Checklist of Orchidaceae from Caquetá, Colombia.

A checklist of Orchidaceae from Caquetá, Colombia is presented here. We recorded 98 genera and 418 species, exceeding a previous inventory by 276 species. The checklist is conservative in the number of genera and species by including only taxa that were fully and reliably identified and that are either linked to a corresponding herbarium voucher, a living collection specimen or a photo taken in the field and published in iNaturalist by one of the authors or a collaborator. The documented species diversity in the region could dramatically increase in the next few years with additional collecting efforts in the eastern slopes of the Andes nested in Caquetá. About 9% (418/4600) of all Orchidaceae species recorded for Colombia are reported for this area, showing the important contribution to orchid diversity of Andean-Amazonian foothills of Caquetá.

Morfometría de la rama mandibular para la estimación del sexo y edad en una población adulta peruana 2014-2019 / Morphometry of the mandibular ramus for the estimation of sex and age in a peruvian adult population 2014-2019

Objetivo: Evaluar la precisión de la estimación del sexo y edad utilizando la morfometría de la rama mandibular mediante un modelo de regresión lineal múltiple incluyendo el ancho intercondilear, el ancho bigonial, la longitud coronoides, la longitud de la rama mandibular, la longitud del cóndilo, el ancho máximo de la rama mandibular y el ángulo goniaco en una población adulta peruana 2014-2019. Material y métodos: Se utilizaron 174 tomografías computarizadas de 18 a 60 años de edad y se analizaron las variables ancho intercondileo (AI), ancho bigonial (AB), longitud coronoides (LCr), longitud del cóndilo (LC), longitud de la rama mandibular (LRm), ancho máximo de la rama mandibular (AMRm) y ángulo goniaco (AG) del lado derecho de la mandíbula. Resultados: La prueba t de muestras independientes determinó que la mayor diferencia entre el sexo fue en la variable LC con 6.9225 mm, la función discriminante obtuvo una tasa de clasificación correcta del sexo con 82.7% y con el modelo de regresión logística múltiple se obtuvo una sensibilidad en el sexo femenino de 81.2%, una especificidad de 85.7%, el sexo masculino una sensibilidad de 85.7%, una especificidad de 81.2%, en la edad la correlación más alta fue en AG con -0.252. Conclusión: Los coeficientes más potentes fueron en LRm, AI y AB con 0.608, 0.606 y 0.604 respectivamente. La mayor diferencia se encontró en el ancho intercondilar con 9.3 mm entre los sexos, en general el porcentaje de precisión predictiva fue de 83.9% en una población egipcia muy parecido a este estudio. (AU)

Objective: To evaluate the precision of the estimation of sex and age using the morphometry of the mandibular ramus through a multiple linear regression model including the intercondylar width, the bigonial width, the coronoid length, the length of the mandibular ramus, the length of the condyle, the maximum width of the mandibular ramus and the gonial angle in a Peruvian adult population 2014-2019. Material and methods: 174 computed tomography scans from 18 to 60 years of age were used and the variables intercondylar width (AI), bigonial width (AB), coronoid length (CLr), condyle length (LC), ramus length mandibular ramus (MRm), maximum width of the mandibular ramus (MRAm) and gonial angle (AG) of the right side of the mandible. Results: The independent samples t-test determined that the greatest difference between the sexes was in the LC variable with 6.9225 mm, the discriminant function obtained a correct classification rate of the sex with 82.7% and with the multiple logistic regression model a sensitivity in the female sex of 81.2%, a specificity of 85.7%, the male sex a sensitivity of 85.7%, a specificity of 81.2%, in age the highest correlation was in AG with -0.252. Discussion: The most powerful coefficients were in LRm, AI and AB with 0.608, 0.606 and 0.604 respectively. The greatest difference was found in the intercondylar width with 9.3 mm between the sexes, in general the percentage of predictive accuracy was 83.9% in an Egyptian population very similar to this study. (AU)

Demographic and clinical characterization of pediatric group patients with inborn errors of the immune system in a Colombian tertiary hospital

Introduction: In recent decades, there has been a growing increase in the diagnosis of patients with inborn errors of the immune system, formerly known as primary immunodeficiency dis-orders (PIDs). Timely diagnosis remains a challenge due to low clinical suspicion and poor edu-cation on the subject. It is estimated that between 70% and 90% of these pathologies remain underdiagnosed in our environment.Objective: The objective of this study is to characterize the demographic and clinical presen-tation of pediatric group patients with inborn errors of the immune system in a Colombian tertiary hospital.Methods: Retrospective descriptive study of 306 patients with a diagnosis of innate errors of the immune system who consulted the PID clinic between 2011 and 2018 in a high-complexity institution in Cali, Colombia.Results: Three-hundred and six patients were included. The median age was 4 years (IQR 2.3–7.7 years), and 59.5% of the patients were male. According to the International Union of Immunological Societies Expert Committee for Primary Immunodeficiency classification for inborn errors of the immune system, the most common group was antibody deficiency in 74.8% (n=229), especially in the age group between 1 and 5 years. The least frequent in our pop-ulation was complement deficiency. Of the warning signs stipulated for these pathologies, the most frequent were the (1) need for intravenous antibiotics (32%), (2) difficulty growing (15.7%), (3) four or more episodes of ear infection (10.8%), and (4) abscesses in organs or cuta-neous abscesses (12.7%). No patient reported two or more episodes of pneumonia or sinusitis, and only 5.8% of the patients received a bone marrow transplant (AU)

Incomplete lineage sorting and reticulate evolution mask species relationships in Brunelliaceae, an Andean family with rapid, recent diversification.

PREMISE: To date, phylogenetic relationships within the monogeneric Brunelliaceae have been based on morphological evidence, which does not provide sufficient phylogenetic resolution. Here we use target-enriched nuclear data to improve our understanding of phylogenetic relationships in the family. METHODS: We used the Angiosperms353 toolkit for targeted recovery of exonic regions and supercontigs (exons + introns) from low copy nuclear genes from 53 of 70 species in Brunellia, and several outgroup taxa. We removed loci that indicated biased inference of relationships and applied concatenated and coalescent methods to infer Brunellia phylogeny. We identified conflicts among gene trees that may reflect hybridization or incomplete lineage sorting events and assessed their impact on phylogenetic inference. Finally, we performed ancestral-state reconstructions of morphological traits and assessed the homology of character states used to define sections and subsections in Brunellia. RESULTS: Brunellia comprises two major clades and several subclades. Most of these clades/subclades do not correspond to previous infrageneric taxa. There is high topological incongruence among the subclades across analyses. CONCLUSIONS: Phylogenetic reconstructions point to rapid species diversification in Brunelliaceae, reflected in very short branches between successive species splits. The removal of putatively biased loci slightly improves phylogenetic support for individual clades. Reticulate evolution due to hybridization and/or incomplete lineage sorting likely both contribute to gene-tree discordance. Morphological characters used to define taxa in current classification schemes are homoplastic in the ancestral character-state reconstructions. While target enrichment data allows us to broaden our understanding of diversification in Brunellia, the relationships among subclades remain incompletely understood.

Evidence-Based Clinical Practice Guidelines for Extramammary Paget Disease.

IMPORTANCE: Extramammary Paget disease (EMPD) is a frequently recurring malignant neoplasm with metastatic potential that presents in older adults on the genital, perianal, and axillary skin. Extramammary Paget disease can precede or occur along with internal malignant neoplasms. OBJECTIVE: To develop recommendations for the care of adults with EMPD. EVIDENCE REVIEW: A systematic review of the literature on EMPD from January 1990 to September 18, 2019, was conducted using MEDLINE, Embase, Web of Science Core Collection, and Cochrane Libraries. Analysis included 483 studies. A multidisciplinary expert panel evaluation of the findings led to the development of clinical care recommendations for EMPD. FINDINGS: The key findings were as follows: (1) Multiple skin biopsies, including those of any nodular areas, are critical for diagnosis. (2) Malignant neoplasm screening appropriate for age and anatomical site should be performed at baseline to distinguish between primary and secondary EMPD. (3) Routine use of sentinel lymph node biopsy or lymph node dissection is not recommended. (4) For intraepidermal EMPD, surgical and nonsurgical treatments may be used depending on patient and tumor characteristics, although cure rates may be superior with surgical approaches. For invasive EMPD, surgical resection with curative intent is preferred. (5) Patients with unresectable intraepidermal EMPD or patients who are medically unable to undergo surgery may receive nonsurgical treatments, including radiotherapy, imiquimod, photodynamic therapy, carbon dioxide laser therapy, or other modalities. (6) Distant metastatic disease may be treated with chemotherapy or individualized targeted approaches. (7) Close follow-up to monitor for recurrence is recommended for at least the first 5 years. CONCLUSIONS AND RELEVANCE: Clinical practice guidelines for EMPD provide guidance regarding recommended diagnostic approaches, differentiation between invasive and noninvasive disease, and use of surgical vs nonsurgical treatments. Prospective registries may further improve our understanding of the natural history of the disease in primary vs secondary EMPD, clarify features of high-risk tumors, and identify superior management approaches.

-Complete plastid genome sequences of two species of the Neotropical genus Brunellia (Brunelliaceae).

Here we present the first two complete plastid genomes for Brunelliaceae, a Neotropical family with a single genus, Brunellia. We surveyed the entire plastid genome in order to find variable cpDNA regions for further phylogenetic analyses across the family. We sampled morphologically different species, B. antioquensis and B. trianae, and found that the plastid genomes are 157,685 and 157,775 bp in length and display the typical quadripartite structure found in angiosperms. Despite the clear morphological distinction between both species, the molecular data show a very low level of divergence. The amount of nucleotide substitutions per site is one of the lowest reported to date among published congeneric studies (π = 0.00025). The plastid genomes have gene order and content coincident with other COM (Celastrales, Oxalidales, Malpighiales) relatives. Phylogenetic analyses of selected superrosid representatives show high bootstrap support for the ((C,M)O) topology. The N-fixing clade appears as the sister group of the COM clade and Zygophyllales as the sister to the rest of the fabids group.

Sebaceous carcinoma: evidence-based clinical practice guidelines.

Sebaceous carcinoma usually occurs in adults older than 60 years, on the eyelid, head and neck, and trunk. In this Review, we present clinical care recommendations for sebaceous carcinoma, which were developed as a result of an expert panel evaluation of the findings of a systematic review. Key conclusions were drawn and recommendations made for diagnosis, first-line treatment, radiotherapy, and post-treatment care. For diagnosis, we concluded that deep biopsy is often required; furthermore, differential diagnoses that mimic the condition can be excluded with special histological stains. For treatment, the recommended first-line therapy is surgical removal, followed by margin assessment of the peripheral and deep tissue edges; conjunctival mapping biopsies can facilitate surgical planning. Radiotherapy can be considered for cases with nerve or lymph node involvement, and as the primary treatment in patients who are ineligible for surgery. Post-treatment clinical examination should occur every 6 months for at least 3 years. No specific systemic therapies for advanced disease can be recommended, but targeted therapies and immunotherapies are being developed.

Proteomic profile associated with cell death induced by androgens in Taenia crassiceps cysticerci: proposed interactome.

Androgens have been shown to exert a cysticidal effect upon Taenia crassiceps, an experimental model of cysticercosis. To further inquire into this matter, the Taenia crassiceps model was used to evaluate the expression of several proteins after testosterone (T4) and dihydrotestosterone (DHT) in vitro treatment. Under 2-D proteomic maps, parasite extracts were resolved into approximately 130 proteins distributed in a molecular weight range of 10-250 kDa and isoelectrical point range of 3-10. The resultant proteomic pattern was analysed, and significant changes were observed in response to T4 and DHT. Based on our experience with electrophoretic patterns and proteomic maps of cytoskeletal proteins, alteration in the expression of isoforms of actin, tubulin and paramyosin and of other proteins was assessed. Considering that androgens may exert their biological activity in taeniids through the non-specific progesterone receptor membrane component (PGRMC), we harnessed bioinformatics to propose the identity of androgen-regulated proteins and establish their hypothetical physiological role in the parasites. These analyses yield a possible explanation of how androgens exert their cysticidal effects through changes in the expression of proteins involved in cytoskeletal rearrangement, dynamic vesicular traffic and transduction of intracellular signals.

The Successful Treatment of Elephantiasis Nostras Verrucosa With Ablative Carbon Dioxide Laser.

BACKGROUND AND OBJECTIVE: Elephantiasis nostras verrucosa (ENV) is a disfiguring skin condition that is difficult to treat. Existing treatment modalities serve to improve cosmesis or treat symptoms. Herein, we report a case of ENV with lymphocutaneous fistula successfully treated with ablative carbon dioxide laser. STUDY DESIGN/PATIENTS AND METHODS: A 57-year-old woman with biopsy-proven ENV with lymphocutaneous fistula was treated with ablative carbon dioxide laser to the symptomatic area of her right thigh in 3 treatment sessions over 6 months. RESULTS: The patient had resolution of lymphocutaneous drainage as well as 90% improvement in the appearance of ENV lesions at the 1-month follow-up visit. CONCLUSION: Ablative carbon dioxide laser may provide cosmetic, symptomatic, and medical benefit for patients with localized ENV.

Neutrophil CD64 expression, procalcitonin and presepsin are useful to differentiate infections from flares in SLE patients with SIRS.

Background/Objective Differentiating systemic lupus erythematosus (SLE) activity from infections in febrile patients is difficult because of similar initial clinical presentation. The aim of this study is to evaluate the usefulness of a number of biomarkers for differentiating infections from activity in SLE patients admitted with systemic inflammatory response (SIRS). Methods Patients with SLE and SIRS admitted to the emergency room were included in this study. Measurements of different markers including procalcitonin, neutrophil CD64 expression and presepsin, were performed. Infection was considered present when positive cultures and/or polymerase chain reaction were obtained. Sensitivity and specificity were calculated for all biomarkers. Results Twenty-seven patients were admitted, 23 women (82.5%), mean age 33.2 years. An infectious disease was confirmed in 12 cases. Markers for SLE activity including anti-DNA titers by IIF ( p = 0.041) and enzyme-linked immunosorbent assay ( p = 0.009) were used for differentiating SLE flares from infection. On the contrary, increased procalcitonin ( p = 0.047), neutrophil CD64 expression by flow cytometry ( p = 0.037) and presepsin ( p = 0.037) levels were observed in infected SLE patients. Conclusions High neutrophil CD64 expression, presepsin and procalcitonin levels are useful to differentiate infections from activity in SLE patients. In most cases, a positive bioscore that includes these three markers demonstrate the presence of an infectious disease.

Development of an advanced radioactive airborne particle monitoring system for use in early warning networks.

Automatic real-time warning networks are essential for the almost immediate detection of anomalous levels of radioactivity in the environment. In the case of Extremadura region (SW Spain), a radiological network (RARE) has been operational in the vicinity of the Almaraz nuclear power plant and in other areas farther away since 1992. There are ten air monitoring stations equipped with Geiger-Müller counters in order to evaluate the external ambient gamma dose rate. Four of these stations have a commercial system that provides estimates of the total artificial alpha and beta activity concentrations in aerosols, and of the 131I activity (gaseous fraction). Despite experience having demonstrated the benefits and robustness of these commercial systems, important improvements have been made to one of these air monitoring systems. In this paper, the analytical and maintenance shortcomings of the original commercial air monitoring system are described first; the new custom-designed advanced air monitoring system is then presented. This system is based mainly on the incorporation of gamma spectrometry using two scintillation detectors, one of NaI:Tl and the other of LaBr3:Ce, and compact multichannel analysers. Next, a comparison made of the results provided by the two systems operating simultaneously at the same location for three months shows the advantages of the new advanced air monitoring system. As a result, the gamma spectrometry analysis allows passing from global alpha and beta activity determinations due to artificial radionuclides in aerosols, and the inaccurate measurement of the gaseous 131I activity concentration, to the possibility of identifying a large number of radionuclides and quantifying each of their activity concentrations. Moreover, the new station's dual capacity is designed to work in early warning monitoring mode and surveillance monitoring mode. This is based on custom developed software that includes an intelligent system to issue the necessary warnings when radiological anomalies or technical problems are identified. Implicitly, for the construction of the advanced station, substantial mechanical and electronic developments have been required. They have essentially consisted of integrating a new replacement device, whose operation has reduced the maintenance tasks.

Zeolite molecular accessibility and host-guest interactions studied by adsorption of organic probes of tunable size.

A series of fluorescent probe molecules based on the commercially available trans-4-(4-(diethylamino)styryl)-N-methylpyridinium iodide (DAMPI) scaffold has been developed. The dynamic radii of these DAMPI-type probes covered a range of 5.8 to 10.1 Å and could be changed by varying the alkyl substituents on the amine donor group, with limited effect on the electronic properties. These probe molecules allow for the direct evaluation of the molecular accessibility into confined spaces, more specifically the micropore architecture of zeolite materials. Evaluation of industrially relevant zeolite materials with 8- (CHA), 10- (MFI) and 12-membered ring pores (FAU) showed that steric bulk influences the rate of adsorption, the amount of probe molecule taken up by the zeolite as well as the interaction of the probe molecule with the zeolite material. Furthermore, a positive linear correlation is found between the pore-probe size difference and total probe uptake by the zeolite. The absorption spectra of each probe molecule within the zeolites show that this DAMPI-type compound is chemically bound to the zeolite's acid sites. The new approach shows the general principle of determining size-accessibility relationships in microporous solids with a series of fluorescent probes of systematically tunable size.

Acute pancreatitis in ICU secondary to treatment with tigecycline. / Pancreatitis aguda en la unidad de cuidados intensivos secundaria a tratamiento con tigeciclina.

Tigecycline is a broad spectrum antimicrobial agent, structurally similar to minocycline and that shares some tetracycline-related side effects. A case report is presented on a 68-year-old female who received tigecycline for a sepsis of unknown origin and who, in the following 5days, developed abdominal pain and elevated pancreatic enzymes, which suggested acute pancreatitis. After ruling out other origins, and according to the Naranjo adverse drug reaction probability scale, tigecycline was the probable cause of the acute pancreatitis, a complication that has been reported 5 times in the database of the Spanish pharmacosurveillance system since 2009. Close monitoring of abdominal signs and symptoms is recommended during treatment with tigecycline, since adverse effects affecting the digestive system are the most prevalent ones when using this drug.

Cross-species identification of genomic drivers of squamous cell carcinoma development across preneoplastic intermediates.

Cutaneous squamous cell carcinoma (cuSCC) comprises 15-20% of all skin cancers, accounting for over 700,000 cases in USA annually. Most cuSCC arise in association with a distinct precancerous lesion, the actinic keratosis (AK). To identify potential targets for molecularly targeted chemoprevention, here we perform integrated cross-species genomic analysis of cuSCC development through the preneoplastic AK stage using matched human samples and a solar ultraviolet radiation-driven Hairless mouse model. We identify the major transcriptional drivers of this progression sequence, showing that the key genomic changes in cuSCC development occur in the normal skin to AK transition. Our data validate the use of this ultraviolet radiation-driven mouse cuSCC model for cross-species analysis and demonstrate that cuSCC bears deep molecular similarities to multiple carcinogen-driven SCCs from diverse sites, suggesting that cuSCC may serve as an effective, accessible model for multiple SCC types and that common treatment and prevention strategies may be feasible.

Lessons learnt from the radiological measures performed by the Radiological Emergency Network of Extremadura in the International Emergency Exercise CURIEX 2013.

In late 2013 (5th-7th of November), the Cáceres Urgent Response International Exercise (CURIEX 2013) took place to test the Nuclear Emergency Plan of Cáceres (PENCA) with the collaboration of both national and international support teams. The theme of the exercise was the simulation of a nuclear accident at the Almaraz Nuclear Power Plant located in Extremadura (Spain) with release of radioactive plume. From the point of view of radioactive contamination, the CURIEX exercise objective was to assess the capability of the different radiological teams to quantify the radioactive impact that would occur in this environment, a goal in which the Radiological Emergency Network of Extremadura (RARE) is directly implicated. The present paper analyses in detail the environmental radiological and dosimetrical results obtained by the Radiological Emergency Network of Extremadura during the CURIEX exercise. The rapid radioactivity measurement techniques on air and soil samples performed by the RARE's mobile lab involves great uncertainties. However, the results show a relative good effectiveness both in dose rate car-borne measurements and gamma soil spectrometry with uncertainties over 40%. It also shows a good correlation between the dose rate values measured by car-borne apparatus and those calculated from gamma spectrometry measurements. The capability of the RARE's facilities are evaluated in both the measurements, showing whether or not there is a radiological problem, and the transmission of that data to the decision centres in the shortest time. Although the results were highly satisfactory, some shortcomings were detected and therefore some improvements are proposed in the paper, in order to achieve a greater capacity in response to an event with the characteristics simulated in the CURIEX exercise.

Resultados de cirugía de epilepsia en la Fundación Cardiovascular de Colombia: serie de casos / Results in epilepsy surgery, Fundación Cardiovascular of Colombia: serie cases

Introducción: epilepsia resistente al tratamiento con fármacos antiepilépticos (refractaria), se presenta en el 30 al 35 % de los casos. La cirugía de epilepsia es una opción de manejo de este subgrupo, existen cirugías resectivas donde se extirpa el foco epileptogénico y paliativas a través de las cuales se pretende disminuir el número de crisis en los pacientes. Objetivo: presentar los resultados de efectividad y seguridad de la cirugía de epilepsia en Bucaramanga, Colombia. Material y métodos: estudio descriptivo, retrospectivo de una serie de casos, de pacientes operados en la Fundación Cardiovascular de Colombia, entre enero de 2010 y octubre de 2015 por epilepsia refractaria al tratamiento médico. Se obtiene información de la historia clínicia de los pacientes para evaluar las características demográficas y la eficacia y seguridad de los procedimientos realizados basados en la clasificación Engel para libertad de crisis a un año de seguimiento y complicaciones posquirúrgicas Resultados: en este periodo de tiempo, se intervinieron 26 pacientes; 16 hombres y 10 mujeres, con edad promedio de 22,5 años; la media de edad al inicio de la epilepsia fue de los siete años; el tiempo de evolución de la epilepsia al momento de la cirugía de 22 años para adultos y 5,7 años para niños (menores de 18 años de edad); se realizaron 16 cirugías resectivas (13 temporales y 3 extratemporales) y 10 cirugías paliativas (9 implantaciones de VNS y una callosotomía); evaluando el resultado posquirúrgico solo en los 21 pacientes que tienen más de 12 meses de seguimiento postoperatorio tenemos la siguiente información: cirugías resectivas temporales (9/10) 90% en Engel I, implantaciones de VNS (7/7) y callosotomia (1/1) en 100 % en Engel III y resectivas extratemporales (2/3) 66,6 % en Engel I; la hospitalización postoperatoria promedio fue 4,7 días; y las complicaciones más frecuentes fueron la fistula de LCR contenida y la depresión-ansiedad transitoria postoperatoria. Discusión: la efectividad y seguridad de la cirugía de epilepsia en nuestra serie es similar a la mostrada en la literatura mundial. Conclusión: consideramos que en nuestro centro los pacientes que hemos operado se han beneficiado favorablemente de esta opción de tratamiento para la epilepsia refractaria. Se requiere un seguimiento a 5 años de esta cohorte para validar estos resultados.

Introduction: Drug resistant epilepsy, is presented in the 30% or 35% of the cases. The epilepsy surgery is an option to drive in this subgroup, being resective surgeries when the epileptogenic focus is extirped, and palliative surgeries when the target is to dismisse the number of crisis. Objective: The goal in this reviewing is to present effectiveness and safety outcomes in epilepsy surgery in Bucaramanga. Materials and methods: Retrospective and descriptive study of series of cases, taken from the patients operated of refractary epilepsy surgery in the Fundación cardiovascular of Colombia, since january 2010 until october 2015; review recordsof patients, to assess the demographic characteristic and the efficacy and safety of the procedures performed, based on Engel classification for freedom of crisis 1 year follow-up and post-surgical complications Results: In this length of time, were operated 26 patients, 16 men and 10 women, with an average of age 22,5 years; media of age at the beginning of the epilepsy 7 years; with the time of evolution of the epilepsy at the momento of the surgery 22 years for adults, and 5,7 years for childen (less tan 18 years); were performed 16 resective surgeries (13 temporal lobe and 3 extratemporal) and 10 palliative surgeries (9 VNS implantations and 1 callosotomy); we evaluated the postoperative outcomes, just in 21 patients who have more than 12 months of following, we get the next results: temporal lobe resective surgeries (9/10) 90% in Engel I, VNS implantations (7/7) and callosotomy (1/1) 100% in Engel III, and extratemporal resective surgeries (2/3) 66% in Engel I; the media of postoperative hospitalization days were 4,7; and the more frequently complications were the contenied CSF leak and transitory depression and anxiety postoperative. Discussion: The effectiveness and safety of epilepsy surgery in our series is similar to that shown in the literature. Conclusion: We can say that in our center, patients who have operated have benefited from this treatment option for drug resistant epilepsy. 5-year follow up of this cohort to validate these results is required.

Evaluation of nerves in Mohs micrographic surgery: histologic mimickers of perineural invasion and nervous tissue on frozen section.

BACKGROUND: Perineural invasion (PNI) is an important histologic finding and may be a negative prognostic factor for squamous cell carcinoma (SCC). It may be associated with more-aggressive tumor behavior. Mohs surgeons encounter microscopic PNI regularly and must be able to diagnose it accurately to guide care decisions. OBJECTIVE: To describe benign histologic mimickers of PNI and neural structures in SCC commonly encountered on frozen, hematoxylin and eosin-stained sections and to review how to differentiate them from PNI. METHODS AND MATERIALS: Review of the literature regarding histologic mimickers of PNI and additional contributions to frozen section PNI and nerve tissue mimickers. RESULTS: We describe benign findings, including arrector pili muscles, eccrine muscles, vessels, granulomatous inflammation, and eddies of SCC, that may each be mistaken for nerves or PNI. We discuss the ways in which they may be distinguished on frozen sections and review other commonly encountered entities that resemble PNI. CONCLUSION: Perineural inflammation and peritumoral fibrosis are common mimickers of PNI on frozen section, although other mimickers exist on permanent sections. Normal structures may appear "neural" by way of frozen tissue orientation, processing, or inflammation and thus must be differentiated from nerve tissue and PNI during Mohs surgery.

Global Burden of Neural Tube Defects, Risk Factors, and Prevention.

Neural tube defects (NTDs), serious birth defects of the brain and spine usually resulting in death or paralysis, affect an estimated 300,000 births each year worldwide. Although the majority of NTDs are preventable with adequate folic acid consumption during the preconception period and throughout the first few weeks of gestation, many populations, in particular those in low and middle resource settings, do not have access to fortified foods or vitamin supplements containing folic acid. Further, accurate birth defects surveillance data, which could help inform mandatory fortification and other NTD prevention initiatives, are lacking in many of these settings. The burden of birth defects in South East Asia is among the highest in the world. Expanding global neural tube defects prevention initiatives can support the achievement of the United Nations Millennium Development Goal 4 to reduce child mortality, a goal which many countries in South East Asia are currently not poised to reach, and the 63rd World Health Assembly Resolution on birth defects. More work is needed to develop and implement mandatory folic acid fortification policies, as well as supplementation programs in countries where the reach of fortification is limited.