Post-seizure drug treatment in young rats determines clear incremental losses of frontal cortical and hippocampal neurons: the resultant damage is similar to very old brains.

Loss of neurons occurs with aging and following lithium/pilocarpine-induced epileptic seizures. In the present study, the numbers of neurons within the layers from sample areas of the four lobes of the neocortices and the hippocampus were counted by light microscopy in brains of rats that had been administered lithium or pilocarpine and then injected immediately or shortly after seizure onset with either acepromazine, ketamine, or prazosin. The mean numbers of neocortical and hippocampal neurons were lowest in rats treated with acepromazine or prazosin 1h after seizure onset, while those of rats immediately treated with ketamine displayed the least decrements and were most similar to normal rats. The largest loss of neurons occurred within the CA1 field and layers 5 and 6 of the frontal cortices. The mean numbers of neurons within the cortices in rats whose treatments had been delayed for 1h were similar to those of normal rats over 700 days of age. These results support the hypothesis that neuronal loss from cumulative effects of seizure-induced brain damage simulates aging.

A 40-Year-Old Man with Anemia, Proctitis, Rectal Bleeding, and a Perianal Rash Due to Mpox (Monkeypox) Infection.

BACKGROUND A recently described zoonotic viral infection, mpox (monkeypox), is an Orthopoxvirus transmitted by close contact, which causes symptoms similar to smallpox, although less severe. This report presents the case of a 40-year-old man with anemia, proctitis, rectal bleeding, and a perianal rash due to mpox infection. CASE REPORT A 40-year-old man with a medical history of human immunodeficiency virus (HIV) and syphilis presented multiple times with progressive and painful perianal lesions. On initial presentation, swabbing of the lesions and polymerase chain reaction (PCR) testing confirmed a diagnosis of mpox infection, and treatment with a 14-day course of Tecovirimat was started. Nine days after initiating Tecovirimat, the patient presented again with worsening perianal pain and associated hematochezia resulting in acute symptomatic anemia. Despite a blood transfusion to treat his anemia, the patient's status declined as his viral symptoms progressed. Computed tomography (CT) investigation demonstrated significant proctitis with interval development of small perianal abscesses. A multidisciplinary approach for medical management and treatment was instituted. The resolution of the patient's anemia and mpox proctitis was confirmed on follow-up. CONCLUSIONS Despite treatment with antiviral agents, mpox infection can progress quickly; thus, swift management with a multidisciplinary approach and close follow-up is needed to treat and prevent secondary complications such as anemia and proctitis. Further data collection regarding the sexual practices of those with diagnoses of mpox as well as seminal, anorectal, and genital swabbing would be valuable to confirm the mode of transmission and cause of mpox proctitis.

Refractory Fulminant Colitis Requiring Surgical Intervention in a Patient With Ulcerative Colitis on Atezolizumab Therapy for Small Cell Lung Cancer: An Atypical Case.

Atezolizumab is a programmed death-ligand 1 (PD-L1) targeted antibody that prevents the binding of PD-L1 to specific T-cell receptors, thereby increasing anticancer immunity. It has been regarded as a useful first-line treatment in patients with small-cell lung cancer with a more tolerable side effect profile than chemotherapeutic agents. However, few studies focusing on the severity of adverse effects from immune checkpoint inhibitors (ICPI) have been previously reported, particularly acute fulminant colitis requiring surgical invention. We report a case of fulminant colitis refractory to high dose corticosteroid treatment in a patient with known ulcerative colitis (UC) undergoing treatment for small-cell lung cancer (SCLC) with atezolizumab. The upregulation of PD-L1 expression in patients with ulcerative colitis may play a significant role in an imbalanced T-helper cell response creating a pro-inflammatory state. The use of ICPIs to treat SCLC has been reported to increase the risk of developing inflammatory colitis. Atezolizumab use in a patient with known inflammatory bowel disease (IBD) may predispose this population to a higher risk of developing severe inflammatory colitis. We present an unusual complication associated with medical intervention in an immunocompromised patient without an established pathophysiology. The suspicion of using ICPIs in patients with IBD as a potential cause for the development of fulminant colitis is relevant and essential in the diagnostic workup for this patient population complaining of significant gastrointestinal symptoms.

Implications of the growing incidence of global colorectal cancer.

The expanding worldwide burden of colorectal cancer (CRC) is a significant public health issue. Understanding the shift in the geo-demographic, socioeconomic, environmental, and biogenetic distribution of CRC is paramount. The Human Development Index (HDI) measuring life expectancy, education, and gross national income is a composite index comparing health outcomes between countries. This has been shown to be a useful comparison tool in measuring the health dimension among high, middle, and low-income countries. CRC has a wide global distribution in incidence and mortality with majority of cases occurring in countries with a high or very high HDI. However, in developing countries and in those undergoing rapid socioeconomic growth, there has also been a marked rise in CRC rates as well. This pattern is noted globally and seems to correlate with increase in a country's specific HDI. Additionally, another unique pattern of CRC incidence has emerged with more cancers being diagnosed in adults younger than 50 years old. Further investigation is needed to determine CRC risks reduction and implementation of primary prevention and early detection strategies within different country specific healthcare systems. Globally, improvement in healthcare equality, access to medical care and screening for CRC particularly in resource-limited (low HDI) countries is essential.

S100 Staining Adds to the Prognostic Significance of the Combination of Perineural Invasion and Lymphovascular Invasion in Colorectal Cancer.

Studies have suggested that perineural invasion (PNI) and lymphovascular invasion (LVI) serve as independent prognostic factors in colorectal cancer (CRC). Currently, little is known regarding the combination of PNI and LVI as prognostic factors, independent of stage. We hypothesized that this combination was a better prognostic marker than either PNI or LVI alone, and that S100 staining would detect PNI not seen with hematoxylin and eosin (H&E). Surgical pathology slides were retrospectively reviewed for 151 stages I to IV CRC patients who had surgery between January 1, 2008 and December 8, 2008 at 3 Hackensack Meridian Health hospitals in New Jersey. PNI and LVI were detected by H&E staining and a subset of 127 patient samples were additionally examined for PNI by S100 staining. Correlation between staining characteristics and patient outcomes was assessed using the Pearson χ tests and the Fisher exact tests. Survival was analyzed using Kaplan-Meier methods. Of the 151 cases reviewed, 30.5% were positive for PNI and 35.1% were positive for LVI by H&E. The use of S100 staining for PNI enabled its detection in 27 additional cases. Median time from patient diagnosis to death was significantly shorter for patients who were positive for both PNI and LVI (P<0.001). PNI and LVI were individual markers for poor survival in CRC patients and their combined presence had an even worse outcome. Failure to detect PNI on H&E can be overcome by S100 staining.

Appendiceal goblet cell carcinoma: comparison of classification and staging systems with evaluation of the prognostic role of immunohistochemistry stains

Background: Goblet cell carcinoma (GCC) of the appendix is a unique lesion that exhibits features of both adenocarcinoma and neuroendocrine tumors. Due to the rarity of this cancer, multiple grading (e.g., Tang, Yozu, and Lee) and staging systems (e.g., tumor, lymph nodes, and metastasis [TNM]) have been developed for classification. This study aimed to compare commonly used classification systems and evaluate the prognostic effectiveness immunohistochemical staining may or may not have for appendiceal GCC. Methods: An electronic medical records review of patients who were diagnosed with GCC of the appendix in our hospital system from 2010 to 2020. The data were collected regarding the age at diagnosis, gender, initial diagnosis at presentation, operation(s) performed, final pathology results, current survival status, and year of recurrent disease or death year. Results: Ten patients were evaluated. Seventy percent of the patients were above the age of 50 years at diagnosis. Postdischarge survival ranged from 1 month to 109 months postdiagnosis. Two patients expired from GCC at 13- and 54-months following diagnosis. When comparing the classification systems, Lee categorized more patients as high risk than Tang and Yozu. Immunohistochemical staining was analyzed using four staining methods: Ki67, E-cadherin, Beta-catenin, and p53. Tumor, lymph nodes, and metastasis staging has supportive evidence for worsening prognosis and overall survival secondary to the depth of invasion of the tumor. Conclusion: Tumor, lymph nodes, and metastasis staging may be superior to the other classification systems in predicting overall mortality. Our study demonstrated that immunohistochemistry staining does not appear to have a significant impact in determining the prognosis for GCC of the appendix. (AU)

Primary Leiomyosarcoma of the Colon: A Report of Two Cases, Review of the Literature, and Association with Immunosuppression for IBD and Rheumatoid Arthritis.

Primary leiomyosarcomas (LMS) of the colon are rare and aggressive neoplasms and have been infrequently reported in the literature. These tumors are more aggressive and have poorer prognoses than adenocarcinoma of the colon and are often mistaken as such on initial evaluation. While the former has a clear association with inflammatory bowel disease (IBD), this correlation is not known to exist with LMS and IBD. Nor is there a known link between LMS and the immunosuppression for IBD, despite the known association between malignancy and immunosuppression for other diseases. Due to the low prevalence of this disease entity, there is limited knowledge and literature on the approach to diagnosing and treating these neoplasms, especially in the setting of the aforementioned comorbidities. Here, we describe two cases of this rare entity, presenting in two different circumstances: one in the setting of immunosuppression for IBD and arthritis, with a synchronous urothelial carcinoma, and the second appearing as the source of an acute abdomen. Both diagnoses were established following pathologic analysis.

A Case of Midgut Volvulus Associated with a Jejunal Diverticulum.

Midgut volvulus in adults is a rare entity that may present with intermittent colicky abdominal pain mixed with completely asymptomatic episodes. This small bowel twist may result in complications of obstruction, ischemia, hemorrhage, or perforation. With a midgut volvulus, complications may be life-threatening, and emergent surgical intervention is the mainstay of treatment. This current case involves an 80-year-old woman with intermittent abdominal pain with increasing severity and decreasing interval of time to presentation. A CAT scan revealed mesenteric swirling with possible internal hernia. A diagnostic laparoscopy followed by laparotomy revealed a midgut volvulus, extensive adhesions involving the root of the mesentery, and a large jejunal diverticulum. The adhesions were lysed enabling untwisting of the bowel, allowing placement of the small bowel in the correct anatomic position and resection of the jejunal diverticulum. This is a rare case of midgut volvulus with intermittent abdominal pain, associated with jejunal diverticulum managed successfully. A midgut volvulus should be considered in the differential diagnosis of a patient who present with a small bowel obstruction secondary to an internal hernia, especially when a swirl sign is present on the CAT scan.

H. Pylori in a gastric schwannoma: a case report.

Schwannomas are benign, often asymptomatic, slow-growing tumors that originate from Schwann cells of the neural sheath. Although H. Pylori has been associated with gastric adenocarcinoma, there has never been a recorded association with schwannoma formation. We present a 64-year-old woman who underwent a laparoscopic partial wedge gastrectomy for an incidentally discovered gastric mass. Histologic examination was consistent with schwannoma; however, chronic inflammation with microorganisms morphologically consistent with H. Pylori was also present. This case suggests the first recorded case of H. Pylori in an immunohistochemically confirmed gastric schwannoma.

Early Clinical Outcomes of a Novel Antibiotic-Coated, Non-Crosslinked Porcine Acellular Dermal Graft after Complex Abdominal Wall Reconstruction.

BACKGROUND: Non-crosslinked porcine acellular dermal grafts (NCPADG) are currently the mainstay biomaterial for abdominal wall reconstruction (AWR) in complex hernia patients. We report early clinical outcomes using a novel rifampin/minocycline-coated NCPADG for AWR. STUDY DESIGN: A multi-institutional retrospective review was performed of patients who underwent ventral hernia repair using XenMatrix AB Surgical Graft (CR Bard, Inc [Davol]). Patient demographics, hernia and procedure characteristics, and surgical site occurrences/postoperative complications were reviewed up to 6 months after AWR. RESULTS: Seventy-four patients underwent AWR using XenMatrix AB Surgical Graft. Open AWR was performed in 52 patients (70.3%), and 22 patients (29.7%) underwent laparoscopic VHR. Median hernia size/area was 66.0 cm(2) (range 9.4 to 294.5 cm(2)). Sixteen patients (21.6%) had previous wound infections, and 16 patients (21.6%) had violation of the gastrointestinal tract during hernia repair. The most common locations of NCPADG placement were within the intraperitoneal (32.4%) and onlay (21.6%) positions, respectively. Median hospital length of stay was 4 days. Within 30 days after AWR, 6 (8.1%) patients were readmitted, postoperative seroma formation developed in 4 (5.4%) patients, 1 patient required percutaneous drainage, and surgical site infections developed in 5 (6.8%) patients. At 6 months follow-up, hernia recurrence had developed in 4 (5.4%) patients. CONCLUSIONS: Data suggest that use of a novel rifampin/minocycline-coated NCPADG was associated with a low rate of postoperative surgical site occurrences/postoperative complications during the first 30 days of follow-up in complex AWR patients. In addition, data suggest a low rate of hernia recurrence at 6-month follow-up. Additional study is warranted to determine whether early antimicrobial protection of the device translates into longer-term protection of the repair.

The Impact of Radiation on an Unusual Case of Omental Epithelioid Angiosarcoma.

Epithelioid angiosarcoma is a rare high-grade tumor with irregular vascular morphology. We report an unusual case of intra-abdominal epithelioid angiosarcoma affecting the omentum and peritoneal surfaces resulting in significant hemorrhagic and inflammatory changes. As in other cases of this tumor this patient had previously undergone radiation treatment for a history of cervical cancer.

Intermittent exposures to nanoTesla range, 7 Hz, amplitude-modulated magnetic fields increase regeneration rates in planarian.

PURPOSE: To discern if physiologically and naturally-patterned electromagnetic fields presented with base frequencies of 7 Hz within the 100 nT range could facilitate regeneration in planarian similar to microTesla, 60 Hz fields. METHODS: In two separate experiments planarian were decapitated and exposed to either 140 or 400 nT peak amplitude-modulated 7 Hz magnetic fields for 6 min once per hour, 8 h per night for 5 days. Daily regeneration rates and movement velocities (cm/min) were measured. RESULTS: The planarian exposed to either intensity magnetic field exhibited faster regeneration of photoreceptors and auricles compared to sham field and reference groups. The magnetic field exposure accommodated 50% of the variance during the faster growth days. CONCLUSIONS: Naturally-patterned, intermittently-presented weaker electromagnetic fields may produce enhanced regeneration rates in flat worms similar to those observed for 60 Hz, higher intensity fields.

O poder das equipes: um guia prático para implementar equipes interfuncionais de alto desempenho / The teamworks power: a practical guide to implement cross-functional teams

Oferece orientação específica e auxílio prático a membros de organizações que tenham chegado à conclusão de que as equipes interfuncionais representarão um fator importante em sua estratégia de negócios. Tem por base uma pesquisa de opinião com empresas públicas e privadas feita com o objetivo de buscar as melhores práticas que pudessem inspirar e ajudar aqueles que estejam tendo dificuldades com o potencial das equipes interfuncionais. Inicia uma discussão sobre as seis vantagens competitivas que as equipes interfuncionais oferecem a uma empresa. Mostra como as equipes interfuncionais estão ajudando a agilizar o processo de desenvolvimento de produtos, melhorar o enfoque dado ao cliente, aumentar a capacidade criativa da empresa, oferecer um fórum para o aprendizado organizacional e servir de ponto único de contato para clientes, fornecedores e outros envolvidos-chave

O poder das equipes: um guia prático para implementar equipes interfuncionais de alto desempenho / The teamworks power: a practical guide to implement cross-functional teams

Oferece orientação específica e auxílio prático a membros de organizações que tenham chegado à conclusão de que as equipes interfuncionais representarão um fator importante em sua estratégia de negócios. Tem por base uma pesquisa de opinião com empresas públicas e privadas feita com o objetivo de buscar as melhores práticas que pudessem inspirar e ajudar aqueles que estejam tendo dificuldades com o potencial das equipes interfuncionais. Inicia uma discussão sobre as seis vantagens competitivas que as equipes interfuncionais oferecem a uma empresa. Mostra como as equipes interfuncionais estão ajudando a agilizar o processo de desenvolvimento de produtos, melhorar o enfoque dado ao cliente, aumentar a capacidade criativa da empresa, oferecer um fórum para o aprendizado organizacional e servir de ponto único de contato para clientes, fornecedores e outros envolvidos-chave