Cutaneous angiosarcoma presenting as bilateral periorbital edema

A 66-year-old man presented with chronic bilateral periorbital edema with associated yellowish hue, scattered violaceous smooth macules and contracture of the forehead. He had undergone dental surgery 3 months prior to symptom onset. Laboratory workup for common causes of eyelid edema was unremarkable and MRI of the orbits was unrevealing. The patient did not respond to oral corticosteroids or antibiotics. Punch biopsies were obtained which revealed atypical lymphatic endothelial cells consistent with a diagnosis of cutaneous angiosarcoma.The patient was deemed not to be a surgical candidate and underwent 3 cycles of immunotherapy with limited response. He declined further treatment and transitioned to hospice care. Although cutaneous angiosarcoma uncommonly involves the periorbital region, it should be considered in the differential diagnosis of eyelid edema as early recognition and treatment are critical to prevent rapid intradermal spread and metastases.

Comparison of Temperature Readings, Infrared, Non-Contact Thermometer with Contact Digital Thermometer Readings in Children

BACKGROUND

Body temperature is an important vital sign in clinical practice which can be measured via electronic contact thermometers and infrared non-contact thermometers.

OBJECTIVE

To compare temperature readings taken by non contact infrared thermometer with the conventional digital axillary, rectal and oral temperature readings as well as the influence of environmental temperature on noncontact infrared thermometer readings.

METHODOLOGY

A prospective study carried out in the Paediatric outpatient clinic of the Rivers State University Teaching Hospital, Nigeria from September 2020 to December 2020. Infrared noncontact forehead and jugular temperatures along with contact axillary, oral and rectal temperatures at a recorded atmospheric temperature and pressure were measured. Data collected was analysed.

RESULTS

A total of 247 children aged 1month to 16 years were enrolled, the mean differences of the temperature pairs of contact and non-contact thermometry ranged from 0.45 - 0.77°C (1.64, -1.81°C) 95% LoA. The highest mean difference was found between infrared forehead and axillary [MD; 0.45(1.64,-0.73°C) 95%LoA] temperatures. There was a significant positive correlation between the mean difference of infrared forehead/ rectal temperature and atmospheric temperature (r = 0 .211 p = 0.029). Linear regression model showed that infrared forehead temperature of 37.1°C was equivalent to rectal temperature of 38°C and axillary of 37.4°C which is the standard cut off for fever. Infrared jugular of 37.2°C was equivalent to rectal of 38°C and axillary temperature of 37.4°C was equivalent to infrared jugular of 37.03°C all at a mean atmospheric temperature of 28.3±1.8°C.

CONCLUSION

The mean difference by which infrared noncontact thermometry predicts core temperatures may differ based on atmospheric temperature. Infrared non-contact forehead thermometer reading of 37.1°C could be considered as the fever cut off for non-contact forehead thermometry in Nigeria in regions where the mean atmospheric temperature is 28.3±1.8°C.

Modeling the Effects of Calcium Overload on Mitochondrial Ultrastructural Remodeling

Mitochondrial cristae are dynamic invaginations of the inner membrane and play a key role in its metabolic capacity to produce ATP. Structural alterations caused by either genetic abnormalities or detrimental environmental factors impede mitochondrial metabolic fluxes and lead to a decrease in their ability to meet metabolic energy requirements. While some of the key proteins associated with mitochondrial cristae are known, very little is known about how the inner membrane dynamics are involved in energy metabolism. In this study, we present a computational strategy to understand how cristae are formed using a phase-based separation approach of both the inner membrane space and matrix space, which are explicitly modeled using the Cahn–Hilliard equation. We show that cristae are formed as a consequence of minimizing an energy function associated with phase interactions which are subject to geometric boundary constraints. We then extended the model to explore how the presence of calcium phosphate granules, entities that form in calcium overload conditions, exert a devastating inner membrane remodeling response that reduces the capacity for mitochondria to produce ATP. This modeling approach can be extended to include arbitrary geometrical constraints, the spatial heterogeneity of enzymes, and electrostatic effects to mechanize the impact of ultrastructural changes on energy metabolism.

The very low number of calcium-induced permeability transition pores in the single mitochondrion

Mitochondrial permeability transition (PT) is a phenomenon of stress-induced increase in nonspecific permeability of the mitochondrial inner membrane that leads to disruption of oxidative phosphorylation and cell death. Quantitative measurement of the membrane permeability increase during PT is critically important for understanding the PT's impact on mitochondrial function. The elementary unit of PT is a PT pore (PTP), a single channel presumably formed by either ATP synthase or adenine nucleotide translocator (ANT). It is not known how many channels are open in a single mitochondrion during PT, which makes it difficult to quantitatively estimate the overall degree of membrane permeability. Here, we used wide-field microscopy to record mitochondrial swelling and quantitatively measure rates of single-mitochondrion volume increase during PT-induced high-amplitude swelling. PT was quantified by calculating the rates of water flux responsible for measured volume changes. The total water flux through the mitochondrial membrane of a single mitochondrion during PT was in the range of (2.5 ± 0.4) × 10-17 kg/s for swelling in 2 mM Ca2+ and (1.1 ± 0.2) × 10-17 kg/s for swelling in 200 µM Ca2+. Under these experimental conditions, a single PTP channel with ionic conductance of 1.5 nS could allow passage of water at the rate of 0.65 × 10-17 kg/s. Thus, we estimate the integral ionic conductance of the whole mitochondrion during PT to be 5.9 ± 0.9 nS for 2 mM concentration of Ca2+ and 2.6 ± 0.4 nS for 200 µM of Ca2+. The number of PTPs per mitochondrion ranged from one to nine. Due to the uncertainties in PTP structure and model parameters, PTP count results may be slightly underestimated. However, taking into account that each mitochondrion has ∼15,000 copies of ATP synthases and ANTs, our data imply that PTP activation is a rare event that occurs only in a small subpopulation of these proteins.

Effects of timing of water stress on yield and berry size

Past irrigation research in Marlborough showed that reducing irrigation on grapes by up to 60% would not have any impact on yield, but that the timing of the irrigation might be important for maintenance of yields. A research trial was set up with Sauvignon blanc grapes planted in containers; periods of water stress were applied for three weeks at different times of the growing season. During the three years of the trial the post-flowering (PO-F) period was consistently most sensitive to water stress. At harvest time, the crop yields for the PO-F water-stressed vines were 55%, 72% and 90% of control yields for the three consecutive years, and the bunch weights were 59%, 84% and 95%. Berry weights for the PO-F water-stressed vines were 87%, 96% and 73% of the control values, although the second-year difference was not significant. In two years out of three, there was a trend for PO-F and pre-veraison (PR-V) water-stressed vines to have the lowest berry soluble solids contents ( degrees Brix), indicating a delay in maturity. We suggest that to use irrigation sustainably, it is safe to reduce water applications for most of the season, but that immediately after flowering, any water stress should be avoided. During the period leading up to veraison, some mild water stress can be applied.