The Medecins Sans Frontieres Intervention in the Marburg Hemorrhagic Fever Epidemic, Uige, Angola, 2005. I. Lessons Learned in the Hospital.

When the epidemic of Marburg hemorrhagic fever occurred in Uige, Angola, during 2005, the international response included systems of case detection and isolation, community education, the burial of the dead, and disinfection. However, despite large investments of staff and money by the organizations involved, only a fraction of the reported number of cases were isolated, and many cases were detected only after death. This article describes the response of Medecins Sans Frontieres Spain within the provincial hospital in Uige, as well as the lessons they learned during the epidemic. Diagnosis, management of patients, and infection control activities in the hospital are discussed. To improve the acceptability of the response to the host community, psychological and cultural factors need to be considered at all stages of planning and implementation in the isolation ward. More interventional medical care may not only improve survival but also improve acceptability

Atypical Presentation of Upshaw Schulman Syndrome: A Case Report

Thrombotic thrombocytopenic purpura (TTP) is a rare coagulation disorder with a typical clinical presentation of low platelets and excessive clotting. Mortality for this disorder may be high if untreated and therefore necessitates a high clinical suspicion. Here we describe a 46-year-old African American woman with a past medical history of multiple cerebrovascular accidents presenting to hematology after a suspected diagnosis of TTP. Presumptive diagnosis of acquired TTP called for treatment with IVIg, but a diagnosis of congenital TTP (Upshaw Schulman syndrome) was made after testing showed a lack of ADAMTS13 antibodies. Treatment with fresh frozen plasma (FFP) showed increase in ADAMTS13 levels which further supported the diagnosis of Upshaw Schulman syndrome. Genomic analysis of ADAMTS13 showed normal sequencing and was not consistent with the diagnosis of Upshaw Schulman syndrome. No prior literature provides an explanation for these findings. This new presentation of a well-classified disease suggests a potential subcategory of TTP that may traditionally be misdiagnosed. Potential explanations for this disease presentation may include IgA-mediated TTP, epigenetic changes of ADAMTS13 expression, or limitations of current testing modalities

Pheochromocytoma with IVC Invasion: Case Report & Systematic Review of Literature

Surgical management and outcome of pheochromocytoma with invasion of the inferior vena cava (IVC) has not been thoroughly reported or widely available in the literature. As determining the malignancy of pheochromocytoma has yet to be clearly defined and the experience of surgical resection of this condition is underrepresented, we include a case report and a systematic literature review on this condition. A literature search in PubMed was performed based on a recent review article by Kassahun et al. (2016). The search yielded 13 case reports between 1988 and 2014 from which data was extracted based on the following variables: patient’s age, gender, comorbidities, laboratory tests for pheochromocytoma diagnosis, size and laterality of the tumor, diagnostic test for IVC invasion, preoperative treatment and imaging, perioperative procedures, and oncological outcomes. The mean age of the patients was 49.4 years, with 38.5% being female (n=5) and 53.3% being male (n=8). 92% (n=12) of the cases were right-sided pheochromocytomas that invaded the IVC, with only one case of pheochromocytoma localized in the organ of Zuckerkandl. Only 46.7% (n=7) of the cases reported using laboratory tests to diagnose pheochromocytoma while only 53.3% (n=8) specifically reported using imaging techniques (CT, MRI, ultrasound, CTA, inferior venacavogram, MIBG-scintigraphy) to diagnose IVC invasion. Four of the surgical cases were performed without cardiopulmonary bypass while three specifically mentioned the use of the bypass technique. There was also further variance in surgical approach as some were performed via sternotomy, thoracophrenolaparotomy, or thoracoabdominal approach to completely resect the tumor and IVC, or to perform a cavotomy with no reconstruction of the IVC necessary. Follow-up of only 8 patients were noted, all of which revealed no evidence of disease, although at different time points post-op. The lack of a thorough and consistent report on pheochromocytoma cases with IVC invasion makes it difficult to compare the management of this condition. We hope a comprehensive review of these patient cases provides greater insight into the diagnosis of pheochromocytoma with IVC invasion and the characteristics and surgical procedure of this tumor invasion that would eliminate recurrence

Ultra-Sensitive Hot-Electron Nanobolometers for Terahertz Astrophysics

The background-limited spectral imaging of the early Universe requires spaceborne terahertz (THz) detectors with the sensitivity 2-3 orders of magnitude better than that of the state-of-the-art bolometers. To realize this sensitivity without sacrificing operating speed, novel detector designs should combine an ultrasmall heat capacity of a sensor with its unique thermal isolation. Quantum effects in thermal transport at nanoscale put strong limitations on the further improvement of traditional membrane-supported bolometers. Here we demonstrate an innovative approach by developing superconducting hot-electron nanobolometers in which the electrons are cooled only due to a weak electron-phonon interaction. At T<0.1K, the electron-phonon thermal conductance in these nanodevices becomes less than one percent of the quantum of thermal conductance. The hot-electron nanobolometers, sufficiently sensitive for registering single THz photons, are very promising for submillimeter astronomy and other applications based on quantum calorimetry and photon counting.Comment: 19 pages, 3 color figure

Is NIPPV Superior to CPAP in Maintaining Targeted Oxygen Saturation Ranges in Preterm Infants on Moderate Non-Invasive Respiratory Support?

Background: Non-invasive positive pressure ventilation (NIPPV) and continuous positive airway pressure (CPAP) are non-invasive respiratory supports commonly used in preterm infants. There is conflicting data on the superiority between these two modes of non-invasive respiratory support. The objective of this study was to determine if oxygen saturation is more within the target range on NIPPV compared to CPAP using the data from histograms. Methods: Retrospective analysis of premature neonates (\u3c 1500 grams, gestational age \u3c 30 weeks) admitted to the NICU for which oxygen saturation histogram data was available one day before and after the transition between NIPPV and CPAP. FiO2 at the time of data collection was greater than 21 percent. This histogram data, the percentage of time spent in certain SpO2 ranges, was compared before and after the de-escalation from NIPPV to CPAP or escalation from CPAP to NIPPV. FiO2 was additionally compared between the two modes of respiratory support. Results: A total of 26 infants were included. The median gestational age was 25.5 weeks and the median weight of the infants was 792 grams. Among the 26 infants, there were 34 episodes of transition between NIPPV and CPAP, 19 switches from NIPPV to CPAP, and 15 from CPAP to NIPPV. The percentage of time that oxygen saturation was within the target range (89-94 %) was not statistically significant between the two modes of respiratory support (CPAP 39.9% vs. NIPPV 43.9%, p=0.09) (Table 1). The percentage of time that oxygen saturation was between 86-88% was higher on NIPPV and the percentage of time that oxygen saturation was \u3e94% was higher on CPAP. There was a trend towards lower FiO2 on NIPPV compared to CPAP. When switched from NIPPV to CPAP, there was a higher percentage of time spent above the target range ( \u3e94%) while on CPAP (56% vs 49%, p=0.001), and below the target range (86-88%) while on NIPPV (5.0% vs 1.4%, p=0.02) (Table 3). When switched from CPAP to NIPPV, there was no difference in oxygen saturation ranges (Table 2). Conclusion: Target oxygen saturation ranges on histogram data were similar in premature infants when supported on CPAP and NIPPV. However, oxygen saturation below the target range was more frequent on NIPPV compared to CPAP. NIPPV is not superior to CPAP in maintaining oxygen saturation within the target range in premature infants on moderate non-invasive respiratory support. The potential risk of low oxygen saturation range while supported on NIPPV in preterm infants requires further research.https://jdc.jefferson.edu/pulmcritcareposters/1003/thumbnail.jp

Malignant melanoma metastatic to the thyroid gland: a case report and review of the literature.

The thyroid gland is a relatively uncommon site for a secondary malignancy; even less common is a case of malignant melanoma metastatic to the thyroid. We describe the case of a 68-year-old man who presented with a neck mass in the posterior triangle. Fine-needle aspiration biopsy (FNAB) identified the mass as a malignant melanoma. The patient had had no known primary skin melanoma. He underwent a left modified radical neck dissection, and the mass was discovered to be a positive lymph node. Postoperatively, he declined to undergo radio- and chemotherapy. Eighteen months later, he returned with a diffusely enlarged thyroid. FNAB again attributed the enlargement to malignant melanoma. Soon thereafter, the patient began experiencing seizures, and on magnetic resonance imaging, he was found to have metastatic disease to the brain. He developed ventilator-dependent respiratory failure and required a subtotal thyroidectomy for the placement of a tracheostomy tube. Patients who present with a thyroid nodule and who have a history of malignancy present a diagnostic dilemma: Is the nodule benign, a new primary, or a distant metastasis? The findings of this case and a review of the literature strengthen the argument that any patient with a thyroid mass and a history of malignancy should be considered to have a metastasis until proven otherwise

Correlation functions quantify super-resolution images and estimate apparent clustering due to over-counting

We present an analytical method to quantify clustering in super-resolution localization images of static surfaces in two dimensions. The method also describes how over-counting of labeled molecules contributes to apparent self-clustering and how the effective lateral resolution of an image can be determined. This treatment applies to clustering of proteins and lipids in membranes, where there is significant interest in using super-resolution localization techniques to probe membrane heterogeneity. When images are quantified using pair correlation functions, the magnitude of apparent clustering due to over-counting will vary inversely with the surface density of labeled molecules and does not depend on the number of times an average molecule is counted. Over-counting does not yield apparent co-clustering in double label experiments when pair cross-correlation functions are measured. We apply our analytical method to quantify the distribution of the IgE receptor (Fc{\epsilon}RI) on the plasma membranes of chemically fixed RBL-2H3 mast cells from images acquired using stochastic optical reconstruction microscopy (STORM) and scanning electron microscopy (SEM). We find that apparent clustering of labeled IgE bound to Fc{\epsilon}RI detected with both methods arises from over-counting of individual complexes. Thus our results indicate that these receptors are randomly distributed within the resolution and sensitivity limits of these experiments.Comment: 22 pages, 5 figure

Canonical Generations and the British Left: The Narrative Construction of the Miners’ Strike 1984–85

‘Generations’ have been invoked to describe a variety of social and cultural relationships, and to understand the development of self-conscious group identity. Equally, the term can be an applied label and politically useful construct; generations can be retrospectively produced. Drawing on the concept of ‘canonical generations’ – those whose experiences come to epitomise an event of historic and symbolic importance – this article examines the narrative creation and functions of ‘generations’ as collective memory shapes and re-shapes the desire for social change. Building a case study of the canonical role of the miners’ strike of 1984–85 in the narrative history of the British left, it examines the selective appropriation and transmission of the past in the development of political consciousness. It foregrounds the autobiographical narratives of activists who, in examining and legitimising their own actions and prospects, (re)produce a ‘generation’ in order to create a relatable and useful historical understanding

Predicting Tumor Related Liver Failure in Unresectable Intrahepatic Cholangiocarcinoma Patients through the Development of an Imaging Based Deep Learning Neural Network Model

https://openworks.mdanderson.org/sumexp21/1008/thumbnail.jp