Correlation of Ocular Plane-Wave Doppler With Optical Coherence Tomography Angiography in Preeclampsia.

OBJECTIVES: Preeclampsia (PE) is a severe complication of pregnancy characterized by hypertension, proteinuria and compromised fetal blood supply. The eye, like other end organs, is affected by this systemic condition, but unlike in other organs, ocular media transparency allows high-resolution optical visualization of the vascular structure of the retina. Our aim was to assess how ultrasound-determined ocular blood-flow correlates with vascular structure of the retina and choriocapillaris determined by optical coherence tomography angiography (OCTA). METHODS: Plane-wave ultrasound and OCTA were performed on both eyes of 40 consecutive subjects consisting of normal controls (n = 11), mild PE (n = 5), severe PE (n = 17) and chronic or gestational hypertension (n = 7) within 72 hours following delivery. From ultrasound, we measured pulsatile flow velocity and resistance indices in the central retinal artery (CRA) and vein, the short posterior ciliary arteries (SPCAs) and choroid. From OCTA, we measured vascular density (VD) in the superficial, deep retina and choriocapillaris. We determined differences in Doppler and OCTA parameters among groups and correlations between ultrasound and OCTA. RESULTS: In severe PE, flow resistance was reduced with respect to controls. Flow velocity and resistance in the and SPCA were moderately correlated with VD in the choriocapillaris and peripapillary retina, but VD in PE did not differ significantly from controls. CONCLUSIONS: Although OCTA parameters were moderately correlated with Doppler ultrasound, OCTA did not demonstrate significant differences between PE and controls postpartum.

International development of a patient-centered core outcome set for assessing health-related quality of life in metastatic breast cancer patients.

PURPOSE: For patients living with metastatic breast cancer (MBC), achieving best possible health-related quality of life, along with maximizing survival, is vital. Yet, we have no systemic way to determine if we achieve these goals. A Core Outcome Set (COS) that allows standardized measurement of outcomes important to patients, but also promotes discussing these outcomes during clinical encounters, is long overdue. METHODS: An international expert group (EG) of patient advocates, researchers, medical specialists, nurse specialists, and pharmaceutical industry representatives (n = 17) reviewed a list of relevant outcomes retrieved from the literature. A broader group (n = 141: patients/patient advocates (n = 45), health care professionals/researchers (n = 64), pharmaceutical industry representatives (n = 28), and health authority representatives (n = 4)) participated in a modified Delphi procedure, scoring the relevance of outcomes in two survey rounds. The EG finalized the COS in a consensus meeting. RESULTS: The final MBC COS includes 101 variables about: (1) health-related quality of life (HRQoL, n = 26) and adverse events (n = 24); (2) baseline patient characteristics (n = 9); and (3) clinical variables (n = 42). Many outcome that cover aspects of HRQoL relevant to MBC patients are included, e.g. daily functioning (including ability to work), psychosocial/emotional functioning, sexual functioning, and relationship with the medical team. CONCLUSION: The COS developed in this study contains important administrative data, clinical records, and clinician-reported measures that captures the impact of cancer. The COS is important for standardization of clinical research and implementation in daily practice and has received accreditation by the International Consortium for Health Outcomes Measurement (ICHOM).

Efficacy of Preoperative Risk Stratification on Resident Phacoemulsification Surgeries.

Purpose: To evaluate efficacy of a novel risk stratification system in minimizing resident surgical complications and to evaluate whether the system could be used to safely introduce cataract surgery to earlier levels of training. Materials and Methods: This is a retrospective cross-sectional study on 530 non-consecutive cataract cases performed by residents at Columbia University. Risk scores, preoperative best corrected visual acuity (BCVA), intraoperative complications, postoperative day 1 (POD1), and month 1 (POM1) exam findings were tabulated. The relationship between risk scores and POD1 and POM1 BCVA was modeled using linear regression. The relationship between risk scores and complication rates was modeled using logistic regression. Logistic regression was used to model the rates of complications across different levels of training. Rates of complications were compared between diabetic versus non-diabetic patients using t-tests. Results: Risk scores did not have significant association with intraoperative complications. Risk scores were predictive of corneal edema (OR = 1.36, p = 0.0032) and having any POM1 complication (OR = 1.20, p = 0.034). Risk scores were predictive of POD1 (ß = 0.13, p < 0.0001) and POM1 (ß = 0.057, p = 0.00048) visual acuity. There was no significant association between level of training and rates of intraoperative (p = 0.9) or postoperative complications (p = 0.06). Rates of intraoperative complication trended higher among diabetic patients but was not statistically significant (p = 0.2). Conclusion: Higher risk scores were predictive of prolonged corneal edema but not risk of intraoperative complications. Our risk stratification system allowed us to safely introduce earlier phacoemulsification surgery.

Glaucomatous Visual Field Progression in the African Descent and Glaucoma Evaluation Study (ADAGES): Eleven Years of Follow-up.

PURPOSE: To compare the rates of visual field (VF) progression between individuals of Black and White race and to investigate whether treatment effects may help explain differences previously reported between racial groups. DESIGN: Multicenter prospective observational cohort study. METHODS: Participants were patients in referral tertiary care glaucoma clinics with open angle glaucoma. Eyes were excluded who had <5 VF tests and <2 years of follow-up or any disease that could affect the optic nerve or the VF. The VF mean deviation (MD) slopes over time (dB/y) were calculated with linear regression models. Socioeconomic variables, rates of glaucoma surgery, medications, treated intraocular pressure (IOP), and central corneal thickness (CCT) were investigated. RESULTS: A total of 516 eyes were included with a mean (95% CI) follow-up time of 11.0 (range, 10.5-11.5) years and 15.0 (range, 14.1-15.8) visits. Participants of Black race were significantly younger (59.7 vs 66.9 years, P < .01) than those of White race. The mean CCT and socioeconomic variables were similar between Black and White groups (P = 0.20 and P = .56, respectively), as were treatment with topical medications (P = .90) and the rate of VF MD change (-0.24 [-0.31 to -0.17] dB/year vs -0.32 [-0.36 to -0.27], P = .11), despite higher treated mean IOP (14.9 [14.5 to 15.4] vs 14.0 [13.6 to 14.4] mm Hg, P = .03) and fewer trabeculectomies (29.5% vs 50.0%, P < .01) in the Black race group. CONCLUSIONS: Rates of VF progression were similar despite higher treated IOP in the Black race group. Mitigation of health access disparities in this study may have equalized previously reported different rates of VF progression between racial groups.

Globe Subluxation After Proning in a Coronavirus Disease 2019 Patient.

A 79-year-old male was hospitalized for respiratory failure secondary to coronavirus disease 2019 pneumonia. Approximately 6 hours after initiating proning, left globe subluxation with darkening of the superior sclera consistent with tache noir was noted. The left globe was thought to be hypotonus secondary to ciliary body shut down after a prolonged period of high intraocular pressure. The globe was reduced in the supine position with gentle traction of the eyelids. Over the next 24 hours, the left intraocular pressure improved to 10 mm Hg, and the tache-noir de la sclérotique resolved. The authors report the first known case of globe subluxation secondary to proning.

Patient Concerns Regarding Suspended Ophthalmic Care Due to COVID-19.

PURPOSE: The temporary cessation and profound changes in ophthalmic care delivery that occurred as a result of the coronavirus disease 2019 (COVID-19) pandemic have yet to be fully understood. Our objective is to assess patients' self-reported impact of health care lockdown measures on their fears and anxieties during the crisis period of the COVID-19 pandemic in New York City. METHODS: We conducted a digital, self-reported, patient care survey distributed by an e-mail at Columbia University's Department of Ophthalmology outpatient faculty practice. Inclusion criteria were age greater than or equal to 18 years, a diagnosis of either retinal disease or glaucoma, and a canceled or rescheduled ophthalmology established patient appointment during the acute phase of the COVID-19 pandemic in New York City. Patients without an e-mail address listed in their electronic medical records were excluded. The survey occurred between March 2, 2020, to May 30, 2020. Primary measures were survey responses to assess key areas of patient anxiety or concern during the pandemic including the safety of care delivery in a COVID pandemic, difficulties contacting or being seen by their ophthalmologist, concern of vision loss or disease progression, and concern over missed or access to treatments. Secondary measures were correlating survey response to factors such as visual acuity, intraocular pressure, diagnosis, disease severity, follow-up urgency, recent treatments, and diagnostic testing data. RESULTS: Of the 2594 surveys sent out, 510 (19.66%) were completed. Over 95% of patients were at least as concerned as in normal circumstances about their ocular health during the peak of the pandemic. Overall, 76% of respondents were more concerned than normal that they could not be seen by their ophthalmologist soon enough. Increased concern over ocular health, disease progression, and access to care all showed positive correlations (P<0.05) with worse disease severity as measured with testing such as visual fields and optical coherence tomography. In addition, 55% of patients were afraid of contracting COVID-19 during an office visit. CONCLUSION AND RELEVANCE: We found a majority of our patients were concerned about limitations in access to ophthalmic care and were fearful of disease progression. In addition, we found a number of demographic and clinical factors that correlated with increased anxiety in our patients.

Recombinant HIV-1 vaccine candidates based on replication-defective flavivirus vector.

Multiple approaches utilizing viral and DNA vectors have shown promise in the development of an effective vaccine against HIV. In this study, an alternative replication-defective flavivirus vector, RepliVax (RV), was evaluated for the delivery of HIV-1 immunogens. Recombinant RV-HIV viruses were engineered to stably express clade C virus Gag and Env (gp120TM) proteins and propagated in Vero helper cells. RV-based vectors enabled efficient expression and correct maturation of Gag and gp120TM proteins, were apathogenic in a sensitive suckling mouse neurovirulence test, and were similar in immunogenicity to recombinant poxvirus NYVAC-HIV vectors in homologous or heterologous prime-boost combinations in mice. In a pilot NHP study, immunogenicity of RV-HIV viruses used as a prime or boost for DNA or NYVAC candidates was compared to a DNA prime/NYVAC boost benchmark scheme when administered together with adjuvanted gp120 protein. Similar neutralizing antibody titers, binding IgG titers measured against a broad panel of Env and Gag antigens, and ADCC responses were observed in the groups throughout the course of the study, and T cell responses were elicited. The entire data demonstrate that RV vectors have the potential as novel HIV-1 vaccine components for use in combination with other promising candidates to develop new effective vaccination strategies.

Diastereoselectivity in the boron aldol reaction of α-alkoxy and α,ß-bis-alkoxy methyl ketones.

In this work, using DFT calculations, we investigated the 1,4 and 1,5 asymmetric induction in boron enolate aldol reactions of α-alkoxy and α,ß-bisalkoxy methyl ketones. We evaluated the steric influence of alkyl substituents at the α position and the stereoelectronic influence of the oxygen protecting groups at the α and ß positions. Theoretical calculations revealed the origins of the 1,4 asymmetric induction in terms of the nature of the ß-substituent. The synergistic effect between the α,ß-syn and α,ß-anti-bisalkoxy stereocenters was elucidated. In the presence of the ß-alkoxy center, the reaction proceeds through the Goodman-Paton 1,5-stereoinduction model, experiencing a minor influence of the α-alkoxy center.

Health care experiences among women diagnosed with gestational breast cancer.

Gestational breast cancer (GBC) presents many challenges for women and the clinicians who care for them. The aim of this study was to explore the health care experiences of women diagnosed with GBC to inform and improve clinical care of women in this predicament. Semi-structured interviews were conducted with 17 women who had been diagnosed with GBC in the previous 5 years. The overarching themes for perceived quality of care were "communication" and "comprehensive care." "Communication" had two sub themes: "interdisciplinary communication" (the way health professionals from different disciplines communicated with each other about the management of the woman's care) and "patient communication" (how they communicated this to the woman). The "comprehensive care" theme incorporated three sub themes: "the spirit" (psychological care); "the mind" (information provision); and "the body" (management of treatment side effects). Women's own accounts of positive and negative experiences of GBC care provide unique and specific insights which improve understanding of their concerns and needs. The findings can inform advances in quality and efficacy of clinical care; offer guidance for obstetricians, oncologists and allied health professionals about the needs of women diagnosed with GBC and how care can be optimised; and inform the development of resources to assist women and their families.

Rate of positive diagnosis of skin cancer and its stage in two-week wait referrals in England according to age.

BACKGROUND: The incidence of skin cancer is increasing. The two-week wait conversion rate (TWWCR) is the percentage of urgent suspected skin cancer referrals that are confirmed as cancer. AIMS: To examine the relationships between different epidemiological factors and TWWCR for malignant melanoma (MM) and cutaneous squamous cell carcinoma (SCC). METHODS: We extracted data from the National Cancer Data Repository (NCDR) and National Cancer Waiting Times Monitoring Dataset between 2009 and 2010 for MM and SCC in England. We conducted partial correlation and stepwise multiple regression analysis on TWWCR, age, incidence, detection rate, tumour thickness (MM only), percentage MM/SCC and social deprivation. We also looked at the two-week wait referral rate (TWWRR) and incidence rate with respect to age. RESULTS: TWWCR was significantly correlated with age when partial correlation was used to control for the factors described above for MM (P < 0.05) and SCC (P < 0.001). Stepwise regression of these factors returned only age as significant in the final model for MM (P < 0.001) and SCC (P < 0.01). Incidence of MM and SCC increased with age. TWWRR also increase with age, but with higher rate in younger people relative to their incidence. CONCLUSIONS: Age is a predictor of TWWCR independent of the other factors measured, including thickness and incidence. This may be explained by the higher number of referrals for younger patients despite the lower incidence of skin cancer in this group. This may reflect a more appropriate rate of referral in order to achieve earlier diagnosis and better outcomes.

Detection of Salmonella enterica Serovar Montevideo and Newport in Free-ranging Sea Turtles and Beach Sand in the Caribbean and Persistence in Sand and Seawater Microcosms.

Salmonellae are Gram-negative zoonotic bacteria that are frequently part of the normal reptilian gastrointestinal flora. The main objective of this project was to estimate the prevalence of non-typhoidal Salmonella enterica in the nesting and foraging populations of sea turtles on St. Kitts and in sand from known nesting beaches. Results suggest a higher prevalence of Salmonella in nesting leatherback sea turtles compared with foraging green and hawksbill sea turtles. Salmonella was cultured from 2/9 and identified by molecular diagnostic methods in 3/9 leatherback sea turtle samples. Salmonella DNA was detected in one hawksbill turtle, but viable isolates were not recovered from any hawksbill sea turtles. No Salmonella was detected in green sea turtles. In samples collected from nesting beaches, Salmonella was only recovered from a single dry sand sample. All recovered isolates were positive for the wzx gene, consistent with the O:7 serogroup. Further serotyping characterized serovars Montevideo and Newport present in cloacal and sand samples. Repetitive-element palindromic PCR (rep-PCR) fingerprint analysis and pulsed-field gel electrophoresis of the 2014 isolates from turtles and sand as well as archived Salmonella isolates recovered from leatherback sea turtles in 2012 and 2013, identified two distinct genotypes and four different pulsotypes, respectively. The genotyping and serotyping were directly correlated. To determine the persistence of representative strains of each serotype/genotype in these environments, laboratory-controlled microcosm studies were performed in water and sand (dry and wet) incubated at 25 or 35°C. Isolates persisted for at least 32 days in most microcosms, although there were significant decreases in culturable bacteria in several microcosms, with the greatest reduction in dry sand incubated at 35°C. This information provides a better understanding of the epizootiology of Salmonella in free-ranging marine reptiles and the potential public health risks associated with human interactions with these animals in the Caribbean.

Rapid declines of large mammal populations after the collapse of the Soviet Union.

Anecdotal evidence suggests that socioeconomic shocks strongly affect wildlife populations, but quantitative evidence is sparse. The collapse of socialism in Russia in 1991 caused a major socioeconomic shock, including a sharp increase in poverty. We analyzed population trends of 8 large mammals in Russia from 1981 to 2010 (i.e., before and after the collapse). We hypothesized that the collapse would first cause population declines, primarily due to overexploitation, and then population increases due to adaptation of wildlife to new environments following the collapse. The long-term Database of the Russian Federal Agency of Game Mammal Monitoring, consisting of up to 50,000 transects that are monitored annually, provided an exceptional data set for investigating these population trends. Three species showed strong declines in population growth rates in the decade following the collapse, while grey wolf (Canis lupus) increased by more than 150%. After 2000 some trends reversed. For example, roe deer (Capreolus spp.) abundance in 2010 was the highest of any period in our study. Likely reasons for the population declines in the 1990s include poaching and the erosion of wildlife protection enforcement. The rapid increase of the grey wolf populations is likely due to the cessation of governmental population control. In general, the widespread declines in wildlife populations after the collapse of the Soviet Union highlight the magnitude of the effects that socioeconomic shocks can have on wildlife populations and the possible need for special conservation efforts during such times.

Interactions between conventional and organic farming for biocontrol services across the landscape.

While the area of organic crop production increases at a global scale, the potential interactions between pest management in organic and conventionally managed systems have so far received little attention. Here, we evaluate the landscape-level codependence of insecticide-based and natural enemy-based pest management using a simulation model for parasitoid-host interactions in landscapes consisting of conventionally and organically managed fields. In our simulations conventional management consists of broad-spectrum or selective insecticide application, while organic management involves no insecticides. Simulations indicate that insecticide use can easily result in lose-lose scenarios whereby both organically and conventionally managed fields suffer from increased pest loads as compared to a scenario where no insecticides are used, but that under some conditions insecticide use can be compatible with biocontrol. Simulations also suggest that the pathway to achieve the insecticide reduction without triggering additional pest pressure is not straightforward, because increasing the proportion of organically managed fields or reducing the spray frequency in conventional fields can potentially give rise to dramatic increases in pest load. The disruptive effect of insecticide use, however, can be mitigated by spatially clustering organic fields and using selective insecticides, although the effectiveness of this mitigation depends on the behavioral traits of the biocontrol agents. Poorly dispersing parasitoids and parasitoids with high attack rates required a lower amount of organically managed fields for effective pest suppression. Our findings show that the transition from a landscape dominated by conventionally managed crops to organic management has potential pitfalls; intermediate levels of organic management may lead to higher pest burdens than either low or high adoption of organic management.

Emergency presentation of cancer and short-term mortality.

BACKGROUND: The short-term survival following a cancer diagnosis in England is lower than that in comparable countries, with the difference in excess mortality primarily occurring in the months immediately after diagnosis. We assess the impact of emergency presentation (EP) on the excess mortality in England over the course of the year following diagnosis. METHODS: All colorectal and cervical cancers presenting in England and all breast, lung, and prostate cancers in the East of England in 2006-2008 are included. The variation in the likelihood of EP with age, stage, sex, co-morbidity, and income deprivation is modelled. The excess mortality over 0-1, 1-3, 3-6, and 6-12 months after diagnosis and its dependence on these case-mix factors and presentation route is then examined. RESULTS: More advanced stage and older age are predictive of EP, as to a lesser extent are co-morbidity, higher income deprivation, and female sex. In the first month after diagnosis, we observe case-mix-adjusted excess mortality rate ratios of 7.5 (cervical), 5.9 (colorectal), 11.7 (breast ), 4.0 (lung), and 20.8 (prostate) for EP compared with non-EP. CONCLUSION: Individuals who present as an emergency experience high short-term mortality in all cancer types examined compared with non-EPs. This is partly a case-mix effect but EP remains predictive of short-term mortality even when age, stage, and co-morbidity are accounted for.

High incidence of skin cancer in the Channel Islands.

BACKGROUND: Previous studies looking at rates of malignant melanoma (MM) and nonmelanoma skin cancer (NMSC) in the UK have documented one of the highest rates in the southwest of England; however, the incidence of these tumours in Guernsey and Jersey, two of the Channel Islands, has not previously been reported. AIMS: To determine the incidence of cutaneous MM and NMSC in the Channel Islands. METHODS: Data for the period 2005-2009 were obtained from clinical and histopathological records for all MMs excised in the Channel Islands, and from the South-west Cancer Registry for MMs excised in the southwest of England and for NMSCs in both areas. The age-standardized incidence rate (ASRs) per 100,000 of the population in the Channel Islands were compared with those with the southwest of England, the UK and the rest of Europe where available. The MM characteristics of the Channel Islands were then compared with the southwest of England using standardized incidence ratios (SIRs). RESULTS: The ASR/100,000 for cutaneous MM for 2005-2009 was 30 for the Channel Islands (31.3 for Jersey, 28.2 for Guernsey), 20.3 for the southwest of England, and 15.6 for the UK. Comparison with the rest of Europe indicated that the incidence of MM in the Channel Islands is one of the highest in Europe. The highest incidence of MM was in the over 65 years age group on both Guernsey and Jersey, and when divided into 5-year age bands, the 70-74 years age group had the highest rate. This suggests that this particular age group may have previously received greater exposure to some environmental factor that promotes MM development. The ASR/100,000 for NMSC was also higher for the Channel Islands (263.3) than for the southwest of England (174.6) for 2005-2009, and for the UK in 2009 (104.9). CONCLUSIONS: This study indicates that the Channel Islands have a high incidence of skin cancer (both MM and NMSC). In addition, the data show that the ASRs in older people in this population group differ from those in mainland UK, showing higher rates in the over 65 years age group.

Routes to diagnosis for cancer - determining the patient journey using multiple routine data sets.

BACKGROUND: Cancer survival in England is lower than the European average, which has been at least partly attributed to later stage at diagnosis in English patients. There are substantial regional and demographic variations in cancer survival across England. The majority of patients are diagnosed following symptomatic or incidental presentation. This study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised to examine demographic, organisational, service and personal reasons for delayed diagnosis. METHODS: Administrative Hospital Episode Statistics data are linked with Cancer Waiting Times data, data from the cancer screening programmes and cancer registration data. Using these data sets, every case of cancer registered in England, which was diagnosed in 2006-2008, is categorised into one of eight 'Routes to Diagnosis'. RESULTS: Different cancer types show substantial differences between the proportion of cases that present by each route, in reasonable agreement with previous clinical studies. Patients presenting via Emergency routes have substantially lower 1-year relative survival. CONCLUSION: Linked cancer registration and administrative data can be used to robustly categorise the route to a cancer diagnosis for all patients. These categories can be used to enhance understanding of and explore possible reasons for delayed diagnosis.

The experience of pregnancy and early motherhood in women diagnosed with gestational breast cancer.

OBJECTIVE: To explore the psychosocial experiences of pregnancy in women diagnosed with breast cancer during or shortly after pregnancy. METHODS: A retrospective qualitative design was employed. Fifteen women who had received a gestational breast cancer (GBC) diagnosis participated in semi- structured interviews. The interviews sought to identify the emotional and social issues related to the experiences of pregnancy and motherhood in women diagnosed with gestational breast cancer. RESULTS: Women diagnosed with GBC experience difficulties in adjusting to two different and conflicting life events; the threat of their breast cancer alongside the news of their pregnancy. They have to make difficult decisions that impact on their own life, the life of their foetus/new baby and that of their existing family. Women who received a GBC diagnosis reported high levels of anxiety and stress, which pervaded their whole GBC experience. Women reported their anxiety was linked to the conflict between the concern for their baby's health and the concern for their own health and wellbeing. CONCLUSIONS: Women diagnosed with GBC attributed different meanings to their experience of pregnancy and motherhood and made choices based on their own beliefs, values and how complete they believed their family was.

Increased incidence of bronchopulmonary fistulas complicating pediatric pneumonia.

BACKGROUND: The frequency of complicated pneumococcal disease, including necrotizing pneumonia, has increased over the last decade. During 2008-2009, we noted an increase in the number of children whose empyema was complicated by the development of a bronchopleural fistula and air leak. We studied these children to see if there was an associated cause. METHODS: This was a retrospective case note and database review of children admitted to our tertiary unit with a parapneumonic effusion or empyema from 2002 to 2007, compared with 2008 to 2009. For the latter period, we also compared the outcomes of those with a bronchopleural fistula to those without. RESULTS: During the 8-year period, 310 children were admitted. In the first 6 years, the frequency of air leaks was 1% (2/258) rising to 33% (16/49) in the last 2 years (P<0.0001). Three children were excluded as their fistulas were possibly iatrogenic. This was associated with a significant increase in median hospital stay (7 vs. 10 days, P<0.0001) and surgical intervention rate (2% vs. 14%, P=0.001). In the latter 2 years, S. pneumoniae serotype 3 was identified in 10/16 (91%) of those with a bronchopleural fistula compared to 1/33 (3%) of those without. CONCLUSIONS: The frequency of bronchopleural fistulas increased markedly in the 2 years 2008-2009. Although these cases were associated with pneumococcal serotype 3 infection, which was not covered by the heptavalent pneumococcal vaccine Prevenar® in use at that time, we do not know whether the increased incidence of fistulas was due to a change in serotype 3 prevalence.

Orbital solitary fibrous tumor: encompassing terminology for hemangiopericytoma, giant cell angiofibroma, and fibrous histiocytoma of the orbit: reappraisal of 41 cases.

Hemangiopericytomas and solitary fibrous tumors are uncommon neoplasms found in many locations, including the orbit. Both mesenchymal neoplasms share several clinicopathologic features, thus prompting intense debate as to whether they are variants of the same entity or merit separate designations in the orbit. These 2 entities, with the addition of giant cell angiofibroma of orbit, are of benign- to uncertain-behavior, CD34-positive, collagen-rich, specialized fibroblastic tumors, which may have overlapping or histologically identical features. In addition, so-called fibrous histiocytoma of orbit, a previous designation, has overlapping morphologic features with these tumors. To date, a large series of these collagen-rich fibroblastic tumors of the orbit has not been fully explored. Forty-one fibroblastic orbital tumors, originally diagnosed as hemangiopericytomas (n = 16), fibrous histiocytomas (n = 9), mixed tumors (hemangiopericytomas/fibrous histiocytoma) (n = 14), and giant cell angiofibromas of orbit (n = 2) between 1970 and 2009, were retrieved from our consultation files, the Ophthalmic Registry, at the Armed Forces Institute of Pathology. Slides and clinical records were reviewed, analyzed, and compared. Immunochemistry was performed for CD34, CD99, Bcl-2, Ki-67, and p53. Upon histologic review, all cases were reclassified as solitary fibrous tumor (41/41). The patients included 23 (56%) males, 17 (41%) females, and 1 unknown, with a mean age at presentation of 40.7 years (range, 16-70 years). The sites of involvement were the right orbit in 18 (44%) cases and the left in 16 (39%) cases. Tumors ranged in size from 0.4 to 5.0 cm (mean, 2.2 cm). Seventeen (41%) patients presented with an orbital mass, 8 (20%) with proptosis, 2 (5%) with painful mass, and 2 (5%) with painless mass. Duration of symptoms ranged from 3 to 96 months, with a mean of 23 months (median, 9 months). Microscopically, all lesions showed considerable similarity, varying in degree of cellularity, stromal collagen, and the presence of giant cells. Overlapping features with soft tissue giant cell fibroblastoma were observed. Immunochemistry revealed positivity for CD34 in all cases (100%), p53 in 85%, CD99 in 67.5%, and Bcl-2 in 47.5%. Although Ki-67 labeling was seen in all cases, it ranged from less than 1% in 54.3% of cases to 5% to 10% in 20% of cases. Taken together, the findings of this study suggest that orbital hemangiopericytoma and some cases previously designated as fibrous histiocytoma, giant cell angiofibroma of orbit, and solitary fibrous tumor have overlapping morphologic and immunohistochemical features and should be designated as solitary fibrous tumor. Adipocytes and unusual multivacuolated adipocytic cells may be present in these tumors, as well stromal myxoid change; and even stromal intramembranous ossification can be observed. There are overlapping features of orbital solitary fibrous tumor with another CD34-positive specialized fibroblastic tumor of soft tissue, giant cell fibroblastoma. Morphologic criteria for uncertain behavior to low-grade malignant ocular solitary fibrous tumors can be made by cytologic atypia and increased mitotic activity, but overall outcome for malignant solitary fibrous tumors of the eye should be further explored.

Why do stigmas move in a flexistylous plant?

Flexistyly is a recently documented stylar polymorphism involving both spatial and temporal segregation of sex roles within hermaphroditic flowers. Using the experimental manipulation of stigma movement in self-compatible Alpinia mutica, we tested the hypothesis that selection for reducing interference between male and female function drives the evolution and/or maintenance of stigma movement. In experimental arrays, anaflexistylous (protogynous) flowers served as pollen donors competing for mating opportunities on cataflexistylous (protandrous) flowers. The pollen donors were either manipulated so their stigmas could not move or were left intact, and their success was determined using allozymes to assess the paternity of recipient seeds. We found that manipulated flowers sired a significantly smaller proportion of seeds, showing that stigma movement in unmanipulated plants increased male fitness. This result was strongest under conditions in which pollen competition was expected to be highest, specifically when pollinators visited multiple donor plants before visiting recipient flowers.