Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy

Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function

Presence: Twelve Artists

Show card featuring alumni and faculty.https://digitalcommons.udallas.edu/alumni_87-88/1009/thumbnail.jp

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

A framework for human microbiome research

A variety of microbial communities and their genes (the microbiome) exist throughout the human body, with fundamental roles in human health and disease. The National Institutes of Health (NIH)-funded Human Microbiome Project Consortium has established a population-scale framework to develop metagenomic protocols, resulting in a broad range of quality-controlled resources and data including standardized methods for creating, processing and interpreting distinct types of high-throughput metagenomic data available to the scientific community. Here we present resources from a population of 242 healthy adults sampled at 15 or 18 body sites up to three times, which have generated 5,177 microbial taxonomic profiles from 16S ribosomal RNA genes and over 3.5 terabases of metagenomic sequence so far. In parallel, approximately 800 reference strains isolated from the human body have been sequenced. Collectively, these data represent the largest resource describing the abundance and variety of the human microbiome, while providing a framework for current and future studies

Structure, function and diversity of the healthy human microbiome

Author Posting. © The Authors, 2012. This article is posted here by permission of Nature Publishing Group. The definitive version was published in Nature 486 (2012): 207-214, doi:10.1038/nature11234.Studies of the human microbiome have revealed that even healthy individuals differ remarkably in the microbes that occupy habitats such as the gut, skin and vagina. Much of this diversity remains unexplained, although diet, environment, host genetics and early microbial exposure have all been implicated. Accordingly, to characterize the ecology of human-associated microbial communities, the Human Microbiome Project has analysed the largest cohort and set of distinct, clinically relevant body habitats so far. We found the diversity and abundance of each habitat’s signature microbes to vary widely even among healthy subjects, with strong niche specialization both within and among individuals. The project encountered an estimated 81–99% of the genera, enzyme families and community configurations occupied by the healthy Western microbiome. Metagenomic carriage of metabolic pathways was stable among individuals despite variation in community structure, and ethnic/racial background proved to be one of the strongest associations of both pathways and microbes with clinical metadata. These results thus delineate the range of structural and functional configurations normal in the microbial communities of a healthy population, enabling future characterization of the epidemiology, ecology and translational applications of the human microbiome.This research was supported in part by National Institutes of Health grants U54HG004969 to B.W.B.; U54HG003273 to R.A.G.; U54HG004973 to R.A.G., S.K.H. and J.F.P.; U54HG003067 to E.S.Lander; U54AI084844 to K.E.N.; N01AI30071 to R.L.Strausberg; U54HG004968 to G.M.W.; U01HG004866 to O.R.W.; U54HG003079 to R.K.W.; R01HG005969 to C.H.; R01HG004872 to R.K.; R01HG004885 to M.P.; R01HG005975 to P.D.S.; R01HG004908 to Y.Y.; R01HG004900 to M.K.Cho and P. Sankar; R01HG005171 to D.E.H.; R01HG004853 to A.L.M.; R01HG004856 to R.R.; R01HG004877 to R.R.S. and R.F.; R01HG005172 to P. Spicer.; R01HG004857 to M.P.; R01HG004906 to T.M.S.; R21HG005811 to E.A.V.; M.J.B. was supported by UH2AR057506; G.A.B. was supported by UH2AI083263 and UH3AI083263 (G.A.B., C. N. Cornelissen, L. K. Eaves and J. F. Strauss); S.M.H. was supported by UH3DK083993 (V. B. Young, E. B. Chang, F. Meyer, T. M. S., M. L. Sogin, J. M. Tiedje); K.P.R. was supported by UH2DK083990 (J. V.); J.A.S. and H.H.K. were supported by UH2AR057504 and UH3AR057504 (J.A.S.); DP2OD001500 to K.M.A.; N01HG62088 to the Coriell Institute for Medical Research; U01DE016937 to F.E.D.; S.K.H. was supported by RC1DE0202098 and R01DE021574 (S.K.H. and H. Li); J.I. was supported by R21CA139193 (J.I. and D. S. Michaud); K.P.L. was supported by P30DE020751 (D. J. Smith); Army Research Office grant W911NF-11-1-0473 to C.H.; National Science Foundation grants NSF DBI-1053486 to C.H. and NSF IIS-0812111 to M.P.; The Office of Science of the US Department of Energy under Contract No. DE-AC02-05CH11231 for P.S. C.; LANL Laboratory-Directed Research and Development grant 20100034DR and the US Defense Threat Reduction Agency grants B104153I and B084531I to P.S.C.; Research Foundation - Flanders (FWO) grant to K.F. and J.Raes; R.K. is an HHMI Early Career Scientist; Gordon&BettyMoore Foundation funding and institutional funding fromthe J. David Gladstone Institutes to K.S.P.; A.M.S. was supported by fellowships provided by the Rackham Graduate School and the NIH Molecular Mechanisms in Microbial Pathogenesis Training Grant T32AI007528; a Crohn’s and Colitis Foundation of Canada Grant in Aid of Research to E.A.V.; 2010 IBM Faculty Award to K.C.W.; analysis of the HMPdata was performed using National Energy Research Scientific Computing resources, the BluBioU Computational Resource at Rice University

The James Webb Space Telescope

The James Webb Space Telescope (JWST) is a large (6.6m), cold (50K), infrared-optimized space observatory that will be launched early in the next decade. The observatory will have four instruments: a near-infrared camera, a near-infrared multi-object spectrograph, and a tunable filter imager will cover the wavelength range, 0.6 to 5.0 microns, while the mid-infrared instrument will do both imaging and spectroscopy from 5.0 to 29 microns. The JWST science goals are divided into four themes. The End of the Dark Ages: First Light and Reionization theme seeks to identify the first luminous sources to form and to determine the ionization history of the early universe. The Assembly of Galaxies theme seeks to determine how galaxies and the dark matter, gas, stars, metals, morphological structures, and active nuclei within them evolved from the epoch of reionization to the present day. The Birth of Stars and Protoplanetary Systems theme seeks to unravel the birth and early evolution of stars, from infall on to dust-enshrouded protostars to the genesis of planetary systems. The Planetary Systems and the Origins of Life theme seeks to determine the physical and chemical properties of planetary systems including our own, and investigate the potential for the origins of life in those systems. To enable these observations, JWST consists of a telescope, an instrument package, a spacecraft and a sunshield. The telescope consists of 18 beryllium segments, some of which are deployed. The segments will be brought into optical alignment on-orbit through a process of periodic wavefront sensing and control. The JWST operations plan is based on that used for previous space observatories, and the majority of JWST observing time will be allocated to the international astronomical community through annual peer-reviewed proposal opportunities.Comment: 96 pages, including 48 figures and 15 tables, accepted by Space Science Review

A Helicopter Observation Platform for Atmospheric Boundary Layer Studies

<p>Spatial variability of the Earth's surface has a considerable impact on the atmosphere at all scales and understanding the mechanisms involved in land-atmosphere interactions is hindered by the scarcity of appropriate observations. A measurement gap exists between traditional point sensors and large aircraft and satellite-based sensors in collecting measurements of atmospheric quantities. Point sensors are capable of making long time series of measurements, but cannot make measurements of spatial variability. Large aircraft and satellites make measurements over large spatial areas, but with poor spatial and temporal resolution. A helicopter-based platform can make measurements on scales relevant for towers, especially close to the Earth's surface, and can extend these measurements to account for spatial variability. Thus, the Duke University Helicopter Observation Platform (HOP) is designed to fill the existing measurement gap. </p><p>Because measurements must be made in such a way that they are as uncontaminated by the platform itself as much as is possible, it is necessary to quantify the aerodynamic envelope of the HOP. The results of an analytical analysis of the location of the main rotor wake at various airspeeds are shown. Similarly, the results of a numerical analysis using the commercial Computational Fluid Dynamics software Fluent are shown. The optimal flight speed for the sampling of turbulent fluxes is found to be around 30 m/s. At this airspeed, the sensors located in front of the nose of the HOP are in advance of the wake generated by the main rotor. This airspeed is also low enough that the region of high pressure due to the stagnation point on the nose of the HOP does not protrude far enough forward to affect the sensors. Measurements of differential pressures, variables and turbulent fluxes made while flying the HOP at different airspeeds support these results. No systematic effects of the platform are seen at airspeeds above about 10 m/s.</p><p>Processing of HOP data collected using the current set of sensors is discussed, including the novel use of the Empirical Mode Decomposition (EMD) to detrend and filter the data. The EMD separates the data into a finite number of Impirical Mode Functions (IMFs), each of which is unique and orthogonal. The basis is determined by the data itself, so that it need not be known a priori, and it is adaptive. The EMD is shown to be an ideal tool for the filtering and detrending of HOP data using data gathered during the Cloud and Land Surface Interaction Campaign (CLASIC). </p><p>The ability of the HOP to accurately measure atmospheric profiles of potential temperature is demonstrated. During experiments conducted in the marine boundary layer (MBL) and the convective boundary layer (CBL), HOP profiles are evaluated using profiles from an elastic backscatter lidar. The HOP and the lidar agree on the height of the boundary layer in both cases, and the HOP effectively locates other atmospheric structures.</p><p>Atmospheric sensible and latent heat fluxes, turbulence kinetic energy (TKE) and horizontal momentum fluxes are also measured, and the resulting information is used to provide context to tower-based data collected concurrently. A brief comparison made over homogeneous ocean conditions yields good results. A more exhaustive evaluation is made using short HOP flights made over an orchard during the Canopy Horizontal Turbulence Study (CHATS).</p>Dissertatio

Imagining realism: Strategies for reform in the late-Victorian and Edwardian drama of the West End

In the period 1890-1914, such playwrights as G. B. Shaw, Oscar Wilde, Harley Granville Barker, Henry Arthur Jones, and Elizabeth Robins led a movement to revive the drama as an intellectual art: these playwrights sought to create a theater that could treat social and political issues and themes hitherto banned from (or limited in treatment on) the public stage while at the same time retaining the theater\u27s hold over a popular audience. In the case of Jones, Wilde, and Shaw, each playwright would revise his early style to create plays that had strong ties to more traditional popular dramas but which nonetheless offered a critique of those older, expected forms. Despite the severe limitations in the theater, dramatists had room for experimentation in the relation of genre to the mise en scene. The nineteenth-century theater had been notable for its preference for fantasy genres, such as melodrama and farcical comedy; at the same time, however, the audience maintained an appetite for realism in the staging of plays. It is in this seeming opposition of dramatic form and theatrical realization, the mechanistic and fantastic versus the hyper-real, that the innovators of this period could find a way to change the older drama while working within it. Victorian stage realism was in fact carefully contained within generic structures that artificially solved social problems depicted in the plays. Wilde, Jones, and Shaw would all manipulate conventions of genre and scenic effect in order to make overt the problem of defining the real in the theater. On another front, their critical and theoretical writings analyzed this troublesome connection between the worlds on-and off-stage, and were intended to change the way audiences viewed plays by providing a critical frame. The Edwardian playwrights also faced the problem of enforced generic continuity, and some of them, particularly St. John Hankin, Harley Granville Barker, and John Galsworthy, would use the continuing popularity of realism to undermine melodramatic structure. Often the settings of their plays, in their mannered distortion of traditional representative scenes, alter the desires of the audience for generic conformity

Processing Turbulence Data Collected on board the Helicopter Observation Platform (HOP) with the Empirical Mode Decomposition (EMD) Method

Abstract The Duke University Helicopter Observation Platform (HOP) has previously been shown to be a useful instrument for the measurement of turbulent atmospheric fluxes. As with all such measurements, especially those made from moving platforms, spurious signals, such as instrument noise and mesoscale atmospheric motions, are superposed on the desired signal. Empirical mode decomposition (EMD) is applied in a novel way to identify and separate out different signals represented by intrinsic mode functions (IMFs) in the HOP data and is shown to be an effective tool for the task. The method produces a basis that is adaptive, unique, and orthogonal, all of which are required for this type of data processing, and none of which are present in more traditional techniques. The results of applying EMD are shown to be nonlinear, and occasionally the removal of the correct number of IMFs increases the observed value of energy and fluxes calculated with the eddy correlation technique