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Due to therapeutic advances and improvements in follow-up care, the diagnosis and treatment of extrahepatic metastases of hepatocellular carcinoma [HCC] have gained clinical significance. However, adrenal gland metastases of HCC remain a rare clinical encounter. Several systemic and local treatment options are discussed in current literature. Adrenalectomy in cases of isolated adrenal metastases with well-controlled intrahepatic lesions has been shown to benefit patients in case series. This 65-year-old patient presented with suspected metachronous left sided adrenal metastasis seven years after bisegmentectomy for HCC and after undergoing trans-arterial chemoembolization [TACE] for multifocal intrahepatic recurrences while being listed for liver transplantation "beyond Milan criteria". Adrenalectomy was suggested for histopathological confirmation of the suspected metastasis and re-consideration for liver transplant. The resection was performed laparoscopically and metastasis of HCC was confirmed in histopathological analysis. Postoperatively, the patient recovered quickly. However, the patient decided against re-listing for liver transplantation. Current literature suggests, that minimally-invasive adrenalectomy should be considered in patients with no more than two extrahepatic lesions, a Child-Pugh-Score of less than A5, low alpha-fetoprotein [AFP] levels <100 ng/ml and size <3 cm. The oncological goal should be to achieve a tumor free extrahepatic situation with a potential oncological benefit. Our patient presented as an ideal candidate for resection of the adrenal gland metastasis and could have been re-assessed postoperatively for liver transplantation. Still, more research is needed to improve patient-selection for metastasectomy in HCC. • Adrenal gland metastases of HCC remain a rare clinical encounter. • Adrenal gland metastases of HCC have gained relevance due to advances in therapy and follow-up care of patients with HCC. • Adrenalectomy of patients with isolated adrenal gland metastases of HCC has shown to benefit patients. • The goal should be to achieve a tumor free extrahepatic situation for potential oncological benefit. [ABSTRACT FROM AUTHOR]

The article discusses studies on diagnostic imaging for breast cancer. A study stressed that excision of lobular neoplasia (LN) is unnecessary if careful radiographic-pathologic correlation is performed and strict histologic criteria are adhered when making the diagnosis. A research highlighted the outcomes among breast imaging-reporting and data system (BI-RADS)-5 lesion patients who were treated in a community practice in the U.S. from 1998 to 2002. Another study evaluated the efficiency of core biopsy for BI-RADS-5 breast lesions.

Partitioning of 14C-2,2',4,4'-TCB (tetrachlorobiphenyl) between sediment, and water and suspended particles was studied in eutrophic and oligotrophic benthic microcosms, respectively. Microcosms consisted of glass aquaria with homogenized clay sediment, circulatedwith natural seawater (60 m, 340/00). Organic enrichment in the eutrophic treatment was obtained by adding a phytoplankton culture of themarine diatom Phaeodactylum tricornutum into the water column; the oligotrophic aquaria received only filtered seawater. 14C-TCB was added to the water using a generator column technique. Phytoplankton and TCB were continuously added during an exposure phase of 8 days, followed by a semi-static phase in which TCB and phytoplankton were left to equilibrate and sediment during one month. Presence of phytoplankton induced a higher concentration of TCB in the water column. Higher concentration of TCB in the water was not caused by higher amounts of TCB bound to algal cells but due to an association of TCB with an increased production of dissolved organic matter and bacteriain the eutrophic treatment. TCB concentration in the sediments was not significantly different between treatments. The observed partitioning of TCB between water and sediment was in accordance with a predicted distribution, based on the equilibrium partitioning model. [ABSTRACT FROM AUTHOR]

Abstract: The origin of adult behavior and the possible pathogenesis of psychiatric disorders remain elusive, but extensive research indicates that interaction of genes and environment play a crucial role for adult phenotype. Differences in susceptibility may arise by earlier experiences and genomic variables, either alone or in combination. The acoustic startle response (ASR) has been shown to be altered in patients with several psychiatric diseases, a change that could result from a persistent sensitization caused by chronic arousal secondary to a traumatic incident. The current work hypothesized that a single aversive procedure would induce long-term hyperactivity in the HPA-axis of rats that had become vulnerable by prenatal stress, and thereby change reactivity in the ASR. Prenatal stress was achieved by maternal gestational exposure to Chronic Mild Stress (CMS). At age 3 months, the offspring were blood sampled by a stressful procedure, and subsequently tested in the acoustic startle paradigm. Prenatal CMS strongly reduced prepulse inhibition (PPI) whereas postnatal blood sampling under restraint generally increased PPI. Our data demonstrate interplay between pre- and postnatal stressful events, but also that this interaction is complex and could influence the interplay between PPI and basal startle. Our results suggest that circumstances dating back to early development may have implications for adult life behavior, and based on this we propose a new theory of a threshold in the induction of a stress response in the ASR test, which influences whether the PPI or basal startle response will be affected. [Copyright &y& Elsevier]

OBJECTIVE: Understanding the attitudes of patients to being treated by residents in the community. METHODS: A questionnaire was administered to patients visiting community family medicine teaching clinics. The study methodology included statements to which they agree or disagree. RESULTS: Three hundred and four questionnaires were completed by patients; 94% had visited a resident in the past year; 78.9% agreed that residents were as skilled as senior doctors, but only 45.4% felt that they were as quick at diagnosis as the senior doctors; 73.0% felt that residents spent more time with them; 40.0% were not pleased by the constant change of the residents attending on them. Analysis by logistic regression showed that men had a more positive attitude to the competence of the residents as well as their professionalism (OR 2.73, 95% CI, 1.45-5.10). Frequent visitors to the clinic had a more negative attitude to the residents' professionalism (OR 0.91 (0.85-0.98)) and were more likely to agree with the statement 'I would prefer to see the regular doctor and not a different resident each time' (OR 1.09 (1.01-1.18)). Those who were attended more by residents on their visits showed a positive attitude to the professionalism of residents (OR 1.14 (1.01-1.28)) and were less likely to agree with the statement 'I would prefer to see the regular doctor and not a different resident each time' (OR 0.90 (0.84-0.98)). CONCLUSIONS: Patients have a positive attitude to being treated by residents in ambulatory clinics, which is associated with repeat exposure to care by residents. PRACTICAL IMPLICATIONS: Departments with ambulatory training should consider having constant presence of residents in their teaching clinics, and teaching staff in the clinics should develop ways to recommend patients to be seen by residents. [ABSTRACT FROM AUTHOR]

Abstract: Electromigration in damascene Cu/low dielectric constant interconnects with overlayers of CoWP, Ta/TaN, SiN x or SiC x N y H z and Cu(Ti) interconnects capped with SiN x was studied. The results showed that the migration fast path in the bamboo-like lines primarily occurred at the interface. Cu lines fabricated with various forms of TaN/Ta liner including PVD TaN, ALD TaN, and PVD body centered cubic α- or tetragonal β-Ta liners were also investigated. Both thin surface layers of CoWP or Ta/TaN and the addition of Ti in the Cu lines significantly reduced the Cu/cap interface diffusivity and remarkably improved the electromigration lifetime when compared with Cu lines capped with SiN x or SiC x N y H z . Activation energies for electromigration were found to be 1.9–2.4eV, 1.4eV, 0.85–1.1eV, and 1.3eV for the bamboo-like Cu lines capped with CoWP, Ta/TaN, and SiN x or SiC x N y H z , and Cu(Ti) bamboo lines capped with SiN x , respectively. The structural phase of the Ta was found to have an insignificant effect on the Cu mass flow rate. A large via size, thicker liner and/or stable connected exposed liner can provide a longer lifetime and tighter lifetime distribution, at the expense of chip density or effective Cu line conductivity. [Copyright &y& Elsevier]