Asymptomatic Necrotizing Granulomatous Disease of the Neck With Unknown Etiology.

Patients presenting with unilateral neck masses is not an uncommon occurrence in an otolaryngology clinic. Especially those with risk factors such as older age and a history of smoking or drinking along with certain characteristics of the mass including rapid growth, immobility, and the presence of other masses elsewhere in the head and neck that can lead to more concerning etiologies such as cancer. However, in those who are younger with non-tender unilateral mobile masses, the differential is wide. We present the case of a 30-year-old male who presented with a non-tender left-sided neck mass with no associated or systemic symptoms. Workup including labs for HIV, syphilis, and fungal stains was negative. Pathology demonstrated lymphadenitis with necrotizing granulomas with no recurrence of symptoms after excisional biopsy. The patient continued to have no associated symptoms or recurrent mass thus no further workup was deemed necessary. Although unilateral neck mass and lymphadenitis with necrotizing lymphadenitis have a broad differential diagnosis, this patient's etiology continues to be unknown.

Internal Carotid Artery Pseudoaneurysm After Transsphenoidal Pituitary Tumor Resection: A Case Report.

Here, we present a case report on internal carotid artery pseudoaneurysm (ICAP) which highlights a rare but potentially life-threatening complication of transsphenoidal pituitary surgery. A 32-year-old male underwent resection of a pituitary tumor and developed a large cerebrospinal fluid (CSF) leak during surgery, which was reconstructed with a fat graft and nasoseptal flap. Postoperatively, he was recovering well and discharged without complications; however, eight days after surgery he returned with massive epistaxis and hematemesis. This was initially managed with endoscopic exploration, nasal packing, and transfusion of blood products. Imaging revealed a pseudoaneurysm on the right internal carotid artery. The patient was started on aspirin and clopidogrel, and a flow diverter stent was placed without complications. Our case emphasizes the importance of prompt recognition and management of vascular injuries such as an internal carotid pseudoaneurysm after transsphenoidal pituitary surgery to prevent catastrophic outcomes.

Case report of recurrent fibromatosis with laryngeal involvement: Treatment based on network analyses of NGS data.

Aggressive fibromatosis (AF) is a rare, benign neoplasm originating from musculoaponeurotic stromal structures characterized by aggressive growth and infiltration of local tissues. To date, only six previous cases of AF involving the larynx have been reported. The present case was that of a 70-year-old female patient with a 5-year history of hoarseness and an enlarging neck mass consistent with aggressive recurrent fibromatosis. MRI displayed a large, solid mass arising from the left anterior cervical space displacing the trachea and upper airway to the right. At one year after the initial radical resection, the patient presented with recurrence. A second radical excision was performed not including a laryngectomy. Radiation therapy was considered for possible local treatment to prevent subsequent tumor recurrence. According to the literature, AF has recurrence rates of up to 40-70% within 18 months. There is only sparse literature to guide treatment. Using the mutations detected in the patient's AF tissue, an Ingenuity Pathway Analysis (IPA) was used to guide treatment of the recurrence. In the present case, the IPA analysis indicated the use of pazopanib to treat the patient's cancer. In general, surgery appears to be the treatment of choice for head and neck AF, but the management of recurrence is controversial.

Frequency and prevalence of obesity and related comorbidities in West Texas.

The aim of this cross-sectional study was to estimate the frequency and prevalence of obesity and its association with diabetes mellitus, systemic hypertension, hyperlipidemia, coronary artery disease, myocardial infarction, and obstructive sleep apnea in West Texas adults. Data were extracted from 9528 clinic patients: 2287 (24.4%) were normal weight or underweight, and 7057 (75.5%) were overweight or obese (28.9% and 46.6%, respectively). We observed a lower prevalence of any degree of obesity in men compared to women (43.8% vs 48.6%). Diabetes mellitus (odds ratio [OR] = 2.56; 95% confidence interval [CI], 2.30-2.85), hypertension (OR = 2.28; 95% CI, 2.06-2.53), hyperlipidemia (OR = 1.90; 95% CI, 1.71-2.10), and obstructive sleep apnea (OR = 7.18; 95% CI, 5.84-8.83) were associated with obesity. The association of coronary artery disease (OR = 1.17; 95% CI, 1.03-1.33) with obesity was small, and myocardial infarction did not show any association with weight status. The frequency and prevalence of obesity are progressively increasing in West Texas adults and are linked to significant comorbidities, especially in low-income areas. Access to preventive interventions and further investigations are needed to slow the rising prevalence of obesity and its comorbidities.

Characterizing Injuries from Genital Foreign Objects: Analysis from the National Electronic Injury Surveillance System.

INTRODUCTION: Genital foreign body injuries are becoming more common with the growing popularity of genital piercings and devices such as penile rings. We evaluated a nationwide sample of emergency department data to determine trends in demographics, injury locations, disposition and source of injury over time with regard to genital foreign bodies. METHODS: Using NEISS (National Electronic Injury Surveillance System), a representative sample of data collected from hospital emergency department visits associated with consumer product related injuries occurring in the United States, we retrospectively identified cases of genital foreign body injuries in males and females. Means were compared with the independent t-test and proportions with chi-square analysis. RESULTS: We identified 184 genital foreign body injuries in NEISS from 2008 to 2017 consisting of 87 piercing injuries (47.3%) and 97 genital ring injuries (52.7%). The most common body part injured was the penile foreskin (100 cases, 54.3%). Mean age was 35.9 years, and males were more commonly injured than females (127, 69.0% vs 57, 31.0%). Genital foreign body injuries increased over time from 2008 (10, 5.4%) to 2017 (25, 13.6%), and most patients (166, 90.2%) were treated and released from the emergency department. CONCLUSIONS: Although genital foreign body injuries caused by piercings and sex toys are becoming more common, most can be safely managed at the emergency department without hospitalization. Affected patients tend to be younger and male with most injuries occurring on the penile foreskin. More large-scale studies are needed to determine trends according to economic status, education level and location within the United States.

Similar acute physiological responses from effort and duration matched leg press and recumbent cycling tasks.

The present study examined the effects of exercise utilising traditional resistance training (leg press) or 'cardio' exercise (recumbent cycle ergometry) modalities upon acute physiological responses. Nine healthy males underwent a within session randomised crossover design where they completed both the leg press and recumbent cycle ergometer conditions. Conditions were approximately matched for effort and duration (leg press: 4 × 12RM using a 2 s concentric and 3 s eccentric repetition duration controlled with a metronome, thus each set lasted  60 s; recumbent cycle ergometer: 4 × 60 s bouts using a resistance level permitting 80-100 rpm but culminating with being unable to sustain the minimum cadence for the final 5-10 s). Measurements included VO2, respiratory exchange ratio (RER), blood lactate, energy expenditure, muscle swelling, and electromyography. Perceived effort was similar between conditions and thus both were well matched with respect to effort. There were no significant effects by 'condition' in any of the physiological responses examined (all p > 0.05). The present study shows that, when both effort and duration are matched, resistance training (leg press) and 'cardio' exercise (recumbent cycle ergometry) may produce largely similar responses in VO2, RER, blood lactate, energy expenditure, muscle swelling, and electromyography. It therefore seems reasonable to suggest that both may offer a similar stimulus to produce chronic physiological adaptations in outcomes such as cardiorespiratory fitness, strength, and hypertrophy. Future work should look to both replicate the study conducted here with respect to the same, and additional physiological measures, and rigorously test the comparative efficacy of effort and duration matched exercise of differing modalities with respect to chronic improvements in physiological fitness.

Fruit volatile analysis using an electronic nose.

Numerous and diverse physiological changes occur during fruit ripening, including the development of a specific volatile blend that characterizes fruit aroma. Maturity at harvest is one of the key factors influencing the flavor quality of fruits and vegetables. The validation of robust methods that rapidly assess fruit maturity and aroma quality would allow improved management of advanced breeding programs, production practices and postharvest handling. Over the last three decades, much research has been conducted to develop so-called electronic noses, which are devices able to rapidly detect odors and flavors. Currently there are several commercially available electronic noses able to perform volatile analysis, based on different technologies. The electronic nose used in our work (zNose, EST, Newbury Park, CA, USA), consists of ultra-fast gas chromatography coupled with a surface acoustic wave sensor (UFGC-SAW). This technology has already been tested for its ability to monitor quality of various commodities, including detection of deterioration in apple; ripeness and rot evaluation in mango; aroma profiling of thymus species; C(6) volatile compounds in grape berries; characterization of vegetable oil and detection of adulterants in virgin coconut oil. This system can perform the three major steps of aroma analysis: headspace sampling, separation of volatile compounds, and detection. In about one minute, the output, a chromatogram, is produced and, after a purging cycle, the instrument is ready for further analysis. The results obtained with the zNose can be compared to those of other gas-chromatographic systems by calculation of Kovats Indices (KI). Once the instrument has been tuned with an alkane standard solution, the retention times are automatically converted into KIs. However, slight changes in temperature and flow rate are expected to occur over time, causing retention times to drift. Also, depending on the polarity of the column stationary phase, the reproducibility of KI calculations can vary by several index units. A series of programs and graphical interfaces were therefore developed to compare calculated KIs among samples in a semi-automated fashion. These programs reduce the time required for chromatogram analysis of large data sets and minimize the potential for misinterpretation of the data when chromatograms are not perfectly aligned. We present a method for rapid volatile compound analysis in fruit. Sample preparation, data acquisition and handling procedures are also discussed.

Measuring local equilibrium flavor distributions in SDS solution using headspace solid-phase microextraction.

Solid-phase microextraction (SPME) sampling of the headspace above an aqueous micellar solution of sodium dodecyl sulfate (SDS) was shown to be effective for quantifying the equilibrium partitioning of limonene solute between water and SDS micellar aggregates. Concentrations in the headspace were determined from the amount absorbed by the SPME fiber during 1 min extractions, with the quantity on the fiber determined using gas chromatography/mass spectrometry (GC/MS). Headspace concentrations as a function of surfactant concentration were fit to a mass balance to yield the partition coefficient and critical micelle concentration. When the total limonene in the system was low enough that it could be completely dissolved by water in the absence of micelles, a constant value for the partition coefficient of 1700 M(-1) was obtained, independent of the limonene concentration. However, at higher total limonene concentrations, the partition coefficient became a function of the amount of limonene in the micelles, as confirmed by separate experiments in which either limonene or SDS concentration was varied. The observed increase in partition coefficient with increasing limonene likely signals a shift from micelles to swollen micelles and ultimately to microemulsion droplets. The effect of SDS concentration on the aqueous solubility limit of limonene could also be observed in HS-SPME experiments where either SDS or limonene was varied.

Measuring gas-liquid partition coefficients of aroma compounds by solid phase microextraction, sampling either headspace or liquid.

Hydrophobic compounds are important odorants and nutrients in foods and beverages, as well as environmental contaminants and pharmaceuticals. Factors influencing their partitioning within multi-component systems and/or from the bulk liquid phase to the air are critical for understanding aroma quality and nutrient bioavailability. The equilibrium partitioning of hydrophobic analytes between air and water was analyzed using solid phase microextraction (SPME) in the headspace (HS-SPME) and via direct immersion in the liquid (DI-SPME). The compounds studied serve as models for hydrophobic aroma compounds covering a range of air-water partition coefficients that extends over four orders of magnitude. By varying the total amount of analyte as well as the ratio of vapor to liquid in the closed, static system, the partition coefficient, K(vl), can be determined without the need for an external calibration, eliminating many potential systematic errors. K(vl) determination using DI-SPME in this manner has not been demonstrated before. There was good agreement between results determined by DI-SPME and by HS-SPME over the wide range of partitioning behavior studied. This shows that these two methods are capable of providing accurate, complementary measurements. Precision in K(vl) determination depends strongly on K(vl) magnitude and the ratio of the air and liquid phases.

Diffusion of sodium dodecyl sulfate micelles in agarose gels.

The gradient diffusion of ionic sodium dodecyl sulfate micelles in agarose gel was investigated at moderate concentrations above the CMC. Of particular interest were the effects of micelle, gel, and sodium chloride concentration on the micelle diffusivity. Holographic interferometry was used to measure the gradient diffusion coefficient at three sodium chloride concentrations (0, 0.03, 0.10 M), three gel concentrations (0, 1, 2 wt%), and several surfactant concentrations. Time-resolved fluorescence quenching was used to measure aggregation numbers both in solution and gel. The micelle diffusivity increased linearly with surfactant concentration at the two larger sodium chloride concentrations and all gel concentrations. In general, the strength of this effect increased with decreasing sodium chloride concentration and increased with gel concentration. This behavior is evidence of decreasing micelle-micelle electrostatic interactions with increasing sodium chloride concentrations, and increasing excluded volume effects and hydrodynamic screening with increasing gel concentration, respectively. The only exception was at 0.1M sodium chloride and 2 wt% agarose, which showed a slight reduction in the slope compared to 1 wt% agarose. It was found that the concentration effect is quite strong for charged solutes: at a NaCl concentration of 0.03 M in a 2% agarose gel, in a solution with 3% SDS micelles by volume, the micelle diffusion coefficient is doubled relative to its value in the same gel at infinite dilution. The extrapolated, infinite-dilution diffusion coefficients and the rate at which the micelle diffusivity increased with surfactant concentration were compared with predictions of previously published theories in which the micelles are treated as charged, colloidal spheres and the gel as a Brinkman medium. The experimental data and theoretical predictions were in good agreement.

Assignment of an essential role for the Neurospora frequency gene in circadian entrainment to temperature cycles.

Circadian systems include slave oscillators and central pacemakers, and the cores of eukaryotic circadian clocks described to date are composed of transcription and translation feedback loops (TTFLs). In the model system Neurospora, normal circadian rhythmicity requires a TTFL in which a White Collar complex (WCC) activates expression of the frequency (frq) gene, and the FRQ protein feeds back to attenuate that activation. To further test the centrality of this TTFL to the circadian mechanism in Neurospora, we used low-amplitude temperature cycles to compare WT and frq-null strains under conditions in which a banding rhythm was elicited. WT cultures were entrained to these temperature cycles. Unlike those normal strains, however, frq-null mutants did not truly entrain to the same cycles. Their peaks and troughs always occurred in the cold and warm periods, respectively, strongly suggesting that the rhythm in Neurospora lacking frq function simply is driven by the temperature cycles. Previous reports suggested that a FRQ-less oscillator (FLO) could be entrained to temperature cycles, rather than being driven, and speculated that the FLO was the underlying circadian-rhythm generator. These inferences appear to derive from the use of a phase reference point affected by both the changing waveform and the phase of the oscillation. Examination of several other phase markers as well as results of additional experimental tests indicate that the FLO is, at best, a slave oscillator to the TTFL, which underlies circadian rhythm generation in Neurospora.