activities of zinc, copper, cerium oxide, silver, gold, and selenium nanoparticles against clinical isolates of Aspergillus

Objective(s): Aspergillus species are found as opportunistic agents to cause a wide variety of clinical manifestations. Regarding the drug resistance emergence against Aspergillus species, new aspects of using nanoparticles (NPs) as antifungal agents are considerable. This study takes a new approach to biosynthesized NPs of zinc oxide, copper oxide, cerium oxide, silver, gold, and selenium influence on the clinical isolates of Aspergillus species.Materials and Methods: The antifungal activities of six NPs were examined against a total of 12 clinical isolates of Aspergillus species, including A. flavus (n=4), A. welwitschiae (n= 4), and A. fumigatus (n=4) based on the M38-A2 guideline.Results: According to minimum inhibitory concentration (MIC) values, NPs of ZnO, Ag, Au, and Se showed a significant antifungal effect. CuO-NPs and CeO2-NPs didn’t show an inhibitory effect against Aspergillus isolates. The MIC ranges of ZnO-NPs, Ag-NPs, Au-NPs, and Se-NPs were 128-512, 26-53, 21-85, and 6-26 µg⁄mL for A. fumigatus; and 512->512, 26-53, 85, and 1-13 µg⁄mL for A. welwitschiae, respectively. In addition, the MIC ranges of Ag-NPs and Se-NPs were 26-53 and 106-425 µg⁄mL for A. flavus, respectively. However, A. flavus were not inhibited by NPs of ZnO and Au.Conclusion: Among the examined NPs, ZnO, Ag, Au, and Se showed a significant effect against Aspergillus isolates except for CuO and CeO2. However, Ag-NPs seemed to be the most effective nanoparticle against the Aspergillus species. Compared to other Aspergillus species, A. flavus was not inhibited by NPs of ZnO and Au

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality among Patients with COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis. Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU). Design, Setting, and Participants: Multicenter randomized trial with a 2 � 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020. Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up. Main Outcomes and Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 �103/µL). All outcomes were blindly adjudicated. Results: Among 600 randomized patients, 562 (93.7) were included in the primary analysis (median interquartile range age, 62 50-71 years; 237 42.2% women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% 95% CI,-6.6% to 9.8%; odds ratio, 1.06 95% CI, 0.76-1.48; P =.70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% 1-sided 97.5% CI,-� to 3.4%; odds ratio, 1.83 1-sided 97.5% CI, 0.00-5.93), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% 95% CI, 0.4%-3.8%; P =.01). Conclusions and Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19. Trial Registration: ClinicalTrials.gov Identifier: NCT04486508. © 2021 American Medical Association. All rights reserved

Design and prototyping of indoor positioning systems for Internet-of-Things sensor networks

Accurate indoor positioning of narrowband Internet-of-Things (IoT) sensors has drawn more attention in recent years. The introduction of Bluetooth Low Energy (BLE) technology is one of the latest developments of IoT and especially applicable for Ultra-Low Power (ULP) applications. BLE is an attractive technology for indoor positioning systems because of its low-cost deployment and reasonable accuracy. Efficient indoor positioning can be achieved by deducing the sensor position from the estimated signal Angle-of-Arrival (AoA) at multiple anchors. An anchor is a base station of known position and equipped with a narrowband multi-antenna array. However, the design and implementation of indoor positioning systems based on AoA measurements involve multiple challenges. The first part of this thesis mainly addresses the impact of hardware impairments on the accuracy of AoA measurements. In practice, the subspace-based algorithms such as Multiple Signal Classification (MUSIC) suffer from sensitivity to array calibration errors coming from hardware imperfections. A detailed experimental implementation is performed using a Software Defined Radio (SDR) platform to precisely evaluate the accuracy of AoA measurements. For this purpose, a new Over-the-Air (OTA) calibration method is proposed and the array calibration error is investigated. The experimental results are compared with the theoretical analysis. These results show that array calibration errors can cause some degrees of uncertainty in AoA estimation. Moreover, we propose iterative positioning algorithms based on AoA measurements for low capacity IoT sensors with high accuracy and fair computational complexity. Efficient positioning accuracy is obtained by iterating between the angle and position estimation steps. We first develop a Data-Aided Maximum a Posteriori (DA- MAP) estimator based on the preamble of the transmitted signal. DA-MAP estimator relies on the knowledge of the transmitted signal which makes it impractical for narrowband communications where the preamble is short. For this reason, a Non-Data- Aided Maximum a Posteriori (NDA-MAP) estimator is developed to improve the AoA accuracy. The iterative positioning algorithms are therefore classified as Data-Aided Iterative (DA-It) and Non-Data-Aided Iterative (NDA-It) depending on the knowledge of the transmitted signal that is used for estimation. Both numerical and experimental analyses are carried out to evaluate the performance of the proposed algorithms. The results show that DA-MAP and NDA-MAP estimators are more accurate than MUSIC. The results also show that DA-It comes very close to the performance of the optimal approach that directly estimates the position based on the observation of the received signal, known as Direct Position Estimation (DPE). Furthermore, the NDA-It algorithm significantly outperforms the DA-It because it can use a much higher number of samples; however, it needs more iterations to converge. In addition, we evaluate the computational savings achieved by the iterative schemes compared to DPE through a detailed complexity analysis. Finally, we investigate the performance degradation of the proposed iterative algorithms due to the impact of multipath and NLOS propagation in indoor environments. Therefore, we develop an enhanced iterative positioning algorithm with an anchor selection method in order to identify and exclude NLOS anchors. The numerical results show that applying the anchor selection strategy significantly improves the positioning accuracy in indoor environments.Doctorat en Sciences de l'ingénieur et technologieinfo:eu-repo/semantics/nonPublishe

Histopathologic Evaluation of Periapical Radiolucencies Clinico-Radiographically Diagnosed as Endodontic Lesions: A Retrospective Analysis

Statement of the Problem: Periapical cyst and granuloma are inflammatory endodontic lesions. Periapical granuloma usually heals spontaneously after endodontic treatment; however, periapical cyst mostly needs to be removed via surgical approaches. Although some clinicians believe that microscopic examination of periapical lesions is unnecessary, it is proved that some of them has non-endodontic nature that need critical consideration. Purpose: The purpose of this study was to assess the disagreement between clinico-radiographic and microscopic diagnosis of periapical cysts and granulomas in a major center of oral pathology service in Iran.Materials and Method: In this retrospective, descriptive cross-sectional study, the archives of the oral and maxillofacial pathology department of Shahid Beheshti University of Medical Sciences served as the source of the material during an 18-year-period for this retrospective, descriptive cross-sectional study. The reports of all patients whose initial clinical diagnosis was a periapical cyst/granuloma were extracted.Results: In the present study, 474 cases were diagnosed with a periapical cyst/granuloma clinico-radiographically, of which 61 cases (12.86%) received a microscopic diagnosis of a non-endodontic pathology. The most frequent lesion was odontogenic keratocyst (n= 12, 19.67%) followed by infected odontogenic cyst (n= 12, 19.67%). About 21.31% of diagnoses were non-cystic lesions and 4.9% were malignancies. The most odontogenic tumors that were diagnosed as periapical cyst/granuloma in clinico-radiography were the ameloblastoma variants (n= 4, 6.55%).Conclusion: A wide variety of microscopic diagnoses, including aggressive lesions such as ameloblastoma, as well as other malignant lesions was noted in this study. These misdiagnoses can lead to an inappropriate treatment plan. It is important to microscopically examine all lesions removed from the jaw

Synthesis, Characterization and Thermal Analysis of a New Acetic Acid (2-Hydroxy-benzylidene)-hydrazide and its Complexes with Hg(II) and Pd(II)

The new complexes have been synthesized by the reaction of Hg(II) and Pd(II) with acetic acid(2-hydroxy-benzylidene)- hydrazide (L). These new complexes were characterized by elemental analysis, IR, H NMR spectroscopy and UV spectral techniques. The changes observed between the FT-IR, H NMR and UV-Vis spectra of the ligands and of the complexes allowed us to establish the coordination mode of the metal in complexes. Thermal properties, TG-DTA of these complexes were studied. TG- DTA and other analytical methods have been applied to the investigation of the thermal behavior and structure of the compounds [M(L)2]Cl2 M= Hg, Pd. Thermal decomposition of these compounds is multi-stage processes

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

BackgroundFuture trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050.MethodsUsing forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline.FindingsIn the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]).InterpretationGlobally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions.FundingBill & Melinda Gates Foundation.</p