Thrombotic thrombocytopenic purpura during pregnancy versus imitator of preeclampsia.

BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is a severe disorder affecting the microcirculation of multiple organs due to a systemic endothelial cell injury secondary to a deficiency in ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13) activity. TTP is a rare complication of pregnancy with a poor prognosis and high fetal mortality, especially when it occurs during the first trimester. Recent data have supported that effective treatment of TTP is plasma therapy. Unfortunately a major problem remains in the delay in diagnosis due to confounding factors between other "imitators of preeclampsia." Rapid and readily available laboratory testing to quickly diagnose TTP is desperately needed to improve care and to save mother and future child life. CASE REPORT We describe a rare case of successful pregnancy after TTP manifestations occurring in the first trimester; most importantly, our experience represents the first case of atypical manifestation due to neurologic and kidney manifestations preceding laboratory assay alterations. RESULTS We treated a patient with plasma replacement of 30 mL/kg/day and daily plasmapheresis in combination with continuous infusion of fresh-frozen plasma 10 mL/kg/day. The response of clinical manifestation immediately improved. At 30 weeks, the patient had multiple episodes of high blood pressure and concomitant decrease of hemoglobin and platelet count, so a cesarean section was immediately performed. She delivered a healthy female baby. CONCLUSION Early diagnosis by ADAMTS13 activity, occasionally occurring before clinical manifestations, aided us in promptly administering commended and life-saving treatments.

Enhanced Caching Strategies At the Edge of LTE Mobile Networks

With a boom in the usage of mobile devices for traffic-heavy applications, mobile networks struggle to deliver good performance while saving resources to support more users and save on costs. In this paper, we propose enhanced strategies for the preemptive migration of content stored in Information-Centric Networking caches at the edge of LTE mobile networks. With such strategies, the concept of content following the users interested in it becomes a reality and content within caches is more optimized towards the requests of nearby users. Results show that the strategies are feasible, efficient and, when compared to default caching strategies, ensure that content is delivered faster to end users while using bandwidth and storage resources more efficiently at the core of the network.

Integrin mediated growth and apoptosis in human gastric adenocarcinoma

Integrins are important as the primary cell adhesion molecule providing information about the extracellular microenvironment to the interior of the cell to influence cellular behavior such as differentiation, proliferation and apoptosis. Apoptotic death due to loss of adhesion is termed anoikis. In this study we have obtained a parental human gastric adenocarcinoma cell line that yielded two variant lines that had differing responses to lack of adhesion. The STAD.APO cell line undergoes apoptosis when denied adherence and the STAD.ARR cell line enters into cell cycle arrest under the identical suspended conditions. We have shown that cyclin A and cyclin D mRNA and protein are down regulated when cells are denied adherence for 24 hours in tissue culture wells previously coated with poly-HEMA. To test whether cyclin A was able to rescue cells from cell cycle arrest and/or anoikis by overriding the cell cycle machinery we transfected the full length cDNA in to each cell type. Surprisingly we found that anoikis and cell cycle arrest due to suspended conditions was not affected by overexpression of cyclin A protein, but that growth under adhered conditions was reduced compared to vector alone control transfectants. Further, we transfected other cell lines; ST7, gastric cancer, MDA-MB-4.35, breast cancer, and HPB T-cell leukemic and in no case were suspended culturing conditions overcome by cyclin A. This result indicates an additional level of regulation for the cell cycle machinery. Additionally, soluble collagen was shown to be able to save from anoikis and also from cell cycle arrest while the β1 specific mAb 33B6 was only able to save from anoikis. Immunofluorescent studies show that soluble collagen creates clusters of β1 with FAK and also β1 with actin in the STAD.ARR cells but does not in the STAD.APO cells. This result indicates that the phenotypes under suspended conditions between these cell lines may diverge at their requirements for integrin ligation. Additionally we characterized the nature of anoikis by showing cytochrome c release, caspase 3, p21 and p53 activation in STAD.APO cells. Thus, our results have implications in the understanding of integrin biology and neoplastic progression. ^

Polybrominated diphenyl ethers: Potential human exposure through household dust and dryer lint

This MPH thesis consists of (1) literature review of the relatively new synthetic persistent organic pollutants (POP), polybrominated diphenyl ethers (PBDEs), a type of flame retardant posing a potential public health hazard, (2) Presentation of data on PBDE levels in dryer lint from Dallas, TX and Hamburg, Germany. ^ PBDEs are used as additive fire retardants in plastics, polyurethane foam and electronic equipment to reduce flammability and thus save life and property. PBDEs have been widely used beginning in the 1970s. They resemble polychlorinated biphenyls (PCBs) in structure and toxicity. PBDEs are found in environmental sediments, sludges, and wildlife and even in human blood, milk and tissues. ^ PBDEs, due to their lipophilicity, accumulate in fat and other tissues and biomagnify up the food chain, with increasing concentrations. Animal studies have suggested potential health effects including thyroid disruption, permanent learning and memory impairment, fetal malformations, developmental neurotoxicity and, at high doses, possibly cancer. ^ PBDE levels are increasing in blood and breast milk in North America, but PBDEs intake unlike PCBs appears to be not primarily through food; food PBDE levels in the U.S. are not markedly higher than in Europe yet U.S. human blood and milk levels are much higher. For this reason various exposure pathways including PBDE contaminated dust and air have been studied to better characterize routes of PBDE intake into humans. ^ The scientific literature on PBDE levels in household dust reports higher PBDE concentration in dust than that found in dryer lint; levels in the U.S are elevated compared to other countries with congeners such as BDE 47, 99, 100 and 209 predominating. The United Kingdom has elevated BDE 209 due to high usage of Deca commercial mixture. These studies suggest that indoor PBDE contamination through household dust could be a potential source of PBDE exposure and body burden especially in young children. ^ PBDE levels in dryer lint from U.S ranged from 321 to 3073 ng/g (Mean: 1138 ng/g, Median: 803 ng/g) and from Germany were from 330 to 2069 ng/g (Median: 71ng/g, Mean: 361 ng/g). High median levels in U.S samples indicate contamination of lint with PBDEs although the source of the PBDEs in lint may be from dryer electrical components or air deposition onto clothes, lint may be one source of PBDE exposure to humans. ^

The diagnostic value of a 12-lead electrocardiogram in patients with cardiac tamponade due to a malignant pericardial effusion

Background. Cardiac tamponade can occur when a large amount of fluid, gas, singly or in combination, accumulating within the pericardium, compresses the heart causing circulatory compromise. Although previous investigators have found the 12-lead ECG to have a poor predictive value in diagnosing cardiac tamponade, very few studies have evaluated it as a follow up tool for ruling in or ruling out tamponade in patients with previously diagnosed malignant pericardial effusions. ^ Methods. 127 patients with malignant pericardial effusions at the MD Anderson Cancer Center were included in this retrospective study. While 83 of these patients had a cardiac tamponade diagnosed by echocardiographic criteria (Gold standard), 44 did not. We computed the sensitivity (Se), specificity (Sp), positive (PPV) and negative predictive values (NPV) for individual and combinations of ECG abnormalities. Individual ECG abnormalities were also entered singly into a univariate logistic regression model to predict tamponade. ^ Results. For patients with effusions of all sizes, electrical alternans had a Se, Sp, PPV and NPV of 22.61%, 97.61%, 95% and 39.25% respectively. These parameters for low voltage complexes were 55.95%, 74.44%, 81.03%, 46.37% respectively. The presence of all three ECG abnormalities had a Se = 8.33%, Sp = 100%, PPV = 100% and NPV = 35.83% while the presence of at least one of the three ECG abnormalities had a Se = 89.28%, Sp = 46.51%, PPV = 76.53%, NPV = 68.96%. For patients with effusions of all sizes electrical alternans had an OR of 12.28 (1.58–95.17, p = 0.016), while the presence of at least one ECG abnormality had an OR of 7.25 (2.9–18.1, p = 0.000) in predicting tamponade. ^ Conclusions. Although individual ECG abnormalities had low sensitivities, specificities, NPVs and PPVs with the exception of electrical alternans, the presence of at least one of the three ECG abnormalities had a high sensitivity in diagnosing cardiac tamponade. This could point to its potential use as a screening test with a correspondingly high NPV to rule out a diagnosis of tamponade in patients with malignant pericardial effusions. This could save expensive echocardiographic assessments in patients with previously diagnosed pericardial effusions. ^

Critical indicators associated with negative performance in a selectively manned unit

Introduction. Selectively manned units have a long, international history, both military and civilian. Some examples include SWAT teams, firefighters, the FBI, the DEA, the CIA, and military Special Operations. These special duty operators are individuals who perform a highly skilled and dangerous job in a unique environment. A significant amount of money is spent by the Department of Defense (DoD) and other federal agencies to recruit, select, train, equip and support these operators. When a critical incident or significant life event occurs, that jeopardizes an operator's performance; there can be heavy losses in terms of training, time, money, and potentially, lives. In order to limit the number of critical incidents, selection processes have been developed over time to “select out” those individuals most likely to perform below desired performance standards under pressure or stress and to "select in" those with the "right stuff". This study is part of a larger program evaluation to assess markers that identify whether a person will fail under the stresses in a selectively manned unit. The primary question of the study is whether there are indicators in the selection process that signify potential negative performance at a later date. ^ Methods. The population being studied included applicants to a selectively manned DoD organization between 1993 and 2001 as part of a unit assessment and selection process (A&S). Approximately 1900 A&S records were included in the analysis. Over this nine year period, seventy-two individuals were determined to have had a critical incident. A critical incident can come in the form of problems with the law, personal, behavioral or family problems, integrity issues, and skills deficit. Of the seventy-two individuals, fifty-four of these had full assessment data and subsequent supervisor performance ratings which assessed how an individual performed while on the job. This group was compared across a variety of variables including demographics and psychometric testing with a group of 178 individuals who did not have a critical incident and had been determined to be good performers with positive ratings by their supervisors.^ Results. In approximately 2004, an online pre-screen survey was developed in the hopes of preselecting out those individuals with items that would potentially make them ineligible for selection to this organization. This survey has aided the organization to increase its selection rates and save resources in the process. (Patterson, Howard Smith, & Fisher, Unit Assessment and Selection Project, 2008) When the same prescreen was used on the critical incident individuals, it was found that over 60% of the individuals would have been flagged as unacceptable. This would have saved the organization valuable resources and heartache.^ There were some subtle demographic differences between the two groups (i.e. those with critical incidents were almost twice as likely to be divorced compared with the positive performers). Upon comparison of Psychometric testing several items were noted to be different. The two groups were similar when their IQ levels were compared using the Multidimensional Aptitude Battery (MAB). When looking at the Minnesota Multiphasic Personality Inventory (MMPI), there appeared to be a difference on the MMPI Social Introversion; the Critical Incidence group scored somewhat higher. When analysis was done, the number of MMPI Critical Items between the two groups was similar as well. When scores on the NEO Personality Inventory (NEO) were compared, the critical incident individuals tended to score higher on Openness and on its subscales (Ideas, Actions, and Feelings). There was a positive correlation between Total Neuroticism T Score and number of MMPI critical items.^ Conclusions. This study shows that the current pre-screening process is working and would have saved the organization significant resources. ^ If one was to develop a profile of a candidate who potentially could suffer a critical incident and subsequently jeopardize the unit, mission and the safety of the public they would look like the following: either divorced or never married, score high on the MMPI in Social Introversion, score low on MMPI with an "excessive" amount of MMPI critical items; and finally scores high on the NEO Openness and subscales Ideas, Feelings, and Actions.^ Based on the results gleaned from the analysis in this study there seems to be several factors, within psychometric testing, that when taken together, will aid the evaluators in selecting only the highest quality operators in order to save resources and to help protect the public from unfortunate critical incidents which may adversely affect our health and safety.^

Statistical Methods for Differential Expressions of Genes Detected in Multiple-Condition Experiment of Microarray

Most studies of differential gene-expressions have been conducted between two given conditions. The two-condition experimental (TCE) approach is simple in that all genes detected display a common differential expression pattern responsive to a common two-condition difference. Therefore, the genes that are differentially expressed under the other conditions other than the given two conditions are undetectable with the TCE approach. In order to address the problem, we propose a new approach called multiple-condition experiment (MCE) without replication and develop corresponding statistical methods including inference of pairs of conditions for genes, new t-statistics, and a generalized multiple-testing method for any multiple-testing procedure via a control parameter C. We applied these statistical methods to analyze our real MCE data from breast cancer cell lines and found that 85 percent of gene-expression variations were caused by genotypic effects and genotype-ANAX1 overexpression interactions, which agrees well with our expected results. We also applied our methods to the adenoma dataset of Notterman et al. and identified 93 differentially expressed genes that could not be found in TCE. The MCE approach is a conceptual breakthrough in many aspects: (a) many conditions of interests can be conducted simultaneously; (b) study of association between differential expressions of genes and conditions becomes easy; (c) it can provide more precise information for molecular classification and diagnosis of tumors; (d) it can save lot of experimental resources and time for investigators.^

Volunteering: Demographic characteristics, motives and potential benefits from service

Volunteering is intricately woven into the fabric of our society. In 2009 alone, approximately 63.4 million Americans participated in volunteer activities, collectively donating over 8.1 billion service-hours (Corporation for National and Community Service [CNCS], 2010). Each service-hour is determined by the U.S. Bureau of Labor Statistics (2010) to be valued at $20.85/hr which translates to a national savings of $169 billion. Thus, we can clearly observe the significance of volunteer contribution to the overall benefit of society. In addition, there is now evidence that voluntary service may also benefit the actual volunteer, especially individuals who are 65+ years. As we reach 2020 this elderly class, composed of nearly 13 million (CNCS, 2010) Americans, will be of much consequence. Their potential to contribute in community-related efforts may save the U.S. billions in labor costs, and may also help reduce healthcare-related expenditures if volunteering proves to be a protective factor. In this literature review, we set out to explore the potential relationship between volunteer participation and increased mental and physical wellness. We also examined volunteer demographic characteristics and common motives for engaging in service-related activities. Analysis showed that volunteer work often combined low-impact physical activity and mental satisfaction from serving others, resulting in overall health benefit. Demographic characteristics displayed were consistent with previous studies and found that a majority of volunteers were female, White, married status, having received college degree or higher, employed, middle-high SES. In addition, age was seen to be a key characteristic in forecasting volunteer motivation and self-reported perceived health benefits.^

Rabies control in the developing world: Results of a cross-sectional study in Bohol, Philippines

Rabies remains a significant problem in much of the developed world, where canine rabies is not well controlled, and the bite of an infected dog is the most common means of transmission. The Philippines continues to report several hundred cases of human rabies every year, and many more cases go undetected. In recent years, the province of Bohol has been targeted by the Philippine government and the World Health Organization for a rabies eradication program. ^ The primary objective of this dissertation research was to describe factors associated with dog vaccination coverage and knowledge, attitudes, and practices regarding rabies among households in Bohol, Philippines. Utilizing a cross-sectional cluster survey design, we sampled 460 households and 541 dogs residing within dog-owning households. ^ Multivariate linear regression was used to examine potential associations between knowledge, attitudes, and practices (KAPs) and variables of interest. Forty-six percent of households knew that rabies was spread through the bite of an infected dog. The mean knowledge score was 8.36 (SD: ± 3.4; range: 1–24). We found that having known someone with rabies was significantly associated with an almost one point increase in the knowledge score (β = 0.88; p = 0.02). The mean attitudes score was 5.65 (SD: ± 0.63; range: 2–6), and the mean practices score was 7.07 (SD: ± 1.7; range: 2–9). Both the attitudes score and the practices score were positively and significantly associated with only the knowledge score and no other covariates. ^ Multivariate logistic regression was used to examine associations between dog vaccination coverage and variables of interest. Approximately 71% of owned dogs in Bohol were reported as vaccinated at some time during their lives. We found that a dog's age was significantly associated with vaccination, and the odds of vaccination increased in a linear fashion with age. We also found that dogs had approximately twice the odds of being vaccinated if they were confined both day and night to the household premises or if the owner was employed; however, these results were only marginally significant (p = 0.07) in the multivariate model. ^ Finally, a systematic review was conducted on canine rabies vaccination and dog population demographics in the developing world. We found few studies on this topic, especially in countries where the burden of rabies is greatest. Overall, dog ownership is high. Dogs are quite young and do not live very long due to disease and accidents. The biggest deterrent to vaccination is the rapid dog population turnover. ^ It is our hope that this work will be used to improve dog rabies vaccination programs around the world and save lives, both human and canine.^

Poda de verano en manzanos Red Delicious : efecto sobre la calidad de la fruta y las hojas de los dardos

En el Alto Valle del Río Negro y Neuquén, Argentina (latitud 38° 55´ Sur) se realizó un estudio en árboles cv. Red Delicious, conducidos en espaldera, de 4 m de altura, distanciamiento de 4 x 3 m y una orientación de la plantación Este - Oeste. Durante diciembre los árboles se podaron, eliminando 2/3 de cada crecimiento del año o fueron dejados sin podar (testigo). En la cosecha, en cada árbol y a ambos lados de la fila se determinaron tres alturas sobre el nivel del suelo (1.0 m, 2.5 m y 3.8 m) para la medición de la Radiación Fotosintéticamente Activa (PAR) y muestreo de frutos y hojas de dardos. En el fruto se evaluó: peso, contenido de sólidos solubles, firmeza de pulpa y porcentaje de color rojo de la piel. También se midió el Peso Específico de Hoja (PEH). La utilización de la poda de verano actúa en forma directa sobre el aumento del color rojo de la piel de los frutos y sobre la pérdida de la firmeza de la pulpa. El PAR afecta en un 50 % los parámetros de calidad y madurez de la fruta y en un 63 % el PEH; a su vez el PAR es afectado significativamente por la poda sólo en la parte superior del lado sur y en la parte media e inferior del lado norte. De esta manera se logrará ahorrar aproximadamente un 50 % del costo de la mano de obra de la poda estival total.

Algunos epigramas de Goethe y de Schiller

Este trabajo ofrece algunos epigramas de Goethe y de Schiller en una versión que puede llamarse rítmica porque ha procurado hacer justicia tanto a la sentencia como a la forma de los mismos. Pero precisamente por ser ésta una versión rítmica, no se ha de encontrar, en todos los casos, una correspondencia literal con los originales. La meta ha sido salvar siempre la idea y el ritmo de cada epigrama, a sabiendas de que ello obligaría a sacrificar, acá y allá, más de una palabra. Los epigramas que pertenecen a dos grupos. El primero, vinculado con el nombre de Goethe, está integrado por doce de ellos, que se dan a conocer aquí por primera vez. El segundo grupo abarca, por su parte, dieciséis de treinta epigramas ya publicados, aunque ahora renovados, con la figura rítmica regular de la que carecían.

Para pensar la identidad cultural en el desierto de Lavalle

El desierto de Lavalle, en el N.E. de la provincia de Mendoza, es un espacio donde a pesar de un fortísimo proceso de aculturación que ha durado cuatro siglos, perviven signos de una cultura que nos remonta a los antiguos Huarpes, habitantes de estas tierras. La extracción de las riquezas del desierto que se realizó durante el s. XIX dejó, al finalizar en el s.XX, una tierra yerma y a los habitantes de este desierto abandonados y en la miseria pero también libres para retomar los viejos patrones de asentamiento disperso, cierto nomadismo, autonomía y libertad que siempre caracterizaron a estos puesteros. En este trabajo intentamos relatar los puntos principales de la historia de este proceso de aculturación, de desertificación antrópica pero también de perduración del habitus que están tratando de rescatar las comunidades Huarpes en la actualidad.

Evaluación del rendimiento y calidad de cultivares de ajo colorado fertirrigados con nitrógeno

El objetivo de este trabajo fue diferenciar cultivares monoclonales de ajos colorados argentinos por sus características productivas, de calidad y respuesta a la fertilización nitrogenada en la región de Cuyo. Durante la campaña 2003 se realizó un ensayo en La Consulta, San Carlos, Mendoza, Argentina (950 msnm; 33° 42' S y 69° 04' W). El diseño experimental fue en franjas con parcelas divididas dispuestas en un diseño de bloques completos al azar de tres repeticiones en el cual las dosis de nitrógeno (75, 150, 225 y 300 kg de N·ha-1) incorporadas como SolUAN (30 % N) se asignaron a las parcelas principales y las subparcelas correspondieron a cinco clones de ajo: Fuego INTA, Sureño INTA, Gostoso INTA, Inco 30 y Rubí INTA. Se adicionó además un tratamiento control sin nitrógeno. En el análisis estadístico de los rendimientos (r2 = 0,81; cv%: 8,48 y p < 0,0001) se detectaron efectos significativos de las variables cultivares y dosis de fertilización nitrogenada pero no de la interacción de ambas. Se determinó que en suelos con contenidos medios de nitrógeno total (800 mg·kg-1), la dosis que maximiza los rendimientos es de 150 kg N·ha-1 en todas las cultivares salvo Gostoso cuyo valor crítico resultó mayor que el resto. El incremento de rendimiento atribuible a la fertirrigación con 150 kg N·ha-1 respecto del testigo fue: 45 % en Rubí (17,7 t· ha-1), 31 % en Fuego (15,3 t·ha-1), 19 % en Inco (15,4 t·ha-1) y 23 % en Sureño (13 t·ha-1). Gostoso aumentó un 21 % (13,8 t·ha-1) su rendimiento respecto del testigo con la dosis de 300 kg N·ha-1. El análisis de clasificación jerárquica permitió agrupar los genotipos según su potencial productivo, de mayor a menor, en tres clases: I: cv. Rubí ; II: cv. Inco 30 y cv. Fuego; III: cv. Sureño y Gostoso. La fertilización nitrogenada incrementó la manifestación de malformaciones en todas las cultivares respecto del testigo sin fertilización, excepto Sureño que presentó mayores anormalidades en el tratamiento testigo sin fertilizar.

Paisajismo sustentable en zonas áridas : especies útiles para parquizaciones xéricas

Se analiza el valor económico, ecológico y paisajístico de especies vegetales, pertenecientes a la flora espontánea de Mendoza (Argentina), resistentes a la sequía y que pueden alcanzar porte arbóreo. Su empleo ahorra agua de riego en espacios verdes ornamentales y de protección ambiental. Se sugiere medidas de conservación de las especies espontáneas más útiles paisajísticamente, así como normas generales sobre métodos de plantación y mantenimiento. Se recomiendan especies leñosas espontáneas de la provincia, de bajo requerimiento hídrico, utilizables paisajísticamente.

La lógica social del boxeo en el Chicago negro. Hacia una sociología del boxeo

Este artículo es dedicado a la memoria de Aaron, jovencito español y amigo del gimnasio, a quien el ring no lo salvó de los peligros de la calle. Este trabajo se benefició de las respuestas, los comentarios críticos y el aliento de una serie de colegas, entre los cuales se encuentran Pierre Bourdieu, Rogers Brubaker, Dan Chambliss, S. Lynn Chancer, Rick Fantasia, Harvey Molotch, Bill Wilson, y los miembros del Centro de Sociología Europea en París. También agradezco a mis colegas de la "la dulce ciencia", que me enseñaron mucho más que a lanzar gancho de izquierda, y a mi familia y amigos que me apoyaron moralmente durante este extenuante proyecto (con mención especial para Elizabeth Bonamour du Tartre, una importante asistente en el lugar). Esta investigación fue posible en parte por el apoyo financiero de la Maison des sciences de l'homme, un Lavoisier Fellowship del Gobierno Francés y la Fundación Milton de la Universidad de Harvard.