Rapid onset of hypercalcemia from high-grade lymphoma in the setting of HIV-related immune reconstitution inflammatory syndrome.

Hypercalcemia in HIV patients has been previously reported, but 1,25-(OH)2 vitamin D-mediated hypercalcemia, due to increased activity of extrarenal 1-alpha hydroxylase, is rarely described with HIV-related infections or malignancies. We describe a case of 1,25-(OH)2 vitamin D-mediated hypercalcemia in a patient presenting with progressive cognitive decline and weakness. Initial evaluation revealed a new diagnosis of HIV, for which he was started on antiretroviral therapy (ART). He was also noted to have mild asymptomatic hypocalcemia, likely from his acute illness and malnutrition, which was not further investigated at the time. While the patient's mental status initially improved with ART, he became progressively delirious and was found to be hypercalcemic approximately 4 weeks after the initiation of ART. Possible etiologies for hypercalcemia were vigorously evaluated, including granulomatous disease, infection, and malignancy, in the setting of suspected immune reconstitution inflammatory syndrome (IRIS), due to recent initiation of ART. Infectious workup was unrevealing, but computed tomography (CT) of the chest, abdomen, and pelvis revealed new extensive diffuse lymphadenopathy and hepatomegaly, not present on admission studies. Cytology and flow cytometry of a liver biopsy specimen revealed CD10 positive high-grade B-cell lymphoma. Chemotherapy was not pursued due to poor performance status. Over the next week, spontaneous tumor lysis developed, and the patient expired. Postmortem, his 1,25-(OH)2 vitamin D level returned as markedly elevated. Immunohistochemical staining of his liver biopsy tissue showed strong expression of CYP27B1. 1,25-(OH)2 vitamin D-mediated hypercalcemia is uncommon in a patient with newly diagnosed HIV and, in this case, was likely due to IRIS unmasking an underlying high-grade lymphoma and restoration of immune function (including T-cells and cytokine production). This case emphasizes the importance of including aggressive lymphomas, capable of progressing over days to weeks, in the evaluation of hypercalcemia in HIV patients at risk for developing IRIS and the rapid dynamic changes in mineral homeostasis that can occur with such an aggressive tumor in an immunocompromised host

Further detections of OH masers in carbon stars with silicate features

A sample of J-type carbon stars was searched for OH maser emission. The new detection of three OH lines towards two silicate carbon stars is reported. In V778 Cyg, previously known as the main-lines (1665 and 1667 MHz) maser source, the satellite 1612 MHz emission was discovered while in NSV 2814 the main OH lines were detected. The presence of OH maser lines confirms the former suggestion that oxygen-rich material is located in the vicinity ($\approx$ $10^{15-16}$ cm) of silicate carbon stars.Comment: LaTeX2e, 4 pages with 2 figure

A middle cerebral artery ischemic stroke occurring in a child with a large prolactinoma.

Pituitary adenomas are rare in children, and often present with symptoms of headache, nausea or emesis, visual disturbance, or hormonal hypersecretion. With large tumors, mass effect from the lesion can lead to severe endocrinopathy and compression of intracranial neurovascular structures. In this case report, we describe an unusual presentation of an ischemic stroke in the territory of the right middle cerebral artery resulting from a prolactin-secreting macroadenoma. The patient's primary symptoms were headache, left facial droop, and left hemibody weakness. She was successfully managed with cabergoline, a dopamine agonist, with a reduction in the size of the tumor and normalization of serum prolactin levels. She remained clinically stable throughout her hospitalization, and was safely discharged without surgical intervention. In her recent 2-year follow-up, her tumor and prolactin levels were stable and she had dramatic improvements in her left-sided muscle strength

Spatial conductivity measurements on high T(sub c) superconducting films

High T(sub c) superconducting thin and thick films have potential applications in future NASA flight projects. In anticipation of film use, the Materials Branch is developing a nondestructive, non-contact method of measuring the spatial variation of conductivity across a film sample. This method uses a computer-controlled, X-Y positioning table to scan a conventional eddy current probe across the surface of a film. The induced changes in impedance caused by variations in film conductivity are recorded during the scanning process. Ultimately the two-dimensional data set is displayed using imaging equipment on a personal computer

Thermal OH (1667/65 MHz) Absorption and Nonthermal OH (1720 MHz) Emission Towards the W28 Supernova Remnant

The W28 supernova remnant is an excellent prototype for observing shocked gas resulting from the interaction of supernova remnants (SNRs) and adjacent molecular clouds (MCs). We present two new signatures of shocked molecular gas in this remnant. One is the detection of main-line extended OH (1667 MHz) absorption with broad linewidths. The column density of OH estimated from the optical depth profiles is consistent with a theoretical model in which OH is formed behind a C-type shock front. The second is the detection of extended, weak OH (1720 MHz) line emission with narrow linewidth distributed throughout the shocked region of W28. These give observational support to the idea that compact maser sources delineate the brightest component of a much larger region of main line OH absorption and nonthermal OH (1720 MHz) emission tracing the global structure of shocked molecular gas. Main line OH (1665/67) absorption and extended OH (1720 MHz) emission line studies can serve as powerful tools to detect SNR-MC interaction even when bright OH (1720 MHz) masers are absent.Comment: 14 pages, 3 figures, one table, to appear in ApJ (Jan 10, 2003

RARE-30. PEDIATRIC GLIOBLASTOMA IN THE POST-TEMOZOLOMIDE ERA: OUTCOMES AND CHARACTERISTICS

Abstract INTRODUCTION Glioblastoma (GBM) is the most common brain tumor, however, is a rare occurrence in children and is poorly characterized. We evaluated the characteristics and outcomes of pediatric GBM (pGBM). METHODS Retrospective analysis of pediatric (age< 18) patients diagnosed with GBM undergoing first glioblastoma resection at our brain tumor center (2005- 2016). RESULTS From 1457 GBM patients, we identified twenty-four (1.65%) pGBMs (Median Age=9 years, Females=45.8%). Median overall survival (OS) was 32.1 months, while the median progression-free survival was 11.5 months. The commonest symptoms at presentation were headaches (54.2%,n=13) and motor symptoms (50%,n=12). Mean tumor diameter was 4.5 cm and 25% of the cohort underwent gross total resection (GTR) of their tumor. Univariate analysis revealed median OS significantly associated with tumor extent of resection (GTR=56.4 months; STR/Biopsy=13.7 months, p=0.001), age at surgery (>10 years=43.9 months, < 10 years= 17.2 months, p=0.01), tumor size (> 4cm= 9.1 months, < 4cm=56.9 months, p=0.01),motor symptoms at presentation (present=14.9 months, absent=41.04 months, p=0.02) and infratentorial tumors (infratentorial=17.4 vs supratentorial=53.4 months, p=0.02). Multivariate analysis revealed GTR (HR 0.2[95% CI 0.07–0.72]; p=0.03), Age >10 years (HR 0.6[95% CI 0.02–0.64]; p=0.002), tumor >4 cm (HR 2.89[95% CI 1.88–4.11]; p=0.001) and EGFR amplification (HR 3.48[95% CI 0.82–17.4]; p=0.005) to be independent predictors of OS. Comparing patients under and over 10 years, we found that older patients had smaller tumors at presentation (4.9 vs 3.6 cms, p=0.03), greater rates of preoperative temozolomide (n=1,7.7% vs n=6, 54.5%) and bevacizumab (n=1,7.7% vs n=4, 36.4%) treatment, and lower rates of EGFR amplification (66.7% vs 11.1%) that could explain survival disparities between groups. CONCLUSION Motor symptoms, larger tumors at presentation and tumor EGFR amplification may be indictive of poorer outcomes in pGBM. However, maximal tumor resection, aggressive chemoradiation and tumor presentation at age >10 years may confer better prognosis in these patients

Gender-based differences in letters of recommendation written for ophthalmology residency applicants.

BACKGROUND:To determine whether gender-based differences may be present in letters of recommendation written for ophthalmology residency applicants. METHODS:All applications submitted through SF Match to the UCLA Stein Eye Institute Residency Training Program from the 2017-2018 application cycle were analyzed using validated text analysis software (Linguistic Inquiry and Word Count (Austin, TX)). The main outcome measures were differences in language use in letters of recommendation by gender of applicant. RESULTS:Of 440 applicants, 254 (58%) were male and 186 (42%) were female. The two gender groups had similar United States Medical Licensing Exam (USMLE) Step 1 scores, undergraduate grade point averages (uGPA's), proportions of underrepresented minority (URM) applicants and Gold Humanism Honor Society members, numbers of academic and service activities listed, and gender distributions of their letter writers (all P values > 0.05). However, letters written for male applicants were determined to use more "authentic" words than those written for female applicants (mean difference, 0.800; 95% CI, 0.001-1.590; P = 0.047). Letters written for male applicants also contained more "leisure" words (mean difference, 0.056; 95% CI, 0.008-0.104; P = 0.023) and fewer "feel" words (mean difference, 0.033; 95% CI, 0.001-0.065; P = 0.041) and "biological processes" words (mean difference, 0.157; 95% CI, 0.017-0.297; P = 0.028). CONCLUSIONS:There were gender differences detected in recommendation letters in ophthalmology consistent with prior studies from other fields. Awareness of these differences may improve residency selection processes

An historical explanation of the development of occupational health and safety and the important position it now occupies in society

Scientific and social (economic and ethical) dimensions of occupational health and safety (OH&S) are discussed. Three broad stages in the development of ethics in Western society are analysed in order to assist in understanding the arrival of moral relativism and constructivism under postmodernism. Against this background three recent stages in the emergence of OH&S are outlined and OH&S is shown to be of key importance to sustainable development. Comment is made about the prospects for survival, under moral relativism, of the duty of care ethic which lies at the heart of OH&S and which has until the present time catalysed professionally responsible innovation and change. It is argued that (1) because OH&S tools and techniques called up in legislation are scientific in nature and apply equally to all under law, and (2) because OH&S is increasingly understood as a profitability strategy, ongoing duty of care appeals for reform may continue to be effective even against the corrosive malaise of moral relativism. OH&S workers are reminded of the contribution their profession can make to safe and civil society and to sustainable development and their responsibility for upholding and promoting the ethical dimension expressed through duty of care