Case Presentation for Hypertrophic Cardiomyopathy

CASE HISTORY: The patient is a 21-year-old African American male basketball player. The patient has been involved with sports and athletics since his elementary years without suffering any cardiovascular issues. The patient had no significant issues in his medical history including any heart-related problems in his past. PHYSICAL EXAM: The patient initially presented no significant findings regarding his physical health until pre-participation exams identified cardiac abnormalities. DIFFERENTIAL DIAGNOSES: Hypertrophic cardiomyopathy; myocarditis, coronary artery disease; mitral valve prolapse; aortic stenosis. TESTS & RESULTS: The patient had an EKG and echocardiogram done, which detected hypertrophic cardiomyopathy. FINAL DIAGNOSIS: Hypertrophic cardiomyopathy. DISCUSSION: Hypertrophic cardiomyopathy(HCM) is a condition of the heart characterized by the thickening of the interventricular septum. Sudden cardiac death due to HCM-related causes is most prevalent in young African-American male athletes. Most patients with risk factors in these categories are strongly recommended to abstain from participating in sports with high physical demands. This case presents a 21-year-old African-American male athlete playing Division 1 basketball diagnosed with HCM, that did not report any symptoms related to a cardiac illness. OUTCOME OF THE CASE: Considering the athlete’s medical history, and understanding the probabilities of a HCM-related episode occurring, the decision was made to implant an ICD prior to returning to athletic participation. An ICD is an Implantable Cardioverter Defibrillator, which is a device embedded underneath the skin to record and track the heartbeat. If the ICD detects an irregular heart rhythm, it will send an electrical shock to restore the heart’s normal activity. The patient had the ICD implanted and returned to full participation by the start of the basketball season. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: He visited the cardiologist for a follow-up 6 months after the ICD implantation. Other treatments included periodic BP and pulse rate monitoring during physical activity and gradual physical conditioning before the preseason started

Wind Symphony

Bone Student Center Ballroom Sunday Afternoon October 7, 1997 3:00 p.m

Characteristics and treatments of large cystic brain metastasis: radiosurgery and stereotactic aspiration.

Brain metastasis represents one of the most common causes of intracranial tumors in adults, and the incidence of brain metastasis continues to rise due to the increasing survival of cancer patients. Yet, the development of cystic brain metastasis remains a relatively rare occurrence. In this review, we describe the characteristics of cystic brain metastasis and evaluate the combined use of stereotactic aspiration and radiosurgery in treating large cystic brain metastasis. The results of several studies show that stereotactic radiosurgery produces comparable local tumor control and survival rates as other surgery protocols. When the size of the tumor interferes with radiosurgery, stereotactic aspiration of the metastasis should be considered to reduce the target volume as well as decreasing the chance of radiation induced necrosis and providing symptomatic relief from mass effect. The combined use of stereotactic aspiration and radiosurgery has strong implications in improving patient outcomes

Loyalty Among Relationally Oriented Customers: Not Just an Issue of Managing Satisfaction: Working Paper Series--02-27

This paper explores empirically the relative impacts of satisfaction, brand community, and consumer experience on customer loyalty as expressed by future purchase intentions. Data drawn from qualitative research and a survey of relationally-oriented customers in a casino setting indicate that satisfaction yields to brand community as a key driver of loyalty. Important implications of this research for theory as well as marketing practice are discussed

Exploring Planets with Directed Aerial Robot Explorers

Global Aerospace Corporation (GAC) is developing a revolutionary system architecture for exploration of planetary atmospheres and surfaces from atmospheric altitudes. The work is supported by the NASA Institute for Advanced Concepts (NIAC). The innovative system architecture relies upon the use of Directed Aerial Robot Explorers (DAREs), which essentially are long-duration-flight autonomous balloons with trajectory control capabilities that can deploy swarms of miniature probes over multiple target areas. Balloon guidance capabilities will offer unprecedented opportunities in high-resolution, targeted observations of both atmospheric and surface phenomena. Multifunctional microprobes will be deployed from the balloons once over the target areas, and perform a multitude of functions, such as atmospheric profiling or surface exploration, relaying data back to the balloons or an orbiter. This architecture will enable low-cost, low-energy, long-term global exploration of planetary atmospheres and surfaces. This paper focuses on a conceptual analysis of the DARE architecture capabilities and science applications for Venus, Titan and Jupiter. Preliminary simulations with simplified atmospheric models show that a relatively small trajectory control wing can enable global coverage of the atmospheres of Venus and Titan by a single balloon over a 100-day mission. This presents unique opportunities for global in situ sampling of the atmospheric composition and dynamics, atmospheric profiling over multiple sites with small dropsondes and targeted deployment of surface microprobes. At Jupiter, path guidance capabilities of the DARE platforms permits targeting localized regions of interest, such as "hot spots" or the Great Red Spot. A single DARE platform at Jupiter can sample major types of the atmospheric flows (zones and belts) over a 100-day mission. Observations by deployable probes would reveal if the differences exist in radiative, dynamic and compositional environments at these sites

Do changes in health reveal the possibility of undiagnosed pancreatic cancer? Development of a risk-prediction model based on healthcare claims data.

Background and objectiveEarly detection methods for pancreatic cancer are lacking. We aimed to develop a prediction model for pancreatic cancer based on changes in health captured by healthcare claims data.MethodsWe conducted a case-control study on 29,646 Medicare-enrolled patients aged 68 years and above with pancreatic ductal adenocarcinoma (PDAC) reported to the Surveillance Epidemiology an End Results (SEER) tumor registries program in 2004-2011 and 88,938 age and sex-matched controls. We developed a prediction model using multivariable logistic regression on Medicare claims for 16 risk factors and pre-diagnostic symptoms of PDAC present within 15 months prior to PDAC diagnosis. Claims within 3 months of PDAC diagnosis were excluded in sensitivity analyses. We evaluated the discriminatory power of the model with the area under the receiver operating curve (AUC) and performed cross-validation by bootstrapping.ResultsThe prediction model on all cases and controls reached AUC of 0.68. Excluding the final 3 months of claims lowered the AUC to 0.58. Among new-onset diabetes patients, the prediction model reached AUC of 0.73, which decreased to 0.63 when claims from the final 3 months were excluded. Performance measures of the prediction models was confirmed by internal validation using the bootstrap method.ConclusionModels based on healthcare claims for clinical risk factors, symptoms and signs of pancreatic cancer are limited in classifying those who go on to diagnosis of pancreatic cancer and those who do not, especially when excluding claims that immediately precede the diagnosis of PDAC

Traumatic Endophthalmitis due to Cellulosimicrobium cellulans

Purpose. To report a case of traumatic endophthalmitis due to Cellulosimicrobium cellulans. Design. Case report. Methods. Retrospective chart review. Results. To our knowledge, this is the first report of traumatic endophthalmitis due to C. cellulans, which did not respond to intravitreal antibiotics or repeat vitrectomy and ultimately led to the discovery of an occult intraocular foreign body. Conclusions. C. cellulans is a rare cause of endophthalmitis. Greater awareness of this bacterium in the ophthalmic literature as a cause of endophthalmitis and its association with foreign bodies may allow earlier and more purposeful intervention in future cases

Ambiguity Aversion and Household Portfolio Choice Puzzles: Empirical Evidence

We test the relation between ambiguity aversion and five household portfolio choice puzzles: nonparticipation in equities, low allocations to equity, home-bias, own-company stock ownership, and portfolio under-diversification. In a representative US household survey, we measure ambiguity preferences using custom-designed questions based on Ellsberg urns. As theory predicts, ambiguity aversion is negatively associated with stock market participation, the fraction of financial assets in stocks, and foreign stock ownership, but it is positively related to own-company stock ownership. Conditional on stock ownership, ambiguity aversion is related to portfolio under-diversification, and during the financial crisis, ambiguity-averse respondents were more likely to sell stocks

Aberrant oligodendroglial-vascular interactions disrupt the blood-brain barrier, triggering CNS inflammation.

Disruption of the blood-brain barrier (BBB) is critical to initiation and perpetuation of disease in multiple sclerosis (MS). We report an interaction between oligodendroglia and vasculature in MS that distinguishes human white matter injury from normal rodent demyelinating injury. We find perivascular clustering of oligodendrocyte precursor cells (OPCs) in certain active MS lesions, representing an inability to properly detach from vessels following perivascular migration. Perivascular OPCs can themselves disrupt the BBB, interfering with astrocyte endfeet and endothelial tight junction integrity, resulting in altered vascular permeability and an associated CNS inflammation. Aberrant Wnt tone in OPCs mediates their dysfunctional vascular detachment and also leads to OPC secretion of Wif1, which interferes with Wnt ligand function on endothelial tight junction integrity. Evidence for this defective oligodendroglial-vascular interaction in MS suggests that aberrant OPC perivascular migration not only impairs their lesion recruitment but can also act as a disease perpetuator via disruption of the BBB

Long-term safety study of infliximab in moderate-to-severe chronic obstructive pulmonary disease

SummaryRationaleThere was an increased number of malignancies in infliximab-treated (5.7%) over placebo-treated (1.3%) patients in a 44-week, phase 2 clinical study of 234 patients with moderate-to-severe chronic obstructive pulmonary disease (COPD).ObjectivesTo collect malignancy and mortality data from completed clinical studies of infliximab in COPD treatment.MethodsThe multicenter, observational Remicade Safety Under Long-Term Study in COPD (RESULTS COPD) collected malignancy and mortality data every six months for five years from patients who received ≥1 study-agent dose in a phase 2 study. Co-primary endpoints were the number of patients with malignancy and the number of deaths. Secondary endpoints included the number of patients with a malignancy according to malignancy type.ResultsThere was a gap period between the end of the phase 2 study and the initiation of RESULTS COPD, during which six malignancies and 14 deaths were reported spontaneously for the 107 (45.7%) of 234 patients with long-term safety information. Twenty-eight patients (overall 12.0%; placebo 10.4%, infliximab 12.7%) reported malignancies, including 12 patients during RESULTS COPD. Twenty-six patients (overall 11.1%; placebo 9.1%, infliximab 12.1%) died, including nine during RESULTS COPD. Lung cancer was the most common malignancy type (placebo n = 2; infliximab n = 10).ConclusionsThe greater proportion of malignancies observed with infliximab versus placebo in a phase 2 study diminished over the long-term follow-up. Due to the observational nature, limited patient participation, potential reporting bias from the interim spontaneous reporting period, and unblinding of all patients, more definitive conclusions cannot be drawn.Trial Registration Number: NCT00056264