Mandibular metastasis of follicular thyroid carcinoma: A case report along with the concise review of literature.

Metastasis is one of the most common consequences of malignant tumors, and it is one of the leading causes of morbidity and mortality. Metastatic cancers to oral cavity are extremely rare. Moreover, the true incidence has yet to be determined. Despite their rarity, they are important clinically, since they can be the first and the only evidence of spread in many situations. Breast, kidney, lung, prostate and gastrointestinal tract are the most common sources of metastases in the oral cavity. Thyroid carcinoma is the most prevalent type of endocrine cancer, yet it rarely spreads to the oral cavity. After papillary thyroid carcinoma, follicular thyroid carcinoma is the second-most frequent kind of thyroid cancer. Jawbones are more commonly affected than soft tissues. Literature research revealed that till date, 44 cases of metastatic follicular thyroid cancer to the jawbones have been documented with mandibular preponderance (40 cases). With the rising occurrence of oral metastatic tumors in recent years, it has become increasingly important to diagnose them early to avoid future consequences. We present here an unusual case of metastatic follicular thyroid cancer in the mandible of an elderly adult along with a comprehensive review of the literature.

Factors Influencing Acute Stroke Thrombolytic Treatments in Hispanics In the San Diego Region.

BACKGROUND: Since the introduction of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke, rt-PA rate and number of stroke centers have increased. Despite this, studies have shown racial and ethnic disparities in stroke care especially in Black and Hispanic populations. What factors are related to the administration of rt-PA within the Hispanic population has to date been unclear. METHODS: We performed a retrospective review of IRB approved, prospectively collected data from the UC San Diego Stroke Registry from 7/2004-7/2016. Patients were included based on the primary diagnosis of Transient Ischemic Attack or Ischemic Stroke. Hispanic vs non-Hispanic patients were compared to assess for overall rt-PA treatment rates and process of care intervals. For the Hispanic cohort itself, demographics and NIHSS scores were assessed to determine why some Hispanics received rt-PA while others were not. RESULTS: Overall, 1489 patients (300 Hispanic vs. 1189 non-Hispanic) were included. Comparing Hispanics to non-Hispanics, there was no difference in rt-PA rate (35.3% vs. 33.1%; p=0.49). In rt-PA treated patients, "onset to arrival" interval was higher in Hispanics (1.03 vs. 0.88 hours; p=0.04), while the "arrival to treatment" interval was not different (1.13 vs. 1.02 hours; p=0.07). When looking at Hispanic patients only, there was no difference in baseline characteristics except for initial NIHSS in treated vs. non-treated patients (13.27 vs. 7.24; p<.001). CONCLUSION: Our analyses sought to determine the factors important to administration of rt-PA to Hispanic patients. These findings highlight the need for strategies to improve recognition and presentation pathways for Hispanics.

Relaxation lifetimes of plasmonically enhanced hybrid gold-carbon nanotubes systems.

Recently, we introduced a novel hybridization route for carbon nanotubes using gold nanoparticles, whose close proximity neatly enhances their radiative emission. Here we investigate the mechanisms behind the enhancement by monitoring the de-excitation dynamics of our π-hybrids through two-color pump-probe time-resolved spectroscopy. The de-excitation process reveals a fast component and a slow component. We find that the presence of gold prominently affects the fast processes, indicating a stronger influence of the gold nanoparticle on the intra-band non-radiative relaxation than on the inter-band recombination of the single-walled carbon nanotube. By evaluating the de-excitation times, we estimate the balance between near-field pumping and the faster metal-induced de-excitation contributions, proving the enhanced pumping to be the leading mechanism.

Non-enhanced CT Maximum Intensity Projections for the Detection of Large Vessel Occlusions.

BACKGROUND: Identification of large vessel occlusions (LVO) is important with recent guidelines supporting endovascular therapy in selected acute ischemic stroke patients. Many stroke centers perform CT angiography (CTA) in patients with suspected LVO, however this requires additional time and contrast administration. Non-enhanced CT maximum intensity projection (NECT-MIPs) may offer a rapid alternative to CTA. METHODS: We retrospectively reviewed acute stroke patients with LVO in the UCSD Stroke Registry, presenting between 6/2014-7/2016. NECT-MIPs were evaluated for presence of LVO. Gold standard comparison was to CTA. Results were stratified by level of training (Faculty, Fellow and Acute Care Practitioners [ACPs]). Inter-rater agreement was assessed using Fleiss' Kappa Coefficient. RESULTS: We reviewed 24 patients using NECT-MIPs for the detection of LVO. Faculty had a sensitivity and specificity of 95% & 92% for ICA/M1, 42% & 100% for M2, and 67% & 96% for basilar occlusions. Fellows and ACPs had a sensitivity and specificity of 61% & 94% for ICA/M1, 19% & 83% for M2, and 75% & 95% for basilar occlusions. Inter-rater agreement among Faculty readers was k=0.75 for ICA/M1, k=0.79 for M2 and k=0.14 for basilar occlusions. Among Fellows and ACPs, k=0.57 for ICA/M1, k=0.40 for M2, and k=0.27 for basilar occlusions. CONCLUSIONS: NECT-MIPs have high sensitivity and specificity for the detection of LVO when compared to CTA. Inter-rater agreement is fair and higher amongst more experienced reviewers. These results suggest that NECT-MIPs may be helpful to streamline the identification of LVO and reduce door to needle and door to intervention times.

Soft Tissue Osteochondroma in Elbow Joint: A case report.

ABSTRACT: A case of histopathologically verified soft tissue osteochondroma of the elbow joint is presented along with clinical and radiographic findings. The unique feature of this case is that the joint capsule was intact and the tumour was entirely extra-articular. A diagnosis of extraskeletal osteochondroma should be considered when a discrete ossified mass is localized in the soft tissue. Excision and biopsy were performed with complete resolution of the symptoms. KEY WORDS: soft tissue tumour, chondroma, osteochondroma.

Modeling anaerobic digestion of dairy manure using the IWA Anaerobic Digestion Model no. 1 (ADM1).

The Anaerobic Digestion Model No. 1 (ADM1) can be used to describe treatment of dairy manure once manure characteristics have been incorporated in the model. In this paper a parameter set is presented that can be used with ADM1 for simulation of dairy manure digester performance. Model results have been verified with bench-scale experiments and reported data from full-scale systems. Model predictions fit experimental data best for biogas composition and digester effluent COD. Simulated biogas productions were inconsistent with measurements from three different digesters. The model overpredicted acetogenesis, resulting in higher simulated than observed acetate concentrations. However, total volatile acid concentrations were simulated reasonably well. The model consistently predicted higher inorganic nitrogen than measured or reported results, indicating a need for further research in that area. The presented model and associated parameter set can be used to simulate and optimize the performance of full-scale dairy manure digesters.

Bilateral endogenous panophthalmitis caused by Salmonella typhi: first case report.

Metastatic bilateral endogenous panophthalmitis is a rare but devastating ocular infection. A young male presented with high-grade fever of 4 days duration along with rapidly progressive proptosis and loss of vision in both eyes. Systemic examination revealed bronchopneumonia and the blood culture was positive for Salmonella typhi. Ocular examination revealed bilateral panophthalmitis, which was confirmed on ultrasound B scan and MRI of the orbits. The patient was started on intravenous antibiotics and a core vitrectomy was performed in the right eye along with intravitreal antibiotic injection. Bronchopneumonia, proptosis and periorbital edema resolved with systemic antibiotic therapy but the patient developed bilateral phthisis bulbi. This is the first case report of metastatic, bilateral panophthalmitis caused by Salmonella typhi.

D-lactic acidosis 23 years after jejuno-ileal bypass.

Accumulation of D-lactate after gastrointestinal surgery, particularly jejuno-ileal bypass, is an uncommon and often misdiagnosed clinical disturbance. The syndrome may be complicated by dizziness, ataxia, confusion, headache, memory loss, and aggressive behavior. Serum chemistries are often deceptive because the anion gap is frequently normal in spite of severe metabolic acidosis. Moreover, the urine anion gap may be positive, incorrectly suggesting a defect in renal net acid excretion. Indeed, the combination of a normal anion gap metabolic acidosis and positive urine anion gap may erroneously suggest a diagnosis of renal tubular acidosis. Importantly, all reported cases of D-lactic acidosis secondary to bypass surgery have been encountered within 5 to 10 years following the surgery. Here we present an unusual case of D-lactic acidosis (complicated by encephalopathy) presenting 23 years after a jejuno-ileal bypass procedure. The patient was initially diagnosed with a drug intoxication secondary to benzodiazepines. Ultimately, the diagnosis of D-lactate encephalopathy was established after challenging the patient with a carbohydrate load. Thus, administration of 40 kcal/kg over 16 hours reproduced the clinical syndrome and was accompanied by a marked increment in serum and urine D-lactate concentration. The patient had sustained resolution of her symptoms after treatment with oral vancomycin.

Effect of vitamin A deficiency on oxalate uptake by rat intestinal brush border membrane vesicles (BBMV) and its contribution towards urolithiasis.

The intestinal uptake of [14C]oxalate, [14C]glyoxylate, and [14C]glycolate are studied in brush border membrane vesicles (BBMV) isolated from vitamin A-deficient and pair-fed control rats. The data obtained indicate that oxalate and its precursors are transported across the BBMV by passive diffusion. The intestinal uptake of glyoxylate and glycolate remains unaltered in vitamin A deficiency, while uptake rate of oxalate was significantly increased (p less than 0.01) in vitamin A-deficient rats as compared to pair-fed controls. In conclusion, the results indicate that vitamin A deficiency leads to hyperabsorption of oxalate through the gut.

Binary conjugational transfer system of vectors pRK290 and pLAFRI is proficient both ways between Escherichia coli and Rhizobium.

Wide host range vector plasmids pRK290 and pLAFRI carrying genomic fragments of Rhizobium are transferable both ways between R. meliloti and R. leguminosarum cells on the one hand and to E. coli cells on the other, in triparental matings involving E. coli cells carrying pRK2013, the helper for Tra functions to the vector plasmids. The vector plasmids pRK290 and pLAFRI can be employed for recovering clones harbored by R. leguminosarum and R. meliloti by transfer to Rhizobium cells by direct matings of the library with them.

Comparative studies on the effect of vitamin A, B1 and B6 deficiency on oxalate metabolism in male rats.

The study was conducted to investigate the effect of vitamin A, B1 and B6 deficiency on oxalate metabolism in rats. A significant hyperoxaluria was the common observation in all the three vitamin deficiencies (vitamin B6 greater than vitamin A greater than vitamin B1). The activities of hepatic glycolate oxidase and glycolate dehydrogenase were markedly enhanced in vitamin-A- and vitamin-B6-deficient rats. However, lactate dehydrogenase levels remained unaltered in these deficiencies as compared to their respective pair-fed controls. Vitamin B1 deficiency of 4 weeks' duration could augment the activity of glycolate oxidase only, with no alterations in the glycolate dehydrogenase and lactate dehydrogenase levels. Intestinal oxalate uptake studies revealed increased bio-availability of oxalate from the gut in vitamin-A- and vitamin-B6-deficient rats. Thus, the results suggest the relative contribution of both exogenous as well as endogenous oxalate in the process of calculogenesis under various nutritional stress conditions in rat.