Transient hypercortisolism and symptomatic hyperthyroidism associated to primary hyperparathyroidism in an elderly patient: case report and literature review.

Abstract Background: Primary hyperparathyroidism (PHPT) is often found on routine blood tests, at a relatively asymptomatic stage. However many studies suggest different systemic effects related to PHPT, which could be enhanced by an abnormal cortisol release due to chronic stress of hyperparathyroidism. Being PHPT frequently found in the 6th to 7th decade of life, a careful and multifaceted approach should be taken. Case presentation: We report the case of an elderly patient with symptomatic PHPT and incidental pulmonary embolism. He was treated with hydration, zoledronic acid, cinacalcet and high-dose unfractionated heparin. Parathyroid surgery was successfully performed, but patient's conditions suddenly worsened because of a transient thyrotoxicosis, probably induced by a previous exposure to iodine load and/or thyroid surgical manipulation. A short-term treatment with beta-blockers was introduced for symptomatic relief. The patient also presented a transient hypercortisolism with elevated ACTH, likely due to stress related not only to aging and hospitalization but also to PHPT, resolved only four months after parathyroid surgery. Conclusion: Chronic hyperparathyroidism has been linked with increased all-cause mortality. A functional chronic hypercortisolism could be established, enhancing PHPT related disorders. Only parathyroid surgery has been demonstrated to cure PHPT and complications related, showing similar outcome between older and younger patients. However, the management of post-operative period should be more careful in fragile patients. In particular, the early diagnosis and treatment of a transient post-operative thyrotoxicosis could improve recovery. Due to the increase in prevalence and the evidence of many related complications even in asymptomatic PHPT, expert opinion-based guidelines for surgical treatment of PHPT should be developed especially for elderly patients

Estimated Sales and Investment Costs to Produce and Retail Gelato in the Petaluma Area

Recent events in the California dairy have left many dairy producers with high feed costs, low profits, and low (sometimes negative) margins. Some producers have transitioned to producing value-added or artisanal dairy products to help increase the revenues earned from farm milk, particularly in Sonoma County. Because limited research exists on the business opportunities in response to a rapidly growing market for value-added products, this project explores the feasibility of starting a gelato production and retail business in the Petaluma area. To assess business feasibility, a consumer survey was created to estimate the percent of residents and non-residents who would have an interest in purchasing locally-produced gelato, as one component of estimating potential retail sales. The initial investment and operating costs associated with starting a gelato scoop shop in Petaluma were also estimated using secondary data from retail space lessors and equipment suppliers and previous studies of value-added dairy operations. Many survey respondents have interest in purchasing a gelato product; 66% and 64% of residents and non-residents expressed at least a moderate interest, respectively. Based on this interest and their stated frequency of visits to other scoop shops, estimated monthly sales for a retail gelato shop ranged from 6,454 to 21,299 scoops. At an assumed $3.50/scoop based on stated consumer willingness to pay, this could generate estimated annual revenues between$271,068 and $894,558. Based on the estimated sales volumes, the variable cost per unit sold would be$0.20, which would result in a gross margin of $3.30 per unit sold. The estimated annual income over key operating expenses of ingredient costs per batch, packaging and materials, monthly rent, utility, repair and maintenance, and labor expenses could generate between$229,178 and $484,796, depending on the amount of units sold per visit. Thus, a gelato scoop shop could be a feasible and profitable business in the Petaluma area, and further detailed study and development of a business plan appears justified. The values for demand and operating expenses listed in this project are initial estimates and a refined analysis is appropriate as a part of a more comprehensive business plan

Antiangiogenic activity of semisynthetic biotechnological heparins: low-molecular-weight-sulfated Escherichia coli K5 polysaccharide derivatives as fibroblast growth factor antagonists.

OBJECTIVE: Low-molecular-weight heparin (LMWH) exerts antitumor activity in clinical trials. The K5 polysaccharide from Escherichia coli has the same structure as the heparin precursor. Chemical and enzymatic modifications of K5 polysaccharide lead to the production of biotechnological heparin-like compounds. We investigated the fibroblast growth factor-2 (FGF2) antagonist and antiangiogenic activity of a series of LMW N,O-sulfated K5 derivatives. METHODS AND RESULTS: Surface plasmon resonance analysis showed that LMW-K5 derivatives bind FGF2, thus inhibiting its interaction with heparin immobilized to a BIAcore sensor chip. Interaction of FGF2 with tyrosine-kinase receptors (FGFRs), heparan sulfate proteoglycans (HSPGs), and alpha(v)beta3 integrin is required for biological response in endothelial cells. Similar to LMWH, LMW-K5 derivatives abrogate the formation of HSPG/FGF2/FGFR ternary complexes by preventing FGF2-mediated attachment of FGFR1-overexpressing cells to HSPG-bearing cells and inhibit FGF2-mediated endothelial cell proliferation. However, LMW-K5 derivatives, but not LMWH, also inhibit FGF2/alpha(v)beta3 integrin interaction and consequent FGF2-mediated endothelial cell sprouting in vitro and angiogenesis in vivo in the chick embryo chorioallantoic membrane. CONCLUSIONS: LMW N,O-sulfated K5 derivatives affect both HSPG/FGF2/FGFR and FGF2/alpha(v)beta3 interactions and are endowed with FGF2 antagonist and antiangiogenic activity. These compounds may provide the basis for the design of novel LMW heparin-like angiostatic compounds

Lagunitas Brewing Company

The story of Lagunitas Beer is presented, from its start as a hobby for the founder Tony Magee to its current production of over 600,000 barrels per year, making it the 5th largest craft brewer in the US in 2013. To add perspective, a brief history of beer and the emergence of craft beer is included

Predictive Braking on a Nonplanar Road

We present an approach for predictive braking of a four-wheeled vehicle on a nonplanar road. Our main contribution is a methodology to consider friction and road contact safety on general smooth road geometry. We use this to develop an active safety system to preemptively reduce vehicle speed for upcoming road geometry, such as off-camber turns. Our system may be used for human-driven or autonomous vehicles and we demonstrate it with a simulated ADAS scenario. We show that loss of control due to driver error on nonplanar roads can be mitigated by our approach

Reply: "Human Pose Estimation Is Approximate: Limitations and Considerations for its Use in Clinical Trials"

[no abstract available