Rosette-forming glioneuronal tumor of the fourth ventricle: Report of two cases with a differential diagnostic overview

We report on clinicopathological findings in two cases of rosette-forming glioneuronal tumor of the fourth ventricle (RGNT) occurring in females aged 16 years (Case 1) and 30 years (Case 2). Symptoms included vertigo, nausea, cerebellar ataxia, as well as headaches, and had been present for 4-months and 1 week, respectively. Magnetic resonance imaging (MRI) indicated a cerebellar-based tumor of 1.8cm (Case 1) and 5cm (Case 2) diameter each, bulging into the fourth ventricle. Case 2 involved a cyst-mural-nodule configuration. In both instances, the solid component appeared isointense on T(1) sequences, hyperintense in the T(2) mode, and enhanced moderately. Gross total resection was achieved via suboccipital craniotomy. However, functional recovery was disappointing in Case 1. On microscopy, both tumors comprised an admixture of low-grade astrocytoma interspersed with circular aggregates of synaptophysin-expressing round cells harboring oligodendrocyte-like nuclei. The astrocytic moiety in Case 1 was nondescript, and overtly pilocytic in Case 2. The architecture of neuronal elements variously consisted of neurocytic rosettes, of pseudorosettes centered on a capillary core, as well as of concentric ribbons along irregular lumina. Gangliocytic maturation, especially "floating neurons", or a corresponding immunoreactivity for neurofilament protein was absent. Neither of these populations exhibited atypia, mitotic activity, or a significant labeling for MIB-1. Cerebellar parenchyma included in the surgical specimen did not reveal any preexisting malformative anomaly. Despite sharing some overlapping histologic traits with dysembryoplastic neuroepithelial tumor (DNT), the presentation of RGNT with respect to both patient age and location is consistent enough for this lesion to be singled out as an autonomous entity.

Neoatherosclerosis as reason for stent failures beyond 5 years after drug-eluting stent implantation

A 69-year-old male (case 1) was admitted due to acute non-ST-segment elevation myocardial infarction (NSTEMI). Eight years earlier, he had previously undergone treatment with a sirolimus-eluting stent (SES). Four years after stent implantation, a follow-up angiography was obtained showing a patent stent without obstructive in-stent restenosis (Panel A). Angiograms obtained at the time of NSTEMI (Panel B) disclosed subtotal occlusion in the middle of the SES (arrowheads). Optical coherence tomography revealed a signal intense luminal layer with an underlying, highly attenuating, diffusely demarcated area, suggestive for an instent fibroatheroma (Panel D) with a minimal cap thickness of 80 µm. Accordingly, ischaemia was caused by the high degree of stenosis (Panel E). Similarly, a 59-year-old male (case 2) was admitted due to STEMI. Nine years before, he had received a paclitaxel-eluting stent (PES). Five years after stent implantation, a follow-up angiography revealed a patent stent (Panel F). Angiograms obtained at the time of STEMI (Panel G) disclosed total occlusion in the proximal of PES (arrowheads). Optical coherence tomography showed a rupture of thin cap fibroatheroma within the stented segment (Panel I). The thin cap fibroatheroma caused a severe stenosis with superimposed thrombus (Panel J). Neoatherosclerosis has been recently described as particular disease entity being responsible for very late stent failures. These two cases illustrate that the presence of a favourable long-term angiographic result years after DES implantation does not exclude a future neoatherosclerosis-related event (restenosis or stent thrombosis). Large observational and long-term intracoronary imaging studies are required to fully elucidate the dynamics and clinical relevance of neoatherosclerosis.

Life-threatening adverse events following therapeutic opioid administration in adults: Is pharmacogenetic analysis useful?

BACKGROUND Systemic approaches are needed to understand how variations in the genes associated with opioid pharmacokinetics and response can be used to predict patient outcome. The application of pharmacogenetic analysis to two cases of life-threatening opioid-induced respiratory depression is presented. The usefulness of genotyping in the context of these cases is discussed. METHODS A panel of 20 functional candidate polymorphisms in genes involved in the opioid biotransformation pathway (CYP2D6, UGT2B7, ABCB1, OPRM1, COMT) were genotyped in these two patients using commercially available genotyping assays. RESULTS In case 1, the patient experienced adverse outcomes when administered codeine and morphine, but not hydromorphone. Genetic test results suggested that this differential response may be due to an inherent propensity to generate active metabolites from both codeine and morphine. These active metabolites are not generated with hydromorphone. In case 2, the patient experienced severe respiratory depression during postoperative recovery following standard doses of morphine. The patient was found to carry genetic variations that result in decreased morphine efflux transporter activity at the blood-brain barrier and increased sensitivity to opioids. CONCLUSIONS Knowledge of the relative contribution of pharmacogenetic biomarkers and their influence on opioid response are continually evolving. Pharmacogenetic analysis, together with clinical history, has the potential to provide mechanistic insight into severe respiratory depressive events in patients who receive opioids at therapeutic doses.

Late onset and pregnancy-induced congenital thrombotic thrombocytopenic purpura.

UNLABELLED We report on our patient (case 2) who experienced a first acute episode of thrombotic thrombocytopenic purpura (TTP) at the age of 19 years during her first pregnancy in 1976 which ended in a spontaneous abortion in the 30th gestational week. Treatment with red blood cell concentrates was implemented and splenectomy was performed. After having suffered from several TTP episodes in 1977, possibly mitigated by acetylsalicylic acid therapy, an interruption and sterilization were performed in 1980 in her second pregnancy thereby avoiding another disease flare-up. Her elder sister (case 1) had been diagnosed with TTP in 1974, also during her first pregnancy. She died in 1977 during her second pregnancy from a second acute TTP episode. DIAGNOSIS In 2013 a severe ADAMTS13 deficiency of <10% without detectable ADAMTS13 inhibitor was repeatedly found. Investigation of the ADAMTS13 gene showed that the severe ADAMTS13 deficiency was caused by compound heterozygous ADAMTS13 mutations: a premature stop codon in exon 2 (p.Q44X), and a missense mutation in exon 24 (p.R1060W) associated with low but measurable ADAMTS13 activity. CONCLUSION Genetic analysis of the ADAMTS13 gene is important in TTP patients of all ages if an ADAMTS13 inhibitor has been excluded.

Are shrubs really a sign of declining ecosystem function? Disentangling the myths and truths of woody encroachment in Australia

Since European settlement, there has been a dramatic increase in the density, cover and distribution of woody plants in former grassland and open woodland. There is a widespread belief that shrub encroachment is synonymous with declines in ecosystem functions, and often it is associated with landscape degradation or desertification. Indeed, this decline in ecosystem functioning is considered to be driven largely by the presence of the shrubs themselves. This prevailing paradigm has been the basis for an extensive program of shrub removal, based on the view that it is necessary to reinstate the original open woodland or grassland structure from which shrublands are thought to have been derived. We review existing scientific evidence, particularly focussed on eastern Australia, to question the notion that shrub encroachment leads to declines in ecosystem functions. We then summarise this scientific evidence into two conceptual models aimed at optimising landscape management to maximise the services provided by shrub-encroached areas. The first model seeks to reconcile the apparent conflicts between the patch- and landscape-level effects of shrubs. The second model identifies the ecosystem services derived from different stages of shrub encroachment. We also examined six ecosystem services provided by shrublands (biodiversity, soil C, hydrology, nutrient provision, grass growth and soil fertility) by using published and unpublished data. We demonstrated the following: (1) shrub effects on ecosystems are strongly scale-, species- and environment-dependent and, therefore, no standardised management should be applied to every case; (2) overgrazing dampens the generally positive effect of shrubs, leading to the misleading relationship between encroachment and degradation; (3) woody encroachment per se does not hinder any of the functions or services described above, rather it enhances many of them; (4) no single shrub-encroachment state (including grasslands without shrubs) will maximise all services; rather, the provision of ecosystem goods and services by shrublands requires a mixture of different states; and (5) there has been little rigorous assessment of the long-term effectiveness of removal and no evidence that this improves land condition in most cases. Our review provides the basis for an improved, scientifically based understanding and management of shrublands, so as to balance the competing goals of providing functional habitats, maintaining soil processes and sustaining pastoral livelihoods.

"Leiomyomatoid angiomatous neuroendocrine tumor" (LANT) of the pituitary reflects idiosyncratic angiogenesis in adenomas of the gonadotroph cell lineage.

Based on a single-case observation, the descriptive label "leiomyomatoid angiomatous neuroendocrine tumor" (LANT) has been tentatively applied to what was perceived as a possible novel type of dual-lineage pituitary neoplasm with biphasic architecture. We report on two additional examples of an analogous phenomenon encountered in male patients, aged 59 years (Case 1) and 91 years (Case 2). Both tumors were intra- and suprasellar masses, measuring 5.6 cm × 4.4 cm × 3.4 cm, and 2.7 cm × 2 cm × 1.7 cm, respectively. Histologically, Case 1 was an FSH-cell adenoma interwoven by vascularized connective tissue septa that tended to exhibit incremental stages of adventitial overgrowth. The epithelial component of Case 2 corresponded to an LH-cell adenoma, and lay partitioned by a maze of paucicellular to hyalinized vascular axes. Irrespective of architectural variations, perivascular spindle cells exhibited immunopositivity for vimentin, muscular actin, and smooth muscle actin. Conversely, negative results were obtained for CD34, EMA, S100 protein, GFAP, and TTF-1. Ultrastructural study failed to reveal metaplastic cell forms involving transitional features between adenohypophyseal-epithelial and mesenchymal-contractile phenotype. We propose that LANT be regarded as a peculiar reflection of maladaptive angiogenesis in some pituitary adenomas, rather than a genuine hybrid neoplasm. While no mechanistic clue is forthcoming to account for this distinctive pattern, hemodynamic strain through direct arterial - rather than portal - supply of the adenoma's capillary bed may be one such explanatory factor. The apparent predilection of the LANT pattern for macroadenomas of the gonadotroph cell lineage remains unexplained.

Very Late Scaffold Thrombosis: Intracoronary Imaging and Histopathological and Spectroscopic Findings.

BACKGROUND Bioresorbable scaffolds provide transient lumen support followed by complete resorption. OBJECTIVES This study examined whether very late scaffold thrombosis (VLScT) occurs when resorption is presumed to be nearly complete. METHODS Patients with VLScT at 3 tertiary care centers underwent thrombus aspiration followed by optical coherence tomography (OCT). Thrombus aspirates were analyzed by histopathological and spectroscopic examination. RESULTS Between March 2014 and February 2015, 4 patients presented with VLScT at 44 (case 1), 19 (cases 2 and 4), and 21 (case 3) months, respectively, after implantation of an Absorb Bioresorbable Vascular Scaffold 1.1 (Abbott Laboratories, Abbott Park, Illinois). At the time of VLScT, all patients were taking low-dose aspirin, and 2 patients were also taking prasugrel. OCT showed malapposed scaffold struts surrounded by thrombus in 7.1%, 9.0%, and 8.9% of struts in cases 1, 2, and 4, respectively. Scaffold discontinuity with struts in the lumen center was the cause of malapposition in cases 2 and 4. Uncovered scaffold struts with superimposed thrombus were the predominant findings in case 3. OCT percent area stenosis at the time of VLScT was high in case 1 (74.8%) and case 2 (70.9%) without evidence of excessive neointimal hyperplasia. Spectroscopic thrombus aspirate analysis showed persistence of intracoronary polymer fragments in case 1. CONCLUSIONS VLScT may occur at advanced stages of scaffold resorption. Potential mechanisms specific for VLScT include scaffold discontinuity and restenosis during the resorption process, which appear delayed in humans; these findings suggest an extended period of vulnerability for thrombotic events.

Na 1 Nachlass Max Horkheimer, 674 - Forschungsprojekte über Antisemitismus, Vorurteil, Autorität: Einzeluntersuchungen (p. IX 141.1-24- IX 142.1-6)

Bettelheim, Bruno; Janowitz, Morris: "A Study on Anxiety and Social Aggression Among Different Groups of War Veterans", 1945-1947; Über die Anfälligkeit der Veteranen für antisemitische Propaganda, Typoskript, englisch, 1 Blatt; "Preliminary Study on the Evaluation of Intolerance Propaganda". Typoskript, 29 Blatt; "Isolationg the Patterns of Intolerance". Typoskript, 30 Blatt; "Distribution of Ethic Intolerance". Typsokript, 18 Blatt; "The Social Characteristics of the Intolerant". Typoskript, 22 Blatt; "Addendum to Social Characteristics of the Intolerant". Typoskript, 16 Blatt; "Impact of War Experiences". Typoskript, 26 Blatt; "Pattern on Sterepotypes". Typoskript, 14 Blatt; "Appendix No. 1: Schedule of Questions Employed in Interview". Typoskript, 6 Blatt; "Appendix No. 2: The Verteran´s Comment on the Interview Situation". Typoskript, 7 Blatt; "Preliminary Report of the Evaluation of Tolerance Propaganda". Typoskript, 19 Blatt; Einleitung zur Beschreibung des Forschungsprojekts, Typoskript, englisch, 1 Blatt; "Instructions for Interviewers". Typoskript, 2 Blat; "Questionaire". Typoskrip, 10 Blatt; "Prupose of the Investigation". Typoskript, 4 Blatt; "Schedule for Interviewers". Typoskript, 6 Blatt; "Appendix: Chicago Veterans Project". Typoskript, 3 Blatt; Memodanden zu Sitzungen mit Bruno Bettelheim, Edward Shils und Theodor W. Adorno; Memorandum 03.04.1945, Typoskript, 2 Blatt; Memorandum 15.03.1945; a) Typoskript, 3 Blatt; b) Typoskript, 4 Blatt; Memorandum 07.03.1945; a) Typoskript, 5 Blatt; b) Typoskript, 6 Blatt; University of Chicago: 1 Brief an Max Horkheimer, Chicago, 29.10.1945; University of Chicago, 1 Brief an Edward Shils undBruno Bettelheim, Chicago, 05.07.1945; Fine, Benjamin: "For Education against Intolerance and Prejudice"; Sonderdruck aus: The Menorah Journal, 1944, Vol. XXXII, No. 2, S. 161-180; Drucksachen, Materialien, 10 Blatt; Ackerman, Nathan W.: zum 'Psychoanalyst Project', 1945-1946; "Towards a Dynamic definition of Anti-Semitism". Typoskript, 13 Blatt; "The Use of Psychoanalytic Case Histories for the Study of Anti-Semitism". Typoskript, 14 Blatt; "Case Material Summary", Tabelle, 5 Blatt; "From for the Collection of Clinical Data on Anti-Minority and Anti-Semitic Attitudes". Als Typoskript vervielfältigt, 5 Blatt; "Case 2". Typoskript, 5 Blatt; "Case 24". Typoskript, 8 Blatt;

Tab. 1: Geochemical analysis and age dating of Kap Washington Group volcanites and related dykes

The bimodal, alkaline volcanic suite of the Kap Washington Group (KWG) at the northern coast of Greenland was investigated during the BGR CASE 2 expedition in 1994. Geochemical and Nd and Sr isotopic data are presented for basalts to rhyolites of the KWG and of related basaltic dykes cutting Lower Paleozoic sediments. In the evd(t) vs. (87Sr/86Sr)t diagram, the KWG basalts and rhyolites follow a common mixing trend with increasing crustal contamination from basic to acid volcanites. Assimilation of pre-existing crustal rocks during formation of the rhyolitic melt is documented by Nd model ages of 0.9-1.2 Ga and by different fractionation trends for the basalts and the rhyolites in the Y vs. Zr diagram. Petrographical and geochemical features indicate intra-plate volcanism which was active most probably during a continental rifting phase. A new Rb/Sr whole rock age on rhyolites of 64 ±3 Ma, corresponding to the result of LARSEN (1982), confirms that the volcanic activity lasted until the Cretaceous-Tertiary boundary. 40Ar139Ar dating on amphibol separates from a comendite yielded strongly disturbed age spectra with a minimum age of 37.7 ±0.3 Ma. This age is interpreted to date a hydrothermal overprint of the volcanic rocks related to compressive tectonics which led to the overthrust of basement rocks over the Kap Washington Group.

Absorption coefficients of particulate matter and chlorophyll a concentrations at time series station OLIPAC

Spectral absorption coefficients of total particulate matter ap (lambda) were determined using the in vitro filter technique. The present analysis deals with a set of 1166 spectra, determined in various oceanic (case 1) waters, with field chl a concentrations ([chl]) spanning 3 orders of magnitude (0.02-25 mg/m**3). As previously shown [Bricaud et al., 1995, doi:10.1029/95JC00463] for the absorption coefficients of living phytoplankton a phi (lamda), the ap (labda) coefficients also increase nonlinearly with [chl]. The relationships (power laws) that link ap (lambda) and a phi (lambda) to [chl] show striking similarities. Despite large fluctuations, the relative contribution of nonalgal particles to total absorption oscillates around an average value of 25-30% throughout the [chl] range. The spectral dependence of absorption by these nonalgal particles follows an exponential increase toward short wavelengths, with a weakly variable slope (0.011 ± 0.0025/nm). The empirical relationships linking ap (lambda) to ([chl]) can be used in bio-optical models. This parameterization based on in vitro measurements leads to a good agreement with a former modeling of the diffuse attenuation coefficient based on in situ measurements. This agreement is worth noting as independent methods and data sets are compared. It is stressed that for a given ([chl]), the ap (lambda) coefficients show large residual variability around the regression lines (for instance, by a factor of 3 at 440 nm). The consequences of such a variability, when predicting or interpreting the diffuse reflectance of the ocean, are examined, according to whether or not these variations in ap are associated with concomitant variations in particle scattering. In most situations the deviations in ap actually are not compensated by those in particle scattering, so that the amplitude of reflectance is affected by these variations.

Early termination of R&D projects

Early project termination is one of the most difficult decisions to be made by Research and Development managers. While there is the risk of terminating good projects, there is also the opposite risk of not terminating bad projects and overspend resources in unproductive research. Criteria used for identifying these projects are common subject of research in Business Administration. In addition, companies might take important lessons from its interrupted projects that could improve their overall portfolio technical and commercial success. Finally, the set and weight of criteria, as well as the procedures companies use for achieve learning from cancelled projects may vary depending on the project type. This research intends to contribute to the understanding of policies applied to projects that were once considered attractive, but by some reason is not appreciated anymore. The research addressed the question: How companies deal with projects that become unattractive? More specifically, this research tried to answer the following questions: (1) Are projects killed or (otherwise) they die naturally by lack of resources? (2) What criteria are used to terminate projects during development? (3) How companies learn from the terminated projects to improve the overall portfolio performance? (4) Are the criteria and learning procedures different for different types of projects? In order to answer these questions, we performed a multiple case study with four companies that are reference in business administration and innovation: (1) Oxiteno, considered the base case, (2) Natura, the literal replication, (3) Mahle and (4) AES, the theoretical replications. The case studies were performed using a semi-structured protocol for interviews, which were recorded and analyzed for comparison. We found that the criteria companies use for selecting projects for termination are very similar to those anticipated by the literature, except for a criteria related to compliance. We have evidences to confirm that the set of criteria is not altered when dealing with different project types, however the weight they are applied indeed varies. We also found that learning with cancelled projects is yet very incipient, with very few structured formal procedures being described for capturing learning with early-terminated projects. However, we could observe that these procedures are more common when dealing with projects labeled as innovative, risky, big and costly, while those smaller and cheaper derivative projects aren\'t subject of a complete investigation on the learning they brought to the company. For these, the most common learning route is the informal, where the project team learns and passes the knowledge though interpersonal information exchange. We explain that as a matter of cost versus benefit of spending time to deeply investigate projects with little potential to bring new knowledge to the project team and the organization