Renal angiomyolipoma presenting with massive retroperitoneal haemorrhage due to deranged clotting factors: a case report

BACKGROUND: Angiomyolipomata of the kidney are unusual lesions composed of abnormal vasculature, smooth muscle, and adipose elements. They may be associated with tuberous sclerosis and occasionally present with flank pain, a palpable mass, and gross haematuria. As angiomyolipomata grow their risk of bleeding increases, with a greater than 50% chance of significant bleeding in lesions > 4 cm; anticoagulant therapy accentuates this risk. CASE PRESENTATION: A case of massive retroperitoneal haemorrhage in a patient on warfarin is presented. The underlying diagnosis of renal angiomyolipoma was diagnosed based on CT findings. Emergency resuscitation and selective interpolar arterial embolization was performed which saved the patient's life as well as his kidney. CONCLUSION: This case illustrates the clinical scenario of massive retroperitoneal haemorrhage in an anticoagulated patient with renal angiomyolipomata. In the emergent situation, adequate resuscitation along ABC principles, as well as control of haemorrhage with either nephrectomy (partial or radical), non-selective renal arterial embolization, or selective embolization of the feeding vessel(s), is necessary. For this to occur, it is imperative to consider the diagnosis early in warfarinized patients (and others at risk of bleeding) who present with abdominal pain. The authors hope this case report highlights to readers the clinical scenario of massive retroperitoneal haemorrhage in anticoagulated patients with renal angiomyolipomata so that they can deal appropriately with such presentations

Accreting Black Holes

This chapter provides a general overview of the theory and observations of black holes in the Universe and on their interpretation. We briefly review the black hole classes, accretion disk models, spectral state classification, the AGN classification, and the leading techniques for measuring black hole spins. We also introduce quasi-periodic oscillations, the shadow of black holes, and the observations and the theoretical models of jets.Comment: 41 pages, 18 figures. To appear in "Tutorial Guide to X-ray and Gamma-ray Astronomy: Data Reduction and Analysis" (Ed. C. Bambi, Springer Singapore, 2020). v3: fixed some typos and updated some parts. arXiv admin note: substantial text overlap with arXiv:1711.1025

The effects of high density on the X-ray spectrum reflected from accretion discs around black holes

Current models of the spectrum of X-rays reflected from accretion discs around black holes and other compact objects are commonly calculated assuming that the density of the disc atmosphere is constant within several Thomson depths from the irradiated surface. An important simplifying assumption of these models is that the ionization structure of the gas is completely specified by a single, fixed value of the ionization parameter $\xi$, which is the ratio of the incident flux to the gas density. The density is typically fixed at $n_\text{e}$ = 10$^{15}$ cm$^{−3}$. Motivated by observations, we consider higher densities in the calculation of the reflected spectrum. We show by computing model spectra for $n_\text{e}$ $\gtrsim$ 10$^{17}$ cm$^{−3}$ that high-density effects significantly modify reflection spectra. The main effect is to boost the thermal continuum at energies $\lesssim$2 keV. We discuss the implications of these results for interpreting observations of both active galactic nuclei and black hole binaries. We also discuss the limitations of our models imposed by the quality of the atomic data currently available.JG and JEM acknowledge the support of a CGPS grant from the Smithsonian Institution. ACF acknowledges ERC Advanced Grant 340442 Feedback. JFS has been supported by the Einstein Fellowship grant PF5-160144

Crew Resource Management for Automated Teammates (CRM-A)

Crew Resource Management (CRM) is the application of human factors knowledge and skills to ensure that teams make effective use of all resources. This includes ensuring that pilots bring in opinions of other teammates and utilize their unique capabilities. CRM was originally developed 40 years ago in response to a number of airline accidents in which the crew was found to be at fault. The goal was to improve teamwork among airline cockpit crews. The notion of "team" was later expanded to include cabin crew and ground resources. CRM has also been adopted by other industries, most notably medicine. Automation research now finds itself faced with similar issues to those faced by aviation 40 years ago: how to create a more robust system by making full use of both the automation and its human operators. With advances in machine intelligence, processing speed and cheap and plentiful memory, automation has advanced to the point that it can and should be treated as a teammate to fully take advantage of its capabilities and contributions to the system. This area of research is known as Human-Autonomy Teaming (HAT). Research on HAT has identified reusable patterns that can be applied in a wide range of applications. These patterns include features such as bi-directional communication and working agreements. This paper will explore the synergies between CRM and HAT. We believe that HAT research has much to learn from CRM and that there are benefits to expanding CRM to cover automation

Transoral laser microsurgery for laryngeal cancer: A primer and review of laser dosimetry

Transoral laser microsurgery (TLM) is an emerging technique for the management of laryngeal and other head and neck malignancies. It is increasingly being used in place of traditional open surgery because of lower morbidity and improved organ preservation. Since the surgery is performed from the inside working outward as opposed to working from the outside in, there is less damage to the supporting structures that lie external to the tumor. Coupling the laser to a micromanipulator and a microscope allows precise tissue cutting and hemostasis; thereby improving visualization and precise ablation. The basic approach and principles of performing TLM, the devices currently in use, and the associated dosimetry parameters will be discussed. The benefits of using TLM over conventional surgery, common complications and the different settings used depending on the location of the tumor will also be discussed. Although the CO2 laser is the most versatile and the best-suited laser for TLM applications, a variety of lasers and different parameters are used in the treatment of laryngeal cancer. Improved instrumentation has lead to an increased utilization of TLM by head and neck cancer surgeons and has resulted in improved outcomes. Laser energy levels and spot size are adjusted to vary the precision of cutting and amount of hemostasis obtained

[11C]-DPA-713 and [18F]-DPA-714 as New PET Tracers for TSPO: A Comparison with [11C]-(R)-PK11195 in a Rat Model of Herpes Encephalitis

Background: Activation of microglia cells plays an important role in neurological diseases. Positron emission tomography (PET) with [C-11]-(R)-PK11195 has already been used to visualize activated microglia cells in neurological diseases. However, [C-11]-(R)-PK11195 may not possess the required sensitivity to visualize mild neuroinflammation. In this study, we evaluated the PET tracers [C-11]-DPA-713 and [F-18]-DPA-714 as agents for imaging of activated microglia in a rat model of herpes encephalitis. Materials and Methods: Rats were intranasally inoculated with HSV-1. On day 6 or 7 after inoculation, small animal PET studies were performed to compare [C-11]-(R)-PK11195, [C-11]-DPA-713, and [F-18]-DPA-714. Results: Uptake of [C-11]-DPA-713 in infected brain areas was comparable to that of [C-11]-(R)-PK11195, but [C-11]-DPA-713 showed lower non-specific binding. Non-specific uptake of [F-18]-DPA-714 was lower than that of [C-11]-(R)-PK11195. In the infected brain, total [F-18]-DPA-714 uptake was lower than that of [C-11]-(R)-PK11195, with comparable specific uptake. Conclusions: [C-11]-DPA-713 may be more suitable for visualizing mild inflammation than [C-11]-(R)-PK11195. In addition, the fact that [F-18]-DPA-714 is an agonist PET tracer opens new possibilities to evaluate different aspects of neuroinflammation. Therefore, both tracers warrant further investigation in animal models and in a clinical setting

Computer-aided dermoscopy for diagnosis of melanoma

BACKGROUND: Computer-aided dermoscopy using artificial neural networks has been reported to be an accurate tool for the evaluation of pigmented skin lesions. We set out to determine the sensitivity and specificity of a computer-aided dermoscopy system for diagnosis of melanoma in Iranian patients. METHODS: We studied 122 pigmented skin lesions which were referred for diagnostic evaluation or cosmetic reasons. Each lesion was examined by two clinicians with naked eyes and all of their clinical diagnostic considerations were recorded. The lesions were analyzed using a microDERM(® )dermoscopy unit. The output value of the software for each lesion was a score between 0 and 10. All of the lesions were excised and examined histologically. RESULTS: Histopathological examination revealed melanoma in six lesions. Considering only the most likely clinical diagnosis, sensitivity and specificity of clinical examination for diagnosis of melanoma were 83% and 96%, respectively. Considering all clinical diagnostic considerations, the sensitivity and specificity were 100% and 89%. Choosing a cut-off point of 7.88 for dermoscopy score, the sensitivity and specificity of the score for diagnosis of melanoma were 83% and 96%, respectively. Setting the cut-off point at 7.34, the sensitivity and specificity were 100% and 90%. CONCLUSION: The diagnostic accuracy of the dermoscopy system was at the level of clinical examination by dermatologists with naked eyes. This system may represent a useful tool for screening of melanoma, particularly at centers not experienced in the field of pigmented skin lesions

Antiepileptic drugs’ tolerability and safety – a systematic review and meta-analysis of adverse effects in dogs

<p>Various anti-epileptic drugs (AEDs) are used for the management of idiopathic epilepsy (IE) in dogs. Their safety profile is an important consideration for regulatory bodies, owners and prescribing clinicians. However, information on their adverse effects still remains limited with most of it derived from non-blinded non-randomized uncontrolled trials and case reports.</p><p><span>This poster won third place, which was presented at the Veterinary Evidence Today conference, Edinburgh November 1-3, 2016. </span></p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /