Metastasis of serous ovarian carcinoma to the breast: a case report and review of the literature.

BACKGROUND: Breast metastasis from primary ovarian cancer is rare, with an estimated frequency of 0.07%. More than 110 cases are reported in the literature of metastatic spread of ovarian cancer to the breast and axilla. This entity usually represents aggressive late disease characterized by multi-drug chemoresistance and a poor prognosis with a median survival time of 16 months. Currently no standardized treatment protocol exists for this condition. CASE PRESENTATION: We present a case of a 59-year-old Caucasian female with recurrent high-grade serous ovarian cancer who was diagnosed with symptomatic unilateral breast metastasis while on fourth line chemotherapy with weekly paclitaxel. She was treated with local radiation with 2300 cGy to the right breast with a complete response. She then had a subsequent recurrence in the ipsilateral breast 8 months after completion of post treatment imaging. She remains alive to date approximately 2 years after her initial diagnosis of breast metastasis on seventh line treatment. CONCLUSIONS: Breast metastasis from primary ovarian cancer is rare and represents advanced disease characterized by multi-drug chemoresistance and a poor prognosis. This case describes radiation therapy as a safe, effective treatment option to improve local control and quality of life in these patients, but with limited durability of response.

Leptomeningeal Carcinomatosis From Primary Mucinous Carcinoma of the Ovary.

Leptomeningeal carcinomatosis (LMC) is an extremely rare site for metastasis from a primary ovarian cancer. LMC occurs when the thin layers of tissue that surround the brain and spinal cord are infiltrated by ovarian cancer metastasis. We present a case of a 63-year-old female with recurrent metastatic mucinous adenocarcinoma of the ovary who was diagnosed with LMC. While undergoing sixth-line chemotherapy, she presented with debilitating headaches and gait instability. Brain MRI revealed subarachnoid enhancement and other findings diagnostic of LMC. Given the rarity of this disease, treatment protocols have yet to be established. In patients with primary ovarian cancer that present with new onset neurological complaints, LMC should be suspected and appropriate imaging obtained.

Pathways to Immunity: Patterns of Excess Death Across the United States and Within Closed Religious Communities.

Public health officials promoted COVID-19 vaccines to limit burdens placed on the U.S. healthcare system and end the pandemic. People in some closed religious communities refused to vaccinate and likely acquired temporary immunity through infection. This paper compares the death rates in Amish, Old Order Mennonites, and conservative Mennonite groups to a rate estimated for the U.S. population. Approximately two-thirds of the U.S. population was immunized against COVID-19, while few in the Amish/Mennonite community were. We find divergent patterns. Once vaccines became available, excess deaths declined in the general population and remained elevated among Amish and Mennonites. Vaccination campaigns must consider and value the cultural beliefs of closed religious communities to be effective.

Initial Evaluation Practices to Identify Young Children with Delays and Disabilities.

The value of early intervention is well demonstrated; however, less is known about the processes that initial evaluation teams use to evaluate and determine young children's eligibility for early intervention (EI) and preschool special education. The present study surveyed multidisciplinary early childhood providers (N = 1445) who conduct initial evaluations for young children. Quantitative survey data were analyzed using descriptive analyses to describe the location of initial evaluations, tools used, team membership, and approaches to eligibility determination for children with possible delays and disabilities. Evaluation practices varied greatly, but evaluation teams most often included early childhood special educators and speech and language pathologists, school psychologists or other specialists were less frequently involved. Eligibility approaches were also wide-ranging with percentage delay and standard deviation below the mean most often used; several challenges when determining eligibility were also described. Evaluations for EI and preschool special education were compared to look at variations. Statistically significant differences were found when comparing evaluations focused on eligibility for EI or preschool special education. Implications and future directions are explored. Supplementary Information: The online version contains supplementary material available at 10.1007/s40688-023-00467-3.

Accelerating Drug Discovery: Synthesis of Complex Chemotypes via Multicomponent Reactions.

The generation of multiple bonds in one reaction step has attracted massive interest in drug discovery and development. Multicomponent reactions (MCRs) offer the advantage of combining three or more reagents in a one-pot fashion to effectively yield a synthetic product. This approach significantly accelerates the synthesis of relevant compounds for biological testing. However, there is a perception that this methodology will only produce simple chemical scaffolds with limited use in medicinal chemistry. In this Microperspective, we want to highlight the value of MCRs toward the synthesis of complex molecules characterized by the presence of quaternary and chiral centers. This paper will cover specific examples showing the impact of this technology toward the discovery of clinical compounds and recent breakthroughs to expand the scope of the reactions toward topologically rich molecular chemotypes.

Imaging of penetrating vascular trauma of the body and extremities secondary to ballistic and stab wounds.

In the United States, gunshot wounds (GSWs) have become a critical public health concern with substantial annual morbidity, disability, and mortality. Vascular injuries associated with GSW may pose a clinical challenge to the physicians in the emergency department. Patients demonstrating hard signs require immediate intervention, whereas patients with soft signs can undergo further diagnostic testing for better injury delineation. Although digital subtraction angiography is the gold standard modality to assess vascular injuries, non-invasive techniques such as Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography have evolved as appropriate alternatives. This article discusses penetrating bodily vascular injuries, specifically ballistic and stab wounds, and the corresponding radiological presentations.

Imaging Review of the Endoscopic Operative Corridor for Clivus Lesions.

Traditional transcranial approaches for lesions involving the clivus, in particular skull base chordoma have several disadvantages for midline skull base lesions as compared to the endoscopic endonasal approach (EEA), such as higher morbidity and lesser extent of resection. These disadvantages led to the development of endoscopic skull-base approaches to access pathology that involves the anterior cranial fossa, central skull base, and lower skull base lesions. In particular, lesions of the clivus are well suited for EEA. Surgical access of the clivus falls into 2 stages: the endonasal approach for access, and the endonasal resection of tumor. The objective of this article is to review the anatomy along the operative corridor for the purpose of image interpretation in preoperative planning in the context of EEA. We provide an imaging review of the sinonasal anatomy used for access by otolaryngologists and the anatomy of the clivus used by neurosurgeons for preoperative planning and resection.

Rituals of Contagion in Closed Religious Communities: A Case Study of Amish and Mennonite Communities in the USA During the Beginning of the COVID-19 Pandemic.

At the onset of the COVID-19 pandemic, government and medical guidelines emphasized social distancing to limit exposure. These guidelines significantly impacted closed religious communities, particularly those opposed to modern technologies, such as Amish and Mennonite communities. How did these religious communities respond to COVID-19 policies in the USA? We draw data from Ohio and Pennsylvania scribe entries published in an Amish/Mennonite correspondence newspaper. While some of these communities altered church rituals to comply with government directives, others maintained communal worship without disruption. Mennonite communities were more likely to conform to guidelines.

Behavioral changes in senescent giant Pacific octopus (Enteroctopus dofleini) are associated with peripheral neural degeneration and loss of epithelial tissue.

Most species of octopus experience extreme physical decline after a single reproductive bout which extends over a period of days, weeks, or months before eventual death. Although outward indicators of senescence are widely recognized, comparatively little is known about physiological and neural changes accompanying terminal decline in octopuses. Here, we measured changes in behavioral response to nociceptive stimuli across the lifespan in giant Pacific octopus (GPO), Enteroctopus dofleini, held in public aquariums in the USA. Post-euthanasia, tissue was collected from arm tips, and neural and epithelial cell degeneration was quantified and compared with biopsies of arm tips from healthy, pre-reproductive GPOs. Behavioral assays showed significant changes both in low threshold mechanosensory responses and nociceptive behavioral responses beginning early in senescence and extending until euthanasia. Histology data showed that while the ratio of apoptotic cells to total cell number stayed constant between healthy and senescent GPOs, overall neural and epithelial cell density was significantly lower in terminally senescent octopuses compared with healthy controls. Our data provide new insight into the time-course and causes of sensory dysfunction in senescent cephalopods and suggest proactive welfare management should begin early in the senescence phase, well before animals enter terminal decline.

Interventional radiology in renal emergencies: a pictorial essay.

Renal emergencies necessitate prompt diagnosis and management to stop active bleeding and retain kidney function. Causes of renal emergencies can be classified into traumatic, atraumatic, iatrogenic, and obstructive etiologies. Interventional radiology (IR) has emerged as an acceptable alternative to surgical treatment in the management of renal emergencies due to its minimally invasive nature. With the rise of interventional procedures, there is a need for further discussion of angiographic and fluoroscopic imaging in the setting of renal emergencies.

Role of imaging in penetrating vascular injuries of the craniocervical region.

Penetrating vascular injury has become the topic of interest with increased gun violence in the United States. The radiologist plays a crucial role in establishing and systemizing the signs of vascular injury such as intimal flap, dissection, pseudoaneurysm, rupture, and arteriovenous fistula. Various imaging techniques such as ultrasound Doppler, computed tomographic angiography (CTA), magnetic resonance angiography, and conventional angiography are being employed based on clinical recommendations. Of all the techniques, CTA has been shown to embrace a promising role in identifying vascular injuries with superior sensitivity, specificity, and accuracy. An acquaintance of the imaging features has been shown to improve the approach to trauma patients in clinical settings. This article details the imaging modalities and the features of the head-and-neck penetrating vascular injury.

It Matters: Early Childhood Mental Health, Educator Stress, and Burnout.

Early childhood educators (ECEs) face several workplace challenges, including young children's difficult behavior and mental health needs, workplace stress, low systemic support, and high levels of burnout. Both education and perceived confidence are often cited as important buffering factors, yet neither is well studied in the existing literature. The present study aimed to better understand and describe these factors. A survey, including both open and closed questions, was sent out to a large group of ECEs. Results were analyzed using descriptive statistics, T-tests, and the constant comparison method of qualitative coding. Findings suggest that the types of training ECEs have had is related to their comfort in recognizing and responding to young children's mental health and challenging behaviors. Both systemic changes and didactic needs were cited as necessary to further support ECEs. Supplementary Information: The online version contains supplementary material available at 10.1007/s10643-022-01438-8.

Machine-Learning Photodynamics Simulations Uncover the Role of Substituent Effects on the Photochemical Formation of Cubanes.

Photochemical [2 + 2]-cycloadditions store solar energy in chemical bonds and efficiently access strained organic molecular architectures. Functionalized [3]-ladderdienes undergo [2 + 2]-photocycloadditions to afford cubanes, a class of strained organic molecules. The substituents (e.g., methyl, trifluoromethyl, and cyclopropyl) affect the overall reactivities of these cubane precursors; the yields range from 1 to 48%. However, the origin of these substituent effects on the reactivities and chemoselectivities is not understood. We now integrate single and multireference calculations and machine-learning-accelerated nonadiabatic molecular dynamics (ML-NAMD) to understand how substituents affect the ultrafast dynamics and mechanism of [2 + 2]-photocycloadditions. Steric clashes between substituent groups destabilize the 4π-electrocyclic ring-opening pathway and minimum energy conical intersections by 0.72-1.15 eV and reaction energies by 0.68-2.34 eV. Noncovalent dispersive interactions stabilize the [2 + 2]-photocycloaddition pathway; the conical intersection energies are lower by 0.31-0.85 eV, and the reaction energies are lower by 0.03-0.82 eV. The 2 ps ML-NAMD trajectories reveal that closed-shell repulsions block a 6π-conrotatory electrocyclic ring-opening pathway with increasing steric bulk. Thirty-eight percent of the methyl-substituted [3]-ladderdiene trajectories proceed through the 6π-conrotatory electrocyclic ring-opening, whereas the trifluoromethyl- and cyclopropyl-substituted [3]-ladderdienes prefer the [2 + 2]-photocycloaddition pathways. The predicted cubane yields (H: 0.4% < CH3: 1% < CF3: 14% < cPr: 15%) match the experimental trend; these substituents predistort the reactants to resemble the conical intersection geometries leading to cubanes.

Pancreatic metastasis from papillary thyroid carcinoma: Case report and literature review.

Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy. Papillary thyroid carcinoma generally spreads locally to the cervical lymph nodes, but distant metastases are seen in 5%-7% of cases. Most distant metastases occur in the bone, lung, and brain. Pancreatic metastases of PTC are extremely rare. Herein we present a patient with PTC treated with total thyroidectomy and two rounds of radioactive iodine (RAI) ablation that was subsequently found to have a pancreaticmetastasis detected on fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) imaging 3 years from the initial diagnosis.

Current update on vaginal malignancies.

Primary vaginal cancers are rare and account for 1-3% of all gynecologic malignancies. There are several histological subtypes that affect a wide range of the population. Imaging plays an important role in the diagnosis, staging, and treatment planning of vaginal cancers. This article reviews the relevant anatomy, clinical findings, imaging characteristics, and recent advances in the management of vaginal malignancies.

Closed but Not Protected: Excess Deaths Among the Amish and Mennonites During the COVID-19 Pandemic.

"Excess deaths" is a means to estimate the lethality of COVID-19 (directly and indirectly). Assessing "excess death" in closed religious communities provides information on how COVID-19 impacted these communities. We use obituary information published in an Amish/Mennonite newspaper to examine excess death among the Amish/Mennonites in 2020. Our results indicate the Amish/Mennonite excess death rates are similar to the national trends in the USA. The excess death rate for Amish/Mennonites spiked with a 125% increase in November 2020. The impact of COVID-19 on this closed religious community highlights the need to consider religion to stop the spread of COVID-19.

Giant Right Coronary Ostial Aneurysm in a Patient With Marfan Syndrome.

Aortic root dilation and aortic insufficiency are prominent causes of morbidity in Marfan syndrome. These pathologies necessitate surgical repair, including aortic root and aortic valve replacement procedures, to improve prognosis. Coronary artery aneurysms, particularly giant coronary ostial aneurysms, are rare complications of these surgeries in the Marfan population. Due to the significant life-threatening sequelae of coronary artery aneurysms, it is imperative to bring attention regarding this complication to the radiologist assessing thoracic imaging in this patient population.

Imaging Review of Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema of the Head and Neck.

Angiotensin-converting enzyme inhibitors (ACE-i) are commonly used medications to treat hypertension and congestive heart failure. Angioedema is a well-established side effect of ACE-i and most commonly manifests as swelling of the mucosal and extra-mucosal soft tissues in the head and neck. CT with contrast is generally used to evaluate for airway compromise and to exclude other etiologies of edema. Herein we present five cases that illustrate the radiological findings specific to ACE-i-induced angioedema on enhanced CT scans.

Characterizing children hospitalized for suicide-related thoughts and behaviors.

BACKGROUND: Despite alarming increases in suicide deaths among preadolescent children, knowledge of the precipitants of suicide risk and the characteristics of children who seek treatment for suicidality is limited. This study's purpose is to describe children (ages 6-12) hospitalized for suicide-related concerns and compare demographic and diagnostic differences between children and adolescent (ages 13-18) patients. METHODS: This retrospective study analyzed medical records of 502 children and adolescents ages 6-18 admitted for suicide-related risk to one psychiatric inpatient hospital in southeastern United States between 2015 and 2018. RESULTS: Patients were predominantly White (63.5%), female (64.5%), and non-Hispanic/Latino (85.1%). We conducted descriptive analyses and a series of logistic regressions comparing children and adolescents with data extracted from discharge summaries, (i.e. primary reasons for admission, environmental stressors, and diagnostic categories). Common environmental stressors included school (63.2%) and family (60.7%), and the most common diagnosis included depressive disorders. Compared to adolescents, children were more likely to be Black (OR = 1.99), male (OR = 1.94), and receive neurodevelopmental disorder (aOR = 3.0) or trauma and stress-related disorder (aOR = 2.6) diagnoses, but less likely to be diagnosed with a depressive disorder (aOR = 0.4). Across both age-groups, Black patients were more likely to be diagnosed with neurodevelopmental disorders and less likely to receive internalizing disorder diagnoses. CONCLUSIONS: Characteristics of children hospitalized for suicide-related risk are relatively similar to characteristics of children dying by suicide. Compared to adolescents, hospitalized children are more likely to be Black, male, and have a neurodevelopmental disorder diagnosis. Proactively identifying and providing strengths-based supports for Black boys and families appear critical for suicide prevention in children.