Primary vaginal leiomyosarcoma, a rare tumour: case report and review

Primary vaginal leiomyosarcomas (pvLMS) are rare, recurrent tumours accounting for ca. 2% of all vaginal cancers. The etiology is still unknown, the prognosis is poor and there is no consensus guideline on its management. Diagnosis is usually made during the 5th decade due to the presence of a vaginal mass or nodule [1-2]. Current medical literature reports about 200 cases (PubMed®); only 3 studies have considered the ultrastructure [2-4]. Herein a pvLMS is presented and discussed. A nodular, 25 x 23 x 28 mm-mass, infiltrating the urethra but not the rectovaginal septum, was widely excised from the superior vaginal wall of a 58-year-old previously hysterectomized woman. Macroscopic images and MRI were performed. Iliac lymph nodes and HMB45 were negative. The sample was fixed and prepared for light microscopy, transmission (TEM) and scanning (SEM) electron microscopy. Semithin sections showed a storiform pattern of spindle shaped cells with blunt-ended nuclei. Cells arranged in interwoven fascicles within a dense and richly vascularised stroma (neoangiogenesis). Some atypic mitotic figures and focal necrosis were seen. SEM evidenced a dense collagenous stroma with numerous microvessels. TEM showed neoplastic and pleomorphic cells with complex cytoplasm projections containing paranuclear crowds of dilated mitochondria, free ribosomes and a well-developed rough endoplasmic reticulum. Nuclei were large, mostly hyperchromatic, usually indented, with prominent nucleoli and nucleolonema. The dense intercellular space contained dense bundles of collagen fibers. A high and reactive endothelium lined blood vessels. After 4 follow-ups, the patient is fine and without recurrence. Best outcomes occur when the tumour is small, localized, and can be removed surgically with wide, clear margins, as it was for this case. As there are different kinds of LMS, biopsy followed by immunohistochemistry and electron microscopy still represents a good diagnostic choice. References [1] Umeadi et al. (2008) Vaginal leiomyosarcoma. J Obstet Gynaecol 28(5): 553-554. [2] Tobon et al. (1973) Primary leiomyosarcoma of the vagina. Light and electron microscopic observations. Cancer 32(2): 450-457. [3] Akhtar et al. (1978) Primary leiomyosarcoma of the vagina: light and electron microscopic study of a case with review of literature. Tex Med 74(9): 67-71. [4] Rastogi et al. (1984) Primary leiomyosarcoma of the vagina: a study of five cases. Gynecol Oncol 18(1): 77-86

Sildenafil dosed concomitantly with bosentan for adult pulmonary arterial hypertension in a randomized controlled trial

BACKGROUND: Few controlled clinical trials exist to support oral combination therapy in pulmonary arterial hypertension (PAH). METHODS: Patients with PAH (idiopathic [IPAH] or associated with connective tissue disease [APAH-CTD]) taking bosentan (62.5 or 125 mg twice daily at a stable dose for ≥3 months) were randomized (1:1) to sildenafil (20 mg, 3 times daily; n = 50) or placebo (n = 53). The primary endpoint was change from baseline in 6-min walk distance (6MWD) at week 12, assessed using analysis of covariance. Patients could continue in a 52-week extension study. An analysis of covariance main-effects model was used, which included categorical terms for treatment, baseline 6MWD (<325 m; ≥325 m), and baseline aetiology; sensitivity analyses were subsequently performed. RESULTS: In sildenafil versus placebo arms, week-12 6MWD increases were similar (least squares mean difference [sildenafil-placebo], -2.4 m [90% CI: -21.8 to 17.1 m]; P = 0.6); mean ± SD changes from baseline were 26.4 ± 45.7 versus 11.8 ± 57.4 m, respectively, in IPAH (65% of population) and -18.3 ± 82.0 versus 17.5 ± 59.1 m in APAH-CTD (35% of population). One-year survival was 96%; patients maintained modest 6MWD improvements. Changes in WHO functional class and Borg dyspnoea score and incidence of clinical worsening did not differ. Headache, diarrhoea, and flushing were more common with sildenafil. CONCLUSIONS: Sildenafil, in addition to stable (≥3 months) bosentan therapy, had no benefit over placebo for 12-week change from baseline in 6MWD. The influence of PAH aetiology warrants future study

Comment on topyła-putowska et al. echocardiography in pulmonary arterial hypertension. comprehensive evaluation and technical considerations. j. clin. med. 2021, 10, 3229

A comprehensive PAH echocardiographic examination of patients with pulmonary arterial hypertension (PAH) should include a set of parameters resembling the pathophysiological changes occurring in the course of the disease. This approach could help clinicians build a complete picture of the patient, test the effects of targeted therapies and identify patients who need a more aggressive therapeutic approach to achieve a low risk-status

feasibility analysis of coupling an orc to a mgt in a biogas plant

Abstract An increasing interest is devoted to biogas plants as they might play a key role in the reduction of current fossil fuel consumption for power production. The main component of the plant is the anaerobic digester where the organic fraction of waste products is converted in a gas with high concentration of methane and carbon dioxide. This biogas is converted in power and heat in a cogeneration unit that may consist in a micro gas turbine or an internal combustion engine. Electric power is used to satisfy the plant internal need and the surplus is sold to the grid. A portion of the heat is used to keep the digester at a constant temperature as requested by the anaerobic digestion, the reaming is generally dissipated. This study focuses on the potential of using an Organic Rankine Cycle as a possible additional thermal user to reduce the amount of dissipated heat and increase the power production. The study is based on an existing biogas plant operating in the town of Viareggio (Italy) which will be equipped with a 600kWe micro gas turbine. The integration of the two systems was studied in detail to have high values of thermal energy recovery. A reference and a modified solution were simulated in AMESim by considering a yearlong period with actual ambient conditions. Off-design behavior of all the components was also included in the simulation. The results of the investigation showed that a thermal energy recovery up to 77% could be achieved. From the economic point of view, the plant modification for introducing the ORC system has a payback period lower than 6 years and an interesting profitability index

The GM1 Ganglioside Forms GM1-Rich Gel Phase Microdomains within Lipid Rafts

Abstract: Mercury-supported, self-assembled monolayers of the sole (SAMs) dioleoylphosphatidylcholine (DOPC)and of a raft -forming mixture of DOPC, cholesterol (Chol) and palmitoylsphingomyelin of (59:26:15) mol% composition(PSM) , were investigated by electrochemical impedance spectroscopy (EIS), both in the absence and in the presence of the monosialoganglioside GM1. The impedance spectra of these four SAMs were fitted by a series of parallel combinations of a resistance and a capacitance ( RC meshes) and displayed on plots of ω Z ′ against −ω Z ″, where Z ′ and Z ″ are the in -phase and quadrature components of the impedance and is the angular frequency. A comparison among these ωdifferent impedance spectra points to the formation of GM1-rich gel phase microdomains within the lipid rafts of the DOPC/Chol/PSM mixture, thanks to the unique molecular-level smooth support provided by mercury, whichallows EIS to detect the protruding gel phase microdomains by averaging them over a macroscopically large area

Exercise Interventions for the Management of Polycystic Ovary Syndrome (PCOS): An Update of the Literature

Polycystic Ovary Syndrome (PCOS) affects 6–10% women of reproductive age, and the diagnosis requires two of the three criteria: (1) menstrual irregularity; (2) polycystic ovaries on ultrasound; (3) elevated hormones (such as testosterone). Approximately 50–70% women have underlying insulin resistance and/or have a body mass index (BMI) greater than 28.0 kg/m2, and if not managed, it can worsen the symptoms of PCOS. The first line of treatment for PCOS includes lifestyle management such as diet and/or exercise. Previous studies evaluated interventions such as aerobic, aerobic plus resistance and high intensity aerobic. These interventions formed part of the initial guidelines for the management of PCOS, although the guidelines did not include recommendations of resistance training in isolation. More recently, new studies have emerged which assessed resistance training interventions in isolation in PCOS, where these findings led to an update in the guidelines in PCOS to recommend resistance training as part of the management. The chapter will look to provide an update of the exercise literature in PCOS, as well as provide recommendations for future research

ALOYSIUS LILIUS AUTHOR OF THE GREGORIAN REFORM OF THE CALENDAR

During the 16th century the disagreement between the dates of the Julian calendar, that had been in use since 46 BC and the vernal equinox, necessitated a correction to the computational rules used to regulate the flow of time. This was a very difficult task as it was necessary to resynchronize the civil time with celestial indicators, maintaining a lien adamant: the date of the vernal equinox, conventionally fixed perennially on March 21. In fact, during the Nicaea Council (325) the celebration of Easter was fixed on the first Sunday following the XIV Moon (Full Moon) belonging to the first month after the vernal equinox. Luigi Lilio, a physician, astronomer and mathematician, using imprecise astronomical data contained in tables from three centuries before, was able to elaborate a calendar that has stood the test of time. By the use of two equations he was able to synchronize the solar and lunar cycles and to develop a useful tool, named the epact cycle, to determine without uncertainty the Easter date. Furthermore, the Lilian method offers the possibility to correct the calendar according to the variation of the tropic year during time. Unfortunately, only a few details of his personal life are known. Indeed, he has left only a few faint traces in public or private archives, so that today his name is almost unknown. In this paper are reported the few details known of his life and a reconstruction of his plan for the calendar reform

Elevated serum levels of macrophage migration inhibitory factor and stem cell growth factor β in patients with idiopathic and systemic sclerosis associated pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) can be idiopathic or secondary to autoimmune diseases, and it represents one of the most threatening complications of systemic sclerosis (SSc). Macrophage migration inhibitory factor (MIF) is a pleiotropic cytokine with proinflammatory functions that appears to be involved in the pathogenesis of hypoxia-induced PH. In SSc patients, high serum levels of MIF have been associated with the development of ulcers and PAH. Stem cell growth factor β (SCGF β) is a human growth factor that, together with MIF, is involved in the pathogenesis of chronic spinal cord injury. The aim of our study was to measure serum levels of MIF in patients with idiopathic and SSc-associated PAH. We enrolled 13 patients with idiopathic PAH and 15 with SSc-associated PAH. We also selected 14 SSc patients without PAH and 12 normal healthy controls, matched for sex and age. PAH was confirmed by right hearth catheterism (mPAP>25 mmHg). MIF and SCGF β levels were measured by ELISA. We found significantly higher circulating levels of MIF and of SCGF β in patients with idiopathic PAH (P=0.03 and P=0.004) and with PAH secondary to SSc (P=0.018 and P=0.023) compared to SSc patients without PAH. Higher levels of MIF were found in those patients with an higher New York Heart Association (NYHA) class (P=0.03). We can hypothesize that MIF and SCGF β are able to play a role in PAH, both idiopathic or secondary, and in the future they may be evaluated as useful biomarkers and prognostic factors for this serious vascular disease

A Prediction of SICK Scapula Syndrome Score from Scapular Stabilizer Muscle Activation Analysis in Overhead Athletes

Objective: To determine if subject score on the SICK Scapula, Static Measurements, 0 to 20 Point Rating Scale1 can be predicted from scapular stabilizer muscle activation. Design: Quasi-experimental, one group design with a counterbalancing of two functional tasks. Subjects: NCAA Division I and/or recreational club overhead athletes (n = 40). Measurements: The SICK Scapula, Static Measurements, 0 to 20 Point Rating Scale(1) was used for assessing the severity of scapular malposition. Muscle activation was recorded for the upper trapezius, middle trapezius, lower trapezius, and serratus anterior muscles. Results: Regression analyses revealed that scapular stabilizer muscle activation amplitude did not significantly predict the subject score on the SICK Scapula, Static Measurements, 0 to 20 Point Rating Scale.(1) Conclusion: In overhead athletes, mean muscle activation amplitude of the scapular stabilizers was not found to be valid predictor of subject score on the SICK Scapula, Static Measurements, 0 to 20 Point Rating Scale.(1