Persistent hypersomnia following repetitive mild experimental traumatic brain injury: Roles of chronic stress and sex differences.

Traumatic brain injury (TBI) is often more complicated than a single head injury. An extreme example of this point may be military service members who experience a spectrum of exposures over a prolonged period under stressful conditions. Understanding the effects of complex exposures can inform evaluation and care to prevent persistent symptoms. We designed a longitudinal series of non-invasive procedures in adult mice to evaluate the effects of prolonged mild stress and head injury exposures. We assessed anxiety, depression, and sleep-wake dysfunction as symptoms that impact long-term outcomes after mild TBI. Unpredictable chronic mild stress (UCMS) was generated from a varied sequence of environmental stressors distributed within each of 21 days. Subsequently, mice received a mild blast combined with closed-head mild TBI on 5 days at 24-h intervals. In males and females, UCMS induced anxiety without depressive behavior. A major finding was reproducible sleep-wake dysfunction through 6- to 12-month time points in male mice that received UCMS with repetitive blast plus TBI events, or surprisingly after just UCMS alone. Specifically, male mice exhibited hypersomnia with increased sleep during the active/dark phase and fragmentation of longer wake bouts. Sleep-wake dysfunction was not found with TBI events alone, and hypersomnia was not found in females under any conditions. These results identify prolonged stress and sex differences as important considerations for sleep-wake dysfunction. Furthermore, this reproducible hypersomnia with impaired wakefulness is similar to the excessive daytime sleepiness reported in patients, including patients with TBI, which warrants further clinical screening, care, and treatment development.

Carcinoma anaplasico de tiroides: citomorfologia e importancia clinica de la biopsia por aspiración / Anaplastic thyroid carcinoma: cytomorphology and clinical significance of aspiration biopsy

El carcinoma anaplásico de tiroides (CAT) constituye el 3% de los tumores tiroideos y el 8 a 10% de todas las neoplasias malignas de tiroides. El CAT es usualmente visto en adultos mayores y tiene predilección por el sexo femenino. Su curso clínico es agresivo, con pobre pronóstico.; la mayoría de pacientes fallecen dentro del primer año de diagnóstico. En el Instituto Regional de Enfermedades Neoplásicas (IREN ûNorte) se diagnosticaron tres casos de carcinoma anáplasico de tiroides de un total de 31 aspirados hechos durante el año 2009 Todas las pacientes fueron mujeres, con un promedio de edad de 61 años, que presentaron masa cervical, indolora, de crecimiento progresivo Citologicamente las neoplasias se caracterizaron por la presencia de células gigantes, pleomórficas con múltiples núcleos y prominentes nucléolos. Una presentó asociación con neoplasia papilar. Dos citologías se informaron como carcinoma anáplasico y una como sugestiva de carcinoma. En este último caso se realizo la tiroidectomia. Los tres pacientes fallecieron al poco tiempo del diagnóstico. En el examen histológico se identificaron los mismos elementos morfológicos del estudio citológico, lo que indica que en el algoritmo diagnóstico de esta neoplasia la biopsia aspiración aguja fina es importante y no requiere de la confirmación histológica.

Anaplastic thyroid carcinoma (ATC) accounts for 3% of thyroid tumors and 8 to 10% of all thyroid malignancies. The ATC is usually seen in older adults and has a predilection for females. Its clinical course is aggressive with poor prognosis. Most patients die within the first year of diagnosis. In the North-Regional Institute of Neoplastic Diseases (IREN) were diagnosed three cases of anaplastic thyroid carcinoma in a total of 31 aspirates made during 2009. All patients were women, with an average age of 61 years old, who had mass cervical, painless, progressively growing. Cytologically this disease characterized by the presence of giant cells, pleomorphic or spindle-shaped with multiple nuclei and prominent nucleoli. One presented association with papillary neoplasm Two smears were reported as anaplastic carcinoma and one as suggestive of carcinoma. In the latter case was performed thyroidectomy. The three patients died soon after diagnosis. Histologic examination identified the same elements morphological cytology, indicating that the diagnostic algorithm of this tumor fine needle aspiration biopsy is important and does not requires histological confirmation.