Fallopian Tube Originating Ovarian Cancer in a 53-Year-Old Postmenopausal Female With Hereditary Breast Cancer (BRCA) Genes: A Case Study.

Ovarian cancer is the second most common gynecologic malignancy, but it is the deadliest of the gynecologic cancers. Out of 21,410 new cases of ovarian cancer in the United States in 2021, more than half were fatal. In this case study, a 53-year-old sexually active postmenopausal patient with a family history of breast cancer presented to her gynecologist for an annual exam. Given the patient's family history and breast cancer mutations, malignancy was a concern that had to be addressed. Elective bilateral salpingo-oophorectomy of the patient revealed ovarian serous carcinoma originating from the fallopian tubes. Historically, fallopian tube carcinoma was presumed to be rare, though many high-grade serous carcinomas previously classified as advanced ovarian carcinomas are now believed to have actually originated from the fallopian tubes. This case study adds to the body of evidence that many high-grade carcinomas have fallopian tube origins. This emerging perspective of ovarian cancer's origin provides healthcare workers and the scientific community a more complete picture of the etiologies and dissemination pattern of ovarian cancer. We hope this study will help physicians have a more extensive knowledge base of such a disease when looking for risk factors and taking care of their patients.

Panhypopituitarism Presents As Amenorrhea Secondary to Post Traumatic Stress Disorder in a 33-Year-Old Patient: A Case Report.

Hormonal derangements should be suspected whenever a patient experiences amenorrhea with no abnormal physical exam findings. Clinical suspicion is increased if she also reports psychological trauma that could affect her nervous system and, by association, her hormones since the pituitary gland is present in the brain. Additional exams that aid in the diagnosis of amenorrhea include a variety of blood panels and imaging scans. Panhypopituitarism is a disorder in which there is a deficiency of all pituitary hormones that include but are not limited to the thyroid-stimulating hormone (FSH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Diagnosis is usually made by baseline blood sampling of these hormones. Secondary to panhypopituitarism, amenorrhea can be disguised as other neurogenic problems. In this case study, we present a 33-year-old female patient who presented to the clinic with amenorrhea and a traumatic past social history. Upon further workup of the patient, it was determined that the patient had panhypopituitarism that had to be managed with medications indefinitely. This case study is of the utmost interest because it highlights how panhypopituitarism, being such a rare condition, can easily be mistaken as amenorrhea secondary to psychological issues and how integral it is for a physician to keep an open mind when evaluating such patients.

Hydatidiform Mole Presents As Pregnancy in a 48-Year-Old Perimenopausal Female: A Case Study.

Pregnancy should be suspected whenever a woman in her childbearing years misses a menstrual period. Clinical suspicion is increased if she also reports any sexual activity while not using contraception or is inconsistent in her use of contraception. Laboratory findings that aid in the diagnosis of pregnancy include the detection of human chorionic gonadotropin (hCG) in blood or urine. Hydatidiform mole (HM) is part of a group of diseases classified under gestational trophoblastic disease (GTD), which originate in the placenta and have the potential to locally invade the uterus and metastasize. Although molar pregnancies are designated as benign, they have the potential to develop into a malignancy. In this case study, we present a 48-year-old peri-menopausal female patient, with a 1+ year history of irregular menses, who presented to the clinic with signs and symptoms of pregnancy, unprotected sexual activity, and a positive at-home pregnancy test. Upon further workup of the patient, it was diagnosed that the patient had a hydatidiform molar pregnancy. It is interesting to note that benign gestational trophoblastic diseases generally occur in younger women, of "reproductive age" (generally in their twenties to early thirties), and is extremely rare in peri- and post-menopausal women.

Retrograde amnesia of contextual fear conditioning: Evidence for retrosplenial cortex involvement in configural processing.

It has been suggested that contextual fear conditioning can be supported by either an elemental system, where individual features of the environment are associated with shock, or a configural system, where environmental features are bound together and associated with shock. Although the retrosplenial cortex (RSC) is known to be involved in contextual fear conditioning, it is not clear whether it contributes to the elemental or configural system. To isolate the role of the RSC in contextual fear conditioning, the current experiments examined the influence of RSC lesions on the context preexposure facilitation effect, a procedure known to produce conditioning to a configural representation of context. In Experiment 1, rats that were preexposed to the conditioning context froze more compared to rats that were not, replicating the context preexposure facilitation effect. Although pretraining lesions of the RSC had no impact on the context preexposure facilitation effect (Experiment 2a), posttraining lesions attenuated the effect (Experiment 2b), suggesting that the RSC normally contributes to a configural context representation. Retrohippocampal contributions to contextual fear conditioning are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

SerpinB13 antibodies promote ß cell development and resistance to type 1 diabetes.

Pancreatic endocrine cell development is dependent on the rescue of the neurogenin3 (Ngn3) transcription factor from repression by Notch. The signals that prevent Notch signaling, thereby allowing the formation of pancreatic endocrine cells, remain unclear. We show that inhibiting serpinB13, a cathepsin L (CatL) protease inhibitor expressed in the pancreatic epithelium, caused in vitro and in vivo cleavage of the extracellular domain of Notch1. This was followed by a twofold increase in the Ngn3+ progenitor cell population and enhanced conversion of these cells to express insulin. Conversely, both recombinant serpinB13 protein and CatL deficiency down-regulated pancreatic Ngn3+ cell output. Mouse embryonic exposure to inhibitory anti-serpinB13 antibody resulted in increased islet cell mass and improved outcomes in streptozotocin-induced diabetes at 8 weeks of age. Moreover, anti-serpinB13 autoantibodies stimulated Ngn3+ endocrine progenitor formation in the pancreas and were associated with delayed progression to type 1 diabetes (T1D) in children. These data demonstrate long-term impact of serpinB13 activity on islet biology and suggest that promoting protease activity by blocking this serpin may have prophylactic potential in T1D.

Evaluating and communicating about the healthiness of foods: Predictors of parents' judgments and parent-child conversations.

Parents are typically in charge of purchasing the food that their children eat, but little is known about how parents decide if particular foods are healthy for their children and how their beliefs about nutrition influence their children's beliefs. In two studies, we investigated how parents of children ages 4 to 12 (N = 826) make decisions about the healthiness of foods, when presented with different representations of the same nutritional information. Providing parents with nutritional information did not influence their ratings of how healthy food items are, compared to when they are shown only pictures of the foods. Parents reported talking with their children about nutrition, believed they are the best source of information for children about nutrition, and believed their nutrition beliefs influence their child's beliefs. Our findings highlight the role of prior knowledge in food cognition and how beliefs about foods are transmitted from parents to children.

Evaluating the quality of reporting of melanoma prediction models.

BACKGROUND: Multivariable prediction models combine patient data points to provide actionable estimates of outcomes. Prediction models for melanoma are important for guidance in the midst of the rising incidence and evolving treatment options. This study evaluates the quality of reporting of prediction models using the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) checklist. METHODS: We performed a systematic literature search to identify publications describing development and/or validation of melanoma prediction models. For each study, reviewers assessed compliance with 22 TRIPOD items. We also assessed a model's predictive ability (area under the curve) compared with TRIPOD adherence. RESULTS: We originally identified 67 articles, of which 27 met inclusion criteria. No study completely followed the TRIPOD checklist, and median overall adherence was 61%. Authors were least likely to report participant characteristics, title, and abstract in accordance with the TRIPOD checklist. Linear correlation between a model's area under the curve and TRIPOD checklist adherence was not statistically significant, r = -0.09 (P = .34). CONCLUSION: Current reporting of melanoma multivariable prediction models does not meet standards. Although there is room for improvement in how melanoma models are reported, our findings do not indicate a significant relationship between the model's performance and adherence to the TRIPOD checklist.

Embracing Death: Mexican Parent and Child Perspectives on Death.

A mixed-method approach was used to explore parent and child perspectives on death in Mexico. Parents' and children's death-related experiences and understanding of death were examined. While all children in this sample displayed a biological understanding of death, older children were less likely to endorse that all living things die. Children also displayed coexistence of beliefs related to death that can be attributed to both their biological and spiritual understanding of death. We also found that older children were more likely to report that a child should feel sad following the death of a loved one. These findings highlight how cultural practices shape the development of cognitive and affective processes related to death.

Drawing across media: A cross-sectional experiment on preschoolers' drawings produced using traditional versus electronic mediums.

Young children's growing access to touchscreen technology represents one of many contextual factors that may influence development. The focus of the current study was the impact of traditional versus electronic drawing materials on the quality of children's drawings during the preschool years. Young children (2-5 years, N = 73) and a comparison group of adults (N = 24) copied shapes using three mediums: marker on paper, stylus on touchscreen tablet, finger on touchscreen tablet. Drawings were later deemed codable or uncodable (e.g., scribbles), and codable drawings were then scored for subjective quality on a 4-point scale. Girls and older children (vs. boys and younger children) produced more codable drawings; however, this gap closed when children drew with their finger on a tablet. Medium also affected the quality of adults' drawings, favoring marker on paper. Thus, drawing on a tablet helped younger children produce drawings but resulted in lower quality drawings among adults. These findings underscore the importance of considering environmental constraints on drawing production. Moreover, since clinical assessments often include measures of drawing quality, and sometimes use tablet computers for drawing, these findings have practical implications for education and clinical practice. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Do you remember being told what happened to grandma? The role of early socialization on later coping with death.

Using a mixed-methods approach, we examined how participants' memories of socialization regarding death might influence their self-reported coping with losses in childhood and adulthood. We recruited 318 adults to complete an online survey. Path analyses indicated that participants who remembered their parents shielding them less from issues related to death reported better coping as children and adults. Qualitative responses suggested participants wanted to receive more information about death from their parents as they went through the grieving process. We highlight the potential benefits of socializing children about death, and how it may aid in their coping with death-related events.

Symptomatic elevation creatine kinase following treatment of rheumatoid arthritis with baricitinib.

The aim of RA treatment is to achieve reduction of disease activity and prevent joint damage and disability. Baricitinib is a synthetic small molecule which targets the JAK/STAT pathway which is implicated in the inflammatory response in RA. Baricitinib selectively targets JAK1 and JAK2 and has been shown to have efficacy in treating patients with RA. Common adverse effects reported during baricitinib therapy includes infection, asymptomatic changes in laboratory parameters including changes in neutrophil, lymphocyte, platelet counts, alanine aminotransferase, cholesterol, creatinine and creatine kinase (CK). We report the first two documented cases in Australia of baricitinib-induced symptomatic elevation of CK.

Association of age, sex and BMI with the rate of change in tibial cartilage volume: a 10.7-year longitudinal cohort study.

BACKGROUND: To describe the association of age, sex and body mass index with the rate of change of tibial knee cartilage volume over 10.7 years in a community-based sample of older adults. METHODS: Four hundred and eighty-one participants (49% female, mean age 60.8 years [range 51.1-79.7], 49% had knee pain and 58% radiographic osteoarthritis) were included. Tibial cartilage volume of the right knee was assessed on T1-weighted fat-suppressed 1.5 T MRI at baseline and 10.7 years. Data analyses were performed using linear regression models. RESULTS: The average rate of loss of cartilage volume was 1.2%/year (range 0.2-3.9%) with all participants losing cartilage volume over the study period. There was a significant association between age and loss of tibial cartilage volume in the medial (0.023%/year, 95% confidence interval [CI] 0.010 to 0.036%, p < 0.001), lateral (0.013%/year, 95% CI 0.003 to 0.023%, p = 0.012) and total tibia (0.018%/year, 95% CI 0.009 to 0.026%, p < 0.001). Higher body mass index at baseline and increases in body mass index over time were associated with a greater tibial cartilage loss at the medial (body mass index at baseline 0.040%/year, 95% CI 0.022 to 0.058%, p < 0.001; increases in body mass index 0.055%/year, 95% CI 0.018 to 0.093%, p = 0.004) but not lateral compartment. No evidence of non-linear relationships was observed. Compared to males, females lost more lateral tibial cartilage with increasing age (0.023%/year, 95% CI 0.003 to 0.043%, p = 0.024 for interaction). CONCLUSIONS: Tibial cartilage volume declines at a faster rate with increasing age and body mass index in both males and females, particularly in the medial compartment. In contrast to the low rate of change in radiographs, our findings suggest that cartilage loss at the tibia is universal in this age group.

Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study.

BACKGROUND: Unplanned hospital readmissions are a quality and safety indicator. In Australian, 8% to 11.1% of unplanned readmissions occur ≤1 day of acute care discharge. The aim of this study was to explore the reasons for unplanned hospital readmissions ≤1 day of acute care discharge, and determine what proportion of such unplanned hospital readmissions were potentially preventable. METHODS: A retrospective exploratory cohort design was used to conduct this two phase study. In Phase 1, organisational data from 170 readmissions ≤1 day and 1358 readmissions between 2 and 28 days were compared using the Cochran-Mantel-Haenszel test. Binary logistic regression was used to examine factors associated with unplanned readmission ≤1 day. In Phase 2, a medical record audit of 162 Phase 1 readmissions ≤1 day was conducted and descriptive statistics used to summarise the study data. Index discharges occurred between 1 August and 31 December 2015. RESULTS: In Phase 1, unplanned readmissions ≤1 day were more likely in paediatric patients (< 0.001); index discharges on weekends (p = 0.006), from short stay unit (SSU) (p < 0.001) or against health professional advice (p = 0.010); or when the readmission was for a Diagnosis Related Group (p < 0.001). The significant predictors of unplanned readmission ≤1 day were index discharge against advice or from SSU, and 1-5 hospital admissions in the 6 months preceding index admission. In Phase 2, 88.3% readmissions were unpreventable and 11.7% were preventable. The median patient age was 57 years and comorbidities were uncommon (3.1%). Most patients (94.4%) lived at home and with others (78.9%). Friday was the most common day of index discharge (17.3%) and Saturday was the most common day of unplanned readmission (19.1%). The majority (94.4%) of readmissions were via the emergency department: 58.5% were for a like diagnosis and pain was the most common reason for readmission. CONCLUSIONS: Advanced age, significant comorbidities and social isolation did not feature in patients with an unplanned readmission ≤1 day. One quarter of patients were discharged on a Friday or weekend, one quarter of readmissions occurred on a weekend, and pain was the most common reason for readmission raising issues about access to services and weekend discharge planning.

Action Errors: A Window Into the Early Development of Perception-Action System.

In this chapter, we explore an interesting class of behaviors, referred to as action errors, which, we argue, provide a window in to the early development of the perception-action system. As we examine these behaviors, we discuss how acquisition of motor and cognitive skills interact at particular periods of development to make children more likely to perform action errors. However, we also provide evidence that even adults perform action errors under certain task demands. We argue that it is fruitful to examine the developing perception-action system in terms of the dynamic interplay of constraints within the environment, the individual child, and the task that they are attempting to complete. This interaction of constraints is dynamic and multiply determined, which is why action errors do not occur whenever a child sees a photograph of an object, views a tiny chair, or interacts with grandparents over interactive media. We argue, however, that not all constraints are weighted equally in the emergence of a specific behavior. Rather, the child's goal or intention plays a key role in organizing factors that lead to a specific behavior.

A functional circuit for the retrieval of remote cued fear memory.

Although the retrosplenial cortex (RSC) is necessary for the retrieval of remotely acquired fear to a discrete auditory cue, it is not necessary for the retrieval of recently acquired cued-fear memories. Thus, the RSC's role in memory retrieval for discrete cues is time-dependent. The purpose of the current experiment was to identify the larger cortical circuit involved in the retrieval of remotely-acquired auditory fear memories. One candidate circuit involves the RSC and secondary auditory cortex; the secondary auditory cortex is also necessary for the retrieval of remotely acquired auditory fear memories (Sacco & Sacchetti, 2010), and sends direct projections to the RSC. To test this possibility, we assessed retrieval of remote memory following functional disconnection of the RSC and secondary auditory cortex. Complete disconnection of these regions produced a larger impairment in fear expression to a remotely acquired auditory cue compared to partial disconnection of these regions. These results are consistent with the notion that RSC and secondary auditory cortex form a functional circuit involved in the retrieval of remotely acquired fear to a discrete auditory cue. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Retrosplenial cortex has a time-dependent role in memory for visual stimuli.

Although the retrosplenial cortex (RSC) is critically involved in spatial learning and memory, it appears to have more selective contributions to learning and memory for discrete cues. For example, damage to the RSC does not impair Pavlovian delay fear conditioning to a discrete auditory cue (e.g., tone), when RSC manipulation occurs just prior to, or shortly after, conditioning. In contrast, when lesions of the RSC occur following a substantial retention interval (e.g., 28 days), the RSC is necessary for retrieval of fear to the tone. Thus, the RSC makes time-dependent contributions to memory retrieval for discrete auditory cues. The purpose of the current experiment was to assess if the time-dependent involvement of the RSC in cue-specific fear memory extended to cues of other sensory modalities. Rats firsts underwent fear conditioning to a visual stimulus, and lesions of the RSC subsequently occurred 1 or 28 days later. Lesions of the RSC impaired fear expression when made 28 days after conditioning, but not when made 1 day following conditioning. Coupled with previous findings, the current results suggest the RSC is necessary for retrieval of remotely acquired cued fear memories across multiple modalities. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

COMMENTARY: WHAT HEALS AND WHY? CHILDREN'S UNDERSTANDING OF MEDICAL TREATMENTS.

Lockhart and Keil have written an interesting monograph focusing on the development of reasoning about medicine, a relatively underexplored area of research with potentially broad implications with respect to the design of more-effective medical interventions. In a set of 15 studies with well over 2,200 participants, they examine how children and adults combine aspects of biological and psychological reasoning to create working models of medicine. Lockhart and Keil explore developmental changes in reasoning about illness and its treatment using medicines in terms of dualism (e.g., psychological vs. physical), spatial proximity, differential timing of effects, potential side effects, and treatment tradeoffs. This commentary highlights the novel contributions of this monograph, examines issues that need additional considerations, and makes suggestions for future research.

Knowing How to Fold 'em: Paper Folding across Early Childhood.

Folding paper is a seemingly simple act that requires planning, bimanual coordination, and manual strength and control to produce specific forces. Although paper folding has been used as an assessment tool and as a way to promote spatial skills, this study represents the first attempt to document when paper folding emerges across early childhood. Seventy-seven children (ages 18 months to 7 years) and an adult reference group (24 college-aged adults) completed three pre-specified folds on a single piece of paper. Dependent variables included whether children attempted each fold and, if so, the accuracy of each fold. Grip strength, pinch strength, and developmental level were examined as potential correlates of paper folding. The results demonstrated that paper folding emerges as early as 27 months of age but becomes more accurate with age. At least 50% of children between 4 and 5 1/2 years of age completed folds. Additionally, children with more age-appropriate problem-solving skills attempted more folds, independent of age. These findings provide a descriptive framework for the ages at which paper folding emerges and suggest that paper-folding interventions could be implemented at even earlier ages than what previously has been examined.