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    These are rare neoplasms occurring in an obscure gland. The early pathology literature referred to many of these tumors as thymic carcinoid tumors. However, unlike carcinoid tumors occurring in other organs such as the lung, these tumors were clinically malignant in the vast majority of cases. Thus investigators classify these tumors as part of the spectrum of neuroendocrine carcinomas. Well differentiated tumors may show prominent spindling, mucinous stroma, oncocytic changes, and divergent cell lines with mesenchymal elements and amyloid-like stroma. High grade tumors may show areas indistinguishable from small cell carcinoma. Tumors with oncocytic features must be distinguished from other simulators including paragangliioma, parathyroid adenomas, and metastastic tumors with oncocytic changes (such as breast CA, renal cell CA, malignant mesothelioma, and metastatic melanoma). Thymic neuroendocrine (carcinoid) tumors are a rare neoplasm of the anterior mediastinum. Although the thrills of March Madness have provided a brief respite, the NCAA’s ongoing legal crises are difficult to ignore. While the federal investigation into recruiting practices in men’s college basketball[1] may be the center of attention, there is pending litigation on other issues that has the potential to redefine the relationship between college athletes and their schools. These include the [2]—which could rollback the NCAA’s amateurism regulations even further than O’Bannon did[3], and the “single school/single sport” concussion cases filed by hundreds of players against their former schools and athletic conferences.[4] The concussion litigation, which is separate from the NCAA Concussion Settlement[5] that is currently awaiting implementation[6], has the potential to clarify a school’s duty of care to its athletes and provide monetary relief for thousands of former football players.[7] Similar to the NFL[8] and NHL[9], the NCAA and its member institutions have been the subject of an increasing wave of concussion-related complaints amid mounting evidence linking contact sports to diminished brain health and other neurocognitive issues.[10] The lawsuit that sparked the recent uptick in concussion litigation in college sports came from former Eastern Illinois football player Adrian Arrington, who in 2011 sued the NCAA for its “negligence and inaction with respect to concussions and concussion-related maladies sustained by its student-athletes.”[11] Other players followed suit[12], and the cases were consolidated in an Illinois federal court and later settled in 2014.[13] As currently constituted, the NCAA Concussion Settlement provides all former NCAA athletes—not just football players—with medical monitoring for concussion-related injuries (the settlement has not yet been implemented due to procedural delays[14]). The settlement agreement contains two important caveats: 1) It does not provide monetary compensation to athletes concussed while playing in the NCAA[15], but 2) It allows former athletes from a single sport (e.g., football, lacrosse, hockey) to seek financial damages from their school and/or athletic conference in separate lawsuits.[16] These carve-outs motivated a wave of “single school/single sport” lawsuits, which were consolidated in the same Illinois federal court as the NCAA Concussion Settlement and are being overseen by the same judge. [17] Over 100 “single school/single sport” cases have been filed to date, arguing that schools, athletic conferences, and the NCAA (“Defendants”) had a duty to ensure athletes’ safety given the extensive research on the dangers of concussions, but “failed to educate…[college] football players of the link between TBIs in amateur football and chronic neurological damage, illnesses, and decline.”[18] The players assert breach of contract, negligence, fraudulent concealment, and unjust enrichment claims [19] and seek damages for the past, present, and future effects of their injuries.[20] Though the cases have been consolidated, the court has not yet decided whether to certify a class against the NCAA or against a particular conference or school. To help resolve that issue, the parties have selected two “sample” cases apiece that can best indicate whether the “single school/single sport” complaints should move forward on a class basis.[21] These test cases will proceed through motions, discovery and, if necessary, trial to determine how best to approach the remainder of the cases. At present, the four sample cases (“Sample Cases”) have been selected and are currently in the motion to dismiss phase.[22] In the Sample Cases, the key allegation of the Player-Plaintiffs is that the Defendants “owe[d] a duty of care to safeguarding the well-being of its student-athletes,”[23] yet only recently implemented concussion management procedures.

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    Three groups of hypertensive patients were studied after they had received one of the three pharmacologically different beta blockers for at least 1 month: pindolol, 10 mg twice a day (n = 7), propranolol median dose, 80 mg three times a day (n = 9), or metoprolol, 150 mg (twice a day (n = 8). After abrupt withdrawal of drug and replacement with placebo, we mwasured the following on day 0 and approximately every 2 days up to 3 weeks; beta-adrenergic sensitivity (BAS) by the chronotropic dose of isoproterenol to increase heart rate by 25 bpm (CD values of 618 μg for pindolol, 57 μg for propranolol, and 10 μg for metoprolol as compared to 2.8, 2.4, and 3.0 μg, respectively, at days 14 to 21, which were considered the ultimate baseline. After pindolol on day 0, the CD decreased significantly two- to fivefold below baseline from days 4 to 14 (↑BAS) and after metoprolol two- to threefold below baseline from days 2 to 8. After pindolol, heart rate and blood pressure gradually returned to, but not above, ultimate baseline. In contrast, during the period of ↑BAS there was a significant overshoot of heart rate in eight of eight patients after metoprolol (day 0 = 61, peak = 88, baseline = 74) but not after propranolol, while a significant overshoot of blood pressure occurred in six of nine patients after propranolol () but not after metoprolol. Withdrawal symptoms of headache, palpitations, and tremor occurred in one of seven patients after pindolol, six of nine after propranolol, and three of eight after metoprolol. The degree and duration of beta blockade appeared related to drug potency. Metoprolol Side Effects, Dosage, Uses, and More - Healthline buy viagra belfast Metoprolol withdrawal phenomena mechanism Weaning off Metoprolol Mayo Clinic Connect
     
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