Metastase axillaire d'un carcinome papillaire de la thyroïde: À propos d'un cas

Les métastases axillaires dans le cadre d'un cancer de la thyroïde sont extrêmement rares. Plusieurs hypothèses expliquent ce drainage. Nousrapportons le cas d'un patient de 78 ans ayant pour antécédents  chirurgicaux une lobo-isthmectomie en 1987, puis une totalisation chirurgicale en 1997 non documentés, admis en septembre 2008 pour exploration d'une masse latéro-cervicale gauche. Le reste de l'examen clinique révèle la présence de multiples adénopathies axillaires bilatérales. La biopsie exérèse d'une adénopathie axillaire droite (côté controlatéral) retrouve une métastase ganglionnaire d'un carcinome papillaire de la thyroïde avec effraction capsulaire. La tomodensitométrie cervico-thoracique note la présence d'un processus tumoral latéro-cervical gauche, un lobe thyroïdien droit siège de multiples nodules hypodenses, des adénopathies cervicales et axillaires et des lésions suspectes au niveau du parenchyme pulmonaire. Une thyroïdectomie totale avec curage  ganglionnaire cervical est décidée, complétée par une ablation des ganglions axillaires macroscopiquement atteints. Des cures d'iode  radioactif (IRA-thérapie) sont indiquées. Bien qu'exceptionnelle, la  présence de métastases axillaires d'un carcinome thyroïdien est de  pronostic péjoratif. On se demande alors si ces patients ne nécessitent pas une prise en charge particulière. Une réflexion à une stratégie  thérapeutique est donc nécessaire

E-Cigarette: Exploring Awareness and Understanding of Students in a State University in the Philippines

Introduction: E-cigarettes (eCigs), battery-powered devices that heat e-liquid to produce an aerosol, are becoming more popular among young people. The popularity of pod-based devices, especially among teenagers and young people, may increase the risk of nicotine addiction and pose respiratory, cardiovascular, and mental health risks despite perceptions of safety.Objectives: This study explores university students\u27 awareness and understanding of e-cigarette smoking, focusing on socio-demographic factors.Methods: A descriptive-correlational approach was used with 389 University students who completed the questionnaire to gather the data needed for this study. Statistical tools, including frequency and percentages, mean, simple correlation, and ANOVA were used to analyze the data. Results: The study reveals that while students generally exhibit a high level of awareness and understanding of e-cigarettes, significant differences emerge in specific areas, such as the physical effects of e-cigarettes, based on smoking status and potential sources of influence. In addition, female students tend to have a higher awareness and understanding of eCigs. Conclusion: There is a need for gender-sensitive and targeted educational interventions that consider individual characteristics and external factors to enhance e-cigarette awareness among students in the university. Universities should also consider leveraging peer education, media campaigns, and family engagement as part of a holistic approach to increase awareness, particularly on the physical effects of e-cigarette use

The Association Between Mobile App Use and Change in Functional Capacity Among Cardiac Rehabilitation Participants: Cohort Study

BackgroundCardiac rehabilitation (CR) is underused in the United States and globally, with participation disparities across gender, socioeconomic status, race, and ethnicities. The pandemic led to greater adoption of telehealth CR and mobile app use.ObjectiveOur primary objective was to estimate the association between CR mobile app use and change in functional capacity from enrollment to completion in patients participating in a CR program that offered in-person, hybrid, and telehealth CR. Our secondary objectives were to study the association between mobile app use and changes in blood pressure (BP) or program completion.MethodsWe conducted a retrospective cohort study of participants enrolled in CR at an urban CR program in the United States. Participants were English speaking, at least 18 years of age, participated in the program between May 22, 2020, and May 21, 2022, and downloaded the CR mobile app. Mobile app use was quantified by number of exercise logs, vitals logs, and education material views. The primary outcome was change in functional capacity, measured by change in 6-minute walk distance (6MWD) from enrollment to completion. The secondary outcome was change in BP from enrollment to completion. We estimated associations using multivariable linear or logistic regression models adjusted for age, sex, race, ethnicity, socioeconomic status by ZIP code, insurance, and primary diagnosis for CR referral.ResultsA total of 107 participants (mean age 62.9, SD 13.02 years; 90/107, 84.1% male; and 57/105, 53.3% self-declared as White Caucasian) used the mobile app and completed the CR program. Participants had a mean 64.0 (SD 54.1) meter increase in 6MWD between enrollment and completion (P<.001). From enrollment to completion, participants with an elevated BP at baseline (≥130/80 mmHg) experienced a significant decrease in BP (systolic BP -11.5 mmHg; P=.002 and diastolic BP -7.7 mmHg; P=.003). We found no significant association between total app interactions and change in 6MWD (coefficient -0.03, 95% CI -0.1 to 0.07; P=.59) or change in BP (systolic coefficient 0.002, 95% CI -0.03 to 0.03; P=.87 and diastolic coefficient -0.005, 95% CI -0.03 to 0.02; P=.65). There was no significant association between total exercise logs and change in 6MWD (coefficient 0.1, 95% CI -0.3 to 0.4; P=.57) or total BP logs and change in BP (systolic coefficient -0.02, 95% CI -0.1 to 0.06; P=.63 and diastolic coefficient -0.02, 95% CI -0.09 to 0.04; P=.50). There was no significant association between total app interactions and completion of CR (adjusted odds ratio 1.00, 95% CI 0.99-1.01; P=.44).ConclusionsCR mobile app use as part of an in-person, hybrid, or telehealth CR program was not associated with greater improvement in functional capacity or BP or with program completion

Insulin-like Stimulatory Effect of Human Immunoglobulin G on Adipocyte Lipogenesis

An investigation into the possible effect of thyroid stimulating immunoglobulin G on lipogenesis by adipocytes led to the discovery that all human IgGs exerted an insulin-like stimulatory effect on lipogenesis by rat adipocytes in vitro. Highly purified polyclonal IgGs prepared from normal subjects had stimulatory potencies similar to those of monoclonal IgGs obtained from patients with IgG myeloma. However, whole sera from myeloma patients with elevated IgG concentrations had a significantly higher stimulatory effect on adipocyte lipogenesis than control sera. These observations provide the first evidence that human IgG has an insulin-like metabolic effect, and that this effect is probably exerted by a nonspecific nonvariable portion of the IgG molecule. IgG may thus contribute to the non-suppressible insulin-like activity in the serum.</jats:p

The Association Between Mobile App Use and Change in Functional Capacity Among Cardiac Rehabilitation Participants: Cohort Study

BackgroundCardiac rehabilitation (CR) is underused in the United States and globally, with participation disparities across gender, socioeconomic status, race, and ethnicities. The pandemic led to greater adoption of telehealth CR and mobile app use. ObjectiveOur primary objective was to estimate the association between CR mobile app use and change in functional capacity from enrollment to completion in patients participating in a CR program that offered in-person, hybrid, and telehealth CR. Our secondary objectives were to study the association between mobile app use and changes in blood pressure (BP) or program completion. MethodsWe conducted a retrospective cohort study of participants enrolled in CR at an urban CR program in the United States. Participants were English speaking, at least 18 years of age, participated in the program between May 22, 2020, and May 21, 2022, and downloaded the CR mobile app. Mobile app use was quantified by number of exercise logs, vitals logs, and education material views. The primary outcome was change in functional capacity, measured by change in 6-minute walk distance (6MWD) from enrollment to completion. The secondary outcome was change in BP from enrollment to completion. We estimated associations using multivariable linear or logistic regression models adjusted for age, sex, race, ethnicity, socioeconomic status by ZIP code, insurance, and primary diagnosis for CR referral. ResultsA total of 107 participants (mean age 62.9, SD 13.02 years; 90/107, 84.1% male; and 57/105, 53.3% self-declared as White Caucasian) used the mobile app and completed the CR program. Participants had a mean 64.0 (SD 54.1) meter increase in 6MWD between enrollment and completion (P<.001). From enrollment to completion, participants with an elevated BP at baseline (≥130/80 mmHg) experienced a significant decrease in BP (systolic BP –11.5 mmHg; P=.002 and diastolic BP –7.7 mmHg; P=.003). We found no significant association between total app interactions and change in 6MWD (coefficient –0.03, 95% CI –0.1 to 0.07; P=.59) or change in BP (systolic coefficient 0.002, 95% CI –0.03 to 0.03; P=.87 and diastolic coefficient –0.005, 95% CI –0.03 to 0.02; P=.65). There was no significant association between total exercise logs and change in 6MWD (coefficient 0.1, 95% CI –0.3 to 0.4; P=.57) or total BP logs and change in BP (systolic coefficient –0.02, 95% CI –0.1 to 0.06; P=.63 and diastolic coefficient –0.02, 95% CI –0.09 to 0.04; P=.50). There was no significant association between total app interactions and completion of CR (adjusted odds ratio 1.00, 95% CI 0.99-1.01; P=.44). ConclusionsCR mobile app use as part of an in-person, hybrid, or telehealth CR program was not associated with greater improvement in functional capacity or BP or with program completion

Analisa Unjuk Kerja Heat Recovery Steam Generator (HRSG) dengan Menggunakan Pendekatan Porous Media di PLTGU - Jawa Timur

Untuk meningkatkan produksi energi listrik maka komponen-komponen utama Pembangkit Listrik Tenaga Gas dan Uap (PLTGU) haruslah beroperasi secara optimal. Salah satu komponen utama dari PLTGU adalah Heat Recovery Steam Generator (HRSG). HRSG memiliki beberapa komponen utama yaitu superheater, evaporator dan economizer yang tersusun atas tube-tube yang memiliki struktur dan jumlah tertentu yang mempengaruhi performa HRSG. Pada penelitian ini dilakukan analisa unjuk kerja HRSG dengan menggunakan pendekatan porous media. Pada penelitian ini dilakukan tiga variasi yaitu variasi satu dengan jumlah tube aktual sesuai dengan real plant HRSG yang terdapat di PLTGU – Jawa Timur dengan jumlah tube 6976 buah. Variasi kedua yaitu dengan menambahkan tube sehingga jumlah tube total menjadi 7116 buah. Variasi ketiga yaitu mengurangi jumlah tube sehingga jumlah tube total menjadi 6836 buah. Jumlah tube ini berpengaruh pada jumlah tube pada setaip komponen di HRSG. Pada variasi I suhu HRSG yang ditunjukkan oleh suhu pada HP superheater II adalah 741 K, sedangkan suhu pada variasi II adalah 745 K dan suhu pada variasi III adalah 741 K. Suhu pada variasi II lebih besar dibandingkan dengan variasi I dan II dikarenakan variasi II memiliki jumlah tube yang lebih banyak sehingga area perpindahan panas yang dimiliki variasi II lebih besar. Kecepatan aliran outlet pada variasi I adalah 3,442 m/s, variasi II 3,463 m/s dan variasi III 3,319 m/s. Variasi II memiliki kecepatan yang lebih besar dibandingkan dengan variasi I dan III dikarenakan luasan bidang yang dilewati semakin kecil seiringnya dengan bertambahnya jumlah tube