The present study explored the effects of thyroid hormone (TH) treatment on post-ischemic cardiac function and potential implicated mechanisms. Acute myocardial infarction (AMI) was induced in mice by coronary artery ligation while sham-operated animals served as controls. This procedure resulted in a marked depression of cardiac function and significant reduction in TH levels in plasma. TH was given at a dose aiming to normalize T3 levels in plasma [AMI-TH (A)] and also at higher doses. The group of animals treated with the highest dose of TH, which displayed significantly increased mortality rate was included in the study [AMI-TH (B)]. In AMI-TH (A) mice, TH significantly improved left ventricular (LV) ejection fraction (EF%), [27.9% (1.4) in AMI versus 38.0 (3.1) in AMI-TH (A), P < 0.05], and favorably remodeled LV chamber while α-MHC was the dominant isoform expressed. In AMI-TH (B) mice, TH treatment resulted in increased mortality as compared to untreated mice (73% vs 47%, P < 0.05), while the favorable effect of TH was not evident in the survived animals. At the molecular level, TH, at the replacement dose, modestly increased p-Akt levels in the myocardium without any change in p-ERK levels. On the contrary, TH at the higher dose resulted in further increase in p-Akt along with an increase in p-ERK levels. In conclusion, TH appears to have a dose-dependent bimodal effect on post-ischemic cardiac performance and this effect may, at least in part, be mediated by a distinct pattern of activation of Akt and ERK signaling.

Background: The use of intraoperative neuromonitoring (IONM) provides surgeons with real time information about recurrent laryngeal nerves (RLN) functional integrity. Hence, allowing them to modify the initially scheduled bilateral procedure, to a two-stage thyroidectomy in cases of loss of signal (LOS) on the first side of resection resulting in minimization of bilateral RLN injury. The purpose of our study was to present our results since the implementation of the above mentioned process in both malignant and benign thyroid disease. Methods: We conducted a retrospective, observational cohort study of prospectively collected data from all patients who underwent a scheduled total thyroidectomy with or without neck dissection in our Department over the last 4 years [2013-2016]. From the 1,138 patients who received surgical treatment during that period, 284 were excluded since they did not meet the criteria. Exclusion criteria involved previous neck operation, parathyroid surgery, pre-existing vocal cord palsy (VCP) and unilateral surgery. A total of 854 patients were eligible for our study. All patients were subjected to pre-and postoperative indirect laryngoscopy by the same experienced ENT specialist team and all the surgeries were performed by the same experienced team. The whole procedure followed the International Neural Monitoring Study Group's (INMSG) Guideline Statement. Results: We experienced 70 cases (70/854, 8.2%) with postoperative VCP. Two of them (0.23%) had permanent VCP and the rest of those patients (7.97%) experienced transient VCP. Twenty-three (2.7%) patients were candidates for staged thyroidectomy after LOS on the first side of resection, including ten patients with papillary or medullary thyroid carcinoma and one with toxic multinodular goiter (MNG). Of those patients, 22 incidents of VCP (95.7%) have recovered within two months and one of them persisted for more than six months (permanent VCP). We did not experience any permanent bilateral RLN palsy after the implementation of the staged procedure. Conclusions: Staged thyroidectomy seems a very attractive and promising procedure for both patient and surgeon, since it nearly eliminates one of the most fearful complications in thyroid surgery. We suggest staged thyroidectomy in all cases with first side of resection signal loss, even in malignancies, since the benefits are much more than the disabilities in a patient's morbidity and quality of life.

Small bowel metastatic deposits attributed to malignant melanoma are found in 2-5% of patients with malignant melanoma of the skin. Ileo-ileo intussusception caused by metastatic melanoma is a very rare condition. The prognosis of metastatic melanoma is poor. We report a case of a cutaneous malignant melanoma which metastasised to the small bowel causing enteroenteric intussusception. This case refers to a 66-year-old male patient who underwent surgery for suspected enteric intussusception. This diagnosis was suggested by computer tomography scan. The patient had had previous surgery for a primary malignant melanoma in the eyelid of the right eye. Segmental intestinal resection with regional lymph node dissection and ileo-ileo anastomosis was performed. Metastatic melanoma in the gastrointestinal tract should be suspected in patients with history of melanoma of the skin and acute gastrointestinal symptoms. Immediate laparotomy and excision of the affected bowel segment is the appropriate treatment.

The hydrogenation of the triglyceride oil, soya bean oil, has been studied in the temperature range 130±160°C and in the pressure range 100±600 kPa using (i) a 5% w/w Pd/C slurry catalyst and (ii) a 3% w/w Pd/Al 2 O 3 Raschig ring catalyst in a cocurrent down¯ow contactor (CDC) reactor. Separate studies of residence time distribution (RTD) were carried out in a modi®ed CDC device in order to determine dispersion numbers and dispersion coef®cients. The RTD measurements indicated that the overall¯ow was a mixture of well-mixed and plug¯ow for the unpacked CDC, so that the entry section (0±30 cm from entrance) was perfectly mixed and the remainder of the column (30±130 cm) gave predominantly plug¯ow behaviour. The introduction of random packing in the form of 13 mm Raschig rings gave rise to increased back mixing in the lower part of the CDC and the overall dispersion number increased due to liquid and gas circulation around the packing elements. Kinetic studies revealed an initial rate reaction order of 1.24±1.26 with respect to hydrogen concentration both in slurry and ®xed bed CDC reactors and is interpreted as a combination of a parallel pair of ®rst and second order reactions during the initial stages of reaction. Mass transfer coef®cients for gas absorption (k L a) and liquid±solid mass transport (k s ) were determined for both types of reactor. The k L a values lay in the range 1.0±3.33 s À1 and the liquid±solid transport resistances (X LS ) were all`1%, so that the reaction was almost totally surface reaction rate controlled. Apparent energy of activation measurements gave values of E A =49 AE6 kJ mol À1 , which is strongly indicative of surface reaction rate control involving the hydrogenation of an ole®nic double bond. The selectivity in respect of linolenate (three double bonds) removal and linoleate (two double bonds) retention was high with, for palladium, relatively low trans-isomer production (`30%). The overall selectivity was slightly, but signi®cantly, better for the ®xed bed CDC reactor and this is attributed to the greater degree of plug¯ow behaviour in the latter, despite the bed causing an increase in dispersion number. However, there is no reaction in the well-mixed section of the ®xed bed CDC reactor as there is in the slurry CDC reactor and this is likely to improve selectivity in a consecutive reaction sequence. NOTATION aGas±liquid interfacial area (m À1 ) a p External particle area (m À1 ) A Column cross-sectional area (m 2 ) C Aig Gas-side concentration of A at gas±liquid interface (mol m À3 ) C Ae Equilibrium concentration of A in solution (mol m À3 ) C As Surface concentration of A (mol m À3 ) d c Column diameter (m) d p Particle diameter (m) D Dispersion coef®cient (cm 2 s À1 ) D A Diffusion coef®cients of A (H 2 ) in solvent (m 2 s À1 ) E l Liquid energy dissipation term (kgf m À2 s À ) H dispPFR Height of PFR section (m) H p Height of packed bed (m) H s Height of single phase section (m) IV Iodine value k L Gas±liquid mass transfer coef®cients (m s À1 ) k r Reaction rate constant (m...