Acute life-threatening extrinsic allergic alveolitis in a paint controller

Background Occupational diisocyanate-induced extrinsic allergic alveolitis (EAA) is a rare and probably underestimated diagnosis. Two acute occupational EAA cases have been described in this context, but neither of them concerned hexamethylene diisocyanate (HDI) exposure. Aims To investigate the cause of a life-threatening EAA arising at work in a healthy 30-year-old female paint quality controller. Methods Occupational medical assessment, workplace evaluation, airborne and biological monitoring and immunodermatological tests. Results Diagnosis of EAA relied on congruent clinical and radiological information, confirmed occupational HDI exposure and positive IgG antibodies and patch tests. The patient worked in a small laboratory for 7 years, only occasionally using HDI-containing hardeners. While working with HDI for 6 h, she developed breathlessness, rapidly progressing to severe respiratory failure. Workplace HDI airborne exposure values ranged from undetectable levels to 4.25 p.p.b. Biological monitoring of urinary hexamethylene diamine in co-workers ranged from <1.0 to 15.4 μg/g creatinine. Patch tests 8 months later showed delayed skin reaction to HDI at 48 h. Subsequent skin biopsy showed spongiotic dermatitis with infiltration of CD4+ and CD8+ T cells. Conclusions We believe this is the first reported case of acute life-threatening EAA following exposure to HDI. Low concentrations of airborne HDI and relatively high urinary hexamethylene diamine suggest significant skin absorption of HDI could have significantly contributed to the development of this acute occupational EA

Intracranial Penetration During Temporal Soft Tissue Filler Injection-Is It Possible?

BACKGROUND Treating temporal volume loss for aesthetic and reconstructive purposes can be achieved by superficial or deep injections of soft tissue fillers into the temples. The latter is performed with bone contact that can lead to intracranial penetration when the bone is accidentally penetrated. OBJECTIVE Based on a clinical case, the potential risk of accidental intracranial penetration was investigated. MATERIALS AND METHODS Twenty fresh-frozen hemi-faces (all Caucasian ethnicity, 10 women, 10 men, mean age 72.8 +/- 11.2 years) were investigated. Shape of pterion and bone-stability parameters of the temporal fossa were investigated. Bone stability was tested using uniaxial mechanical indentation (18-G, 1.25-mm diameter, 15-mm length blunt-tip device) until intracranial perforation occurred. RESULTS Variations in the shape of the pterion, bone thickness, and density correlates were detected, however, without statistical significant differences in side symmetry. Minimum force necessary to penetrate intracranially was 40.4 N. Maximum force generated by an 18-g, 70-mm length blunt-tip cannula was 32.1 +/- 4.2 N in 70 mm length and 75.3 +/- 10.2 N in 15 mm length. CONCLUSION Based on the results of this investigation, it can be concluded that there is a risk for intracranial penetration performing the deep temple injection technique with direct pressure on the bone

Organics in comet 67P – a first comparative analysis of mass spectra from ROSINA–DFMS, COSAC and Ptolemy

The ESA Rosetta spacecraft followed comet 67P at a close distance for more than 2 yr. In addition, it deployed the lander Philae on to the surface of the comet. The (surface) composition of the comet is of great interest to understand the origin and evolution of comets. By combining measurements made on the comet itself and in the coma, we probe the nature of this surface material and compare it to remote sensing observations. We compare data from the double focusing mass spectrometer (DFMS) of the ROSINA experiment on ESA's Rosetta mission and previously published data from the two mass spectrometers COSAC (COmetary Sampling And Composition) and Ptolemy on the lander. The mass spectra of all three instruments show very similar patterns of mainly CHO-bearing molecules that sublimate at temperatures of 275 K. The DFMS data also show a great variety of CH-, CHN-, CHS-, CHO2- and CHNO-bearing saturated and unsaturated species. Methyl isocyanate, propanal and glycol aldehyde suggested by the earlier analysis of the measured COSAC spectrum could not be confirmed. The presence of polyoxymethylene in the Ptolemy spectrum was found to be unlikely. However, the signature of the aromatic compound toluene was identified in DFMS and Ptolemy data. Comparison with remote sensing instruments confirms the complex nature of the organics on the surface of 67P, which is much more diverse than anticipated

Difference-frequency generation with quantum-limited efficiency in triply-resonant nonlinear cavities

We present a comprehensive study of second-order nonlinear difference frequency generation in triply resonant cavities using a theoretical framework based on coupled-mode theory. We show that optimal quantum-limited conversion efficiency can be achieved at any pump power when the powers at the pump and idler frequencies satisfy a critical relationship. We demonstrate the existence of a broad parameter range in which all triply-resonant DFG processes exhibit monostable conversion. We also demonstrate the existence of a geometry-dependent bistable region.Comment: 10 pages, 3 figure

Efficient Terahertz Generation in Triply Resonant Nonlinear Photonic Crystal Microcavities

We propose a scheme for efficient cavity-enhanced nonlinear THz generation via difference-frequency generation (DFG) processes using a triply resonant system based on photonic crystal cavities. We show that high nonlinear overlap can be achieved by coupling a THz cavity to a doubly-resonant, dual-polarization near-infrared (e.g. telecom band) photonic-crystal nanobeam cavity, allowing the mixing of three mutually orthogonal fundamental cavity modes through a chi(2) nonlinearity. We demonstrate through coupled-mode theory that complete depletion of the pump frequency - i.e., quantum-limited conversion - is possible in an experimentally feasible geometry, with the operating output power at the point of optimal total conversion efficiency adjustable by varying the mode quality (Q) factors.Comment: 8 pages, 3 figure

Recruitment of latent pools of high-avidity CD8+ T cells to the antitumor immune response

A major barrier to successful antitumor vaccination is tolerance of high-avidity T cells specific to tumor antigens. In keeping with this notion, HER-2/neu (neu)-targeted vaccines, which raise strong CD8+ T cell responses to a dominant peptide (RNEU420-429) in WT FVB/N mice and protect them from a neu-expressing tumor challenge, fail to do so in MMTV-neu (neu-N) transgenic mice. However, treatment of neu-N mice with vaccine and cyclophosphamide-containing chemotherapy resulted in tumor protection in a proportion of mice. This effect was specifically abrogated by the transfer of neu-N–derived CD4+CD25+ T cells. RNEU420-429-specific CD8+ T cells were identified only in neu-N mice given vaccine and cyclophosphamide chemotherapy which rejected tumor challenge. Tetramer-binding studies demonstrated that cyclophosphamide pretreatment allowed the activation of high-avidity RNEU420-429-specific CD8+ T cells comparable to those generated from vaccinated FVB/N mice. Cyclophosphamide seemed to inhibit regulatory T (T reg) cells by selectively depleting the cycling population of CD4+CD25+ T cells in neu-N mice. These findings demonstrate that neu-N mice possess latent pools of high-avidity neu-specific CD8+ T cells that can be recruited to produce an effective antitumor response if T reg cells are blocked or removed by using approaches such as administration of cyclophosphamide before vaccination