Sarcoidosis Presenting as an Intraperitoneal Mass

Background: Sarcoidosis is an idiopathic, inflammatory condition primarily encountered within the lungs but very rarely identified in the peritoneum. Case Study: A 34-year-old woman presented with pleural effusion, ascites and an adnexal mass, indicative of ovarian cancer. Results: A biopsy revealed granulomas and lymphocytic infiltrate, consistent with sarcoidosis. The patient’s symptoms were resolved with corticosteroids. However, 2 years later, she developed another pelvic mass and underwent a diagnostic laparoscopy. Final pathology revealed granulomas and endometriosis, consistent with sarcoidosis. Conclusion: Since intraperitoneal sarcoidosis is extremely rare, the differential diagnosis is unlikely to include this condition in the context of presumptive ovarian cancer. However, in patients with a history of sarcoidosis, physicians should maintain a high index of suspicion to effectuate early detection and provide appropriate treatment

A Rare Case of Idiopathic Pyometra in a Premenopausal Patient.

Pyometra is a very uncommon disease principally occurring in postmenopausal women. It is characterized by the accumulation of purulent material within the uterine cavity. This paper presents the clinical history of a 35-year-old premenopausal woman with otherwise normal menstruation who developed heavy menstruation and was diagnosed with a benign pyometra of indeterminate etiology in March 2017. The patient underwent repeated ultrasound-guided drainage, dilation and curettage, and antibiotic therapy. Biopsies of the pelvic sidewall revealed endometriosis in June 2017. The heavy menstruation and suppurative fluid in the uterus of the patient persisted in which intramuscular leuprolide acetate was prescribed to address the endometriosis and heavy menstrual bleeding. Ultimately, the leuprolide acetate effectively resolved the patient\u27s bleeding and pyometra. The medication was concluded after 12 months of supervision and the patient is currently symptom free. Pyometra is an unusual condition rarely identified in premenopausal women. Drainage and antibiotic therapy are routinely employed; however, one may consider gonadotropin-releasing hormone agonist medication to potentially confer a beneficial patient outcome in rare cases where endometriosis and bleeding are intractable

Endometrial Adenocarcinoma with Concomitant Left Atrial Myxoma

Background: Atrial myxomas are the most common primary heart tumors and predominantly considered to be benign lesions. Case Study: We report a case involving a 77-year-old woman who presented with a pelvic mass. She was found to have a primary endometrial cancer and primary lung cancer with concomitant metastatic adrenal gland and mesenteric lesions. Her prior medical history also included an untreated 4.0 × 2.0-cm left atrial myxoma which was identified on CT scan during the workup of her pelvic mass. Results: A clinical decision was made to proceed with surgery for the pelvic mass with a subsequent recommendation for left atrial mass resection. Currently, the patient is scheduled to begin chemotherapy for primary lung cancer. Conclusion: The reported incidence of uterine cancer and a concurrent atrial myxoma is very rare. Consequently, the manner and timing in which treatment should be provided is imprecise. In the present case, the risk for cardiac complications was high, but given the presence of a partial bowel obstruction and the need to diagnose the primary site of her metastatic malignancy, the decision was made to proceed with exploratory abdominal surgery

Reinstated episodic context guides sampling-based decisions for reward.

How does experience inform decisions? In episodic sampling, decisions are guided by a few episodic memories of past choices. This process can yield choice patterns similar to model-free reinforcement learning; however, samples can vary from trial to trial, causing decisions to vary. Here we show that context retrieved during episodic sampling can cause choice behavior to deviate sharply from the predictions of reinforcement learning. Specifically, we show that, when a given memory is sampled, choices (in the present) are influenced by the properties of other decisions made in the same context as the sampled event. This effect is mediated by fMRI measures of context retrieval on each trial, suggesting a mechanism whereby cues trigger retrieval of context, which then triggers retrieval of other decisions from that context. This result establishes a new avenue by which experience can guide choice and, as such, has broad implications for the study of decisions

Metabolic drift in the aging brain.

Brain function is highly dependent upon controlled energy metabolism whose loss heralds cognitive impairments. This is particularly notable in the aged individuals and in age-related neurodegenerative diseases. However, how metabolic homeostasis is disrupted in the aging brain is still poorly understood. Here we performed global, metabolomic and proteomic analyses across different anatomical regions of mouse brain at different stages of its adult lifespan. Interestingly, while severe proteomic imbalance was absent, global-untargeted metabolomics revealed an energymetabolic drift or significant imbalance in core metabolite levels in aged mouse brains. Metabolic imbalance was characterized by compromised cellular energy status (NAD decline, increased AMP/ATP, purine/pyrimidine accumulation) and significantly altered oxidative phosphorylation and nucleotide biosynthesis and degradation. The central energy metabolic drift suggests a failure of the cellular machinery to restore metabostasis (metabolite homeostasis) in the aged brain and therefore an inability to respond properly to external stimuli, likely driving the alterations in signaling activity and thus in neuronal function and communication

Loss of neuronal integrity during progressive HIV-1 infection of humanized mice.

Neuronal damage induced by ongoing human immunodeficiency virus type 1 (HIV-1) infection was investigated in humanized NOD/scid-IL-2Rγ(c)(null) mice transplanted at birth with human CD34-positive hematopoietic stem cells. Mice infected at 5 months of age and followed for up to 15 weeks maintained significant plasma viral loads and showed reduced numbers of CD4(+) T-cells. Prospective serial proton magnetic resonance spectroscopy tests showed selective reductions in cortical N-acetyl aspartate in infected animals. Diffusion tensor imaging revealed structural changes in cortical gray matter. Postmortem immunofluorescence brain tissue examinations for neuronal and glial markers, captured by multispectral imaging microscopy and quantified by morphometric and fluorescence emission, showed regional reduction of neuronal soma and synaptic architectures. This was evidenced by loss of microtubule-associated protein 2, synaptophysin, and neurofilament antigens. This study is the first, to our knowledge, demonstrating lost neuronal integrity after HIV-1 infection in humanized mice. As such, the model permits studies of the relationships between ongoing viral replication and virus-associated neurodegeneration

Re-integerization of fractional charges in the correlated quarter-filled band

Previous work has demonstrated the existence of soliton defect states with charges +/- e/2 in the limits of zero and of infinite on-site Coulomb interactions in the one-dimensional (1D) quarter-filled band. For large but finite on-site Coulomb interaction, the low temperature 2k_F bond distortion that occurs within the 4k_F bond-distorted phase is accompanied by charge-ordering on the sites. We show that a ``re-integerization'' of the defect charge occurs in this bond-charge density wave (BCDW) state due to a ``binding'' of the fractional charges. We indicate briefly possible implications of this result for mechanisms of organic superconductivity.Comment: 4 eps figure

Chemical evolution of the Galactic bulge as traced by microlensed dwarf and subgiant stars. II. Ages, metallicities, detailed elemental abundances, and connections to the Galactic thick disc

The Bulge is the least understood major stellar population of the Milky Way. Most of what we know about the formation and evolution of the Bulge comes from bright giant stars. The underlying assumption that giants represent all the stars, and accurately trace the chemical evolution of a stellar population, is under debate. In particular, recent observations of a few microlensed dwarf stars give a very different picture of the evolution of the Bulge from that given by the giant stars. [ABRIDGED] We perform a detailed elemental abundance analysis of dwarf stars in the Galactic bulge, based on high-resolution spectra that were obtained while the stars were optically magnified during gravitational microlensing events. [ABRIDGED] We present detailed elemental abundances and stellar ages for six new dwarf stars in the Galactic bulge. Combining these with previous events, here re-analysed with the same methods, we study a homogeneous sample of 15 stars, which constitute the largest sample to date of microlensed dwarf stars in the Galactic bulge. We find that the stars span the full range of metallicities from [Fe/H]=-0.72 to +0.54, and an average metallicity of =-0.08+/-0.47, close to the average metallicity based on giant stars in the Bulge. Furthermore, the stars follow well-defined abundance trends, that for [Fe/H]<0 are very similar to those of the local Galactic thick disc. This suggests that the Bulge and the thick disc have had, at least partially, comparable chemical histories. At sub-solar metallicities we find the Bulge dwarf stars to have consistently old ages, while at super-solar metallicities we find a wide range of ages. Using the new age and abundance results from the microlensed dwarf stars we investigate possible formation scenarios for the Bulge.Comment: New version accepted for publication in Astronomy and Astrophysic

'Tough'-constructions and their derivation

This article addresses the syntax of the notorious 'tough' (-movement) construction (TC) in English. TCs exhibit a range of apparently contradictory empirical properties suggesting that their derivation involves the application of both A-movement and A'-movement operations. Given that within previous Principles and Parameters models TCs have remained “unexplained and in principle unexplainable” (Holmberg 2000: 839) due to incompatibility with constraints on theta-assignment, locality, and Case, this article argues that the phase-based implementation of the Minimalist program (Chomsky 2000, 2001, 2004) permits a reanalysis of null wh-operators capable of circumventing the previous theoretical difficulties. Essentially, 'tough'-movement consists of A-moving a constituent out of a “complex” null operator which has already undergone A'-movement, a “smuggling” construction in the terms of Collins (2005a,b