Retropharyngeal Hematoma as an Unusual Presentation of Myelodysplastic Syndrome: A Case Report

Patient: Male, 90

Final Diagnosis: Spontaneous retropharyngeal hematoma

Symptoms: Dysphagia

Medication: —

Clinical Procedure: —

Specialty: Hematology

Sleep debt at the community level: impact of age, sex, race/ethnicity and health

OBJECTIVES

Insufficient sleep has become recognized as a pervasive problem in modern society. Sleep debt is a novel measure of sleep adequacy that may be useful in describing those at risk for inadequate sleep. Our objective was to investigate factors that may be associated with sleep debt at the population level, as well as build upon previous data that showed that minority groups may be more likely to have sleep debt.

DESIGN

A cross-sectional population phone survey included questions regarding amount of sleep required and amount of sleep achieved. Sleep debt was calculated by subtracting sleep achieved from sleep required.

SETTING

This study was designed by the Philadelphia Health Management Corporation and conducted over landlines and cell phones.

PARTICIPANTS

The Random Digit Dialing method was used to randomly choose 8,752 adults older than 18 years from several counties in and around Philadelphia to answer questions about sleep.

MEASUREMENTS

Logistic regression was performed to test associations between sleep debt and various sociodemographic factors in different population subgroups to identify those at risk for sub-optimal sleep duration.

RESULTS

Sleep debt was seen to decrease with age, a novel finding that is in contrast with literature suggesting that older adults have poor sleep. Greater sleep debt was also associated with female gender, Hispanic/Latino ethnicity, <40 years of age, self-reported poor health, and increased stress.

CONCLUSIONS

Although older adults may sleep less as they age, they may also require less sleep to feel rested, resulting in less sleep debt. This and other demographic factors, such as female gender and Hispanic/Latino ethnicity, can be used to identify those at higher risk of inadequate sleep and potentially manage their sleep debt.

Moving Bioethics Toward Its Better Self: a sociologist's perspective

The value and belief questions with which bioethics deals have social, cultural, moral, and societal implications that are not confined to certain spheres of biology and medicine, health and illness, and the delivery of medical care. And yet, throughout its history, the field has continued to be focused on a narrow array of medically associated phenomena to which it has applied a limited set of ethical precepts that originate in Western and American philosophical thought. It has done so in an intellectual atmosphere that has not been characterized by vigorous debate. This paper reflects on these attributes of bioethics, offers some suggestions about how it might expand its topical, ethical, cross-cultural, and international orbit, and invites participants in the field to bring this about through a self-critical process.

Deciphering the surgeons' stories

Twelve narratives written by surgeons on ethical decision-making are analyzed in this commentary. Several major themes in their narratives are discussed: the preponderance of end-of-life issues; the struggle to be inclusively empathetic, even under emotionally alienating circumstances; social justice; and the disagreement among colleagues about how to deal with patients in situations of medical uncertainty. The commentary not only discusses the areas of stress that the surgeons identify in their accounts. It also highlights phenomena and themes that are missing from them, and calls for more work to be done gathering stories from surgeons to explore and explain the "gaps" in this narrative collection.

Fibroblast growth factor 21 and thyroid hormone show mutual regulatory dependency but have independent actions in vivo

Thyroid hormone (TH) regulates fibroblast growth factor 21 (FGF21) levels in the liver and in the adipose tissue. In contrast, peripheral FGF21 administration leads to decreased circulating levels of TH. These data suggest that FGF21 and TH could interact to regulate metabolism. In the present study, we confirmed that TH regulates adipose and hepatic FGF21 expression and serum levels in mice. We next investigated the influence of TH administration on key serum metabolites, gene expression in the liver and brown adipose tissue, and energy expenditure in FGF21 knockout mice. Surprisingly, we did not observe any significant differences in the effects of TH on FGF21 knockout mice compared with those in wild-type animals, indicating that TH acts independently of FGF21 for the specific outcomes studied. Furthermore, exogenous FGF21 administration to hypothyroid mice led to similar changes in serum and liver lipid metabolites and gene expression in both hypothyroid and euthyroid mice. Thus, it appears that FGF21 and TH have similar actions to decrease serum and liver lipids despite having some divergent regulatory effects. Whereas TH leads to up-regulation in the liver and down-regulation in brown adipose tissue of genes involved in the lipid synthesis pathway (eg, fatty acid synthase (FASN) and SPOT14), FGF21 leads to the opposite changes in expression of these genes. In conclusion, TH and FGF21 act independently on the outcomes studied, despite their ability to regulate each other's circulating levels. Thus, TH and FGF21 may modulate the availability of each other in critical metabolic states.

Testosterone influences spatial strategy preferences among adult male rats

Males outperform females on some spatial tasks, and this may be partially due to the effects of sex steroids on spatial strategy preferences. Previous work with rodents indicates that low estradiol levels bias females toward a striatum-dependent response strategy, whereas high estradiol levels bias them toward a hippocampus-dependent place strategy. We tested whether testosterone influenced the strategy preferences in male rats. All subjects were castrated and assigned to one of three daily injection doses of testosterone (0.125, 0.250, or 0.500 mg/rat) or a control group that received daily injections of the drug vehicle. Three different maze protocols were used to determine rats' strategy preferences. A low dose of testosterone (0.125 mg) biased males toward a motor-response strategy on a T-maze task. In a water maze task in which the platform itself could be used intermittently as a visual cue, a low testosterone dose (0.125 mg) caused a significant increase in the use of a cued-response strategy relative to control males. Results from this second experiment also indicated that males receiving a high dose of testosterone (0.500 mg) were biased toward a place strategy. A third experiment indicated that testosterone dose did not have a strong influence on the ability of rats to use a nearby visual cue (floating ball) in the water maze. For this experiment, all groups seemed to use a combination of place and cued-response strategies. Overall, the results indicate that the effects of testosterone on spatial strategy preference are dose dependent and task dependent.

FGF21 regulates PGC-1α and browning of white adipose tissues in adaptive thermogenesis

Certain white adipose tissue (WAT) depots are readily able to convert to a "brown-like" state with prolonged cold exposure or exposure to β-adrenergic compounds. This process is characterized by the appearance of pockets of uncoupling protein 1 (UCP1)-positive, multilocular adipocytes and serves to increase the thermogenic capacity of the organism. We show here that fibroblast growth factor 21 (FGF21) plays a physiologic role in this thermogenic recruitment of WATs. In fact, mice deficient in FGF21 display an impaired ability to adapt to chronic cold exposure, with diminished browning of WAT. Adipose-derived FGF21 acts in an autocrine/paracrine manner to increase expression of UCP1 and other thermogenic genes in fat tissues. FGF21 regulates this process, at least in part, by enhancing adipose tissue PGC-1α protein levels independently of mRNA expression. We conclude that FGF21 acts to activate and expand the thermogenic machinery in vivo to provide a robust defense against hypothermia.

Mentoring new faculty in a department of psychiatry

A formalized mentoring program was developed in response to several problems experienced by new faculty in a department of psychiatry. Goals of the program were to facilitate socialization/orientation to academic psychiatry, facilitate and improve functioning of faculty, and increase retention of new faculty members. A 36-item questionnaire and a program evaluation form were developed to evaluate the effectiveness of the program. Significant differences were found for the overall mean of all pre- vs. postmeasures and the sum of the items related to facilitation of socialization/orientation to academic psychiatry. Mentors and mentees evaluated the program as worthwhile and would recommend it to other faculty members.

Random phase data masks: fabrication tolerances and advantages of four phase level masks

An analysis is presented of the intensity variations in the Fourier transform plane resulting from the use of a bilevel random phase mask for holographic data recording as suggested by Burckhardt. To maintain a fixed ratio of peak intensities between in-phase amplitude components and out-of-phase components for an imperfect phase mask, the permissible error in the phase shift varies as 1/N, where N is the number of apertures in the data mask. A factor of 2(1/2) reduction in the rms intensity fluctuations in both the Fourier transform plane where the hologram is recorded and in the retrieved image may be obtained by using four levels of phase shift. No further improvement is obtained with additional levels.

The problem or oral ulcerations in general practice with special reference to herpetic herpetiform lesions

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