Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis. While mitotane is the only agent approved for ACC, clinical data are scarce, especially in the Asian population. We reviewed 10 patients with ACC who received mitotane as a single agent or in combination with other agents in our institution. Patient characteristics, clinical outcomes, and toxicities were analyzed. Mitotane was administered to 2 patients as an adjuvant therapy and to 8 patients for systemic control. In the latter 8 patients, 1 patient had locally advanced disease and 1 had metastatic disease at the time of initial diagnosis, whereas the other 6 patients experienced metastatic relapse at mitotane initiation. The administered regimen was mitotane alone in 7 patients, and mitotane plus cytotoxic chemotherapy in 3 patients. The initial daily mitotane dose was 3.0 g in 2 patients, 1.5 g in 7 patients, and 1.0 g in 1 patient. The median duration of treatment was 3.7 (range, 0.7-22.1) months. In 8 systemic cases, the median overall survival from chemotherapy initiation was 7.2 months, and only 1 patient survived over 1 year. The median interval from mitotane termination to death in systemic cases was 2.8 months, and the cause was progressive disease in 4 patients and toxicity (hallucination, mycobacteriosis, or liver injury) in 3 patients. As a second-line regimen, 2 systemic cases and 1 adjuvant case were enrolled in clinical trials. Our analysis exhibited extremely poor prognosis under mitotane-based regimens, and further treatment strategies are warranted to improve outcomes.The functional role of the transcription factors NR5A1 and NR5A2 and their interaction with Clock gene and bone morphogenetic proteins (BMPs) were investigated in human granulosa KGN cells. Treatment with BMP-15 and GDF-9 suppressed forskolin (FSK)-induced steroidogenesis as shown by the mRNA expression levels of StAR and P450scc but not the mRNA expression level of P450arom. Of interest, treatment with BMP-15 and GDF-9 also suppressed FSK-induced NR5A2 mRNA expression. Treatment with BMP-15 suppressed NR5A2 mRNA and protein expression but increased Clock mRNA and protein expression levels by granulosa cells. The mRNA expression levels of NR5A1, but not those of NR5A2, were positively correlated with the levels of Clock mRNA, while the mRNA levels of Id-1, the target gene of BMP signaling, were positively correlated with those of NR5A1 but not with those of NR5A2. It was also demonstrated that the mRNA expression levels of NR5A1 were positively correlated with those of P450arom and 3βHSD, whereas the mRNA expression level of NR5A2 was correlated with those of StAR and P450scc. Furthermore, inhibition of Clock gene expression by siRNA attenuated the expression of NR5A1, and the mRNA levels of Clock gene were significantly correlated with those of NR5A1. Collectively, the results suggested a novel mechanism by which Clock gene expression induced by BMP-15 is functionally linked to the expression of NR5A1, whereas NR5A2 expression is suppressed by BMP-15 in granulosa cells. The interaction between Clock NR5A1/NR5A2 and BMP-15 is likely to be involved in the fine-tuning of steroidogenesis by ovarian granulosa cells.Vegetarian restaurants were part of the city landscape of late nineteenth and early twentieth-century Britain. Most meat-free eateries were located in London, numbering around thirty by 1890, but similar establishments could also be found in Birmingham, Glasgow and Manchester. Drawing on fictional representations, newspaper articles, advertisements and health reform literature, this article explores the cultural meanings attached to vegetarian dining in this period. Following the establishment of the first Vegetarian Society in 1847, the meat-free cause was embraced as part of a broader progressive scene that encompassed temperance and labor rights, pacifism and socialism. Restaurants were key to furthering the meat-free movement, but they also served city clerks in search of cheap meal and women workers in need of somewhere respectable to dine. Mapped back onto the urban imaginary, the vegetarian restaurant emerges as discursive site in which the complex politics of consumption were negotiated."The student who dives deep into the mysteries that enshrine Truth . Selleckchem VX-478 . . will tell of her beauties, and proclaim to those who have ears to hear the words of healing." So wrote English cleric and spiritualist W. Stainton Moses in his Spirit Teachings (1883)-or, if Moses is to be believed, so wrote the spirit "Imperator," who, promising spiritual and bodily edification, enlisted Moses as his earthly amanuensis. Treating purportedly real spirit writings like those transcribed by Moses and the discourses of their reception in occultism, psychical research, and literature, this paper examines the phenomenon of automatic writing, also called spirit writing, passive writing, or psychography, as an evolving means of wellness and, later, a source of medical prescription from the 1850s through the 1890s. This essay suggests a yet-unintuited connection between the rise of automatic writing and the Spasmodic poetics alternately championed and critiqued by Sydney Dobell.In both the U.S. and Britain, Dr. Lydia Fowler was a leader in women's political and health reform organizations and temperance associations. Her publications, which targeted a popular audience of women and children, included self-help medical lectures and guides, a book of poetry, and the temperance novel Nora The Lost and Redeemed (1853). Nora represents the broader political fight surrounding temperance, but also the medical arguments about alcohol abuse itself. Fowler's phrenological writings, including Nora, served as a bridge between the nineteenth-century construction of "intemperance" as a moral failing and the disease model of "alcoholism" that came to dominate medicine in the early twentieth century. With Nora, Fowler employs the power and reach of Victorian fiction to dramatize the dangers of alcohol and the hopeful remedies of feminist-driven reform.Britain's Contagious Diseases Acts (1864, 1866, 1869) mandated the use of medical detention and speculum exams to manage the bodies of "common prostitutes" and thereby reduce sexually transmitted diseases among enlisted men. Repeal advocates challenged the gendered power structure of the Acts but also used melodramatic frameworks to produce a broader critique of nineteenth-century Britain's centralizing medical orthodoxy and to argue for unregulated traditional approaches to medicine. Across a variety of repeal speeches and documents, advocates idealized alternative health practices in order to challenge institutionalized modern medicine and the governmental interests that extended its authority. J. J. Garth Wilkinson's Forcible Introspection of Women for the Army and Navy by the Oligarchy, Considered Physically (1870) exemplifies the multivocal and intertextual medicolegal plots of repeal melodrama as it cast professionalized modern medicine as corrupt, villainous, and in collusion with the state while presenting alternative medicine as authentically preventative, curative, and democratic.