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Primary cutaneous perivascular epithelioid cell tumors: two cases and a review of the literature
No full textReport _Case Presentation _Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: Primary cutaneous perivascular epithelioid cell tumors: two cases and a review of the literature Authors: Jennifer Wong1 DO, Jason Mammino2 DO, Jennifer Seyffert3 DO, Kristen Schmits4 MD, Etan Marks4 MD, Daniel Rivlin3 MD Affiliations: 1Department of Dermatology, LECOM- Larkin Community Hospital, Miami, Florida, USA, 2Department of Dermatology, KCUMB - Advanced Dermatology and Cosmetic Surgery, Orlando, Florida, USA, 3Department of Dermatology, LECOM- Skin and Cancer Associates, Miami Beach, Florida, USA, 4Department of Dermatopathology Advanced Dermatology and Cosmetic Surgery Pathology Laboratory, Delray Beach, Florida, USA Corresponding Author: Jennifer Seyffert DO, 4308 Alton Road, Suite 510, Miami Beach, FL 33140, Tel: 305-674-8865, Fax: 305-674-1459, Email: [email protected] Abstract: Perivascular epithelioid cell tumors, also known as PEComas, are mesenchymal neoplasms which uncommonly originate within the skin, with only 23 cases documented within the literature. These rare neoplasms classically display epithelioid cells composed of granular or clear cytoplasm arranged in sheets, nests, or cords. Their immunoreactivity for melanocytic and smooth muscle markers makes these tumors distinct and unique.[1] We herein present two cases of primary cutaneous PEComas that clinically mimic other common cutaneous neoplasms and illustrate the necessity for clinical-pathologic correlation. A literature review is also presented to compare the different clinical and histological presentations of cutaneous PEComas
The c-Jun kinase signaling cascade promotes glial engulfment activity through activation of draper and phagocytic function
No full textCo-author Johnna Doherty is a student in the Neuroscience program in the Morningside Graduate School of Biomedical Sciences (GSBS) at UMass Medical School, and Jennifer MacDonald is in the MD/PhD program.After neuronal injury or death glial cells become reactive, exhibiting dramatic changes in morphology and patterns of gene expression and ultimately engulfing neuronal debris. Rapid clearance of degenerating neuronal material is thought to be crucial for suppression of inflammation and promotion of functional recovery. Here we demonstrate that Drosophila c-Jun N-terminal kinase (dJNK) signaling is a critical in vivo mediator of glial engulfment activity. In response to axotomy, we find glial dJNK signals through a cascade involving the upstream mitogen-activated protein kinase kinase kinases Slipper and Tak1, the mitogen-activated protein kinase kinase MKK4, and ultimately the Drosophila activator protein 1 (AP-1) transcriptional complex composed of Jra and Kayak to initiate glial phagocytosis of degenerating axons. Interestingly, loss of dJNK also blocked injury-induced upregulation of Draper levels in glia, and glial-specific overexpression of Draper was sufficient to rescue engulfment defects associated with loss of dJNK signaling. This work identifies that the dJNK pathway is a novel mediator of glial engulfment activity and a primary role for the glial Slipper/Tak1short right arrowMKK4short right arrowdJNKshort right arrowdAP-1 signaling cascade appears to be activation of draper expression after axon injury.Cell Death and Differentiation advance online publication, 26 April 2013; doi:10.1038/cdd.2013.30.MD/PhDNeuroscienc
Maintaining Privacy During Psychosocial Research on the International Space Station
No full textConducting psychosocial research on the International Space Station (ISS) requires rigorous privacy precautions that exceed standard scientific human subject protocols. In our previous study involving crewmembers on Mir, and in our ongoing ISS work, special precautions were taken during each phase of the missions. Pre-flight, participants received detailed consent forms explaining that only group-level data would be presented, and they chose ID codes known only to them. In-flight, special procedures protected data during collection and transmission. Post-flight, our analytic strategy further masked participants’ identities, and participant representatives were invited to review manuscript drafts prior to publication. In this paper we describe lessons learned during our on-orbit studies and discuss their relation to maintaining privacy on studies of future long-duration space missions
A Wild Rabbit Chase: When Tularemia Hops into the Differential
No full textCase Presentation
A 43-year-old previously healthy male presented to the ED for four days of a painful skin lesion, which he had attributed to a suspected spider bite. He reported associated chills, myalgias, and headaches. The wound was cultured, and he was discharged on empiric cephalexin and trimethoprim-sulfamethoxazole. Five days later he returned to the ED with progressive symptoms, including high fevers, shortness of breath, nausea with emesis, diarrhea, blurry vision, and visual hallucinations. His exam was significant for an eschar at the left lower chest with surrounding erythema and pustules. Labs revealed neutrophilic leukocytosis, elevated transaminases, and hyponatremia. He was admitted for broad-spectrum antibiotics and additional work-up. Further testing including CT head, lumbar puncture, and routine blood cultures were negative. A CT chest revealed multiple pulmonary nodules concerning multifocal infection or septic emboli. A TTE did not show any valvular pathology or vegetations. A punch biopsy of the eschar showed epidermal ulceration, a dense dermal inflammatory infiltrate, and peri-eccrine inflammation, suggestive a spider bite. He improved and was discharged home on a short course of amoxicillin/clavulanic acid and doxycycline. His initial wound culture was ultimately sent to the state health department for further identification, and Francisella tularensis was diagnosed via PCR. The F. tularensis IgG drawn during his hospitalization also returned positive. Although he still had some residual symptoms, he declined re-admission for aminoglycoside therapy and was started on 10-day course of ciprofloxacin with near symptom resolution and interval reduction of pulmonary nodules on follow up CT chest. Discussion
Tularemia may develop after the bite of an infected insect, such as a tick or deerfly. Individuals typically develop symptoms three to five days after a bite. Domestic animals, including dogs, can sometimes play a role in transmitting the pathogen to humans. Tularemia presents in six major clinical forms: glandular, ulceroglandular, oculoglandular, typhoidal, pneumonic, and oropharyngeal. Symptoms may be nonspecific, and patients may infrequently display features of several forms. Severe disease can occur in healthy, young adults and is not restricted to those with weakened immune systems or preexisting health conditions Approximately 200 cases of tularemia are reported annually in the United States, with the highest incidence in the southern and central states. In 2023, only two cases were reported in Virginia. Microbiology lab members should be alerted immediately with any concerns for tularemia due to the need for special culture media and biosafety precautions. Aminoglycosides remain gold standard therapy, though doxycycline or a fluoroquinolone may be prescribed for mild-moderate infections. This patient’s partial response to doxycycline may be attributed to the higher rates of treatment failure and relapse associated with doxycycline compared to fluoroquinolones in the treatment of tularemia. Tularemia is uncommon in the Southeast US, and disseminated tularemia with primary skin lesions is rare. A high index of suspicion and a careful review of exposure history are essential for more rapid diagnosis and appropriate treatment
Science is perception: what can our sense of smell tell us about ourselves and the world around us?
No full textHuman sensory processes are well understood: hearing, seeing, perhaps even tasting and touch—but we do not understand smell—the elusive sense. That is, for the others we know what stimuli causes what response, and why and how. These fundamental questions are not answered within the sphere of smell science; we do not know what it is about a molecule that … smells. I report, here, the status quo theories for olfaction, highlighting what we do not know, and explaining why dismissing the perception of the input as ‘too subjective’ acts as a roadblock not conducive to scientific inquiry. I outline the current and new theory that conjectures a mechanism for signal transduction based on quantum mechanical phenomena, dubbed the ‘swipe card’, which is perhaps controversial but feasible. I show that such lines of thinking may answer some questions, or at least pose the right questions. Most importantly, I draw links and comparisons as to how better understanding of how small (10’s of atoms) molecules can interact so specially with large (10 000’s of atoms) proteins in a way that is so integral to healthy living. Repercussions of this work are not just important in understanding a basic scientific tool used by us all, but often taken for granted, it is also a step closer to understanding generic mechanisms between drug and receptor, for example
Simple Regrets: Counterfactuals and the Dialogic Mind
No full textCounterfactuals, or unrealized scenarios, have been a focus of research in an array of disciplines, though their rhetorical implications have gone largely unexplored. This interdisciplinary study uses a cognitive methodology in taking a fresh look at counterfactual scenarios in discourse. The study argues that when counterfactual scenarios are introduced into discourse and paired with an evaluative stance, the result is a creative and persuasive scenario that allows a speaker to communicate a perspective that a listener may reinforce, revise, or reject. Counterfactuals thus have the ability to convey an evaluation, to convey emotion, to provide a window for disagreement, or to foster solidarity. In literature, counterfactual scenarios additionally serve as an embedded element of discourse that may convey the perspective of characters and/or the implied author. The reader juggles the counterfactual scenarios, and the perspectives they convey, with other textual elements to grasp the meaning of the story.
This study furthers previous research on counterfactuality by considering the phenomenon from a cognitive rhetorical perspective. Rather than focusing on counterfactual thinking, as psychologists have done, or on linguistic forms, as linguists have done, this study considers both the cognitive and discursive dimensions of counterfactuals in a fully integrated analysis. Furthermore, this study places counterfactuals within a communicative paradigm that considers the role of both speaker and listener, or author and reader, in developing and interpreting counterfactual scenarios. This study thus demonstrates the largely unrecognized rhetorical dimensions of counterfactual scenarios in both ordinary and literary discourse
Trade Policy at the Cross-Roads
No full textIt is now widely agreed that the World Trade Organization (WTO) is in trouble, struggling to deliver the national rewards available from liberalising through multilateral negotiations. Prime Minister Howard and President Bush have committed to help restore the ability of the WTO system to deliver those rewards. This paper examines the contribution of domestic transparency procedures, introduced by and operating within participating countries, in dealing with the domestic causes of the problem facing the multilateral system. It explains the relevance of the proposal, prepared for Prime Minister Howard, in meeting the commitment he has taken. The Hong Kong Ministerial Meeting in December 2005 provides an opportunity to advance such a proposal and, in doing so, enhance our own trade performance. The author was involved, with Alf Rattigan and John Crawford, in establishing the Industries Assistance Commission and was its chairman from 1985 to 1988. He was a member of the international study group chaired by the former Director-General of the GATT, Olivier Long which drew attention during the Uruguay Round of multilateral trade negotiations (1986 1994) to the need for domestic transparency in trade policy. He co-authored a review of trade policy conduct of industrial nations, which was published by the National Centre for Development Studies in 1996. He and Professor Ross Garnaut prepared a domestic transparency proposal for Prime Minister Howard in February 2004 to provide the basis for an Australian initiative in the Doha Round. This paper explains how this proposal would contribute to restoring an effective WTO system by enabling domestic economic welfare to replace domestic political pressures as the driver of multilateral trade negotiations.World Trade Organization, trade, policy, multilateral, negotiations, Howard, Bush
Delusional Parasitosis vs. Morgellons Disease: Diagnostic Challenges, Overlaps, and Clinical Implications
No full textTitle: Delusional Parasitosis vs. Morgellons Disease: Diagnostic Challenges, Overlaps, and Clinical Implications.
Author Names: Katheryn Bell1, Jennifer Beckman1, Suki Sasic1, Josey Mckinley, and Mushashra Raza M.D., MPH2
Indiana University School of Medicine.
Department of Psychiatry, Indiana University School of Medicine.
Background: Delusional parasitosis (DP) is a delusional disorder where patients believe they are infested with a parasite/bug [1]. In contrast, Morgellons disease (MD) is a psycho-dermatologic condition where a patient has the sensation of fibers in/on their skin, often with associated itching and ulcerative lesions [2]. Both conditions can either be primary or secondary to psychiatric/medical conditions. The diagnostic criteria for both is complicated by commonly associated psychiatric disorders and substance abuse, as well as the need to completely rule out underlying pathologies causing the delusions [3,4].
Case: 42 y.o. female with a history of Major Depressive Disorder (MDD), unspecified psychosis/schizophrenia, anxiety disorder, and substance use disorders involving cocaine, amphetamines, cannabis, and tobacco admitted due to suicidal ideation with plan. The patient reported a several-year history of feeling her body was infested with small bugs, insisting a bag of black fibers were those bugs. She also noted several symptoms of depression, but denied auditory hallucinations or any other symptoms of psychosis. Drug screen was positive for cocaine and cannabis. Physical exam found rashes and erosions on the face, arms, and hands. She was started on 2mg risperidone with improvement and discharged on day 7 with follow up.
Clinical Significance: The unique overlap of etiologies in this patient makes this an interesting case. The patient presented with a variety of confounding factors- substance abuse, depression, delusions of bug infestation, and presence of fibers- which make distinguishing between diagnoses such as DP, MD, psychosis, and substance-induced formication difficult. However, the patient improved with conventional treatment, calling into question whether this diagnostic parsing is even necessary.
Conclusion: Patient presented with suicidal ideation and feeling of bugs inside her body, suggestive of an MD or PD etiology, thus raising the question of whether distinguishing the two is critical for treatment
Art of Analysis
No full textArt of Analysis (AoA) is a nationally-recognized partnership between the Columbus Museum of Art (CMA) and the Ohio State University Medicine and the Arts (Ohio State M&A) initiative. AoA uses art as a catalyst for conversation and collaboration, fostering a range of skills essential for student wellness, quality medical care, and resilience in a high burnout field. The session takes AoA as a case study to explore what makes a meaningful, sustainable partnership for wellness and growth. Presenters will 1) recreate a portion of the AoA experience; 2) highlight key aspects of wellness fostered through the experience; 3) identify elements that support success and present challenges; and 4) support participants to generate ideas for taking these lesson to their own contexts. Art of Analysis brings students and faculty from medical sciences across Ohio State to CMA for an evening of in-gallery, facilitated discussion. Participants practice critical and creative thinking habits, including careful observation, questioning assumptions, collaborative thinking, reasoning with evidence, and adopting multiple perspectives. AoA began in 2010 as an approach to fostering observation skills and comfort with ambiguity – both crucial skillsets for diagnosis and treatment, and both identified as growth areas for medical students by the then-dean of the College of Medicine. Evaluations revealed participant perception that AoA supported their observation skills and shifted their thinking about the role of ambiguity/developing and reasoning through multiple interpretations. Evaluations also surfaced emergent, highly-valuable outcomes: students reported: feeling compassion for subjects of works of art, valuing the exploration of points of view different from their own, gaining appreciation for peers' perspectives, and cherishing the time to slow down. In other words, the experience created the opportunity to build empathetic behaviors necessary for the human work of medicine, and provided participants with self-care strategies to support resilience as students and medical professionals. Based on these findings, AoA has evolved to explicitly support a broader range of critical, creative and empathetic dispositions. The session advocates that these dispositions are essential for individual and community wellness, and supports attendees to think in fresh ways about deeply-meaningful partnerships for their own contexts. AoA is the subject of an article in the Journal of Learning Through the Arts. Session presenters Jennifer Lehe (manager of strategic partnerships, CMA) and Dr. Linda Stone, MD (special assistant to the dean for humanism and professionalism, Ohio State COM) presented AoA at a national convening of medical school-art museum partnerships (Art of Examination, 2016 MoMA). Art of Analysis is part of Ohio State's Medicine and the Arts Initiative, for which Dr. Stone was awarded the 2017 Governor's Awards for the Arts for Community Development and Participation.AUTHOR AFFILIATION: Jennifer Lehe, Manager of Strategic Partnerships, Columbus Museum of Art, Ohio State Medicine and the Arts Board, [email protected] (Corresponding Author); Linda Stone, MD, Special Assistant to the Dean for Humanism and Professionalism, Ohio State College of Medicine, Ohio State Medicine and the Arts Board, Ohio State Medical Humanities.Art of Analysis (AoA) is a nationally-recognized partnership between the Columbus Museum of Art (CMA) and The Ohio State University Medicine and the Arts (OSU M&A). Attendees will explore the partnership, which brings students and faculty from Ohio State medical sciences to CMA for an evening of facilitated discussion with art. AoA participants practice critical, creative, and empathetic thinking, including close observation, questioning assumptions and adopting multiple perspectives. Learn how presenters co-created and evolved a program to support wellness and learning for students by capitalizing on the expertise of art museum educators and emergent outcomes. The presenters advocate that the dispositions fostered in AoA are essential for indivi-dual and community wellness, while supporting participants to think in fresh ways about deeply meaningful partnerships. Attendees will have time to generate and receive input on ideas for their own contexts
Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas
No full text2019 EAST PODIUM PAPER Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas Harmon, Laura A. MD; Haase, Daniel J. MD; Kufera, Joseph A. MA; Adnan, Sakib BS; Cabral, Donna BNS; Lottenberg, Lawrence MD; Cunningham, Kyle W. MD, MPH; Bonne, Stephanie MD; Burgess, Jessica MD; Etheridge, James MD; Rehbein, Jennifer L. MD; Semon, Gregory DO; Noorbakhsh, Matthew R. MD; Cragun, Benjamin N. MD; Agrawal, Vaidehi PhD; Truitt, Michael MD; Marcotte, Joseph MD; Goldenberg, Anna DO; Behbahaninia, Milad MD; Keric, Natasha MD; Hammer, Peter M. MD; Nahmias, Jeffry MD; Grigorian, Areg MD; Turay, Dave MD; Chakravarthy, Vikram MD; Lalchandani, Priti MD; Kim, Dennis MD; Chapin, Trinette; Dunn, Julie MD; Portillo, Victor MD; Schroeppel, Thomas MD, MS; Stein, Deborah M. MD, MPH Author Information Journal of Trauma and Acute Care Surgery 87(1):p 61-67, July 2019. | DOI: 10.1097/TA.0000000000002327 Buy CME Test Erratum Abstract BACKGROUND
Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis. METHODS
Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ2 and Wilcoxon\u27s rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center. RESULTS
Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF (p = 0.8) nor did trajectory through the oropharynx (p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics (p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = \u3c0.001) and in patients with surgical intervention (10% vs. 3%; p \u3c 0.001). CONCLUSION
There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use. LEVEL OF EVIDENCE
Therapeutic, level IV
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