Isolated metastatic melanoma to the pancreas in the context of myeloproliferative neoplasm: a rare occurrence.

Isolated metastatic melanoma to the pancreas is a rare occurrence, representing less than 1 per cent of metastatic melanoma. This case describes the clinical presentation and course of illness of a patient who was diagnosed with a solitary metastasis to the pancreas 11 months after a clear margin resection of a pT1b, stage IB melanoma. Her melanoma metastasis was diagnosed on Endoscopic Ultrasound-Fine Needle Biopsy (EUS-FNB). This patient was found to have a concurrent myeloproliferative neoplasm (MPN) at the time of diagnosis. This case importantly highlights the course of a rare finding in isolated metastatic melanoma to the pancreas that may have been accelerated by the patient's immunocompromised state with concurrent MPN. A high index of suspicion must be raised in patients with abdominal symptoms and melanoma history as the therapeutic window for these patients is quite narrow.

Strengths-based inquiry of resiliency factors among refugees in Metro Vancouver: A comparison of newly-arrived and settled refugees.

STRENGTHS-BASED INQUIRY OF RESILIENCY FACTORS AMONG REFUGEES IN METRO VANCOUVER: A comparison of newly-arrived and settled refugees. OBJECTIVE: To identify the resiliency factors among refugees in the Metro Vancouver area, and compare these factors between newly-arrived and settled refugees. DESIGN: Semi-structured individual interviews. SETTING: Vancouver, British Columbia, and surrounding suburban communities. PARTICIPANTS: 13 key informants from resettlement, healthcare, and public education sectors who work closely with refugees, 13 refugees who have resided less than five years in Canada (LTFYRs), and 8 refugees who have resided greater than five years in Canada (GTFYRs). Refugee source countries were Syria, Iraq, Afghanistan, Iran, Kenya, Vietnam, Somalia, and Mexico. MAIN FINDINGS: Key informants stated that knowledge from this study would help create and improve current supports for refugees, inform policy, increase understanding of refugee perspectives, and promote strengths-based resettlement strategies. Resiliency factors were grouped into themes, which were categorized as internal or external resiliency factors. Internal resiliency factors included fixed characteristics (age at arrival, female gender, and past education/skills), positive coping strategies (acceptance and positivity), proactivity, and integration (personal identity and adaptation). External resiliency factors identified were support systems, employment and finances, living environment, and societal encouragement of refugees. Comparison of responses between LTFYRs and GTFYRs revealed overall consistency in resiliency factors, but with LTFYRs identifying characteristics that assisted with acute integration, such as age at arrival, more often than GTFYRs. Comparison of responses between refugees and key informants revealed that key informants less frequently identified internal resiliency factors. CONCLUSION: This study qualitatively describes several internal and external resiliency factors of refugees in Vancouver. Awareness and promotion of these resiliency factors in refugee populations, in collaboration with healthcare providers, settlement organizations and education systems, may improve refugee resettlement. These findings will also help generate the groundwork for local interventions that can support refugee resiliency in the population studied.

Older patients with differentiated thyroid cancer exhibit more aggressive pathological characteristics than younger patients

Summary: Differentiated thyroid cancer (DTC) has long been recognized as having a worse prognosis in older people. We retrospectively evaluated the clinical and pathological characteristics of 973 sequentially treated patients with primary DTC stratified into 2 age groups, ≥ 55 or < 55 years, based on the current American Joint Committee on Cancer (AJCC) DTC staging system. We found that older patients had a higher frequency of extrathyroidal cancer extension and larger cancers, and that their cancers were less commonly completely resectable.

Skeletal muscle AMPK is essential for the maintenance of FNDC5 expression.

Fibronectin type III domain-containing protein 5 (FNDC5) expression is controlled by the transcriptional co-activator, peroxisome proliferator-activated receptor gamma, coactivator 1 alpha (PGC1α). FNDC5 expression has been shown to be increased in muscle in response to endurance exercise in some but not all studies, therefore a greater understanding of the mechanisms controlling this process are needed. The AMP-activated protein kinase (AMPK) is activated by exercise in an intensity dependent manner and is an important regulator of PGC1α activity; therefore, we explored the role of AMPK in the regulation of FNDC5 using AMPK ß1ß2 double muscle-null mice (AMPK DMKO), which lack skeletal muscle AMPK activity. We found that FNDC5 expression is dramatically reduced in resting muscles of AMPK DMKO mice compared to wild-type littermates. In wild-type mice, activating phosphorylation of AMPK was elevated immediately post contraction and was abolished in muscle from AMPK DMKO mice. In contrast, PGC1α was increased in both wild-type and AMPK DMKO mice 3 h post contraction but FNDC5 protein expression was not altered. Lastly, acute or chronic activation of AMPK with the pharmacological AMPK activator AICAR did not increase PGC1α or FNDC5 expression in muscle. These data indicate that skeletal muscle AMPK is required for the maintenance of basal FNDC5 expression.