Acceptance or rejection of welfare migration-an experimental investigation.

We study decisions on welcoming or opposing welfare migration in a laboratory setting with two societies in which one subject can migrate from the poorer to the richer society, provided a majority in the richer society votes to allow that. In each society, subjects indicate their preference for a percentage contribution to a public pool. The median of these rates sets the contributions paid by everybody; a feature that results in high contribution rates with an average of 90%. Varying the multiplier with which contributions are magnified before redistribution to society members, and thus the expected gain/loss associated with migration, we find that subjects overwhelmingly welcome migrants if they expect an economic benefit, while most participants oppose migration if they would be negatively affected by it. Regarding participants' attitudes, we find that more altruistic people are more in favor of migration than more selfish people and that center right-wing oriented subjects propose lower contribution levels than center left-wing oriented subjects. We conclude that economic motives are a crucial factor for accepting or rejecting welfare migration. Therefore, a key to promoting acceptance of new migrants is to ensure and then communicate that their net effect on growth, society, and the public purse is positive. Supplementary Information: The online version contains supplementary material available at 10.1007/s43546-022-00356-6.

Paradoxical antidepressant effects of alcohol are related to acid sphingomyelinase and its control of sphingolipid homeostasis.

Alcohol is a widely consumed drug that can lead to addiction and severe brain damage. However, alcohol is also used as self-medication for psychiatric problems, such as depression, frequently resulting in depression-alcoholism comorbidity. Here, we identify the first molecular mechanism for alcohol use with the goal to self-medicate and ameliorate the behavioral symptoms of a genetically induced innate depression. An induced over-expression of acid sphingomyelinase (ASM), as was observed in depressed patients, enhanced the consumption of alcohol in a mouse model of depression. ASM hyperactivity facilitates the establishment of the conditioned behavioral effects of alcohol, and thus drug memories. Opposite effects on drinking and alcohol reward learning were observed in animals with reduced ASM function. Importantly, free-choice alcohol drinking-but not forced alcohol exposure-reduces depression-like behavior selectively in depressed animals through the normalization of brain ASM activity. No such effects were observed in normal mice. ASM hyperactivity caused sphingolipid and subsequent monoamine transmitter hypo-activity in the brain. Free-choice alcohol drinking restores nucleus accumbens sphingolipid- and monoamine homeostasis selectively in depressed mice. A gene expression analysis suggested strong control of ASM on the expression of genes related to the regulation of pH, ion transmembrane transport, behavioral fear response, neuroprotection and neuropeptide signaling pathways. These findings suggest that the paradoxical antidepressant effects of alcohol in depressed organisms are mediated by ASM and its control of sphingolipid homeostasis. Both emerge as a new treatment target specifically for depression-induced alcoholism.

Facial Drooping, Aphasia, and an Incidental Lung Mass in a Nonsmoker.

BACKGROUND: Atrial fibrillation and atrial flutter are atrial tachycardias associated with embolic strokes. To date, there have only been a few reports highlighting the incidence of these atrial tachycardias due to mechanical compression of myocardial structures and the pulmonary vasculature in certain mediastinal masses and cysts. CASE: We present a case of a 75-year-old gentleman who is a nonsmoker with a history of hypertension who presents with an acute embolic stroke due to atrial flutter likely from mechanical compression from an underlying squamous cell carcinoma of the lung. CONCLUSION: This case represents, to the best of our knowledge, a rare case of squamous cell carcinoma of the lung in a nonsmoker likely leading to mechanical compression and a resultant atrial tachycardia with an embolic stroke.

Absence or Presence of High-Grade Squamous Intraepithelial Lesion in Cervical Conization Specimens: A Clinicopathologic Study of 540 Cases.

OBJECTIVES: To explore the implications of cervical conization specimens lacking the targeted high-grade squamous intraepithelial lesions (negative cone). METHODS: We studied 540 conization procedures: 400 positive cones and 140 negative cones. Clinicopathologic features and 2-year follow-up results were reported. RESULTS: Negative cones comprised 22% of procedures triggered by CIN2 or higher biopsies. Procedures triggered by cytology produced much higher percentages of negative cones (37% high-grade squamous intraepithelial lesion [HSIL], 46% atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion [ASC-H], and 76% low-grade squamous intraepithelial lesion-cannot exclude high-grade squamous intraepithelial lesion [LSIL-H]). Upon reviewing negative excision-triggering biopsy and cytology, we downgraded 24 (24%) CIN2 biopsies, three (14%) HSIL, five (83%) ASC-H, and 12 (92%) LSIL-H. One-third of our negative cones can be attributed to overdiagnosis either on biopsy or cytology. Patients with negative cones were older and had smaller excisions, negative colposcopic findings, and negative/equivocal high-risk human papillomavirus (HR-HPV). Within 2 years, 35 (25%) women with negative cones experienced ASCUS or LSIL. Only one (0.7%) recurred as CIN3, a significantly lower percentage than women with positive cones (13%). CONCLUSIONS: We advocate careful review of all excision-triggering biopsy and cytology, especially in cases of LSIL-H. Patients with negative cones should be surveyed with cytology and HR-HPV testing.

Clinical outcomes of patients with insufficient sample from endometrial biopsy or curettage.

Endometrial biopsy and curettage are widely used uterine sampling procedures. Occasionally, the amount of tissue obtained is so minimal that diagnosis cannot be reached. In published studies, insufficient samples comprise 2% to 60% of endometrial samples and are influenced by multiple contributory factors. To date, specific quantitative criteria for an adequate endometrial sample have not been established in the pathology community. The decision to classify a sample as nondiagnostic is subject to great interobserver variability, especially where elderly patients are concerned. Meanwhile, whether or not to repeat the procedure is the dilemma for clinical management. Herein we studied the clinicopathologic features of 1120 endometrial samples designated as insufficient for diagnosis. Such samples were more commonly encountered in elderly patients than younger ones (14.6% vs. 5.8%). Our pathologists generally required one intact tissue fragment containing both glands and stroma for premenopausal patients and 5 to 10 strips of atrophic endometrial epithelium for postmenopausal patients. By the 12-mo follow-up, 38% of patients with nondiagnostic samples had second sampling procedures and 7% underwent hysterectomy. The second sample was adequate in 75% of patients, 10% of which showed malignant tumor. If any worrisome histologic findings were present in the initial nondiagnostic sample, a high percentage of these patients were found to have uterine malignancy on second procedures (43%). Aims of this study are to bring awareness to this commonly overlooked topic, to validate our diagnostic criteria, and to outline important clinical implications.

Appendiceal mucosal Schwann cell proliferation: a putative histologic marker of appendiceal diverticular disease.

Recognition of an appendiceal diverticulum is important because of its association with an appendiceal neoplasm. The incidence of mucosal Schwann cell proliferation in 24 cases of appendiceal diverticular disease, 17 serrated polyps, 4 cases of mucosal hyperplasia, and 45 normal appendices was determined. Ten (42%) of 24 cases with diverticula, 2 (50%) of 4 cases of mucosal hyperplasia with concurrent surface low-grade dysplasia, and 9 (20%) of 45 cases of normal appendices showed mucosal Schwann cell proliferation. It was not seen within the 17 cases of serrated polyps. Mucosal Schwann cell proliferation is common in appendiceal diverticular disease and may serve as a histologic marker for the presence of an appendiceal diverticulum. Thus, when routine histologic sections of a removed appendix demonstrate Schwann cell proliferation, further examination of the specimen may detect possible coexisting diverticular disease, which in turn may be associated with appendiceal neoplasms and epithelial dysplasia.

Atypical follicular cells with equivocal features of papillary thyroid carcinoma is not a low-risk cytologic diagnosis.

OBJECTIVE: To determine whether or not significant differences in the risk of malignancy exist between subgroups of atypical follicular cells in The Bethesda System for Reporting Thyroid Cytology (TBSRTC) in patients who underwent surgical resection. STUDY DESIGN: Between 2004 and 2009, consecutive thyroid fine-needle aspirates at our institutions with a cytologic diagnosis of 'atypical follicular cells' were retrieved and subclassified using the diagnosis and diagnostic comment as: (1) atypical follicular cells with equivocal features of papillary carcinoma [cannot exclude papillary thyroid carcinoma (PTC)] and (2) atypical follicular cells, other patterns. The risks of malignancy for excised nodules were calculated and comparisons were made between these subgroups. Categorical analysis was performed using a 2-tailed Fisher's exact test, and p < 0.05 was considered statistically significant. RESULTS: A total of 7,072 thyroid fine-needle aspiration cases were retrieved, with 1,542 (21.8%) having a histologic follow-up. There were 222 (3.1%) cases of 'atypical follicular cells', with 127 (57.2%) having a histologic correlation and 33 having confirmed malignancies. Atypical follicular cells, cannot exclude PTC, have a significantly higher risk of malignancy than atypical follicular cells, other patterns (45.8 vs. 13.9%, p < 0.01). CONCLUSIONS: Atypical follicular cells with equivocal features of papillary carcinoma is not a low-risk cytologic diagnosis.