A magnetar giant flare in the nearby starburst galaxy M82.

Magnetar giant flares are rare explosive events releasing up to 1047 erg in gamma rays in less than 1 second from young neutron stars with magnetic fields up to 1015-16 G (refs. 1,2). Only three such flares have been seen from magnetars in our Galaxy3,4 and in the Large Magellanic Cloud5 in roughly 50 years. This small sample can be enlarged by the discovery of extragalactic events, as for a fraction of a second giant flares reach luminosities above 1046 erg s-1, which makes them visible up to a few tens of megaparsecs. However, at these distances they are difficult to distinguish from short gamma-ray bursts (GRBs); much more distant and energetic (1050-53 erg) events, originating in compact binary mergers6. A few short GRBs have been proposed7-11, with different amounts of confidence, as candidate giant magnetar flares in nearby galaxies. Here we report observations of GRB 231115A, positionally coincident with the starburst galaxy M82 (ref. 12). Its spectral properties, along with the length of the burst, the limits on its X-ray and optical counterparts obtained within a few hours, and the lack of a gravitational wave signal, unambiguously qualify this burst as a giant flare from a magnetar in M82.

Plexiform Schwannoma of the Eyelid.

Plexiform schwannoma of the lacrimal gland of the palpebral lobe has not been previously described. This 41-year-old male presented with a 2-year history of a left upper eyelid mass and associated regional irritation. MRI of the head and orbits confirmed a left superolateral multinodular mass centered on the palpebral lobe of the left lacrimal gland. Excision revealed a schwannoma of the plexiform subtype.

Tackling sport-related concussion: effectiveness of lowering the maximum legal height of the tackle in amateur male rugby - a cross-sectional analytical study.

OBJECTIVE: Rugby union ('rugby') is popular globally, with most of its participants being amateur. Concern regarding sport-related concussion (SRC) sustained during rugby is increasing. SRC occurs most frequently in the tackle, yet few interventions have aimed to mitigate this risk factor. This study investigated the influence of a lowered legal tackle height on SRC incidence in amateur rugby. DESIGN: Cross-sectional analytical study: 2018 (control-standard tackle height) and 2019 (intervention-lowered legal tackle height) seasons. SETTING: South African collegiate student rugby competition. PARTICIPANTS: Between 800 and 900 male amateur student players (age: 20±1.6 years) in each year. INTERVENTION: Maximum legal tackle height lowered from line of the shoulder on the ball carrier to the line of the armpit. OUTCOME MEASURES: Number of overall (medical attention) and time-loss (≥1 day lost) injuries, head injuries and SRCs in 2018 and 2019 (dependent variables); events associated with injury incidents (independent variables). RESULTS: There was no statistically significant difference in incidences of time-loss injuries (IRR: 0.79; 95% CI: 0.6 to 1.1; p=0.13), head injuries (IRR: 0.83; 95% CI: 0.5 to 1.3; p=0.42) and SRC (IRR: 0.69; 95% CI: 0.4 to 1.2; p=0.20). In 2018 and 2019, most time-loss head injuries (57%, n=43) and SRCs (55%, n=26) occurred during the tackle. CONCLUSIONS: Despite a trend towards reducing injuries, head injuries and SRC, lowering maximum legal tackle height to armpit level did not change SRC incidence in this amateur male rugby cohort. Most time-loss head injuries and SRCs occurred during the tackle. Further tackle-related interventions to reduce SRC incidence require investigation.

Histopathological Characteristics of Lacrimal Gland Prolapse.

PURPOSE: Lacrimal gland prolapse is an acquired clinical condition that can present as an upper eyelid mass. Patients may undergo lacrimal gland biopsy when there is diagnostic uncertainty. We aim to describe the histopathological features of this patient group. METHODS: Retrospective case series involving 11 patients. RESULTS: The mean age at presentation was 52.3 ± 16.2 years (range: 31-77 years) with 8 patients (72.3%) being female. The most common presenting symptom was a palpable mass (9; 81.8%) followed by dermatochalasis (4; 36.4%). Three cases (27.3%) were bilateral. Common imaging findings include lacrimal gland enlargement and visualization of the prolapse. All biopsies demonstrated features of mild chronic inflammation with preserved glandular structures. Ten patients (90.9%) underwent surgical intervention involving lacrimal gland pexy and 1 patient (9.1%) was elected for observation only. One patient required repeat surgery after 4 years due to recurrence of symptoms. At the last follow-up, all patients had stable disease or complete resolution of symptoms. CONCLUSION: We present a case series of patients diagnosed with lacrimal gland prolapse who underwent a biopsy during their workup. All biopsies demonstrated features of mild chronic inflammation (dacryoadenitis). All patients had stable disease or complete resolution of symptoms. This case series suggests that chronic inflammation is a common finding in patients with lacrimal gland prolapse but bears minimal clinical consequence.

A novel case of recurrent cylindroma of the orbit.

Cylindroma is a rare benign tumour of eccrine origin that has not been previously reported within the orbit. We report a case of a recurrent orbital cylindroma following incomplete excision. A 75-year-old female presented with a recurrent left inferomedial orbital mass. Seven years prior a mass of the same location was excised and on histology at the time resembled a cylindroma. The patient had a history of lung adenocarcinoma. Magnetic resonance imaging (MRI) found the recurrent mass to be a well-circumscribed lesion anterior to the inferior oblique. The mass was subsequently excised. Histological analysis found a well-circumscribed neoplasm with a characteristic jigsaw pattern of nested cells, consistent with cylindroma. This case demonstrates the possibility for cylindromas to occur within the orbit and their ability to reoccur if incompletely excised.

Cutaneous squamous cell carcinoma radiographically mimicking infiltration into the lacrimal gland.

Cutaneous squamous cell carcinoma (SCC) is a common malignancy of the skin, with the potential for local invasion and metastasis. Here, we present a case series of two patients with SCCs, suggesting radiological infiltration of the lacrimal gland on magnetic resonance imaging. However, histopathological examination revealed lymphoplasmacytic infiltration of the lacrimal gland consistent with dacryoadenitis, with no evidence of SCC infiltration. Our cases highlight the potential for peritumoural inflammation to cause dacryoadenitis and radiologically mimic tumour infiltration into the lacrimal gland.

Two cases of granulomatous mycosis fungoides mimicking interstitial granulomatous dermatosis.

Two patients presented with erythematous papules within larger patches and thin plaques. Following biopsies, each case was initially thought to represent interstitial granulomatous dermatitis (IGD); however, clinicopathological correlation led to a diagnosis of granulomatous mycosis fungoides (GMF). Drawing upon the similarities between these cases, this report explores the clinical and histological manifestations of GMF, features distinguishing GMF from other granulomatous diseases like IGD and the prognostic significance of distinguishing GMF from classic mycosis fungoides. This report also shows that despite the potential for histological overlap between GMF and IGD, the existing literature does not reveal an epidemiological or pathophysiological link between these two conditions.

Idiopathic Lipogranulomatous Orbital Inflammation: A Case Report and Literature Review.

A 57-year old woman presented with a 6-month history of a left red eye associated with diplopia. Examination was remarkable for 2 mm left-sided axial proptosis and restriction on left upgaze and abduction associated with diplopia. She had no previous history of trauma or surgery to the face. Magnetic resonance imaging revealed an enhancing infiltrative mass in the left intraconal space. Biopsy of the anterior orbital fat revealed extensive lipogranulomatous inflammation with no abnormalities noted on flow cytometry, culture, or special stains. The patient was managed with a tapering course of oral prednisolone and two 40 mg intraorbital triamcinolone injections resulting in complete resolution of her presenting symptoms. This represents a rare case of idiopathic lipogranulomatous orbital inflammation.

The potential impacts of early secreted antigenic target of 6 kDa of Mycobacterium tuberculosis on KSHV-infected cells.

Kaposi's sarcoma-associated herpesvirus (KSHV) causes several human cancers, including Kaposi's sarcoma (KS) and primary effusion lymphoma, which are mostly seen in immunocompromised patients, such as human immunodefeciency virus (HIV)+ individuals. Tuberculosis (TB), caused by the bacterial pathogen Mycobacterium tuberculosis (Mtb), remains one of the deadliest infectious diseases in the world. The risk of developing TB is dramatically higher in people living with HIV than among those without HIV infection. Case reports link cutaneous or pulmonary KS in HIV+ patients with mycobacterial co-infections, however, impacts of Mtb infection or its products on KSHV-infected cells are not known. We report here that ESAT-6, a secreted Mtb virulence factor, induces viral reactivation from KSHV-infected cells. KSHV-infected pulmonary endothelial cells were resistant to ESAT-6 induced inhibition of cell growth. Our data demonstrate that Mtb virulence factors influence the biology of KSHV-infected cells, highlighting the need to study the interactions between these two pathogens commonly found in people living with HIV.

BokSmart rugby safety education courses are associated with improvements in behavioural determinants in attending coaches and referees: presurvey-postsurvey study.

BACKGROUND/AIM: BokSmart is a nationwide injury prevention programme that aims to reduce players' injury risk mainly through education of coaches and referees in mandatory biennial education courses. These courses are held throughout each rugby season. The objective of this cross-sectional study was to assess whether these courses were associated with improvements in attendees' behavioural determinants. METHODS: Coaches and referees completed a questionnaire based on the theory of planned behaviour, immediately before and after their 2012 BokSmart courses. Twelve behavioural determinants were assessed on a five-point Likert scale and open-ended questions. A meaningful change was defined as an improvement of ≥1 unit score supported by null hypothesis testing. Odds of improving by ≥1 unit score (compared with not improving) were assessed in attendees using multivariate logistic regression. RESULTS: In total, 390 coaches and 74 referees completed both questionnaires. 'Before' scores were high for most outcomes, except for knowledge. Although there was a significant (p<0.001) improvement in all 'after' course scores, the only meaningful change (=1 unit) was in knowledge of scrum techniques/rules. CONCLUSION: Although the only meaningful improvement in 2012 BokSmart course attendees was in one outcome, it should be noted that before-course scores were already high, reducing the questionnaire's ability to assess change because of a ceiling effect. Nonetheless, the knowledge acquisition of these courses was low and not related to previous course attendance or more years of rugby experience. These results justify the biennial nature of this safety course but also indicate that knowledge acquisition is generally low.

Evaluating the Implementation of Injury Prevention Strategies in Rugby Union and League: A Systematic Review using the RE-AIM Framework.

Rugby (union and league) has come under intense scrutiny due to its injury risk. Various interventions have been introduced to protect players from injury, with many deemed efficacious and advocated for use across various worldwide contexts. However, their implementation is less clear. The objective of this systematic review was to determine whether injury prevention interventions in rugby have evaluated their 'reach', 'effectiveness', 'adoption', 'implementation' and 'maintenance' as per the RE-AIM Multi-Dimension Item Checklist. Six electronic databases were searched in November 2019. Inclusion criteria included: English language, peer-reviewed journal article, original research, field-based rugby code, prospective intervention. Of the 4253 studies identified, 74 met the full inclusion criteria. Protective equipment, predominately mouthguards, was the intervention of interest in 44 studies. Other interventions included multimodal national injury prevention programmes, law changes and neuromuscular training programmes. 'Effectiveness' was the highest scoring RE-AIM dimension (55%), followed by 'reach' (26%). All other RE-AIM dimensions scored below 20%. Research currently focuses on determining intervention 'effectiveness'. For injury prevention strategies to have their desired impact, there must be a shift to address all determinants associated with implementation. Consideration should be given to how this can be achieved by adopting specific reporting checklists, research frameworks and study designs.

Cutaneous sebaceous carcinoma.

Cutaneous sebaceous carcinoma occurs almost exclusively on the head and neck and has a significant propensity for recurrence and metastasis. It is easily mistaken for benign conditions, resulting in inappropriate management. Thus, it is important to maintain a high index of suspicion. Despite previous reports, sebaceous carcinoma may occur with similar frequency in Asians and whites. Recent genetic data suggest there are multiple mutational groups of sebaceous carcinoma, paving the way for targeted treatment. After a diagnosis, investigations for staging and for Muir-Torre syndrome should be considered. The available evidence on the treatment options for sebaceous carcinoma is discussed, and specific recommendations for management are made.

Swinging inferior turbinate approach to the nasolacrimal duct.

Purpose: To report a case of a lacrimal sac tumour identified at the time of endoscopic dacryocystorhinostomy and describe a swinging inferior turbinate approach to the nasolacrimal duct (NLD) to facilitate an en-bloc excision of the lacrimal drainage apparatus.Methods: An 88-year-old male presented with a 6-month history of epiphora and mucocele. Endonasal DCR was performed for nasolacrimal duct obstruction (NLDO). Intraoperatively, a biopsy was performed of abnormal appearing lacrimal sac mucosa, following opening of the lacrimal sac. Subsequent definitive management was performed via a combined external and endoscopic approach using a swinging inferior turbinate approach to the NLD to facilitate an en-bloc excision of the lacrimal drainage apparatus, without removal of the bony medial wall of the maxillary sinus.Results: The excised lacrimal drainage showed insitu and invasive squamous cell carcinoma of the canaliculi and lacrimal sac with focal divergent neuroendocrine and sebaceous differentiation. There was no local tumour recurrence or metastatic spread at 3 months of follow-up.Conclusions: We describe a swinging inferior turbinate approach to the NLD to facilitate an en-bloc excision of the lacrimal drainage apparatus, without entering the maxillary sinus. We believe this modified technique is a useful option to consider in the management of tumours of the lacrimal drainage apparatus.

Determinants of Suicide-related Ideation in Late Life Depression: Associations with Perceived Stress.

Objectives: Perceived stress is emerging as a potential contributing factor in suicide-related ideation in older adults. We hypothesized higher levels of perceived stress would be associated with increased self-reported suicidal ideation independent of depressive symptom severity.Methods: This study used data from community-dwelling older adults aged ≥65 with a current diagnosis of major depression. Eligible participants completed measures of depression symptom severity (Hamilton Depression Rating Scale-17 item), current suicidal ideation (Geriatric Suicide Ideation Scale), and perceived stress (Perceived Stress Scale).Results: Participants were 225 older adults with a mean age of 71.4 (SD = 5.6). Sixty-five percent of the sample was female. Fifteen percent of the variance in suicidal ideation was accounted for by lower education (p = .03), male sex (p = .03) and higher current perceived stress (p < .001). Specifically, stress accounted for 12% of the variance.Conclusions: Perceived stress is an important avenue to increase identification of individuals with a higher risk of suicide-related ideation among older adults with a current diagnosis of major depression.Clinical Implications: Screening for perceived stress may allow for improved screening and prevention of suicidal activity in depressed older adults.

'In a blink of an eye your life can change': experiences of players sustaining a rugby-related acute spinal cord injury.

BACKGROUND: Though rare, rugby union carries a risk for serious injuries such as acute spinal cord injuries (ASCI), which may result in permanent disability. Various studies have investigated injury mechanisms, prevention programmes and immediate medical management of these injuries. However, relatively scant attention has been placed on the player's experience of such an injury and the importance of context. AIM: The aim of this study was to explore the injury experience and its related context, as perceived by the catastrophically injured player. METHODS: A qualitative approach was followed to explore the immediate, postevent injury experience. Semi-structured interviews were conducted with 48 (n=48) players who had sustained a rugby-related ASCI. RESULTS: Four themes were derived from the data. Participants described the context around the injury incident, which may be valuable to help understand the mechanism of injury and potentially minimise risk. Participants also described certain contributing factors to their injury, which included descriptions of foul play and aggression, unaccustomed playing positions, pressure to perform and unpreparedness. The physical experience included signs and symptoms of ASCI that is important to recognise by first aiders, fellow teammates, coaches and referees. Lastly, participants described the emotional experience which has implications for all ASCI first responders. SIGNIFICANCE: All rugby stakeholders, including players, first responders, coaches and referees, may gain valuable information from the experiences of players who have sustained these injuries. This information is also relevant for rugby safety initiatives in shaping education and awareness interventions.

Primary orbital melanoma: a case series and literature review.

Primary orbital melanoma (POM) is a very rare condition. We report further four cases and review all previously reported cases. We present a multicentre retrospective review of patients with POM. Clinical, radiological, surgical, histological, and follow-up data is presented. Four patients with POM were identified between 2000 and 2013. All presented with proptosis and diplopia without reduced vision. Two had known pre-existing blue cell naevi. All were stage T1N0M0. All underwent exenteration with adjuvant radiotherapy. All are disease free at follow-up durations of 24-151 months. The present three cases and review of all cases in the literature suggest a higher likelihood of disease-free survival from primary exenteration (7/8 disease-free survival, 1/8 death from metastatic disease) than wide local excision (7/16 disease-free survival, 9 recurrence or metastasis of whom 4 died). Adjuvant radiotherapy may additionally improve outcomes.

Alternative Route to Nanoscale Aggregates with a pH-Responsive Random Copolymer.

A random copolymer, poly(methyl methacrylate-co-2-dimethylaminoethyl methacrylate) (poly(MMA-co-DMAEMA)) is shown to form nanoscale aggregates (NAs) (∼20 nm) at copolymer concentrations ≥10% w/w, directly from the preformed surfactant-stabilized latex (∼120 nm) in aqueous solution. The copolymer is prepared by conventional emulsion polymerization. Introducing a small mole fraction of DMAEMA (∼10%) allows the copolymer hydrophilicity to be adjusted by the pH and external temperature, generating NAs with tuneable sizes and a defined weight-average aggregation number, as observed by dynamic light scattering (DLS) and small-angle neutron scattering (SANS). These NAs are different from the so-called mesoglobular systems and are insensitive to temperature at fixed pH. The relatively broad chemical composition distribution of the copolymer and lumpy (or blocky but not diblock) incorporation of DMAEMA mean that the NAs cannot be simply thought of as conventional polymer micelles. In the acidic pH regime, the amphiphilic copolymer exhibits a defined critical assembly concentration (CAC) and a minimum air-water surface tension of 45.2 mN m-1. This copolymer represents a convenient route to self-assembled NAs, which form directly in aqueous dispersions after pH and temperature triggers, rather than the typically applied (and time-consuming) water-induced micellization approach for common polymer micelles.