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Introduction: Clear cell renal cell carcinoma (ccRCC), the most common type of kidney cancer in adults, presents significant challenges owing to its resistance to conventional therapies. Standard treatment primarily revolves around surgical methods, particularly nephrectomy, which is critical for managing localized diseases. Despite recent advancements, the metastatic potential of ccRCC necessitates ongoing vigilance in postoperative monitoring to manage and detect disease recurrence. Recent shifts in treatment paradigms, especially with the integration of molecular patterns in ccRCC, have enabled the development of targeted therapies. Immune checkpoint and tyrosine kinase inhibitors (TKIs) have become central to managing metastatic ccRCC, offering new hope through improved survival outcomes. Recent studies have corroborated this by demonstrating the benefits of combining these therapies. Case Presentation: This report discusses a case study of a patient with high-grade ccRCC and thyroid metastases initially deemed non-resectable. The combination of immunotherapy and TKIs reduced tumor size, transforming the thyroid metastasis to a resectable state. Conclusion: This case highlights significant advancements in treatment approaches and the critical in the management of ccRCC, underscoring the necessity for continuous adaptation of clinical practices to incorporate new therapeutic developments.

The paper presents a method for measuring the amount of hoar frost formation in the recuperation channels of ventilation systems using the adjustable mathematical model of the hoar frost process. The principle is based on the fact that the contour of the adjustment of the hoar frost model is included in the measurement in accordance with the measured pressure drop, which is proportional to the amount of hoar frost. Unlike the known measurement methods, it is proposed to use the state variables of the mathematical model as the measured value. These state variables are not subject to non-deterministic interferences and random influences. The paper presents simulation results confirming the adequacy of the dynamic model. In conclusion, an example of the use of a recuperation channel in the defrost management system is given.

As some researchers predicted, online education is taking precedence over higher education worldwide. This work deals with this situation using three frameworks appropriate for the three concepts involved (i.e. technology, teacher and students). The literature was reviewed in the context of good-quality education and its relation to three distance-education frameworks. Some approaches and strategies indicate improvement in achieving electronic media-based learning (e-Learning) recognition for better outreach. This manuscript also shows that the most critical aspect of this outreach is thinking about the learning benefits that learners might gain from it and how they might assess those benefits using various tools, not only by direct comparison with old pedagogies or methods.

This article provides a synthesis of the virtual Coastal Dunes for Resilience Workshop held on December 8th and 9th, 2021. In an effort to foster knowledge-sharing across these sites and disseminate information and lessons learned, the California Dune Science Network hosted the Workshop that featured recent dune research, information about nature-based dune and resilience projects, and collaborative learning opportunities at California's pilot project and natural dune sites. It also engaged diverse perspectives on coastal resource stewardship, public access, and culturally inclusive climate adaptation approaches and how these play a role in the success of coastal dune resilience efforts. The Coastal Dunes for Resiliency Workshop provided an initial opportunity for ideas and strategies to be shared amongst the many practitioners working in the coastal resilience space. The workshop highlighted common challenges, needs, and four emerging themes for implementing coastal dunes for resilience in California: (1) there is no one-size-fits-all approach to designing dunes for resilience, (2) defining resilience goals and expectations are key to selecting an effective dunes approach, (3) importance of socio-cultural engagement and perceptions in dune project success, and (4) evaluating project and shoreline resilience is key to optimizing project designs and developing best practices.These initial recommendations will allow for further conversations on how to evaluate strategies and move forward in a more unified and efficient way to meet the needs of our coastal communities and ecosystems. The Network will continue to build its base of knowledge and contribute to best practices that make sense for the California landscape. Further workshops should dig into the details of how to effectively design dune resilience projects and monitoring and management strategies, while meeting the changing and unique needs of beach users and coastal community members and infrastructure impacted by sea-level rise.

Differences between orbital and subcutaneous abdominal fat in the same patient have been noted but not formally investigated, previously. The objective of this research was to compare the differential expression of protein profiles in subcutaneous abdominal and orbital adipose tissues. In this cross-sectional, observational study, orbital fat tissue was sampled from 10 patients who underwent blepharoplasty and agreed to provide a small sample of subcutaneous abdominal fat. Shotgun mass spectrometry was performed on the extracted proteome. Data were analyzed using protein appearance patterns, differential expression and statistical enrichment. Protein analysis revealed significant differences in proteomics and differential expression between the orbital and subcutaneous abdominal adipose tissues, which presented five proteins that were uniquely expressed in the orbital fat and 18 in the subcutaneous abdominal fat. Gene Ontology analysis identified significantly different cellular processes and components related to the extracellular matrix or basement membrane components. This analysis shows the differences between orbital and subcutaneous abdominal fat found in proteomics differential expression, uniquely expressed proteins, and cellular processes. Further research is needed to correlate specific proteins and cellular processes to the mechanism of fat accumulation and obesity.

Abstract The human aryl hydrocarbon receptor (AHR) undergoes continuous shuttling between nucleus and cytoplasm. Binding to exogenous or endogenous ligands promotes its rapid nuclear import. The proposed mechanism for the ligand-dependent import is based on exposing the bipartite nuclear localisation signal (NLS) to members of the importin (IMP) superfamily. Among this, the molecular interactions involved in the basal import still need to be clarified. Utilizing fluorescently fused AHR variants, we recapitulated and characterized AHR localization and nucleo-cytoplasmic shuttling in living cells. Analysis of AHR variants carrying NLS point mutations demonstrated a mandatory role of first (13RKRRK17) and second (37KR-R40) NLS segments on the basal import of AHR. Further experiments indicated that ligand-induced import is mainly regulated through the first NLS, while the second NLS is supportive but not essential. Additionally, applying IMPα/β specific inhibitors, ivermectin (IVM) and importazole (IPZ), slowed down the ligand-induced import and, correspondingly, decreased the basal nuclear accumulation of the receptor. In conclusion, our data show that ligand-induced and basal nuclear entry of AHR rely on the same mechanism but are controlled uniquely by the two NLS components.

Objectives: We evaluated the diagnostic accuracy of cerebrospinal fluid (CSF) inflammatory markers for diagnosing bacterial meningitis in neonates with sepsis and/or meningitis. Methods: Cases were identified from a prospective multicenter study including patients aged 0-3 months with Group B Streptococcal (GBS) or Escherichia coli culture positive sepsis/meningitis. CSF CXCL10, MDC, IL-6, IL-8, IL-10, TNF- α, MIF, IL-1RA, CXCL13, IL-1β, CRP and procalcitonin concentrations were measured with Luminex technology. Results: In 61/373 patients (17%) residual CSF from the lumbar puncture was available, of whom 16 (26%) had definitive meningitis, 15 (25%) probable meningitis and 30 (49%) had sepsis. All biomarkers were detectable in CSF and showed significantly higher concentrations in definitive meningitis versus sepsis patients and six biomarkers in probable meningitis versus sepsis patients. Discrimination between definitive meningitis and sepsis was excellent for IL-1RA (area under the receiver operating characteristic curve [AUC] 0.93), TNF-α (AUC 0.92), CXCL10 (AUC 0.90), IL-1β (AUC 0.92), IL-6 (AUC 0.94), IL-10 (AUC 0.93) and a combination of IL-1RA, TNF-α, CXCL-10 and CSF leukocyte count (AUC 0.95). CSF leukocyte count remained the predictor with the highest diagnostic accuracy (AUC 0.96). Conclusion: CSF inflammatory markers can be used to differentiate between neonatal sepsis and meningitis.

The parathyroid cell is a vital regulator of extracellular calcium levels, operating through the secretion of parathyroid hormone (PTH). Despite its importance, the regulation of PTH secretion remains complex and not fully understood, representing a unique interplay between extracellular and intracellular calcium, and hormone secretion. One significant challenge in parathyroid research has been the difficulty in maintaining cells ex vivo for in-depth cellular investigations. To address this issue, we introduce a novel platform for parathyroid cell transplantation and noninvasive in vivo imaging using the anterior chamber of the eye as a transplantation site. We found that parathyroid adenoma tissue transplanted into the mouse eye engrafted onto the iris, became vascularized, and retained cellular composition. Transplanted animals exhibited elevated PTH levels, indicating a functional graft. With in vivo confocal microscopy, we were able to repetitively monitor parathyroid graft morphology and vascularization. In summary, there is a pressing need for new methods to study complex cellular processes in parathyroid cells. Our study provides a novel approach for noninvasive in vivo investigations that can be applied to understand parathyroid physiology and pathology under physiological and pathological conditions. This innovative strategy can deepen our knowledge on parathyroid function and disease.

Abstract Background Planning for return to work (RTW) is relevant among sub‐groups of metastatic breast cancer (mBC) survivors. RTW and protective factors for RTW in patients with mBC were determined. Methods Patients with mBC, ages 18–63 years, were identified in Swedish registers, and data were collected starting 1 year before their mBC diagnosis. The prevalence of working net days (WNDs) (>90 and >180) during the year after mBC diagnosis (y1) was determined. Factors associated with RTW were assessed using regression analysis. The impact of contemporary oncological treatment of mBC on RTW and 5‐year mBC‐specific survival was compared between those diagnosed in 1997–2002 and 2003–2011. Results Of 490 patients, 239 (48.8%) and 189 (36.8%) had >90 and >180 WNDs, respectively, during y1. Adjusted odds ratios (AORs) of WNDs >90 or >180 during y1 were significantly higher for patients with age ≤50 years (AOR180 = 1.54), synchronous metastasis (AOR90 = 1.68, AOR180 = 1.67), metastasis within 24 months (AOR180 = 1.51), soft tissue, visceral, brain as first metastatic site (AOR90 = 1.47) and sickness absence

This document provides a brief report of activities conducted as part of the final capstone project for submission to Scripps Institution of Oceanography’s Master of Advanced Studies graduate degree program in Marine Biodiversity and Conservation. The project: Designing a Marine Management Plan for Fish Reproduction Zones of Curaçao, Lesser Antilles, was completed with the support of the Waitt Institute, CARMABI Institute, and Curaçao’s Ministry of Health, Environment and Nature. It was drafted using successful previous management plans as a reference and was edited and finalized after site visits and stakeholder engagement. The Fish Reproduction Zone Management Plan will be submitted to the Ministry for consideration as well as submitted with this report for review and evaluation by the Capstone Advisory Committee.

نفذ البحث في قرية فديو التابعة لمحافظة اللاذقية خلال العام (2022) على أشجار الحمضيات صنف " فالنسيا" بعمر 15 سنة مطعمة على أصل الزفير، ونفذت التجربة بـــ 9 معاملات وكل معاملة بثلاث مكررات، وهدف البحث إلى "دراسة تأثير التغذية الورقية بالمخصب العضوي "الأرغومين" ومستخلص الطحالب البحرية Amino Food"" في تحسين محتوى الورقة من الكلوروفيل وجودة الثمار لصنف البرتقال " فالنسيا وبينت النتائج الآتي: -أعطت المعاملة ( Orgomin 2 سم3 / ليتر + Amino Food 2 سم3 / ليتر) أعلى محتوى للورقة من كلوروفيل a و b والكلوروفيل الكلي ( 0.749 مغ/غ، 0.478 مغ/غ، و1.227مغ/غ) على التوالي. وبينت نتائج التحليل الإحصائي تفوق هذه المعاملة على كافة المعاملات الأخرى. أما من حيث جودة الثمار فقد أظهرت النتائج تفوق المعاملة (Orgomin 2 سم3/ ليتر + Amin food 2 سم3/ ليتر) في متوسط وزن الثمرة الذي بلغ (284.50غ)، وفي محتوى العصير من المواد الصلبة الذائبة الكلية بقيمة التي بلغت (12.33%)، كما تفوقت المعاملة (Orgomin 1.5 سم3/ ليتر + Amino Food 1 سم3/ ليتر ) في محتوى العصير من السكريات الكلية بقيمة بلغت (9.99%). أما بالنسبة لحموضة العصير فقد أدى الرش بـــــ (Orgomin 2 سم3/ ليتر + Amino food 1 سم3/ ليتر) إلى انخفاض الحموضة الكلية ( 0.359 %) بالمقارنة مع الشاهد الذي حقق أعلى زيادة للحموضة الكلية بقيمة بلغت (1.127%)، وبناءً على ذلك يمكن استخدام التغذية الورقية بالمخصب الحيوي ومستخلص الطحالب البحرية لتحسين محتوى الأوراق من الكلوروفيل وتحسين نوعية الثمار.

Background: The ongoing war in Sudan has triggered a massive displacement crisis, leaving internally displaced people (IDP) struggling to access healthcare services. This study aimed to investigate healthcare access, utilization, and the quality of life among Sudanese IDP during the conflict. Methods: This cross-sectional study was carried out among Sudanese internally displaced people in six states. Quality of life was assessed using the WHOQOL-Bref questionnaire. Accessibility, utilization, and the consequences of not accessing healthcare were evaluated using an author-designed questionnaire, which was piloted prior to the study. Chi-square tests were used to analyze associations between categorical variables, while ANOVA was applied to assess differences in quality-of-life domains based on displacement duration and living conditions. Multinomial logistic regression identified predictors of healthcare affordability, with significance set at p < 0.05. Results: Among 612 participants, 40.3% reported facilities being very close, 13.0% faced waits over 2 h, and 54.3% found healthcare unaffordable. Only 33.6% always had access to qualified staff, and 22.8% of IDP visited public healthcare facilities supported by non-governmental organizations. The psychological domain had the highest quality-of-life mean score at 49.7 (18.1). Worsened symptoms (44%) were a common consequence of healthcare inaccessibility, while lack of transport (37.9%) was the most common barrier. Availability of qualified staff significantly increased the likelihood of seeking care (χ² = 11.30, p = 0.022). Quality-of-life domains varied significantly by displacement duration and living situation (p < 0.011). Conclusion: This study revealed significant variations in healthcare access and utilization among Sudanese IDP, with quality-of-life domains lower than those of IDP in other countries. Interventions should prioritize innovative solutions like telemedicine, targeted support for vulnerable groups, and expanding health insurance coverage to enhance access and long-term health outcomes. [ABSTRACT FROM AUTHOR]

Angiosarcoma, an aggressive sarcoma subtype originating from lymphatic or vascular endothelial cells, is rare, constituting less than 2% of all soft tissue sarcomas. Predominantly affecting adult and elderly patients, it manifests diversely across various anatomical locations, with cutaneous lesions being the most common, particularly in the head and neck region. Noteworthy for its infiltrative nature, angiosarcoma demonstrates high rates of local recurrence and metastasis, leading to poor overall survival. The diagnosis may be difficult due to nonspecific clinical symptoms, and histological examination is essential in this disease. Treatment typically requires radical surgery, with addition of either chemo- or radiotherapy, or occasionally both, but there is a lack of formal evidence for the order of the modalities employed. Emerging therapies, such as targeted medicines and immunotherapy, show promising results in improving outcomes. This report presents a comprehensive analysis of a rare case of a young male with pelvic angiosarcoma. The patient underwent multiple operations, chemotherapy, and radiation, which highlights the complexities in management and the need for a multidisciplinary approach. Despite challenges, the patient achieved complete remission and is disease-free over 16 years after pelvic exenteration, demonstrating the potential for successful long-term outcomes. The case underscores the importance of personalized, multimodal treatment plans and close collaboration between surgeons and oncologists. Continued research into tailored therapies offers hope for improved prognosis and quality of life for individuals facing this uncommon sarcoma. [ABSTRACT FROM AUTHOR]

A 7-year-old boy presented to the hospital with recurrent nausea and vomiting over 2 weeks. A cranial MRI revealed a large heterogeneous lesion in the posterior fossa extending from the fourth ventricle to the foramen magnum with contact to the brainstem. The lesion showed moderate diffusion restriction and multiple small cystic components. The child underwent gross total resection. The primary histological findings suggested proliferative active tumor without further definition. The extended histological examination 3 weeks later confirmed the diagnosis of astroblastoma. Due to complete resection and full recovery of the patient, watchful waiting with radiological follow-up was recommended. Astroblastoma is an extremely rare tumor especially in the posterior fossa. However, it should be considered as a differential diagnosis in every tumor presenting the discussed radiological and histological features, especially in young aged patients. [ABSTRACT FROM AUTHOR]

Background/objectives: The outcome of refractory/relapsed systemic Anaplastic Large Cell Lymphoma (R/R-sALCL), especially for anaplastic lymphoma kinase-1 (ALK-1)-negative disease, remains dismal even after autologous hematopoietic stem cell transplantation (AHSCT). The intensification of both salvage and conditioning regimens, without increasing the toxicity, could improve the outcome of AHSCT in R/R-sALCL. Methods: Based on the successful experience of the incorporation of antiD20 monoclonal antibodies in the treatment of B-Cell Lymphomas, we designed a salvage and conditioning regimen incorporating the antiCD30-conjugated antibody (Brentuximab Vedotin, BV) to standard chemotherapy regimens, and we describe herein the clinical course of a patient with AKL-ve, R/R-sALCL, who received salvage regimen BV + DHAP, followed by AHSCT with preparative regimen consisted of BV plus standard BEAM. Results: The novel regimen was well tolerated, and no severe adverse effects were noticed. The engraftment was prompt and successful. The patient remained in complete metabolic remission for almost 12 months post-transplant. Conclusions: The proposed treatment approach, which combines antiCD30-conjugated antibody with standard salvage and conditioning regimens, demonstrated a completely acceptable toxicity with promising efficacy. [ABSTRACT FROM AUTHOR]

Emerging evidence suggests that fusion of cancer cells with leucocytes, such as macrophages, plays a significant role in cancer metastasis and results in tumor hybrid cells that acquire resistance to chemo- and radiation therapy. However, the precise mechanisms behind the leukocyte-cancer cell fusion remain unclear. The present in vitro study explores the presence of fusion between the monocyte cell line (THP-1) and the breast cancer cell line (MCF-7) in relation to the expression of CD36 and phosphatidylserine with and without treatment of these cells with ionizing radiation. The study reveals that spontaneous THP-1/MCF-7 cell fusion increases significantly from 2.8% to 6% after irradiation. The interaction between CD36 and phosphatidylserine plays a pivotal role in THP-1/MCF-7 cell fusion, as inhibiting this interaction using anti-CD36 antibodies significantly reduces cell fusion. While irradiation leads to a dose-dependent escalation in phosphatidylserine expression in MCF-7 cells, it does not impact the expression of CD36 in either THP-1 or MCF-7 cells. To the best of our knowledge, this is the first study to demonstrate the involvement of the CD36-phosphatidylserine interaction in the fusion between monocytes and cancer cells, shedding light on a novel explanatory mechanism for the roles of CD36 and phosphatidylserine in tumor progression. [ABSTRACT FROM AUTHOR]

Abstract The aim of the study was to compare 3 blood sampling methods, including capillary blood sampling, for determining Tamoxifen (TAM), Z-endoxifen (END), and 4-hydroxytamoxifen (4HT) concentrations. High performance liquid chromatography-mass spectrometry was used to quantify concentrations of TAM, END, and 4HT in plasma, venous blood, and capillary blood samples of 16 participants on TAM therapy for breast cancer. The rhelise kit was used for capillary sampling. Calibration curves using 13C-labeled analogs of TAM, END, and 4HT as internal standards were used for quantifications. A capillary sampling kit was used successfully for all participants. Mean TAM concentrations did not differ significantly in the 3 types of samples. Mean END and 4HT concentrations did differ significantly between capillary and venous blood samples, possibly related to photodegradation in the internal standards prior to use or degradation products with chromatographic retention times similar to the metabolites. TAM, END, and 4HT concentrations were relatively stable when stored for 14 days at 8 °C and 20 °C. Therapeutic drug monitoring of TAM using an innovative kit and capillary blood sampling is feasible. Preliminary data from this study will aid in developing a multicenter, randomized clinical trial of personalized TAM dose monitoring and adjustments, with the goal of enhancing the quality-of-life and outcomes of patients with breast cancer. Clinical Trial Identification: EudraCT No 2017-000641-44.

Accumulating evidence indicates that tumor-associated macrophages promote tumor progression and that high macrophage infiltration is correlated with advanced tumor stages and poor prognosis in breast cancer. GATA binding protein 3 (GATA-3) is a differentiation marker related to differentiated states in breast cancer. In this study, we explore how the extent of MI relates to GATA-3 expression, hormonal status, and the differentiation grade of breast cancer. To examine breast cancer in early development, we selected 83 patients that were treated with radical breast-conserving surgery (R0), without lymph node metastases (N0) or distant metastases (M0), with and without postoperative radiotherapy. Immunostaining of M2-macrophage-specific antigen CD163 was used to detect tumor-associated macrophages, and macrophage infiltration was estimated semi-quantitatively into no/low, moderate, and high infiltration. The macrophage infiltration was compared to GATA-3, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 expression in cancer cells. GATA-3 expression is associated with ER and PR expression but inversely correlated to macrophage infiltration and Nottingham histologic grade. High macrophage infiltration in advanced tumor grade was associated with low GATA-3 expression. The disease-free survival is inversely related to Nottingham histologic grade in patients having tumors with no/low macrophage infiltration, a difference that is not found in patients with moderate/high macrophage infiltration. These findings indicate that macrophage infiltration might impact the differentiation, malignant behavior, and prognosis of breast cancer, regardless of the morphological and hormonal states of the cancer cells in the primary tumor.

Background: One of the most prevalent illnesses in neonates that needs care and treatment is neonatal jaundice. Several drugs are used as pharmacological modalities for treating hyperbilirubinemia, like intravenous immunoglobulin, D-penicillamine, metalloporphyrin, phenobarbital, zinc sulfate and clofibrate. Previous studies suggest the usefulness of fenofibrate in the treatment of hyperbilirubinemia. Objectives: The study aims at assessing the effectiveness of oral fenofibrate in the treatment of indirect neonatal hyperbilirubinemia in full-term neonates. Method: This is a quasi-experimental study that was conducted at Heevi Pediatrics Teaching Hospital in Duhok, which is located in the Kurdistan Region of Iraq. It involved term infants who had jaundice. The neonates who were eligible for the study were randomly assigned to one of two groups: the intervention group or the control group. Both groups were treated with conventional phototherapy. Fenofibrate was administered in a single oral dose of 10 mg/kg to the participants in the intervention group. Throughout the entirety of the treatment, levels of total serum bilirubin were compared and contrasted between the two groups. Results: After 12 h of treatment, a statistically significant difference (p-value = 0.001) was seen in the serum bilirubin levels between the two groups. The difference in serum bilirubin levels became significantly progressively pronounced after 24, 48, and 72 h. The average time of discharge was 63.6 h for the intervention group and 90.9 h for the control group, and this difference was statistically significant (p-value < 0.001). Conclusions: The time it takes to lower high bilirubin levels in neonates may be shortened by combining conventional phototherapy with a single oral dosage of 10 mg/kg fenofibrate. Consequently, these neonates will experience a shorter hospitalization and an accelerated discharge from the hospital.

Recent exploration of the Khaybar oasis by the Khaybar Longue Durée Archaeological Project (AFALULA-RCU-CNRS) has led to the discovery of an exceptional Bronze Age fortified site called al-Natah. For the first time in Northwestern Arabia, the characteristics of a third/second-millennium-BCE settlement can be assessed over a large area. Preliminary archaeological survey and soundings have revealed a fortified 2.6-hectares town built around 2400–2000 BCE which lasted until at least 1500 BCE and possibly 1300 BCE−but with possible interruptions−, functionally subdivided into a residential area, a probable decision-making zone and a necropolis. The nucleated dwellings were constructed following a standard plan and were connected by small streets. By comparison with neighboring oasis centers, we suggest that Northwestern Arabia during the Bronze Age−largely dominated by pastoral nomadic groups and already integrated into long-distance trade networks−was dotted with interconnected monumental walled oases centered around small fortified towns. And by comparison with the contemporary situation in the Southern Levant, we also envisage that the archaeological record bears witness to a 'low urbanization' (or 'slow urbanism'), indigenous to North Arabia, evidencing weak but increasing social complexity through the Early and Middle Bronze Ages. [ABSTRACT FROM AUTHOR]

Differences between orbital and subcutaneous abdominal fat in the same patient have been noted but not formally investigated, previously. The objective of this research was to compare the differential expression of protein profiles in subcutaneous abdominal and orbital adipose tissues. In this cross-sectional, observational study, orbital fat tissue was sampled from 10 patients who underwent blepharoplasty and agreed to provide a small sample of subcutaneous abdominal fat. Shotgun mass spectrometry was performed on the extracted proteome. Data were analyzed using protein appearance patterns, differential expression and statistical enrichment. Protein analysis revealed significant differences in proteomics and differential expression between the orbital and subcutaneous abdominal adipose tissues, which presented five proteins that were uniquely expressed in the orbital fat and 18 in the subcutaneous abdominal fat. Gene Ontology analysis identified significantly different cellular processes and components related to the extracellular matrix or basement membrane components. This analysis shows the differences between orbital and subcutaneous abdominal fat found in proteomics differential expression, uniquely expressed proteins, and cellular processes. Further research is needed to correlate specific proteins and cellular processes to the mechanism of fat accumulation and obesity. [ABSTRACT FROM AUTHOR]

Adrenal incidentalomas are commonly detected via routine radiological procedures, and any sign of grossly invasive properties may alert the clinical team to suspect malignancy. Adreno-hepatic fusion (AHF) is a developmental disorder in which the parenchyma of the right adrenal gland is partly or wholly fused with the liver. The development of an adrenal cortical tumor in AHFs is a rare phenomenon that may mimic an invasive lesion. The index patient is a 74-year-old male with an incidental finding of a 25 mm lesion in segment VI of the liver. The lesion was deemed as fat-containing with magnetic resonance imaging (MRI) scans, and no signal was obtained on fluorodeoxyglucose-positron emission tomography (FDG-PET). A core needle biopsy was taken, and histology displayed adrenal cortical tumor lacking pleomorphism, mitoses and necrosis intermingled with hepatocytes. The favored diagnosis was adrenal cortical adenoma (ACA) arising in an AHF. Surgical resection was subsequently performed, thus verifying the diagnosis. A review of the current literature identified 10 cases with ACA development in AHF, predominantly detected as incidental masses in older female patients, and always positive for markers of adrenal differentiation when assessed. We conclude that radiological evidence of an adrenal tumor adherent to the liver capsule should not automatically imply adrenal cortical carcinoma, especially if the tumor is small and FDG-PET negative. Although exceedingly rare, adenoma formation in a pre-existing AHF should constitute a differential diagnosis in this specific clinical setting. Moreover, adrenal cortical immunohistochemical markers seem to correctly identify the tissue origin in these rare malformations.

ObjectiveDorsal instrumentation of the cervical spine is an established treatment in spine surgery. However, careful planning is required, particularly in elderly patients. This study evaluates early clinical outcomes in geriatric patients undergoing complex spine surgery.MethodsIn this retrospective, single center cohort study, we included all geriatric patients (aged ≥65 years) who underwent dorsal instrumentation between January 2013 and December 2020. We analyzed postoperative complications and the 30-day in-hospital mortality rate. Furthermore, the Charlson comorbidity index (CCI) and Clavien-Dindo grading system (CDG) were used to assess the patients' comorbidity burden.ResultsIn total, 153 patients were identified and included. The mean age of patients was 78 years (SD ± 7). Traumatic injury (53.6%) was the most common reason for surgery. 60.8% of the patients underwent dorsal instrumentation with 3 or more levels. The most common comorbidities were arterial hypertension (64%), diabetes mellitus (22.2%), coronary heart disease and atrial fibrillation (19.6%). The most common adverse event (AE) was pneumonia (4%) and the most common surgery-related complication was wound infection (5.2%). Among patients categorized as high risk for AE (CCI > 5), 14.6% suffered a postoperative AE. In our univariate analysis, we found no risk factors for high rates of complications or mortality.ConclusionOur data demonstrates that older patients were at no significant risk of postoperative complications. The CCI/CDG scores may identify patients at higher risk for adverse events after dorsal instrumentation, and these assessments should become an essential component of stratification in this older patient population.

ObjectiveAntithrombotic therapy is common in older patients to avoid thromboembolic events. Careful planning is required, particularly in the perioperative environment. There are no clearly date guidelines on the best timing for interrupting the use of anticoagulation in the case of spinal surgery. This study evaluates early per procedural clinical outcomes in patients whose antithrombotic therapy was interrupted for spinal surgery.MethodsThis is a retrospective cohort study. All patients who underwent dorsal instrumentation from January 1, 2019 to December 31, 2020 were included. In group A, vitamin K antagonists (VKA) were suspended for 5 days and direct oral anticoagulants (DOAC) for 3 days. In group B, antiplatelet agents (APA) were paused for at least 7 days before surgery to prevent perioperative bleeding. Patients not taking anticoagulation medication were gathered into control group C. We analyzed demographic data, ASA status, blood loss, comorbidities, duration of surgery, blood transfusion, length of hospital stay, complications, thromboembolism, and 30 day in-hospital mortality. Multivariate analyses from the three groups were further analyzed and conducted.ResultsA total of 217 patients were operated and included. Twenty-eight patients taking VKA/DOAC (group A), 37 patients using APA (group B), and 152 patients without anticoagulation (group C) underwent spinal surgery. Those using anticoagulants were significantly older and often with multimorbidity, but did not differ significantly in procedural bleeding, time of surgery, length of hospital stay, complication rate, thromboembolism, or 30 day in-hospital mortality (p > 0.05).ConclusionOur data show that dorsal instrumentation safely took place in patients whose antithrombotic therapy was interrupted.