Chest wall mass as a sign of ignored hepatocellular carcinoma in an alcoholic cirrhotic patient: a case report.

Bone metastasis of hepatocellular carcinoma (HCC) is usually seen in the course of advanced intrahepatic HCC. Isolated bone metastasis as an initial manifestation of HCC is uncommon. Case presentation: The authors report a case of a 68-year-old male with a history of chronic alcohol consumption who presented with epigastric pain, abdominal distension, and a hard, tender lump on the right posterolateral aspect of his back. Investigation revealed HCC with isolated metastasis to the posterior thoracic wall. Clinical discussion: HCC usually develops secondary to chronic hepatitis B and C infection in the background of chronic liver disease. Common presenting symptoms of bone metastasis include local pain, neurological manifestations, palpable subcutaneous masses, and pathological fractures. An immunohistochemistry analysis is important to differentiate HCC from non-HCC metastasis in patients without known underlying HCC. Treatment is often directed towards palliative care as the prognosis is poor. Conclusion: An isolated rib mass can be an initial presentation of metastatic HCC. Thus, HCC with bone metastasis should be considered in the differential diagnosis in patients presenting with painful swelling in the thoracic region.

Braking behavior of major approach turning vehicles at rural two-way stop controlled intersections: A naturalistic driving study.

Objective: Using naturalistic driving data, this study analyzed the driving behavior of major approach right and left turning vehicles to minor approach at rural two-way stop controlled intersections by detecting the location where drivers reacted to the upcoming intersection to complete a turning maneuver.Methods: The study used 449 time series traces from 29 two-way stop controlled intersections across five states for the analysis. All 449 traces were associated to free flow condition with driving not obstructed by the vehicle ahead. Each time series trace was analyzed to check the point drivers first reacted to the intersection for the turning maneuver and this point was called the reaction point. Braking Behavior of Major Approach Turning Vehicles at Rural Two-Way Stop Controlled Intersections: A Naturalistic Driving StudyResults: The results from this study showed that right turning vehicles began reacting, in general, sooner than left turning vehicles. More than 75% of drivers showed a reaction within 300 meters upstream of intersection for both types of turning maneuver. The study found driving speed at the reaction point significantly affecting the initial point of reaction. Drivers who were traveling faster than the posted speed limit were associated with a reaction point farther upstream than vehicles traveling at the speed limit. On-pavement marking upstream of the intersection was found to be associated with longer reaction distance, while posted intersection ahead warning signs showed a reverse effect. The result provides information on braking zone of turning vehicles at intersections which has implication on the placement of different countermeasures upstream at the major approach.Conclusions: By detecting reaction distance of all 449 time series trace, the study provides an influence area of the intersection for the turning vehicles.

Assessing driving behavior upstream of work zones by detecting response points in speed profile: A naturalistic driving study.

Objective: To assess driving behavior when presented with different work zone features such as signs. Driving behavior upstream of a work zone is of interest since this is the point where drivers need to slow or react to upcoming conflicts such as lane closures, congested traffic, or presence of workers and equipment.Methods: Using 299 time series traces from four-lane roadways with both shoulder and lane closure scenario from the naturalistic driving study, this study analyzed driving behavior by detecting response points within the advance warning area from the first sign to the start of work zone. Response point was defined as the point where drivers reduced speed by a certain threshold. A mixed effect logistic model was developed to assess the relationship between driver response and work zone characteristics.Results: Results indicated the first work zone sign a driver encountered in the immediate area upstream of the work zone was not significantly likely to elicit a driver response. The model found lane ends, speed limit, and active changeable message signs (CMS) as statistically significant. Since more than one sign can be legible to the driver at the same time, the effect of overlapping signs was evaluated, but was not found to have significant effect on the driver response. In general, drivers were more likely to show a response to the signs the closer they got to the start of the work zone. Static work zone speed limit and dynamic speed feedback signs were both found to be more likely to elicit a response as compared to normal speed limit signs (non-work zone related). Drivers who were traveling over the posted speed limit were more likely to show response at any given work zone signs with the exception of the first sign. In addition, driver distraction, and driver information like age, gender, experience and other environmental factors were not found to be significant in the model.Conclusions: Overall, drivers were likely to show a response at the lane ends, work zone speed limit signs, and speed feedback signs.

Geochemical and geostatistical appraisal of fluoride contamination: An insight into the Quaternary aquifer.

Fluoride (F-) in groundwater poses a severe public health threat in the Dwarka River Basin (DRB) of West Bengal, India, where many cases of fluorosis have been reported. This research evaluates the spatial distribution patterns of major cations and anions, delineates zones of high F- concentrations within alluvial sediments of the DRB, and identifies both the sources and the geochemical processes responsible for the release of F- to groundwater. A total of 607 groundwater samples were collected from shallow and deep tube wells located within the DRB, encompassing an area of 435 km2 and including 211 villages. Fluoride levels range from 0.01 to 10.6 mg/L, and high concentrations (>1.5 mg/L) are restricted to isolated areas within the basin (occurring within nine of the villages and comprising 4.3% of the samples collected). The high-fluoride areas are characterized by mostly Na-HCO3 type groundwater, where the abundance of cations and anions are Na+ > Ca2+ > Mg2+ > K+ and HCO3- > Cl- > SO42- > F- > NO3- > Br-, respectively. Analyses of the groundwater geochemistry and sediment mineralogy suggest that fluoride is released to groundwater primarily through the hydrolysis of albite and biotite; however, the resulting alkaline conditions are also favorable for release of fluoride from weathered biotite and clay minerals through anion exchange (OH- in groundwater replacing F- within the mineral structure). Multiple linear regression models show that fluoride concentrations can be predicted from the measures of other dissolved constituents with a high degree of accuracy (R2 = 0.96 for high fluoride samples and R2 = 0.8 for low fluoride samples).

Post and during event effect of cell phone talking and texting on driving performance--a driving simulator study.

OBJECTIVE: A number of studies have been done in the field of driver distraction, specifically on the use of cell phone for either conversation or texting while driving. Researchers have focused on the driving performance of drivers when they were actually engaged in the task; that is, during the texting or phone conversation event. However, it is still unknown whether the impact of cell phone usages ceases immediately after the end of task. The primary objective of this article is to analyze the post-event effect of cell phone usage (texting and conversation) in order to verify whether the distracting effect lingers after the actual event has ceased. METHODS: This study utilizes a driving simulator study of 36 participants to test whether a significant decrease in driver performance occurs during cell phone usage and after usage. Surrogate measures used to represent lateral and longitudinal control of the vehicle were standard deviation (SD) of lane position and mean velocity, respectively. RESULTS: RESULTS suggest that there was no significant decrease in driver performance (both lateral and longitudinal control) during and after the cell phone conversation. For the texting event, there were significant decreases in driver performance in both the longitudinal and lateral control of the vehicle during the actual texting task. The diminished longitudinal control ceased immediately after the texting event but the diminished lateral control lingered for an average of 3.38 s. The number of text messages exchanged did not affect the magnitude or duration of the diminished lateral control. CONCLUSION: The result indicates that the distraction and subsequent elevated crash risk of texting while driving linger even after the texting event has ceased. This finding has safety and policy implications in reducing distracted driving.