Hypovolemic shock and hemoperitoneum from spontaneous avulsion of a large pedunculated uterine leiomyoma

Hemoperitoneum with hypovolemic shock from avulsion of a pedunculated leiomyoma is a rare but highly fatal condition that can occur spontaneously or as a result of trauma. We report a case of hemoperitoneum and hypovolemic shock secondary to a bleeding leiomyoma detected via computed tomography (CT) scan in a 39 year old premenopausal, gravida 0 female that presented with abdominal pain and became hemodynamically unstable in the emergency department. A preoperative bimanual exam revealed a mass consistent with a 20 week gestational uterus. Following fluid resuscitation, the patient underwent emergent myomectomy and ligation of the right uterine artery and was discharged home in good condition. © 2017, EduRad. All rights reserved

Integrating Remote Sensing Data with Socioeconomic Data: Sensitivity, Confidentiality, Privacy, and Intellectual Property Challenges

The integration of remote sensing data with socioeconomic data presents new opportunities for scientific discovery and analysis that can improve understanding of the environmental sustainability issues that society faces today. Such integrated data products and services can be used to study interdisciplinary issues by investigators representing various disciplines. In addition to the scientific benefits that can be attained by integrating remote sensing data with socioeconomic data, the integration of these data also present challenges that reflect the complex issues that arise when sharing and integrating different types of science data. When integrating one or more datasets that contain sensitive information, data producers need to be aware of the limitations that have been placed upon the data to protect private property, species or other inhabitants that reside on the property, or restricted information about a particular location. Similarly, confidentiality and privacy issues are a concern for data that have been collected about individual humans and families who have volunteered to serve as human research subjects or whose personal information may have been collected without their knowledge. In addition, intellectual property rights that are associated with a particular dataset may prevent integration with other data or pose constraints on the use of the resulting data products or services. These challenges will be described along with approaches that can be applied to address them when planning projects that involve the integration of remote sensing data with socioeconomic data

Relationship between device acceptance and patient-reported outcomes in left ventricular assist device (LVAD) recipients

The number of Left Ventricular Assist Devices (LVADs) implanted each year is rising. Nevertheless, there are minimal data on device acceptance after LVAD implant, and on its relationship with patient-reported outcomes. We designed a cross-sectional study to address this knowledge gap and test the hypothesis that low device acceptance is associated with poorer quality of life, depression and anxiety. Self-report questionnaires were administered to assess quality of life (12-item Kansas City Cardiomyopathy Questionnaire quality of life subscale), level of anxiety (7-item Generalized Anxiety Disorder; GAD-7), level of depression (9-item Patient Health Questionnaire; PHQ-9) and device acceptance (Florida Patient Acceptance Survey; FPAS) to 101 consecutive patients presenting to LVAD clinic. Regression analysis showed a strong correlation between device acceptance and both psychological distress (p\u2009<\u20090.001) and quality of life (p\u2009<\u20090.001). Analysis of the sub-scales of the FPAS showed that patients had significant body image concerns, but return to function and device-related distress were the main drivers of the observed correlation between device acceptance and patient well-being. Younger age was associated with lower device acceptance (r\u2009=\u20090.36, p\u2009<\u20090.001) and lower quality of life (r\u2009=\u20090.54, p\u2009<\u20090.001). These findings suggest that interventions targeting device acceptance should be explored to improve outcomes in LVAD recipients

Renal cell carcinoma metastatic to the duodenum: Treatment by classic pancreaticoduodenectomy and review of the literature

Renal cell cancer (RCC) most commonly metastasizes to the lungs, bones, liver, renal fossa, and brain, although metastases can occur elsewhere. RCC metastatic to the duodenum is especially rare, with only a small number of cases reported in the literature. Herein, we describe a case of an 86-year-old woman with a history of RCC treated by radical nephrectomy 13 years previously. The patient presented with duodenal obstruction and anemia from a solitary duodenal mass invading into the pancreas and was treated via classic pancreaticoduodenectomy. Preoperative imaging and intra-operative assessment showed no evidence of other disease. Pathology confirmed metastatic RCC without lymph node involvement. Our case report and review of the English language literature underscore the rarity of this entity and support aggressive surgical treatment in such patients

Synthesis of protein conjugates adsorbed on cationic liposomes surface

The well-known Toll like receptor 9 (TLR9) agonist CpG ODN has shown promising results as vaccine adjuvant in preclinical and clinical studies, however its in vivo stability and potential systemic toxicity remain a concern. In an effort to overcome these issues, different strategies have been explored including conjugation of CpG ODN with proteins or encapsulation/adsorption of CpG ODN into/onto liposomes. Although these methods have resulted in enhanced immunopotency compared to co-administration of free CpG ODN and antigen, we believe that this effect could be further improved. Here, we designed a novel delivery system of CpG ODN based on its conjugation to serve as anchor for liposomes. Thiol-maleimide chemistry was utilised to covalently ligate model protein with the CpG ODN TLR9 agonist. Due to its negative charge, the protein conjugate readily electrostatically bound cationic liposomes composed of 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC), cholesterol and dimethyldioctadecylammonium bromide (DDA) in a very high degree. The novel cationic liposomes-protein conjugate complex shared similar vesicle characteristics (size and charge) compared to free liposomes. The conjugation of CpG ODN to protein in conjunction with adsorption on cationic liposomes, could promote co-delivery leading to the induction of immune response at low antigen and CpG ODN doses. • The CpG ODN Toll-like receptor (TLR) 9 agonist was conjugated to protein antigens via thiol-maleimide chemistry. • Due to their negative charge, protein conjugates readily electrostatically bound cationic liposomes composed of 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC), cholesterol and dimethyldioctadecylammonium bromide (DDA) resulting to the design of novel cationic liposomes-protein conjugate complexes. • The method is suited for the liposomal delivery of a variety of adjuvant-protein conjugates

Next Frontier in Planetary Geological Reconnaissance: Low-Latency Telepresence

The most compelling questions about the possibility of life on other planetary bodies will likely be answered only once the human mind can fully engage with the explored alien surface. Current interplanetary science operation models are primarily based on the paradigm of using robotic off-Earth assets for exploration. Conducting field geology research on other planetary bodies requires experts to use data collected from advanced technologies to substitute for their on-site presence to overcome the time delay (e.g., latency) and bandwidth constraints in the transfer of data. To overcome these constraints, astronauts will need to be placed either directly on the surface (e.g., “boots on the ground”) or robotic systems will need to be deployed and directed by humans from Earth with massive time delays. In the next major stage of planetary reconnaissance, as presented here, deployment of teleoperated robotic assets with humans sufficiently proximal to the exploration targets (referred to here as “Low-Latency Telepresence (LLT)”) will greatly enhance scientific return. Humans in orbit can be present electronically/digitally at multiple sites on a planetary surface, and that presence can be sterile, alleviating planetary protection concerns. Crewed astronauts using LLT, in partnership with robotic agents on the surface, will provide scientists the means to explore, for example, the mountains and vast canyon systems on Mars and the submarine environment of Jupiter's moon Europa. Consequently, because LLT does not require humans to be physically present at the exploration site, it is potentially advantageous in terms of schedule and cost, reduces human and planetary risks, while increasing the quantity and quality of the science data that can be returned

Connecting young star clusters to CO molecular gas in NGC 7793 with ALMA-LEGUS

We present an investigation of the relationship between giant molecular cloud (GMC) properties and the associated stellar clusters in the nearby flocculent galaxy NGC 7793. We combine the star cluster catalogue from the HST LEGUS (Legacy ExtraGalactic UV Survey) programme with the 15 pc resolution ALMA CO(2–1) observations. We find a strong spatial correlation between young star clusters and GMCs such that all clusters still associated with a GMC are younger than 11 Myr and display a median age of 2 Myr. The age distribution increases gradually as the cluster–GMC distance increases, with star clusters that are spatially unassociated with molecular gas exhibiting a median age of 7 Myr. Thus, star clusters are able to emerge from their natal clouds long before the time-scale required for clouds to disperse. To investigate if the hierarchy observed in the stellar components is inherited from the GMCs, we quantify the amount of clustering in the spatial distributions of the components and find that the star clusters have a fractal dimension slope of −0.35 ± 0.03, significantly more clustered than the molecular cloud hierarchy with slope of −0.18 ± 0.04 over the range 40–800 pc. We find, however, that the spatial clustering becomes comparable in strength for GMCs and star clusters with slopes of −0.44 ± 0.03 and −0.45 ± 0.06, respectively, when we compare massive (>105 M⊙) GMCs to massive and young star clusters. This shows that massive star clusters trace the same hierarchy as their parent GMCs, under the assumption that the star formation efficiency is a few per cent.Support for Program 13364 was provided by NASA through a grant from the Space Telescope Science Institute. This research has made use of the NASA/IPAC Extragalactic Database (NED) which is operated by the Jet Propulsion Laboratory, California Institute of Technology, under contract with NASA. This paper makes use of the following ALMA data: ADS/JAO.ALMA #2015.1.00782.S. ALMA is a partnership of ESO (representing its member states), NSF (USA) and NINS (Japan), together with NRC (Canada) and NSC and ASIAA (Taiwan) and KASI (Republic of Korea), in cooperation with the Republic of Chile. The Joint ALMA Observatory is operated by ESO, AUI/NRAO, and NAOJ. The National Radio Astronomy Observatory is a facility of the National Science Foundation operated under cooperative agreement by Associated Universities, Inc. Parts of this research were supported by the Australian Research Council Centre of Excellence for All Sky Astrophysics in three Dimensions (ASTRO 3D), through project number CE170100013. AA acknowledges the support of the Swedish Research Council (Vetenskapsradet) and the Swedish National Space Board (SNSB). ˚ MF acknowledges support by the Science and Technology Facilities Council [grant number ST/P000541/1]. This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement number 757535