Intramuscular recurrence in a Hepatocellular carcinoma patient with indolent disease course

<p>Abstract</p> <p>Background</p> <p>Hepatocellular carcinoma (HCC) is a common malignancy worldwide and treatment options are depended on the stage of the tumour. In general, the prognosis of HCC patients with extra-hepatic metastasis is poor. The most common sites of extra-hepatic metastasis are the lung, abdominal lymph nodes and bone.</p> <p>Case presentation</p> <p>Here, we reported a 54-year-old man with an indolent clinical course of HCC. He had multiple extra-hepatic recurrences after initial hepatectomy for HCC and was benefited from repeated resections with prolonged survival. Eventually, he developed intramuscular recurrence in the thigh, which was initially mistaken as deep vein thrombosis.</p> <p>Conclusion</p> <p>Selected patients with indolent disease course of HCC may benefit from repeated resections of extra-hepatic metastases with prolonged survival.</p

COVID-19 Detection from Chest X-Ray Images Using Deep Convolutional Neural Networks with Weights Imprinting Approach

COVID-19 pandemic has drastically changed our lives. Chest radiographyhas been used to detect COVID-19. However, the numberof publicly available COVID-19 x-ray images is extremely limited,resulting in a highly imbalanced dataset. This is a challenge whenusing deep learning for classification and detection. In this work, wepropose the use of pre-trained deep Convolutional Neural Networks(CNN) and integrate them with a few-shot learning approach namedimprinted weights. The integrated model is fine tuned to enhancethe capability of detecting COVID-19. The proposed solution thencombines the fine-tuned models using a weighted average ensemblefor achieving an optimal 82% sensitivity to COVID-19. To thebest of authors’ knowledge, the proposed solution is one of the firstto utilize imprinted weights model with weighted average ensemblefor enhancing the model sensitivity to COVID-19

A Price Worth Paying: The Case for Controlling Marine Emissions in the Pearl River Delta

The Pearl River Delta (PRD) is a region with a single airshed, but different administrative and legal practices for controlling air quality. Under the Regional Cooperation Plan on Building a Quality Living Area (QLA Plan) released in June 2012 the Governments of Hong Kong, Guangdong and Macau have outlined a strategy to collaborate in reducing emissions from vessels throughout the PRD. This report provides evidence designed to assist policymakers in the region with this objective. It focuses on regulating toxic exhaust emissions from ocean-going vessels (OGVs) -- the most significant contributors of marine emissions. The findings show that marine sources of sulphur dioxide (SO2) emissions currently account for 519 premature deaths per annum in the PRD. These deaths could be reduced by 91% should an Emission Control Area (ECA) mandating the use of fuels with lower sulphur content be introduced. The report also demonstrates that three less comprehensive control measures would also reduce OGV emissions and associated public health impacts by 41-62%. Policymakers are encouraged to introduce these measures as stepping-stones on the way to establishment of an ECA for the PRD

Shorter Granulocyte Telomeres Among Children and Adolescents With Perinatally Acquired Human Immunodeficiency Virus Infection and Chronic Lung Disease in Zimbabwe.

BACKGROUND: Chronic lung disease (CLD) has been reported among African children with perinatally acquired human immunodeficiency virus (HIV) infection (C-PHIV), despite combination antiretroviral therapy (cART). In adults, shorter telomere length (TL) has been reported in association with both CLD and HIV. As little is known in children, our objective was to compare TL in HIV-positive (cART-naive or -treated) and HIV-negative children with and without CLD. METHODS: Participants included Zimbabwean C-PHIV, aged 6-16, who were either newly diagnosed and cART-naive, or on cART for >6 months, and HIV-negative controls of similar age and sex. Packed blood cell (granulocyte) TLs from 621 children were compared cross-sectionally between groups. For a subset of newly diagnosed C-PHIV, changes in TL following cART initiation were evaluated. RESULTS: C-PHIV had shorter granulocyte TL compared with uninfected peers, regardless of cART. Among 255 C-PHIV without CLD, TL was shorter in cART-naive participants. In multivariable analyses adjusted for age, sex, CLD, and HIV/cART status, shorter TL was independently associated with older age, being HIV positive, and having reduced forced vital capacity (FVC). Last, cART initiation increased TL. CONCLUSIONS: In this cohort, C-PHIV and those with reduced FVC have shorter granulocyte TL, possibly the result of increased immune activation and cellular turnover due to longstanding HIV infection with delayed cART initiation

Morbi-mortalidad en la unidad de cuidados intensivos del Hospital Pediátrico Provincial Docente Pepe Portilla

Introducción:  las morbi-mortalidad  son parte de los  indicadores  utilizados en las estadísticas  para los centros asistenciales del Sistema de Salud. La Unidad de Cuidados Intensivos Pediátricos responsable de la atención del niño hasta la edad de 18 años tiene una especial distinción porque incluye los grupos poblacionales de mayor vulnerabilidad a múltiples enfermedades con elevado riesgo de morir. Objetivo:  caracterizar la morbi-mortalidad en niños menores de un año ingresados en esta unidad del Hospital Pediátrico Provincial Docente Pepe Portilla en los años 2011 a 2014.Método: se realizó una investigación observacional, descriptiva y transversal en menores de un año ingresados en la unidad de cuidados intensivos del  Hospital Pediátrico ProvincialDocente  Pepe Portilla  en  los años 2011 a 2014. La muestra la constituyen 412 niños. Se utilizaron como fuente las historias clínicas y el libro de registro  de la UCIP, los datos se procesaron manualmente y se analizaron a través de medidas de frecuencia.Resultados:  los grupos con más ingresos fueron los menores de  tres  meses, las morbilidades más frecuentes fueron las enfermedades diarreicas agudas y la neumonía. El mayor número de casos lo aportó el servicio de  Gastroenterología.  La causa básica de muerte más frecuente fue la bronconeumonía. Conclusiones:  la unidad de cuidados intensivos pediátricos constituye un eslabón más dentro de los cuidados progresivos con un nivel de resolución superior, disminuyendo  la mortalidad, lo cual es el objetivo principal que se traza en dicho servicio y es a través de ello que son establecidas las estrategias de labor para el logro de un trabajo de excelencia que se inicia en las áreas de salud

A Bird Survey of Sungai Kangkawat Research Station, Imbak Canyon Conservation Area, Sabah

A bird survey was conducted at the Sungai Kangkawat Research Station (117°3′34.593″E, 5°4′29.187″N), Imbak Canyon Conservation Area (ICCA), Sabah from 5 th until 8 th October, 2018. The objective of this survey was to produce a preliminary checklist of bird species in the study area. The primary method used was mist-netting with occasional observation from vocal and visual identification. A total of 30 mistnets were deployed for 11 hours (0630-1730 hr.) for four consecutive days with a final accumulation of 1840 net/hours. Overall, 59 species comprising 23 families were recorded throughout the survey. Of these, 114 individuals were netted representing 41 species from 13 families. The most abundant species caught was the Little Spiderhunter Arachnothera longirostra with 26 individuals. Additionally, 18 species from 10 different families were identified via opportunistic sighting and vocalisation. This includes one Critically Endangered (Helmeted Hornbill, Buceros vigil), three Vulnerable (i.e., Rhinoceros Hornbill Buceros rhinoceros, Large-billed Blue Flycatcher Cyornis caerulatus and Blue-headed Pitta Pitta baudii and 20 other Near-threatened species. Four endemic species were recorded namely the Bornean Blue Flycatcher Cyornis superbus, White-crowned Shama Copsychus stricklandi, Black-headed Pitta Pitta ussheri and Blue-headed Pitta Pitta baudii. We expect higher diversity of birds in ICCA because the species accumulation curve did not reach an asymptote until the last day of sampling. This suggests additional trapping effort with point counts along predetermined transects should be considered for future surveys

A Bird Survey of Sungai Kangkawat Research Station, Imbak Canyon Conservation Area, Sabah

A bird survey was conducted at the Sungai Kangkawat Research Station (117°3′34.593″E, 5°4′29.187″N), Imbak Canyon Conservation Area (ICCA), Sabah from 5th until 8th October, 2018. The objective of this survey was to produce a preliminary checklist of bird species in the study area. The primary method used was mist-netting with occasional observation from vocal and visual identification. A total of 30 mist-nets were deployed for 11 hours (0630-1730 hr.) for four consecutive days with a final accumulation of 1840 net/hours. Overall, 59 species comprising 23 families were recorded throughout the survey. Of these, 114 individuals were netted representing 41 species from 13 families. The most abundant species caught was the Little Spiderhunter Arachnothera longirostra with 26 individuals. Additionally, 18 species from 10 different families were identified via opportunistic sighting and vocalisation. This includes one Critically Endangered (Helmeted Hornbill, Buceros vigil), three Vulnerable (i.e., Rhinoceros Hornbill Buceros rhinoceros, Large-billed Blue Flycatcher Cyornis caerulatus and Blue-headed Pitta Pitta baudii and 20 other Near-threatened species. Four endemic species were recorded namely the Bornean Blue Flycatcher Cyornis superbus, White-crowned Shama Copsychus stricklandi, Black-headed Pitta Pitta ussheri and Blue-headed Pitta Pitta baudii. We expect higher diversity of birds in ICCA because the species accumulation curve did not reach an asymptote until the last day of sampling. This suggests additional trapping effort with point counts along predetermined transects should be considered for future surveys

Bird diversity in Imbak Canyon Conservation Area, Sabah, Malaysia

A bird survey was conducted at the Sungai Kangkawat Research Station (117°3′34.593″E, 5°4′29.187″N), Imbak Canyon Conservation Area (ICCA), Sabah from 5th until 8th October, 2018. The objective of this survey was to produce a preliminary checklist of bird species in the study area. The primary method used was mist-netting with occasional observation from vocal and visual identification. A total of 30 mist-nets were deployed for 11 hours (0630-1730 hr.) for four consecutive days with a final accumulation of 1840 net/hours. Overall, 59 species comprising 23 families were recorded throughout the survey. Of these, 114 individuals were netted representing 41 species from 13 families. The most abundant species caught was the Little Spiderhunter Arachnothera longirostra with 26 individuals. Additionally, 18 species from 10 different families were identified via opportunistic sighting and vocalisation. This includes one Critically Endangered (Helmeted Hornbill, Buceros vigil), three Vulnerable (i.e., Rhinoceros Hornbill Buceros rhinoceros, Large-billed Blue Flycatcher Cyornis caerulatus and Blue-headed Pitta Pitta baudii and 20 other Near-threatened species. Four endemic species were recorded namely the Bornean Blue Flycatcher Cyornis superbus, White-crowned Shama Copsychus stricklandi, Black-headed Pitta Pitta ussheri and Blue-headed Pitta Pitta baudii. We expect higher diversity of birds in ICCA because the species accumulation curve did not reach an asymptote until the last day of sampling. This suggests additional trapping effort with point counts along predetermined transects should be considered for future surveys

PPI-Delayed Diagnosis of Gastrinoma: Oncologic Victim of Pharmacologic Success

Functional neuroendocrine tumors are often low-grade malignant neoplasms that can be cured by surgery if detected early, and such detection may in turn be accelerated by the recognition of neuropeptide hypersecretion syndromes. Uniquely, however, relief of peptic symptoms induced by hypergastrinemia is now available from acid-suppressive drugs such as proton-pump inhibitors (PPIs). Here we describe a clinical case in which time to diagnosis from the onset of peptic symptoms was delayed more than 10 years, in part reflecting symptom masking by continuous prescription of the PPI omeprazole. We propose diagnostic criteria for this under-recognized new clinical syndrome, and recommend that physicians routinely measure serum gastrin levels in persistent cases of PPI-dependent dyspepsia unassociated with H. pylori