Second trimester hepatic rupture in a 35 year old nulliparous woman with HELLP syndrome: a case report

The HELLP syndrome (haemolysis, elevated liver blood tests and low platelets) is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. Hepatic capsular rupture is a rare yet dramatic complication of HELLP syndrome. The majority of cases occur in multiparous women over the age of 30. Classically it presents with acute onset right upper quadrant pain in the presence of constitutional symptoms such as vomiting and pyrexia. However, symptoms and signs are usually non specific. Spontaneous hepatic rupture can be preceded by signs of hypovolaemic shock; yet the diagnosis is infrequently made prior to emergent laparotomy. We present the case of a 35 year old nulliparous woman with a second trimester gestational hepatic rupture associated with HELLP syndrome. We briefly discuss the aetiology, diagnostic difficulties and treatment options associated with this rare presentation

Biophysical controls of marsh soil shear strength along an estuarine salinity gradient

Sea-level rise, saltwater intrusion, and wave erosion threaten coastal marshes, but the influence of salinity on marsh erodibility remains poorly understood. We measured the shear strength of marsh soils along a salinity and biodiversity gradient in the York River estuary in Virginia to assess the direct and indirect im-pacts of salinity on potential marsh erodibility. We found that soil shear strength was higher in monospecific salt marshes (5–36 kPa) than in biodiverse freshwater marshes (4–8 kPa), likely driven by differences in below ground biomass. However, we also found that shear strength at the marsh edge was controlled by sediment characteristics, rather than vegetation or salinity, suggesting that inherent relationships may be obscured in more dynamic environments. Our results indicate that York River freshwater marsh soils are weaker than salt marsh soils, and suggest that salinization of these freshwater marshes may lead to simultaneous losses in biodiversity and erodibility

Forgetful maps between Deligne-Mostow ball quotients

We study forgetful maps between Deligne-Mostow moduli spaces of weighted points on P^1, and classify the forgetful maps that extend to a map of orbifolds between the stable completions. The cases where this happens include the Livn\'e fibrations and the Mostow/Toledo maps between complex hyperbolic surfaces. They also include a retraction of a 3-dimensional ball quotient onto one of its 1-dimensional totally geodesic complex submanifolds

Management challenges arising from a traumatic 360 degree cyclodialysis cleft

We describe the case of a 28-year-old naval officer who attended the ophthalmology service following blunt ocular trauma to the left eye. Clinical examination revealed a shallow anterior chamber, hypotony, and a 360° cyclodialysis cleft. We discuss the management options in this case, with an overview of the current literature

Equivariant volumes of non-compact quotients and instanton counting

Motivated by Nekrasov's instanton counting, we discuss a method for calculating equivariant volumes of non-compact quotients in symplectic and hyper-K\"ahler geometry by means of the Jeffrey-Kirwan residue-formula of non-abelian localization. In order to overcome the non-compactness, we use varying symplectic cuts to reduce the problem to a compact setting, and study what happens in the limit that recovers the original problem. We implement this method for the ADHM construction of the moduli spaces of framed Yang-Mills instantons on $\R^{4}$ and rederive the formulas for the equivariant volumes obtained earlier by Nekrasov-Shadchin, expressing these volumes as iterated residues of a single rational function.Comment: 34 pages, 2 figures; minor typos corrected, to appear in Comm. Math. Phy

Co-constructive development of a green chemistry-based model for the assessment of nanoparticles synthesis

Nanomaterials (materials at the nanoscale, 10−9m) are extensively used in several industry sectors due to the improved properties they empower commercial products with. There is a pressing need to produce these materials more sustainably. This paper proposes a Multiple Criteria Decision Aiding (MCDA) approach to assess the implementation of green chemistry principles as applied to the protocols for nanoparticles synthesis. In the presence of multiple green and environmentally oriented criteria, decision aiding is performed with a synergy of ordinal regression methods; preference information in the form of desired assignment for a subset of reference protocols is accepted. The classification models, indirectly derived from such information, are composed of an additive value function and a vector of thresholds separating the pre-defined and ordered classes. The method delivers a single representative model that is used to assess the relative importance of the criteria, identify the possible gains with improvement of the protocol’s evaluations and classify the non-reference protocols. Such precise recommendation is validated against the outcomes of robustness analysis exploiting the sets of all classification models compatible with all maximal subsets of consistent assignment examples. The introduced approach is used with real-world data concerning silver nanoparticles. It is proven to effectively resolve inconsistency in the assignment examples, tolerate ordinal and cardinal measurement scales, differentiate between inter- and intra-criteria attractiveness and deliver easily interpretable scores and class assignments. This work thoroughly discusses the learning insights that MCDA provided during the co-constructive development of the classification model, distinguishing between problem structuring, preference elicitation, learning, modeling and problem-solving stages

Mitochondrial Utilization of Competing Fuels Is Altered in Insulin Resistant Skeletal Muscle of Non-obese Rats (Goto-Kakizaki)

Aim: Insulin-resistant skeletal muscle is characterized by metabolic inflexibility with associated alterations in substrate selection, mediated by peroxisome-proliferator activated receptor δ (PPARδ). Although it is established that PPARδ contributes to the alteration of energy metabolism, it is not clear whether it plays a role in mitochondrial fuel competition. While nutrient overload may impair metabolic flexibility by fuel congestion within mitochondria, in absence of obesity defects at a mitochondrial level have not yet been excluded. We sought to determine whether reduced PPARδ content in insulin-resistant rat skeletal muscle of a non-obese rat model of T2DM (Goto-Kakizaki, GK) ameliorate the inhibitory effect of fatty acid (i.e., palmitoylcarnitine) on mitochondrial carbohydrate oxidization (i.e., pyruvate) in muscle fibers. Methods: Bioenergetic function was characterized in oxidative soleus (S) and glycolytic white gastrocnemius (WG) muscles with measurement of respiration rates in permeabilized fibers in the presence of complex I, II, IV, and fatty acid substrates. Mitochondrial content was measured by citrate synthase (CS) and succinate dehydrogenase activity (SDH). Western blot was used to determine protein expression of PPARδ, PDK isoform 2 and 4. Results: CS and SDH activity, key markers of mitochondrial content, were reduced by ∼10–30% in diabetic vs. control, and the effect was evident in both oxidative and glycolytic muscles. PPARδ (p < 0.01), PDK2 (p < 0.01), and PDK4 (p = 0.06) protein content was reduced in GK animals compared to Wistar rats (N = 6 per group). Ex vivo respiration rates in permeabilized muscle fibers determined in the presence of complex I, II, IV, and fatty acid substrates, suggested unaltered mitochondrial bioenergetic function in T2DM muscle. Respiration in the presence of pyruvate was higher compared to palmitoylcarnitine in both animal groups and fiber types. Moreover, respiration rates in the presence of both palmitoylcarnitine and pyruvate were reduced by 25 ± 6% (S), 37 ± 6% (WG) and 63 ± 6% (S), 57 ± 8% (WG) compared to pyruvate for both controls and GK, respectively. The inhibitory effect of palmitoylcarnitine on respiration was significantly greater in GK than controls (p < 10–3). Conclusion: With competing fuels, the presence of fatty acids diminishes mitochondria ability to utilize carbohydrate derived substrates in insulin-resistant muscle despite reduced PPARδ content

Mass spectrometry based metabolomics comparison of liver grafts from donors after circulatory death (DCD) and donors after brain death (DBD) used in human orthotopic liver transplantation

Use of marginal liver grafts, especially those from donors after circulatory death (DCD), has been considered as a solution to organ shortage. Inferior outcomes have been attributed to donor warm ischaemic damage in these DCD organs. Here we sought to profile the metabolic mechanisms underpinning donor warm ischaemia. Non-targeted Fourier transform ion cyclotron resonance (FT-ICR) mass spectrometry metabolomics was applied to biopsies of liver grafts from donors after brain death (DBD; n = 27) and DCD (n = 10), both during static cold storage (T1) as well as post-reperfusion (T2). Furthermore 6 biopsies from DBD donors prior to the organ donation (T0) were also profiled. Considering DBD and DCD together, significant metabolic differences were discovered between T1 and T2 (688 peaks) that were primarily related to amino acid metabolism, meanwhile T0 biopsies grouped together with T2, denoting the distinctively different metabolic activity of the perfused state. Major metabolic differences were discovered between DCD and DBD during cold-phase (T1) primarily related to glucose, tryptophan and kynurenine metabolism, and in the post-reperfusion phase (T2) related to amino acid and glutathione metabolism. We propose tryptophan/kynurenine and S-adenosylmethionine as possible biomarkers for the previously established higher graft failure of DCD livers, and conclude that the associated pathways should be targeted in more exhaustive and quantitative investigations