Intracranial Hemorrhage and Facial Fractures After Nose Blowing and Sternutation: A Case Report

INTRODUCTION: Blowing the nose and sneezing are ubiquitous physiologic processes. While exceedingly rare, traumatic injuries have been described. We detail a case of spontaneous intracranial hemorrhage and orbital fractures sustained as a result of these two phenomena in an otherwise healthy adult without known risk factors for bleeding or intracranial hemorrhage. CASE REPORT: A 79-year-old female presented to the emergency department after blowing her nose with an episode of sneezing following mild epistaxis. She denied any history of trauma, anticoagulation use, bleeding disorders, or pain associated with her symptoms. On examination, she had notable right periorbital swelling. Computed tomography revealed multiple areas of intracranial hemorrhage along with right-sided orbital and zygomatic fractures. After consulting trauma surgery and neurosurgery, we elected to pursue conservative management with repeat imaging. The patient had an uneventful course and was discharged with outpatient follow-up two days later. CONCLUSION: To our knowledge, this is the first case described of this constellation of injuries after a relatively benign process. Despite not having increased risk factors for intracranial hemorrhage (anticoagulation use, history of trauma, history of coagulopathy), this patient had severe injuries that presented with few external symptoms. This case serves as a reminder that while physiologic processes are almost always benign, serious traumatic injuries can result. Clinicians should have a low threshold for advanced imaging when there is a high clinical suspicion of facial fractures or more ominous processes

Spontaneous Arterial Thrombus and Dissection Associated With Exercise and Exogenous Testosterone Use

Spontaneous lower extremity arterial dissection has been linked to atherosclerotic and non-atherosclerotic causes. A 55-year-old male presented to the emergency department via emergency medical services for a chief complaint of right leg pain. He stated that he was performing leg exercises when he felt a sudden pop in his right leg followed by severe pain. His exam was remarkable for lack of ipsilateral distal popliteal or dorsalis pedis pulse by palpation or doppler. The patient was admitted to a three-year history of non-prescription testosterone injection use along with a history of prior portal vein thrombosis two years prior with anticoagulation noncompliance after one month of therapy. A computed tomography angiography of the lower extremity was performed which demonstrated complete acute occlusion of the right common iliac, and right external iliac, along with right femoral artery dissection. The patient was emergently taken to the operating room with vascular surgery where a thrombectomy with stent placement was performed. After three days in the surgical intensive care unit and nine days in the hospital, the patient was subsequently discharged from the hospital in good condition. A post-operative follow-up appointment three weeks after discharge revealed mild residual pain; however, no issues ambulating or residual weakness, and normal ankle-brachial indexes. This case highlights a unique presentation of acute limb ischemia associated with exogenous testosterone use

Lupus nephritis: Correlation of interstitial cells with glomerular function

Lupus nephritis: Correlation of interstitial cells with glomerular function. Mononuclear inflammatory cells were studied using monoclonal antibodies in the interstitium and glomeruli of 35 renal biopsy specimens from patients with lupus nephritis already taking immunosuppressants. The aims of this study were to assess the composition and significance of the infiltrate, and to assess correlations with immediate glomerular function and ability to predict the future course of the disease. The majority of interstitial cells were T lymphocytes and monocytes/macrophages. The number of interstitial CD4 +ve T helper/ inducer lymphocytes was greater than that of CD8 +ve T cytotoxic/ suppressor cells in only 19 out of 35 biopsies, the mean CD4:CD8 ratio being only 1.5 ± 1.2. NK cells and B lymphocytes were a minor component only. Some expression of IL-2, transferrin and C3b receptors was seen on interstitial cells, but HLA-DR expressing cells were much in excess of controls and the number of tubular cells expressing HLA-DR was also increased. The number of interstitial T cells, CD4 +ve cells and monocytes/macrophages was highly correlated with the extent of chronic damage judged by optical microscopy. There was also an association between glomerular function at biopsy and numbers of interstitial T cells, CD8 +ve cells, monocytes/macrophages and DR expressing cells. Subsequent decline in renal function, however, was associated only with numbers of monocytes/macrophages and the rather small number of C3b receptor-positive cells. The presence of tubulointerstitial immune aggregates of Ig and/or C in 63% of patients was associated with greater numbers of NK cells. As previously described, the degree of renal function at biopsy correlated with a chronicity index based on optical microscopy. No correlations were found between numbers or types (mostly monocyte/macrophages) of intraglomerular leukocytes and clinical or biopsy features, except that more proliferative types showed greater leukocyte numbers. One hypothesis consistent with our findings is that interstitial T cells and monocytes may be important determinants of pathogenesis and progression of lupus nephritis. While several mechanisms may play an initial role, interstitial monocytes may be the major factor in chronic injury

Abstention, Protest, and Residual Votes in the 2016 Election

Objective: We analyze the significant increase in the residual vote rate in the 2016 presidential election. The residual vote rate, which is the percentage of ballots cast in a presidential election that contain no vote for president, rose nationwide from 0.99 to 1.41 percent between 2012 and 2016. Method: We use election return data and public opinion data to examine why the residual vote rate increased in 2016. Results: The primary explanation for this rise is an increase in abstentions, which we argue results primarily from disaffected Republican voters rather than alienated Democratic voters. In addition, other factors related to election administration and electoral competition explain variation in the residual vote rates across states, particularly the use of mail/absentee ballots and the lack of competition at the top of the ticket in nonbattleground states. However, we note that the rise in the residual vote rate was not due to changes in voting technologies. Conclusion: Our research has implications for the use of the residual vote as a metric for studying election administration and voting technologies

An early giant planet instability recorded in asteroidal meteorites

Giant planet migration appears widespread among planetary systems in our Galaxy. However, the timescales of this process, which reflect the underlying dynamical mechanisms, are not well constrained, even within the solar system. Since planetary migration scatters smaller bodies onto intersecting orbits, it would have resulted in an epoch of enhanced bombardment in the solar system's asteroid belt. To accurately and precisely quantify the timescales of migration, we interrogate thermochronologic data from asteroidal meteorites, which record the thermal imprint of energetic collisions. We present a database of 40K-40Ar system ages from chondrite meteorites and evaluate it with an asteroid-scale thermal code coupled to a Markov chain Monte Carlo inversion. Simulations require bombardment in order to reproduce the observed age distribution and identify a bombardment event beginning ~11 million years after the Sun formed. Our results associate a giant planet instability in our solar system with the dissipation of the gaseous protoplanetary disk.Comment: 24 pages, 4 figures, 2 tables, 10 extended data items (8 figures, 2 tables). Under review at Nature Astronom

MicroRNA Biomarkers for Infectious Diseases: From Basic Research to Biosensing

In the pursuit of improved diagnostic tests for infectious diseases, several classes of molecules have been scrutinized as prospective biomarkers. Small (18–22 nucleotide), non-coding RNA transcripts called microRNAs (miRNAs) have emerged as promising candidates with extensive diagnostic potential, due to their role in numerous diseases, previously established methods for quantitation and their stability within biofluids. Despite efforts to identify, characterize and apply miRNA signatures as diagnostic markers in a range of non-infectious diseases, their application in infectious disease has advanced relatively slowly. Here, we outline the benefits that miRNA biomarkers offer to the diagnosis, management, and treatment of infectious diseases. Investigation of these novel biomarkers could advance the use of personalized medicine in infectious disease treatment, which raises important considerations for validating their use as diagnostic or prognostic markers. Finally, we discuss new and emerging miRNA detection platforms, with a focus on rapid, point-of-care testing, to evaluate the benefits and obstacles of miRNA biomarkers for infectious disease

A coupled terrestrial and aquatic biogeophysical model of the Upper Merrimack River watershed, New Hampshire, to inform ecosystem services evaluation and management under climate and land-cover change

Accurate quantification of ecosystem services (ES) at regional scales is increasingly important for making informed decisions in the face of environmental change. We linked terrestrial and aquatic ecosystem process models to simulate the spatial and temporal distribution of hydrological and water quality characteristics related to ecosystem services. The linked model integrates two existing models (a forest ecosystem model and a river network model) to establish consistent responses to changing drivers across climate, terrestrial, and aquatic domains. The linked model is spatially distributed, accounts for terrestrial–aquatic and upstream–downstream linkages, and operates on a daily time-step, all characteristics needed to understand regional responses. The model was applied to the diverse landscapes of the Upper Merrimack River watershed, New Hampshire, USA. Potential changes in future environmental functions were evaluated using statistically downscaled global climate model simulations (both a high and low emission scenario) coupled with scenarios of changing land cover (centralized vs. dispersed land development) for the time period of 1980–2099. Projections of climate, land cover, and water quality were translated into a suite of environmental indicators that represent conditions relevant to important ecosystem services and were designed to be readily understood by the public. Model projections show that climate will have a greater influence on future aquatic ecosystem services (flooding, drinking water, fish habitat, and nitrogen export) than plausible changes in land cover. Minimal changes in aquatic environmental indicators are predicted through 2050, after which the high emissions scenarios show intensifying impacts. The spatially distributed modeling approach indicates that heavily populated portions of the watershed will show the strongest responses. Management of land cover could attenuate some of the changes associated with climate change and should be considered in future planning for the region

Transgressing the moral economy: Wheelerism and management of the nationalised coal industry in Scotland

This article illuminates the links between managerial style and political economy in post-1945 Britain, and explores the origins of the 1984–1985 miners' strike, by examining in longer historical context the abrasive attitudes and policies of Albert Wheeler, Scottish Area Director of the National Coal Board (NCB). Wheeler built on an earlier emphasis on production and economic criteria, and his micro-management reflected pre-existing centralising tendencies in the industries. But he was innovative in one crucial aspect, transgressing the moral economy of the Scottish coalfield, which emphasised the value of economic security and changes by joint industrial agreement