Primary Diffuse Large B-cell Lymphoma of the Uterus Manifesting as a Leiomyoma: A Unique Presentation with Review of Literature

We report a primary diffuse large B-cell lymphoma of uterine corpus in a 70-years old woman who presented with symptoms of increased urinary frequency and sense of bloating. Magnetic Resonance Imaging (MRI) findings were suggestive of a degenerating intramural fibroid. Histological examination of tissue samples obtained during hysteroscopy showed diffuse infiltration of fibrous stroma by atypical enlarged mononuclear cells. Immunohistochemical studies were consistent with the diagnosis of diffuse large B-cell lymphoma.Further imaging studies showed no evidence of lymphoma outside the uterus. To our knowledge,this represents the first welldocumented case of primary uterine lymphoma presenting as a leiomyoma on imaging studies

Bimodal coupling of ripples and slower oscillations during sleep in patients with focal epilepsy.

OBJECTIVE: Differentiating pathologic and physiologic high-frequency oscillations (HFOs) is challenging. In patients with focal epilepsy, HFOs occur during the transitional periods between the up and down state of slow waves. The preferred phase angles of this form of phase-event amplitude coupling are bimodally distributed, and the ripples (80-150 Hz) that occur during the up-down transition more often occur in the seizure-onset zone (SOZ). We investigated if bimodal ripple coupling was also evident for faster sleep oscillations, and could identify the SOZ. METHODS: Using an automated ripple detector, we identified ripple events in 40-60 min intracranial electroencephalography (iEEG) recordings from 23 patients with medically refractory mesial temporal lobe or neocortical epilepsy. The detector quantified epochs of sleep oscillations and computed instantaneous phase. We utilized a ripple phasor transform, ripple-triggered averaging, and circular statistics to investigate phase event-amplitude coupling. RESULTS: We found that at some individual recording sites, ripple event amplitude was coupled with the sleep oscillatory phase and the preferred phase angles exhibited two distinct clusters (p \u3c 0.05). The distribution of the pooled mean preferred phase angle, defined by combining the means from each cluster at each individual recording site, also exhibited two distinct clusters (p \u3c 0.05). Based on the range of preferred phase angles defined by these two clusters, we partitioned each ripple event at each recording site into two groups: depth iEEG peak-trough and trough-peak. The mean ripple rates of the two groups in the SOZ and non-SOZ (NSOZ) were compared. We found that in the frontal (spindle, p = 0.009; theta, p = 0.006, slow, p = 0.004) and parietal lobe (theta, p = 0.007, delta, p = 0.002, slow, p = 0.001) the SOZ incidence rate for the ripples occurring during the trough-peak transition was significantly increased. SIGNIFICANCE: Phase-event amplitude coupling between ripples and sleep oscillations may be useful to distinguish pathologic and physiologic events in patients with frontal and parietal SOZ

Making the great transformation, November 13, 14, and 15, 2003

This repository item contains a single issue of the Pardee Conference Series, a publication series that began publishing in 2006 by the Boston University Frederick S. Pardee Center for the Study of the Longer-Range Future. This Conference took place during November 13, 14, and 15, 2003. Co-organized by Cutler Cleveland and Adil Najam.The conference discussants and participants analyze why transitions happen, and why they matter. Transitions are those wide-ranging changes in human organization and well being that can be convincingly attributed to a concerted set of choices that make the world that was significantly and recognizably different from the world that becomes. Transition scholars argue that that history does not just stumble along a pre-determined path, but that human ingenuity and entrepreneurship have the ability to fundamentally alter its direction. However, our ability to ‘will’ such transitions remains in doubt. These doubts cannot be removed until we have a better understanding of how transitions work

Looking ahead: forecasting and planning for the longer-range future, April 1, 2, and 3, 2005

This repository item contains a single issue of the Pardee Conference Series, a publication series that began publishing in 2006 by the Boston University Frederick S. Pardee Center for the Study of the Longer-Range Future. This was the Center's spring Conference that took place during April 1, 2, and 3, 2005.The conference allowed for many highly esteemed scholars and professionals from a broad range of fields to come together to discuss strategies designed for the 21st century and beyond. The speakers and discussants covered a broad range of subjects including: long-term policy analysis, forecasting for business and investment, the National Intelligence Council Global Trends 2020 report, Europe’s transition from the Marshal plan to the EU, forecasting global transitions, foreign policy planning, and forecasting for defense

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

A multi-centre, UK based, non-inferiority randomised controlled trial of 4 follow up assessment methods in Stroke Survivors

Background Recovery following a stroke is a long and ongoing process. Post stroke follow up after leaving hospital is recommended. Methods for follow up patients include face to face, via the telephone, post or online (internet). However, there is debate which method is preferred by patients. This study aimed to determine whether: telephone interview; online questionnaire; and postal questionnaire, were as acceptable as face-to-face follow up. Methods In a blinded, UK wide, multi-centre, Zelen’s designed, 4-arm (postal, online, telephone, compared to face-to-face), pragmatic non-inferiority randomised controlled trial of the mode of administration. Stroke survivors were randomised to: postal, online, telephone, and face-to-face assessment, in an equal ratio (1:1:1:1). The primary outcome was the proportion of participants that responded to the three allocation groups, compared to the face-to-face group. Subgroup analyses for: age; aphasia; type and severity of stroke were carried out. A non-inferiority margin of 0.025 was used, and Holm-Bonferroni multiplicity adjustment was made.ResultsOf the 2,074 eligible patients randomised, 55% were male (1142/2074), with an average age of 73.0 years old (SD=13.2). Of those randomised, 22% (116/525), 9% (47/515), and 20% (101/513) responded in postal, online and telephone, compared to 17% (89/521) in the face-to-face group. The reduction in the online response rate compared to face-to-face was found to be both inferior and not non-inferior, and estimated as an 8% reduction (95% CI 3.9% to 12.0%; p<0.001). The association with lower online completion was present regardless of age, stroke type (haemorrhage or infarct) and stroke severity. In haemorrhagic stroke the reduction in response online, compared to face-to-face, was 21% (95% CI 10% to 32%; p-value=0.002). A secondary analysis found non-aphasic stroke survivors preferred postal completion adjusted odds ratio of 1.43 (95%CI 1.04 to 1.95; p=0.026). Conclusions The study found that fewer stroke survivors completed follow up assessment using an online method, compared to face-to-face. This finding was present in all age groups. Caution should be employed when considering online follow up methods in stroke survivors, particularly in those who have experienced a cerebrovascular haemorrhage

Plant root distributions and nitrogen uptake predicted by a hypothesis of optimal root foraging

CO2-enrichment experiments consistently show that rooting depth increases when trees are grown at elevated CO2 (eCO2), leading in some experiments to increased capture of available soil nitrogen (N) from deeper soil. However, the link between N uptake an

Variation in performance on common content items at UK medical schools

Background: Due to differing assessment systems across UK medical schools, making meaningful cross-school comparisons on undergraduate students’ performance in knowledge tests is difficult. Ahead of the introduction of a national licensing assessment in the UK, we evaluate schools’ performances on a shared pool of “common content” knowledge test items to compare candidates at different schools and evaluate whether they would pass under different standard setting regimes. Such information can then help develop a cross-school consensus on standard setting shared content. Methods: We undertook a cross-sectional study in the academic sessions 2016-17 and 2017-18. Sixty “best of five” multiple choice ‘common content’ items were delivered each year, with five used in both years. In 2016-17 30 (of 31 eligible) medical schools undertook a mean of 52.6 items with 7,177 participants. In 2017-18 the same 30 medical schools undertook a mean of 52.8 items with 7,165 participants, creating a full sample of 14,342 medical students sitting common content prior to graduation. Using mean scores, we compared performance across items and carried out a “like-for-like” comparison of schools who used the same set of items then modelled the impact of different passing standards on these schools. Results: Schools varied substantially on candidate total score. Schools differed in their performance with large (Cohen’s d around 1) effects. A passing standard that would see 5 % of candidates at high scoring schools fail left low-scoring schools with fail rates of up to 40 %, whereas a passing standard that would see 5 % of candidates at low scoring schools fail would see virtually no candidates from high scoring schools fail. Conclusions: Candidates at different schools exhibited significant differences in scores in two separate sittings. Performance varied by enough that standards that produce realistic fail rates in one medical school may produce substantially different pass rates in other medical schools – despite identical content and the candidates being governed by the same regulator. Regardless of which hypothetical standards are “correct” as judged by experts, large institutional differences in pass rates must be explored and understood by medical educators before shared standards are applied. The study results can assist cross-school groups in developing a consensus on standard setting future licensing assessment

Acceptability of the method of administration of a patient-reported outcome measure (PROM) with stroke survivors, a randomised controlled trial protocol

Background: UK-wide national clinical guidelines promote routine 6-month post-stroke follow-up assessment. However, as part of this 6-month assessment little information is gathered from the patient’s perspective. The means of collecting this patient-centred information might be served best by a patient-reported outcome measure (PROM) at the 6-month assessment time point. Currently, four different methods of 6-month follow-up assessment occur; the most common being face-to-face interview followed by telephone interview, postal questionnaire and online questionnaire. Therefore, this study will investigate if the acceptability of telephone, online or postal administration of a PROM at the 6-month post-stoke time point is not inferior to face-to-face administration. Methods/design: A UK multicentre, blinded (analyst and researcher), pragmatic, non-inferiority study, with 80% power using a 2.5% non-inferiority margin was designed to compare the acceptability of three modes of administration (telephone interview, postal questionnaire and online questionnaire) compared with face-to-face interview administration of a PROM. We plan to approach and randomise a minimum of 808 potentially eligible participants, 202 participants per group. Discussion: The aim of this ongoing research is to understand if there is a difference between face-to-face administration and the other three methods of administering a PROM as a patient-centred supplement to the 6-month review for stroke survivors. In utilising a pragmatic design, it is believed that this study will offer UK wide generalisable results, of the acceptability of the methods under investigation, to inform clinicians and commissioners of stroke services