A 78-Year-Old Woman with Fecaloid Vaginal Discharge

A 78-year-old woman with a history of colon cancer with metastasis to the liver was presented to our emergency department because of bilateral groin pain and difficulty in walking, which had gradually increased during the previous 5 days. The pain was of sudden onset, radiating to the back, without aggravating or relieving factors. It was associated with constipation, dysuria and vaginal discharge. She reported passing fecal matter from the vagina one month ago. On physical examination, she appeared malnourished. Her blood pressure was 98/65 mmHg, with a 108 beats/min heart rate and 28 breaths/min respiratory rate. She was afebrile. Physical examinations were unremarkable, except for pale conjunctiva, abdominal distention, and diffuse tenderness especially over the umbilicus with guarding tenderness. Bowel sounds were decreased. Pelvic examination showed a yellowish odorous vaginal discharge from the external orifice of uterus. A complete blood cell count showed the following: leukocyte count, 34,200/mm3; segmented neutrophils, 87.5%; hemoglobin level of 7.4 mg/dl; hematocrit, 18.8%; and platelet, 180000/uL. Other laboratory studies included: glucose, 86 mg/dL; serum urea nitrogen, 28 mg/dL; serum creatinine, 0.87 mg/dL; sodium, 142 mEq/L; potassium, 4.8 mEq/L; albumin, 2.5g/dL; a carbohydrate antigen 19-9 level of 3,244 U/ml, and a carcinoembryonic antigen (CEA) level of 64.6 ng/ml. Coronal and axial cuts of patient’s abdominopelvic computed Tomography (CT) are shown in figures 1 and 2

X-linked hyper-IgM syndrome with CD40LG mutation: Two case reports and literature review in Taiwanese patients

Hyper-IgM syndrome (HIGM) is a rare primary immunodeficiency disorder characterized by elevated or normal serum IgM and decreased IgG, IgA, and IgE due to defective immunoglobulin class switching. X-linked HIGM (XHIGM, HIGM1) is the most frequent type, is caused by mutations in the CD40 ligand gene, and is regarded as a combined T and B immunodeficiency. We report an 18-year-old male who was diagnosed initially with hypogammaglobulinemia in infancy, but developed repeated pneumonia, sepsis, cellulitis, perianal abscess, pericarditis, and bronchiectasis despite regular intravenous immunoglobulin replacement therapy. The patient died at age 18 years due to pneumonia and tension pneumothorax. Mutation analysis revealed CD40L gene mutation within Exon 5 at nucleotide position 476 (cDNA 476G > A). This nonsense mutation predicted a tryptophan codon (TGG) change to a stop codon (TGA) at position 140 (W140X), preventing CD40L protein expression. Sequence analysis in the family confirmed a de novo mutation. The second case of 6-month-old male infant presented as Pneumocystis jiroveci pneumonia and acute respiratory distress syndrome. Gene analysis of the CD40L gene revealed G to C substitution in Intron 4 (c.409 + 5G > C) and mother was a carrier. Hematopoietic stem cell transplantation, the only cure for XHIGM, was arranged in the second case

Stratigraphic reassessment of Grotta Romanelli sheds light on Middle-Late Pleistocene palaeoenvironments and human settling in the Mediterranean

During the last century, Grotta Romanelli (Southern Italy) has been a reference site for the European Late Pleistocene stratigraphy, due to its geomorphological setting and archaeological and palaeontological content. The beginning of the sedimentation inside the cave was attributed to the Last Interglacial (MISs 5e) and the oldest unearthed evidence of human occupation, including remains of hearths, was therefore referred to the Middle Palaeolithic. Recent surveys and excavations produced new U/Th dates, palaeoenvironmental interpretation and a litho-, morpho- and chrono-stratigraphical reassessment, placing the oldest human frequentation of the cave between MIS 9 and MIS 7, therefore embracing Glacial and Interglacial cycles. These new data provide evidence that the sea reached the cave during the Middle Pleistocene and human occupation occurred long before MISs 5e and persisted beyond the Pleistocene- Holocene boundary

Stratigraphic reassessment of Grotta Romanelli sheds light on Middle-Late Pleistocene palaeoenvironments and human settling in the Mediterranean

During the last century, Grotta Romanelli (Southern Italy) has been a reference site for the European Late Pleistocene stratigraphy, due to its geomorphological setting and archaeological and palaeontological content. The beginning of the sedimentation inside the cave was attributed to the Last Interglacial (MISs 5e) and the oldest unearthed evidence of human occupation, including remains of hearths, was therefore referred to the Middle Palaeolithic. Recent surveys and excavations produced new U/Th dates, palaeoenvironmental interpretation and a litho-, morpho- and chronostratigraphical reassessment, placing the oldest human frequentation of the cave between MIS 9 and MIS 7, therefore embracing Glacial and Interglacial cycles. These new data provide evidence that the sea reached the cave during the Middle Pleistocene and human occupation occurred long before MISs 5e and persisted beyond the Pleistocene- Holocene boundary

Were springline carbonates in the Kurkur-Dungul area (Southern Egypt) deposited during glacial periods?

The tufa deposits in the Kurkur–Dungul area, southern Egypt, date from marine isotope stage (MIS) 11 to MIS 1. Springs across the region were active during glacial periods (with sea-level below –50 m), reflecting changed atmospheric circulation over the Indian Ocean, as well as peak interglacial periods. During times of low sea-level, reduced Indonesian throughflow promoted formation of an Indian Ocean Warm Pool, and anomalous rainfall on its western margin. We suggest that Egypt lies at the intersection of westerly (‘maghrebian’) and easterly (‘mashriqian’) rainfall provinces, which show different timing with relation to orbital forcing and different source water regions. Tufa-growth periods are therefore not mechanistically linked to ‘humid periods’ or ‘sapropel events’ identified elsewhere. Stable isotope and T(Δ47) data are also inconsistent with these spring systems being part of a larger system spanning northern Africa, and lack a clear interaction between northern hemisphere heating and mid-latitude rainfall. We also follow previous researchers in concluding that formation of springline deposit formation was probably delayed compared with rainfall, owing to aquifer flow distances. This delay is unlikely to be sufficient to explain why rainfall is out of phase with movements of the monsoon belts, but may complicate interpretation of these records. Supplementary material: A lithofacies description and supplementary figures and tables are available at https://doi.org/10.6084/m9.figshare.c.524666

A late Middle Pleistocene Denisovan mandible from the Tibetan Plateau

Denisovans are members of a hominin group who are currently only known directly from fragmentary fossils, the genomes of which have been studied from a single site, Denisova Cave in Siberia. They are also known indirectly from their genetic legacy through gene flow into several low-altitude East Asian populations and high-altitude modern Tibetans6. The lack of morphologically informative Denisovan fossils hinders our ability to connect geographically and temporally dispersed fossil hominins from Asia and to understand in a coherent manner their relation to recent Asian populations. This includes understanding the genetic adaptation of humans to the high-altitude Tibetan Plateau, which was inherited from the Denisovans. Here we report a Denisovan mandible, identified by ancient protein analysis, found on the Tibetan Plateau in Baishiya Karst Cave, Xiahe, Gansu, China. We determine the mandible to be at least 160 thousand years old through U-series dating of an adhering carbonate matrix. The Xiahe specimen provides direct evidence of the Denisovans outside the Altai Mountains and its analysis unique insights into Denisovan mandibular and dental morphology. Our results indicate that archaic hominins occupied the Tibetan Plateau in the Middle Pleistocene epoch and successfully adapted to high-altitude hypoxic environments long before the regional arrival of modern Homo sapiens

4β-Hydroxywithanolide E from Physalis peruviana (golden berry) inhibits growth of human lung cancer cells through DNA damage, apoptosis and G2/M arrest

<p>Abstract</p> <p>Background</p> <p>The crude extract of the fruit bearing plant, <it>Physalis peruviana </it>(golden berry), demonstrated anti-hepatoma and anti-inflammatory activities. However, the cellular mechanism involved in this process is still unknown.</p> <p>Methods</p> <p>Herein, we isolated the main pure compound, 4β-Hydroxywithanolide (4βHWE) derived from golden berries, and investigated its antiproliferative effect on a human lung cancer cell line (H1299) using survival, cell cycle, and apoptosis analyses. An alkaline comet-nuclear extract (NE) assay was used to evaluate the DNA damage due to the drug.</p> <p>Results</p> <p>It was shown that DNA damage was significantly induced by 1, 5, and 10 μg/mL 4βHWE for 2 h in a dose-dependent manner (<it>p </it>< 0.005). A trypan blue exclusion assay showed that the proliferation of cells was inhibited by 4βHWE in both dose- and time-dependent manners (<it>p </it>< 0.05 and 0.001 for 24 and 48 h, respectively). The half maximal inhibitory concentrations (IC₅₀) of 4βHWE in H1299 cells for 24 and 48 h were 0.6 and 0.71 μg/mL, respectively, suggesting it could be a potential therapeutic agent against lung cancer. In a flow cytometric analysis, 4βHWE produced cell cycle perturbation in the form of sub-G₁accumulation and slight arrest at the G₂/M phase with 1 μg/mL for 12 and 24 h, respectively. Using flow cytometric and annexin V/propidium iodide immunofluorescence double-staining techniques, these phenomena were proven to be apoptosis and complete G₂/M arrest for H1299 cells treated with 5 μg/mL for 24 h.</p> <p>Conclusions</p> <p>In this study, we demonstrated that golden berry-derived 4βHWE is a potential DNA-damaging and chemotherapeutic agent against lung cancer.</p

A precise measurement of the Z -boson double-differential transverse momentum and rapidity distributions in the full phase space of the decay leptons with the ATLAS experiment at √s = 8 TeV

This paper presents for the first time a precise measurement of the production properties of the Z boson in the full phase space of the decay leptons. This is in contrast to the many previous precise unfolded measurements performed in the fiducial phase space of the decay leptons. The measurement is obtained from proton–proton collision data collected by the ATLAS experiment in 2012 at s=8 TeV at the LHC and corresponding to an integrated luminosity of 20.2 fb-1. The results, based on a total of 15.3 million Z-boson decays to electron and muon pairs, extend and improve a previous measurement of the full set of angular coefficients describing Z-boson decay. The double-differential cross-section distributions in Z-boson transverse momentum pT and rapidity y are measured in the pole region, defined as 80&lt;mℓℓ&lt;100 GeV, over the range |y|&lt;3.6. The total uncertainty of the normalised cross-section measurements in the peak region of the pT distribution is dominated by statistical uncertainties over the full range and increases as a function of rapidity from 0.5–1.0% for |y|&lt;2.0 to 2-7% at higher rapidities. The results for the rapidity-dependent transverse momentum distributions are compared to state-of-the-art QCD predictions, which combine in the best cases approximate N4LL resummation with N3LO fixed-order perturbative calculations. The differential rapidity distributions integrated over pT are even more precise, with accuracies from 0.2–0.3% for |y|&lt;2.0 to 0.4–0.9% at higher rapidities, and are compared to fixed-order QCD predictions using the most recent parton distribution functions. The agreement between data and predictions is quite good in most cases

A decision support system for the choice of medium-capacity transit system

The rapid growth in many urban areas has resulted in traffic congestion, social inequity, and environmental problems. To control these problems, many cities have turned to urban transit systems to serve travel demand. The mass rapid rail transit (MRT) system has been implemented in many metropolitan areas. However, many cities do not have either the financial resources to afford a MRT system or the passenger demand to justify it. To improve public transport services, what is needed for such cities is an appropriate transit system which has higher capacity than a regular bus (RB) system and cheaper than the MRT. There are several medium-capacity transit systems that can meet this requirement. Such systems include Bus Rapid Transit (BRT), Light Rapid Transit (LRT), Guided Bus, Automated Guideway Transit (AGT) and Automated Light Rapid Transit (ALRT). Clearly, in the selection of an appropriate medium-capacity transit system for a study area, the option of retaining the existing transit system (usually RB) should also be considered as an alternative. In the past, studies that dealt with the evaluation of alternative transit systems have been largely based on either a single factor (often cost), or on a few factors but with the alternatives compared on each factor individually. To select a suitable public transit system, one has to simultaneously consider and compare several system attributes some of which are quantitative while others are qualitative. In this research, the evaluation shall include both performance and sustainability attributes. After examining a set of preliminary performance and sustainability factors, three attributes are selected for testing the technical feasibility of each transit system alternatives and twelve attributes are used for comparing these alternative systems. A methodology is developed in this study to integrate these decision factors (i.e., system attributes) in the selection of an appropriate medium-capacity transit system for a given area in a rational and organized manner.MASTER OF ENGINEERING (CEE

Preliminary study on the habitat of the Taiwan pangolin (Manis pentadactyla pentadactyla) at Muchia area

我們於2001 年2-7 月在台北市立木柵動物園後山的研究樣區內共發現穿山甲洞穴32 個，其中僅有2 個為使用中或剛使用過之洞穴。洞穴開口處的平均直徑為21.1 cm ，平均深度 至少為108.3 cm ，洞口坡面的平均坡度為33.1 ˚。穿山甲在人為活動稀少的木柵動物園後山次 生林中，對洞穴棲地的選擇並無偏好，洞口周圍植株覆蓋度與隨機點間並無顯著差異。以穿越 線調查樣區內穿山甲可能採食的舉尾蟻（Crematogaster spp.）蟻窩數目，估算出1.6 ha 的樣區 內約有106 個蟻窩（66.3 nests/ha ）。然而在調查過程中，並未發現有穿山甲採食舉尾蟻窩的痕 跡。未來仍需進行更多的野外研究，以期對穿山甲之棲地選擇能有較深入之了解。We found 32 Taiwan Pangolin’s (Manis pentadactyla pentadactyla) burrows in the Taipei Zoo at Muchia area from February to July, 2001. Only two burrows showed signs for being used recently. The average diameter, depth and slope of the burrows were 21.1 cm, 108.3 cm and 33.1 ˚, respectively. The pangolin did not show strong preference for habitat selection in this secondary growth forest with low human disturbance. The vegetation coverage nearby the burrows and the ran-dom points had no significant difference. We found 106 Crematogaster spp. nests, a potential food for pangolins, and estimated the density as 66.3 nests/ha with the transect line method in a 1.6 ha sampling area. However, we did not see any sign of pangolins preying upon the Crematogaster spp. More future field studies are needed in order to gain a better understanding of the pangolin habitat use