Mount Sinai Hospital, founded in 1852, is one of the oldest and largest teaching hospitals in the United States. It is located in East Harlem in the New York City borough of Manhattan, on the eastern border of Central Park stretching along Madison and Fifth Avenues, between East 98th Street and East 103rd Street. The entire Mount Sinai health system has over 7,400 physicians, as well as 3,815 beds, and delivers over 16,000 babies a year. In 2019–20, the hospital was ranked 14th among the nearly 5,000 hospitals in the US by the U.S. News & World Report.
Isolated demyelinating syndrome (IDS), or first demyelinating event, is defined as an acute neurological presentation associated with central nervous system (CNS) demyelination. It may occur as a monophasic episode or represent the initial manifestation of a recurrent demyelinating disorder. IDS is classified as either monofocal -affecting the brain, brainstem, cerebellum, optic nerve, or spinal cord-or multifocal, when a combination of these regions is involved. Management is primarily directed toward optimizing functional recovery. Additionally, in patients who fulfill diagnostic criteria for an underlying demyelinating disease, the initiation of immunosuppressive therapy should be considered.
Neuromyelitis Optica spectrum disorder (NMOSD) is a severe autoimmune disease of the central nervous system characterized primarily by inflammation of the optic nerve, spinal cord, and brainstem. The identification of IgG antibodies against aquaporin-4 (AQP4-IgG) has transformed the understanding and classification of the disease, distinguishing it from other inflammatory CNS disorders. However, some seronegative patients remain a subject of debate.
INTRODUCTION:Several physiological changes occur during the aging process, with perhaps the most apparent being modifications in body composition. The objective was to evaluate ongoing changes in body composition, throughout the aging process. MATERIALS AND METHODS:A cross-sectional study was conducted in 975 participants (612 women, 363 men) aged 18-89 years, whose body composition was assessed using dual-energy X-ray absorptiometry (DXA). RESULTS:The mean age was 48 ± 17 years for women and 43 ±15 years for men (p < 0.01). Men exhibited a greater amount of lean mass compared to women (54.5 ± 9.4 vs. 37.7 ± 5.5 kg; p<0.0001). Women showed a higher percentage of lower limb lean mass than men (78 vs. 74%; p < 0.05). Age was independently associated with decreased appendicular muscle mass, with a reduction of 0.38 kg per decade. On the other hand, women exhibited higher relative fat mass and a greater proportion of lean tissue in the lower limbs. Fat tissue increased with age in both sexes, remaining consistently higher in women. Lean mass and bone mineral content peaked in the second and third decades of life and declined thereafter. CONCLUSION:This study highlights the changes in body composition at various life stages, revealing a peak gain of lean tissue between the second and third decades, followed by a decline in subsequent years. To our knowledge, this is the first study that evaluates the changes in body composition in our country.
Summary Insulinomas are rare and benign human pancreatic adenomas that overproduce insulin and display increased beta cell mass. We and others have shown that transcriptomic and genomic profiling on insulinomas provides a data mine for identifying targets that can be manipulated to induce human beta cell regeneration. Majority of causative genetic variants in insulinomas involve epigenetic regulatory genes. Yet, specifically how these variants lead to human beta cell expansion and increased function is largely unknown. Here, we performed bulk and single-nucleus epigenomic and transcriptomic profiling to define regulatory alterations in human insulinomas. Bulk ATAC-seq and H3K27Ac ChIP-seq revealed significant enrichment of AP-1 transcription factor binding motifs within beta cell-associated open chromatin/enhancer regions in normal islets, accompanied by robust expression of AP-1 family members; in contrast, insulinomas exhibited marked reductions in both AP-1 motif enrichment and AP-1 expression. Our snRNA-seq and snATAC-seq profiling across four independent insulinomas identified a consistent and previously unrecognized signature defined by suppression of AP-1 transcription factors and widespread loss of chromatin accessibility at AP-1 binding sites, particularly at enhancers governing beta cell identity. Collectively, these results establish AP-1-mediated regulatory programs as critical determinants of beta cell maturation and define their disruption as a signature among human insulinomas.
Dorsal definition represents a persistent challenge in rhinoplasty, especially at the osteocartilaginous junction. We present the structural contour technique, a progressive 4-phase surgical approach designed to achieve a more defined and stable nasal dorsum through combined bony and cartilaginous maneuvers. The technique includes bony framework modification through targeted ostectomy and remodeling, osteochondral stabilization at the keystone area using cerclage sutures, controlled inferior reinsertion of the upper lateral cartilages, and final dorsal contour refinement with a continuous absorbable suture to achieve a cylindrical configuration while preserving nasal valve function. In a preliminary descriptive experience involving 4 patients, this technical approach allowed tailored dorsal contour refinement according to individual anatomical and aesthetic requirements. The structural contour technique provides a systematic and reproducible framework for dorsal refinement, integrating bone and cartilage in a controlled and harmonious manner.
