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Malignant melanotic nerve sheath tumors account for less than 1% of all primary peripheral nerve sheath tumors and most often arise from the spinal nerves or visceral autonomic nerves ( MMNST has historically been regarded as an atypical variant of schwannoma and, due to its pigmentation, has been referred to as melanotic schwannoma ( In some series, over 50% of patients with MMNSTs have evidence of Carney complex, an autosomal dominant, occasionally familial multiple neoplasia syndrome ( The average age at diagnosis of MMNST is 41 years, with a reported range of 1181 years, which corresponds well to our patient (46 years) ( Table 1 summarizes cases identified in PubMed using the search terms MMNST and malignant melanotic nerve sheath tumor that were published after the 2021 WHO CNS tumor classification, in which MMNST was designated a potentially aggressive condition

Findings: RCTSTEP UP Trial - Semaglutide 7.2 mg once weekly vs Semaglutide 2.4 mg once weekly in Obese Adults, Lancet Diabetes Endocrinol (2025) [PubMed abstract] Design: Randomized, double-blind, placebo-controlled and active-controlled trial (N=1407 | length = 72 weeks) in adults with BMI 30 without diabetes Treatment: Semaglutide 7.2 mg once weekly vs Semaglutide 2.4 mg once weekly vs Placebo Primary outcome: Percentage change in body weight and the proportion of participants with a body weight reduction of 5% or greater Results: Primary outcome (% decrease in body weight): Semaglutide 7.2 mg - 18.7%, Semaglutide 2.4 mg - 15.6%, Placebo - 3.9% (p 5kg within 90 days) History of chronic pancreatitis Acute pancreatitis within 180 days Baseline characteristics Average age 48 years Female sex - 79% Average weight - 233 lbs (106 kg) Average BMI - 37.6 Randomized treatment groups Group 1 (205 patients): Oral Semaglutide with a target dose of 25 mg once daily Group 2 (102 patients): Placebo Semaglutide was started at 3 mg daily and increased every 4 weeks to 7 mg, 14 mg, and 25 mg All patients also received diet (500 kcal deficit) and exercise (150 min/week) counseling Coprimary endpoints were the percentage change in body weight from baseline to week 64 and achievement of a reduction in body weight of 5% or more from baseline to week 64 Primary outcome: Results Oral semaglutide at a dose of 25 mg once daily resulted in a greater mean reduction in body weight than placebo in participants with overweight or obesity

Many individuals report the injection sensation as barely noticeable, certainly less painful than stepping on a Lego barefoot at 2 AM

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