Subcutaneous emphysema: a rare manifestation of a perforated diverticulitis in a patent inguinal canal

Patients with complicated diverticulitis rarely present with extraperitoneal manifestations but the manifestation of subcutaneous emphysema appears even more seldom. We present the case of a patient with a history of diabetes and immunosuppression, who was admitted with sepsis in association with cellulitis and subcutaneous emphysema of the left groin. The absence of peritonism due to corticosteroid treatment, a history of a recent fall with an ilio- and ischio-pubic fracture and subcutaneous emphysema led to a delay in the diagnosis. The final diagnosis was a perforated diverticulitis in a patent inguinal canal, which was only revealed after surgery. The various complications of diverticulitis, including extraperitoneal manifestations, and associated microorganisms implicated in cellulitis and subcutaneous emphysema are briefly reviewe

Interstellar CN and CH+ in Diffuse Molecular Clouds: 12C/13C Ratios and CN Excitation

We present very high signal-to-noise ratio absorption-line observations of CN and CH+ along 13 lines of sight through diffuse molecular clouds. The data are examined to extract precise isotopologic ratios of 12CN/13CN and 12CH+/13CH+ in order to assess predictions of diffuse cloud chemistry. Our results on 12CH+/13CH+ confirm that this ratio does not deviate from the ambient 12C/13C ratio in local interstellar clouds, as expected if the formation of CH+ involves nonthermal processes. We find that 12CN/13CN, however, can be significantly fractionated away from the ambient value. The dispersion in our sample of 12CN/13CN ratios is similar to that found in recent surveys of 12CO/13CO. For sight lines where both ratios have been determined, the 12CN/13CN ratios are generally fractionated in the opposite sense compared to 12CO/13CO. Chemical fractionation in CO results from competition between selective photodissociation and isotopic charge exchange. An inverse relationship between 12CN/13CN and 12CO/13CO follows from the coexistence of CN and CO in diffuse cloud cores. However, an isotopic charge exchange reaction with CN may mitigate the enhancements in 12CN/13CN for lines of sight with low 12CO/13CO ratios. For two sight lines with high values of 12CO/13CO, our results indicate that about 50 percent of the carbon is locked up in CO, which is consistent with the notion that these sight lines probe molecular cloud envelopes where the transition from C+ to CO is expected to occur. An analysis of CN rotational excitation yields a weighted mean value for T_01(12CN) of 2.754 +/- 0.002 K, which implies an excess over the temperature of the cosmic microwave background of only 29 +/- 3 mK. This modest excess eliminates the need for a local excitation mechanism beyond electron and neutral collisions. The rotational excitation temperatures in 13CN show no excess over the temperature of the CMB.Comment: 27 pages, 21 figures, emulateapj style, accepted for publication in Ap

A search for interstellar anthracene toward the Perseus anomalous microwave emission region

We report the discovery of a new broad interstellar (or circumstellar) band at 7088.8 +- 2.0 \AA coincident to within the measurement uncertainties with the strongest band of the anthracene cation (C$_{14}$H$_{10}$$^+$) as measured in gas-phase laboratory spectroscopy at low temperatures (Sukhorukov et al.2004). The band is detected in the line of sight of star Cernis 52, a likely member of the very young star cluster IC 348, and is probably associated with cold absorbing material in a intervening molecular cloud of the Perseus star forming region where various experiments have recently detected anomalous microwave emission. From the measured intensity and available oscillator strength we find a column density of N$_{an^+}$= 1.1(+-0.4) x 10$^{13}$ cm$^{-2}$ implying that ~0.008% of the carbon in the cloud could be in the form of C$_{14}$H$_{10}$$^+$. A similar abundance has been recently claimed for the naphthalene cation (Iglesias-Groth et al. 2008) in this cloud. This is the first location outside the Solar System where specific PAHs are identified. We report observations of interstellar lines of CH and CH$^+$ that support a rather high column density for these species and for molecular hydrogen. The strength ratio of the two prominent diffuse interstellar bands at 5780 and 5797 \AA suggests the presence of a ``zeta'' type cloud in the line of sight (consistent with steep far-UV extinction and high molecular content). The presence of PAH cations and other related hydrogenated carbon molecules which are likely to occur in this type of clouds reinforce the suggestion that electric dipole radiation from fast spinning PAHs is responsible of the anomalous microwave emission detected toward Perseus.Comment: Accepted for publication in Monthly Notices of the Royal Astronomical Societ

alpha-nucleus potentials for the neutron-deficient p nuclei

alpha-nucleus potentials are one important ingredient for the understanding of the nucleosynthesis of heavy neutron-deficient p nuclei in the astrophysical gamma-process where these p nuclei are produced by a series of (gamma,n), (gamma,p), and (gamma,alpha) reactions. I present an improved alpha-nucleus potential at the astrophysically relevant sub-Coulomb energies which is derived from the analysis of alpha decay data and from a previously established systematic behavior of double-folding potentials.Comment: 6 pages, 3 figures, accepted for publication in Phys. Rev.

Hydraena (s.str.) dinarica, new species (Coleoptera: Hydraenidae) along with further records of Hydraena spp. from Durmitor National Park, Montenegro and comments on the DNA barcoding problem with the genus

Background Long-palped Water Beetles were collected during a taxon expedition in Montenegro which involved citizen scientists, students and taxonomists. The material was collected from springs, brooks, fens and the Tara River, at altitudes between 600 m and 1450 m above sea level, using fine-meshed hand-nets and by manual checking of submerged substrates. The morphological species delimitation was supplemented and congruent with mtDNA sequences mainly obtained in the field using the newly-developed MinION-based ONTrack pipeline. New information The new species Hydraena dinarica Freitag & de Vries, sp. n. from Durmitor Mt. is described, illustrated and compared in detail to closely-related congeners of the H. saga d\u27Orchymont, 1930/H. emarginata Rey, 1885 species complex. Five additional species and female specimens of two unidentified morphospecies of the genus were also recorded in the vicinity of Durmitor National Park. New records and the first DNA barcodes for Hydraena biltoni Jäch & Díaz, 2012 (endemic to Montenegro) and H. morio Kiesenwetter, 1849 are provided. Further records of H. nigrita Germar, 1824, H. minutissima Stephens, 1829, H. subintegra Ganglbauer, 1901 and females of two unidentified morphospecies are commented upon. The resulting inter- and intraspecific genetic distances and some observations of low or zero sequence divergence between recently-diverged species of Hydraena Kugelann, 1794 are briefly discussed

Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care

Objectives: Historically, patients with a hematologic malignancy have one of the highest mortality rates among cancer patients admitted to the ICU. Therefore, physicians are often reluctant to admit these patients to the ICU. The aim of our study was to examine the survival of patients who have a hematologic malignancy and multiple organ failure admitted to the ICU. Design: This retrospective cohort study, part of the HEMA-ICU study group, was designed to study the survival of patients with a hematologic malignancy and organ failure after admission to the ICU. Patients were followed for at least 1 year. Setting: Five university hospitals in the Netherlands. Patients: One-thousand ninety-seven patients with a hematologic malignancy who were admitted at the ICU. Interventions: None. Measurements and Main Results: Primary outcome was 1-year survival. Organ failure was categorized as acute kidney injury, respiratory failure, hepatic failure, and hemodynamic failure; multiple organ failure was defined as failure of two or more organs. The World Health Organization performance score measured 3 months after discharge from the ICU was used as a measure of functional outcome. The 1-year survival rate among these patients was 38%. Multiple organ failure was inversely associated with long-term survival, and an absence of respiratory failure was the strongest predictor of 1-year survival. The survival rate among patients with 2, 3, and 4 failing organs was 27%, 22%, and 8%, respectively. Among all surviving patients for which World Health Organization scores were available, 39% had a World Health Organization performance score of 0-1 3 months after ICU discharge. Functional outcome was not associated with the number of failing organs. Conclusions: Our results suggest that multiple organ failure should not be used as a criterion for excluding a patient with a hematologic malignancy from admission to the ICU.</p

Dietary Tryptophan Induces Opposite Health-Related Responses in the Senegalese Sole (Solea senegalensis) Reared at Low or High Stocking Densities With Implications in Disease Resistance

High rearing densities are typical conditions of both inland and onshore intensive aquaculture units. Despite obvious drawbacks, this strategy is nonetheless used to increase production profits. Such conditions inflict stress on fish, reducing their ability to cope with disease, bringing producers to adopt therapeutic strategies. In an attempt to overcome deleterious effects of chronic stress, Senegalese sole, Solea senegalensis, held at low (LD) or high density (HD) were fed tryptophan-supplemented diets with final tryptophan content at two (TRP2) or four times (TRP4) the requirement level, as well as a control and non-supplemented diet (CTRL) for 38 days. Fish were sampled at the end of the feeding trial for evaluation of their immune status, and mortalities were recorded following intra-peritoneal infection with Photobacterium damselae subsp. piscicida. Blood was collected for analysis of the hematological profile and innate immune parameters in plasma. Pituitary and hypothalamus were sampled for the assessment of neuro-endocrine-related gene expression. During the feeding trial, fish fed TRP4 and held at LD conditions presented higher mortalities, whereas fish kept at HD seemed to benefit from this dietary treatment, as disease resistance increased over that of CTRL-fed fish. In accordance, cortisol level tended to be higher in fish fed both supplemented diets at LD compared to fish fed CTRL, but was lower in fish fed TRP4 than in those fed TRP2 under HD condition. Together with lower mRNA levels of proopiomelanocortin observed with both supplementation levels, these results suggest that higher levels of tryptophan might counteract stress-induced cortisol production, thereby rendering fish better prepared to cope with disease. Data regarding sole immune status showed no clear effects of tryptophan on leucocyte numbers, but TRP4-fed fish displayed inhibited alternative complement activity (ACH50) when held at LD, as opposed to their HD counterparts whose ACH50 was higher than that of CTRLfed fish. In conclusion, while dietary tryptophan supplementation might have harmful effects in control fish, it might prove to be a promising strategy to overcome chronic stress-induced disease susceptibility in farmed Senegalese sole