Splenic Artery Embolization for Idiopathic Warm Autoimmune Hemolytic Anemia Refractory to Medical Therapy

Purpose: While Partial Splenic Artery Embolization (PSAE) is a useful procedure that has been performed for a variety of indications including trauma and hypersplenism, it has been rarely described as a treatment for Idiopathic warm Autoimmune Hemolytic Anemia (AIHA). Previous reports in the literature are limited to case reports in situations that include the patient being a poor surgical candidate, the inability to transfuse blood during surgery because of autoantibodies, and a patient\u27s refusal of blood products on religious grounds. The purpose of this study is to demonstrate the utility of PSAE in the acute management of AIHA refractory to medical treatment. Materials: A case report describing the management of a 27-year-old male diagnosed with AIHA treated successfully with PSAE as a bridging therapy to definitive surgical splenectomy. Relevant laboratory results and imaging were extracted from the electronic medical record. Results: The patient was diagnosed with AIHA and treated with intravenous solumedrol and rituximab and received 12 units of RBCs at an outside institution. The patient was transferred to our institution after developing antibodies that precluded more transfusions. The decision was made to proceed with PSAE. The first hemoglobin post-procedure was 4.5 g/dl, an increase from 2.1 g/dl pre-procedure. After embolization, the patient remained in the inpatient setting for eight days. During the inpatient hospitalization the patient\u27s hemoglobin continued to trend upwards until it stabilized around 6 g/dl. Inpatient laboratory workup showed increasing haptoglobin, and decreasing LDH. After discharge, the patient developed persistent pain two months post-procedure. An elective splenectomy was scheduled three months after the embolization procedure to address the persistent pain. Six months post embolization procedure and three months postoperatively, the patient is doing well clinically with a hemoglobin of 14 g/dl. Conclusions: In conclusion, this case demonstrates the utility of PSAE as an acute life-saving intervention for poor surgical candidates with idiopathic warm AIHA refractory to medical management.https://scholarlycommons.henryford.com/merf2020caserpt/1047/thumbnail.jp

Postural Changes in Blood Pressure Associated with Interactions between Candidate Genes for Chronic Respiratory Diseases and Exposure to Particulate Matter

BACKGROUND. Fine particulate matter [aerodynamic diameter ≤ 2.5 μm (PM2.5)] has been associated with autonomic dysregulation. OBJECTIVE. We hypothesized that PM2.5 influences postural changes in systolic blood pressure (ΔSBP) and in diastolic blood pressure (ΔDBP) and that this effect is modified by genes thought to be related to chronic lung disease. METHODS. We measured blood pressure in participants every 3-5 years. ΔSBP and ΔDBP were calculated as sitting minus standing SBP and DBP. We averaged PM2.5 over 48 hr before study visits and analyzed 202 single nucleotide polymorphisms (SNPs) in 25 genes. To address multiple comparisons, data were stratified into a split sample. In the discovery cohort, the effects of SNP x PM2.5 interactions on ΔSBP and ΔDBP were analyzed using mixed models with subject-specific random intercepts. We defined positive outcomes as p < 0.1 for the interaction; we analyzed only these SNPs in the replicate cohort and confirmed them if p < 0.025 with the same sign. Confirmed associations were analyzed within the full cohort in models adjusted for anthropometric and lifestyle factors. RESULTS. Nine hundred forty-five participants were included in our analysis. One interaction with rs9568232 in PHD finger protein 11 (PHF11) was associated with greater ΔDBP. Interactions with rs1144393 in matrix metalloprotease 1 (MMP1) and rs16930692, rs7955200, and rs10771283 in inositol 1,4,5-triphosphate receptor, type 2 (ITPR2) were associated with significantly greater ΔSBP. Because SNPs associated with ΔSBP in our analysis are in genes along the renin-angiotensin pathway, we then examined medications affecting that pathway and observed significant interactions for angiotensin receptor blockers but not angiotensin-converting enzyme inhibitors with PM2.5. CONCLUSIONS. PM2.5 influences blood pressure and autonomic function. This effect is modified by genes and drugs that also act along this pathway.National Institute of Environmental Health Sciences (T32 ES07069, ES0002, ES015172-01, ES014663, P01 ES09825); United States Environmental Protection Agency (R827353, R832416); National Institutes of Health/National Institute of Aging (AG027014); United States Department of Veterans Affairs; Massachusetts Veterans Epidemiology Research and Information Cente

Accuracy of one-dimensional collision integral in the rigid spheres approximation

The accuracy of calculation of spectral line shapes in one-dimensional approximation is studied analytically in several limiting cases for arbitrary collision kernel and numerically in the rigid spheres model. It is shown that the deviation of the line profile is maximal in the center of the line in case of large perturber mass and intermediate values of collision frequency. For moderate masses of buffer molecules the error of one-dimensional approximation is found not to exceed 5%.Comment: LaTeX, 24 pages, 8 figure

Extension of Bogoliubov theory to quasi-condensates

We present an extension of the well-known Bogoliubov theory to treat low dimensional degenerate Bose gases in the limit of weak interactions and low density fluctuations. We use a density-phase representation and show that a precise definition of the phase operator requires a space discretisation in cells of size $l$. We perform a systematic expansion of the Hamiltonian in terms of two small parameters, the relative density fluctuations inside a cell and the phase change over a cell. The resulting macroscopic observables can be computed in one, two and three dimensions with no ultraviolet or infrared divergence. Furthermore this approach exactly matches Bogoliubov's approach when there is a true condensate. We give the resulting expressions for the equation of state of the gas, the ground state energy, the first order and second order correlations functions of the field. Explicit calculations are done for homogeneous systems.Comment: 32 pages, 2 figures; typos corrected in revised versio

Simple Metals at High Pressure

In this lecture we review high-pressure phase transition sequences exhibited by simple elements, looking at the examples of the main group I, II, IV, V, and VI elements. General trends are established by analyzing the changes in coordination number on compression. Experimentally found phase transitions and crystal structures are discussed with a brief description of the present theoretical picture.Comment: 22 pages, 4 figures, lecture notes for the lecture given at the Erice course on High-Pressure Crystallography in June 2009, Sicily, Ital

Stimulus-dependent maximum entropy models of neural population codes

Neural populations encode information about their stimulus in a collective fashion, by joint activity patterns of spiking and silence. A full account of this mapping from stimulus to neural activity is given by the conditional probability distribution over neural codewords given the sensory input. To be able to infer a model for this distribution from large-scale neural recordings, we introduce a stimulus-dependent maximum entropy (SDME) model---a minimal extension of the canonical linear-nonlinear model of a single neuron, to a pairwise-coupled neural population. The model is able to capture the single-cell response properties as well as the correlations in neural spiking due to shared stimulus and due to effective neuron-to-neuron connections. Here we show that in a population of 100 retinal ganglion cells in the salamander retina responding to temporal white-noise stimuli, dependencies between cells play an important encoding role. As a result, the SDME model gives a more accurate account of single cell responses and in particular outperforms uncoupled models in reproducing the distributions of codewords emitted in response to a stimulus. We show how the SDME model, in conjunction with static maximum entropy models of population vocabulary, can be used to estimate information-theoretic quantities like surprise and information transmission in a neural population.Comment: 11 pages, 7 figure

Neutrino Exotica in the Skew E_6 Left-Right Model

With the particle content of the 27 representation of E_6, a skew left-right supersymmetric gauge model was proposed many years ago, with a variety of interesting phenomenological implications. The neutrino sector of this model offers a natural framework for obtaining small Majorana masses for nu_e, nu_mu, and nu_tau, with the added bonus of accommodating 2 light sterile neutrinos.Comment: 12 pages, no figure, conclusion clarifie