Intermittent hemodialysis treatment in cefepime-induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature.

Cefepime is a broad-spectrum cephalosporin indicated for in-hospital treatment of severe infections. Acute neurotoxicity, an increasingly recognized adverse effect of this drug in an overdose, predominantly affects patients with reduced renal function. Although dialytic approaches have been advocated to treat this condition, their role in this indication remains unclear. We report the case of an 88-year-old female patient with impaired renal function who developed life-threatening neurologic symptoms during cefepime therapy. She was treated with two intermittent 3-hour high-flux, high-efficiency hemodialysis sessions. Serial pre-, post-, and peridialytic (pre- and postfilter) serum cefepime concentrations were measured. Pharmacokinetic modeling showed that this dialytic strategy allowed for serum cefepime concentrations to return to the estimated nontoxic range 15 hours earlier than would have been the case without an intervention. The patient made a full clinical recovery over the next 48 hours. We conclude that at least 1 session of intermittent hemodialysis may shorten the time to return to the nontoxic range in severe clinically patent intoxication. It should be considered early in its clinical course pending chemical confirmation, even in frail elderly patients. Careful dosage adjustment and a high index of suspicion are essential in this population.

An unusual uterine tumour with signet ring cell features

Objective: Lymphomas with signet ring cell features are rare, as is uterine dissemination of lymphomas. We report an exceptional case of a uterine tumor combining these two characteristics. Method: A 61-year-old female was diagnosed in 2004 with localized nodal grade 2 follicular lymphoma (stage IA). She received local radiation therapy, experienced total remission, and did well until 2009 when a systematic CT scan evidenced a pelvic anterior-lateral mass. Total enlarged hysterectomy was performed. Results: The anterior uterine wall contained a 4.8-cm fish flesh well-delineated mass corresponding to a mostly diffuse and focally nodular proliferation of medium to large cells with extensive signet ring cell changes. Tumor cells were CD20-, CD10-, Bcl2-, and Bcl6-positive with a low proliferation rate (<10-15%); CD21 underlined a focal follicular architecture. The vacuoles were PAS-negative and did not stain for immunoglobulin; ultrastructural analysis revealed nonspecific degenerative vacuoles. No lymph nodes were identified isolated from the surgical specimen. The tumor was considered as a secondary localization of the systemic follicular lymphoma, though no signet ring cells were evidenced in the cervical lymph node biopsy (reviewed). Follow-up showed retroperitoneal tissue infiltration (PET-CT) and normal medullar biopsy. She recently started R-CHOP chemotherapy. Conclusion: This case illustrates both an unusual site of dissemination and challenging cytological characteristics in a follicular lymphoma. The signet ring cell changes challenged the adequate classification of this lymphoma as either a large B cell or a follicular B cell lymphoma.

Cardiac re-synchronization therapy in a patient with isolated ventricular non-compaction: a case report.

Isolated ventricular non-compaction (IVNC) is a rare, congenital, unclassified cardiomyopathy characterized by prominent trabecular meshwork and deep recesses. Major clinical manifestations of IVNC are heart failure, atrial and ventricular arrhythmias, and thrombo-embolic events. We describe a case of a 69-year-old woman in whom the diagnosis of IVNC was discovered late, whereas former echocardiographic examinations were considered normal. She was known for systolic left ventricular dysfunction for 3 years and then became symptomatic (NYHA III). In the past, she suffered from multiple episodes of deep vein thrombosis and pulmonary embolism. Electrocardiogram revealed a wide QRS complex, and transthoracic echocardiography showed typical apical thickening of the left and right ventricular myocardial wall with two distinct layers. The ratio of non-compacted to compacted myocardium was >2:1. Cardiac MRI confirmed the echocardiographic images. Cerebral MRI revealed multiple ischaemic sequellae. In view of the persistent refractory, heart failure in medical treatment of patients with classical criteria for cardiac re-synchronization therapy, as well as the ventricular arrhythmias, a biventricular automatic intracardiac defibrillator (biventricular ICD) was implanted. The 2-year follow-up period was characterized by improvement of NYHA functional class from III to I and increasing in left ventricular function. We hereby present a case of IVNC with favourable outcome after biventricular ICD implantation. Cardiac re-synchronization therapy could be considered in the management of this pathology.

La financiación de la Renta Básica, un modelo de microsimulación

[spa] La financiación es uno de los aspectos de la Renta Básica en que más se ha avanzado en los últimos 10 o 12 años. Por Renta Básica aquí se entenderá en todo momento un ingreso pagado por el estado a cada miembro de pleno derecho de la sociedad o residente, incluso si no quiere trabajar de forma remunerada, sin tomar en consideración si es rico o pobre, o dicho de otra forma, independientemente de cuáles puedan ser las otras posibles fuentes de renta, y sin importar con quien conviva. Diversas e interesantes investigaciones para ámbitos geográficos distintos han hecho acto de aparición y han alimentado un vivo debate acerca de las formas de financiar la Renta Básica. La Renta Básica puede ser pagada por parte de distintas instituciones públicas. La propuesta de financiación de la Renta Básica a la que se refiere este artículo consiste en una reforma en profundidad del actual Impuesto de la Renta de las Personas Físicas (IRPF). El estudio opta por este camino porque se ha tenido acceso a datos individualizados del IRPF de Cataluña, pero también porque este impuesto es especialmente útil para apreciar, por ejemplo, la redistribución resultante de la renta. Está basado en un programa de microsimulación específicamente diseñado para este objetivo, aplicado sobre una base de datos provenientes de una muestra de 110.474 declaraciones del IRPF de Cataluña, para evaluar diferentes opciones de políticas de integración de impuestos y prestaciones que incluyan una Renta Básica. Este estudio muestra que la reforma propuesta es viable en términos económicos y que el impacto en la distribución de la renta sería muy progresivo, como después se especificará.

Reading, Translating, Rewriting: Angela Carter's Translational Poetics

In "Reading, Translating, Rewriting: Angela Carter's Translational Poetics", author Martine Hennard Dutheil de la Rochère delves into Carter's The Fairy Tales of Charles Perrault (1977) to illustrate that this translation project had a significant impact on Carter's own writing practice. Hennard combines close analyses of both texts with an attention to Carter's active role in the translation and composition process to explore this previously unstudied aspect of Carter's work. She further uncovers the role of female fairy-tale writers and folktales associated with the Grimms' Kinder- und Hausmärchen in the rewriting process, unlocking new doors to The Bloody Chamber. Hennard begins by considering the editorial evolution of The Fairy Tales of Charles Perrault from 1977 to the present day, as Perrault's tales have been rediscovered and repurposed. In the chapters that follow, she examines specific linkages between Carter's Perrault translation and The Bloody Chamber, including targeted analysis of the stories of Red Riding Hood, Bluebeard, Puss-in-Boots, Beauty and the Beast, Sleeping Beauty, and Cinderella. Hennard demonstrates how, even before The Bloody Chamber, Carter intervened in the fairy-tale debate of the late 1970s by reclaiming Perrault for feminist readers when she discovered that the morals of his worldly tales lent themselves to her own materialist and feminist goals. Hennard argues that The Bloody Chamber can therefore be seen as the continuation of and counterpoint to The Fairy Tales of Charles Perrault, as it explores the potential of the familiar stories for alternative retellings. While the critical consensus reads into Carter an imperative to subvert classic fairy tales, the book shows that Carter valued in Perrault a practical educator as well as a proto-folklorist and went on to respond to more hidden aspects of his texts in her rewritings. Reading, Translating, Rewriting is informative reading for students and teachers of fairy-tale studies and translation studies.

Relocation Assistance and Advisory Services, November 4, 2010

This brochure provides general information about relocation assistance provided by the Iowa Department of Transportation (DOT) for those individuals who may be required to move as a result of a highway project. It is not intended to be a legal document that comprehensively explains every right or obligation you have as established by Chapter 316, Code of Iowa; Federal Public Laws 91-646 and 100-17; and 49 CFR. Your relocation advisor will provide the assistance you need to successfully relocate to a suitable replacement property. Your first contact with your relocation advisor will usually occur during the early stages of the appraisal process, and he or she will continue to work with you until you have moved and become established at a new location. Do not hesitate to ask questions so you are sure you understand the process, your rights and the benefits available to you. Please let your DOT relocation advisor know your needs and preferences. If your relocation advisor is unable to help you with a specific problem or concern, he or she may know of another person or an organization that can help you.

Facts about Iowa Law Enforcement Physical Standards for Pre-employment Testing, 2011

The Iowa Law Enforcement Academy Council, in recognizing the importance of physical fitness status for job performance, established this physical test regimen as a employment standard effective February 15, 1993. No person can be selected or appointed as a law enforcement officer without first successfully passing all of the elements of this test. (See 501 IAC 2.1, adopted pursuant to Section 80B.11(5), Code of Iowa.) Upon entry into the Academy every candidate will be given the same test as an assessment for training purposes and to ensure that each recruit can undergo the physical demands of the Academy without undue risk of injury, and with a level of fatigue tolerance to meet all Academy requirements. If at the time of entrance into the Academy an officer does not meet minimum standards, he or she will not be admitted. This pamphlet will provide information on the rationale, purpose, testing procedures, standards of performance and fitness activities to prepare for the fitness testing. It is intended to answer the basic questions pertaining to all aspects of the fitness testing process.

Visceral leishmaniasis and hemophagocytic syndrome

A 11 months old female infant from Portugal, free of family history, consults for apathy, weight loss, tachycardia, tachypnea, petechiae, pallor without icterus and hepatoslenomegaly. Seven months earlier, while being in Portugal, she presented a persistent bluish pimple on her buttock. Laboratory results showed anemia (35 g/l), leucopenia (3.3 G/l), thrombocytopenia (13 G/l), impaired coagulation (INR 1.4, PTT 41 sec.), hyponatremia (124 mmol/l), elevated CRP (139 mg/l), high ferritin (34.775 μg/l) and high triglycerides (5.22 mmol/l). After correction of vital parameters, a bone marrow aspiration and biopsy (BMB) revealed both the etiological diagnosis, namely a visceral leishmaniasis (VL) as well as one of its potential complications, the hemophagocytic syndrome (HS). Transfusions of whole blood, platelets and fresh frozen plasma were immediately started. Dexamethasone (10 mg/m2) and amphotericin B (3 mg/kg/day) have also been administrated. Visceral leishmaniasis is caused by a protozoan (Leishmania donovani) transmitted by the female sandfly. It is endemic in the Mediterranean basin (including France, Italy, Spain and Portugal), South America, sub-Saharan Africa as well as in India and Bangladesh. The parasite infects macrophages and, after several weeks of incubation, the disease occurs by affection of bloodlines (anemia, leucopenia, thrombocytopenia), hepatosplenomegaly, cachexia, gastrointestinal damage. The complications of the disease may lead to death. Liposomal amphotericin B is the currently recommended treatment. HS is caused by the proliferation and activation of macrophages in the marrow in response to a cytokine storm. It may be of primary cause. When it is secondary, it may be related to infections such as leishmaniasis. Patients present with fever and laboratory diagnostic criteria include cytopenia, hypertriglyceridemia, high ferritin and hemophagocytosis in the BMB. The treatment consists among other in the administration of high doses corticosteroids and, in secondary cases, in the treatment of the underlying cause. In conclusion, the clinical and biological features of VL may mimic haematological disorders as leukemia, but an enlargement of the liver and especially of the spleen should remind in this parasitic infection and its potential fatal complication, the HS.

Magnetic properties of Fe-Cu-Nb-Si-B nanocrystaliine magnetic alloys

Several ribbons of composition Fe73.5Cu1Nb 3Si16.5B6 and Fe73.5Cu1 Nb3Si13.5B9 were prepared by annealing the as-quenched samples between 525°C and 700°C; which induced nucleation of nanocrystallites of Fe bcc-type composition. Mean grain sizes were obtained from X-ray diffraction. Static magnetic properties were measured with both a Magnet Physik Hysteresis-Graph (up to 200 Oe) and a SHE SQUID magnetometer (up to 50 kOe). Soft magnetic parameters (coercive field and initial permeability) were very sensitive to grain size. The ZFC magnetization at low field showed a broad peak at a temperature TM, thus signalling a certain distribution of nanocrystalline sizes, and TM strongly decreased when the mean grain size decreased. Isothermal magnetization curves at low temperature showed the expected asymptotic behavior of a random magnet material at low and high fields.

Double seronegative myasthenia gravis with antiphospholipid syndrome: a case report.

INTRODUCTION: Myasthenia gravis is an autoimmune disease characterized by fluctuating muscle weakness. It is often associated with other autoimmune disorders, such as thyroid disease, rheumatoid arthritis, systemic lupus erythematosus, and antiphospholipid syndrome. Many aspects of autoimmune diseases are not completely understood, particularly when they occur in association, which suggests a common pathogenetic mechanism. CASE PRESENTATION: We report a case of a 42-year-old Caucasian woman with antiphospholipid syndrome, in whom myasthenia gravis developed years later. She tested negative for both antibodies against the acetylcholine receptor and against muscle-specific receptor tyrosine-kinase, but had typical decremental responses at the repetitive nerve stimulation testing, so that a generalized myasthenia gravis was diagnosed. Her thromboplastin time and activated partial thromboplastin time were high, anticardiolipin and anti-β2 glycoprotein-I antibodies were slightly elevated, as a manifestation of the antiphospholipid syndrome. She had a good clinical response when treated with a combination of pyridostigmine, prednisone and azathioprine. CONCLUSIONS: Many patients with myasthenia gravis test positive for a large variety of auto-antibodies, testifying of an immune dysregulation, and some display mild T-cell lymphopenia associated with hypergammaglobulinemia and B-cell hyper-reactivity. Both of these mechanisms could explain the occurrence of another autoimmune condition, such as antiphospholipid syndrome, but further studies are necessary to shed light on this matter.Clinicians should be aware that patients with an autoimmune diagnosis such as antiphospholipid syndrome who develop signs and neurological symptoms suggestive of myasthenia gravis are at risk and should prompt an emergent evaluation by a specialist.

New Convictions Lower for Parole, Data Download, Iowa Department of Corrections, Data Download, November 2011

In June 2011, Lettie Prell released a report entitled Iowa Recidivism Report: Prison Return Rates (FY2007 Releases Tracked for 3 Years), in which she finds that those prison inmates who are paroled are less likely to return to prison due to a new conviction than are inmates who leave prison due to expiration ofsentence.

A New Way to Look at Offender Recidivism, ICON Data Download, Iowa Department of Corrections, January 2007

Traditionally, recidivism is studied from the point when an offender first has an opportunity to reoffend, which is usually when he or she is admitted to community-based corrections supervision. However, an offender beginning supervision has not had an opportunity to complete treatment interventions that would potentially lower their risk of reoffending.

Mossbauer and magnetization studies of amorphous NdFeB compositionally modulated thin films

Several NdFeB compositionally modulated thin films are studied by using both conversion electron Mossbauer spectra and SQUID (superconducting quantum-interference-device) magnetometry. Both the hyperfine fields and the easy magnetization magnitude are not correlated with the modulation characteristic length (lambda) while the magnetization perpendicular to the thin-film plane decreases as lambda increases. The spectra were recorded at room temperature being the gamma rays perpendicular to the substrate plane. The magnetization measurements were recorded by using a SHE SQUID magnetometer in applied magnetic fields up to 5.5 T and in the temperature range between 1.8 and 30 K.

PTLD Burkitt Lymphoma in a Patient with Remote Lymphomatoid Granulomatosis.

Posttransplant lymphoproliferative disorder (PTLD) is a potentially fatal complication of solid organ transplantation. The majority of PTLD is of B-cell origin, and 90% are associated with the Epstein-Barr virus (EBV). Lymphomatoid granulomatosis (LG) is a rare, EBV-associated systemic angiodestructive lymphoproliferative disorder, which has rarely been described in patients with renal transplantation. We report the case of a patient with renal transplantation for SLE, who presented, 9 months after renal transplantation, an EBV-associated LG limited to the intracranial structures that recovered completely after adjustment of her immunosuppressive treatment. Nine years later, she developed a second PTLD disorder with central nervous system initial manifestation. Workup revealed an EBV-positive PTLD Burkitt lymphoma, widely disseminated in most organs. In summary, the reported patient presented two lymphoproliferative disorders (LG and Burkitt's lymphoma), both with initial neurological manifestation, at 9 years interval. With careful reduction of the immunosuppression after the first manifestation and with the use of chemotherapy combined with radiotherapy after the second manifestation, our patient showed complete disappearance of neurologic symptoms and she is clinically well with good kidney function. No recurrence has been observed by radiological imaging until now.

La financiación de la Renta Básica, un modelo de microsimulación

[spa] La financiación es uno de los aspectos de la Renta Básica en que más se ha avanzado en los últimos 10 o 12 años. Por Renta Básica aquí se entenderá en todo momento un ingreso pagado por el estado a cada miembro de pleno derecho de la sociedad o residente, incluso si no quiere trabajar de forma remunerada, sin tomar en consideración si es rico o pobre, o dicho de otra forma, independientemente de cuáles puedan ser las otras posibles fuentes de renta, y sin importar con quien conviva. Diversas e interesantes investigaciones para ámbitos geográficos distintos han hecho acto de aparición y han alimentado un vivo debate acerca de las formas de financiar la Renta Básica. La Renta Básica puede ser pagada por parte de distintas instituciones públicas. La propuesta de financiación de la Renta Básica a la que se refiere este artículo consiste en una reforma en profundidad del actual Impuesto de la Renta de las Personas Físicas (IRPF). El estudio opta por este camino porque se ha tenido acceso a datos individualizados del IRPF de Cataluña, pero también porque este impuesto es especialmente útil para apreciar, por ejemplo, la redistribución resultante de la renta. Está basado en un programa de microsimulación específicamente diseñado para este objetivo, aplicado sobre una base de datos provenientes de una muestra de 110.474 declaraciones del IRPF de Cataluña, para evaluar diferentes opciones de políticas de integración de impuestos y prestaciones que incluyan una Renta Básica. Este estudio muestra que la reforma propuesta es viable en términos económicos y que el impacto en la distribución de la renta sería muy progresivo, como después se especificará.