A 33-year-old Man with Abdominal Pain

A 33-year-old man presented to the emergency department ED) with complaint of 2-day history of abdominal pain. His pain developed with gradual onset prominently in epigastric area after eating dried mushrooms. The pain was diffuse, persistent, radiating to the back and aggravated by meal. He had been tolerating only liquids and had complaints of nausea and vomiting. He had no history of diabetes mellitus, hypertension, alcohol consumption, malignancy, or prior surgery. On arrival his blood pressure was 128/72 mmHg, with a heart rate of 101 beats/minute and a respiratory rate of 20 breaths/minute. He was afebrile. Physical examination revealed diffuse abdominal distention, hyper-pitched bowel sounds, and tenderness more marked over the umbilicus with no guarding or rebound tenderness. A complete blood cell count showed the following: leukocyte count 12600 /mm3; segmented neutrophils 90%; hemoglobin level of 14 mg/dl; hematocrit 30%; and platelet 420000/µL. Other laboratory studies included: glucose 101 mg/dL; serum urea nitrogen 45 mg/dL; serum creatinine 2.0 mg/dL; sodium 148 mEq/L; potassium 3.1 mEq/L; serum glutamic oxaloacetic transaminase (SGOT) 38 U/L and lipase 30 U/L. Figure 1 shows patient’s plain upright abdominal X-ray as well as coronal and axial cuts of abdominal CT scan

Thyroid metastasis in a patient with hepatocellular carcinoma: case report and review of literature

<p>Abstract</p> <p>Background</p> <p>Despite the apparent low incidence of cancer metastatic to the thyroid, autopsy and clinical series suggest it is more common than generally. Although lung, renal, and breast cancer are probably the most common primary sites, a number of cancers have been reported to metastasize to the thyroid synchronously with diagnosis of primary tumor or years after apparently curative treatment.</p> <p>Case presentation</p> <p>We report a rare case of a hepatocellular carcinoma metasatic to the thyroid. The patient presented seven months after original diagnosis and treatment with hepatic lobectomy with multiple neck lesions producing a mass effect on the trachea and bilateral lymphadenopathy. Fine-needle aspiration revealed highly anaplastic carcinoma, and immunohistochemistry confirmed hepatocellular carcinoma. The patient received total thyroidectomy as palliative therapy because of the presence of multiple recurrent lesions in the liver.</p> <p>Conclusion</p> <p>Clinicians should consider the possibility of metastatic cancer in each patient who presents with a new thyroid mass, especially those with a history of cancer, however remote. In cases where cytology or histology is not diagnostic, immunohistochemistry may be definitive in making the diagnosis.</p

Proteinlike behavior of a spin system near the transition between ferromagnet and spin glass

A simple spin system is studied as an analog for proteins. We investigate how the introduction of randomness and frustration into the system effects the designability and stability of ground state configurations. We observe that the spin system exhibits protein-like behavior in the vicinity of the transition between ferromagnet and spin glass. Our results illuminate some guiding principles in protein evolution.Comment: 12 pages, 4 figure

Inversion Symmetry and Critical Exponents of Dissipating Waves in the Sandpile Model

Statistics of waves of topplings in the Sandpile model is analysed both analytically and numerically. It is shown that the probability distribution of dissipating waves of topplings that touch the boundary of the system obeys power-law with critical exponent 5/8. This exponent is not indeendent and is related to the well-known exponent of the probability distribution of last waves of topplings by exact inversion symmetry s -> 1/s.Comment: 5 REVTeX pages, 6 figure

Areca Users in Combination with Tobacco and Alcohol Use Are Associated with Younger Age of Diagnosed Esophageal Cancer in Taiwanese Men

BACKGROUND: Whether the habitual use of substances (tobacco, alcohol, or areca nut (seed of the Areca palm)) can affect the age of esophageal squamous cell carcinoma (ESCC) presentation has rarely been examined. METHODS: The study subjects were those who were males and the first time to be diagnosed as ESCC (ICD-9 150) and who visited any of three medical centers in Taiwan between 2000 and 2009. A standardized questionnaire was used to collect substance uses and other variables. RESULTS: Mean age (±SD) at presentation of ESCC was 59.2 (±11.3) years in a total of 668 cases. After adjusting for other covariates, alcohol drinkers were 3.58 years younger to have ESCC than non-drinkers (p = 0.002). A similar result was found among areca chewers, who were 6.34 years younger to have ESCC than non-chewers (p<0.0001), but not among cigarette smokers (p = 0.10). When compared to the group using 0-1 substances, subjects using both cigarettes and alcohol were nearly 3 years younger to contract ESCC. Furthermore, those who use areca plus another substance were 7-8 years younger. Subjects using all three substances had the greatest age difference, 9.20 years younger (p<0.0001), compared to the comparison group. CONCLUSION: Our findings suggest that habitually consuming tobacco, alcohol, and areca nut can influence the age-onset of ESCC. Since the development of ESCC is insidious and life-threatening, our observation is worthy to be reconfirmed in the large-scale and long-term follow-up prospective cohort studies to recommend the screening strategy of this disease

Molecular cloning and functional analysis of a necrosis and ethylene inducing protein (NEP) from Ganoderma boninense

Fungal necrosis and ethylene inducing proteins (NEPs) induce cell death and elicit strong immune responses in many crops. In this study, we report the cloning and characterization of a transcript encoding NEP from Ganoderma boninense which belongs to a family of fungi in Ganodermataceae that cause serious infections of cacao, rubber, tea, coffee and palms. The open reading frame (ORF) encoding NEP inG. boninense(GbNEP) was cloned by 5′and 3’rapid amplification of cDNA ends (RACE) PCR. The transcript abundance of GbNEP increased in fungal culture treated with salicylic acid and jasmonic acid, respectively. The soluble recombinant Gb EP expressed in Escherichia coli BL21(DE3) pLysS was able to induce necrosis in tobacco and tomato but ineffective when applied to oil palm leaves and root tissues. The recombinant GbNEP could induce localized cell death, and production of hydrogen peroxide and superoxide in tobacco leaves. The addition of LaCl3(a calcium channel inhibitor) and EGTA (a Ca2+chelator) to tobacco leaves prior to the challenge with GbNEP significantly reduced the necrosis symptoms indicating that Ca2+is required for the action of GbNEP. In summary, this is the first report of NEP from Ganoderma species which may contribute to further research on the role of GbNEP during disease development

Renormalization group approach to an Abelian sandpile model on planar lattices

One important step in the renormalization group (RG) approach to a lattice sandpile model is the exact enumeration of all possible toppling processes of sandpile dynamics inside a cell for RG transformations. Here we propose a computer algorithm to carry out such exact enumeration for cells of planar lattices in RG approach to Bak-Tang-Wiesenfeld sandpile model [Phys. Rev. Lett. {\bf 59}, 381 (1987)] and consider both the reduced-high RG equations proposed by Pietronero, Vespignani, and Zapperi (PVZ) [Phys. Rev. Lett. {\bf 72}, 1690 (1994)] and the real-height RG equations proposed by Ivashkevich [Phys. Rev. Lett. {\bf 76}, 3368 (1996)]. Using this algorithm we are able to carry out RG transformations more quickly with large cell size, e.g. $3 \times 3$ cell for the square (sq) lattice in PVZ RG equations, which is the largest cell size at the present, and find some mistakes in a previous paper [Phys. Rev. E {\bf 51}, 1711 (1995)]. For sq and plane triangular (pt) lattices, we obtain the only attractive fixed point for each lattice and calculate the avalanche exponent $\tau$ and the dynamical exponent $z$. Our results suggest that the increase of the cell size in the PVZ RG transformation does not lead to more accurate results. The implication of such result is discussed.Comment: 29 pages, 6 figure