Fatal intrahepatic hemorrhage after nadroparin use for total hip arthroplasty.

Low-molecular-weight heparins have become the predominant choice for deep venous thrombosis prophylaxis and treatment. However, their use may cause bleeding complications. Intrahepatic bleeding is exceptional and only very few cases have been described. The authors present a unique case of fatal intrahepatic hematoma complicating nadroparin use in a 65-year-old woman with a hepatic cyst who was admitted to hospital for unilateral total hip arthroplasty. At autopsy, hemoperitoneum (2,000 ml of blood and clots) was evident. A ruptured sub-capsular hematoma involving the right lobe of the liver was observed. The hemorrhage within the cyst induced by the nadroparin use was likely responsible for the subsequent hepatic hematoma, liver rupture, and death. This case highlights the need for pathologists and surgeons to be aware of the possibility of intrahepatic hematoma in patients who have received low-molecular-weight heparins, undergone major surgery and present postoperative hemodynamic instability, especially in those with preoperative diagnosis of hepatic cyst

Worksite influences on obesogenic behaviors in low-wage workers in St Louis, Missouri, 2013-2014

INTRODUCTION: More than one-third of US adults are obese. Workplace programs to reduce obesity and improve overall health are not available or accessible to all workers, particularly low-wage workers among whom obesity is more prevalent. The goal of the study was to identify modifiable workplace factors and behaviors associated with diet and exercise to inform future workplace interventions to improve health. METHODS: We distributed paper and online surveys to 2 groups of low-wage workers, hospital workers and retail sales workers, at the worksites. The surveys assessed obesity, obesogenic behaviors, workplace factors, and worker participation in workplace health programs (WHPs). Descriptive and regression analyses were conducted to examine workplace factors associated with obesogenic behaviors. RESULTS: A total of 529 surveys were completed (219 hospital workers and 310 retail workers). More than 40% of workers were obese and 27% were overweight. In general, workers had poor diets (frequent consumption of sugary and high-fat foods) and engaged in little physical activity (only 30.9% met recommended physical activity guidelines). Access to and participation in workplace health programs varied greatly between hospital and retail sales workers. We identified several modifiable workplace factors, such as food source and work schedule, that were associated with diet, exercise, or participation in workplace health programs. CONCLUSION: This study illustrates the high prevalence of obesity and obesogenic behaviors workers in 2 low-wage groups. The differences between work groups indicated that each group had unique facilitators and barriers to healthy eating and exercise. An understanding of how socioeconomic, demographic, and work-related factors influence health will help to identify high-risk populations for intervention and to design interventions tailored and relevant to the target audiences

Utilización de variables sencillas para identificar embarazadas con riesgo de preeclampsia-eclampsia

Objetivos: evaluar la prevalencia y los factores de riesgo de pre-eclampsia - eclampsia (PE), y analizar la utilidad de variables clínicas para la detección de gestantes de riesgo.Materiales y métodos: estudio retrospectivo de 15.469 partos consecutivos, asistidos el periodo 11-98/07-08. Se definió pre-eclampsia a 2 tomas de tensión arterial de ≥140-90 más proteinuria y eclampsia en presencia de convulsiones con un score de predicción utilizando el número de variables asociadas significativamente con PE en el análisis de regresión logística múltiple.Resultados: identificamos 623 (4%) pacientes con PE. La incidencia de pre-eclampsia por período fue 1.3% (1998-2000), 2.6% (2001-2002), 6.4% (2003-2004) y 5.5% (2004-2008), p<0.001. Las variables asociadas con PE fueron: primípara (OR=2.3, p<0.0001), edad materna ≥35 años (OR=2, p<0.0001), hipertensión arterial previa (OR=2.3, p<0.0001), embarazo múltiple (OR=3.4 p<0.0001), obesidad, (OR=2, p<0.0001), período inter-genésico ≥3 años (OR=1.4, p<0.0001), tabaquismo (OR=2.1, p<0.0001) y aborto previo (OR=1.3, p=0.014). El score de predicción mostró un área bajo la curva COR para diagnóstico de PE de 0.68, IC95%=0.66-0.70. Según definieron los siguientes cuartiles: C1: ninguna; C2: una variable; C3: dos variables y C4: 3 o más variables. La incidencia de PE de C1 a C4 fue: 1, 2.6, 4.3 y 8.9% (p<0.0001). El riesgo de C2 a C4 en comparación con C1 fue 2.6, 4.4 y 9.5 (<0.0001).Conclusiones: la PE se presentó en 4 de 100 partos, con un incremento de su incidencia. La utilización de un score basado en estos criterios de fácil obtención en la evaluación rutinaria del embarazo permitió identificar a gestantes con riesgo de PE

Working precarious careers trajectories: tracing neoliberal discourses in younger workers’ narratives

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. The aim of this article is to explore how, in the context of the post Global Financial Crisis (GFC), some Italian younger workers in a specific geographical region in Italy recount their work trajectories. Drawing on narrative interviews with ten participants (aged between 24 and 30) as part of a research project carried out in the Autonomous region of Aosta Valley in Italy, the article traces discourses closely associated with neoliberalism–the discourses of the entrepreneurial self, employability and self-responsibilisation–through which subjects’ work experiences take shape. Moreover, the analysis highlights how locality, one’s personal relation with the geographical territory, makes more complex the younger people’s negotiations in crafting themselves vis-à-vis precarious employment opportunities and wider socio-economic dynamics in respect of precarious employment opportunities

Coming Out, But Into What? Problematizing Discursive Variations of Revealing the Gay Self in the Workplace

There is a substantial mainstream literature on coming out in organizations, which investigates the positive effects for gay people of being out at work, but very few contributions that challenge the discourse of coming out. Taking as its starting point Butler's famous question ‘So we are out of the closet but into what?’, this paper problematizes coming out discourses in the workplace. We report on a study in which ten men were invited to talk about their coming out in the workplace. There were three main ways through which our participants constituted themselves as gay men when they talked about coming out: by defining themselves as, and admitting to, being gay; by introducing themselves as being in a gay relationship; and by adopting legitimate subject positions such as the Other, the different one, or the normal gay. Through our analysis, discussions and conclusions, we show how participants position themselves within different discursive variations, thus revealing the multiplicity of ‘the gay self’ and highlighting how coming out repeats and supports normative systems

Transcriptomic Responses of the Honey Bee Brain to Infection with Deformed Wing Virus

Managed colonies of European honey bees (Apis mellifera) are under threat from Varroa destructor mite infestation and infection with viruses vectored by mites. In particular, deformed wing virus (DWV) is a common viral pathogen infecting honey bees worldwide that has been shown to induce behavioral changes including precocious foraging and reduced associative learning. We investigated how DWV infection of bees affects the transcriptomic response of the brain. The transcriptomes of individual brains were analyzed using RNA-Seq after experimental infection of newly emerged adult bees with DWV. Two analytical methods were used to identify differentially expressed genes from the ~15,000 genes in the Apis mellifera genome. The 269 genes that had increased expression in DWV infected brains included genes involved in innate immunity such as antimicrobial peptides (AMPs), Ago2, and Dicer. Single bee brain NMR metabolomics methodology was developed for this work and indicates that proline is strongly elevated in DWV infected brains, consistent with the increased presence of the AMPs abaecin and apidaecin. The 1361 genes with reduced expression levels includes genes involved in cellular communication including G-protein coupled, tyrosine kinase, and ion-channel regulated signaling pathways. The number and function of the downregulated genes suggest that DWV has a major impact on neuron signaling that could explain DWV related behavioral changes

Anthracycline-Free Neoadjuvant Treatment in Patients with HER2-Positive Breast Cancer: Real-Life Use of Pertuzumab, Trastuzumab and Taxanes Association with an Exploratory Analysis of PIK3CA Mutational Status

HER2 is considered one of the most traditional prognostic and predictive biomarkers in breast cancer. Literature data confirmed that the addition of pertuzumab to a standard neoadjuvant chemotherapy backbone (either with or without anthracyclines), in patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (EBC), leads to a higher pathological complete response (pCR) rate, which is known to correlate with a better prognosis. In this retrospective analysis, 47 consecutive patients with HER2-positive EBC received sequential anthracyclines and taxanes plus trastuzumab (ATH) or pertuzumab, trastuzumab and docetaxel (THP). Despite the limited sample size, this monocentric experience highlights the efficacy (in terms of pCR) and safety of THP in the neoadjuvant setting of HER2-positive EBC as an anthracycline-free approach. Given the role of PIK3CA as a prognostic and therapeutic target in breast cancer, tumors were also analyzed to assess the PIK3CA mutational status. Thirty-eight out of forty-seven patients were evaluated, and PIK3CA variants were identified in 21% of tumor samples: overall, one mutation was detected in exon 4 (2.6%), two in exon 9 (5.3%) and four in exon 20 (10.5%). Of note, one sample showed concurrent mutations in exons 9 (codon 545) and 20 (codon 1047). Among patients reaching pCR (n = 13), 38.5% were PIK3CA mutants; on the other hand, among those lacking pCR (n = 25), just 12% showed PIK3CA variants. Regarding THP-treated mutant patients (n = 5), 80% reached pCR (three hormone-receptor-negative, one hormone-receptor-positive). Interestingly, the only patient not achieving pCR had a tumor with two co-occurring PIK3CA mutations. In conclusion, this study provides new evidence about the efficacy and good safety profile of THP, compared to the ATH regimen, as an anthracycline-free neoadjuvant treatment of HER2-positive EBC. Further studies on larger/multicentric cohorts are planned for more in-depth analysis to confirm our molecular and clinical results

Cluster J Mycobacteriophages: Intron Splicing in Capsid and Tail Genes

Bacteriophages isolated on Mycobacterium smegmatis mc2155 represent many distinct genomes sharing little or no DNA sequence similarity. The genomes are architecturally mosaic and are replete with genes of unknown function. A new group of genomes sharing substantial nucleotide sequences constitute Cluster J. The six mycobacteriophages forming Cluster J are morphologically members of the Siphoviridae, but have unusually long genomes ranging from 106.3 to 117 kbp. Reconstruction of the capsid by cryo-electron microscopy of mycobacteriophage BAKA reveals an icosahedral structure with a triangulation number of 13. All six phages are temperate and homoimmune, and prophage establishment involves integration into a tRNA-Leu gene not previously identified as a mycobacterial attB site for phage integration. The Cluster J genomes provide two examples of intron splicing within the virion structural genes, one in a major capsid subunit gene, and one in a tail gene. These genomes also contain numerous freestanding HNH homing endonuclease, and comparative analysis reveals how these could contribute to genome mosaicism. The unusual Cluster J genomes provide new insights into phage genome architecture, gene function, capsid structure, gene mobility, intron splicing, and evolution

Synergistic TLR2/6 and TLR9 Activation Protects Mice against Lethal Influenza Pneumonia

Lower respiratory tract infections caused by influenza A continue to exact unacceptable worldwide mortality, and recent epidemics have emphasized the importance of preventative and containment strategies. We have previously reported that induction of the lungs' intrinsic defenses by aerosolized treatments can protect mice against otherwise lethal challenges with influenza A virus. More recently, we identified a combination of Toll like receptor (TLR) agonists that can be aerosolized to protect mice against bacterial pneumonia. Here, we tested whether this combination of synthetic TLR agonists could enhance the survival of mice infected with influenza A/HK/8/68 (H3N2) or A/California/04/2009 (H1N1) influenza A viruses. We report that the TLR treatment enhanced survival whether given before or after the infectious challenge, and that protection tended to correlate with reductions in viral titer 4 d after infection. Surprisingly, protection was not associated with induction of interferon gene expression. Together, these studies suggest that synergistic TLR interactions can protect against influenza virus infections by mechanisms that may provide the basis for novel therapeutics

Uridine Metabolism in HIV-1-Infected Patients: Effect of Infection, of Antiretroviral Therapy and of HIV-1/ART-Associated Lipodystrophy Syndrome

Background Uridine has been advocated for the treatment of HIV-1/HAART-associated lipodystrophy (HALS), although its metabolism in HIV-1-infected patients is poorly understood. Methods Plasma uridine concentrations were measured in 35 controls and 221 HIV-1-infected patients and fat uridine in 15 controls and 19 patients. The diagnosis of HALS was performed following the criteria of the Lipodystrophy Severity Grading Scale. Uridine was measured by a binary gradient-elution HPLC method. Analysis of genes encoding uridine metabolizing enzymes in fat was performed with TaqMan RT-PCR. Results Median plasma uridine concentrations for HIV-1-infected patients were 3.80 µmol/l (interquartile range: 1.60), and for controls 4.60 µmol/l (IQR: 1.8) (P = 0.0009). In fat, they were of 6.0 (3.67), and 2.8 (4.65) nmol/mg of protein, respectively (P = 0.0118). Patients with a mixed HALS form had a median plasma uridine level of 4.0 (IC95%: 3.40-4.80) whereas in those with isolated lipoatrophy it was 3.25 (2.55-4.15) µmol/l/l (P = 0.0066). The expression of uridine cytidine kinase and uridine phosphorylase genes was significantly decreased in all groups of patients with respect to controls. A higher expression of the mRNAs for concentrative nucleoside transporters was found in HIV-1-infected patients with respect to healthy controls. Conclusions HIV-1 infection is associated with a decrease in plasma uridine and a shift of uridine to the adipose tissue compartment. Antiretroviral therapy was not associated with plasma uridine concentrations, but pure lipoatrophic HALS was associated with significantly lower plasma uridine concentrations