Quiescent Volcano—Chest Wall Hemangioma

Chest wall hemangiomas are rare tumors that may originate within the soft tissue or from the ribs. Intramuscular hemangioma is infrequent, representing less than 1 % of all hemangiomas, and the localization in the chest wall is even less frequent. They are typically cutaneous in location, large, and poorly circumscribed and can be locally destructive. We present a case of a 34-year-old lady presented with firm lump 3 × 3 cm in left upper and inner quadrant of left breast well defined borders, non-pulsatile and restricted mobility. Sono-mammogram was suggestive of ill-defined lesion at 10 o’clock position. CT chest was conclusive of chest wall hemangioma. The patient underwent excision of the lump. HPE was suggestive of cavernous hemangioma. Cavernous hemangioma typically manifest at birth or before the age of 30 years. CT is more sensitive than plain radiography in detecting phleboliths, which are present in approximately 30 % of cavernous hemangiomas. Surgical excision would be treatment of choice. In this case, the site of the lesion was in the breast clinically mimicking that of a fibroadenoma which warrants hemangioma as a differential diagnosis.     

Myoklonus – eine Orientierungshilfe

The puzzling variety of myoclonus is a diagnostic and therapeutic challenge. Early in the diagnostic work-up of myoclonus, electrophysiologic investigations should clarify whether it is myoclonus or not, and whether there are topographic clues, clinical or electrophysiological, to the generating structure. Such clues would influence both the laboratory strategies or neuroimaging investigations aimed at the underlying disease and the selection of drugs to suppress myoclonus.     

Synkopen

Syncope occurs in approximately 25% of the population at least once during their lifetime. It therefore represents the most frequent differential diagnosis of an epileptic seizure. Depending on the prognosis and therapy, syncopes can be divided in cardiac syncope, syncope due to orthostatic hypotension and reflex syncope, of which vasovagal (neurocardiogenic) syncope is the most frequent type. Vasovagal syncope typically occurs after prolonged standing, the sight of blood, pain and medical procedures. The pathophysiology is not well understood. Genetic factors play a role as well, mainly following a complex mode of inheritance. Syncope can usually be differentiated from an epileptic seizure based on the medical history. Typical vasovagal triggers, a typical prodrome and pallor suggest syncope, whereas cyanosis, tongue biting and a prolonged postictal state favor an epileptic seizure. In cases of doubt or if cardiac syncope is suspected additional diagnostic tests may be necessary. Due to the increased mortality, patients with cardiac syncope need urgent cardiological treatment. The aim of the treatment of vasovagal syncope is to avoid additional events as this type is not associated with increased mortality. This can be achieved by behavioral changes, e.g. avoiding the trigger situation and lying down or tensing of arm and leg musculature during the prodrome to avoid further reduction of blood pressure. There is only sparse evidence for pharmacotherapeutic options. Cardiac pacemakers mostly have no effect. The implantation of a pacemaker seems to be beneficial only in patients over 40 years old with frequent vasovagal syncope, asystole and negative tilt table test.     

Early Impacts of a Healthy Food Distribution Program on the Availability and Price of Fresh Fruits and Vegetables in Small Retail Venues in Los Angeles

Healthy food distribution programs that allow small retailers to purchase fresh fruits and vegetables at wholesale prices may increase the profitability of selling produce. While promising, little is known about how these programs affect the availability of fresh fruits and vegetables in underserved communities. This study examined the impacts of a healthy food distribution program in Los Angeles County over its first year of operation (August 2015–2016). Assessment methods included: (1) a brief survey examining the characteristics, purchasing habits, and attitudes of stores entering the program; (2) longitudinal tracking of sales data examining changes in the volume and variety of fruits and vegetables distributed through the program; and (3) the collection of comparison price data from wholesale market databases and local grocery stores. Seventeen stores participated in the program over the study period. One-fourth of survey respondents reported no recent experience selling produce. Analysis of sales data showed that, on average, the total volume of produce distributed through the program increased by six pounds per week over the study period (95% confidence limit: 4.50, 7.50); trends varied by store and produce type. Produce prices offered through the program approximated those at wholesale markets, and were lower than prices at full-service grocers. Results suggest that healthy food distribution programs may reduce certain supply-side barriers to offering fresh produce in small retail venues. While promising, more work is needed to understand the impacts of such programs on in-store environments and consumer behaviors.     

Analysis of core circadian feedback loop in suprachiasmatic nucleus of mCry1-luc transgenic reporter mouse

The suprachiasmatic nucleus (SCN) coordinates circadian rhythms that adapt the individual to solar time. SCN pacemaking revolves around feedback loops in which expression of Period (Per) and Cryptochrome (Cry) genes is periodically suppressed by their protein products. Specifically, PER/CRY complexes act at E-box sequences in Per and Cry to inhibit their transactivation by CLOCK/BMAL1 heterodimers. To function effectively, these closed intracellular loops need to be synchronized between SCN cells and to the light/dark cycle. For Per expression, this is mediated by neuropeptidergic and glutamatergic extracellular cues acting via cAMP/calcium-responsive elements (CREs) in Per genes. Cry genes, however, carry no CREs, and how CRY-dependent SCN pacemaking is synchronized remains unclear. Furthermore, whereas reporter lines are available to explore Per circadian expression in real time, no Cry equivalent exists. We therefore created a mouse, B6.Cg-Tg(Cry1-luc)01Ld, carrying a transgene (mCry1-luc) consisting of mCry1 elements containing an E-box and E′-box driving firefly luciferase. mCry1-luc organotypic SCN slices exhibited stable circadian bioluminescence rhythms with appropriate phase, period, profile, and spatial organization. In SCN lacking vasoactive intestinal peptide or its receptor, mCry1 expression was damped and desynchronized between cells. Despite the absence of CREs, mCry1-luc expression was nevertheless (indirectly) sensitive to manipulation of cAMP-dependent signaling. In mPer1/2-null SCN, mCry1-luc bioluminescence was arrhythmic and no longer suppressed by elevation of cAMP. Finally, an SCN graft procedure showed that PER-independent as well as PER-dependent mechanisms could sustain circadian expression of mCry1. The mCry1-luc mouse therefore reports circadian mCry1 expression and its interactions with vasoactive intestinal peptide, cAMP, and PER at the heart of the SCN pacemaker.