Incidental thyroid papillary carcinoma in a thyroglossal duct cyst – management dilemmas

AbstractINTRODUCTIONBenign thyroglossal duct tract remnants typically thyroglossal duct cysts, (TDCs) are one of the commonest congenital childhood midline neck masses. Clinical presentation of persistent TDCs in adults is uncommon and the occurrence of incidental primary thyroid papillary carcinoma (TPC) in these cysts is rare.PRESENTATION OF CASEWe report the case of a 32-year-old female with an asymptomatic midline neck mass compatible with a TDC that was excised by Sistrunk's procedure. Histopathological examination revealed an incidental primary intraluminal TPC arising from the wall of the TDC.DISCUSSIONManagement dilemmas regarding the roles for total thyroidectomy, regional lymph node dissection, radioactive iodine, and suppressive thyroxine therapy are reviewed in the context of relevant evidence based literature.CONCLUSIONThe occurrence of incidental TPC in a TDC is rare. Though Sistrunk's procedure is adequate treatment for TDC, based on low, moderate, and high risk stratification, recommendations for further management of incidental TPC in TDC is discussed

What can we learn about HIV infection from the dynamics of immune escape?

My work focuses on two important aspects of HIV infection: its ability to mutate and escape immune recognition, and its ability to stay latent and thus evade the effects of antiretroviral drugs. This thesis presents the rules underlying immune escape and reversion of different HIV/SIV strains in MHC-matched and mismatched hosts, and applies these rules to deduce the nature of immune response and the dynamics of latently infected cells, in acute and chronic stages of infection and in different anatomical compartments. In order to explain the large variety of experimental results, I used mathematical modelling, computer simulations and statistical analysis. First I explain the strong dependence of speed of reversion to wild type strain of virus on its content in the infecting inoculum using the underlying dynamics of target cells (cells that can be infected by the virus). Delayed reversion can have an impact on viral load in acute and chronic infection. I then apply the knowledge of the main rules of escape dynamics to the acute SHIV infection in order to deduce the type of immune response that could be causing escape in vivo. The accepted dogma is that viral control is mediated by CD8+ T cell lysis of infected cells. I show that the escape dynamics is inconsistent with the direct killing of infected cells by CD8 T cells, but that it supports the proposition that CD8 T cells suppress cell infection and virus production by cytokine release upon recognition of peptide-MHC complex. From the dynamics of replacement of wild-type virus by escape mutant in resting CD4 T cells and in plasma, I estimate the half-life of latently infected cells in active infection. I find a vast range of half-lives, from less than a day to years. The half-lives were strongly negatively correlated to viral load, implying that latently infected cells tend to reactivate under conditions of high viremia. Using similar ideas of comparing escape rates in plasma and infected cells, I explain the difference in escape kinetics in different tissues by different rates at which infected cells become latent in these tissues. In particular, I show that the apparent delayed escape and later reversion to WT in the gut may be caused by a higher tendency to form latently infected cells in the gut, instead of by less effective immune response in the gut

A study to assess the effectiveness of psychoeducation on knowledge among family members of patient getting lithium therapy at Sneka Mind Care Center, Tirunelveli.

A study to assess the effectiveness of psychoeducation on knowledge among family members of patient getting Lithium therapy at Sneka Mind Care Centre, Thirunelveli, was conducted in partial fulfillment of the requirement for the degree of Master of Science in Nursing, Christian College of Nursing, Neyyoor, which is affiliated to The Tamil Nadu Dr. M.G.R. University, Chennai. OBJECTIVES: 1. To assess the pre test knowledge of family members regarding Lithium therapy. 2. To assess the post test knowledge of family members regarding Lithium therapy. 3. To compare the pre test and post test knowledge of family members regarding Lithium therapy. 4. To determine the relationship between knowledge and selected demographic variables such as age, sex, relationship with client, education, occupation, religion, marital status, habitat of family members regarding Lithium therapy. HYPOTHESES: 1) There will be a significant difference between knowledge of family members regarding Lithium therapy before and after psycho education intervention programme. 2) There will be a significant association between knowledge of family members and selected demographic variables. The study was based on J.W.Kenny’s Open System Model, a quasi experimental one group pre test-post test design was adopted. Convenience sampling technique was used. The data collection was done using semi structured knowledge questionnaire. The data obtained were analyzed in terms of both descriptive and inferential statistics. SIGNIFICANT FINDINGS 1. Regarding the pre test knowledge score of family members all the 30 family members have inadequate knowledge regarding lithium therapy. The mean value for pre test knowledge level is 5.9 and standard deviation is 1.9. 2. Regarding the post test knowledge of family members 3 (10%) had adequate knowledge, 23(76.7%) had moderate knowledge and 4 (13.3%) had inadequate knowledge. The mean value for post test knowledge level is 13.6 and standard deviation is 2.5. 3. The mean improvement of knowledge score was 7.7 ± 2.2 was statistically highly significant. (t= 19.303, df= 29 and p < 0.001). The significant improvement of knowledge shows the effectiveness of psychoeducation. 4. There was no significant association between the knowledge of family members and selected demographic variables

Turbulent Flow Fluid in the Hydrodynamic Plain Bearing to a Non-Textured and Textured Surface

Hydrodynamic bearing are components that provide the guiding in rotation of rotating machines, such as turbines, the reactors. This equipment works under very severe operating conditions: high rotational speed and high radial load. In order to improve the hydrodynamic performance of these rotating machines, the industrialists specialized in the manufacture of hydrodynamic journal bearings, have designed a bearing model with its textured interior surface. The present work is a numerical analysis, carried out to observe the effect of a turbulent fluid flow in a non-textured and textured plain bearing and to thus to see the improvement of the hydrodynamic and tribological performances to a non- textured and textured surface of the plain bearing, under severe operating parameters. The rotational velocity varies from 11,000 to 21,000 rpm and radial load ranging from 2000 N to 9000 N. The numerical analysis is performed by solving the continuity equation of Navier-Stocks, using the finite volume method. The numerical results show that the most important hydrodynamic characteristics such as pressure, flow velocity of the fluid, friction torque, are significant for the textured plain bearing under rotational velocity of 21,000 rpm and radial load 10,000 N compared to obtained for a non-textured plain bearing

Economic impact of zero tillage on wheat cultivation in Ambala (Haryana), India

The present study was conducted with the specific objective i.e. to analyze the economic impact of recourse conservation technology (zero tillage) as compare to conventional tillage practices on wheat cultivation in Ambala district of Haryana. The study revealed that there was significant impact of conservation practices, 22% human labour, 37% machine labour, 25% seed cost and 33% irrigation water was saved under zero tillage compared to conventional tillage (CT) method of wheat production. B: C ratio under zero tillage was 2.86 while underconventional method it was reduced to 2.56. Therefore, zero tillage was economically feasible. It was observed that through the zero tillage farmers can get 3% more yield. The net returns in ZT of wheat production were higher by 4% as compared to CT method. In case of zero tillage, economic efficiency measure was 0.61 as compared to 0.34 in conventional system of wheat cultivation. The research work conducted was holistic in nature combining various elements of technology, resource conservation and economics

A comparative study of the effectiveness of vibration and acoustic emission in diagnosing a defective bearing in a planetry gearbox

Whilst vibration analysis of planetary gearbox faults is relatively well established, the application of Acoustic Emission (AE) to this field is still in its infancy. For planetary-type gearboxes it is more challenging to diagnose bearing faults due to the dynamically changing transmission paths which contribute to masking the vibration signature of interest. The present study is aimed to reduce the effect of background noise whilst extracting the fault feature from AE and vibration signatures. This has been achieved through developing of internal AE sensor for helicopter transmission system. In addition, series of signal processing procedure has been developed to improved detection of incipient damage. Three signal processing techniques including an adaptive filter, spectral kurtosis and envelope analysis, were applied to AE and vibration data acquired from a simplified planetary gearbox test rig with a seeded bearing defect. The results show that AE identified the defect earlier than vibration analysis irrespective of the tortuous transmission pat

The Efficacy of Vortioxetine on Anhedonia in Patients With Major Depressive Disorder

Background: Anhedonia is a common, persistent, and disabling phenomenon in treated adults with Major Depressive Disorder (MDD). Hitherto, relatively few antidepressant agents have been evaluated with respect to their effect on anhedonia in MDD.Methods: This is a post-hoc analysis of a primary study that sought to evaluate the sensitivity to change of the THINC-integrated tool (THINC-it) in MDD (ClinicalTrials.gov Identifier: NCT03053362). Adults meeting DSM-5 criteria for MDD with at least moderate depressive symptom severity [i.e., Montgomery Åsberg Depression Rating Scale (MADRS) total score ≥20] were eligible. Subjects were recruited between October 2017 and August 2018 in Toronto, Ontario at the Brain and Cognition Discovery Foundation. All subjects received open-label vortioxetine (10–20 mg/day, flexibly-dosed) for 8 weeks. Herein, the primary outcome of interest was the change from baseline to endpoint in the Snaith-Hamilton Pleasure Scale (SHAPS) total score, as well as the MADRS anhedonia factor. The mediational effects of improvements in anhedonia on general function and quality of life, as measured by the Sheehan Disability Scale (SDS) and the 5-Item World Health Organization Well-Being Index (WHO-5), were secondarily assessed.Results: A total of 100 subjects with MDD were enrolled in the primary study and began treatment with vortioxetine. Vortioxetine significantly improved anhedonia as evidenced by significant baseline to endpoint improvements in SHAPS and MADRS anhedonia factor scores (p &lt; 0.0001). Improvements in the SHAPS and the MADRS anhedonia factor correlated with improvements in general function (i.e., SDS) and quality of life (i.e., WHO-5) (p &lt; 0.0001). Notably, improvements in anhedonia were found to mediate the association between improvements in overall depressive symptom severity (i.e., MADRS total score) and social functioning (i.e., social life component of the SDS) (p = 0.026).Conclusion: The unmet need in depression is to improve patient functioning and other patient-reported outcomes (e.g., quality of life). Antidepressant interventions capable of attenuating anhedonia as well as cognitive dysfunction in MDD may help in this regard, as improvement in these domains have been associated with improvement in psychosocial function and quality of life

An “Escape Clock” for Estimating the Turnover of SIV DNA in Resting CD4+ T Cells

Persistence of HIV DNA presents a major barrier to the complete control of HIV infection under current therapies. Most studies suggest that cells with latently integrated HIV decay very slowly under therapy. However, it is much more difficult to study the turnover and persistence of HIV DNA during active infection. We have developed an “escape clock” approach for measuring the turnover of HIV DNA in resting CD4+ T cells. This approach studies the replacement of wild-type (WT) SIV DNA present in early infection by CTL escape mutant (EM) strains during later infection. Using a strain-specific real time PCR assay, we quantified the relative amounts of WT and EM strains in plasma SIV RNA and cellular SIV DNA. Thus we can track the formation and turnover of SIV DNA in sorted resting CD4+ T cells. We studied serial plasma and PBMC samples from 20 SIV-infected Mane-A*10 positive pigtail macaques that have a signature Gag CTL escape mutation. In animals with low viral load, WT virus laid down early in infection is extremely stable, and the decay of this WT species is very slow, consistent with findings in subjects on anti-retroviral medications. However, during active, high level infection, most SIV DNA in resting cells was turning over rapidly, suggesting a large pool of short-lived DNA produced by recent infection events. Our results suggest that, in order to reduce the formation of a stable population of SIV DNA, it will be important either to intervene very early or intervene during active replication

Complexity of the Inoculum Determines the Rate of Reversion of SIV Gag CD8 T Cell Mutant Virus and Outcome of Infection

Escape mutant (EM) virus that evades CD8+ T cell recognition is frequently observed following infection with HIV-1 or SIV. This EM virus is often less replicatively “fit” compared to wild-type (WT) virus, as demonstrated by reversion to WT upon transmission of HIV to a naïve host and the association of EM virus with lower viral load in vivo in HIV-1 infection. The rate and timing of reversion is, however, highly variable. We quantified reversion to WT of a series of SIV and SHIV viruses containing minor amounts of WT virus in pigtail macaques using a sensitive PCR assay. Infection with mixes of EM and WT virus containing ≥10% WT virus results in immediate and rapid outgrowth of WT virus at SIV Gag CD8 T cell epitopes within 7 days of infection of pigtail macaques with SHIV or SIV. In contrast, infection with biologically passaged SHIVmn229 viruses with much smaller proportions of WT sequence, or a molecular clone of pure EM SIVmac239, demonstrated a delayed or slow pattern of reversion. WT virus was not detectable until ≥8 days after inoculation and took ≥8 weeks to become the dominant quasispecies. A delayed pattern of reversion was associated with significantly lower viral loads. The diversity of the infecting inoculum determines the timing of reversion to WT virus, which in turn predicts the outcome of infection. The delay in reversion of fitness-reducing CD8 T cell escape mutations in some scenarios suggests opportunities to reduce the pathogenicity of HIV during very early infection