Psoas hematoma in the elderly patient, a diagnostic challenge, a case report

Background: A psoas hematoma is an uncommon condition in patients on anticoagulant therapy and patients with bleeding disorders. It can present itself with non-specific symptoms, as anemia, pain and hemodynamically instability. The CT angioscan is the diagnostic test of choice. Case presentation: We report a series of 3 cases of iliopsoas hematoma in older patients. These patients were all on anticoagulant therapy and presented with non-specific symptoms as pain in back or groin, anemia and weakness of the leg. These symptoms could be well explained by other, concurrent diseases. Moreover in one case it was not possible to obtain a reliable history due to cognitive impairment of the patient. In our cases the diagnosis of a psoas hematoma was made after performing many diagnostics or found fortuitously. All three patients recovered well after (temporarily) ceasing of anticoagulant therapy. Discussion: The diagnosis of a psoas hematoma is difficult, especially in elderly patients as illustrated in these cases. The symptoms of a psoas hematoma are often aspecific and can also be explained by other, comorbid diseases. Moreover, elderly patients often have an unusual presentation of illness and the presence of cognitive impairment compromises the reliability of a patients history. It is important to be aware of this diagnosis and perform a CT-scan when a psoas hematoma is possible. Conclusion: A psoas hematoma is easily overlooked in older patients due to an unusual presentation of illness, comorbidity and cognitive impairment

Enumeration of hypermaps and Hirota equations for extended rationally constrained KP

We consider the Hurwitz Dubrovin--Frobenius manifold structure on the space of meromorphic functions on the Riemann sphere with exactly two poles, one simple and one of arbitrary order. We prove that the all genera partition function (also known as the total descendant potential) associated with this Dubrovin--Frobenius manifold is a tau function of a rational reduction of the Kadomtsev--Petviashvili hierarchy. This statement was conjectured by Liu, Zhang, and Zhou. We also provide a partial enumerative meaning for this partition function associating one particular set of times with enumeration of rooted hypermaps.Comment: 39 page

Further evidence for a QTL influencing body mass index on chromosome 7p from a genome-wide scan in Dutch families.

Obesity is a rapidly growing threat to public health, driven by the increased occurrence of high caloric diets and sedentary lifestyles. Within this environment, genetic influences may largely determine inter-individual differences in obesity-related traits. To map genes involved in weight regulation, we performed a genome-wide linkage scan for body mass index (BMI), a reliable measure of total body fat, in 192 Dutch families including 315 twins and 210 siblings with data on BMI. Using variance components linkage analysis, regions with LOD-scores greater than 2 were observed on 6p25.1 (LOD-score, 2.13) and 7p21.1 (LOD-score, 2.40). LOD-scores higher than 1 were found on chromosomes 3, 13, 15 and 21. Of note, evidence for the putative quantitative trait locus for BMI on 7p was obtained previously from such diverse populations as Mexican-Americans, Asians and Nigerians, suggesting that the underlying genes may effect weight regulation in diverse environments. An obvious positional candidate in the 7p linkage region is the gene encoding neuropeptide Y (NPY) that controls satiety and food intake

What Twin Studies Tell Us About the Heritability of Brain Development, Morphology, and Function: A Review

The development of brain structure and function shows large inter-individual variation. The extent to which this variation is due to genetic or environmental influences has been investigated in twin studies using structural and functional Magnetic Resonance Imaging (MRI). The current review presents an overview of twin studies using MRI in children, adults and elderly, and focuses on cross-sectional and longitudinal designs. The majority of the investigated brain measures are heritable to a large extent (60–80 %), although spatial differences in heritability are observed as well. Cross-sectional studies suggest that heritability estimates slightly increase from childhood to adulthood. Long-term longitudinal studies are better suited to study developmental changes in heritability, but these studies are limited. Results so far suggest that the heritability of change over time is relatively low or absent, but more studies are needed to confirm these findings. Compared to brain structure, twin studies of brain function are scarce, and show much lower heritability estimates (~40 %). The insights from heritability studies aid our understanding of individual differences in brain structure and function. With the recent start of large genetic MRI consortia, the chance of finding genes that explain the heritability of brain morphology increases. Gene identification may provide insight in biological mechanisms involved in brain processes, which in turn will learn us more about healthy and disturbed brain functioning

Inclusion in morning meetings

This thesis explores the extent to which teachers implement best practice of inclusion during their daily Morning Meetings. Morning Meetings are a standard practice at the beginning of the school day where student and teachers greet one another, share personal stories and information, participate in a group activity, and read a morning message written by the teachers. Preschool through third grade teachers in local school districts were given a self-reflection survey. The survey was a standardized checklist that was informed by research on inclusive practices and The Morning Meeting Book (Kriete & Davis, 2014). It was modeled after the Division for Early Childhood (DEC) and the National Association for the Education of Young Children (NAEYC) joint early childhood inclusion policy, which states the defining features of inclusion as access, participation, and supports (2009). The survey lists specific practices that teachers may or may not be implementing that promote inclusion. My hypothesis before the research began was that teachers would struggle to implement the practices that take more time and preparation outside of their normal routine. The analysis of the data showed that my hypothesis was correct to some extent, teachers were more successful when implementing accommodations that they could plan into the whole group, and less successful with one-on-one accommodations that required them to work individually with a student outside of the Morning Meeting

Icodextrin as salvage therapy in peritoneal dialysis patients with refractory fluid overload

BACKGROUND: Icodextrin is a high molecular weight, starch-derived glucose polymer, which is capable of inducing sustained ultrafiltration over prolonged (12–16 hour) peritoneal dialysis (PD) dwells. The aim of this study was to evaluate the ability of icodextrin to alleviate refractory, symptomatic fluid overload and prolong technique survival in PD patients. METHODS: A prospective, open-label, pre-test/post-test study was conducted in 17 PD patients (8 females/9 males, mean age 56.8 ± 2.9 years) who were on the verge of being transferred to haemodialysis because of symptomatic fluid retention that was refractory to fluid restriction, loop diuretic therapy, hypertonic glucose exchanges and dwell time optimisation. One icodextrin exchange (2.5 L 7.5%, 12-hour dwell) was substituted for a long-dwell glucose exchange each day. RESULTS: Icodextrin significantly increased peritoneal ultrafiltration (885 ± 210 ml to 1454 ± 215 ml, p < 0.05) and reduced mean arterial pressure (106 ± 4 to 96 ± 4 mmHg, p < 0.05), but did not affect weight, plasma albumin concentration, haemoglobin levels or dialysate:plasma creatinine ratio. Diabetic patients (n = 12) also experienced improved glycaemic control (haemoglobin Alc decreased from 8.9 ± 0.7% to 7.9 ± 0.7%, p < 0.05). Overall PD technique survival was prolonged by a mean of 11.6 months (95% CI 6.0–17.3 months). On multivariate Cox proportional hazards analysis, extension of technique survival by icodextrin was only significantly predicted by baseline net daily peritoneal ultrafiltration (adjusted HR 2.52, 95% CI 1.13–5.62, p < 0.05). CONCLUSIONS: Icodextrin significantly improved peritoneal ultrafiltration and extended technique survival in PD patients with symptomatic fluid overload, especially those who had substantially impaired peritoneal ultrafiltration