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Primary epididymal lymphomas are very rare condition, only 6 case report was published. In 4 of them, initial presentation was non-tender, continuous growth of testis. It can be misdiagnosed with epididymitis, 5 of them was treated by antibiotics before surgery. One patients treated by surgery another 5 makes neoadjuvant therapy, 2 of radiotherapy 3 of chemotherapy. Only one man died after treatment. This case is about 54-year male patients, diagnosed by diffuse large B-cell lymphoma, who treated by surgery and neoadjuvant chemotherapy combined with radiotherapy.

Solar radiation is a critical variable in global change sciences. While most of the current global datasets provide only the total downward solar radiation, we aim to develop a method to estimate the downward global land surface solar radiation and its partitioned direct and diffuse components, which provide the necessary key meteorological inputs for most land surface models. We developed a simple satellite-based computing scheme to enable fast and reliable estimation of these variables. The global Moderate Resolution Imaging Spectroradiometer (MODIS) products at 1° spatial resolution for the period 2003–2011 were used as the forcing data. Evaluations at Baseline Surface Radiation Network (BSRN) sites show good agreement between the estimated radiation and ground-based observations. At all the 48 BSRN sites, the RMSE between the observations and estimations are 34.59, 41.98 and 28.06 W∙m−2 for total, direct and diffuse solar radiation, respectively. Our estimations tend to slightly overestimate the total and diffuse but underestimate the direct solar radiation. The errors may be related to the simple model structure and error of the input data. Our estimation is also comparable to the Clouds and Earth’s Radiant Energy System (CERES) data while shows notable improvement over the widely used National Centers for Environmental Prediction and National Center for Atmospheric Research (NCEP/NCAR) Reanalysis data. Using our MODIS-based datasets of total solar radiation and its partitioned components to drive land surface models should improve simulations of global dynamics of water, carbon and climate.

OBJECTIVE: Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma, accounting for nearly 50% of the cases in the Hematology Department of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and Instituto do Câncer do Estado de São Paulo. The treatment outcome is influenced by age, abnormal lactate dehydrogenase levels, extranodal infiltration, the disease stage and the patient's performance status. In this study, we sought to report the time-to-treatment of diffuse large B-cell lymphoma in São Paulo's public health system network and its impact on patient outcomes. METHODS: We prospectively followed a cohort of 42 consecutive patients with de novo diffuse large B-cell lymphoma between 2008 and 2012. RESULTS: Our patients had more advanced disease than that reported in the literature (61.9% vs. 46%). In São Paulo's public health system network, it took an average of 7.4 months for a diagnosis to be made and an additional 1.4 months to obtain an appointment with a specialist. Once at our Hematology Department, it took less than 20 days for staging, confirmation of the diagnosis and treatment initiation. An interval from signs or symptoms to treatment of more than 6 months was associated with inferior progression-free survival in 3 years (p = 0.049). CONCLUSION: A delay in the diagnosis of diffuse large B-cell lymphoma is a public health problem and may be associated with worse progression-free survival.

Several studies have shown that changes in incoming solar radiation and variations of the diffuse fraction can significantly modify the vegetation carbon uptake. Hence, monitoring the incoming solar radiation at large scale and with high temporal frequency is crucial for this reason along with many others. The European Organization for the Exploitation of Meteorological Satellites (EUMETSAT) Satellite Application Facility for Land Surface Analysis (LSA SAF) has operationally disseminated in near real time estimates of the downwelling shortwave radiation at the surface since 2005. This product is derived from observations provided by the SEVIRI instrument onboard the Meteosat Second Generation series of geostationary satellites, which covers Europe, Africa, the Middle East, and part of South America. However, near real time generation of the diffuse fraction at the surface level has only recently been initiated. The main difficulty towards achieving this goal was the general lack of accurate information on the aerosol particles in the atmosphere. This limitation is less important nowadays thanks to the improvements in atmospheric numerical models. This study presents an upgrade of the LSA SAF operational retrieval method, which provides the simultaneous estimation of the incoming solar radiation and its diffuse fraction from the satellite every 15 min. The upgrade includes a comprehensive representation of the influence of aerosols based on physical approximations of the radiative transfer within an atmosphere-surface associated medium. This article explains the retrieval method, discusses its limitations and differences with the previous method, and details the characteristics of the output products. A companion article will focus on the evaluation of the products against independent measurements of solar radiation. Finally, the access to the source code is provided through an open access platform in order to share the expertise on the satellite retrieval of this variable with the community.

Diffuse esophageal leiomyomatosis is a rare hamartomatous disorder characterized by proliferation of smooth muscle cells in the esophageal wall causing circumferential thickening. Its incidence is essentially unknown with very few documented cases. It usually occurs in young adults and is found to be associated with Alport′s syndrome. Here, we report this unusual entity in a 22-year-old female presenting with slowly progressive dysphagia with immunopathological study and brief review of the literature.

Mastocytosis is defined as a heterogeneous group of disorders characterized by an accumulation of mast cells in one or more organs, particularly in the skin, bone marrow, liver, spleen and lymph nodes. However here we describe an 11-month-old girl child presented with diffuse cutaneous mastocytosis with bullous lesion, having pulmonary involvement, which is very rare and there is no available case report from India.

Summary Glioblastoma (GBM) is the most common primary brain cancer in adults and is notoriously difficult to treat because of its diffuse nature. We performed single-cell RNA sequencing (RNA-seq) on 3,589 cells in a cohort of four patients. We obtained cells from the tumor core as well as surrounding peripheral tissue. Our analysis revealed cellular variation in the tumor’s genome and transcriptome. We were also able to identify infiltrating neoplastic cells in regions peripheral to the core lesions. Despite the existence of significant heterogeneity among neoplastic cells, we found that infiltrating GBM cells share a consistent gene signature between patients, suggesting a common mechanism of infiltration. Additionally, in investigating the immunological response to the tumors, we found transcriptionally distinct myeloid cell populations residing in the tumor core and the surrounding peritumoral space. Our data provide a detailed dissection of GBM cell types, revealing an abundance of information about tumor formation and migration. [ABSTRACT FROM AUTHOR]

We analyze the output of various state-of-the-art irradiance models for photovoltaic systems. The models include two sun position algorithms, three types of input data time series, nine diffuse fraction models and five transposition models (for tilted surfaces), resulting in 270 different model chains for the photovoltaic (PV) system simulation. These model chains are applied to 30 locations worldwide and three different module tracking types, totaling in 24,300 simulations. We show that the simulated PV yearly energy output varies between -5% and +8% for fixed mounted PV modules and between -26% and +14% for modules with two-axis tracking. Model quality varies strongly between locations; sun position algorithms have negligible influence on the simulation results; diffuse fraction models add a lot of variability; and transposition models feature the strongest influence on the simulation results. To highlight the importance of irradiance with high temporal resolution, we present an analysis of the influence of input temporal resolution and simulation models on the inverter clipping losses at varying PV system sizing factors for Lindenberg, Germany. Irradiance in one-minute resolution is essential for accurately calculating inverter clipping losses. [ABSTRACT FROM AUTHOR]

Background: Congenital hyperinsulinism (CHI) is a major cause of persistent hypoglycemia and brain damage. Therapeutic strategies to avoid near total pancreatectomy in patients who are unresponsive to maximum doses of diazoxide and octreotide remain to be identified, although sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, has been used successfully to treat diffuse type CHI. Case presentation: We used sirolimus to treat three infants with diffuse CHI. Diagnosis was confirmed clinically, biochemically and by genetic testing. Homozygous mutations in KCNJ11, ABCC8 and KCNJ11 were identified in infants 1, 2 and 3, respectively. Each infant had received the therapy for at least 2 months with close monitoring of glycemic response, serum insulin and C-peptide. None of the infants responded to the therapy. Conclusions: We conclude that sirolimus is less effective in the treatment of diffuse CHI in patients with severe mutations in the homozygous state compared with those with the mutations in the heterozygous. [ABSTRACT FROM AUTHOR]

Glucose homeostasis requires appropriate and synchronous coordination of metabolic events and hormonal activities to keep plasma glucose concentrations in a narrow range of 3.5-5.5 mmol/L. Insulin, the only glucose lowering hormone secreted from pancreatic β-cells, plays the key role in glucose homeostasis. Insulin release from pancreatic β-cells is mainly regulated by intracellular ATP-generating metabolic pathways. Hyperinsulinaemic hypoglycaemia (HH), the most common cause of severe and persistent hypoglycaemia in neonates and children, is the inappropriate secretion of insulin which occurs despite low plasma glucose levels leading to severe and persistent hypoketotic hypoglycaemia. Mutations in 12 different key genes (ABCC8, KCNJ11, GLUD1, GCK, HADH, SLC16A1, UCP2, HNF4A, HNF1A, HK1, PGM1 and PMM2) constitute the underlying molecular mechanisms of congenital HH. Since insulin supressess ketogenesis, the alternative energy source to the brain, a prompt diagnosis and immediate management of HH is essential to avoid irreversible hypoglycaemic brain damage in children. Advances in molecular genetics, imaging methods (18F-DOPA PET-CT), medical therapy and surgical approach (laparoscopic and open pancreatectomy) have changed the management and improved the outcome of patients with HH. This up to date review article provides a background to the diagnosis, molecular genetics, recent advances and therapeutic options in the field of HH in children. [ABSTRACT FROM AUTHOR]

Bilateral diffuse uveal melanocytic proliferation ( BDUMP) is a rare paraneoplastic intraocular disease that causes progressive visual loss in patients driven by an IgG factor associated with an underlying malignancy. Characteristic ocular findings include exudative retinal detachment, rapid cataract formation and uveal melanocytic tumours. The awareness and documentation of BDUMP has increased during the past decade, and the increasing amount of data collected demonstrates the effect of treatment with plasmapheresis and the value of diagnostic tools in BDUMP such as genetic and immunologic investigations. The literature of BDUMP has not been reviewed since 2003, and there is a growing need for an updated review on diagnosis and management of BDUMP. We review the literature and report a case of BDUMP with a white ciliary body tumour, iris rubeosis, increased iris pigmentation and cataract. [ABSTRACT FROM AUTHOR]

Background: Linitis plastica due to gastric adenocarcinoma is a condition with a long history, but still lacks a standardized definition and is commonly confused with Borrmann type IV, Lauren diffuse, and signet-cell type gastric cancer. The absence of a clear definition is a problem when investigating its biological characteristics and role as a possible independent factor for prognosis. Nevertheless, the biological behavior for linitis plastica, which is unique, may be valuable in risk stratification and have implications for treatment. A definition of linitis plastica based on molecular or genomic criteria could represent a useful starting point for investigating new targeted therapies. Main body: This literature review of linitis plastica will focus on the current classifications for gastric cancer, illustrating how the concept of linitis plastica relates to them in most cases and identifying a clear and reproducible definition. Moreover, the review will highlight the diagnostic challenges associated with linitis plastica, its prognostic implications, and the therapeutic options available. Future perspectives for its management are also addressed. Conclusion: Linitis plastica is a carcinoma with a scirrhous stroma, involving the submucosal and muscular layers of the stomach even in the absence of mucosal alteration. In most cases, the primary cancer cells are signet-ring cells or scattered cells in the context of a poorly differentiated carcinoma. Diagnosis is challenging. Staging should be thorough, including diagnostic laparoscopy in all cases due to the high incidence of peritoneal involvement. The prognostic significance of linitis plastica is still controversial. Curative-intent surgery, when feasible, should be performed, with a multimodality treatment approach. Cancer-stroma interactions are important features of this disease, and represent attaining potential target for future therapies. Future pathologic assessments of gastric cancer should report the stromal reaction in order to allow better characterization of the tumor. [ABSTRACT FROM AUTHOR]

In 2005, the World Health Organization - European Organization for Research and Treatment of Cancer (WHO- EORTC) classified cutaneous B-cell lymphomas into 4 categories: primary cutaneous marginal zone B-cell lymphoma (PCMZL), primary cutaneous follicle center lymphoma (PCFCL), primary cutaneous dif fuse large B-cell lymphoma, leg type (PCDLBCL-LT), and primary cutaneous dif fuse large B-cell lymphoma, other (PCDLBCL-O). The absence of evident extra-cutaneous disease is a necessary condition for the diagnosis of primary cutaneous B-cell lymphomas, because they have a completely different clinical behavior and prognosis from their nodal counterparts. PCDLBCL-O basically represents a morphological variation, lacking the typical features of PCDLBCL-LT, neither confirming the definition of PCFCCL, but on the clinical ground, its behavior seems at least to partially overlap the indolent course of PCFCCL. In fact, the present WHO lymphoma classification from 2008 overcame the previous WHO-EORTC classification, including at least a part of PCDLBCL-O within the spectrum of PCFCCL. However, owing to the rarity and heterogeneity of the PCDLBCL-O, the precise clinicopathological characteristics have not been well characterized and the optimal treatment for this group of lymphomas is yet to be defined. Nevertheless, dermatologists and pathologists should be aware of this entity in order to avoid unnecessary aggressive treatment. We present a case of a 46-year-old Caucasian male with one large round-shaped tumor and a few scattered nodules localized on the back. The histopathological features of the lesion corresponded to PCDLBCL-O. The patient follow-up showed that he was disease-free three months after surgical excision of the lesions and adjuvant local radiotherapy. No additional therapy was introduced, including chemotherapy with rituximab, cyclophosphamide, doxorubicin hydrochloride, oncovin, prednisolone (R-CHOP). [ABSTRACT FROM AUTHOR]

High temperature oxidation behaviors of Ni 3 Al/Ni-bonded cermets were studied in this paper and results revealed that mass gain of Ni 3 Al-bonded cermet is less than that of Ni-bonded cermet at different oxidation temperatures and the mass gain is in accord with oxidation equation (Δm/S) = k n ·t 0.6 , in which oxidation rate constant, k n , at 800 °C, 900 °C and 1000 °C is 0.157, 0.912 and 2.27 respectively. High temperature oxidation kinetic of Ni 3 Al-bonded cermet belongs to quasi-parabolic kinetic behavior. Moreover, oxidation mechanisms and oxidation morphology of Ni 3 Al-bonded cermet were also investigated. During high-temperature oxidation, Ni 3 Al binder would be oxidized, forming double oxide, NiAl 2 O 4 , which can restrain the diffusion of oxygen in oxide, resulting in an improvement of oxidation resistance of cermet. The cross section morphology of oxidized Ni 3 Al-bonded cermet is comprised of oxide layer (OL), transformed layer (TL), and substrate. Obviously, some pores can be observed in OL and also slight pores exist in TL. Thickness of OL of Ni 3 Al-bonded cermet increased with temperature increasing and keeping time prolonging. In oxidation process, Al, Ti etc. would diffuse outwards to OL from inside of cermet and O 2 would diffuse inwards into cermet forming oxygen permeable zone, namely transitional layer. [ABSTRACT FROM AUTHOR]

Aim To investigate the histological subtypes of oesophageal adenocarcinoma according to the Laurén classification (intestinal/diffuse/mixed) in relation to tumour response to neoadjuvant treatment, and in relation to patients' survival after potentially curative treatment. Methods Data were collected from all oesophageal adenocarcinoma patients who underwent potentially curative treatment in our institute between 1998 and 2014. Treatment consisted of neoadjuvant chemoradiotherapy (36–50 Gy) followed by an oesophagectomy or definitive chemoradiotherapy (50–50.4 Gy). Clinical data were collected from patient records. All endoscopic biopsies and surgical resection specimens were reassessed to determine the histological subtype (intestinal, diffuse or mixed) and the Mandard tumour regression grade (TRG). The impact of the histological subtypes on survival was determined using a Cox model. Results Median follow-up was 68 months. Diffuse and mixed type cancers accounted for 25% of oesophageal adenocarcinomas. Median overall survival differed significantly between patients with intestinal (n = 121, 39 months), diffuse (n = 28, 18 months) or mixed type (n = 11, 25 months) carcinomas (log rank, p = 0.023). In multivariable analysis, the diffuse type was associated with shorter survival (diffuse versus intestinal: hazard ratios 2.06, p = 0.006). A pathologically (near) complete response (TRG 1 or 2) was seen less frequently in diffuse type than in intestinal type carcinomas (24% versus 60%; p = 0.015). Conclusions Patients with diffuse type oesophageal adenocarcinomas had a significantly worse prognosis than those with intestinal type carcinomas. Intestinal type carcinomas showed a better response to neoadjuvant chemoradiotherapy than diffuse type carcinomas. These differences call for the exploration of differentiated approaches in the potentially curative treatment of oesophageal adenocarcinomas. [ABSTRACT FROM AUTHOR]

Concentration of light energy in images causes strong highlights (specular reflection), and challenges the robustness of a large variety of vision algorithms, such as feature extraction and object detection. Many algorithms indeed assume perfect diffuse surfaces and ignore the specular reflections; specularity removal may thus be a preprocessing step to improve the accuracy of such algorithms. Regarding specularity removal, traditional color-based methods generate severe color distortions and local patch-based algorithms do not integrate long range information, which may result in artifacts. In this paper, we present a new image specularity removal method which is based on polarization imaging through global energy minimization. Polarization images provide complementary information and reduce color distortions. By minimizing a global energy function, our algorithm properly takes into account the long range cue and produces accurate and stable results. Compared to other polarization-based methods of the literature, our method obtains encouraging results, both in terms of accuracy and robustness. [ABSTRACT FROM AUTHOR]

Objectives To assess the long-term efficacy and tolerability of mycophenolate mofetil ( MMF) in patients with diffuse cutaneous systemic sclerosis (dc SSc). Methods Patients enrolled in the Australian Scleroderma Cohort study with dc SSc and baseline modified Rodnan skin score ( mRSS) ≥ 12 who were treated for a minimum of 12 months with MMF for the primary indication of skin disease were included and their prospectively collected data retrieved. Change in mRSS, the proportion with a clinically significant improvement (reduction in mRSS ≥ 5 from baseline) and adverse effects due to therapy were determined. Results Seventy-four participants treated with MMF were identified and of these, 42 met inclusion criteria. The mean age was 53 ± 12 years, with mean disease duration at MMF commencement of 4.8 ± 4.3 years. Twenty-one participants (50%) commenced MMF within 2 years of disease onset and the mean duration of therapy was 2.7 ± 1.7 years. The mean mRSS at baseline was 25.9 ± 9.2 with a reduction of 3.7 ± 7.1 ( P = 0.07) after 1 year of therapy, 7.6 ± 8.3 after 2 years ( P = 0.01) and 10.5 ± 10.3 after 5 years ( P < 0.01). Response to treatment was not affected by disease duration at MMF commencement or baseline skin score. Eighteen participants (43%) demonstrated clinically significant improvement after 1 year, increasing to 92% after 4 years. Two participants (5%) ceased MMF due to adverse effects. Conclusion MMF was associated with a modest improvement in mRSS and was well tolerated in the treatment of dc SSc. Given the natural history of dc SSc where skin involvement can spontaneously improve, randomized, placebo-controlled studies are required to confirm whether improvement can be attributed to MMF therapy. [ABSTRACT FROM AUTHOR]

Purpose: Although the use of staging laparoscopy (SL) for detecting peritoneal metastasis (P) and determining peritoneal lavage cytology (CY) is widespread in advanced gastric cancer, an indication for SL based on preoperative clinicopathological factors is controversial. Methods: From May 2006 to September 2015, 120 patients with advanced gastric cancer with primary tumors ≥5 cm and/or with bulky regional lymph nodes (bulky N) underwent SL for assessment of P/CY status. Clinicopathological factors were analyzed retrospectively to determine their influence on peritoneal spread (P1 and/or CY1). An additional analysis of 379 consecutive patients with clinically T2 or deeper gastric cancer in the same time period was carried out to confirm the SL results. Results: Peritoneal spread was confirmed by SL in 54 cases (45%). The presence of type-4 tumors ( n = 38, p < 0.0001) and diffuse-type tumors ( n = 85, p = 0.04) correlated significantly with peritoneal spread. These two factors were also correlated significantly with increased peritoneal spread in a subgroup analysis among patients with tumors with bulky N ( n = 44). The additional analysis of 379 patients showed results consistent with the SL results. The frequency of peritoneal spread was 78% among type-4 tumors, 47% among diffuse-type tumors ≥5 cm, and 38% among diffuse-type tumors with bulky N, whereas among intestinal-type tumors, it was 18% in tumors ≥5 cm and 13% among tumors with bulky N. Conclusions: Among tumors ≥5 cm or with bulky N, type-4 tumors and diffuse-type tumors had a high potential for peritoneal spread and patients with such tumors were considered more suitable candidates for SL. [ABSTRACT FROM AUTHOR]

This paper evaluates the existing policy frameworks for mitigation of diffuse water pollution from agriculture (DWPA) in England and China. With reference to a conceptual model of the process of policy transfer or international lesson drawing, and possible constraints to this, it assesses whether and how China can draw lessons to improve current policy from the supra-national and national provisions of the EU and a member state that by 2016 had comprehensively implemented EU agricultural and environmental policy. DWPA is first analysed as a public policy challenge to inform specification of a generic framework for its mitigation. The current policy frameworks for mitigation of DWPA in England and China are evaluated, and their potential for improvement is assessed. A number of barriers to lesson drawing for regulation, incentive payments schemes and advice provision are diagnosed. These barriers are potentially least in relation to advice provision and its use to promote voluntary action by farmers. Given its structure and capabilities the public agricultural extension system in China is also recognised as a key resource. A focus on three policy approaches to mitigate DWPA in China is recommended: i) targeted regulation to a ‘reference level’ of large intensive livestock, and ultimately other large commercial farms; ii) strategic use of incentive payment schemes to protect water resources from DWPA; and iii) re-orientation of the ethos and modalities of operation of the extension system, informed by international lesson drawing, with the aim of rebalancing farm productivity and environmental protection. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Splenic marginal zone lymphomas (SMZLs) are generally uncommon, indolent lymphomas that typically affect older adults, but the development of the transformation to high-grade lymphoma may occur in a small proportion of patients and represents a rare event with blastic cell infiltration in the lymph nodes and bone marrow. Case Report: Here, we present a young adult patient who was diagnosed with a SMZL and developed a high-grade transformation to diffuse large B cell lymphoma (DLBCL) with central nervous system involvement. The patient was a 31-year-old woman whose hematologic medical history began with severe anemia and thrombocytopenia associated with atypical lymphoid infiltrate in the bone marrow and massive splenomegaly. A splenectomy was performed and revealed the SMZL. She was first treated with the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) and subsequently with the R-FMD regimen (rituximab, fludarabine, mitoxantrone, and dexamethasone) because the peripheral blood leukocytes were remarkably increased postoperatively. Six months after the splenectomy, she complained of headaches. A magnetic resonance imaging scan of her brain revealed intracerebral tumorous lesions from which a biopsy was taken. On morphological and immunohistochemical examination, the tumor fulfilled the criteria for a DLBCL. Treatment with pulse-dose intravenous methylprednisolone followed by high-dose methotrexate was promptly initiated, but the patient's condition continued to deteriorate and she died of the disease 13 months after the splenectomy. Conclusions: Although there is a general tendency for SMZL to display low aggressiveness, central nervous system involvement associated with a histological transformation to high-grade lymphoma, as presented here, can occur in advanced stage of the disease. [ABSTRACT FROM AUTHOR]

The most common NHL subtype in SEEU is DLBCL (39%), and it manifests with a variety of cellular morphologies and a high proliferation index. Also, the GI tract is the most common site of extranodal NHLs, and most NHLs involving the GI tract are of B-cell lineage, of which diffuse large B-cell lymphoma is the most common subtype, irrespective of location. The last few years have seen digital pathology as a vital technology that has a positive impact on diagnostics, but studies on the use of DP for lymphoma identification, however, are still restricted to only determining whether a tumor is present or absent. Using the example of cases of malignant NHL, we aim to investigate the diagnostic utility of DP using QuPath software in evaluating the proliferation index and the prognostic significance and to show that improved visualization and analysis contribute to the convergence of these complementary diagnostic modalities for lymphomas. The average proliferation index (Ki67) was 58.33% with values between 10% and 85%. After the stratification of the cases, an increased proliferation index was observed in the majority of cases (53.33%), and this aspect was associated with the advanced age of the patients ( p = 0.045). Visual assessment provides lower Ki67 values than automated digital image analysis. However, the agreement coefficient between the conventional method and the AI method indicates an excellent level of reliability (ICC1-0.970, ICC2-0.990). The multivariate analysis revealed that in the cases where the proliferation index Ki67 is high (˃70%), the IPI score represents an important risk factor predicting mortality (HR = 10.597, p = 0.033).

Chemical contamination from point source discharges in developed (resource-rich) countries has been widely regulated and studied for decades; however, diffuse sources are largely unregulated and widespread. In the European Union (EU), large dischargers report releases of some chemicals, yet little is known of total emissions (point and diffuse) and their relative significance. We estimated copper loadings from all significant sources including industry, sewage treatment plants, surface runoff (from traffic, architecture, and atmospheric deposition), septic tanks, agriculture, mariculture, marine transport (antifoulant leaching), and natural processes. A combination of European datasets, literature, and industry data were used to generate export coefficients. These were then multiplied by activity rates to derive loads. A total of approximately 8 kt of copper per annum (ktpa) is estimated to enter freshwaters in the EU, and another 3.5 ktpa enters transitional and coastal waters. The main inputs to freshwater are natural processes (3.7 ktpa), agriculture (1.8 ktpa), and runoff (1.8 ktpa). Agricultural emissions are dominated by copper-based plant protection products and farmyard manure. Urban runoff is influenced by copper use in architecture and by vehicle brake linings. Antifoulant leaching from boats (3.2 ktpa) dominates saline water loads of copper. It is noteworthy that most of the emissions originate in a limited number of copper uses where environmental exposure and pathways exist, compared with the bulk of copper use within electrical and electronic equipment and infrastructure that has no environmental pathway during its use. A sensitivity analysis indicated significant uncertainty in data from abandoned mines and urban runoff load estimates. This study provided for the first time a methodology and comprehensive metal load apportionment to European aquatic systems, identifying data gaps and uncertainties, which may be refined over time. Source apportionments using this methodology can inform more cost-effective environmental risk assessment and management. Integr Environ Assess Manag 2023;19:1031-1047. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC)., (© 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).)

Intramedullary tumors represent the major cause of spinal cord injuries, and its symptoms include pain and weakness. Progressive weakness may concomitantly occur in the upper and lower limbs, along with lack of balance, spine tenderness, sensory loss, trophic changes of extremity, hyperreflexia, and clonus. The study protocol was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of the MEDLINE electronic database was performed to identify the studies reporting the clinical features of children and adults who presented with an intramedullary lymphoma. Twenty-one studies were included, reporting 25 cases. Manuscripts were excluded if the full-text article was not available, original data were not reported (e.g., review articles), or if the main disease was not intramedullary lymphoma. A structured data extraction form was employed to standardize the identification and retrieval of data from manuscripts. To enlighten the discussion, a case is also presented. An 82-year-old woman with Fitzpatrick skin type II, diagnosed and treated for non-Hodgkin's lymphoma 7 years ago, was admitted with mental confusion and memory loss for the past 2 months-evolving with recurring falls from her own height. One day before admission, she displayed Brown-Séquard syndrome. An expansive lesion from C2 to C4 in the cervical spinal cord was found and a hypersignal spinal cord adjacent was described at the bulb medullary transition to the C6-C7 level. A primary spinal cord tumor was considered, as well as a melanoma metastasis, due to the lesion's flame pattern. The patient presented a partial recovery of symptoms and a reduction of the spinal cord edema after being empirically treated with corticosteroids, but the lesion maintained its extent. Subsequently, a large diffuse B-cell lymphoma with nongerminal center was found in open body biopsy, infiltrating neural tissue. The main objective of the present study is to report a surgical case treated for a large diffuse B-cell lymphoma, in addition to presenting the results of a systematic review of primary intramedullary spinal cord lymphoma., Competing Interests: Conflict of Interest None declared., (Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: Anal lymphomas are extremely rare. There are no relevant descriptions in professional books, and there are only a few case reports in the literature. Here, we report a new case and review the literature to summarize the clinical and pathological features of anal lymphoma., Methods: We described a case of anal lymphoma confirmed by pathological diagnosis, then searched the PubMed database, and finally selected 12 reported cases to be included in the study. We described the clinical and pathological characteristics of the patients., Results: Thirteen patients with anal lymphoma were confirmed. Seven men and six women with a median age of 50. There were four cases of HIV- and EBV-infected patients. The size of the tumor was 1-13 cm, all of which were diagnosed as B-cell lymphoma, and 61.5% were diffuse large B-cell lymphomas. Among the 13 patients, eight received chemotherapy or immunochemotherapy, two received radiotherapy, one received chemotherapy combined with radiotherapy, one received surgery, and one gave up treatment. Three patients died, and only 2 of 10 surviving patients had complete remission., Conclusion: Anal lymphoma is extremely rare. Patients with persistent abscess complicated with HIV or EBV infection should undergo pathological biopsy to exclude anal lymphoma., (© 2023. The Author(s).)

The purpose of this study was to determine the survival and prognostic factors of patients with diffuse large B-cell lymphoma (DLBCL) of the oral cavity and maxillofacial region. Retrospectively, the clinical records of patients with a primary diagnosis of DLBCL of the oral cavity and maxillofacial region treated at the A.C. Camargo Hospital for Cancer, São Paulo, Brazil, between January 1980 and December 2005 were evaluated to determine (A) overall survival (OS) at 2 and 5 years and the individual survival percentage for each possible prognostic factor by means of the actuarial technique (also known as mortality tables), and the Kaplan Meier product limit method (which provided the survival value curves for each possible prognostic factor); (B) prognostic factors subject to univariate evaluation with the log-rank test (also known as Mantel-Cox), and multivariate analysis with Cox's regression model (all the variables together). The data were considered significant at p ≤ 0.05. From 1980 to 2005, 3513 new cases of lymphomas were treated, of which 151 (4.3%) occurred in the oral cavity and maxillofacial region. Of these 151 lesions, 48 were diffuse large B-cell lymphoma, with 64% for OS at 2 years and 45% for OS at 5 years. Of the variables studied as possible prognostic factors, multivariate analysis found the following variables have statistically significant values: age (p = 0.042), clinical stage (p = 0.007) and performance status (p = 0.031). These data suggest that patients have a higher risk of mortality if they are older, at a later clinical stage, and have a higher performance status.

Diffuse Large B-Cell lymphoma (DLBCL) is the most frequently seen subtype among metastatic breast lymphomas. Metastatic breast lymphomas are more frequently seen and their response to treatment is better than primary breast lymphomas. This report presents a 21 year-old patient who was admitted to our clinic with a complaint of painful mass in her left breast. Further evaluations showed masses with similar radiologic characteristics in her liver, pancreas, bilateral rectus muscles and left ovary. In the histopathological examination of ultrasound guided biopsies taken from the breast, rectus muscle and ovary, the patient was diagnosed as stage IVEB and high risk DLBCL. All of the lesions disappeared after systemic chemotherapy. In the case of mass presence in the breast, lymphoma should be kept in mind and systemic treatment i should be performed.

Patients with large benign goiters often present local compressive symptoms that require surgical treatment, including dysphagia, neck tightness, and airway obstruction. In contrast, patients with such goiters who remain asymptomatic may be observed after exclusion of malignancy. The use of levothyroxine (LT4) to reduce the volume of the goiter is still a controversial treatment for large goiters, and the optimal surgical procedure for multinodular goiter is still debatable. Radioiodine is a safe and effective treatment option when used alone or in combination with recombinant human TSH. This review discusses current therapeutic options to treat diffuse and multinodular nontoxic benign goiters.

Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma comprising a heterogeneous group of disorders with variable histological and clinical behavior. Although other lymphomas may present in the leukemic phase more frequently, this appearance is unusually observed among DLBCL cases. Diagnosing lymphoma is not always easy, and the patient’s clinical status quite often may hamper invasive procedures for diagnosis pushing the clinician to look for alternatives to reach the nearest possible accurate diagnosis. The authors report the case of a middle-aged man who presented the history of malaise, weight loss, and low-grade fever. The peripheral blood count showed leukocytosis with the presence of blasts and thrombocytopenia. The cytological morphology and immunophenotyping of the peripheral blood and bone marrow aspirate, as well as the bone marrow biopsy accompanied by a thorough immunohistochemical analysis, rendered the diagnosis of DLBCL in the leukemic phase. The patient was prescribed R-CHOP with a favorable outcome. Intra-abdominal lymph node biopsy was avoided because of the patient’s critical medical condition. The authors highlight this rare form of presentation of DLBCL as well as the combination of peripheral blood, bone marrow aspirate, and bone marrow biopsy for reaching the diagnosis in cases were a lymph node sample is unavailable for the diagnostic work-up

Introduction: Diffuse large B-cell lymphoma can be cured in 60% – 70% of patients. Autologous stem cell transplantation is the standard treatment for relapsed disease. This high-intensity treatment after first complete remission in patients with high International Prognostic Index remains controversial and was performed in our department during some years. Material and Methods: Retrospective study, review of clinical records. Results: This study evaluates the outcome of 113 patients transplanted between 1992 and 2012. Considering status before transplantation patients were divided in groups: a) first complete remission after 1 line of chemotherapy (n = 64); b) first complete remission after ≥ two chemotherapy lines (n = 15); c) second complete remission (n = 15); d) more advanced diseased (n = 19). Chemotherapy used in first line therapy was mainly R-CHOP (n = 71) and CHOP (n = 28). The median follow-up of patients still alive was 34 months (1 - 221). At five years, overall survival was 73% (± 5) and disease free survival was 75% (± 5). Conclusion: Conventional chemotherapy followed by autologous stem cell transplant is a safe and efficient option for selected patients. In our series 70% high-risk patients were free from disease with this strategy.