Fine-needle aspiration cytology of sarcomatoid renal cell carcinoma: A morphologic and immunocytochemical study of 15 cases

Sarcomatoid renal cell carcinoma (SRCC), which accounts for 5% of all renal cell carcinomas (RCC), has a worse prognosis than conventional nonsarcomatoid RCC. making accurate diagnosis important. This study reports on the morphologic and immunocytochemical features of 15 cases of SRCC (9 primary tumors and 6 metastases) diagnosed by fine-needle aspiration (FNA) biopsy. All but three cases showed a dimorphic cell population consisting of varying proportions of a high-grade epithelial component, either clear or granular-cell type and a spindle cell (sarcomatoid) component, of either fibrosarcomatous, malignant fibrous histiocytoma (MFH), or unclassified types. The sarcomatoid component in the biphasic and monophasic tumors stained positively for cytokeratin in 12 of 14 (85%) cases, for vimentin in 10 of 11 (91 %) cases, and for muscle-specific action in 4 of 11 (36%) cases. Of note, the three cases that demonstrated a purely sarcomatoid morphology stained positively for cytokeratin. Unlike in studies performed on surgically resected specimens, neither the proportion of the sarcomatoid component nor the presence of necrosis had prognostic significance, the discrepancy most likely being related to the sampling. We conclude that SRCC, both primary and metastatic, can be accurately diagnosed by FNA when cytologic features are evaluated in conjunction with immunocytochemical findings.     

Hemorrhagic complications in patients treated with anticoagulant doses of a low molecular weight heparin (enoxaparin) in routine hospital practice.

Low molecular weight heparins (LMWHs) are a rapidly growing class of anticoagulant drug. Their efficacy has been demonstrated in several clinical settings where they are rapidly becoming the anticoagulant of choice. Controlled clinical studies in patients with deep vein thrombosis, pulmonary embolism, and unstable angina have documented that the frequency of major hemorrhage is 0.5-4%. The purpose of the study was to determine the frequency of minor and major hemorrhage occurring in patients receiving anticoagulant doses of an LMWH (enoxaparin) during routine clinical practice. A prospective, observational study of consecutive patients receiving enoxaparin 1 mg/kg twice daily for at least 24 hours in five internal medicine wards of a university teaching hospital was performed. Five hundred forty-nine patients were studied. The mean age was 67.5+/-15.5 years and the mean duration of enoxaparin therapy was 3.8+/-1.5 days. Hemorrhage was documented in a total of 94 patients (17.3%). Major hemorrhage occurred in 14 patients (2.6%), injection-site hemorrhage occurred in 55 patients (10%), and minor hemorrhage (noninjection site) was documented in 25 patients (4.7%). There were two deaths attributed to hemorrhage. Patients with major hemorrhage were older than patients with minor or no hemorrhage (75.5+/-10.4 versus 66.8+/-15.2 years; p=0.03) and occurred in patients receiving enoxaparin for a longer period (5.14+/-3.8 days) than those with minor (4+/-2.5 days) or no hemorrhage (2.9+/-2.1 days). Major hemorrhage was significantly associated with impaired renal function, chronic liver disease, and concomitant treatment with warfarin or a proton pump inhibitor. Enoxaparin used in anticoagulant doses in unselected medical patients is not associated with more major hemorrhagic complications than observed in controlled clinical trials. Major hemorrhage may be more likely in older patients, in patients with chronic liver disease and impaired renal function, in patients receiving prolonged enoxaparin therapy, and in patients receiving warfarin or proton pump inhibitors.     

Fatigue is cross-sectionally not associated with objective assessments of inflammation,but changes in fatigue are associated with changes of disease activity assessments during biologic treatment of patients with established rheumatoid arthritis

Clinical Rheumatology - The associations between fatigue and disease activity in patients with rheumatoid arthritis (RA) have not been defined. The present objectives were to explore in RA patients...     

The ABO blood group is a trans-species polymorphism in primates

The ABO histo-blood group, the critical determinant of transfusion incompatibility, was the first genetic polymorphism discovered in humans. Remarkably, ABO antigens are also polymorphic in many other primates, with the same two amino acid changes responsible for A and B specificity in all species sequenced to date. Whether this recurrence of A and B antigens is the result of an ancient polymorphism maintained across species or due to numerous, more recent instances of convergent evolution has been debated for decades, with a current consensus in support of convergent evolution. We show instead that genetic variation data in humans and gibbons as well as in Old World monkeys are inconsistent with a model of convergent evolution and support the hypothesis of an ancient, multiallelic polymorphism of which some alleles are shared by descent among species. These results demonstrate that the A and B blood groups result from a trans-species polymorphism among distantly related species and has remained under balancing selection for tens of millions of years—to date, the only such example in hominoids and Old World monkeys outside of the major histocompatibility complex.     

Enumeration skills in Down syndrome

Individuals with Down syndrome (DS) exhibit various math difficulties which can be ascribed both to global intelligence level and/or to their atypical cognitive profile. In this light, it is crucial to investigate whether DS display deficits in basic numerical skills. In the present study, individuals with DS and two groups of typically developing (TD) children matched for mental and chronological age completed two delayed match-to-sample tasks in order to evaluate the functioning of visual enumeration skills. Children with DS showed a specific deficit in the discrimination of small numerosities (within the subitizing range) with respect to both mental and chronological age matched TD children. In contrast, the discrimination of larger numerosities, though lower than that of chronological age matched controls, was comparable to that of mental age matched controls. Finally, counting was less fluent but the understanding of cardinality seemed to be preserved in DS. These results suggest a deficit of the object tracking system underlying the parallel individuation of small numerosities and a typical – but developmentally delayed – acuity of the approximate number system for discrimination of larger numerosities.     

Evaluation of different laser wavelengths on ablation lesion and residual thermal injury in intervertebral discs of the lumbar spine

Laser discectomy or nucleotomy is an increasingly important method for less invasive procedures of column, but the ideal kind of laser is still not established. As the wavelength is an important parameter for water absorption, this study was performed to investigate the action of the laser emission in the near infrared (808 to 1908 nm) region in the context of surgical procedures for percutaneous intervertebral disc decompression (nucleotomy). Forty intervertebral discs from pigs lumbar spines were irradiated with laser (λ?=?808, 980, 1470 and 1908 nm), 1-s on/off time cycles, for 120 cycles and 10 W of power (808, 980, and 1470 nm) or 240 cycles and 5 W of power (1908 nm), with total power of 1200 J, and subjected to microscopic evaluation through hematoxylin-eosin (HE) staining in order to measure the ablation lesions and the residual thermal injury. Ten other discs were not irradiated and worked as controls. The ablation lesions were measured (in mm) at 1.08?±?1.25, 1.70?±?0.63, 2.23?±?1.02, 1.37?±?0.39, and 0.94?±?0.41 (median?±?SD) for the control, 808, 980, 1470, and 1908 nm groups, respectively. The difference between 1908 nm and all the other groups was statistically significant (p?<?0.05). The residual thermal injury was less evident in 1908 nm laser and sharper in 980 nm laser wavelengths. The laser at a wavelength of 1908 nm was considered the most efficient for the vaporization of the nucleus pulposus, followed by the laser wavelengths of 1470, 808, and 980 nm, and proved to be useful for laser nucleotomy procedure.     

Chairing the internal medicine department- analysis of current state and future trends in Israel

Background

Professional skills and academic records of the highest degree are essential requirements for the chairmanship of internal medicine departments. Whether the new generation and future successors of Israeli chairmen is endowed with these attributes is not known.

Purpose

To determine whether there is a lack of future suitable successors for the current heads of internal medicine departments in Israel and to compare the demographic, academic and professional characteristics of the older and newer generations of department heads.

Methods

An online anonymous questionnaire was nationally distributed during 2016 to all active heads of internal medicine departments in Israel (n?=?101). First round was followed by two runs of personal phone calls to promote participation.

Results

Sixty-seven (67%) of chairmen responded. The vast majority of current chairs of internal medicine departments are males (N?=?59, 88%) over 50 years of age (N?=?58, 86%) with established academic background with lecturer degree or higher (N?=?57, 85%).Only 19 (28%) of current heads assigned a future successor. Comparison of chairmen who did and did not assigned successors demonstrated that assignment of successors was associated with higher academic status (P?<?0.02) and longer chairmanship (p?<?0.01) but not with mean age of current chairmen (p?<?0.08). Nevertheless, most assignments (55%) were done by chairmen in the 61 to 67 years age group. As compared to current chairmen, the designated successors have lesser academic status (p?<?0.01) and are characterized by a higher female prevalence (P?<?0.03).

Conclusions

Significant demographic, professional and academic differences exist between the current chairs of internal medicine departments in Israeli hospitals and their future successors. This underscores the need for reassessment of the availability and requirements of this crucial position.

     

Age and gender effects on submental motor-evoked potentials

It is not known whether there are age- and/or gender-related differences in magnitude of motor-evoked potentials (MEPs) of the submental muscles. Knowledge of this is important in investigations of neurophysiological aspects of swallowing. Forty healthy participants (20 males, 20 females; 20 young [21–35 years], 20 old [53–88 years]) were recruited. Surface electromyography (EMG) electrodes were placed at midline underlying the submental muscle group. Age- and gender-related differences were evaluated in two neurophysiologic measures of swallowing: MEPs stimulated by single-pulse transcranial magnetic stimulation (TMS) over the motor cortex and surface electromyography (sEMG) recorded from the same submental muscle group during non-stimulated swallows. The older participants had larger MEPs during saliva swallowing than the young participants (p = 0.04, d = 0.86). Conversely, the older participants had lower amplitude submental EMG activity during non-stimulated swallows (p = 0.045, d = 0.67). Gender had no significant effect on MEP magnitude and on submental activity during saliva swallowing. There were no effects of age or gender on MEP latencies. These findings suggest deterioration in muscle function with age in a sample of healthy adults presenting with functional swallowing. We speculate that muscular decline is partially ameliorated by increased cortical activity—i.e., increased submental MEPs—so as to preserve swallowing function in healthy older subjects. These findings emphasize the need for different reference points for evaluation of submental MEPs of different age groups.