Gastrointestinal stromal tumor as cause of acute abdominal pain in a patient with neurofibromatosis type 1: case report and literature review

Acute abdomen is a common and sometimes dramatic clinical condition, which can be fatal if diagnosis is not made in time. There are many etiologies for acute abdominal pain; therefore, the diagnostic approach should be based on clinical assessment, including laboratory and image studies. Neurofibromatosis 1 (NF1) is an autosomal dominant condition, characterized by cutaneous pigmentation and tumor formation along nerves in the brain, skin and other organs, the gastrointestinal stromal tumors are rare mesenchymal neoplasms associated with NF1. The close correlation between both pathologies is well known, and the clinical relevance relies on the different pathogenesis from sporadic gastrointestinal stromal tumor (GIST), with important therapeutic implications as the use of imatinib prior or after surgery, regarding the individual context of the patient. This case report illustrates the management of an NF1 patient presenting with acute abdomen to the emergency room and follow-up

The host-galaxy response to the afterglow of GRB 100901A

For Gamma-Ray Burst 100901A, we have obtained Gemini-North and Very Large Telescope optical afterglow spectra at four epochs: one hour, one day, three days and one week after the burst, thanks to the afterglow remaining unusually bright at late times. Apart from a wealth of metal resonance lines, we also detect lines arising from fine-structure levels of the ground state of Fe II, and from metastable levels of Fe II and Ni II at the host redshift (z = 1.4084). These lines are found to vary significantly in time. The combination of the data and modelling results shows that we detect the fall of the Ni II 4 F9/2 metastable level population, which to date has not been observed. Assuming that the population of the excited states is due to the UV-radiation of the afterglow, we estimate an absorber distance of a few hundred pc. This appears to be a typical value when compared to similar studies. We detect two intervening absorbers (z = 1.3147, 1.3179). Despite the wide temporal range of the data, we do not see significant variation in the absorption lines of these two intervening systems.Comment: 17 pages, 9 figures. Accepted by Monthly Notices of the Royal Astronomical Society on Jan 11th 201

Pressure-Tuneable Visible-Range Band Gap in the Ionic Spinel Tin Nitride

The application of pressure allows systematic tuning of the charge density of a material cleanly, that is, without changes to the chemical composition via dopants, and exploratory high-pressure experiments can inform the design of bulk syntheses of materials that benefit from their properties under compression. The electronic and structural response of semiconducting tin nitride Sn3N4 under compression is now reported. A continuous opening of the optical band gap was observed from 1.3 eV to 3.0 eV over a range of 100 GPa, a 540 nm blue-shift spanning the entire visible spectrum. The pressure-mediated band gap opening is general to this material across numerous high-density polymorphs, implicating the predominant ionic bonding in the material as the cause. The rate of decompression to ambient conditions permits access to recoverable metastable states with varying band gaps energies, opening the possibility of pressure-tuneable electronic properties for future applications

Assessment of the toll-like receptor 4 Asp299Gly, Thr399Ile and interleukin-8 -251 polymorphisms in the risk for the development of distal gastric cancer

<p>Abstract</p> <p>Background</p> <p>The intensity of the inflammation induced by <it>Helicobacter pylori </it>colonization is associated with the development of distal gastric cancer (GC). The host response to <it>H</it>. <it>pylori </it>has been related to genetic polymorphisms that influence both innate and adaptive immune responses.</p> <p>Our aim was to investigate whether the presence of the <it>TLR4 Asp299Gly</it>, <it>TLR4 Thr399Ile </it>and <it>IL-8-251 </it>A/T polymorphisms had any influence in the development of distal GC in a Mexican population.</p> <p>Methods</p> <p>We studied 337 patients that were divided in two groups: 78 patients with histologically confirmed distal GC and 259 non-cancer controls. The presence of <it>H. pylori </it>in the control population was defined by positive results of at least two of four diagnostic tests: serology, histology, rapid urease test and culture. Human DNA was purified and genotyped for <it>TLR4 Asp299Gly </it>polymorphism by pyrosequencing, for <it>TLR4 Thr399Ile </it>by PCR-RFLP and for <it>IL8-251 </it>by the amplification refractory mutation system (ARMS)-PCR.</p> <p>Results</p> <p>The non-cancer control group was found to be in Hardy-Weinberg equilibrium at the polymorphic loci studied (chi-square _H-W= 0.58 for <it>IL8-251</it>, 0.42 for <it>TLR4 Asp299Gly </it>and 0.17 for <it>TLR4 Thr399Ile</it>). The frequencies of mutated alleles (homozygous plus heterozygous) were compared between cases and controls. We found no significant difference for <it>TLR4- Asp299Gly </it>[the 7.7% of distal GC patients and 7.7 % non-cancer controls (p = 0.82)] and for <it>TLR4 Thr399Ile </it>[the 1.3% of GC patients and the 5% of the control population (p = 0.2)]. In contrast, for <it>IL-8-251 </it>A/T, 80.77% of the GC patients and 66.4% in the control group age and gender matched had at least one copy of mutated allele (OR = 2.12, 95% CI = 1.1–4.2) (p = 0.023).</p> <p>Conclusion</p> <p>This study showed that the <it>IL8-251*A </it>allele could be related to the development of distal gastric cancer in this Mexican population.</p

VLT/X-shooter spectroscopy of the candidate black-hole X-ray binary MAXI J1659-152 in outburst

We present the optical to near-infrared spectrum of MAXI J1659-152, during the onset of its 2010 X-ray outburst. The spectrum was obtained with X-shooter on the ESO - Very Large Telescope (VLT) early in the outburst simultaneous with high quality observations at both shorter and longer wavelengths. At the time of the observations, the source was in the low-hard state. The X-shooter spectrum includes many broad (~2000 km/s), double-peaked emission profiles of H, HeI, HeII, characteristic signatures of a low-mass X-ray binary during outburst. We detect no spectral signatures of the low-mass companion star. The strength of the diffuse interstellar bands results in a lower limit to the total interstellar extinction of Av ~ 0.4 mag. Using the neutral hydrogen column density obtained from the X-ray spectrum we estimate Av ~1 mag. The radial-velocity structure of the interstellar NaI D and CaII H & K lines results in a lower limit to the distance of ~ 4 +/- 1 kpc, consistent with previous estimates. With this distance and Av, the dereddened spectral energy distribution represents a flat disk spectrum. The two subsequent 10 minute X-shooter spectra show significant variability in the red wing of the emission-line profiles, indicating a global change in the density structure of the disk, though on a timescale much shorter than the typical viscous timescale of the disk.Comment: Accepted for publication in ApJ Letter

Plant-Based Diets Are Associated With Lower Adiposity Levels Among Hispanic/Latino Adults in the Adventist Multi-Ethnic Nutrition (AMEN) Study

Background: The Hispanic/Latino population in the US is experiencing high rates of obesity and cardio-metabolic disease that may be attributable to a nutrition transition away from traditional diets emphasizing whole plant foods. In the US, plant-based diets have been shown to be effective in preventing and controlling obesity and cardio-metabolic disease in large samples of primarily non-Hispanic subjects. Studying this association in US Hispanic/Latinos could inform culturally tailored interventions.Objective: To examine whether the plant-based diet pattern that is frequently followed by Hispanic/Latino Seventh-day Adventists is associated with lower levels of adiposity and adiposity-related biomarkers.Methods: The Adventist Multiethnic Nutrition Study (AMEN) enrolled 74 Seventh-day Adventists from five Hispanic/Latino churches within a 20 mile radius of Loma Linda, CA into a cross-sectional study of diet (24 h recalls, surveys) and health (anthropometrics and biomarkers).Results: Vegetarian diet patterns (Vegan, Lacto-ovo vegetarian, Pesco-vegetarian) were associated with significantly lower BMI (24.5 kg/m2 vs. 27.9 kg/m2, p = 0.006), waist circumference (34.8 in vs. 37.5 in, p = 0.01), and fat mass (18.3 kg vs. 23.9 kg, p = 0.007), as compared to non-vegetarians. Adiposity was positively associated with pro-inflammatory cytokines (Interleukin-6) in this sample, but adjusting for this effect did not alter the associations with vegetarian diet.Conclusions: Plant-based eating as practiced by US-based Hispanic/Latino Seventh-day Adventists is associated with BMI in the recommended range. Further work is needed to characterize this type of diet for use in obesity-related interventions among Hispanic/Latinos in the US

Diagnosis of Cystic Echinococcosis, Central Peruvian Highlands

High prevalence was confirmed by ultrasonography, radiography, and 2 serologic tests, although usefulness of serologic testing in the field was limited

Scalable and accurate deep learning for electronic health records

Predictive modeling with electronic health record (EHR) data is anticipated to drive personalized medicine and improve healthcare quality. Constructing predictive statistical models typically requires extraction of curated predictor variables from normalized EHR data, a labor-intensive process that discards the vast majority of information in each patient's record. We propose a representation of patients' entire, raw EHR records based on the Fast Healthcare Interoperability Resources (FHIR) format. We demonstrate that deep learning methods using this representation are capable of accurately predicting multiple medical events from multiple centers without site-specific data harmonization. We validated our approach using de-identified EHR data from two U.S. academic medical centers with 216,221 adult patients hospitalized for at least 24 hours. In the sequential format we propose, this volume of EHR data unrolled into a total of 46,864,534,945 data points, including clinical notes. Deep learning models achieved high accuracy for tasks such as predicting in-hospital mortality (AUROC across sites 0.93-0.94), 30-day unplanned readmission (AUROC 0.75-0.76), prolonged length of stay (AUROC 0.85-0.86), and all of a patient's final discharge diagnoses (frequency-weighted AUROC 0.90). These models outperformed state-of-the-art traditional predictive models in all cases. We also present a case-study of a neural-network attribution system, which illustrates how clinicians can gain some transparency into the predictions. We believe that this approach can be used to create accurate and scalable predictions for a variety of clinical scenarios, complete with explanations that directly highlight evidence in the patient's chart.Comment: Published version from https://www.nature.com/articles/s41746-018-0029-