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Background: Though rare, pathologic extramedullary hematopoiesis (EMH) can occur in response to myeloproliferative disorders and may present as paravertebral masses. Case Description: We describe a 63-year-old female with unspecified thalassemia, hemochromatosis, and known asymptomatic extramedullary hematopoiesis of the thoracic spine who acutely developed severe spinal cord compression and a T9 vacuum phenomenon fracture 7 months after her initial diagnosis. Outcome: The patient was treated with urgent decompression and T9 kyphoplasty, which resulted in complete resolution of her neurological deficits. Conclusions: The timeline of symptomatology in the case suggests that asymptomatic patients with T-spine extramedullary hematopoiesis can develop progressive neurologic deterioration and atraumatic compression fractures culminating in acute spinal cord injury. While it may be appropriate to treat asymptomatic patients conservatively, surgical decompression must always remain a consideration.

Introduction Determination of what constitutes necessary surgery in the setting of acute hospital resource strain during the COVID-19 pandemic is an unprecedented challenge for healthcare systems. Over the past two years during the COVID-19 pandemic, there have been many changes in reviews of medically necessary spine surgery. There continues to be no clear guidelines on recommendations and further discussion is necessary to continue to provide appropriate and high-level care during future pandemics. Significance This review critically appraises and evaluates current barriers to medically necessary spine surgery during the COVID-19 pandemic and evaluates future decision making to maintain spine surgery during future pandemics or limitations in medical care. Results Multiple studies included in this review have shown that while various orthopaedic surgeries may be considered elective, medically necessary spine surgery will need to continue during settings of limited medical care. This review discussed multiple methods and recommendations to limit transmission of virus from patients to providers and providers to patients. Conclusion Continued medically necessary spine surgery in the setting of the COVID-19 pandemic and future pandemics should continue while limiting risk of transmission to continue providing high-level medical care and allowing hospitals to maintain financial responsibility.

Summary: Although combination BRAF/MEK inhibition has produced significant survival benefits for BRAF p.V600 mutant melanomas, targeted therapies approved for BRAF non-p.V600 mutant melanomas remain limited. Through the analysis of 772 cutaneous melanoma exomes, we reveal that BRAF non-p.V600 mutations co-occurs more frequently with NF1 loss, but not with oncogenic NRAS mutations, than expected by chance. We present cell signaling data, which demonstrate that BRAF non-p.V600 mutants can signal as monomers and dimers within an NF1 loss context. Concordantly, BRAF inhibitors that inhibit both monomeric and dimeric BRAF synergize with MEK inhibition to significantly reduce cell viability in vitro and tumor growth in vivo in BRAF non-p.V600 mutant melanomas with co-occurring NF1 loss-of-function mutations. Our data suggest that patients harboring BRAF non-p.V600 mutant melanomas may benefit from current FDA-approved BRAF/MEK inhibitor combination therapy currently reserved for BRAF p.V600 mutant patients.

AbstractSamples of two historical papers from the late 17th and early 18th centuries were irradiated with a 350-nm ?maxlight source. Atomic force microscopy examination of untreated samples of these laid paper sheets revealed notable surface inhomogeneity. Diffuse brightness values show that irradiation resulted in an initial decrease followed by a rapid increase in brightness with increasing irradiation time from 0.5 to 28 h. The bleaching effect then slowed, following a logarithmic path that did not plateau within 197 h of irradiation time. Irradiated sheets stored for 3 months exhibited brightness reversion of 7%. Fluorescence also decreased with irradiation time if excitation wavelengths of 320, 350, and 400 nm were applied for samples exposed to narrow-band irradiation at 350 nm. The fold endurance decreased by 34–72% after 197 h of irradiation. Changes in tear and tensile values were less dramatic. The Z-direction ultrasonic velocity decreased after 197 h of irradiation; however, the ultrasonic conductivity partially recovered during 9 months of storage. [ABSTRACT FROM AUTHOR]