A rare case of symptomatic bilateral pheochromocytoma

Pheochromocytoma with reported incidence of 2-8 per million, is a rare and special tumor with its own unique clinical and pathological features, originating from the amazingly intelligent neuroendocrine cells of chromaffin cells of the adrenal medulla. It may behave as ‘great masquerader’ and be sweet and predictable as a child, while at times act as a ‘treacherous murderer’ crashing and tearing everything in its path with fierce rage, the main cornerstone of the disease being surgical excision. Here, we report a rare case of middle aged female presenting with hypertensive crisis which necessitates intensive care unit (ICU) management where she responded well to anti-hypertensives and radiological investigations were suggestive of bilateral pheochromocytoma. The course of treatment consisted of array of investigations to ascertain the diagnosis before embarking on bilateral adrenalectomy keeping in mind the consequences of absence of adrenal and subsequent possibility of Nelsons syndrome, which we were able to treat successfully. Here we want to highlight the consideration of bilateral adrenal tumors as a differential diagnosis for suprarenal growths, subsequent surgical course and post-operative medical treatment highlighting the importance of mineralocorticoids and glucocorticoids for day to day functioning

Bifidobacterial Dominance of the Gut in Early Life and Acquisition of Antimicrobial Resistance.

Bifidobacterium species are important commensals capable of dominating the infant gut microbiome, in part by producing acids that suppress growth of other taxa. Bifidobacterium species are less prone to possessing antimicrobial resistance (AMR) genes (ARGs) than other taxa that may colonize infants. Given that AMR is a growing public health crisis and ARGs are present in the gut microbiome of humans from early life, this study examines the correlation between a Bifidobacterium-dominated infant gut microbiome and AMR levels, measured by a culture-independent metagenomic approach both in early life and as infants become toddlers. In general, Bifidobacterium dominance is associated with a significant reduction in AMR in a Bangladeshi cohort, both in the number of acquired AMR genes present and in the abundance of AMR genes. However, by year 2, Bangladeshi infants had no significant differences in AMR related to their early-life Bifidobacterium levels. A generalized linear model including all infants in a previously published Swedish cohort found a significant negative association between log-transformed total AMR and Bifidobacterium levels, thus confirming the relationship between Bifidobacterium levels and AMR. In both cohorts, there was no change between early-life and later-life AMR abundance in high-Bifidobacterium infants but a significant reduction in AMR abundance in low-Bifidobacterium infants. These results support the hypothesis that early Bifidobacterium dominance of the infant gut microbiome may help reduce colonization by taxa containing ARGs.IMPORTANCE Infants are vulnerable to an array of infectious diseases, and as the gut microbiome may serve as a reservoir of AMR for pathogens, reducing the levels of AMR in infants is important to infant health. This study demonstrates that high levels of Bifidobacterium are associated with reduced levels of AMR in early life and suggests that probiotic interventions to increase infant Bifidobacterium levels have the potential to reduce AMR in infants. However, this effect is not sustained at year 2 of age in Bangladeshi infants, underscoring the need for more detailed studies of the biogeography and timing of infant AMR acquisition

In era of gold standard laparoscopic surgery, a study profile of open Nissen’s fundoplication for drug refractory endoscopically diagnosed and manometrically confirmed hiatus hernia in a tertiary care hospital

Hiatus hernia is a condition in which part of the stomach protrudes into the chest cavity through the esophageal hiatus, a hole in the diaphragm. The condition is often asymptomatic but can cause gastroesophageal reflux disease (GERD), dysphagia, chest pain, and other complications in some cases. The diagnosis of hiatus hernia is typically made using imaging tests such as endoscopy or radiography and confirmation done using esophageal motility studies. Management of hiatus hernia depends on the severity and symptoms of the condition. Mild cases may be managed with lifestyle modifications such as weight loss, dietary changes, and avoiding certain trigger foods. Medications such as proton pump inhibitors (PPIs) and histamine receptor antagonists may also be used to control GERD symptoms in maximum number of cases. Surgical intervention will be necessary for more severe cases or cases that do not respond to conservative management. The two main types of surgery for hiatus hernia are conventional/open Nissen fundoplication and laparoscopic fundoplication. These procedures aim to strengthen the lower esophageal sphincter and prevent stomach acid from flowing back into the esophagus. Overall, the management of hiatus hernia requires a multidisciplinary approach involving gastroenterologists, surgeons, and primary care providers. The optimal management will be an individualized approach addressing severity of symptoms and responses to drugs. This study aims to review the drug refractory cases of hiatus hernia in a select group of adult patients not eligible for standard laparoscopic approach diagnosed endoscopically and managed by open Nissen’s fundoplication

Early life exposure to oestrogen and testicular cancer risk: evidence against an aetiological hypothesis

British Journal of Cancer (2002) 86, 1363–1364. DOI: 10.1038/sj/bjc/6600246 www.bjcancer.co

Use of a corrugated beam pipe as a passive deflector for bunch length measurements

We report the experimental demonstration of bunch length measurements using a corrugated metallic beam pipe as a passive deflector. The corrugated beam pipe has been adopted for reducing longitudinal chirping after the bunch compressors in several XFEL facilities worldwide. In the meantime, there have been attempts to measure the electron bunch's longitudinal current profile using the dipole wakefields generated in the corrugated pipe. Nevertheless, the bunch shape reconstructed from the nonlinearly deflected beam suffers from significant distortion, particularly near the head of the bunch. In this paper, we introduce an iterative process to improve the resolution of the bunch shape reconstruction. The ASTRA and ELEGANT simulations have been performed for pencil beam and cigar beam cases, in order to verify the effectiveness of the reconstruction process. To overcome the undesirable effects of transverse beam spreads, a measurement scheme involving both the corrugated beam pipe and the spectrometer magnet has been employed, both of which do not require a dedicated (and likely very expensive) rf system. A proof-of-principle experiment was carried out at Pohang Accelerator Laboratory (PAL) Injector Test Facility (ITF), and its results are discussed together with a comparison with the rf deflector measurement

Perinatal determinants of germ-cell testicular cancer in relation to histological subtypes

We aimed to investigate the role of perinatal determinants on the risk for germ-cell testicular cancer, with respect to the aetiological heterogeneity between seminomas and non-seminomas. A case–control study of 628 case patients with testicular cancer (308 seminomas and 320 non-seminomas) and 2309 individually matched controls was nested within a cohort of boys born from 1920 to 1980 in two Swedish regions (Uppsala-Örebro Health Care Region and Stockholm). Cases were diagnosed from 1958 to 1998 and were identified through the Swedish National Cancer Registry. Perinatal information on cases and controls was collected through charts available at maternity wards. Gestational duration, categorised in three categories (<37, 37–41, >41 weeks), was negatively associated with the risk for testicular cancer (P value for linear trend=0.008). A protective effect of long gestational duration and an increased risk for high birth weight were found for seminomas. Non-seminomas were associated with short gestational duration, particularly among those with low birth order (odds ratio: 3.02, 95% confidence intervals: 1.53–5.97) and high maternal age (odds ratio: 2.33, 95% confidence intervals: 1.19–4.55). No significant differences were found in tests for heterogeneity between the two histological groups. Our data support the hypothesis that intrauterine environment affects the risk for germ-cell testicular cancer. Seminomas and non-seminomas seemed to have similar risk patterns, although they are not entirely congruent

Serum cholesterol and testicular cancer incidence in 45 000 men followed for 25 years

In a 25-year follow-up study of 44 864 men with measured serum cholesterol levels, the testicular cancer hazard ratios for the serum cholesterol categories 5.7–6.9 and ⩾7.0 mmol l−1 vs the reference category (<5.7 mmol l−1) were 1.3 and 4.5, respectively; P-value for trend=0.005. This highly significant association suggests that high-serum cholesterol is a risk factor for testicular cancer

Scale-insensitive estimation of speed and distance traveled from animal tracking data

Speed and distance traveled provide quantifiable links between behavior and energetics, and are among the metrics most routinely estimated from animal tracking data. Researchers typically sum over the straight-line displacements (SLDs) between sampled locations to quantify distance traveled, while speed is estimated by dividing these displacements by time. Problematically, this approach is highly sensitive to the measurement scale, with biases subject to the sampling frequency, the tortuosity of the animal’s movement, and the amount of measurement error. Compounding the issue of scale-sensitivity, SLD estimates do not come equipped with confidence intervals to quantify their uncertainty.https://doi.org/10.1186/s40462-019-0177-

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin burn propagation into surrounding cold fuel, enabling the possibility of high energy gain. While scientific breakeven (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion

Large-scale collaboration reveals landscape-level effects of land-use on turtle demography

Freshwater turtles and tortoises are declining worldwide and currently represent one of the most imperiled major vertebrate groups. Identifying the conditions that promote long-term viable populations is a critical conservation need. However, for most species, there is relatively little or no empirical information about the factors influencing population demographics. Large-scale population monitoring efforts necessary to acquire such information remain rare due to the logistic challenges associated with low and variable detectability, which generally preclude large monitoring initiatives by any single entity. The development of collaborative population monitoring programs represents one potential strategy for overcoming these challenges. Our goal was to leverage partnerships to identify the potential factors and relevant scales affecting wood turtle (Glyptemys insculpta) population demographics. Through a large-scale collaborative multi-institutional monitoring effort, we conducted 983 spring stream surveys at 293 sites across the northeastern United States. Wood turtle abundance was negatively associated with agriculture (300 m and 5500 m) and road traffic (5500 m) and positively associated with mature forest (5500 m). Juvenile proportion displayed strong negative relationships with stream gradient and imperviousness (300 m). Sex ratios were more male-skewed with higher mature forest cover (90 m) and road density (5500 m) and less undeveloped land (300 m). These findings suggest that effective conservation of demographically robust turtle populations will require consideration of multiple spatial scales. Landscape-level conservation may be particularly important for ensuring long-term viable populations. This study highlights the valuable role that collaboration across institutions and jurisdictions can play in the conservation of cryptic taxa