Lithium overdose and delayed severe neurotoxicity:timing for renal replacement therapy and restarting of lithium

This is a case report of a man in his 60s who presented to an English hospital following a significant lithium overdose. He was monitored for 24 hours, and then renal replacement therapy was initiated after assessment by the renal team. As soon as the lithium level returned to normal therapeutic levels (from 4.7 mEq/L to 0.67 mEq/L), lithium was restarted by the medical team. At this point, the patient developed new slurred speech and later catatonia. In this case report, we discuss the factors that could determine which patients are at risk of neurotoxicity following lithium overdose and the appropriate decision regarding when and how to consider initiation of renal replacement therapy and restarting of lithium

An Application of the Mobile Transient Internet Architecture to IP Mobility and Inter-Operability

We introduce an application of a mobile transient network architecture on top of the current Internet. This paper is an application extension to a conceptual mobile network architecture. It attempts to specifically reinforce some of the powerful notions exposed by the architecture from an application perspective. Of these notions, we explore the network expansion layer, an overlay of components and services, that enables a persistent identification network and other required services. The overlay abstraction introduces several benefits of which mobility and communication across heterogenous network structures are of interest to this paper. We present implementations of several components and protocols including gateways, Agents and the Open Device Access Protocol. Our present identification network implementation exploits the current implementation of the Handle System through the use of distributed, global and persistent identifiers called handles. Handles are used to identify and locate devices and services abstracting any physical location or network association from the communicating ends. A communication framework is finally demonstrated that would allow for mobile devices on the public Internet to have persistent identifiers and thus be persistently accessible either directly or indirectly. This application expands IP inter-operability beyond its current boundaries

Comparison of metabolic abnormalities and clinical lipodystrophy 48 weeks after switching from HAART to Trizivir versus continued HAART: the Trizal study

PURPOSE: To analyze the evolution of clinical lipodystrophy (LD) and metabolic abnormalities in patients continuing to receive HAART versus patients switched to Trizivir (zidovudine, lamivudine, abacavir) after 48 weeks. METHOD: Patients treated with HAART >6 months with plasma HIV-1 RNA viral load (VL) <400 copies/mL and <50 copies/mL at screening were randomly assigned to continue HAART (103 patients) or to receive Trizivir (106 patients). Clinical LD was evaluated using a standardized patient questionnaire only at baseline, weeks 4 and 8, and then every 8 weeks until Week 48. Laboratory evaluation was performed every 4 weeks. RESULTS: The proportion of patients exhibiting >or=1 LD symptom at baseline was 40% in the Trizivir arm and 50% in HAART arm (difference not significant). After 48 weeks, the prevalence was 28% and 42% respectively (p =.03), and the median number of LD symptoms per patient was 2 in the Trizivir arm and 4 in the continued HAART arm (p =.016). Median decreases in cholesterol levels over the 48-week study period were greater in the Trizivir arm than in the continued HAART arm (-0.80 vs. -0.44 mmol/L; p lt.001). Median triglyceride levels decreased in the Trizivir arm but increased in the continued HAART arm (-0.17 and +0.01 mmol/L; p =.006). Suppression of VL was maintained in most patients with no differences between the two arms. CONCLUSION: A switch from "standard" HAART to Trizivir was associated with an improvement in clinical LD and blood lipid abnormalities after 48 weeks

Simulation of penetration into porous geologic media

We present a computational study on the penetration of steel projectiles into porous geologic materials. The purpose of the study is to extend the range of applicability of a recently developed constitutive model to simulations involving projectile penetration into geologic media. The constitutive model is non-linear, thermodynamically consistent, and properly invariant under superposed rigid body motions. The equations are valid for large deformations and they are hyperelastic in the sense that the stress tensor is related to a derivative of the Helmholtz free energy. The model uses the mathematical structure of plasticity theory to capture the basic features of the mechanical response of geological materials including the effects of bulking, yielding, damage, porous compaction and loading rate on the material response. The new constitutive model has been successfully used to simulate static laboratory tests under a wide range of triaxial loading conditions, and dynamic spherical wave propagation tests in both dry and saturated geologic media

UML 1.4 versus UML 2.0 as Languages to Describe Software Architectures.

ML 1.4 is widely accepted as the standard for representing the various software artifacts generated by a development process. For this reason, there have been attempts to use this language to represent the software architec- ture of systems as well. Unfortunately, these attempts have ended in representa- tions (boxes and lines) already criticized by the software architecture commu- nity. Recently, OMG has published a draft that will constitute the future UML 2.0 specification. In this paper we compare the capacities of UML 1.4 and UML 2.0 to describe software architectures. In particular, we study extensions of both UML versions to describe the static view of the C3 architectural style (a simplification of the C2 style). One of the results of this study is the difficulties found when using the UML 2.0 metamodel to describe the concept of connector in a software architecture

Simulation of Comet Impact and Survivability of Organic Compounds

Comets have long been proposed as a potential means for the transport of complex organic compounds to early Earth. For this to be a viable mechanism, a significant fraction of organic compounds must survive the high temperatures due to impact. We have undertaken three-dimensional numerical simulations to track the thermodynamic state of a comet during oblique impacts. The comet was modeled as a 1-km water-ice sphere impacting a basalt plane at 11.2 km/s; impact angles of 15{sup o} (from horizontal), 30{sup o}, 45{sup o}, 65{sup o}, and 90{sup o} (normal impact) were examined. The survival of organic cometary material, modeled as water ice for simplicity, was calculated using three criteria: (1) peak temperatures, (2) the thermodynamic phase of H{sub 2}O, and (3) final temperature upon isentropic unloading. For impact angles greater than or equal to 30{sup o}, no organic material is expected to survive the impact. For the 15{sup o} impact, most of the material survives the initial impact and significant fractions (55%, 25%, and 44%, respectively) satisfy each survival criterion at 1 second. Heating due to deceleration, in addition to shock heating, plays a role in the heating of the cometary material for nonnormal impacts. This effect is more noticeable for more oblique impacts, resulting in significant deviations from estimates using scaling of normal impacts. The deceleration heating of the material at late times requires further modeling of breakup and mixing

Clinical Experience and Results of Microsurgical Resection of Arterioveonous Malformation in the Presence of Space-Occupying Intracerebral Hematoma

BACKGROUND: Management of ruptured arteriovenous malformations (AVMs) with a mass-producing intracerebral hematoma (ICH) represents a surgical dilemma. OBJECTIVE: To evaluate the clinical outcome and obliteration rates of microsurgical resection of AVM when performed concomitantly with evacuation of an associated space-occupying ICH. METHODS: Data of patients with AVM were collected prospectively. Cases were identified in which an AVM was resected and an associated space-occupying ICH was evacuated at the same time, and divided into "group 1," in which the surgery was performed acutely within 48 h of presentation (secondary to elevated intracranial pressure); and "group 2," in which selected patients were operated upon in the presence of a liquefying ICH in the "subacute" stage. Clinical outcomes were assessed using the modified Rankin Scale, with a score of 0 to 2 considered a good outcome. Obliteration rates were assessed using postoperative angiography. RESULTS: From 2001 to 2015, 131 patients underwent microsurgical resection of an AVM, of which 65 cases were included. In "group 1" (n = 21; Spetzler-Ponce class A = 13, class B = 5, and class C = 3), 11 of 21 (52%) had a good outcome and in 18 of 19 (95%) of those who had a postoperative angiogram the AVMs were completely obliterated. In "group 2" (n = 44; Spetzler-Ponce class A = 33, class B = 9, and class C = 2), 31 of 44 (93%) had a good outcome and 42 of 44 (95%) were obliterated with a single procedure. For supratentorial AVMs, the ICH cavity was utilized to provide an operative trajectory to a deep AVM in 11 cases, and in 26 cases the ICH cavity was deep to the AVM and hence facilitated the deep dissection of the nidus. CONCLUSION: In selected patients the presence of a liquefying ICH cavity may facilitate the resection of AVMs when performed in the subacute stage resulting in a good neurological outcome and high obliteration rate

Lipoprotein Profiles in Class III Obese Caucasian and African American Women with Nonalcoholic Fatty Liver Disease

Triglyceride content in the liver is regulated by the uptake, production and elimination of lipoproteins, and derangements in these processes contribute to nonalcoholic fatty liver disease (NAFLD). Previous studies show a direct relationship between intrahepatic fat and production of apolipoprotein B100 (apoB100) containing particles, VLDL and LDL, but little consensus exists regarding changes in lipoprotein production in the development of simple steatosis (SS) versus nonalcoholic steatohepatitis (NASH). Further, ethnic variations in lipoproteins among SS and NASH are unknown as is how such variations might contribute to the differential prevalence of disease among Caucasians versus African Americans. In this study, we assessed plasma lipoprotein profiles by nuclear magnetic resonance (NMR) spectroscopy in 70 non-diabetic class III obese females recruited from the surgical weight loss clinic. Of these, 51 females were stratified by biopsy-staged NAFLD severity (histologically normal, SS, or NASH). NASH females displayed increased circulating triglycerides and increased VLDL particle number and size relative to those with histologically normal livers, while total and large LDL concentration decreased in SS versus NASH and correlated with increased insulin resistance (via HOMA2-IR). When Caucasian women were examined alone (n = 41), VLDL and triglycerides increased between normal and SS, while total LDL and apoB100 decreased between SS and NASH along with increased insulin resistance. Compared to Caucasians with SS, African American women with SS displayed reduced triglycerides, VLDL, and small LDL and a more favorable small to large HDL ratio despite having increased BMI and HOMA2-IR. These findings suggest that ApoB100 and lipoprotein subclass particle number and size can delineate steatosis from NASH in obese Caucasian females, but should be interpreted with caution in other ethnicities as African Americans with SS display relatively improved lipoprotein profiles. This may reflect variation in the relationship between dyslipidemia and NAFLD progression across gender and ethnicity

A pilot clinical trial testing mutant von Hippel-Lindau peptide as a novel immune therapy in metastatic Renal Cell Carcinoma

<p>Abstract</p> <p>Background</p> <p>Due to the lack of specific tumor antigens, the majority of tested cancer vaccines for renal cell carcinoma (RCC) are based on tumor cell lysate. The identification of the <it>von Hippel-Lindau </it>(<it>VHL</it>) gene mutations in RCC patients provided the potential for developing a novel targeted vaccine for RCC. In this pilot study, we tested the feasibility of vaccinating advanced RCC patients with the corresponding mutant VHL peptides.</p> <p>Methods</p> <p>Six patients with advanced RCC and mutated <it>VHL </it>genes were vaccinated with the relevant VHL peptides. Patients were injected with the peptide mixed with Montanide subcutaneously (SQ) every 4 weeks until disease progression or until the utilization of all available peptide stock.</p> <p>Results</p> <p>Four out of five evaluable patients (80%) generated specific immune responses against the corresponding mutant VHL peptides. The vaccine was well tolerated. No grade III or IV toxicities occurred. The median overall survival (OS) and median progression-free survival (PFS) were 30.5 and 6.5 months, respectively.</p> <p>Conclusions</p> <p>The vaccine demonstrated safety and proved efficacy in generating specific immune response to the mutant VHL peptide. Despite the fact that the preparation of these custom-made vaccines is time consuming, the utilization of VHL as a vaccine target presents a promising approach because of the lack of other specific targets for RCC. Accordingly, developing mutant VHL peptides as vaccines for RCC warrants further investigation in larger trials. Trial registration: 98C0139</p