Large Complex Odontoma : A report of a rare entity

Odontomas are hamartomatous lesions composed of mature enamel, dentin, and pulp, and may be compound or complex depending on the extent of morphodifferentiation or on their resemblance to normal teeth. They are the most common benign odontogenic tumours, constituting 22% of all odontogenic tumours of the jaw. They are often non-aggressive and slow growing in nature, and are usually diagnosed on routine radiological examinations in the second decade of life. We report the case of an unusually large, painless, complex odontoma, which is a rare entity. It was located in the left posterior mandible and was associated with missing 1st and 2nd left mandibular molars. The diagnosis was confirmed following surgical excision and histopathological analysis of the lesion

Striatal Acetylcholine-Dopamine Imbalance in Parkinson Disease:In Vivo Neuroimaging Study with Dual-Tracer PET and Dopaminergic PET-Informed Correlational Tractography

Previous studies of animal models of Parkinson disease (PD) suggest an imbalance between striatal acetylcholine and dopamine, although other studies have questioned this. To our knowledge, there are no previous in vivo neuroimaging studies examining striatal acetylcholine-dopamine imbalance in PD patients. Using cholinergic and dopaminergic PET (F-18-fluoroethoxybenzovesamicol [F-18-FEOBV] and C-11-dihydrotetrabenazine [C-11-DTBZ], respectively) and correlational tractography, our aim was to investigate the acetylcholine-dopamine interaction at 2 levels of dopaminergic loss in PD subjects: integrity loss of the nigrostriatal dopaminergic white matter tract and loss at the presynaptic-terminal level. Methods: The study involved 45 subjects with mild to moderate PD (36 men, 9 women; mean age, 66.3 +/- 6.3 y, disease duration, 5.8 +/- 3.6 y; Hoehn and Yahr stage, 2.2 +/- 0.6) and 15 control subjects (9 men, 6 women; mean age, 69.1 +/- 8.6 y). PET imaging was performed using standard protocols. We first estimated the integrity of the dopaminergic nigrostriatal white matter tracts in PD subjects by incorporating molecular information from striatal C-11-DTBZ PET into the fiber tracking process using correlational tractography (based on quantitative anisotropy [QA], a measure of tract integrity). Subsequently, we used voxel-based correlation to test the association of the mean QA of the nigrostriatal tract of each cerebral hemisphere with the striatal F-18-FEOBV distribution volume ratio (DVR) in PD subjects. The same analysis was performed for C-11-DTBZ DVR in 12 striatal subregions (presynaptic-terminal level). Results: Unlike C-11-DTBZ DVR in striatal subregions, the mean QA of the nigrostriatal tract of the most affected hemisphere showed a negative correlation with a striatal cluster of F-18-FEOBV DVR in PD subjects (corrected P = 0.039). We also found that the mean F-18-FEOBV DVR within this cluster was higher in the PD group than in the control group (P = 0.01). Cross-validation analyses confirmed these findings. We also found an increase in bradykinesia ratings associated with increased acetylcholine-dopamine imbalance in the most affected hemisphere (r = 0.41, P = 0.006). Conclusion: Our results provide evidence for the existence of striatal acetylcholine-dopamine imbalance in early PD and may provide an avenue for testing in vivo effects of therapeutic strategies aimed at restoring striatal acetylcholine-dopamine balance in PD

Delayed-onset disseminated BCG disease causing a multi-system illness with fatal mycotic aortic aneurysm

CASE: We report a case of disseminated BCG infection, diagnosed two years after BCG infusion for bladder cancer. Our patient, a 74-year-old male, was referred with an 18-month history of fevers, weight loss and intermittent confusion. Prior to referral, the patient had multiple hospital admissions for evaluation of fever of unknown origin, confusion, and fatigue. He was treated for several acute infections, whilst extensive investigations did not identify a focal cause of the persistent fever. During this period two aneurysms, iliac and aortic, were found and stented. Both were presumed mycotic, but no positive microbiology arose from either. He presented again with fever and confusion and was found to have a left sided pleural effusion, which was drained, and broad-spectrum antibiotics started, but his fever and inflammatory markers did not settle. Mycobacterium tuberculosis PCR on a pleural fluid sample returned a positive result, and later cultures from the same fluid grew Mycobacterium species which whole genome sequencing identified as Mycobacterium Bacillus Calmette-Guérin (BCG). Despite a number of adverse events with anti-BCG medications, the patient was established on four medications (rifampicin/isoniazid/ethambutol/levofloxacin) with symptomatic improvement. He re-presented four months later with abdominal pain and was found to have an inoperable leaking thoracic aortic sac from deterioration of his mycotic aneurysm. Following discussion with the patient and his family he was managed palliatively and died two days later. DISCUSSION: The learning points from this case are to consider disseminated BCG in patients presenting with pyrexia of unknown origin following reported intravesical BCG treatment for bladder malignancy in the years prior to presentation. Mycotic aneurysms are a rare but serious complication of disseminated BCG with a high mortality

Modeling He-rich subdwarfs through the hot-flasher Scenario

We present 1D numerical simulations aimed at studying the hot-flasher scenario for the formation of He-rich subdwarf stars. Sequences were calculated for a wide range of metallicities and physical assumptions, such as the stellar mass at the moment of the helium core flash. This allows us to study the two previously proposed flavors of the hot-flasher scenario ("deep" and "shallow" mixing cases) and to identify a third transition type. Our sequences are calculated by solving simultaneously the mixing and burning equations within a diffusive convection picture, and in the context of standard mixing length theory. We are able to follow chemical evolution during deep-mixing events in which hydrogen is burned violently, and therefore able to present a homogeneous set of abundances for different metallicities and varieties of hot-flashers. We extend the scope of our work by analyzing the effects of non-standard assumptions, such as the effect of chemical gradients, extra-mixing at convective boundaries, possible reduction in convective velocities, or the interplay between difussion and mass loss. Particular emphasis is placed on the predicted surface properties of the models. We find that the hot-flasher scenario is a viable explanation for the formation and surface properties of He-sdO stars. Our results also show that, during the early He-core burning stage, element diffusion may produce the transformation of (post hot-flasher) He-rich atmospheres into He-deficient ones. If this is so, then we find that He-sdO stars should be the progenitors of some of the hottest sdB stars.Comment: 13 pages, including 8 figures and 6 tables. Accepted for publication in A&A. Replaced to match the final version, including a note added in proof regarding PG 1544+48

Alterations in the functional neural circuitry supporting flexible choice behavior in autism spectrum disorders

Restricted and repetitive behaviors, and a pronounced preference for behavioral and environmental consistency, are distinctive characteristics of autism spectrum disorder (ASD). Alterations in frontostriatal circuitry that supports flexible behavior might underlie this behavioral impairment. In an functional magnetic resonance imaging study of 17 individuals with ASD, and 23 age-, gender- and IQ-matched typically developing control participants, reversal learning tasks were used to assess behavioral flexibility as participants switched from one learned response choice to a different response choice when task contingencies changed. When choice outcome after reversal was uncertain, the ASD group demonstrated reduced activation in both frontal cortex and ventral striatum, in the absence of task performance differences. When the outcomes of novel responses were certain, there was no difference in brain activation between groups. Reduced activation in frontal cortex and ventral striatum suggest problems in decision-making and response planning, and in processing reinforcement cues, respectively. These processes, and their integration, are essential for flexible behavior. Alterations in these systems may therefore contribute to a rigid adherence to preferred behavioral patterns in individuals with an ASD. These findings provide an additional impetus for the use of reversal learning paradigms as a translational model for treatment development targeting the domain of restricted and repetitive behaviors in ASD

The ubiquitous nature of the Horizontal Branch second U-jump: A link with the Blue Hook scenario?

In a previous paper we reported on a discontinuity in the extreme horizontal branch (EHB) of the Galactic globular cluster NGC6752, which we called the second U-jump. This feature was attributed to a combination of post zero-age horizontal branch evolution and diffusion effects. In this follow-up study we analyze other EHB clusters and show that the second U-jump is a common feature among EHB clusters reaching T_{eff}\ge 23,000K, and that its onset in different clusters converges around T_{eff}\sim 21,000\pm3,000K. We also present near-ultraviolet diagrams of \omega Cen and NGC2808, the only two objects with spectroscopically confirmed ``blue hook'' stars (T_{eff}\ge 35,000K). We confirm predictions of a photometric discontinuity separating late from early-helium flashers. Moreover, we present empirical evidence that the second U-jump population might be mainly composed by early-helium flashers. Lastly, we revisit the discussion on the ubiquitous nature of the gaps and jumps so far identified in the blue HB tails, suggesting a possible discrete nature of the distribution in temperature of the HB stars.Comment: 15 pages, 8 figures. Higher resolution version available via ftp at ftp://ftp.pd.astro.it/pub/momany/momany.tar A&A accepte