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International audience; Introduction: Resistance to thyroid hormone beta (RTHβ) is a rare disease with an autosomal dominant transmission. Diagnosis may be challenging especially in patients with hyper-or hypothyroidism. Case Presentation: A 31-year-old male patient with suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine and free triiodothyronine, along with high thyroid receptor antibodies was diagnosed with Graves' disease. Benzylthiouracil was started. One month later, reduced sensitivity to thyroid hormones was suspected because of persistently high thyroid hormone levels contrasting with high TSH level. Molecular analysis highlighted a 10c.1357C>T p.P453S mutation in the thyroid hormone receptor beta gene (THRB). RTHβ was diagnosed. Several relatives also had RTHβ (the mother, the young son, and 2 out of 3 siblings). Autoimmune hypothyroidism was present in the mother, whereas 2 out of 3 siblings had asymptomatic autoimmunity. Discussion/Conclusion: Both Graves' disease and autoimmune hypothyroidism were described in patients with RTHβ. We show here for the first time that autoimmune hypo-and hyperthyroidism may coexist in kindred with RTHβ. Seven previously published cases of Graves' disease and RTHβ were retrieved and analyzed. Treatments and thyroid hormone level targets are discussed as well as the possible link between RTHβ and autoimmune thyroid diseases.

Compared to traditional composite steel-concrete beams, where the concrete slab is supported by the top flange of a steel profile, in slim floor systems, the beam is integrated into the height of the concrete slab. These configurations are popular due to their cost-effectiveness and fire performance. However, fire design requires advanced calculation models, as Eurocodes do not provide a simplified method for the analysis of these types of beams when exposed to fire. The validation of the numerical models is an important issue for researchers, designers, software developers, and authorities. The European Standard for the fire design of composite steel and concrete structures, EN 1994-1-2, states that advanced calculation models must be validated against experimental test results. The paper presents the validation of a numerical model, for the thermal and mechanical analysis of slim floor beams, using SAFIR software. SAFIR is a special purpose computer program, based on the Finite Element Method, developed for the analysis of structures under elevated temperature conditions. The model is validated against an existing experimental fire test, available in the literature. The temperatures on the cross-section and the vertical beam displacements obtained numerically are reproducing very well the experimental results.

Despite the advanced therapeutic arsenal in Heart Failure (HF), this progressive disease, symptomatic in many clinical aspects and potentially fatal when compared to oncologic diseases, remains a public health issue, involving both the patient, the clinician and also the health system. By the nature of its’ prolonged evolution, HF affects the quality of life more pronounced compared to other chronic diseases [1]...

Introduction Different consequences concerning the cardiac function and structure in patients with renal artery stenosis (RAS) and completely different patterns of activation of the renin-angiotensin-aldosteron system were reported, depending on RAS severity. These changes might have an impact upon the outcomes after renal revascularization. Purpose The study was aimed to analyze the effect of renal stenting upon echocardiographic parameters of cardiac structure and function in the studied population and by comparison between 3 different RAS-profile patients. Methods A total of 78 hypertensive patients diagnosed by renal angiography with significant RAS (>70%) were prospectively enrolled, thus subsequently resulting in 3 groups (34-unilateral RAS, 28-bilateral RAS, 14-RAS in a solitary kidney). Clinical, laboratory and echocardiographic parameters (left ventricular (LV) dimensions, LV mass index (LVMI), relative wall thickness (RWT), type of cardiac geometry, systolic and diastolic function, LV filling pressures) were assessed before renal stenting and 12 months after the procedure. The evolution of renal function was based on the glomerular filtration rate (eGFRCKD-EPI). Blood pressure evolution after revascularization was defined as cured, controlled, improved or stationary. Results Similar baseline characteristics were found for the 3 study groups regarding demographics, cardiovascular risk factors, baseline LV diameters, RWT and LVMI (p>0.05), although higher values of echocardiographic parameters were observed in solitary kidney RAS patients. Only 9.6% of all cases had normal geometry, the majority of the patients presenting concentric hypertrophy (58.9%) of similar proportions in the defined groups. Analyzing variations of echocardiographic parameters before and 12 months after stenting confirmed significant changes in all structural parameters (LV walls dimensions, LVMI, RWT, p0.05). Conclusions The current analysis showed favorable outcomes after renal angioplasty with stent in RAS patients with regard to structural changes of the LV (regression of LVMI, RWT). However, the impact of these beneficial changes did not have the magnitude for producing a significant effect upon cardiac geometry one year after renal revascularization.

The purpose of this paper is to detect any changes in fatty acid and cholesterol content of goat colostrum in the period of 0-72 hours after kidding. For that purpose, samples of colostrum from 16 goats, belonging to local populations in north-eastern Romania where collected. Samples were preserved by freezing and then subjected to chemical analysis. Preparation of solutions for fatty acids analysis was based on the principle of methylation, by combining alkaline methylation (NaOCH3/MeOH) with acid (BF3/MeOH). For cholesterol we used the principle of fat saponification, using potassium hydroxide, followed by filtration and separation of cholesterol with hexane. Detection of cholesterol and fatty acids content was performed by gas chromatography device. Caprinic acid (C10:0), myristic acid (C14:0), palmitic acid (C16: 0), stearic acid (C18:0) and oleic acid (C18:1) quantified more than 75% of the total fatty acids determined 72 hours after birth. Among short-medium-chain fatty acids, capronic acid (C6:0) was found in highest proportion (average concentration of 5.7% of total fatty acids), but at the same time, presented the most obvious oscillation range from 0 to 72 hours (6.56% at birth, 2.45% and 7.59% from 12 hours to 72 hours), with the differences between mean values being significant (p

We hereby present a case report of a patient with an unusual neoplasic and surgical history. M.V. is a 54-year-old patient who had been operated, two years ago, for intestinal obstruction caused by a sigmoid tumor; a segmental rectal and sigmoid resection (Hartmann's procedure) was then performed. Two other surgical procedures were attempted during the last two years, in another surgical department: a colo-rectal anastomosis and a repair of the parastomal hernia, both failed due to postoperative adhesions syndrome. The patient was hospitalized for peristomal gangrene with necrotizing fasciitis. Emergency action was taken to resolve the parietal gangrene. The postoperative local evolution of the wound was favourable and allowed a skin graft for parietal restoration. An intestinal obstruction occurred 2 months later, caused by an extended metachronous tumor of the splenic flexure. The patient underwent other surgeries including the completion of the left hemicolectomy, total gastrectomy, caudal splenopancreatectomy and left adrenalectomy. The patient has a favourable postoperative evolution after 1 year.We noticed a very severe evolution of the peristomal gangrene and the rapid growth towards intestinal obstruction of the metachronous colonic tumor.

To obtain some experimental information on the possibility of observing interesting phenomena in nucleus - nucleus collisions - correlations, flow, etc - the multiplicity distributions of the particles generated in such collisions are analysed using the moments method. The role of the collision geometry is emphasized. Different calculations are compared with experimental results for negative pion yield in nucleus - nucleus collisions at 4.5A GeV/c. The experimental results are obtained at the Syncrophasotron of JINR Dubna.

The gastric plasmacytoma represents a rarely encountered, so that, the diagnosis criteria, the medical attitude and the evolution of this disease are less coded. It is known the fact that this tumours, extramedullary plasmacytomas with gastric localization, develop in soft submucous tissue, therefore it's very difficult or even impossible preoperative diagnosis through an upper endoscopy including biopsy. We present the case of a 54 years old patient, with no significant pathological personal record, that was admitted in our Clinic for having melenic dark stools which have repeated within a 6 months period prior to this hospitalisation. Repeated gastric mucosal samples taken in another medical unit shown normal aspects, contrary to all imaging testing (e.g. ultrasonography, upper endoscopy and barium swallow) which revealed a tumor mass of considerable extent at the level of the gastric corpus. First-line therapy was gastric resection followed by radiotherapy, because it is well known that the tumour is highly radiosensitive. The patient's postoperative course was satisfactory, showing no signs or recurrence 6 months after surgery at upper endoscopy and CT-scan.

Purpose: Erythropoietin currently used as a hemopoietic agent, has remarkable hemostatic activity which can be lifesaving in diffuse, uncontrollable bleeding processes. Following is an example case report: Case presentation: 47 y/o male was admitted with massive GI bleeding and a Hemoglobin (Hg) of 6.7 mg/dl requiring transfusion of 26U Packed Red Blood Cells {PRBC) and 9U of Fresh Frozen Plasma (FFP). The work up revealed a large cell lymphoma infiltrating the mesenteric lymph nodes, the retroperitoneum and the spleen. The small intestine was diffusely infiltrated and bleeding. A portion of the small intestine was resected in an attempt to stop the bleeding; still, the bleeding continued and the Hg could not be raised above 7.8. Erythropoietin 20,000U was administered subcutaneously on day 9 to help correct the anemia. An additional 40,000U were administered on day 14 and 21. Three days after the 2nd dose of Erythropoietin the bowel movement did not appear grossly bloody, the Hg stabilized, and chemotherapy could be administered. After discharge with a follow up of 10 months his Hg stabilized at 12–12.5 mg/dl without any bleeding or transfusion. Discussion: Erythropoietin has been shown to shorten the bleeding time in chronic renal failure patients on hemodialysis by improving the platelet/subendotelial cell interaction and by raising the platelet count. An enhanced platelet aggregation in response to Ristocetin was noted in Erythropoietin treated uremic patients. This effect was correlated with a rise in platelet Serotonin. Erythropoietin also has been found to have a procoagulant effect in uremic patients by decreasing the protein C, protein S, antithrombin III level. These observations offer an explanation for the clinically observed hemostatic effect of Erythropoietin. Conclusion: This and other cases have shown that Erythropoietin is a potent hemostatic factor in anemic patients with diffuse uncontrollable bleeding processes, where large amounts of transfused PRBC can barely keep up with the losses and hemostatic procedures can either not be done or failed. As more experience accumulates Erythropoietin may start a second life as a hemostatic factor. Figure Figure