Chondroid Syringoma and Eccrine Spiradenoma

Fine needle aspiration cytology (FNAC) is a well established diagnostic tool. However, most clinicians prefer to diagnose suspected skin tumors by excisional biopsy as they are easily accessible and hence benign skin adnexal tumors are rarely encountered on FNAC. There are only a very few case reports describing the fine needle aspiration cytologic features of chondroid syringoma and eccrine spiradenoma for diagnosis. Cases: First case was a 20 year old female who presented with firm,non-tender swelling in the left little finger measuring 1 cm in diameter. Smears showed clusters of round to plasmacytoid cells with moderate to abundant cytoplasm embedded in a chondromyxoid ground substance . Hence, a diagnosis of chondroid syringoma was made. Another case was a 40 year old lady who presented with a painful swelling on the anterior chest wall measuring approximately 0.8 cms in diameter. Smears were moderately cellular with cohesive sheets and clusters of bland cells of three different cell types. Hence, a probable diagnosis of eccrine spiradenoma was made and both the cases were confirmed histologically. Conclusion: Appropriate knowledge of the cytologic features of chondroid syringoma and eccrine spiradenoma helps in providing a definitive diagnosis and correct management of the patient

Relationship Between Coronary Disease and Subclinical Hypothyroidism: an Angiographic Study

INTRODUCTION: The definition of subclinical hypothyroidism (SH) is an asymptomatic state in which free thyroxine (T4) is normal and thyroid-stimulating hormone (TSH) levels are elevated. Its relationship with coronary disease is not clear and has been the subject of recent interest. Current evidence is conflicting and there is a lack of studies supported by coronary angiography. OBJECTIVE: To assess the relationship between SH and the presence and extent of coronary disease diagnosed by angiography. METHODS: We prospectively studied 354 consecutive patients referred for elective coronary angiography. Those with known thyroid disease, documented coronary disease or previous myocardial infarction were excluded. Fasting blood specimens were collected to measure thyroid hormones, lipid profile, high-sensitivity C-reactive protein, fibrinogen and NT-proBNP. Patients with SH were compared with those without to assess differences in clinical characteristics and biochemical and angiographic results. Significant coronary disease was defined as the presence of at least one lesion with > or = 50% luminal stenosis. Lesions with <50% stenosis were considered minimal. RESULTS: SH was diagnosed in 32 (9%) patients. Mean age was similar between the groups. There were more women (66% vs. 39%; p=0.003) and atrial fibrillation was more frequent (25% vs. 11%; p=0.016) in the group of patients with SH. There were no significant differences in the other baseline clinical parameters, and blood biochemistry results were similar in the two groups, with the exception of higher levels of NT-proBNP in SH patients, although without statistical significance. The angiographic results were as follows: significant coronary disease (SH 28.1% vs. non-SH 43.8%; p=0.087); three-vessel disease (9.4% vs. 9.9%; p=0.919); two-vessel disease (12.5% vs. 13.4%; p=0.892); single-vessel disease (6.3% vs. 29.5%; p=0.051); minimal lesions (9.4% vs. 10.9%; p=0.794); and no coronary disease (62.4% vs, 45.3%; p=0.064). CONCLUSION: In this population SH was not associated with the presence or extent of coronary disease diagnosed by coronary angiography

Rupture of a Congenital Aneurysm of the Non-Coronary Sinus of Valsalva Into the Right Atrium

Apresenta-se o caso de um doente avaliado por sopro cardíaco contínuo, em que o estudo ecocardiográfico permitiu diagnosticar ruptura de aneurisma congénito do seio de Valsalva (SV) para a aurícula direita. Os autores fazem uma breve revisão sobre os aspectos clínicos desta patologia

The Cost of Reducing the North Atlantic Ocean Biological Carbon Pump

To predict the impacts of climate change it is essential to understand how anthropogenic change alters the balance between atmosphere, ocean, and terrestrial reservoirs of carbon. It has been estimated that natural atmospheric concentrations of CO2 are almost 200 ppm lower than they would be without the transport of organic material produced in the surface ocean to depth, an ecosystem service driven by mechanisms collectively referred to as the biological carbon pump. Here we quantify potential reductions in carbon sequestration fluxes in the North Atlantic Ocean through the biological carbon pump over the twenty-first century, using two independent biogeochemical models, driven by low and high IPCC AR5 carbon emission scenarios. The carbon flux at 1000 m (the depth at which it is assumed that carbon is sequestered) in the North Atlantic was estimated to decline between 27 and 43% by the end of the century, depending on the biogeochemical model and the emission scenario considered. In monetary terms, the value of this loss in carbon sequestration service in the North Atlantic was estimated to range between US$170–US$3000 billion in abatement (mitigation) costs and US$23–US$401 billion in social (adaptation) costs, over the twenty-first century. Our results challenge the frequent assumption that coastal habitats store more significant amounts of carbon and are under greater threat. We highlight the largely unrecognized economic importance of the natural, blue carbon sequestration service provided by the open ocean, which is predicted to undergo significant anthropogenic-driven change

An Over-Massive Black Hole in the Compact Lenticular Galaxy NGC1277

All massive galaxies likely have supermassive black holes at their centers, and the masses of the black holes are known to correlate with properties of the host galaxy bulge component. Several explanations have been proposed for the existence of these locally-established empirical relationships; they include the non-causal, statistical process of galaxy-galaxy merging, direct feedback between the black hole and its host galaxy, or galaxy-galaxy merging and the subsequent violent relaxation and dissipation. The empirical scaling relations are thus important for distinguishing between various theoretical models of galaxy evolution, and they further form the basis for all black hole mass measurements at large distances. In particular, observations have shown that the mass of the black hole is typically 0.1% of the stellar bulge mass of the galaxy. The small galaxy NGC4486B currently has the largest published fraction of its mass in a black hole at 11%. Here we report observations of the stellar kinematics of NGC 1277, which is a compact, disky galaxy with a mass of 1.2 x 10^11 Msun. From the data, we determine that the mass of the central black hole is 1.7 x 10^10 Msun, or 59% its bulge mass. Five other compact galaxies have properties similar to NGC 1277 and therefore may also contain over-sized black holes. It is not yet known if these galaxies represent a tail of a distribution, or if disk-dominated galaxies fail to follow the normal black hole mass scaling relations.Comment: 7 pages. 6 figures. Nature. Animation at http://www.mpia.de/~bosch/blackholes.htm

Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: A comprehensive review

Background: Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives: To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples’ preferences, needs, opportunities and barriers to palliative care. Methods: A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly’s hierarchy of evidence-for-practice in qualitative research. Results: Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples’ experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions: The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas

Vascular basement membranes as pathways for the passage of fluid into and out of the brain

In the absence of conventional lymphatics, drainage of interstitial fluid and solutes from the brain parenchyma to cervical lymph nodes is along basement membranes in the walls of cerebral capillaries and tunica media of arteries. Perivascular pathways are also involved in the entry of CSF into the brain by the convective influx/glymphatic system. The objective of this study is to differentiate the cerebral vascular basement membrane pathways by which fluid passes out of the brain from the pathway by which CSF enters the brain. Experiment 1: 0.5 µl of soluble biotinylated or fluorescent Aβ, or 1 µl 15 nm gold nanoparticles was injected into the mouse hippocampus and their distributions determined at 5 min by transmission electron microscopy. Aβ was distributed within the extracellular spaces of the hippocampus and within basement membranes of capillaries and tunica media of arteries. Nanoparticles did not enter capillary basement membranes from the extracellular spaces. Experiment 2: 2 µl of 15 nm nanoparticles were injected into mouse CSF. Within 5min, groups of nanoparticles were present in the pial-glial basement membrane on the outer aspect of cortical arteries between the investing layer of pia mater and the glia limitans. The results of this study and previous research suggest that cerebral vascular basement membranes form the pathways by which fluid passes into and out of the brain but that different basement membrane layers are involved. The significance of these findings for neuroimmunology, Alzheimer's disease, drug delivery to the brain and the concept of the Virchow-Robin space are discussed

Theoretical and practical convergence of a self-adaptive penalty algorithm for constrained global optimization

This paper proposes a self-adaptive penalty function and presents a penalty-based algorithm for solving nonsmooth and nonconvex constrained optimization problems. We prove that the general constrained optimization problem is equivalent to a bound constrained problem in the sense that they have the same global solutions. The global minimizer of the penalty function subject to a set of bound constraints may be obtained by a population-based meta-heuristic. Further, a hybrid self-adaptive penalty firefly algorithm, with a local intensification search, is designed, and its convergence analysis is established. The numerical experiments and a comparison with other penalty-based approaches show the effectiveness of the new self-adaptive penalty algorithm in solving constrained global optimization problems.The authors would like to thank the referees, the Associate Editor and the Editor-in-Chief for their valuable comments and suggestions to improve the paper. This work has been supported by COMPETE: POCI-01-0145-FEDER-007043 and FCT - Funda¸c˜ao para a Ciˆencia e Tecnologia within the projects UID/CEC/00319/2013 and UID/MAT/00013/2013.info:eu-repo/semantics/publishedVersio