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Sample records for eagle syndrome diagnostic

  1. Eagle's Syndrome

    PubMed Central

    Pinheiro, Thaís Gonçalves; Soares, Vítor Yamashiro Rocha; Ferreira, Denise Bastos Lage; Raymundo, Igor Teixeira; Nascimento, Luiz Augusto; Oliveira, Carlos Augusto Costa Pires de

    2013-01-01

    Summary Introduction: Eagle's syndrome is characterized by cervicopharyngeal signs and symptoms associated with elongation of the styloid apophysis. This elongation may occur through ossification of the stylohyoid ligament, or through growth of the apophysis due to osteogenesis triggered by a factor such as trauma. Elongation of the styloid apophysis may give rise to intense facial pain, headache, dysphagia, otalgia, buzzing sensations, and trismus. Precise diagnosis of the syndrome is difficult, and it is generally confounded by other manifestations of cervicopharyngeal pain. Objective: To describe a case of Eagle's syndrome. Case Report: A 53-year-old man reported lateral pain in his neck that had been present for 30 years. Computed tomography (CT) of the neck showed elongation and ossification of the styloid processes of the temporal bone, which was compatible with Eagle's syndrome. Surgery was performed for bilateral resection of the stylohyoid ligament by using a transoral and endoscopic access route. The patient continued to present pain laterally in the neck, predominantly on his left side. CT was performed again, which showed elongation of the styloid processes. The patient then underwent lateral cervicotomy with resection of the stylohyoid process, which partially resolved his painful condition. Final Comments: Patients with Eagle's syndrome generally have a history of chronic pain. Appropriate knowledge of this disease is necessary for adequate treatment to be provided. The importance of diagnosing this uncommon and often unsuspected disease should be emphasized, given that correct clinical-surgical treatment is frequently delayed. The diagnosis of Eagle's syndrome is clinical and radiographic, and the definitive treatment in cases of difficult-to-control pain is surgical. PMID:25992033

  2. Eagle syndrome surgical treatment with piezosurgery.

    PubMed

    Bertossi, Dario; Albanese, Massimo; Chiarini, Luigi; Corega, Claudia; Mortellaro, Carmen; Nocini, Pierfrancesco

    2014-05-01

    Eagle syndrome (ES) is an uncommon complication of styloid process elongation with stylohyoideal complex symptomatic calcification. It is an uncommon condition (4% of the population) that is symptomatic in only 4% of the cases. Eagle syndrome is usually an acquired condition that can be related to tonsillectomy or to a neck trauma. A type of ES is the styloid-carotid syndrome, a consequence of the irritation of pericarotid sympathetic fibers and compression on the carotid artery. Clinical manifestations are found most frequently after head turning and neck compression. Although conservative treatment (analgesics, anticonvulsants, antidepressants, local infiltration with steroids, or anesthetic agents) have been used, surgical treatment is often the only effective treatment in symptomatic cases. We present the case of a 55-year-old patient, successfully treated under endotracheal anesthesia. The cranial portion of the calcified styloid process was shortened through an external approach, using a piezoelectric cutting device (Piezosurgery Medical II; Mectron Medical Technology, Carasco, Italy) with MT1-10 insert, pump level 4, vibration level 7. No major postoperative complications such as nerve damage, hematoma, or wound dehiscence occurred. After 6 months, the patient was completely recovered. Two years after the surgery, the patient did not refer any symptoms related to ES. The transcervical surgical approach in patients with ES seems to be safe and effective, despite the remarkable risk for transient marginal mandibular nerve palsy. This risk can be decreased by the use of the piezoelectric device for its distinctive characteristics--such as precision, selective cut action, and bloodless cut.

  3. Eagle's syndrome-A non-perceived differential diagnosis of temporomandibular disorder.

    PubMed

    Thoenissen, P; Bittermann, G; Schmelzeisen, R; Oshima, T; Fretwurst, T

    2015-01-01

    This article unveils a case of the classic styloid syndrome and states that panoramic imaging and ultrasound can be an alternative to computed tomography. In addition, the endoscope-assisted extraoral approach using CT-based navigation is useful. Eagle's Syndrome is an aggregate of symptoms described by Eagle in 1937. He described different forms: the classic styloid syndrome consisting of elongation of the styloid process which causes pain. Second, the stylo-carotid-artery syndrome which is responsible for transient ischemic attack or stroke. Using the example of a 66 years old male patient suffering from long term pain, we explain our diagnostic and surgical approach. After dissecting the styloid process of the right side using an extraoral approach, the pain ceased and the patient could be discharged without any recurrence of the pain up to this point. Eagle's syndrome, with its similar symptoms, is rather difficult to differentiate from temporomandibular joint disorders (TMD), but can be easily excluded from possible differential diagnoses of TMD using panoramic radiographs and ultrasound. Making use of low cost and easily accessible diagnostic workup techniques can reveal this particular cause for chronic pain restricting quality of life. Thereby differentiation from the TMD symptomatic complex is possible. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Eagle's syndrome associated with lingual nerve paresthesia: a case report.

    PubMed

    Dong, Zhiwei; Bao, Haihong; Zhang, Li; Hua, Zequan

    2014-05-01

    Eagle's syndrome is characterized by a variety of symptoms, including throat pain, sensation of a foreign body in the pharynx, dysphagia, referred otalgia, and neck and throat pain exacerbated by head rotation. Any styloid process longer than 25 mm should be considered elongated and will usually be responsible for Eagle's syndrome. Surgical resection of the elongated styloid is a routine treatment and can be accomplished using a transoral or an extraoral approach. We report a patient with a rare giant styloid process that was approximately 81.7 mm. He complained of a rare symptom: hemitongue paresthesia. After removal of the elongated styloid process using the extraoral approach, his symptoms, including the hemitongue paresthesia, were alleviated. We concluded that if the styloid process displays medium to severe elongation, the extraoral approach will be appropriate. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. A rare fatality due to calcified stylohyoid ligament (Eagle syndrome).

    PubMed

    Gupta, Avneesh; Aggrawal, Anil; Setia, Puneet

    2017-06-01

    The elongation or calcification of the stylohyoid ligament that leads to pressure symptoms, or entrapment of nearby glossopharyngeal nerve or carotid artery, is known as Eagle syndrome. A PubMed search leads to finding of rare fatality among the 49 reported cases. In the present case, the deceased was a 40-year-old male who choked on his food. We hypothesise that the impaction of food in the upper respiratory tract, as well as the inability to intubate the person, were both the result of the calcified stylohyoid ligament.

  6. Heterogeneity in the clinical presentation of Eagle's syndrome.

    PubMed

    Mendelsohn, Abie H; Berke, Gerald S; Chhetri, Dinesh K

    2006-03-01

    Eagle's syndrome (ES) or symptomatic elongated styloid process is an uncommon but important cause of chronic head and neck pain. This study reports our experience in the diagnosis and treatment of a series of patients with ES. Patient histories, radiographic tests, and operative reports of 3 patients over a 3-month period were prospectively collected. Tertiary referral otolaryngology service. All patients had resolution of symptoms relating to their elongated styloid processes after surgical resection. Although sometimes clouded by coexisting symptoms, ES can be easily diagnosed based on good history taking and physical examination. If diagnosed appropriately, surgical treatment can be administered promptly. Patients with ES commonly have a long history of chronic pain treated by multiple physicians. Appropriate diagnosis can lead to prompt treatment of this condition. C-4.

  7. [Transcient ischemic attack, a rare manifestation of Eagle syndrome].

    PubMed

    Usseglio, J; Montoro, F Macian; Martin, S; Lerat, J; Laloze, J; Taibi, A; Brie, J

    2016-12-01

    Clinical presentation of Eagle syndrome (ES) is very variable and non-specific, making its diagnosis difficult. It is usually limited to pain. Transient neurological manifestations are exceptional. We report one case in which the diagnosis of ES has been made based on neurological events occurring during left anterolateral head bending, without pain. A 47-year-old man presented with transient neurological events progressing since two years, half-right body paresthesia and reduced field of vision on the left side type, triggered by left anterolateral head flexion and regressive in neutral position. Transcranial Doppler and CT angiography of the supra-aortic trunks were performed in neutral position and in right and left head rotation that showed a disruption of the left sylvian flow and an extrinsic compression of the left internal carotid artery, due to a musculoskeletal impediment involving the lower end of the temporal styloid process. Complete recovering was achieved after surgical resection of this process. A control CT angiography confirmed the cessation of the compression. ES has non-specific and highly variable clinical manifestations making diagnosis difficult or leading to misdiagnosis. ES should be considered in any transient neurological deficit, especially when occurring during head rotation. Treatment relies on surgical resection of the excessively long styloid process. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. Trigeminal neuralgia post-styloidectomy in Eagle syndrome: a case report

    PubMed Central

    2012-01-01

    Introduction Eagle syndrome is a condition characterized by an elongated (>3cm) styloid process with associated symptoms of recurrent facial or throat pain. In this report we present a case of Eagle syndrome exhibiting the typical findings of glossopharyngeal nerve involvement, as well as unusual involvement of the trigeminal nerve. Notably, this patient developed a classical trigeminal neuralgia post-styloidectomy. Case presentation A 68-year-old Caucasian woman presented with a 25-year history of dull pain along the right side of her throat, lateral neck, and jaw. Her symptoms were poorly controlled with medication until 15 years ago when she was diagnosed with Eagle syndrome, and underwent a manual fracture of her styloid process. This provided symptomatic relief until 5 years ago when the pain recurred and progressed. She underwent a styloidectomy via a lateral neck approach, which resolved the pain once again. However, 6 months ago a new onset of triggerable, electric shock-like facial pain began within the right V1 and V2 distributions. Conclusions Eagle syndrome is distressing to patients and often difficult to diagnose due to its wide variability in symptoms. It is easily confused with dental pain or temporomandibular joint disorder, leading to missed diagnoses and unnecessary procedures. Pain along the jaw and temple is an unusual but possible consequence of Eagle syndrome. An elongated styloid process should be considered a possible etiology of dull facial pain in the trigeminal distributions, in particular V3. PMID:23031688

  9. Eagle's syndrome veiling as pain of odontogenic origin: Report of two cases with cone beam computed tomography illustration

    PubMed Central

    Ranjan, Vikash; Rai, Shalu; Misra, Deepankar; Panjwani, Sapna

    2015-01-01

    Eagle's syndrome, also known as an elongated styloid process, is a condition that may be the source of craniofacial and cervical pain. It is infrequently reported but is probably more common than generally considered. The symptoms related to Eagle's syndrome can be confused with those attributed to a wide variety of facial neuralgia and or oral, dental, and temporomandibular joint diseases. In this paper, there are two cases, which reported to the Department of Oral Medicine, Diagnosis, and Maxillofacial Radiology, with a chief complaint of radiating pain in the preauricular region of the face. After radiographic investigation, these cases are considered as a case of Eagle's syndrome because of increase in the size of the styloid process. PMID:27390501

  10. Eagle's syndrome: treatment by intraoral bilateral resection of the ossified stylohyoid ligament. A review and report of two cases.

    PubMed

    Martins, Wilson Denis; Ribas, Marina de Oliveira; Bisinelli, Julio; França, Beatriz Helena Sottile; Martins, Guilherme

    2013-07-01

    The complexities of Eagle's syndrome are examined according to anatomical, historical, clinical, and treatment aspects. There appears to be little correlation between the extent, form, and size of the anomalies of the styloid process and the stylohyoid ligament and the predictability of patients with related symptoms. Surgical treatment and the advantages and disadvantages of each surgical approach (intra- and extraoral) are discussed. The probable causes of enlargement of the styloid process and ossification of the stylohyoid ligament are addressed. Two cases of Eagle's syndrome are presented: one unilateral and the other bilateral. An intraoral modified surgical technique is presented.

  11. Munchausen Syndrome by Proxy: medical diagnostic criteria.

    PubMed

    Rosenberg, Donna Andrea

    2003-04-01

    Medical diagnostic criteria for Munchausen Syndrome by Proxy are presented. The strength of the known facts may vary from case to case, and thus there may be different degrees of diagnostic conviction. Therefore, diagnostic criteria for a definitive diagnosis, and a possible diagnosis of Munchausen Syndrome by Proxy are provided. Because the gathering of evidence in a case may, ultimately, diminish or exclude the diagnosis of Munchausen Syndrome by Proxy, diagnostic criteria for the inconclusive determination and the definitely excluded diagnosis are also enunciated.

  12. [Radiological diagnostics in CUP syndrome].

    PubMed

    Kazmierczak, P M; Nikolaou, K; Rominger, A; Graser, A; Reiser, M F; Cyran, C C

    2014-02-01

    , diffusion), e.g. investigation of breast carcinoma or prostate carcinoma. Whole body staging stands at the beginning of the diagnostic algorithm in CUP syndrome to localize a potential primary tumor. Clinically, contrast-enhanced CT of the neck, thorax and abdomen is frequently applied; however, many studies have demonstrated augmented sensitivity of (18)F-FDG PET-CT for the detection of primary tumors and metastatic tumor manifestations.

  13. Munchausen Syndrome by Proxy: Medical Diagnostic Criteria.

    ERIC Educational Resources Information Center

    Rosenberg, Donna Andrea

    2003-01-01

    Medical diagnostic criteria for Munchausen Syndrome by Proxy (a persistent fabrication by one individual of illness in another) are presented. Since the strength of the known facts may vary from case to case, diagnostic criteria are given for a definitive diagnosis, a possible diagnosis, an inconclusive determination, and the definitely excluded…

  14. Kabuki syndrome: diagnostic and treatment considerations

    PubMed Central

    2012-01-01

    Kabuki syndrome (KS) is a rare genetic disorder first diagnosed in 1981. Unknown by most primary care physicians and clinicians in the mental health fields, children with KS present with unique facial characteristics, mental retardation, health problems and socio-emotional delays that are often mistaken for other diagnostic problems. Literature detailing the psychological and psychosocial features of this disorder is scant, and psychotherapeutic approaches have not been described. In this article, we present a case description and treatment of a child with KS and her family. A brief review of KS is then provided, highlighting its signs and symptoms. Factors related to differential diagnoses are identified to aid primary care and mental health clinicians in better understanding this unique syndrome. Interventions with similar populations are discussed from which a psychological approach to KS is suggested. Finally, implications for primary care physicians are described and suggestions for further research indicated. PMID:23997823

  15. Visual acuity in adults with Asperger's syndrome: no evidence for "eagle-eyed" vision.

    PubMed

    Falkmer, Marita; Stuart, Geoffrey W; Danielsson, Henrik; Bram, Staffan; Lönebrink, Mikael; Falkmer, Torbjörn

    2011-11-01

    Autism spectrum conditions (ASC) are defined by criteria comprising impairments in social interaction and communication. Altered visual perception is one possible and often discussed cause of difficulties in social interaction and social communication. Recently, Ashwin et al. suggested that enhanced ability in local visual processing in ASC was due to superior visual acuity, but that study has been the subject of methodological criticism, placing the findings in doubt. The present study investigated visual acuity thresholds in 24 adults with Asperger's syndrome and compared their results with 25 control subjects with the 2 Meter 2000 Series Revised ETDRS Chart. The distribution of visual acuities within the two groups was highly similar, and none of the participants had superior visual acuity. Superior visual acuity in individuals with Asperger's syndrome could not be established, suggesting that differences in visual perception in ASC are not explained by this factor. A continued search for explanations of superior ability in local visual processing in persons with ASC is therefore warranted. Copyright © 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  16. [Diagnostics of keratitis-ichthyosis-deafness syndrome (KID- syndrome)].

    PubMed

    Markova, T G; Brazhkina, N B; Bliznets, E V; Poliakov, A V; Tavartkiladze, G A

    2012-01-01

    The combination of pre-lingual and sensorinerual deafness with skin hyperkeratinization is a relatively rare pathology. Only 11 families affected by this disorder were described in the literature during the last 30 years (from 1975 to 2002). To date, there are no more than 50 cases of this condition known in the world. Modern molecular methods revealed in all such patients a mutation in the GJB2 gene as the primary cause of the disease. We studied a 4 year-old girl with bilateral congenital grade IV sensorineural deafness. Her unusual appearance drew attention aas early as the primary examination; the patient had the deep-set eyes and dry skin over the entire body, she presented with hypotrichosis of the scalp, thin and light-blond hair. Analysis of the nucleotide sequence of the GJB2 gene revealed the substitution of guanine-148 by adenine that led to D50N amino acid substitution. This dominant mutation proved to be the cause of keratitis-ichthyosis-deafness syndrome (KID-syndrome). A review of the literature concerning molecular diagnostics and clinical features of this syndrome is presented. The results of molecular-genetic investigations provided the data on pathogenesis of different variants of sensorineural deafness and the associated genotype-phenotype relationships that may be used as a basis for the further development of the methods for the prevention and treatment of KID-syndrome.

  17. Intrapartum diagnostic of Roberts syndrome - case presentation.

    PubMed

    Socolov, Răzvan Vladimir; Andreescu, Nicoleta Ioana; Haliciu, Ana Maria; Gorduza, Eusebiu Vlad; Dumitrache, Florentin; Balan, Raluca Anca; Puiu, Maria; Dobrescu, Mihaela Amelia; Socolov, Demetra Gabriela

    2015-01-01

    Roberts syndrome is a rare disease, with multiple limb and skeletal abnormalities (called "pseudothalidomide disease"). There are only around 150 cases described in literature. We present a case of Roberts syndrome, diagnosed in moment of delivery, after a pregnancy without prenatal follow-up. The stillborn baby was naturally delivered by a 17-year-old primiparous woman at 38 weeks of amenorrhea. The pregnancy was not followed due to socioeconomic and family situation, and no prenatal ultrasound was performed. The male baby has 2650 g and presented several morphological abnormalities and tight double umbilical abdominal loop. The macroscopic evaluation showed: dolichocephaly, hypoplastic inferior maxilla with micrognathia, antimongoloid palpebral slant, pterygium colli, abnormal and lower implanted ears, superior limbs phocomelia, syndactyly at lower left limb and tetradactyly in all limbs, bilateral cryptorchidism, pancreatic aplasia. Roberts syndrome is a rare genetic disease with recessive autosomal transmission generated by mutations in ESCO2 gene, located on chromosome 8. The disease should be easy to diagnose by antenatal ultrasound examination, but in our case, the lack of prenatal follow-up determined the diagnostic at term. We believe consider this case is an argument towards introducing ultrasound-screening compulsory to all pregnancies. To identify a possible genetic mutation, further investigations of the parents are in progress, but classically the disease has a recessive autosomal transmission.

  18. Diagnostic Criteria for Cannabis Withdrawal Syndrome

    PubMed Central

    Gorelick, David A.; Levin, Kenneth H.; Copersino, Marc L.; Heishman, Stephen J.; Liu, Fang; Boggs, Douglas L.; Kelly, Deanna L.

    2011-01-01

    Objective Cannabis withdrawal occurs in frequent users who quit, but there are no accepted diagnostic criteria for a cannabis withdrawal syndrome (CWS). This study evaluated diagnostic criteria for CWS proposed in DSM-V and two earlier proposals. Method A convenience sample of 384 adult, non-treatment-seeking lifetime cannabis smokers provided retrospective self-report data on their “most difficult” quit attempt without formal treatment, which was used in this secondary analysis. Prevalence, time of onset, and peak intensity (5-point Likert scale) for 39 withdrawal symptoms (drawn from the literature) were assessed via computer-administered questionnaire. Subject groups were compared using chi-square or ANOVA. Symptom clustering was evaluated with principal components analysis. Results 40.9% of subjects met the DSM-V criterion of ≥ 3 symptoms from a list of 7. There were no associations with sex, race, or type of cannabis preparation used. There were significant positive associations between duration or frequency of cannabis use prior to the quit attempt and experiencing CWS. Subjects with CWS had a significantly shorter duration of abstinence. Alternative syndromal criteria (dropping physical symptoms from DSM-V list; requiring ≥ 2or ≥ 4 symptoms from a list of 11) yielded a similar prevalence of CWS and similar associations with prior cannabis use and relapse. The PCA yielded 12 factors, including some symptom clusters not included in DSM-V. Conclusions Findings support the concurrent and predictive validity of the proposed DSM-V CWS, but suggest that the list of withdrawal symptoms and number required for diagnosis warrant further evaluation. PMID:22153944

  19. Rett syndrome: revised diagnostic criteria and nomenclature.

    PubMed

    Neul, Jeffrey L; Kaufmann, Walter E; Glaze, Daniel G; Christodoulou, John; Clarke, Angus J; Bahi-Buisson, Nadia; Leonard, Helen; Bailey, Mark E S; Schanen, N Carolyn; Zappella, Michele; Renieri, Alessandra; Huppke, Peter; Percy, Alan K

    2010-12-01

    Rett syndrome (RTT) is a severe neurodevelopmental disease that affects approximately 1 in 10,000 live female births and is often caused by mutations in Methyl-CpG-binding protein 2 (MECP2). Despite distinct clinical features, the accumulation of clinical and molecular information in recent years has generated considerable confusion regarding the diagnosis of RTT. The purpose of this work was to revise and clarify 2002 consensus criteria for the diagnosis of RTT in anticipation of treatment trials. RettSearch members, representing the majority of the international clinical RTT specialists, participated in an iterative process to come to a consensus on a revised and simplified clinical diagnostic criteria for RTT. The clinical criteria required for the diagnosis of classic and atypical RTT were clarified and simplified. Guidelines for the diagnosis and molecular evaluation of specific variant forms of RTT were developed. These revised criteria provide clarity regarding the key features required for the diagnosis of RTT and reinforce the concept that RTT is a clinical diagnosis based on distinct clinical criteria, independent of molecular findings. We recommend that these criteria and guidelines be utilized in any proposed clinical research.

  20. Rett Syndrome: Revised Diagnostic Criteria and Nomenclature

    PubMed Central

    Neul, Jeffrey L.; Kaufmann, Walter E.; Glaze, Daniel G.; Christodoulou, John; Clarke, Angus J.; Bahi-Buisson, Nadia; Leonard, Helen; Bailey, Mark E. S.; Schanen, N. Carolyn; Zappella, Michele; Renieri, Alessandra; Huppke, Peter; Percy, Alan K.

    2010-01-01

    Objective Rett syndrome (RTT) is a severe neurodevelopmental disease that affects approximately 1 in 10,000 live female births and is often caused by mutations in Methyl-CpG-binding protein 2 (MECP2). Despite distinct clinical features, the accumulation of clinical and molecular information in recent years has generated considerable confusion regarding the diagnosis of RTT. The purpose of this work was revise and clarify 2002 consensus criteria for the diagnosis of RTT in anticipation of treatment trials. Method RettSearch members, representing the majority of the international clinical RTT specialists, participated in an iterative process to come to a consensus on a revised and simplified clinical diagnostic criteria for RTT. Results The clinical criteria required for the diagnosis of classic and atypical RTT were clarified and simplified. Guidelines for the diagnosis and molecular evaluation of specific variant forms of RTT were developed. Interpretation These revised criteria provide clarity regarding the key features required for the diagnosis of RTT and reinforce the concept that RTT is a clinical diagnosis based on distinct clinical criteria, independent of molecular findings. We recommend that these criteria and guidelines be utilized in any proposed clinical research. PMID:21154482

  1. Bald Eagles at Bay

    ERIC Educational Resources Information Center

    Laycock, George

    1974-01-01

    Describes the process of transplanting eggs from one nest to another in an attempt to aid in the strengthening of the eagle population. Discusses pressures exerted on eagles by hunting, trapping and pesticides. (SLH)

  2. Experimental lead poisoning in bald eagles

    USGS Publications Warehouse

    Pattee, H.; Wiemeyer, S.; Hoffman, P.; Carpenter, J.; Sileo, L.

    1979-01-01

    Captive, crippled bald eagles unsuitable for release were fed lead shot to determine diagnostic criteria for lead poisoning. The eagles were fluoroscoped and bled periodically to determine shot retention and blood delta--aminolevulinic acid dehydratase activity. Microscopic examination revealed renal tubular degeneration, arterial fibrinoid necrosis and myocardial necrosis. Acid-fast intra-nuclear inclusion bodies were not found in proximal convoluted tubule cells. Analyses of blood and toxicological data are not yet complete.

  3. Differential diagnostic of the burnout syndrome

    PubMed Central

    Korczak, Dieter; Huber, Beate; Kister, Christine

    2010-01-01

    it can have also negative effects on significant others (for example patients). There is no evidence for stigmatization of persons with burnout. Discussion The evidence of the majority of the studies is predominantly low. Most of the studies are descriptive and explorative. Self-assessment tools are mainly used, overall the Maslach Burnout Inventory (MBI). Objective data like medical parameters, health status, sick notes or judgements by third persons are extremely seldomly included in the studies. The sample construction is coincidental in the majority of cases, response rates are often low. Almost no longitudinal studies are available. There are insufficient results on the stability and the duration of related symptoms. The ambiguity of the burnout diagnosis is regularly neglected in the studies. Conclusions The authors conclude, that (1) further research, particularly high-quality studies are needed, to broaden the understanding of the burnout syndrome. Equally (2) a definition of the burnout syndrome has to be found which goes beyond the published understanding of burnout and is based on common scientific consent. Furthermore, there is a need (3) for finding a standardized, international accepted and valid procedure for the differentiated diagnostics of burnout and for (4) developing a third party assessment tool for the diagnosis of burnout. Finally, (5) the economic effects and implication of burnout diagnostics on the economy, the health insurances and the patients have to be analysed. PMID:21289882

  4. PHACE syndrome: new views on diagnostic criteria.

    PubMed

    Poetke, M; Frommeld, T; Berlien, H P

    2002-12-01

    The association of large facial hemangiomas with posterior fossa malformations and vascular anomalies has been termed the PHACE syndrome. It is characterized by the association of posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta and other cardiac defects, and eye abnormalities. Since most articles focus on isolated case reports, an extended retrospective literature review of all reports of large hemangiomas with associated abnormalities of the central nervous system and other malformations was performed to examine the clinical features, and other not as yet reported associated anomalies. Reports were found on 59 patients with PHACE syndrome, to which we added ten cases of our own. The Dandy-Walker syndrome is the most common CNS abnormality reported in association with PHACE syndrome and was seen in 48 (81 %) patients. Arterial malformations were found in 13 (22 %) cases; only 11 patients (19 %) had structural arterial abnormalities without associated Dandy-Walker complex. As published, about one third of patients (31 %) had further ophthalmologic abnormalities, and cardiac anomalies, including coarctation of the aorta. Subglottic hemangiomas were seen in 4 (7 %) patients and ventral developmental defects also in 3 cases. In seven of 59 patients (12 %) with PHACE syndrome, intracranial hemangiomas were present. This study demonstrates that among other CNS abnormalities, special attention should be given to intracranial hemangiomas which seems to be a peculiar phenotype of PHACE syndrome. We therefore suggest that a sixth criterion should be added to the five minimal inclusion criteria for PHACE syndrome. The inclusion criteria would then be: arterial abnormalities or/and intracranial hemangiomas. On the basis of our experience with our patients and with those previously reported, we stress the importance of using contrast-enhanced imaging to detect intracranial lesions.

  5. Three Diagnostic Approaches to Asperger Syndrome: Implications for Research

    ERIC Educational Resources Information Center

    Klin, Ami; Pauls, David; Schultz, Robert; Volkmar, Fred

    2005-01-01

    Objective: To examine the implications for research of the use of three alternative definitions for Asperger syndrome (AS). Differences across the three nosologic systems were examined in terms of diagnostic assignment, IQ profiles, comorbid symptoms, and familial aggregation of social and other psychiatric symptoms. Method: Standard data on…

  6. Nature Photography - Bald Eagle

    NASA Image and Video Library

    2016-12-12

    An American bald eagle soars from its perch in a tree at NASA's Kennedy Space Center in Florida. Several eagles call the center home. The center shares a boundary with the Merritt Island National Wildlife Refuge. The refuge is home to more than 65 amphibian and reptile species, along with 330 native and migratory bird species, 25 mammal and 117 fish species.

  7. Nature Photography - Bald Eagle

    NASA Image and Video Library

    2016-12-12

    An American bald eagle perches in a tree at NASA's Kennedy Space Center in Florida. Several eagles call the center home. The center shares a boundary with the Merritt Island National Wildlife Refuge. The refuge is home to more than 65 amphibian and reptile species, along with 330 native and migratory bird species, 25 mammal and 117 fish species.

  8. Nature Photography - Bald Eagles

    NASA Image and Video Library

    2017-01-04

    One American bald eagle sits in its nest, while another eagle perches on a branch in tree at NASA's Kennedy Space Center in Florida. The center shares a border with the Merritt Island National Wildlife Refuge. More than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles call Kennedy and the wildlife refuge home.

  9. Nature Photography - Bald Eagle

    NASA Image and Video Library

    2016-12-12

    An American bald eagle begins to soar from its perch in a tree at NASA's Kennedy Space Center in Florida. Several eagles call the center home. The center shares a boundary with the Merritt Island National Wildlife Refuge. The refuge is home to more than 65 amphibian and reptile species, along with 330 native and migratory bird species, 25 mammal and 117 fish species.

  10. 77 FR 42714 - Eagle Creek Hydropower, LLC, Eagle Creek Land Resources, LLC, Eagle Creek Water Resources, LLC...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-20

    ... Hydropower, LLC, Eagle Creek Land Resources, LLC, Eagle Creek Water Resources, LLC; Notice of Application...: Eagle Creek Hydropower, LLC; Eagle Creek Land Resources, LLC; and Eagle Creek Water Resources, LLC. e... Contact: Robert Gates, Senior Vice President-- Operations, Eagle Creek Hydropower, LLC, Eagle Creek Water...

  11. [Usher syndrome: clinical features, diagnostic options, and therapeutic prospects].

    PubMed

    Seeliger, M W; Fischer, M D; Pfister, M

    2009-06-01

    Usher syndrome denotes a clinically and genetically heterogeneous combination of retinitis pigmentosa and sensorineural deafness. The division into subtypes I, II, and III is based on the degree of hearing loss: Type I is characterized by deafness from birth together with ataxia and retarded motor development, type II by a stationary deafness of a moderate degree, and type III by a progressive deafness with adult onset. In Germany, Usher syndrome currently bears particular relevance because in January 2009 a new compulsory screening of auditory function in newborn infants was introduced. Consequently, it can be expected that a higher number of patients with Usher syndrome will be identified in early childhood and referred to ophthalmologists. The focus of this work is to introduce the typical clinical picture of Usher syndrome, summarize diagnostic options, and give an overview of therapeutic strategies.

  12. Proposed Diagnostic Criteria for Night Eating Syndrome

    PubMed Central

    Allison, Kelly C.; Lundgren, Jennifer D.; O’Reardon, John P.; Geliebter, Allan; Gluck, Marci E.; Vinai, Piergiuseppe; Mitchell, James E.; Schenck, Carlos H.; Howell, Michael J.; Crow, Scott J.; Engel, Scott; Latzer, Yael; Tzischinsky, Orna; Mahowald, Mark W.; Stunkard, Albert J.

    2015-01-01

    Objective To propose criteria for diagnosis of the night eating syndrome (NES). Method An international research meeting was held in April 2008, and consensus criteria for NES diagnosis were determined. Results The core criterion is an abnormally increased food intake in the evening and nighttime, manifested by (1) consumption of at least 25% of intake after the evening meal, and/or (2) nocturnal awakenings with ingestions at least twice per week. Awareness of the eating episodes is required, as is distress or impairment in functioning. Three of five modifiers must also be endorsed. These criteria must be met for a minimum duration of 3 months. Discussion These criteria help standardize the definition of NES. Additional aspects of the nosology of NES yet to be fully elaborated include its relationship to other eating and sleep disorders. Assessment and analytic tools are needed to assess these new criteria more accurately. PMID:19378289

  13. The intersection syndrome: Ultrasound findings and their diagnostic value

    PubMed Central

    Montechiarello, S.; Miozzi, F.; D’Ambrosio, I.; Giovagnorio, F.

    2010-01-01

    Introduction The intersection syndrome is a well-known overuse syndrome of the distal forearm. It is characterized by noninfectious, inflammatory changes involving the area of intersection of the first (abductor pollicis longus and extensor pollicis brevis) and second (extensor carpi radialis longus and extensor carpi radialis brevis) extensor compartments in the dorsoradial aspect of the distal forearm. Imaging modalities used to diagnosis this syndrome include ultrasonography (US) and magnetic resonance imaging. The purpose of this report is to describe typical US findings in the intersection syndrome and to demonstrate the diagnostic value of this approach. Materials and methods We reviewed US findings in 4 patients (mean age 40 years) referred to our staff for symptoms suggestive of the intersection syndrome (pain, swelling, erythema, and edema of the wrist). Results In all 4 cases, the US examination revealed peritendinous edema and synovial fluid within the tendon sheaths at the intersection between the first and the second dorsal extensor tendon compartments. Discussion Our experience shows that the intersection syndrome is associated with typical signs on US. This imaging modality can be considered a reliable tool for diagnosing this syndrome and may eliminate the need for other more expensive tests. PMID:23396515

  14. Diagnostic Approach to a Patient With Paraneoplastic Neurological Syndrome.

    PubMed

    Mahta, Ali; Vijayvergia, Namrata; Bhavsar, Tapan M; Ward, Lawrence D

    2012-10-01

    Herein, we discussed a case of an otherwise healthy man who presented with progressive gait imbalance and ataxia, found to have small cell lung cancer. Based upon our clinical findings and laboratory data, a diagnosis of paraneoplastic cerebellar degeneration was made. Paraneoplastic neurological syndromes (PNS) are relatively rare but diverse and always should be considered in differentials. A diagnostic algorithm along with appropriate work up is discussed here.

  15. Diagnostic Approach to a Patient With Paraneoplastic Neurological Syndrome

    PubMed Central

    Mahta, Ali; Vijayvergia, Namrata; Bhavsar, Tapan M.; Ward, Lawrence D.

    2012-01-01

    Herein, we discussed a case of an otherwise healthy man who presented with progressive gait imbalance and ataxia, found to have small cell lung cancer. Based upon our clinical findings and laboratory data, a diagnosis of paraneoplastic cerebellar degeneration was made. Paraneoplastic neurological syndromes (PNS) are relatively rare but diverse and always should be considered in differentials. A diagnostic algorithm along with appropriate work up is discussed here. PMID:29147315

  16. Diagnostic features of polycystic ovary syndrome in adolescents (review).

    PubMed

    Beltadze, K; Barbakadze, L

    2015-01-01

    The problem of Polycystic Ovary Syndrome (PCOS) is of a special importance due to its connection with not only medical but with psychosocial factors. PCOS is the most common endocrine cause of anovulatory infertility. It is a major factor for the metabolic syndrome, cardiovascular disease, type 2 diabetes mellitus (T2DM). Clinical symptoms of PCOS such as acne, hirsutism, obesity, alopecia represent psychological problem, especially for the adolescents. Many women who have PCOS have the onset of symptoms during adolescence. Early diagnosis and treatment of PCOS are important for preventing of the above mentioned long-term consequences associated with this condition. Adolescent patients often have diagnostic problems because the features of normal puberty are similar with symptoms of PCOS. This article reviews the diagnostic and differential diagnostic characteristics of PCOS in adolescents. In conclusion, consensus statement in adolescent patients is still awaiting. Our data suggest that it may be prudent to define adolescent PCOS according to the Carmina modified Rotterdam criteria. The increase rate of metabolic syndrome in adolescents with PCOS emphasize the importance of regular screening due to the high cardiometabolic disorders risk.

  17. [Infantile Munchausen syndrome. Etiology, diagnostic criteria, and treatment].

    PubMed

    Morales-Franco, B; de la Morena-Fernández, M L

    1995-01-01

    In this paper, we study a special kind of child abuse, the Münchhausen Syndrome by proxy, which consists of a group of diseases that some parents invent in their own children. These parents describe false symptoms of disease in their children, or manipulate the bodies of their children in order to cause alterations. Their purpose is that the doctor will carry out diagnostic tests and medical treatments with the children who really aren't ill. Our objective is to understand this syndrome, so we can report the factors that influence its appearance, study the diagnostic guidelines and the importance of doing a correct differential diagnostic with other real pathologies, and we analyze the preventive and therapeutic measures that health professionals must carry out in children and in their parents. When these professionals understand this syndrome they will be able to detect it before children are subjected to more unnecessary suffering. And, they will be able to prevent that these aggressions on children continue.

  18. Wildlife Photography - Eagles

    NASA Image and Video Library

    2018-03-13

    An adult American bald eagle perches in a nest in a tree along State Road 3 at NASA's Kennedy Space Center in Florida. Eagles have built nests in trees at the center for many years. The center shares a border with the 140,000-acre Merritt Island National Wildlife Refuge. More than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles call Kennedy and the wildlife refuge home.

  19. Wildlife Photography - Eagles

    NASA Image and Video Library

    2018-03-13

    An adult American bald eagle perches on a branch in a tree along State Road 3 at NASA's Kennedy Space Center in Florida. Eagles have built nests in trees at the center for many years. The center shares a border with the 140,000-acre Merritt Island National Wildlife Refuge. More than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles call Kennedy and the wildlife refuge home.

  20. Bald eagle and osprey

    USGS Publications Warehouse

    Henny, C.J.; Anthony, R.G.; Pendleton, Beth Giron

    1989-01-01

    Bald eagles nested in all nine western states during recent years (about 19% of known U.S. population in 1982). The known numbers of nesting pairs in the west increased substantially in the last 10 years and totaled 584 in 1986. Much of the increase was due to more intensive survey efforts, but most biologists cite examples of new palrs establishing nesting territories. In contrast, productivity was relatively stable at 0.9 young produced per occupied territory with small annual fluctuations, a level slightly below the requirement for delisting (1.0 young per occupied territory) by the Pacific States Bald Eagle Recovery Plan. About 4,500 to 6,000 (minimum estimate) bald eagles winter throughout the western United States, which is about 50% of the surveyed population in the contiguous 48 states. Osprey range expansion and population increases have been documented in the West since 1981, when the population was estimated at 1,472 palrs (i.e., about 18% of the U.S. population). Monitoring efforts in the 1980s were not as intensive for ospreys as for bald eagles, but productivity was usually at the upper end of 0.95 to 13 young per occupied territory (a rate generally believed adequate for population stability). Although bald eagle and osprey nesting populations and productivity show cause for optimism, organochlorine contaminants remain a problem in a few individual birds and in some localized areas (e.g., lower Columbia River). DDE residues high enough to reduce productivity have been documented in eggs of both species during the 1980s. In addition, the bald eagle, which also forages on sick or dead prey, has been exposed to lead shot and the organophosphorus insecticide famphur. These contaminants have killed numbers of them in the West in recent years. Nesting ospreys appear more tolerant than nesting bald eagles of man and his disturbance; thus, more restrictions are required at bald eagle nest sites. Furthermore, bald eagles winter within the United States and

  1. Solar Eagle 2

    NASA Technical Reports Server (NTRS)

    Roberto, Richard D.

    1995-01-01

    During a 22-month period from February 1991 to December 1993, a dedicated group of students, faculty, and staff at California State University, Los Angeles completed a project to design, build, and race their second world class solar-powered electric vehicle, the Solar Eagle 2. This is the final report of that project. As a continuation of the momentum created by the success of the GM-sponsored Sunrayce USA in 1990, the U.S. Department of Energy (DOE) picked up the banner from General Motors as sponsors of Sunrayce 93. In February 1991, the DOE sent a request for proposals to all universities in North America inviting them to submit a proposal outlining how they would design, build, and test a solar-powered electric vehicle for a seven-day race from Arlington, Texas to Minneapolis, Minnesota, to be held in June 1993. Some 70 universities responded. At the end of a proposal evaluation process, 36 universities including CSLA were chosen to compete. This report documents the Solar Eagle 2 project--the approaches take, what was learned, and how our experience from the first Solar Eagle was incorporated into Solar Eagle 2. The intent is to provide a document that would assist those who may wish to take up the challenge to build Solar Eagle 3.

  2. Experimental lead-shot poisoning in bald eagles

    USGS Publications Warehouse

    Pattee, O.H.; Wiemeyer, Stanley N.; Mulhern, B.M.; Sileo, L.; Carpenter, J.W.

    1981-01-01

    Captive, crippled bald eagles unsuitable for release were fed lead shot to determine diagnostic criteria for lead poisoning. The eagles were fluoroscoped and bled periodically to determine shot retention and blood delta--aminolevulinic acid dehydratase activity. Microscopic examination revealed renal tubular degeneration, arterial fibrinoid necrosis and myocardial necrosis. Acid-fast intra-nuclear inclusion bodies were not found in proximal convoluted tubule cells. Analyses of blood and toxicological data are not yet complete.

  3. The dilemma of diagnostic testing for Prader-Willi syndrome

    PubMed Central

    Hung, Dorothy

    2017-01-01

    Although Prader-Willi syndrome (PWS) is a well-described clinical dysmorphic syndrome, DNA testing is required for a definitive diagnosis. A definitive diagnosis can be made in approximately 99% of cases using DNA testing; there are a number of DNA tests that can be used for this purpose, although there is no set standard algorithm of testing. The dilemma arises because of the complex genetic mechanisms at the basis of PWS, which need to be elucidated. To establish the molecular mechanism with a complete work up, involves at least 2 tests. Here we discuss the commonly used tests currently available and suggest a cost—effective approach to diagnostic testing. PMID:28164030

  4. Diagnostic test for prenatal identification of Down's syndrome and mental retardation and gene therapy therefor

    DOEpatents

    Smith, Desmond J.; Rubin, Edward M.

    2000-01-01

    A a diagnostic test useful for prenatal identification of Down syndrome and mental retardation. A method for gene therapy for correction and treatment of Down syndrome. DYRK gene involved in the ability to learn. A method for diagnosing Down's syndrome and mental retardation and an assay therefor. A pharmaceutical composition for treatment of Down's syndrome mental retardation.

  5. Rett syndrome diagnostic criteria: lessons from the Natural History Study.

    PubMed

    Percy, Alan K; Neul, Jeffrey L; Glaze, Daniel G; Motil, Kathleen J; Skinner, Steven A; Khwaja, Omar; Lee, Hye-Seung; Lane, Jane B; Barrish, Judy O; Annese, Fran; McNair, Lauren; Graham, Joy; Barnes, Katherine

    2010-12-01

    Analysis of 819 participants enrolled in the Rett syndrome (RTT) Natural History Study validates recently revised diagnostic criteria. 765 females fulfilled 2002 consensus criteria for classic (653/85.4%) or variant (112/14.6%) RTT. All participants classified as classic RTT fulfilled each revised main criterion; supportive criteria were not uniformly present. All variant RTT participants met at least 3 of 6 main criteria in the 2002, 2 of 4 main criteria in the current format, and 5 of 11 supportive criteria in both. This analysis underscores the critical role of main criteria for classic RTT; variant RTT requires both main and supportive criteria.

  6. Wildlife - Bald Eagle

    NASA Image and Video Library

    2007-03-20

    High in a pine tree at NASA's Kennedy Space Center, an adult bald eagle (right) and a fledgling keep watch from their nest. There are approximately a dozen active bald eagle nests both in KSC and in the Merritt Island National Wildlife Refuge, which surrounds KSC. The refuge includes several wading bird rookeries, many osprey nests, up to 400 manatees during the spring, and approximately 2,500 Florida scrub jays. It also is a major wintering area for migratory birds. More than 500 species of wildlife inhabit the refuge, with 15 considered federally threatened or endangered.

  7. 77 FR 13592 - AER NY-Gen, LLC; Eagle Creek Hydro Power, LLC, Eagle Creek Water Resources, LLC, Eagle Creek Land...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-07

    ...; Eagle Creek Hydro Power, LLC, Eagle Creek Water Resources, LLC, Eagle Creek Land Resources, LLC; Notice... 24, 2012, AER NY-Gen, LLC (transferor), Eagle Creek Hydro Power, LLC, Eagle Creek Water Resources.... Cherry, Eagle Creek Hydro Power, LLC, Eagle Creek Water Resources, LLC, and Eagle Creek Land Resources...

  8. 75 FR 27332 - AER NY-Gen, LLC; Eagle Creek Hydro Power, LLC; Eagle Creek Water Resources, LLC; Eagle Creek Land...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-14

    ... 9690-106] AER NY-Gen, LLC; Eagle Creek Hydro Power, LLC; Eagle Creek Water Resources, LLC; Eagle Creek... Power, LLC, Eagle Creek Water Resources, LLC, and Eagle Creek Land Resources, LLC (transferees) filed an.... Paul Ho, Eagle Creek Hydro Power, LLC, Eagle Creek Water Resources, LLC, and Eagle Creek Land Resources...

  9. Diagnostic Performance of Electronic Syndromic Surveillance Systems in Acute Care

    PubMed Central

    Kashiouris, M.; O’Horo, J.C.; Pickering, B.W.; Herasevich, V.

    2013-01-01

    Context Healthcare Electronic Syndromic Surveillance (ESS) is the systematic collection, analysis and interpretation of ongoing clinical data with subsequent dissemination of results, which aid clinical decision-making. Objective To evaluate, classify and analyze the diagnostic performance, strengths and limitations of existing acute care ESS systems. Data Sources All available to us studies in Ovid MEDLINE, Ovid EMBASE, CINAHL and Scopus databases, from as early as January 1972 through the first week of September 2012. Study Selection: Prospective and retrospective trials, examining the diagnostic performance of inpatient ESS and providing objective diagnostic data including sensitivity, specificity, positive and negative predictive values. Data Extraction Two independent reviewers extracted diagnostic performance data on ESS systems, including clinical area, number of decision points, sensitivity and specificity. Positive and negative likelihood ratios were calculated for each healthcare ESS system. A likelihood matrix summarizing the various ESS systems performance was created. Results The described search strategy yielded 1639 articles. Of these, 1497 were excluded on abstract information. After full text review, abstraction and arbitration with a third reviewer, 33 studies met inclusion criteria, reporting 102,611 ESS decision points. The yielded I2 was high (98.8%), precluding meta-analysis. Performance was variable, with sensitivities ranging from 21% –100% and specificities ranging from 5%-100%. Conclusions There is significant heterogeneity in the diagnostic performance of the available ESS implements in acute care, stemming from the wide spectrum of different clinical entities and ESS systems. Based on the results, we introduce a conceptual framework using a likelihood ratio matrix for evaluation and meaningful application of future, frontline clinical decision support systems. PMID:23874359

  10. Diagnostic algorithm for relapsing acquired demyelinating syndromes in children.

    PubMed

    Hacohen, Yael; Mankad, Kshitij; Chong, W K; Barkhof, Frederik; Vincent, Angela; Lim, Ming; Wassmer, Evangeline; Ciccarelli, Olga; Hemingway, Cheryl

    2017-07-18

    To establish whether children with relapsing acquired demyelinating syndromes (RDS) and myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) show distinctive clinical and radiologic features and to generate a diagnostic algorithm for the main RDS for clinical use. A panel reviewed the clinical characteristics, MOG-Ab and aquaporin-4 (AQP4) Ab, intrathecal oligoclonal bands, and Epstein-Barr virus serology results of 110 children with RDS. A neuroradiologist blinded to the diagnosis scored the MRI scans. Clinical, radiologic, and serologic tests results were compared. The findings showed that 56.4% of children were diagnosed with multiple sclerosis (MS), 25.4% with neuromyelitis optica spectrum disorder (NMOSD), 12.7% with multiphasic disseminated encephalomyelitis (MDEM), and 5.5% with relapsing optic neuritis (RON). Blinded analysis defined baseline MRI as typical of MS in 93.5% of children with MS. Acute disseminated encephalomyelitis presentation was seen only in the non-MS group. Of NMOSD cases, 30.7% were AQP4-Ab positive. MOG-Ab were found in 83.3% of AQP4-Ab-negative NMOSD, 100% of MDEM, and 33.3% of RON. Children with MOG-Ab were younger, were less likely to present with area postrema syndrome, and had lower disability, longer time to relapse, and more cerebellar peduncle lesions than children with AQP4-Ab NMOSD. A diagnostic algorithm applicable to any episode of CNS demyelination leads to 4 main phenotypes: MS, AQP4-Ab NMOSD, MOG-Ab-associated disease, and antibody-negative RDS. Children with MS and AQP4-Ab NMOSD showed features typical of adult cases. Because MOG-Ab-positive children showed notable and distinctive clinical and MRI features, they were grouped into a unified phenotype (MOG-Ab-associated disease), included in a new diagnostic algorithm. © 2017 American Academy of Neurology.

  11. Nature Photography - Bald Eagles

    NASA Image and Video Library

    2016-12-13

    An American bald eagle soars through the air above NASA's Kennedy Space Center in Florida. The center shares a border with the Merritt Island National Wildlife Refuge. More than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles call Kennedy and the wildlife refuge home.

  12. Nature Photography - Bald Eagles

    NASA Image and Video Library

    2016-12-13

    An American bald eagle soars through the air above NASA's Kennedy Space Center in Florida. The center shares a border with the Merritt Island National Wildlife Refuge. The bird is one of more than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles that call Kennedy and the wildlife refuge home.

  13. Nature Photography - Bald Eagles

    NASA Image and Video Library

    2016-12-13

    With wings outstretched, an American bald eagle soars through the air above NASA's Kennedy Space Center in Florida. The center shares a border with the Merritt Island National Wildlife Refuge. The bird is one of more than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles that call Kennedy and the wildlife refuge home.

  14. Nature Photography - Bald Eagles

    NASA Image and Video Library

    2016-12-13

    Two American bald eagles are perched in a nest atop a pole at NASA's Kennedy Space Center in Florida. The center shares a border with the Merritt Island National Wildlife Refuge. More than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles call Kennedy and the wildlife refuge home.

  15. Wildlife Photography - Eagles

    NASA Image and Video Library

    2017-05-04

    A juvenile bald eagle watches for prey in the grass at NASA's Kennedy Space Center in Florida. The center shares a border with the Merritt Island National Wildlife Refuge. More than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles call Kennedy and the wildlife refuge home.

  16. Wildlife Photography - Eagles

    NASA Image and Video Library

    2017-05-04

    An American bald eagle eats its prey on a wooden dock at NASA's Kennedy Space Center in Florida. The center shares a border with the Merritt Island National Wildlife Refuge. More than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles call Kennedy and the wildlife refuge home.

  17. Wildlife Photography - Eagles

    NASA Image and Video Library

    2017-05-04

    A juvenile bald eagle sits in the grass at NASA's Kennedy Space Center in Florida. The center shares a border with the Merritt Island National Wildlife Refuge. More than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles call Kennedy and the wildlife refuge home.

  18. Wildlife Photography - Bald Eagle

    NASA Image and Video Library

    2017-05-04

    An American bald eagle soars through the air with its prey at NASA's Kennedy Space Center in Florida. The center shares a border with the Merritt Island National Wildlife Refuge. More than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles call Kennedy and the wildlife refuge home.

  19. Creative Photography - Baby Eagles

    NASA Image and Video Library

    2018-02-08

    A baby eagle perches in a nest in a tree along State Road 3 at NASA's Kennedy Space Center in Florida. The center shares a border with the 140,000-acre Merritt Island National Wildlife Refuge. More than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles call Kennedy and the wildlife refuge home.

  20. Creative Photography - Baby Eagles

    NASA Image and Video Library

    2018-02-08

    Two baby eagles perch in a nest in a tree along State Road 3 at NASA's Kennedy Space Center in Florida. The center shares a border with the 140,000-acre Merritt Island National Wildlife Refuge. More than 330 native and migratory bird species, 25 mammals, 117 fishes and 65 amphibians and reptiles call Kennedy and the wildlife refuge home.

  1. Cyclic vomiting syndrome: diagnostic approach and current management strategies.

    PubMed

    Hayes, William J; VanGilder, Deidra; Berendse, Joseph; Lemon, Michael D; Kappes, John A

    2018-01-01

    Cyclic vomiting syndrome (CVS) is a disorder characterized by episodes of nausea and vomiting lasting for 1-5 days followed by asymptomatic periods. The etiology of CVS is unknown, but it shares similar characteristics to migraine headaches. CVS is generally classified as having four phases: prodromal, acute/vomiting/hyperemesis, recovery, and remission/interepisodic. Current management strategies include trigger avoidance, abortive and prophylactic medication therapies, and supportive care. The goal of therapy for the remission phase is prophylaxis of further episodes. Antidepressant, antiepileptic, and antimigraine medications show an overall reduction or remission of CVS symptoms in more than 70% of patients. This article provides a summary of diagnostic strategies and reviews current management strategies for CVS.

  2. Cyclic vomiting syndrome: diagnostic approach and current management strategies

    PubMed Central

    Hayes, William J; VanGilder, Deidra; Berendse, Joseph; Lemon, Michael D; Kappes, John A

    2018-01-01

    Cyclic vomiting syndrome (CVS) is a disorder characterized by episodes of nausea and vomiting lasting for 1–5 days followed by asymptomatic periods. The etiology of CVS is unknown, but it shares similar characteristics to migraine headaches. CVS is generally classified as having four phases: prodromal, acute/vomiting/hyperemesis, recovery, and remission/interepisodic. Current management strategies include trigger avoidance, abortive and prophylactic medication therapies, and supportive care. The goal of therapy for the remission phase is prophylaxis of further episodes. Antidepressant, antiepileptic, and antimigraine medications show an overall reduction or remission of CVS symptoms in more than 70% of patients. This article provides a summary of diagnostic strategies and reviews current management strategies for CVS. PMID:29520160

  3. Diagnostic methods and recommendations for the cerebral creatine deficiency syndromes.

    PubMed

    Clark, Joseph F; Cecil, Kim M

    2015-03-01

    Primary care pediatricians and a variety of specialist physicians strive to define an accurate diagnosis for children presenting with impairment of expressive speech and delay in achieving developmental milestones. Within the past two decades, a group of disorders featuring this presentation have been identified as cerebral creatine deficiency syndromes (CCDS). Patients with these disorders were initially discerned using proton magnetic resonance spectroscopy of the brain within a magnetic resonance imaging (MRI) examination. The objective of this review is to provide the clinician with an overview of the current information available on identifying and treating these conditions. We explain the salient features of creatine metabolism, synthesis, and transport required for normal development. We propose diagnostic approaches for confirming a CCDS diagnosis. Finally, we describe treatment approaches for managing patients with these conditions.

  4. [Sjögren syndrome in ORL. Diagnostic considerations].

    PubMed

    Leache Pueyo, J J; Sevil Navarro, J; Del Agua, C

    2001-01-01

    A presentation the history of a 51-year-old woman with xerostomia and keratoconjunctivitis sicca (KCS), developed in 10 months, investigations revealed the presence in serum of antibodies against cytoplasmic antigens SS-A (Ac anti-Ro/SS-A), antinuclear antibodies (ANAs) and rheumatoid factor (RF). The Rose Bengal test was positive and in the salivary gammagraphy, made with pertecnate 99 mTc, it was observed a decrease of the captation and excretion of the designer for salivary glands. The histopathology and immunohistochemical study of minor salivary glands showed the presence of a focal lymphocitic sialadenitis (fsa) and a predominance of lymphocites CD4+. It was diagnosed as primary Sjögren's syndrome (PSS) and the patient treated with salivary substitutes, artificial tears and corticoids. We analyse the current diagnostic criteria of the group of study of the European Community for the Sjögren's syndrome (SS) and emphasize the importance of histologic and immunochemical studies, that together with the rest of complementary tests will led us to distinguish not only the different forms of the presentation of the illness but also those of all patients with pathologies which are nowadays very prevalent in our environment, such as the hepatitis C (HCV) an the human immune deficiency (HIV) virus infections.

  5. Diagnostic criteria for cryopyrin-associated periodic syndrome (CAPS).

    PubMed

    Kuemmerle-Deschner, Jasmin B; Ozen, Seza; Tyrrell, Pascal N; Kone-Paut, Isabelle; Goldbach-Mansky, Raphaela; Lachmann, Helen; Blank, Norbert; Hoffman, Hal M; Weissbarth-Riedel, Elisabeth; Hugle, Boris; Kallinich, Tilmann; Gattorno, Marco; Gul, Ahmet; Ter Haar, Nienke; Oswald, Marlen; Dedeoglu, Fatma; Cantarini, Luca; Benseler, Susanne M

    2017-06-01

    Cryopyrin-associated periodic syndrome (CAPS) is a rare, heterogeneous disease entity associated with NLRP3 gene mutations and increased interleukin-1 (IL-1) secretion. Early diagnosis and rapid initiation of IL-1 inhibition prevent organ damage. The aim of the study was to develop and validate diagnostic criteria for CAPS. An innovative process was followed including interdisciplinary team building, item generation: review of CAPS registries, systematic literature review, expert surveys, consensus conferences for item refinement, item reduction and weighting using 1000Minds decision software. Resulting CAPS criteria were tested in large cohorts of CAPS cases and controls using correspondence analysis. Diagnostic models were explored using sensitivity analyses. The international team included 16 experts. Systematic literature and registry review identified 33 CAPS-typical items; the consensus conferences reduced these to 14. 1000Minds exercises ranked variables based on importance for the diagnosis. Correspondence analysis determined variables consistently associated with the diagnosis of CAPS using 284 cases and 837 controls. Seven variables were significantly associated with CAPS (p<0.001). The best diagnosis model included: Raised inflammatory markers (C-reactive protein/serum amyloid A) plus ≥two of six CAPS-typical symptoms: urticaria-like rash, cold-triggered episodes, sensorineural hearing loss, musculoskeletal symptoms, chronic aseptic meningitis and skeletal abnormalities. Sensitivity was 81%, specificity 94%. It performed well for all CAPS subtypes and regardless of NLRP3 mutation. The novel approach integrated traditional methods of evidence synthesis with expert consensus, web-based decision tools and innovative statistical methods and may serve as model for other rare diseases. These criteria will enable a rapid diagnosis for children and adults with CAPS. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  6. Eagle Feathers, the Highest Honor.

    ERIC Educational Resources Information Center

    Beaverhead, Pete

    Following his own advice that elders of the tribe share their knowledge so that "the way of the Indians would come back to the children of today," Pete Beaverhead (1899-1975) tells of the traditions of respect and honor surrounding the eagle feather in a booklet illustrated with black and white drawings. The eagle is an Indian symbol of…

  7. Lead Levels in Utah Eagles

    NASA Astrophysics Data System (ADS)

    Arnold, Michelle

    2006-10-01

    Lead is a health hazard to most animals, causing adverse effects to the nervous and reproductive systems if in sufficient quantity. Found in most fishing jigs and sinkers, as well as some ammunition used in hunting, this metal can poison wildlife such as eagles. Eagles are raptors, or predatory birds, and their lead exposure would most likely comes from their food -- a fish which has swallowed a sinker or lead shot in carrion (dead animal matter). As part of an ongoing project to investigate the environment lead levels in Utah, the bone lead levels in the wing bones of eagles have been measured for eagle carcasses found throughout Utah. The noninvasive technique of x-ray fluorescence was used, consisting of a Cd-109 radioactive source to activate lead atoms and a HPGe detector with digital electronics to collect the gamma spectra. Preliminary results for the eagles measured to date will be presented.

  8. EAGLES NEST WILDERNESS, COLORADO.

    USGS Publications Warehouse

    Tweto, Ogden; Williams, Frank E.

    1984-01-01

    On the basis of a geologic and mineral survey, a primitive area that constitutes the nucleus of the Eagles Nest Wilderness, Colorado was appraised to offer little promise for the occurrence of mineral or energy resources. Among the additional areas later incorporated in the wilderness, only a strip near a major fault west and northwest of Frisco and Dillon is classed as having probable mineral-resource potential. If mineral deposits exist, they probably are of the silver-lead-zinc or fluorspar types.

  9. Nationwide survey of Arima syndrome: revised diagnostic criteria from epidemiological analysis.

    PubMed

    Itoh, Masayuki; Iwasaki, Yuji; Ohno, Kohsaku; Inoue, Takehiko; Hayashi, Masaharu; Ito, Shuichi; Matsuzaka, Tetsuo; Ide, Shuhei; Arima, Masataka

    2014-05-01

    We have never known any epidemiological study of Arima syndrome since it was first described in 1971. To investigate the number of Arima syndrome patients and clarify the clinical differences between Arima syndrome and Joubert syndrome, we performed the first nationwide survey of Arima syndrome, and herein report its results. Furthermore, we revised the diagnostic criteria for Arima syndrome. As a primary survey, we sent out self-administered questionnaires to most of the Japanese hospitals with a pediatric clinic, and facilities for persons with severe motor and intellectual disabilities, inquiring as to the number of patients having symptoms of Arima syndrome, including severe psychomotor delay, agenesis or hypoplasia of cerebellar vermis, renal dysfunction, visual dysfunction and with or without ptosis-like appearance. Next, as the second survey, we sent out detailed clinical questionnaires to the institutes having patients with two or more typical symptoms. The response rate of the primary survey was 72.7% of hospitals with pediatric clinic, 63.5% of national hospitals and 66.7% of municipal and private facilities. The number of patients with 5 typical symptoms was 13 and that with 2-4 symptoms was 32. The response rate of the secondary survey was 52% (23 patients). After reviewing clinical features of 23 patients, we identified 7 Arima syndrome patients and 16 Joubert syndrome patients. Progressive renal dysfunction was noticed in all Arima syndrome patients, but in 33% of those with Joubert syndrome. It is sometimes difficult to distinguish Arima syndrome from Joubert syndrome. Some clinicians described a patient with Joubert syndrome and its complications of visual dysfunction and renal dysfunction, whose current diagnosis was Arima syndrome. Thus, the diagnosis of the two syndromes may be confused. Here, we revised the diagnostic criteria for Arima syndrome. Copyright © 2013 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights

  10. EAGLE: 'EAGLE'Is an' Algorithmic Graph Library for Exploration

    SciTech Connect

    2015-01-16

    The Resource Description Framework (RDF) and SPARQL Protocol and RDF Query Language (SPARQL) were introduced about a decade ago to enable flexible schema-free data interchange on the Semantic Web. Today data scientists use the framework as a scalable graph representation for integrating, querying, exploring and analyzing data sets hosted at different sources. With increasing adoption, the need for graph mining capabilities for the Semantic Web has emerged. Today there is no tools to conduct "graph mining" on RDF standard data sets. We address that need through implementation of popular iterative Graph Mining algorithms (Triangle count, Connected component analysis, degree distribution,more » diversity degree, PageRank, etc.). We implement these algorithms as SPARQL queries, wrapped within Python scripts and call our software tool as EAGLE. In RDF style, EAGLE stands for "EAGLE 'Is an' algorithmic graph library for exploration. EAGLE is like 'MATLAB' for 'Linked Data.'« less

  11. Ophthalmologic Findings in H Syndrome: A Unique Diagnostic Clue.

    PubMed

    Molho-Pessach, Vered; Mechoulam, Hadas; Siam, Rula; Babay, Sofia; Ramot, Yuval; Zlotogorski, Abraham

    2015-01-01

    H syndrome is an autosomal recessive histiocytosis with multisystemic involvement caused by mutations in the SLC29A3 gene. The term H syndrome was coined to denote the major clinical findings which include hyperpigmentation, hypertrichosis, hearing loss, hepatosplenomegaly, hypogonadism, hyperglycemia/diabetes mellitus and hallux valgus/flexion contractures. Almost 100 individuals affected with this disorder have been reported, however, a thorough evaluation of the ophthalmologic features of H syndrome has not yet been performed. Ophthalmic examination of a 50-year-old male with H syndrome. Mutation analysis of SLC29A3 was also performed in this patient. Ophthalmic findings included; shallow orbits with exorbitism, bilateral pterygium, limbal thickening, corneal arcus and cortical cataract. We also review ophthalmologic findings in previously reported H syndrome patients. The presence of dilated lateral scleral vessels, corneal arcus and shallow orbits should raise the suspicion of H syndrome, especially when seen in young age.

  12. Coping with the diagnostic complexities of the compartment syndrome

    NASA Technical Reports Server (NTRS)

    Mubarak, S. J.; Hargens, A. R.; Karkal, S. S.

    1988-01-01

    This review recognizes that, given the various complexities associated with the condition, no pat answers can be given to fit every patient with the compartment syndrome. The authors first give a definition of the syndrome, together with a brief account of how this self-perpetuating pathologic cycle is triggered. Next, they delineate specific anatomical features of compartments that are likely to be involved, and follow this with an inventory of symptoms and signs to look for in suspected cases. After sorting out the entities that can mimic the compartment syndrome, the authors describe three essential techniques of measuring tissue pressure, which can prove invaluable in diagnosing the compartment syndrome.

  13. Fragile X Syndrome in Males: Diagnostic, Behavioral, and Educational Implications.

    ERIC Educational Resources Information Center

    Bellinger, Diane; And Others

    This paper reviews the research on fragile X syndrome, the second most common cause of mental retardation related to chromosomal anomaly. It notes that far more males than females are affected by the fragile X syndrome, which typically results in craniofacial changes, delays in growth and development, speech/language difficulties, and cognitive…

  14. Uptake of prenatal diagnostic testing and the effectiveness of prenatal screening for Down syndrome.

    PubMed

    Jaques, Alice M; Collins, Veronica R; Muggli, Evelyne E; Amor, David J; Francis, Ivan; Sheffield, Leslie J; Halliday, Jane L

    2010-06-01

    To map prenatal screening and diagnostic testing pathways in Victorian pregnant women during 2003 to 2004; measure the impact of prenatal diagnostic testing uptake on the effectiveness of prenatal screening for Down syndrome; and assess factors influencing uptake of diagnostic testing following screening. State-wide data collections of prenatal screening and diagnostic tests were linked to all Victorian births and pregnancy terminations for birth defects. Overall, 52% of women had a prenatal test (65 692/126 305); screening (44.9%), diagnostic testing (3.9%), or both (3.2%). Uptake of diagnostic testing was 71.4% (2390/3349) after an increased risk screen result, and 2.5% (1381/54 286) after a low risk result. Variation in uptake of diagnostic testing reduced the effectiveness of the screening program by 11.2%: from 87.4% (sensitivity - 125/143) to 76.2% (prenatal diagnoses of Down syndrome - 109/143). In both the increased and low risk groups, uptake was influenced by absolute numerical risk, as well as by the change in numerical risk from a priori risk. This comprehensive follow-up demonstrates clearly that numerical risk is being used to aid in decision making about confirmatory diagnostic testing. Collectively, these fundamental individual decisions will impact on the overall effectiveness of screening programmes for Down syndrome.

  15. Genomic analysis of bone marrow failure and myelodysplastic syndromes reveals phenotypic and diagnostic complexity

    PubMed Central

    Zhang, Michael Y.; Keel, Siobán B.; Walsh, Tom; Lee, Ming K.; Gulsuner, Suleyman; Watts, Amanda C.; Pritchard, Colin C.; Salipante, Stephen J.; Jeng, Michael R.; Hofmann, Inga; Williams, David A.; Fleming, Mark D.; Abkowitz, Janis L.; King, Mary-Claire; Shimamura, Akiko

    2015-01-01

    Accurate and timely diagnosis of inherited bone marrow failure and inherited myelodysplastic syndromes is essential to guide clinical management. Distinguishing inherited from acquired bone marrow failure/myelodysplastic syndrome poses a significant clinical challenge. At present, diagnostic genetic testing for inherited bone marrow failure/myelodysplastic syndrome is performed gene-by-gene, guided by clinical and laboratory evaluation. We hypothesized that standard clinically-directed genetic testing misses patients with cryptic or atypical presentations of inherited bone marrow failure/myelodysplastic syndrome. In order to screen simultaneously for mutations of all classes in bone marrow failure/myelodysplastic syndrome genes, we developed and validated a panel of 85 genes for targeted capture and multiplexed massively parallel sequencing. In patients with clinical diagnoses of Fanconi anemia, genomic analysis resolved subtype assignment, including those of patients with inconclusive complementation test results. Eight out of 71 patients with idiopathic bone marrow failure or myelodysplastic syndrome were found to harbor damaging germline mutations in GATA2, RUNX1, DKC1, or LIG4. All 8 of these patients lacked classical clinical stigmata or laboratory findings of these syndromes and only 4 had a family history suggestive of inherited disease. These results reflect the extensive genetic heterogeneity and phenotypic complexity of bone marrow failure/myelodysplastic syndrome phenotypes. This study supports the integration of broad unbiased genetic screening into the diagnostic workup of children and young adults with bone marrow failure and myelodysplastic syndromes. PMID:25239263

  16. Diagnostic performance of BMI percentiles to identify adolescents with metabolic syndrome.

    PubMed

    Laurson, Kelly R; Welk, Gregory J; Eisenmann, Joey C

    2014-02-01

    To compare the diagnostic performance of the Centers for Disease Control and Prevention (CDC) and FITNESSGRAM (FGram) BMI standards for quantifying metabolic risk in youth. Adolescents in the NHANES (n = 3385) were measured for anthropometric variables and metabolic risk factors. BMI percentiles were calculated, and youth were categorized by weight status (using CDC and FGram thresholds). Participants were also categorized by presence or absence of metabolic syndrome. The CDC and FGram standards were compared by prevalence of metabolic abnormalities, various diagnostic criteria, and odds of metabolic syndrome. Receiver operating characteristic curves were also created to identify optimal BMI percentiles to detect metabolic syndrome. The prevalence of metabolic syndrome in obese youth was 19% to 35%, compared with <2% in the normal-weight groups. The odds of metabolic syndrome for obese boys and girls were 46 to 67 and 19 to 22 times greater, respectively, than for normal-weight youth. The receiver operating characteristic analyses identified optimal thresholds similar to the CDC standards for boys and the FGram standards for girls. Overall, BMI thresholds were more strongly associated with metabolic syndrome in boys than in girls. Both the CDC and FGram standards are predictive of metabolic syndrome. The diagnostic utility of the CDC thresholds outperformed the FGram values for boys, whereas FGram standards were slightly better thresholds for girls. The use of a common set of thresholds for school and clinical applications would provide advantages for public health and clinical research and practice.

  17. ROHHAD Syndrome: Reasons for Diagnostic Difficulties in Obesity.

    PubMed

    Kocaay, Pınar; Şıklar, Zeynep; Çamtosun, Emine; Kendirli, Tanıl; Berberoğlu, Merih

    2014-12-01

    A very rare syndrome of rapid-onset obesity with hypoventilation, hypothalamic dysfunction and autonomic dysregulation (ROHHAD) has been recently described as causing morbidity due to hypothalamic dysfunction and respiratory arrest. Its prognosis is poor and often cardiac arrest occurs due to alveolar hypoventilation. This disorder can mimic genetic obesity syndromes and several endocrine disorders. We present a 13-year-old female patient who was reported to be healthy until the age of 3 years. She was admitted to our emergency department, presenting with respiratory distress. Features matching ROHHAD syndrome such as rapid-onset obesity, alveolar hypoventilation, central hypothyroidism, hyperprolactinemia, Raynaud phenomenon and hypothalamic hypernatremia were detected in the patient. In addition to these features, the patient was found to have hypergonadotropic hypogonadism and megaloblastic anemia. Because of its high mortality and morbidity, the possibility of ROHHAD syndrome needs to be considered in all pediatric cases of early- and rapid-onset obesity associated with hypothalamic-pituitary endocrine dysfunction.

  18. [Multiple sclerosis associated with antiphospholipid syndrome: diagnostic and therapeutic difficulties].

    PubMed

    Ahbeddou, N; Ait Ben Haddou, E; Hammi, S; Slimani, C; Regragui, W; Benomar, A; Yahyaoui, M

    2012-01-01

    Strokes are the main neurological manifestation of antiphospholipid syndrome. Other clinical presentations are possible and may mimic classic symptoms of multiple sclerosis (MS). A 46-year-old woman, with a history of two miscarriages, presented four subacute neurological episodes (optic neuritis, right facial paralysis, paraparesis of the thigh, and right brachial monoparesis). Using McDonald criteria, the diagnosis of multiple sclerosis was retained. Because of the occurrence of thrombocytopenia during a final relapse, we reconsidered the diagnosis of MS. Search for antiphospholipid antibodies was positive. All clinical manifestations and complementary tests were compatible with the diagnosis of antiphospholipid syndrome associated with multiple sclerosis. Given the great similarity of clinical, radiological and biological findings in the two diseases, non-thrombotic neurological manifestations of antiphospholipid syndrome can be difficult to distinguish from MS associated with antiphospholipid syndrome. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  19. The Eagle's EGGs

    NASA Astrophysics Data System (ADS)

    2001-12-01

    VLT ISAAC Looks for Young Stars in the Famous "Pillars of Creation" Summary Through imaging at infrared wavelengths, evidence has been found for recent star formation in the so-called "Pillars of Creation" in the Eagle Nebula (also known as Messier 16 ), made famous when the NASA/ESA Hubble Space Telescope (HST) obtained spectacular visible-wavelength images of this object in 1995. Those huge pillars of gas and dust are being sculpted and illuminated by bright and powerful high-mass stars in the nearby NGC 6611 young stellar cluster . The Hubble astronomers suggested that perhaps even younger stars were forming inside. Using the ISAAC instrument on the VLT 8.2-m ANTU telescope at the ESO Paranal Observatory , European astronomers have now made a wide-field infrared image of the Messier 16 region with excellent spatial resolution, enabling them to penetrate the obscuring dust and search for light from newly born stars . Two of the three pillars are seen to have very young, relatively massive stars in their tips. Another dozen or so lower-mass stars seem to be associated with the small "evaporating gaseous globules (EGGs)" that the Hubble astronomers had discovered scattered over the surface of the pillars. These findings bring new evidence to several key questions about how stars are born . Was the formation of these new stars triggered as the intense ultraviolet radiation from the NGC 6611 stars swept over the pillars, or were they already there? Will the new stars be prematurely cut off from surrounding gas cloud, thus stunting their growth? If the new stars have disks of gas and dust around them, will they be destroyed before they have time to form planetary systems? PR Photo 37a/01 : Full wide-field ISAAC image of the Eagle Nebula. PR Photo 37b/01 : Close-up view of the ISAAC image , showing the famous "Pillars of Creation". PR Photo 37c/01 : Enlargement of the head of Column 1 . PR Photo 37d/01 : Enlargement of the head of Column 2 . PR Photo 37e/01

  20. Preliminary report on aerotoxic syndrome (AS) and the need for diagnostic neurophysiological tests.

    PubMed

    Hale, Margaret A; Al-Seffar, Judith A

    2009-09-01

    Researchers have found, in studies carried out over several years, that many passengers and crew, following their recent flights in commercial jet aeroplanes, have become unwell, with a range of symptoms in common. This condition, which has not yet been officially recognised, is called Aerotoxic Syndrome (AS). It seems to be caused, primarily, by neurotoxic organophosphates contaminating the air circulating in jet cabins. Patients with such symptoms may visit their GPs, who then arrange diagnostic tests. Some of their symptoms fall within the jurisdiction of diagnostic neurophysiological investigations, but neurophysiology practitioners may be unaware of this syndrome. Until AS is officially recognised as an illness, and guidelines for diagnostic procedures established, patients requiring specific investigations may not be appropriately referred, or tests may be performed unnecessarily. This report seeks to stimulate debate within the field, and facilitate studies, if needed, to help define the diagnostic criteria.

  1. Fly with Eagles

    NASA Astrophysics Data System (ADS)

    Brown, G. E.

    My training in many areas of research in theoretical physics derived from what I learned from the "eagles" I flew with. Let me enumerate them. First of all, when the Navy sent me to the University of Wisconsin in January 1944 to become an electrical engineering officer, I met Gregory Breit, who practically adopted me as a son. I learned from him to drag a problem bleeding through the street until it cried for help and gave up. My political indiscretions during my young life forced me to flee to England from Joe McCarthy, where I ended up in the inspiring theory group of Rudi Peierls. Peierls taught us to drive immediately to fundamentals. When I began collaborating with Hans Bethe, the first thing I learned was why he had never had long-term collaborators. I had to wait until he was more than 70 years old in order to have any chance of keeping up with him. He worked like a bulldozer, heading directly for the light at the end of the tunnel. Most important is confidence. He starts each day with a pile of white paper in the upper left-hand corner of his desk and fills it with calculations at a more or less even rate, although he's happy to stop for lunch. I found this to be an amazingly effective procedure to imitate. From my training with Rudi Peierls, his closest friend, I was well prepared to work with Hans. The twenty-odd years I've collaborated with him have been exciting and productive.

  2. ROHHAD Syndrome: Reasons for Diagnostic Difficulties in Obesity

    PubMed Central

    Kocaay, Pınar; Şıklar, Zeynep; Çamtosun, Emine; Kendirli, Tanıl; Berberoğlu, Merih

    2014-01-01

    A very rare syndrome of rapid-onset obesity with hypoventilation, hypothalamic dysfunction and autonomic dysregulation (ROHHAD) has been recently described as causing morbidity due to hypothalamic dysfunction and respiratory arrest. Its prognosis is poor and often cardiac arrest occurs due to alveolar hypoventilation. This disorder can mimic genetic obesity syndromes and several endocrine disorders. We present a 13-year-old female patient who was reported to be healthy until the age of 3 years. She was admitted to our emergency department, presenting with respiratory distress. Features matching ROHHAD syndrome such as rapid-onset obesity, alveolar hypoventilation, central hypothyroidism, hyperprolactinemia, Raynaud phenomenon and hypothalamic hypernatremia were detected in the patient. In addition to these features, the patient was found to have hypergonadotropic hypogonadism and megaloblastic anemia. Because of its high mortality and morbidity, the possibility of ROHHAD syndrome needs to be considered in all pediatric cases of early- and rapid-onset obesity associated with hypothalamic-pituitary endocrine dysfunction. PMID:25541898

  3. A new diagnostic approach to popliteal artery entrapment syndrome

    SciTech Connect

    Williams, Charles; Kennedy, Dominic; Bastian-Jordan, Matthew

    A new method of diagnosing and defining functional popliteal artery entrapment syndrome is described. By combining ultrasonography and magnetic resonance imaging techniques with dynamic plantarflexion of the ankle against resistance, functional entrapment can be demonstrated and the location of the arterial occlusion identified. This combination of imaging modalities will also define muscular anatomy for guiding intervention such as surgery or Botox injection.

  4. Asperger Syndrome or Autistic Disorder? The Diagnostic Dilemma.

    ERIC Educational Resources Information Center

    Freeman, B. J.; Cronin, Pegeen; Candela, Pete

    2002-01-01

    This article examines the difficulties in diagnosing Asperger syndrome (AS) and differentiating AS from autism. It stresses the need for gathering a developmental history and reviews considerations in conducting different assessments related to medical condition, psychological condition, communication, language, occupational and physical therapy,…

  5. Fetal Alcohol Syndrome: Diagnostic Features and Psychoeducational Risk Factors.

    ERIC Educational Resources Information Center

    Phelps, LeAdelle; Grabowski, Jo-Anne

    1992-01-01

    Discusses Fetal Alcohol Syndrome (FAS), accepted as leading known cause of mental retardation. Relates chronicity, timing, and severity of alcohol exposure to age-specific developmental and behavioral consequences. Delineates specific interventions with infants, preschoolers, school-age children, and adolescents. Advocates for accurate diagnosis…

  6. [Diagnostics and treatment of polyglandular syndrome of adults].

    PubMed

    Larina, A A; Shapoval'iants, O S; Mazurina, N V; Troshina, E A

    2012-01-01

    Autoimmune polyendocrine syndromes (APS) are rare endocrinopathies characterized by the coexistence of at least two glandular autoimmune diseases. APS comprise a wide spectrum of autoimmune disorders and are divided into a very rare juvenile (APS type 1) and a more common adult type with (APS 2) or without adrenal failure (APS 3). The first clinical manifestations of APS 1 usually occur in childhood whereas APS 2 mostly occurs during the third and fourth decades of life. The third type has been described in adults that, contrary to types 1 and 2, does not involve the adrenal cortex. No clinical differences between types 2 and 3 have been described except the absence of adrenal failure. Type 4 APS is a rare syndrome characterized by the combination of autoimmune conditions not falling into the above categories. It consists of adrenal failure with one or more minor autoimmune disorders barring major components of type 1 and 2 APS. Usually, autoimmune polyendocrine syndrome of adults manifests itself as one of the major autoimmune diseases (such as adrenal failure, Grave's disease, or type 1 diabetes) and minor autoimmune disorders (vitiligo, alopecia) preceding the development of autoimmune deficiency of major endocrine glands. This article describes a patient with type 3 APS, who developed type 1 diabetes. Grave's disease and vitiligo. The development of the syndrome started from vitiligo in the chidhood. Moreover, the patient suffered primary sterility and presented with progressive diabetic nephropathy of autoimmune origin. It is concluded that patients with a single autoimmune component of polyendocrine syndrome should be screened to exclude other autoimmune endocrine disorders.

  7. The diagnostic value of late-night salivary cortisol for diagnosis of subclinical Cushing's syndrome.

    PubMed

    Kuzu, Idris; Zuhur, Sayid Shafi; Demir, Nazan; Aktas, Gokce; Yener Ozturk, Feyza; Altuntas, Yuksel

    2016-01-01

    Late-night salivary cortisol is a frequently used and easily implemented diagnostically valuable test for the diagnosis of overt Cushing's syndrome. The use of late-night salivary cortisol in the diagnosis of subclinical Cushing's syndrome is somewhat controversial. In this study, we aimed to determine the diagnostic value of late-night salivary cortisol in diagnosing subclinical Cushing's syndrome and compare it with 24-hour urinary free cortisol levels (UFC). The study consisted of 33 cases of subclinical Cushing's syndrome, 59 cases of non-functioning adrenal adenoma, and 41 control subjects. Late-night salivary cortisol and UFC were measured in all the cases. The diagnosis of subclinical Cushing's syndrome was based on combined results of 1 mg dexamethasone suppression test > 1.8 μg/dL and ACTH < 10 pg/mL. Mean late-night salivary cortisol levels in subjects with subclinical Cushing's syndrome were significantly higher than in subjects with non-functioning adrenal adenoma and the control group (p < 0.001). Using a cut-off value of 0.18 μg/dL, the sensitivity and specificity of late-night salivary cortisol for diagnosing subclinical Cushing's syndrome were determined as 82% and 60%, respectively. Using a cut-off value of 137 μg/day, the sensitivity and specificity of UFC was determined as 18% and 90%, respectively. Because the sensitivity of late-night salivary cortisol for the diagnosis of subclinical Cushing's syndrome is limited, using it as the sole screening test for subclinical Cushing's syndrome may lead to false negative results. However, using it as an adjunct test to other tests may be beneficial in the diagnosis of subclinical Cushing's syndrome. (Endokrynol Pol 2016; 67 (5): 487-492).

  8. Multispectral diagnostic imaging of the iris in pigment dispersion syndrome.

    PubMed

    Roberts, Daniel K; Lukic, Ana; Yang, Yongyi; Wilensky, Jacob T; Wernick, Miles N

    2012-08-01

    To determine if wavelength selection with near infrared iris imaging may enhance iris transillumination defects (ITDs) in pigment dispersion syndrome. An experimental apparatus was used to acquire iris images in 6 African-American (AA) and 6 White patients with pigment dispersion syndrome. Light-emitting diode probes of 6 different spectral bands (700 to 950 nm) were used to project light into patients' eyes. Iris patterns were photographed, ITD regions of interest were outlined, and region of interest contrasts were calculated for each spectral band. Contrasts varied as a function of wavelength (P<0.0001) for both groups, but tended to be highest in the 700 to 800 nm range. Contrasts were higher in Whites than AAs at 700 nm but the opposite was found at 810 nm (P<0.001). Optimized near infrared iris imaging may be wavelength dependent. Ideal wavelength to image ITDs in more pigmented eyes may be slightly longer than for less pigmented eyes.

  9. Burning mouth syndrome: A diagnostic and therapeutic dilemma

    PubMed Central

    Panat, Sunil R.

    2012-01-01

    Burning mouth syndrome (BMS) has been considered an enigmatic condition because the intensity of pain rarely corresponds to the clinical signs of the disease. Various local, systemic and psychological factors are associated with BMS, but its etiology is not fully understood. Also there is no consensus on the diagnosis and classification of BMS. A substantial volume of research has been focused on BMS during the last two decades. Progress has been made but the condition remains a fascinating, yet poorly understood area, in the field of oral medicine. Recently, there has been a resurgence of interest in this disorder with the discovery that the pain of BMS may be neuropathic in origin and originate both centrally and peripherally. The aim of this paper is to explore the condition of BMS with the specific outcome of increasing awareness of the condition. Key words:Burning mouth syndrome, stomatodynia, oral dysesthesia, pain management. PMID:24558551

  10. A bald eagle at KSC

    NASA Technical Reports Server (NTRS)

    2000-01-01

    High in a pine tree on the grounds of the Kennedy Space Center, a bald eagle perches on a branch. The Southern Bald Eagle ranges throughout Florida and along the coasts of California, Texas, Louisiana, and the south Atlantic states. Bald eagles are listed as endangered in the U.S., except in five states where they are listed as threatened. The number of nesting pairs of the southern race once numbered several thousand; recent estimates are only 350-375. Most of the southern race nests in Florida. Eagles arrive at KSC during late summer and leave for the north in late spring. They move to nest sites in October and November and lay one to three eggs. The young fledge from February to April. KSC shares a boundary with the Merritt Island National Wildlife Refuge, which encompasses 92,000 acres that are a habitat for more than 331 species of birds, 31 mammals, 117 fishes, and 65 amphibians and reptiles. The marshes and open water of the refuge provide wintering areas for 23 species of migratory waterfowl, as well as a year-round home for great blue herons, great egrets, wood storks, cormorants, brown pelicans and other species of marsh and shore birds, as well as a variety of insects.

  11. A bald eagle at KSC

    NASA Technical Reports Server (NTRS)

    2000-01-01

    On the grounds of the Kennedy Space Center, a bald eagle takes wing away from two vultures at the site of an undetermined carcass. The Southern Bald Eagle ranges throughout Florida and along the coasts of California, Texas, Louisiana, and the south Atlantic states. Bald eagles are listed as endangered in the U.S., except in five states where they are listed as threatened. The number of nesting pairs of the southern race once numbered several thousand; recent estimates are only 350-375. Most of the southern race nests in Florida. Eagles arrive at KSC during late summer and leave for the north in late spring. They move to nest sites in October and November and lay one to three eggs. The young fledge from February to April. KSC shares a boundary with the Merritt Island National Wildlife Refuge, which encompasses 92,000 acres that are a habitat for more than 331 species of birds, 31 mammals, 117 fishes, and 65 amphibians and reptiles. The marshes and open water of the refuge provide wintering areas for 23 species of migratory waterfowl, as well as a year-round home for great blue herons, great egrets, wood storks, cormorants, brown pelicans and other species of marsh and shore birds, as well as a variety of insects.

  12. A bald eagle at KSC

    NASA Technical Reports Server (NTRS)

    2000-01-01

    A bald eagle joins two vultures at the site of an undetermined carcass on the grounds of the Kennedy Space Center. The Southern Bald Eagle ranges throughout Florida and along the coasts of California, Texas, Louisiana, and the south Atlantic states. Bald eagles are listed as endangered in the U.S., except in five states where they are listed as threatened. The number of nesting pairs of the southern race once numbered several thousand; recent estimates are only 350-375. Most of the southern race nests in Florida. Eagles arrive at KSC during late summer and leave for the north in late spring. They move to nest sites in October and November and lay one to three eggs. The young fledge from February to April. KSC shares a boundary with the Merritt Island National Wildlife Refuge, which encompasses 92,000 acres that are a habitat for more than 331 species of birds, 31 mammals, 117 fishes, and 65 amphibians and reptiles. The marshes and open water of the refuge provide wintering areas for 23 species of migratory waterfowl, as well as a year-round home for great blue herons, great egrets, wood storks, cormorants, brown pelicans and other species of marsh and shore birds, as well as a variety of insects.

  13. NIF Discovery Science Eagle Nebula

    NASA Astrophysics Data System (ADS)

    Kane, Jave; Martinez, David; Pound, Marc; Heeter, Robert; Casner, Alexis; Villette, Bruno; Mancini, Roberto

    2017-10-01

    The University of Maryland and and LLNL are investigating the origin and dynamics of the famous Pillars of the Eagle Nebula and similar parsec-scale structures at the boundaries of HII regions in molecular hydrogen clouds. The National Ignition Facility (NIF) Discovery Science program Eagle Nebula has performed NIF shots to study models of pillar formation. The shots feature a new long-duration x-ray source, in which multiple hohlraums mimicking a cluster of stars are driven with UV light in series for 10 to 15 ns each to create a 30 to 60 ns output x-ray pulse. The source generates deeply nonlinear hydrodynamics in the Eagle science package, a structure of dense plastic and foam mocking up a molecular cloud containing a dense core. Omega EP and NIF shots have validated the source concept, showing that earlier hohlraums do not compromise later ones by preheat or by ejecting ablated plumes that deflect later beams. The NIF shots generated radiographs of shadowing-model pillars, and also showed evidence that cometary structures can be generated. The velocity and column density profiles of the NIF shadowing and cometary pillars have been compared with observations of the Eagle Pillars made at the millimeter-wave BIMA and CARMA observatories. Prepared by LLNL under Contract DE-AC52-07NA27344.

  14. Nesting bald eagles attack researcher

    Treesearch

    Teryl G. Grubb

    1976-01-01

    Because of the large and relatively stable Bald Eagle (Haliaeetus leucocephalus) population on Kodiak Island, Alaska, studies on nesting, productivity, and other aspects of the species' life history have been a part of a continuing research program on the Kodiak National Wildlife Refuge (Hensel and Troyer 1964, Condor 66: 282; Troyer and...

  15. Basal cell nevus syndrome (Gorlin syndrome): genetic insights, diagnostic challenges, and unmet milestones.

    PubMed

    Akbari, Maryam; Chen, Harold; Guo, Grace; Legan, Zachary; Ghali, Ghali

    2018-01-31

    In this article, we present three clinical case reports on Basal Cell Nevus Syndrome (Gorlin Syndrome). Gorlin syndrome is an inherited medical condition with challenges that manifest in multiple body systems and complicate early diagnosis. We examine the epidemiology of the disease and benefits of genetic testing, molecular pathophysiology, and advancement in the molecular-based therapy of Basal Cell Nevus syndrome. The goal of this paper is to shed light on both unmet challenges and advancements in the management of Gorlin syndrome and to provide a new clinical perspective and guidance for future research. Furthermore, the FDA approved Hedgehog pathway inhibitors Vismodegib and Sonidegib designed for advanced basal cell carcinoma have opened a new door for treatment that may ultimately decrease the number of surgeries for a patient with Gorlin syndrome. The role of these agents in syndromic odontogenic keratocyst has not been studied extensively, but one study found that hedgehog pathway inhibitors decrease the size of syndromic odontogenic keratocyst. Ideal surgical treatment that balances low recurrence rates with low impact on one's quality of life for syndromic odontogenic keratocyst is another unanswered question for oral and maxillofacial surgeons. Per survey studies, treatment options practiced for syndromic odontogenic keratocyst range from marsupialization to segmental osteotomy. Future studies performed should take a comprehensive long-term approach with at least three years of follow-up in order to determine the most appropriate treatment. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. Peutz-Jeghers syndrome: Diagnostic and therapeutic approach

    PubMed Central

    Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan

    2009-01-01

    Peutz-Jeghers syndrome (PJS) is an inherited, autosomal dominant disorder distinguished by hamartomatous polyps in the gastrointestinal tract and pigmented mucocutaneous lesions. Prevalence of PJS is estimated from 1 in 8300 to 1 in 280 000 individuals. PJS predisposes sufferers to various malignancies (gastrointestinal, pancreatic, lung, breast, uterine, ovarian and testicular tumors). Bleeding, obstruction and intussusception are common complications in patients with PJS. Double balloon enteroscopy (DBE) allows examination and treatment of the small bowel. Polypectomy using DBE may obviate the need for repeated urgent operations and small bowel resection that leads to short bowel syndrome. Prophylaxis and polypectomy of the entire small bowel is the gold standard in PJS patients. Intraoperative enteroscopy (IOE) was the only possibility for endoscopic treatment of patients with PJS before the DBE era. Both DBE and IOE facilitate exploration and treatment of the small intestine. DBE is less invasive and more convenient for the patient. Both procedures are generally safe and useful. An overall recommendation for PJS patients includes not only gastrointestinal multiple polyp resolution, but also regular lifelong cancer screening (colonoscopy, upper endoscopy, computed tomography, magnetic resonance imaging or ultrasound of the pancreas, chest X-ray, mammography and pelvic examination with ultrasound in women, and testicular examination in men). Although the incidence of PJS is low, it is important for clinicians to recognize these disorders to prevent morbidity and mortality in these patients, and to perform presymptomatic testing in the first-degree relatives of PJS patients. PMID:19916169

  17. [Culture-bound syndromes: pertinence as a diagnostic category].

    PubMed

    Perez, S; Junod, A; Pilard, M

    2000-01-01

    Culture-bound syndromes (CBS) are supposedly confined to one specific cultural areas. These syndromes were first studied by western anthropologists and psychiatrists working overseas, and later by practitioners treating patients from societies with traditional customs and values. The latest edition of the American Psychiatry Association classification (DSM IV) includes an annex on CBS. This report gives a concise background of the process that led to the inclusion of this annex. Then using Koro (a sudden and intense fear that the genitals organs will recede into the body) as an example, a number psychopathological parallels are drawn between CBS and classic manifestations of individual and mass hysteria. The pertinence of individualizing the CBS in the psychiatric nosography including the epistemologic implications is analyzed with reference to the concepts of the French and American Schools of Anthropology. Since attitudes toward mental illness are culturally determined and subject to variation in time and space, we feel that this debate should be placed within the context of a general dialectic between etic (universality) and emic (cultural specificity) rather than a controversy on the need for an annex on CBS in the DSM IV.

  18. Stable coronary syndromes: pathophysiology, diagnostic advances and therapeutic need

    PubMed Central

    Corcoran, David

    2018-01-01

    The diagnostic management of patients with angina pectoris typically centres on the detection of obstructive epicardial CAD, which aligns with evidence-based treatment options that include medical therapy and myocardial revascularisation. This clinical paradigm fails to account for the considerable proportion (approximately one-third) of patients with angina in whom obstructive CAD is excluded. This common scenario presents a diagnostic conundrum whereby angina occurs but there is no obstructive CAD (ischaemia and no obstructive coronary artery disease—INOCA). We review new insights into the pathophysiology of angina whereby myocardial ischaemia results from a deficient supply of oxygenated blood to the myocardium, due to various combinations of focal or diffuse epicardial disease (macrovascular), microvascular dysfunction or both. Macrovascular disease may be due to the presence of obstructive CAD secondary to atherosclerosis, or may be dynamic due to a functional disorder (eg, coronary artery spasm, myocardial bridging). Pathophysiology of coronary microvascular disease may involve anatomical abnormalities resulting in increased coronary resistance, or functional abnormalities resulting in abnormal vasomotor tone. We consider novel clinical diagnostic techniques enabling new insights into the causes of angina and appraise the need for improved therapeutic options for patients with INOCA. We conclude that the taxonomy of stable CAD could improve to better reflect the heterogeneous pathophysiology of the coronary circulation. We propose the term ‘stable coronary syndromes’ (SCS), which aligns with the well-established terminology for ‘acute coronary syndromes’. SCS subtends a clinically relevant classification that more fully encompasses the different diseases of the epicardial and microvascular coronary circulation. PMID:29030424

  19. Phenotypic variability in gap junction syndromic skin disorders: experience from KID and Clouston syndromes' clinical diagnostics.

    PubMed

    Kutkowska-Kaźmierczak, Anna; Niepokój, Katarzyna; Wertheim-Tysarowska, Katarzyna; Giza, Aleksandra; Mordasewicz-Goliszewska, Maria; Bal, Jerzy; Obersztyn, Ewa

    2015-08-01

    Connexins belong to the family of gap junction proteins which enable direct cell-to-cell communication by forming channels in adjacent cells. Mutations in connexin genes cause a variety of human diseases and, in a few cases, result in skin disorders. There are significant differences in the clinical picture of two rare autosomal dominant syndromes: keratitis-ichthyosis-deafness (KID) syndrome and hidrotic ectodermal dysplasia (Clouston syndrome), which are caused by GJB2 and GJB6 mutations, respectively. This is despite the fact that, in both cases, malfunctioning of the same family proteins and some overlapping clinical features (nail dystrophy, hair loss, and palmoplantar keratoderma) is observed. KID syndrome is characterized by progressive vascularizing keratitis, ichthyosiform erythrokeratoderma, and neurosensory hearing loss, whereas Clouston syndrome is characterized by nail dystrophy, hypotrichosis, and palmoplantar keratoderma. The present paper presents a Polish patient with sporadic KID syndrome caused by the mutation of p.Asp50Asn in GJB2. The patient encountered difficulties in obtaining a correct diagnosis. The other case presented is that of a family with Clouston syndrome (caused by p.Gly11Arg mutation in GJB6), who are the first reported patients of Polish origin suffering from this disorder. Phenotype diversity among patients with the same genotypes reported to date is also summarized. The conclusion is that proper diagnosis of these syndromes is still challenging and should always be followed by molecular verification.

  20. A diagnostic and therapeutic approach to primary burning mouth syndrome.

    PubMed

    Moghadam-Kia, Siamak; Fazel, Nasim

    Primary burning mouth syndrome (BMS) is an oral mucosal disorder that is characterized by a chronic and often debilitating intraoral burning sensation for which no localized or systemic cause can be found. BMS most commonly affects postmenopausal women. The pathophysiology of primary BMS is not well understood. Diagnosing BMS can prove to be challenging. BMS patients can also pose a therapeutic challenge to clinicians who are consulted to evaluate these patients. Most commonly used therapies include tricyclic antidepressants, α-lipoic acid, clonazepam, and cognitive-behavioral therapy. Clinical judgment, patient counseling, and monitoring of pain are important. Further research is required to assess the effectiveness of serotonin and newer serotonin-noradrenalin reuptake inhibitors. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Ataques de nervios: proposed diagnostic criteria for a culture specific syndrome.

    PubMed

    Oquendo, M; Horwath, E; Martinez, A

    1992-09-01

    The authors propose a set of diagnostic criteria and report two cases of ataque de nervios, a syndrome of brief duration seen primarily in Spanish-speaking people of the Caribbean. Following a psychosocial stressor, the afflicted person demonstrates impulsivity, dissociation and communication and perceptual disturbances. The symptoms often begin in the presence of the family, allow a temporary relinquishing of social roles, and result in the mobilization of the social network in support of the person. Further research is needed to improve our understanding of this culture specific syndrome and its relationship to psychiatric disorder.

  2. [Case report: Neuroleptic malignant syndrome and diagnostic difficulties].

    PubMed

    Khouri, C; Planès, S; Logerot, S; Villier, C; Mallaret, M

    2016-06-01

    Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic drugs. It is commonly characterized by muscular rigidity, fever, altered mental status, and autonomic dysfunction. Emerging of NMS is possible with all neuroleptics, classic and atypical. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. The frequency of NMS ranges from 0.07 to 2.2%. Its pathophysiology is not clearly understood but the blockade of dopamine receptors appears to be the central mechanism. Issues of NMS are those of diagnosis, treatment and reintroduction of antipsychotic treatment or not. We here present an interesting case because of its atypical clinical presentation and its slow resolution, illustrating the various problems linked to the NMS. A 55-year-old woman with a history of mental retardation and infantile psychosis is hospitalized for worsening of her psychiatric symptoms. She is treated by risperidone long-acting injection every 2weeks, escitalopram 20 mg/d and oxazepam 10 mg/d. Early December 2012, she had fever spikes treated with many antibiotics and neuroleptics were stopped, without improvement. Early January 2013, a pulmonary embolism was diagnosed, and a treatment with loxapine is introduced and her injection of risperidone is done because of the state of agitation of the patient. Two weeks later, a NMS is suspected to hyperthermia, tremor of the limbs, a slight stiffness, and neuroleptics are stopped. Dantrolene is then introduced, but after 7days of treatment the fever is still important. Other assumptions are then discussed: infection, serotonin syndrome, encephalopathy, catatonia, malignant hyperthermia. But diagnosis of NMS is finally retained because of the recurrence of symptoms after introduction of clozapine early February. In this patient, diagnosis was made more difficult by the use of long-acting neuroleptic. NMS was indeed partly rejected because

  3. Kindler syndrome: a new mutation and new diagnostic possibilities.

    PubMed

    Burch, Joanna M; Fassihi, Hiva; Jones, Catherine A; Mengshol, Sarah C; Fitzpatrick, James E; McGrath, John A

    2006-05-01

    Kindler syndrome (KS) is a rare genetic disorder that is characterized by blistering in infancy, followed by the onset of poikiloderma and photosensitivity in childhood. The recently elucidated molecular pathogenesis involves mutations in KIND1, a gene encoding the protein kindlin-1, which is involved in the attachment of the actin cytoskeleton to the extracellular matrix in basal keratinocytes. We describe a child with the neonatal diagnosis of epidermolysis bullosa simplex who developed poikiloderma and skin fragility at 6 years of age. His skin showed diminished staining with anti-kindlin-1 antibody, and genetic analysis revealed that he was a compound heterozygote with a previously unreported mutation in KIND1. Ultrastructural clues to the diagnosis of KS were present in a biopsy specimen that was obtained when the patient was 10 months old, before he developed poikiloderma and photosensitivity. In this case, a combination of a known mutation (R271X) and a newly described mutation (1755delT) in the KIND1 gene produced loss of function in kindlin-1, leading to the clinical features of KS. Ultrastructural findings characteristic of KS were evident years before the onset of poikiloderma and sun sensitivity. In infancy, electron microscopy can enable early, accurate diagnosis of KS.

  4. Congenital central hypoventilation syndrome: diagnostic and management challenges.

    PubMed

    Kasi, Ajay S; Perez, Iris A; Kun, Sheila S; Keens, Thomas G

    2016-01-01

    Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder with failure of central control of breathing and of the autonomic nervous system function due to a mutation in the paired-like homeobox 2B (PHOX2B) gene. Affected patients have absent or negligible ventilatory sensitivity to hypercapnia and hypoxemia, and they do not exhibit signs of respiratory distress when challenged with hypercarbia or hypoxia. The diagnosis of CCHS must be confirmed with PHOX2B gene mutation. Generally, the PHOX2B mutation genotype can aid in anticipating the severity of the phenotype. They require ventilatory support for life. Home assisted ventilation options include positive pressure ventilation via tracheostomy, noninvasive positive pressure ventilation, and diaphragm pacing via phrenic nerve stimulation, but each strategy has its associated limitations and challenges. Since all the clinical manifestations of CCHS may not manifest at birth, periodic monitoring and early intervention are necessary to prevent complications and improve outcome. Life-threatening arrhythmias can manifest at different ages and a normal cardiac monitoring study does not exclude future occurrences leading to the dilemma of timing and frequency of cardiac rhythm monitoring and treatment. Given the rare incidence of CCHS, most health care professionals are not experienced with managing CCHS patients, particularly those with diaphragm pacers. With early diagnosis and advances in home mechanical ventilation and monitoring strategies, many CCHS children are surviving into adulthood presenting new challenges in their care.

  5. Update on hemolytic uremic syndrome: Diagnostic and therapeutic recommendations

    PubMed Central

    Salvadori, Maurizio; Bertoni, Elisabetta

    2013-01-01

    Hemolytic uremic syndrome (HUS) is a rare disease. In this work the authors review the recent findings on HUS, considering the different etiologic and pathogenetic classifications. New findings in genetics and, in particular, mutations of genes that encode the complement-regulatory proteins have improved our understanding of atypical HUS. Similarly, the complement proteins are clearly involved in all types of thrombotic microangiopathy: typical HUS, atypical HUS and thrombotic thrombocytopenic purpura (TTP). Furthermore, several secondary HUS appear to be related to abnormalities in complement genes in predisposed patients. The authors highlight the therapeutic aspects of this rare disease, examining both “traditional therapy” (including plasma therapy, kidney and kidney-liver transplantation) and “new therapies”. The latter include anti-Shiga-toxin antibodies and anti-C5 monoclonal antibody “eculizumab”. Eculizumab has been recently launched for the treatment of the atypical HUS, but it appears to be effective in the treatment of typical HUS and in TTP. Future therapies are in phases I and II. They include anti-C5 antibodies, which are more purified, less immunogenic and absorbed orally and, anti-C3 antibodies, which are more powerful, but potentially less safe. Additionally, infusions of recombinant complement-regulatory proteins are a potential future therapy. PMID:24255888

  6. Bertolotti syndrome: a diagnostic and management dilemma for pain physicians.

    PubMed

    Jain, Anuj; Agarwal, Anil; Jain, Suruchi; Shamshery, Chetna

    2013-10-01

    Bertolotti's syndrome (BS), a form of lumbago in lumbosacral transitional vertebrae, is an important cause of low back pain in young patients. The purpose of this study was to assess the etiology of low back pain and the efficacy of treatment offered to patients with BS. All patients of BS Castellvi type1a during a period of 6 months were enrolled in the study. The patients underwent interventional pain procedures for diagnosis and pain relief. Response to the therapy was assessed based on VAS and ODI scores. A 50% decrease in VAS score or a VAS score less than 3 would be considered adequate pain relief. All 20 patients diagnosed with BS during the 6-month observation period had scoliosis. Common causes of back pain were the ipsilateral L5-S1 facet joint, neoarticulation, the SI joint, and disc degeneration. Responses to various interventions for pain relief were different and inconsistent from patient to patient. In particular, responses to interventions for neoarticular pain were generally poor. Pain in patients with BS does not usually respond to interventional pain treatment. A very dynamic treatment approach must be pursued while managing BS patients, and the treatment plan must be individualized at various stages in order to obtain satisfactory pain relief.

  7. Bertolotti Syndrome: A Diagnostic and Management Dilemma for Pain Physicians

    PubMed Central

    Agarwal, Anil; Jain, Suruchi; Shamshery, Chetna

    2013-01-01

    Background Bertolotti's syndrome (BS), a form of lumbago in lumbosacral transitional vertebrae, is an important cause of low back pain in young patients. The purpose of this study was to assess the etiology of low back pain and the efficacy of treatment offered to patients with BS. Methods All patients of BS Castellvi type1a during a period of 6 months were enrolled in the study. The patients underwent interventional pain procedures for diagnosis and pain relief. Response to the therapy was assessed based on VAS and ODI scores. A 50% decrease in VAS score or a VAS score less than 3 would be considered adequate pain relief. Results All 20 patients diagnosed with BS during the 6-month observation period had scoliosis. Common causes of back pain were the ipsilateral L5-S1 facet joint, neoarticulation, the SI joint, and disc degeneration. Responses to various interventions for pain relief were different and inconsistent from patient to patient. In particular, responses to interventions for neoarticular pain were generally poor. Conclusions Pain in patients with BS does not usually respond to interventional pain treatment. A very dynamic treatment approach must be pursued while managing BS patients, and the treatment plan must be individualized at various stages in order to obtain satisfactory pain relief. PMID:24156003

  8. International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management.

    PubMed

    Ghadri, Jelena-Rima; Wittstein, Ilan Shor; Prasad, Abhiram; Sharkey, Scott; Dote, Keigo; Akashi, Yoshihiro John; Cammann, Victoria Lucia; Crea, Filippo; Galiuto, Leonarda; Desmet, Walter; Yoshida, Tetsuro; Manfredini, Roberto; Eitel, Ingo; Kosuge, Masami; Nef, Holger M; Deshmukh, Abhishek; Lerman, Amir; Bossone, Eduardo; Citro, Rodolfo; Ueyama, Takashi; Corrado, Domenico; Kurisu, Satoshi; Ruschitzka, Frank; Winchester, David; Lyon, Alexander R; Omerovic, Elmir; Bax, Jeroen J; Meimoun, Patrick; Tarantini, Guiseppe; Rihal, Charanjit; Y-Hassan, Shams; Migliore, Federico; Horowitz, John D; Shimokawa, Hiroaki; Lüscher, Thomas Felix; Templin, Christian

    2018-06-07

    The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians.

  9. International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management

    PubMed Central

    Ghadri, Jelena-Rima; Wittstein, Ilan Shor; Prasad, Abhiram; Sharkey, Scott; Dote, Keigo; Akashi, Yoshihiro John; Cammann, Victoria Lucia; Crea, Filippo; Galiuto, Leonarda; Desmet, Walter; Yoshida, Tetsuro; Manfredini, Roberto; Eitel, Ingo; Kosuge, Masami; Nef, Holger M; Deshmukh, Abhishek; Lerman, Amir; Bossone, Eduardo; Citro, Rodolfo; Ueyama, Takashi; Corrado, Domenico; Kurisu, Satoshi; Ruschitzka, Frank; Winchester, David; Lyon, Alexander R; Omerovic, Elmir; Bax, Jeroen J; Meimoun, Patrick; Tarantini, Guiseppe; Rihal, Charanjit; Y.-Hassan, Shams; Migliore, Federico; Horowitz, John D; Shimokawa, Hiroaki; Lüscher, Thomas Felix; Templin, Christian

    2018-01-01

    Abstract The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians. PMID:29850820

  10. 3. EAGLE ROCK CONTROL CENTER, OPERATIONS CONTROL. AS SYSTEM BECOMES ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. EAGLE ROCK CONTROL CENTER, OPERATIONS CONTROL. AS SYSTEM BECOMES INCREASINGLY AUTOMATED, EAGLE ROCK WILL BECOME MORE AND MORE THE CENTRAL CONTROL SYSTEM OF THE METROPOLITAN WATER DISTRICT. - Eagle Rock Operations Control Center, Pasadena, Los Angeles County, CA

  11. Metabolic syndrome in Mexican children: Low effectiveness of diagnostic definitions.

    PubMed

    Peña-Espinoza, Barbara Itzel; Granados-Silvestre, María de Los Ángeles; Sánchez-Pozos, Katy; Ortiz-López, María Guadalupe; Menjivar, Marta

    Early identification of children with metabolic syndrome (MS) is essential to decrease the risk of developing diabetes and cardiovascular disease in adulthood. Detection of MS is however challenging because of the different definitions for diagnosis; as a result, preventive actions are not taken in some children at risk. The study objective was therefore to compare prevalence of MS in children according to the IDF, NCEP-ATP-III, Cook, de Ferranti and Weiss definitions, considering insulin resistance (IR) markers such as HOMA-IR and/or metabolic index (MI). A total of 508 Mexican children (aged 9 to 13 years) from seven schools were enrolled in a cross-sectional study. Somatometric, biochemical, and hormonal measurements were evaluated. Frequency of MS was 2.4-45.9% depending on the definition used. Frequency of IR in children not diagnosed with MS was 12.4-25.2% using HOMA-IR and 4.0-16.3% using MI. When HOMA-IR or MI was included in each of the definitions, frequency of MS was 8.5-50.2% and 7.7-46.9% respectively. The kappa value including HOMA-IR and/or MI was greater than 0.8. This study demonstrated the poor effectiveness of the current criteria used to diagnose MS in Mexican children, as shown by the variability in the definitions and by the presence of IR in children who not diagnosed with MS. Inclusion of HOMA-IR and/or MI in definitions of MS (thus increasing agreement between them) decreases the chance of excluding children at risk and allows for MS prevalence between populations. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. 8p11 myeloproliferative syndrome: diagnostic challenges and pitfalls.

    PubMed

    Antic, Darko A; Vukovic, Vojin M; Milosevic Feenstra, Jelena D; Kralovics, Robert; Bogdanovic, Andrija D; Dencic Fekete, Marija S; Mihaljevic, Biljana S

    2016-01-01

    8p11 myeloproliferative syndrome (EMS) is a very rare clinicopathological entity which is characterized by the appearance of a myeloproliferative neoplasm in the bone marrow, peripheral lymphadenopathy, usually caused by T or B lymphoblastic lymphoma/leukemia, and a reciprocal translocation involving chromosome 8p11. Herein we describe a 22-year-old male patient with unusual clinical presentation of EMS. Namely, he initially presented with prolonged epistaxis. Complete blood count showed elevated hemoglobin (17.7g/dl), thrombocytopenia (98x109/l) and leukocytosis (57x109/l). Bone marrow aspirate and biopsy findings corresponded with the presence of a myeloproliferative neoplasm while cytogenetic analysis revealed t(8;13)(p11q12). After that ZMYM2-FGFR1 in-frame fusion was confirmed at the molecular level. Immediately after establishing the diagnosis of a myeloproliferative neoplasm (MPN) generalized lymphadenopathy was developed. Histopathologic examination of lymph node sample confirmed the diagnosis of a T cell lymphoblastic lymphoma without bone marrow involvement. Four cycles of Hyper CVAD chemotherapy were administered with complete morphological and cytogenetic remission. Four weeks after evaluation, patient developed peripheral blood monocytosis and eosinophilia without bone marrow criteria for acute leukemia. Cytogenetic analysis showed t(8;13) accompanied by complex numerical and structural aberrations. The patient underwent allogeneic stem cell transplantation (allo-SCT) from HLA matched sister and he subsequently achieved complete remission. In conclusion, patients with MPN and translocations involving chromosome 8 need to be carefully evaluated for EMS. However, having in mind the very aggressive clinical course of EMS allo-SCT is the only potential curative option.

  13. 77 FR 47628 - Eagle Mountain Pumped Storage Hydroelectric Project; Eagle Crest Energy; Notice of Meeting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-09

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [P-13123-002-CA] Eagle Mountain Pumped Storage Hydroelectric Project; Eagle Crest Energy; Notice of Meeting Postponement On July 17, 2012, the...), on the Eagle Mountain Pumped Storage Hydroelectric Project. However, the meeting has been postponed...

  14. 76 FR 15971 - Eagle Mountain Pumped Storage Hydroelectric Project; Eagle Crest Energy; Notice of Teleconference

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-22

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [P-13123-002-CA] Eagle Mountain Pumped Storage Hydroelectric Project; Eagle Crest Energy; Notice of Teleconference a. Date and Time of Meeting... staff of the U.S. Fish and Wildlife Service and Eagle Crest Energy as part of its on-going Section 7...

  15. 76 FR 22699 - Eagle Mountain Pumped Storage Hydroelectric Project, Eagle Crest Energy; Notice of Teleconference

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-22

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [P-13123-002--CA] Eagle Mountain Pumped Storage Hydroelectric Project, Eagle Crest Energy; Notice of Teleconference a. Date and Time of Meeting... staff of the U.S. Fish and Wildlife Service and Eagle Crest Energy as part of its on-going Section 7...

  16. 77 FR 27174 - Eagle Permits; Changes in the Regulations Governing Eagle Permitting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-09

    ..., proposed rule to revise the regulations for permits for nonpurposeful take of golden eagles (Aquila... will post all comments on http:/www.regulations.gov. This generally means that we will post any... of golden eagles (Aquila chrysaetos) and bald eagles (Haliaeetus leucocephalus), where the take is...

  17. The Northern Bald Eagle (Haliaeetus leucocephalus alascanus).

    DTIC Science & Technology

    1979-01-01

    finally lured out of the nest with a show of food. Kussman (1976, cited in Diss. Abst. Intern. 38(3):1033-D) studied post- fledging behavior of eagles...Frenzel, L. D., G. Juenemann, and J. Kussman 1973 Behavioral Aspects of Eagle Nest Surveys. pp 33-36 in: Bald Eagle Nest Survey Workshop, 15 Aug. U.S...J. Ligas, and W. B. Robertson, Jr. 1970 Organochlorine and Heavy Metal Residues in Bald Eagle Eggs. Pestic. Monit. Jour., 3(3): 136-140. Kussman , J

  18. [Diagnostics and treatment decisions in acute compartment syndrome. Results of a survey in German hospitals].

    PubMed

    Sellei, R M; Andruszkow, H; Weber, C; Damen, T O; Pape, H-C; Hildebrand, F

    2016-02-01

    The presented survey was intended to evaluate whether a standardization of diagnostics and therapy for acute compartment syndrome has been achieved. University hospitals, academic teaching hospitals, and county hospitals in Germany were included. A total of 38% (n=120) of all contacted hospitals participated in this study with questions mainly answered by consulting physicians (68%). In general the importance of the clinical examination was considered as being more important than other diagnostic measures. In cases where further diagnostics were necessary, the intramuscular pressure measurement was used most frequently. Of the participants 50% performed surgical fasciotomy based on the clinical examination in combination with the intramuscular pressure measurement; however, there were considerable differences between the participating hospitals with respect to the anatomical position of intramuscular measurements, the limiting value of the intramuscular pressure and the surgical technique for performing fasciotomy. According to the presented analysis the diagnosis and indications for surgical treatment in patients developing an acute compartment syndrome do not seem to be sufficiently clarified. The establishment of unified treatment guidelines could help to reduce the number of delayed diagnoses of compartment syndrome.

  19. Transitional lumbosacral vertebrae and low back pain: diagnostic pitfalls and management of Bertolotti's syndrome.

    PubMed

    Almeida, Daniel Benzecry de; Mattei, Tobias Alécio; Sória, Marília Grando; Prandini, Mirto Nelso; Leal, André Giacomelli; Milano, Jerônimo Buzzeti; Ramina, Ricardo

    2009-06-01

    Bertolotti's syndrome is a spine disorder characterized by the occurrence of a congenital lumbar transverse mega-apophysis in a transitional vertebral body that usually articulates with the sacrum or the iliac bone. It has been considered a possible cause of low back pain. We analyzed the cases of Bertolotti's syndrome that failed clinical treatment and reviewed the literature concerning this subject. Five patients in our series had severe low back pain due to the neo-articulation and two of them were successfully submitted to surgical resection of the transverse mega-apophysis. Taking into account the clinical and surgical experience acquired with these cases, we propose a diagnostic-therapeutic algorithm. There is still no consensus about the most appropriate therapy for Bertolotti's syndrome. In patients in whom the mega-apophysis itself may be the source of back pain, surgical resection may be a safe and effective procedure.

  20. Choroidal abnormalities in café-au-lait syndromes: a new differential diagnostic tool?

    PubMed

    Cassiman, C; Casteels, I; Jacob, J; Plasschaert, E; Brems, H; Dubron, K; Keer, K V; Legius, E

    2017-04-01

    The best known café-au-lait syndrome is neurofibromatosis type 1 (NF1). Legius syndrome (LS) is another, rarer syndrome with café-au-lait macules (CALMs). In young patients their clinical picture is often indistinguishable. We investigated the presence of choroidal abnormalities in syndromes with CALMs as a candidate tool for a more efficient diagnosis. Thirty-four patients with NF1 (14 with a truncating mutation, 14 with a non-truncating mutation and 6 with unknown mutation) and 11 patients with LS. All patients underwent an ophthalmological examination. Infrared images were performed. Choroidal nodules were diagnosed in 65% of the NF1 group. About 71% of NF1 patients with a truncating mutation and 50% of patients with a non-truncating mutation were found to have nodules. Choroidal nodules were seen in 18% of the LS patients, never more than one nodule/eye was detected in this group. Choroidal nodules are more abundantly present in NF1 genotypes with truncating mutations. In contrast, the number of choroidal nodules in LS is comparable with their presence in healthy individuals. Especially at an early age, when the clinical picture is incomplete, the detection of choroidal nodules is of diagnostic value, and helps in an appropriate genetic counselling and follow-up. These results support the suggestion to include choroidal nodules to the diagnostic criteria for NF1. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Human adjuvant-related syndrome or autoimmune/inflammatory syndrome induced by adjuvants. Where have we come from? Where are we going? A proposal for new diagnostic criteria.

    PubMed

    Alijotas-Reig, J

    2015-09-01

    In 1964, Miyoshi reported a series of patients with diverse symptoms after receiving treatment with silicone or paraffin fillers. Miyoshi named this condition 'human adjuvant disease'. Since then, the literature has been flooded with case reports and case series of granulomatous and systemic autoimmune disorders related to vaccines, infection or other adjuvants such as silicone and other biomaterials. A new term -autoimmune/inflammatory syndrome induced by adjuvants--has recently been coined for a process that includes several clinical features previously described by Miyoshi plus other clinical and laboratory parameters related to exposure to diverse external stimuli. Disorders such as siliconosis, Gulf War syndrome, macrophagic myofasciitis syndrome, sick building syndrome and post-vaccination syndrome have been included in autoimmune/inflammatory syndrome induced by adjuvants. Disorders such as Spanish toxic oil syndrome and Ardystil syndrome could also be included. Furthermore, biomaterials other than silicone should also be considered as triggering factors for these adjuvant-related syndromes. New diagnostic criteria in this field have been proposed. Nevertheless, many of these criteria are too subjective, leading to some patients being diagnosed with chronic fatigue syndrome or other 'central sensitization syndromes'. Diagnostic criteria based only on objective clinical and laboratory data to be further discussed and validated are proposed herein. © The Author(s) 2015.

  2. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria.

    PubMed

    Yildiz, Bulent Okan; Bozdag, Gurkan; Yapici, Zuhal; Esinler, Ibrahim; Yarali, Hakan

    2012-10-01

    What is the prevalence, phenotype and metabolic features of polycystic ovary syndrome (PCOS) in the same population according to three different diagnostic criteria? The prevalence of PCOS under National Institutes of Health (NIH), Rotterdam and Androgen Excess and PCOS (AE-PCOS) Society criteria was 6.1, 19.9 and 15.3%, respectively. PCOS carried a 2-fold increased risk of metabolic syndrome regardless of the diagnostic criteria used. The prevalence rates of PCOS differ depending on the diagnostic criteria used to define the syndrome. The current paper gives the prevalence rates of the component and composite phenotypes of PCOS in the same population and reports similar rates of metabolic syndrome in women with PCOS under contrasting diagnostic criteria. In this cross-sectional study, 392 women between the ages of 18 and 45 years were analyzed. When the prevalence of PCOS according to NIH was set to 8% with a precision of 2.2% and confidence interval of 95%, the sample size required for a prevalence survey was found to be 400 subjects. The study was carried out in the General Directorate of Mineral Research and Exploration, a government-based institute, in which the largest number of female staff (n = 527) are employed within a single institute in Ankara, Turkey. The study was performed between 7 December 2009 and 30 April 2010. All female subjects between the ages of 18 and 45 years were invited to participate. Women older than 45 or younger than 18 years, post-menopausal women, women with a history of hysterectomy or bilateral oopherectomy and pregnant women were excluded. Totally, 392 of the employees were recruited for the final analyses. The prevalence of PCOS under NIH, Rotterdam and AE-PCOS Society criteria were 6.1, 19.9 and 15.3%, respectively. While the prevalence of metabolic syndrome was 6.1% in the whole study group, within the patients diagnosed as PCOS according to NIH, Rotterdam and AE-PCOS Society criteria, it was 12.5, 10.3 and 10

  3. Constructing bald eagle nests with natural materials

    Treesearch

    T. G. Grubb

    1995-01-01

    A technique for using natural materials to build artificial nests for bald eagles (Haliaeetus leucocephalus) and other raptors is detailed. Properly constructed nests are as permanently secured to the nest tree or cliff substrate as any eagle-built nest or human-made platform. Construction normally requires about three hours and at least two people. This technique is...

  4. ASBO Eagle Institute: A Leadership Opportunity

    ERIC Educational Resources Information Center

    Scharff, James

    2012-01-01

    Each summer, ASBO International conducts an Eagle Institute leadership session in the Washington, D.C., area that provides a group of about 25 participants, including Eagle Award recipients, an opportunity to network with and learn from exemplary leaders inside and outside the field of school business management. Each year, the focus of the…

  5. EAGLE The controlled source experiment

    NASA Astrophysics Data System (ADS)

    Maguire, P. K. H.; Eagle Controlled Source Group

    2003-04-01

    In January 2003, a wide-angle reflection / refraction seismic project was carried out over the north-eastern section of the Main Ethiopian Rift as part of the international EAGLE (Ethiopia Afar Geoscientific Lithospheric Experiment) programme. EAGLE comprises a combination of passive and controlled source seismic experiments to determine the geometry and kinematics of a continental rift immediately prior to break-up, enabling the development of magmatic margin break-up models. A total of ˜900 seismic instruments were deployed along two 450km profiles, one along the axis of the Ethiopian Rift into the south-west corner of Afar; and a second across the rift, extending north and south across the uplifted, flood basalt covered, Ethiopian plateau. The two profiles intersect over the Nazret volcanic segment in the rift. This may be indicative of the transition from continental style rifting in which strain is accommodated on the rift bounding border faults, to a state where strain and magmatism have migrated to a narrow zone within the rift, a necessary pre-cursor to break-up. A further ˜300 instruments were deployed in a 100x100km^2 array around the intersection of the two profiles. A total of 16 borehole and 2 lake shots were fired into the network over a period of four days. The principal objectives of the controlled source project were to examine crustal strain, the distribution of crustal magmatic intrusions, the influence of pre-rift crustal property variations on rift development and also to provide a crustal seismic velocity distribution to improve images of the deep mantle, as well as earthquake locations derived from the EAGLE passive arrays.

  6. A Next Generation Sequencing custom gene panel as first line diagnostic tool for atypical cases of syndromic obesity: Application in a case of Alström syndrome.

    PubMed

    Maltese, Paolo E; Iarossi, Giancarlo; Ziccardi, Lucia; Colombo, Leonardo; Buzzonetti, Luca; Crinò, Antonino; Tezzele, Silvia; Bertelli, Matteo

    2018-02-01

    Obesity phenotype can be manifested as an isolated trait or accompanied by multisystem disorders as part of a syndromic picture. In both situations, same molecular pathways may be involved to different degrees. This evidence is stronger in syndromic obesity, in which phenotypes of different syndromes may overlap. In these cases, genetic testing can unequivocally provide a final diagnosis. Here we describe a patient who met the diagnostic criteria for Alström syndrome only during adolescence. Genetic testing was requested at 25 years of age for a final confirmation of the diagnosis. The genetic diagnosis of Alström syndrome was obtained through a Next Generation Sequencing genetic test approach using a custom-designed gene panel of 47 genes associated with syndromic and non-syndromic obesity. Genetic analysis revealed a novel homozygous frameshift variant p.(Arg1550Lysfs*10) on exon 8 of the ALMS1 gene. This case shows the need for a revision of the diagnostic criteria guidelines, as a consequence of the recent advent of massive parallel sequencing technology. Indications for genetic testing reported in these currently accepted diagnostic criteria for Alström syndrome, were drafted when sequencing was expensive and time consuming. Nowadays, Next Generation Sequencing testing could be considered as first line diagnostic tool not only for Alström syndrome but, more generally, for all those atypical or not clearly distinguishable cases of syndromic obesity, thus avoiding delayed diagnosis and treatments. Early diagnosis permits a better follow-up and pre-symptomatic interventions. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. [Somatic disease or Munchausen syndrome by proxy? Mother's or child's disease? Diagnostic controversies].

    PubMed

    Janas-Kozik, Małgorzata; Albert, Joanna; Kresimon, Ewa; Stokowacka-Zakrzewska, Magdalena; Wawrzyniak, Karina

    2007-01-01

    INTRODUCTIONn: The Munchausen Syndrome by Proxy occurs when parents make a child believe he or she suffers from a disease while in fact this is not true. A medical diagnosis ruling out a possible disease of the child does not calm the parents down and only confirms--in their belief--the doctor's incompetence which in turn makes them seek a second opinion. This may be repeated over and over again and be accompanied by administration of medicines, overprotection, introducing a diet, limiting exercise as well as limiting motoric and mental development. Authors present diagnostic difficulties in diagnosing the Munchausen syndrome. A 6-year old girl was hospitalized for the first time at the Developmental Age Psychiatry and Psychotherapy Ward of the John Paul II Pediatric Center in Sosnowiec, Poland (until then she had received psychiatric treatment at the Center on an outpatient basis only). Medical history provided by her mother as well as supplied documents show numerous hospitalizations at Pediatric Wards since the girl was 6 weeks old due to intensified vomiting and frequent diarrheas. Since the age of 4, the girl has been provoking vomiting as well as temporarily refusing meals and liquids. Authors present diagnostic difficulties in diagnosing the Munchausen syndrome mainly caused by discharging the patient from the Ward on her mother's request as well as non-specific nature of the symptoms.

  8. The role of IQSEC2 in syndromic intellectual disability: Narrowing the diagnostic odyssey.

    PubMed

    Helm, Benjamin M; Powis, Zoe; Prada, Carlos E; Casasbuenas-Alarcon, Olga L; Balmakund, Tonya; Schaefer, G B; Kahler, Stephen G; Kaylor, Julie; Winter, Susan; Zarate, Yuri A; Schrier Vergano, Samantha A

    2017-10-01

    While X-linked intellectual disability (XLID) syndromes pose a diagnostic challenge for clinicians, an increasing number of recognized disorders and their genetic etiologies are providing answers for patients and their families. The availability of clinical exome sequencing is broadening the ability to identify mutations in genes previously unrecognized as causing XLID. In recent years, the IQSEC2 gene, located at Xp11.22, has emerged as the cause of multiple cases of both nonsyndromic and syndromic XLID. Herein we present a case series of six individuals (five males, one female) with intellectual disability and seizures found to have alterations in IQSEC2. In all cases, the diagnostic odyssey was extensive and expensive, often including invasive testing such as muscle biopsies, before ultimately reaching the diagnosis. We report these cases to demonstrate the exhaustive work-up prior to finding the changes in IQSEC2 gene, recommend that this gene be considered earlier in the diagnostic evaluation of individuals with global developmental delay, microcephaly, and severe, intractable epilepsy, and support the use of intellectual disability panels including IQSEC2 in the first-line evaluation of these patients. © 2017 Wiley Periodicals, Inc.

  9. Survey for hemoparasites in imperial eagles (Aquila heliaca), steppe eagles (Aquila nipalensis), and white-tailed sea eagles (Haliaeetus albicilla) from Kazakhstan.

    PubMed

    Leppert, Lynda L; Layman, Seth; Bragin, Evgeny A; Katzner, Todd

    2004-04-01

    Prevalence of hemoparasites has been investigated in many avian species throughout Europe and North America. Basic hematologic surveys are the first step toward evaluating whether host-parasite prevalences observed in North America and Europe occur elsewhere in the world. We collected blood smears from 94 nestling imperial eagles (Aquila heliaca), five nestling steppe eagles (Aquila nipalensis), and 14 nestling white-tailed sea eagles (Haliaeetus albicilla) at Naurzum Zapovednik (Naurzum National Nature Reserve) in Kazakhstan during the summers of 1999 and 2000. In 1999, six of 29 imperial eagles were infected with Lencocytozoon toddi. Five of 65 imperial eagles and one of 14 white-tailed sea eagle were infected with L. toddi in 2000. Furthermore, in 2000, one of 65 imperial eagles was infected with Haemoproteus sp. We found no parasites in steppe eagles in either year, and no bird had multiple-species infections. These data are important because few hematologic studies of these eagle species have been conducted.

  10. EAGLE: relay mirror technology development

    NASA Astrophysics Data System (ADS)

    Hartman, Mary; Restaino, Sergio R.; Baker, Jeffrey T.; Payne, Don M.; Bukley, Jerry W.

    2002-06-01

    EAGLE (Evolutionary Air & Space Global Laser Engagement) is the proposed high power weapon system with a high power laser source, a relay mirror constellation, and the necessary ground and communications links. The relay mirror itself will be a satellite composed of two optically-coupled telescopes/mirrors used to redirect laser energy from ground, air, or space based laser sources to distant points on the earth or space. The receiver telescope captures the incoming energy, relays it through an optical system that cleans up the beam, then a separate transmitter telescope/mirror redirects the laser energy at the desired target. Not only is it a key component in extending the range of DoD's current laser weapon systems, it also enables ancillary missions. Furthermore, if the vacuum of space is utilized, then the atmospheric effects on the laser beam propagation will be greatly attenuated. Finally, several critical technologies are being developed to make the EAGLE/Relay Mirror concept a reality, and the Relay Mirror Technology Development Program was set up to address them. This paper will discuss each critical technology, the current state of the work, and the future implications of this program.

  11. Breeding bald eagles in captivity

    USGS Publications Warehouse

    Maestrelli, J.R.; Wiemeyer, Stanley N.

    1975-01-01

    A 7-year-old female Bald Eagle from Alabama was paired with a 4-year-old Alaskan male in a large flight pen during December 1969. Both birds were free of physical defects when originally placed in the pen but the female was blind in one eye prior to the 1973 breeding season.....Nesting first occurred during 1971 when at least two eggs were laid; all but one, which showed no sign of embryonic development after being incubated for 56 days, were broken by the adult birds. Two of three eggs laid in 1972 hatched. Both young died a few days after hatching following a period of inclement weather. Three eggs were laid and hatched during 1973. Antagonism between the nestlings was observed soon after hatching and may have been responsible for the unobserved death of one nestling, two days after the third young hatched. The two remaining young were raised by the adult birds and eventually left the nest 85 days after the first egg hatched. Incubation periods for the 1972-73 clutches averaged 35 days. No renesting attempts were made by the eagles during the 3.year period.

  12. 36 CFR 71.5 - Golden Eagle Passport.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 36 Parks, Forests, and Public Property 1 2013-07-01 2013-07-01 false Golden Eagle Passport. 71.5... RECREATION FEES § 71.5 Golden Eagle Passport. (a) The Golden Eagle Passport is an annual permit, valid on a... Passport shall be $10. The annual Golden Eagle Passport shall be nontransferable and the unlawful use...

  13. 36 CFR 71.5 - Golden Eagle Passport.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Golden Eagle Passport. 71.5... RECREATION FEES § 71.5 Golden Eagle Passport. (a) The Golden Eagle Passport is an annual permit, valid on a... Passport shall be $10. The annual Golden Eagle Passport shall be nontransferable and the unlawful use...

  14. 36 CFR 71.5 - Golden Eagle Passport.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 1 2014-07-01 2014-07-01 false Golden Eagle Passport. 71.5... RECREATION FEES § 71.5 Golden Eagle Passport. (a) The Golden Eagle Passport is an annual permit, valid on a... Passport shall be $10. The annual Golden Eagle Passport shall be nontransferable and the unlawful use...

  15. 36 CFR 71.5 - Golden Eagle Passport.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false Golden Eagle Passport. 71.5... RECREATION FEES § 71.5 Golden Eagle Passport. (a) The Golden Eagle Passport is an annual permit, valid on a... Passport shall be $10. The annual Golden Eagle Passport shall be nontransferable and the unlawful use...

  16. 36 CFR 71.5 - Golden Eagle Passport.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 1 2011-07-01 2011-07-01 false Golden Eagle Passport. 71.5... RECREATION FEES § 71.5 Golden Eagle Passport. (a) The Golden Eagle Passport is an annual permit, valid on a... Passport shall be $10. The annual Golden Eagle Passport shall be nontransferable and the unlawful use...

  17. Sotos syndrome: a study of the diagnostic criteria and natural history.

    PubMed Central

    Cole, T R; Hughes, H E

    1994-01-01

    Seventy-nine patients with a provisional diagnosis of Sotos syndrome were clinically assessed, and their photographs between the ages of 1 and 6 years evaluated. These photographs, together with photographs of first degree relatives, also at ages 1 to 6 years, were reviewed by four clinical geneticists. Forty-one probands (but no first degree relatives) were identified in whom the facial gestalt was thought to be characteristic of Sotos syndrome. Comparison of anthropometric measurements, bone age, and developmental delay in these 41 probands showed marked differences between them and the remaining 38 probands, and allowed the formulation of guidelines for the diagnosis of Sotos syndrome. Length was identified as the most significantly increased prenatal parameter. In childhood occipitofrontal head circumference (OFC), height, and weight were all increased. OFC remained above the 97th centile in all but one case throughout childhood and adulthood, whereas height and weight had a tendency to return towards the mean. This 'normalisation' was more pronounced in females and was probably related to their early puberty. Early developmental delay and an advanced bone age, seen in 100% and 84% respectively of study cases, may be invariable in Sotos syndrome, but selection bias and limited data prevented confirmation of this supposition. The authors suggest that facial gestalt, growth pattern, bone age, and developmental delay are the major diagnostic criteria. Using these criteria, no affected first degree relatives were identified. There were few long term medical complications in the probands, but behavioural difficulties caused considerable parental concern. Images PMID:7512144

  18. Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome

    PubMed Central

    Dumesic, Daniel A.; Oberfield, Sharon E.; Stener-Victorin, Elisabet; Marshall, John C.; Laven, Joop S.

    2015-01-01

    Polycystic ovary syndrome (PCOS) is a heterogeneous and complex disorder that has both adverse reproductive and metabolic implications for affected women. However, there is generally poor understanding of its etiology. Varying expert-based diagnostic criteria utilize some combination of oligo-ovulation, hyperandrogenism, and the presence of polycystic ovaries. Criteria that require hyperandrogenism tend to identify a more severe reproductive and metabolic phenotype. The phenotype can vary by race and ethnicity, is difficult to define in the perimenarchal and perimenopausal period, and is exacerbated by obesity. The pathophysiology involves abnormal gonadotropin secretion from a reduced hypothalamic feedback response to circulating sex steroids, altered ovarian morphology and functional changes, and disordered insulin action in a variety of target tissues. PCOS clusters in families and both female and male relatives can show stigmata of the syndrome, including metabolic abnormalities. Genome-wide association studies have identified a number of candidate regions, although their role in contributing to PCOS is still largely unknown. PMID:26426951

  19. A molecular diagnostic test for persistent Müllerian duct syndrome in miniature schnauzer dogs.

    PubMed

    Pujar, S; Meyers-Wallen, V N

    2009-01-01

    In persistent Müllerian duct syndrome (PMDS), Müllerian ducts fail to regress in males during sexual differentiation. In the canine miniature schnauzer model, PMDS is caused by a C to T transition in exon 3 of the Müllerian inhibiting substance type II receptor (MISRII), which introduces a DdeI restriction site. Here we report a molecular diagnostic test for PMDS in the miniature schnauzer to identify affected dogs and carriers. As our test results suggest that the mutation is identical by descent in affected dogs of this breed, the test could be used to eliminate this mutation from the miniature schnauzer breed worldwide.

  20. A Molecular Diagnostic Test for Persistent Müllerian Duct Syndrome in Miniature Schnauzer Dogs

    PubMed Central

    Pujar, S.; Meyers-Wallen, V.N.

    2010-01-01

    In persistent Müllerian duct syndrome (PMDS), Müllerian ducts fail to regress in males during sexual differentiation. In the canine miniature schnauzer model, PMDS is caused by a C to T transition in exon 3 of the Müllerian inhibiting substance type II receptor (MISRII), which introduces a DdeI restriction site. Here we report a molecular diagnostic test for PMDS in the miniature schnauzer to identify affected dogs and carriers. As our test results suggest that the mutation is identical by descent in affected dogs of this breed, the test could be used to eliminate this mutation from the miniature schnauzer breed worldwide. PMID:20051676

  1. The diagnostic utility of bone marrow aspiration and biopsy in patients with acquired immunodeficiency syndrome.

    PubMed Central

    Gluckman, R. J.; Rosner, F.; Guarneri, J. J.

    1989-01-01

    Diagnostic bone marrow aspiration, biopsy, and culture are useful procedures in the evaluation of patients with suspected or proven acquired immunodeficiency syndrome (AIDS) who are febrile. In as many as one fourth of these patients, the information provided by the bone marrow examination may establish a diagnosis of a disseminated opportunistic infection when other studies are not informative. We have also discovered a previously unreported association between thrombocytopenia and the presence of bone marrow granulomas in our patients with AIDS and suggest that thrombocytopenia may be a clue to enable the clinician to predict a positive bone marrow result more accurately. The explanation for this apparent association remains to be elucidated. PMID:2733050

  2. The diagnostic utility of bone marrow aspiration and biopsy in patients with acquired immunodeficiency syndrome.

    PubMed

    Gluckman, R J; Rosner, F; Guarneri, J J

    1989-02-01

    Diagnostic bone marrow aspiration, biopsy, and culture are useful procedures in the evaluation of patients with suspected or proven acquired immunodeficiency syndrome (AIDS) who are febrile. In as many as one fourth of these patients, the information provided by the bone marrow examination may establish a diagnosis of a disseminated opportunistic infection when other studies are not informative. We have also discovered a previously unreported association between thrombocytopenia and the presence of bone marrow granulomas in our patients with AIDS and suggest that thrombocytopenia may be a clue to enable the clinician to predict a positive bone marrow result more accurately. The explanation for this apparent association remains to be elucidated.

  3. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology.

    PubMed

    Ghadri, Jelena-Rima; Wittstein, Ilan Shor; Prasad, Abhiram; Sharkey, Scott; Dote, Keigo; Akashi, Yoshihiro John; Cammann, Victoria Lucia; Crea, Filippo; Galiuto, Leonarda; Desmet, Walter; Yoshida, Tetsuro; Manfredini, Roberto; Eitel, Ingo; Kosuge, Masami; Nef, Holger M; Deshmukh, Abhishek; Lerman, Amir; Bossone, Eduardo; Citro, Rodolfo; Ueyama, Takashi; Corrado, Domenico; Kurisu, Satoshi; Ruschitzka, Frank; Winchester, David; Lyon, Alexander R; Omerovic, Elmir; Bax, Jeroen J; Meimoun, Patrick; Tarantini, Guiseppe; Rihal, Charanjit; Y-Hassan, Shams; Migliore, Federico; Horowitz, John D; Shimokawa, Hiroaki; Lüscher, Thomas Felix; Templin, Christian

    2018-06-07

    Takotsubo syndrome (TTS) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that TTS may be associated with severe clinical complications including death and that its prevalence is probably underestimated. Since current guidelines on TTS are lacking, it appears timely and important to provide an expert consensus statement on TTS. The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology. This consensus also proposes new diagnostic criteria based on current knowledge to improve diagnostic accuracy.

  4. Cushing Syndrome: Diagnostic Workup and Imaging Features, With Clinical and Pathologic Correlation.

    PubMed

    Wagner-Bartak, Nicolaus A; Baiomy, Ali; Habra, Mouhammed Amir; Mukhi, Shalini V; Morani, Ajaykumar C; Korivi, Brinda R; Waguespack, Steven G; Elsayes, Khaled M

    2017-07-01

    Cushing syndrome (CS) is a constellation of clinical signs and symptoms resulting from chronic exposure to excess cortisol, either exogenous or endogenous. Exogenous CS is most commonly caused by administration of glucocorticoids. Endogenous CS is subdivided into two types: adrenocorticotropic hormone (ACTH) dependent and ACTH independent. Cushing disease, which is caused by a pituitary adenoma, is the most common cause of ACTH-dependent CS for which pituitary MRI can be diagnostic, with bilateral inferior petrosal sinus sampling useful in equivocal cases. In ectopic ACTH production, which is usually caused by a tumor in the thorax (e.g., small cell lung carcinoma, bronchial and thymic carcinoids, or medullary thyroid carcinoma) or abdomen (e.g., gastroenteropancreatic neuroendocrine tumors or pheochromocytoma), CT, MRI, and nuclear medicine tests are used for localizing the source of ACTH. In ACTH-independent CS, which is caused by various adrenal abnormalities, adrenal protocol CT or MRI is usually diagnostic.

  5. Ignored Disease or Diagnostic Dustbin? Sudden Infant Death Syndrome in the British Context

    PubMed Central

    Ferguson, Angus H.

    2015-01-01

    Sudden Infant Death Syndrome (SIDS) was defined in 1969 and incorporated into the International Classification of Diseases a decade later. To advocates of SIDS as a diagnosis, medical interest in sudden infant death was long overdue. However, the definition of SIDS lacked positive diagnostic criteria, provoking some to view it as a ‘diagnostic dustbin’ for the disposal of problematic cases where cause of death was unclear. This paper examines the development of medical interest in sudden infant death in Britain during the middle decades of the twentieth century. It highlights the importance of recognising the historicity of SIDS as a diagnosis facilitated by changes in law and medicine over the course of the nineteenth and twentieth centuries. It suggests that SIDS provides a definitive case study of the medicalisation of life and death, and a unique example of an officially recognised disease that had no symptoms, signs, pathology or patients. PMID:26217070

  6. Diagnostic value of Vbeta2-positive T-cell expansion in toxic shock syndrome.

    PubMed

    Wenisch, Christoph; Strunk, D; Krause, R; Smolle, K H

    2007-06-01

    diagnostic dilemma in toxic shock syndrome (TSS) is that the results of microbiologic investigations are often not available immediately because of the need for incubation, or no obvious entry point can be found. We describe three patients with a clinical diagnosis of TSS in whom microbiologic tests were negative. All patients had complicated courses with vasopressor-dependent shock, renal and respiratory failure, and disseminated intravascular coagulation for at least 1 week. In all three patients, diagnosis was considerably faster with the assessment of the expansion of T-cell-receptor Vbeta2-positive T cells (> 15%) than by Centers for Disease Control and Prevention (CDC) diagnosis, because of the complicated clinical picture or the delay caused by waiting for the results of microbiologic investigations. Our results indicate that diagnostic procedures incorporating Vbeta2-positive T cells could be a useful tool for the diagnosis of TSS.

  7. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology

    PubMed Central

    Ghadri, Jelena-Rima; Wittstein, Ilan Shor; Prasad, Abhiram; Sharkey, Scott; Dote, Keigo; Akashi, Yoshihiro John; Cammann, Victoria Lucia; Crea, Filippo; Galiuto, Leonarda; Desmet, Walter; Yoshida, Tetsuro; Manfredini, Roberto; Eitel, Ingo; Kosuge, Masami; Nef, Holger M; Deshmukh, Abhishek; Lerman, Amir; Bossone, Eduardo; Citro, Rodolfo; Ueyama, Takashi; Corrado, Domenico; Kurisu, Satoshi; Ruschitzka, Frank; Winchester, David; Lyon, Alexander R; Omerovic, Elmir; Bax, Jeroen J; Meimoun, Patrick; Tarantini, Guiseppe; Rihal, Charanjit; Y.-Hassan, Shams; Migliore, Federico; Horowitz, John D; Shimokawa, Hiroaki; Lüscher, Thomas Felix; Templin, Christian

    2018-01-01

    Abstract Takotsubo syndrome (TTS) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that TTS may be associated with severe clinical complications including death and that its prevalence is probably underestimated. Since current guidelines on TTS are lacking, it appears timely and important to provide an expert consensus statement on TTS. The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology. This consensus also proposes new diagnostic criteria based on current knowledge to improve diagnostic accuracy. PMID:29850871

  8. Agonistic asymmetries and the foraging ecology of Bald Eagles

    USGS Publications Warehouse

    Knight, Richard L.; Skagen, Susan Knight

    1988-01-01

    We investigated the effects of both asymmetries and differing food levels on contest outcomes of wintering Bald Eagles (Haliaeetus leucocephalus) feeding on chum salmon (Oncorhynchus keta) carcasses. Large eagles, regardless of age, were more successful in pirating than smaller eagles. Small pirating eagles were usually unsuccessful unless they were adults attempting to supplant other small eagles. Feeding eagles were more successful in defeating pirating eagles according to (1) whether their heads were up to prior to a pirating attempt, (2) how long their heads had been up, and (3) whether they displayed. During periods of food scarcity pirating eagles were less successful, a fact attributed in a proximate sense to the increase incidence of retaliation by feeding birds. When food was scarce and eagles had a choice between scavenging the pirating, they chose to scavenge more often. Body size appears to be an important factor in determining social dominance and influencing differences in foraging modes of wintering Bald Eagles.

  9. Bald eagle predation on common loon egg

    USGS Publications Warehouse

    DeStefano, Stephen; McCarthy, Kyle P.; Laskowski, Tom

    2010-01-01

    The Common Loon (Gavia immer) must defend against many potential egg predators during incubation, including corvids, Herring Gulls (Larus argentatus), raccoons (Procyon lotor), striped skunk (Mephitis mephitis), fisher (Martes pennanti), and mink (Neovison vison) (McIntyre 1988, Evers 2004, McCann et al. 2005). Bald Eagles (Haliaeetus leucocephalus) have been documented as predators of both adult Common Loons and their chicks (Vliestra and Paruk 1997, Paruk et al. 1999, Erlandson et al. 2007, Piper et al. 2008). In Wisconsin, where nesting Bald Eagles are abundant (>1200 nesting pairs, >1 young/pair/year), field biologists observed four instances of eagle predation of eggs in loon nests during the period 2002–2004 (M. Meyer pers. comm.). In addition, four cases of eagle predation of incubating adult loons were inferred from evidence found at the loon nest (dozens of plucked adult loon feathers, no carcass remains) and/or loon leg, neck, and skull bones beneath two active eagle nests, including leg bones containing the bands of the nearby (<25 m) incubating adult loon. However, although loon egg predation has been associated with Bald Eagles, predation events have yet to be described in peer-reviewed literature. Here we describe a photographic observation of predation on a Common Loon egg by an immature Bald Eagle as captured by a nest surveillance video camera on Lake Umbagog, a large lake (32 km2) at Umbagog National Wildlife Refuge (UNWR) in Maine.

  10. Proposed minimal diagnostic criteria for myelodysplastic syndromes (MDS) and potential pre-MDS conditions

    PubMed Central

    Valent, Peter; Orazi, Attilio; Steensma, David P.; Ebert, Benjamin L.; Haase, Detlef; Malcovati, Luca; van de Loosdrecht, Arjan A.; Haferlach, Torsten; Westers, Theresia M.; Wells, Denise A.; Giagounidis, Aristoteles; Loken, Michael; Orfao, Alberto; Lübbert, Michael; Ganser, Arnold; Hofmann, Wolf-Karsten; Ogata, Kiyoyuki; Schanz, Julie; Béné, Marie C.; Hoermann, Gregor; Sperr, Wolfgang R.; Sotlar, Karl; Bettelheim, Peter; Stauder, Reinhard; Pfeilstöcker, Michael; Horny, Hans-Peter; Germing, Ulrich; Greenberg, Peter; Bennett, John M.

    2017-01-01

    Myelodysplastic syndromes (MDS) comprise a heterogeneous group of myeloid neoplasms characterized by peripheral cytopenia, dysplasia, and a variable clinical course with about 30% risk to transform to secondary acute myeloid leukemia (AML). In the past 15 years, diagnostic evaluations, prognostication, and treatment of MDS have improved substantially. However, with the discovery of molecular markers and advent of novel targeted therapies, new challenges have emerged in the complex field of MDS. For example, MDS-related molecular lesions may be detectable in healthy individuals and increase in prevalence with age. Other patients exhibit persistent cytopenia of unknown etiology without dysplasia. Although these conditions are potential pre-phases of MDS they may also transform into other bone marrow neoplasms. Recently identified molecular, cytogenetic, and flow-based parameters may add in the delineation and prognostication of these conditions. However, no generally accepted integrated classification and no related criteria are as yet available. In an attempt to address this challenge, an international consensus group discussed these issues in a working conference in July 2016. The outcomes of this conference are summarized in the present article which includes criteria and a proposal for the classification of pre-MDS conditions as well as updated minimal diagnostic criteria of MDS. Moreover, we propose diagnostic standards to delineate between ´normal´, pre-MDS, and MDS. These standards and criteria should facilitate diagnostic and prognostic evaluations in clinical studies as well as in clinical practice. PMID:29088721

  11. [Rumination syndrome: Diagnostic and therapeutic difficulties of a not so uncommon disorder].

    PubMed

    Giménez Casado, Aida; López Liñán, María José; Barba Orozco, Elisabeth; Accarino Garaventa, Anna; Álvarez Beltrán, Marina; Azpiroz Vidaur, Fernando; Segarra Cantón, Oscar

    2018-02-01

    Rumination syndrome is an uncommon gastrointestinal functional disorder that may be difficult to diagnose, as not many physicians are aware of this condition. In many cases, patients undergo numerous tests and are prescribed several treatments based on erroneous diagnoses. When the correct diagnosis is eventually made, therapy for the syndrome can be difficult and complex because of its multifactorial nature. The aim of this study was to present our experience with this condition, by presenting an analysis of the clinical, diagnostic, and therapeutic data of our patients. A prospective and retrospective study was conducted on all cases of rumination syndrome diagnosed between January 2010 and May 2016 in patients attending the Paediatric Gastroenterology Departments of two hospitals: Consorci Sanitari de Terrassa and Hospital Materno-Infantil Vall d'Hebron (Barcelona, Spain). The analysis included 12 patients, with a mean age at the onset of symptoms of 9 years and 1 month, and the mean time period to make the diagnosis was 2 years and 3 months. A mean of 8.1 complementary tests were carried out before establishing the diagnosis. In 10 of the 12 patients, some type of treatment had been given before the diagnosis of rumination syndrome, but was unsuccessful in all cases. Ten of our patients underwent the novel, experimental biofeedback therapy. Due to the limited knowledge of this condition among attending professionals in terms of the clinical presentation, diagnosis, and treatment, patients with rumination syndrome are often misdiagnosed and undergo numerous avoidable complementary tests, and invasive, costly treatments. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Golden eagle records from the Midwinter Bald Eagle Survey: information for wind energy management and planning

    USGS Publications Warehouse

    Eakle, Wade; Haggerty, Patti; Fuller, Mark; Phillips, Susan L.

    2013-01-01

    The purpose of this Data Series report is to provide the occasions, locations, and counts when golden eagles were recorded during the annual Midwinter Bald Eagle Surveys. Golden eagles (Aquila chrysaetos) are protected by Federal statutes including the Bald and Golden Eagle Protection Act (BGEPA) (16 USC 668-668c) and the Migratory Bird Treaty Act (MBTA) (16 USC 703-12). The U.S. Fish and Wildlife Service (Service) manages golden eagles with the goal of maintaining stable or increasing breeding populations (U.S. Fish and Wildlife Service, 2009). Development for the generation of electricity from wind turbines is occurring in much of the range of the golden eagle in the western United States. Development could threaten population stability because golden eagles might be disturbed by construction and operation of facilities and they are vulnerable to mortality from collisions with wind turbines (Smallwood and Thelander, 2008). Therefore, the Service has proposed a process by which wind energy developers can collect information that could lead to Eagle Conservation Plans (ECP), mitigation, and permitting that allow for golden eagle management in areas of wind energy development (U.S. Fish and Wildlife Service, 2011). The Service recommends that ECP be developed in stages, and the first stage is to learn if golden eagles occur at the landscape level where potential wind facilities might be located. Information about where eagles occur can be obtained from technical literature, agency files, and other sources of information including on-line biological databases. The broad North American distribution of golden eagles is known, but there is a paucity of readily available information about intermediate geographic scales and site-specific scales, especially during the winter season (Kochert and others, 2002).

  13. MQ-1C Gray Eagle Unmanned Aircraft System (MQ-1C Gray Eagle)

    DTIC Science & Technology

    2015-12-01

    Selected Acquisition Report ( SAR ) RCS: DD-A&T(Q&A)823-420 MQ-1C Gray Eagle Unmanned Aircraft System (MQ-1C Gray Eagle) As of FY 2017 President’s...Budget Defense Acquisition Management Information Retrieval (DAMIR) March 21, 2016 17:33:19 UNCLASSIFIED MQ-1C Gray Eagle December 2015 SAR March 21...Gray Eagle December 2015 SAR March 21, 2016 17:33:19 UNCLASSIFIED 3 PB - President’s Budget PE - Program Element PEO - Program Executive Officer PM

  14. Diagnostic value of prostate-specific antigen in women with polycystic ovary syndrome.

    PubMed

    Mardanian, Farahnaz; Heidari, Nasrin

    2011-08-01

    Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. Its presentation is that of irregular menstruation associated with ovulation defects. Because of adverse outcomes such as metabolic and cardiovascular disorders, its diagnosis and treatment is very important. Therefore, the diagnostic value of prostatespecific antigen (PSA) in women with polycystic ovary syndrome was evaluated. A total of 32 women with PCOS and 32 aged matched healthy females were recruited in this case-control study. The subjects were compared by means of metabolic measures and serum PSA level. The correlations between these markers were evaluated. Sensitivity and specificity values and cut off levels of PSA were established for diagnosis of PCOS. Mean PSA, Ferriman Gallwey score (FGS), luteinizing hormone/follicle stimulating hormone ratio (LH/FSH), testosterone, dehydroepiandrosterone sulfate (DHEAS), 17(α) hydroxyprogesterone (17(α) HP) levels were significantly higher in PCOS (P<0.001, respectively). PSA levels greater than 0.07 ng/ml yielded a sensitivity of 91% and specificity of 82%, and was helpful as a diagnostic tool for women with PCOS. Circulating androgens and hirsutism were associated with higher levels of PSA in PCOS women. Our results showed direct correlation between PSA, hirsutism and hyperandrogemsm state. Therefore, it seems logical to use PSA level for detection of hyperandrogemsm state in women.

  15. [Arousal of respiratory origin and upper airway resistance syndrome: pathophysiological and diagnostic aspects].

    PubMed

    Puertas, F J; Ondzé, B; Carlander, B; Billiard, M

    The description of Upper Airway Resistance Syndrome (UARS) let us to recognize the importance of the pair 'respiratory effort-arousal' on sleep-disordered breathing pathophysiology. First part of this paper reviews knowledge about respiratory arousal pathophysiology. Arousal response is normally needed to end obstructive respiratory episodes, but it is also the cause of sleep fragmentation. Among respiratory stimuli able to provoke arousal (respiratory effort, hypoxemia and hypercapnia), respiratory effort is the most constant. Neurophysiological mechanisms involved in arousal, sleep and vegetative consequences, and the possible role of non visible arousals, are also discussed. In UARS, because of the absence of apnea/hypopnea and significative O2 desaturations, arousals are induced by the increased respiratory effort. Diagnosis needs the simultaneous recording of polysomnography and esophageal pressure. Some symptoms and signs of UARS are similar to those of Obstructive Sleep Apnea Syndrome. However, UARS shows any differences: a lower Body Mass Index, less constant snoring, males and females are similarly affected or higher frequency of craniofacial abnormalities. Diagnostic difficulties may be due to confusion between hypopneas and episodes of increased resistance of upper airway, or to the lack of definitive diagnostic criteria. Finally, differential diagnosis needs a broad knowledge of disorders of excessive daytime sleepiness.

  16. White-Nose Syndrome Disease Severity and a Comparison of Diagnostic Methods.

    PubMed

    McGuire, Liam P; Turner, James M; Warnecke, Lisa; McGregor, Glenna; Bollinger, Trent K; Misra, Vikram; Foster, Jeffrey T; Frick, Winifred F; Kilpatrick, A Marm; Willis, Craig K R

    2016-03-01

    White-nose syndrome is caused by the fungus Pseudogymnoascus destructans and has killed millions of hibernating bats in North America but the pathophysiology of the disease remains poorly understood. Our objectives were to (1) assess non-destructive diagnostic methods for P. destructans infection compared to histopathology, the current gold-standard, and (2) to evaluate potential metrics of disease severity. We used data from three captive inoculation experiments involving 181 little brown bats (Myotis lucifugus) to compare histopathology, quantitative PCR (qPCR), and ultraviolet fluorescence as diagnostic methods of P. destructans infection. To assess disease severity, we considered two histology metrics (wing area with fungal hyphae, area of dermal necrosis), P. destructans fungal load (qPCR), ultraviolet fluorescence, and blood chemistry (hematocrit, sodium, glucose, pCO2, and bicarbonate). Quantitative PCR was most effective for early detection of P. destructans, while all three methods were comparable in severe infections. Correlations among hyphae and necrosis scores, qPCR, ultraviolet fluorescence, blood chemistry, and hibernation duration indicate a multi-stage pattern of disease. Disruptions of homeostasis occurred rapidly in late hibernation. Our results provide valuable information about the use of non-destructive techniques for monitoring, and provide novel insight into the pathophysiology of white-nose syndrome, with implications for developing and implementing potential mitigation strategies.

  17. Advances in diagnostic and treatment options in patients with fibromyalgia syndrome

    PubMed Central

    Gur, Ali; Oktayoglu, Pelin

    2009-01-01

    Fibromyalgia (FM) is characterized as a chronic, painful, noninflammatory syndrome affecting the musculoskeletal system. In addition to pain, common co-morbid symptoms associated with FM include sleep disturbances, fatigue, morning stiffness, affective disorders, chronic daily headache, dyscognition, irritable bowel syndrome, and irritable bladder. Fibromyalgia is usually classified by application of the American College of Rheumatology (ACR) criteria. Although these criteria are accepted among investigators who agree with the concept of fibromyalgia, they do so with some reservations. Tender points and widespread pain alone does not describe the esence of fibromyalgia. New diagnostic tools including either clinical or radiological components are studied to diminish these problems. Although various pharmacological solutions have been studied for treating fibromyalgia, no single drug or groups of drugs have proved to be useful in treating fibromyalgia patients. Recently, three drugs, pregabalin, duloxetine and milnacipran, were approved for the treatment of FM by the US Food and Drug Administration (FDA). Novel therapeutic approaches to the management of FM include cannabinoids, sodium channel blockade and new generation antiepileptics. This review evaluates both new diagnostic tools, including clinical or radiological regimes, and tries to highlight the efficacy of medicinal and nonmedicinal treatments with new therapeutic approaches in the management of FM with a wide perspective. PMID:27789991

  18. An Eagle of Cosmic Proportions

    NASA Astrophysics Data System (ADS)

    2009-07-01

    Today ESO has released a new and stunning image of the sky around the Eagle Nebula, a stellar nursery where infant star clusters carve out monster columns of dust and gas. Located 7000 light-years away, towards the constellation of Serpens (the Snake), the Eagle Nebula is a dazzling stellar nursery, a region of gas and dust where young stars are currently being formed and where a cluster of massive, hot stars, NGC 6611, has just been born. The powerful light and strong winds from these massive new arrivals are shaping light-year long pillars, seen in the image partly silhouetted against the bright background of the nebula. The nebula itself has a shape vaguely reminiscent of an eagle, with the central pillars being the "talons". The star cluster was discovered by the Swiss astronomer, Jean Philippe Loys de Chéseaux, in 1745-46. It was independently rediscovered about twenty years later by the French comet hunter, Charles Messier, who included it as number 16 in his famous catalogue, and remarked that the stars were surrounded by a faint glow. The Eagle Nebula achieved iconic status in 1995, when its central pillars were depicted in a famous image obtained with the NASA/ESA Hubble Space Telescope. In 2001, ESO's Very Large Telescope (VLT) captured another breathtaking image of the nebula in the near-infrared, giving astronomers a penetrating view through the obscuring dust, and clearly showing stars being formed in the pillars. The newly released image, obtained with the Wide-Field Imager camera attached to the MPG/ESO 2.2-metre telescope at La Silla, Chile, covers an area on the sky as large as the full Moon, and is about 15 times more extensive than the previous VLT image, and more than 200 times more extensive than the iconic Hubble visible-light image. The whole region around the pillars can now be seen in exquisite detail. The "Pillars of Creation" are in the middle of the image, with the cluster of young stars, NGC 6611, lying above and to the right. The

  19. Perceived risk of prenatal diagnostic procedure-related miscarriage and Down syndrome among pregnant women.

    PubMed

    Caughey, Aaron B; Washington, A Eugene; Kuppermann, Miriam

    2008-03-01

    The objective of the study was to identify correlates of perceived risk of carrying a Down syndrome-affected fetus or experiencing a procedure-related miscarriage among a diverse group of pregnant women. We conducted a cross-sectional survey of 1081 English-, Spanish-, or Chinese-speaking women receiving prenatal care in the San Francisco Bay area. Perceived risk of procedure-related miscarriage or carrying a Down syndrome-affected fetus was assessed using a linear rating scale from 0 (no risk) to 1 (high risk). Bivariate and multivariable analyses were used to explore associations between maternal characteristics including age, race/ethnicity, and socioeconomic status and perceived risks of carrying a Down syndrome-affected fetus or experiencing a procedure-related miscarriage. Women aged 35 years old or older had a higher perceived risk of Down syndrome than younger women (0.28 vs 0.22 on a scale from 0 to 1, P < .001) but a lower perceived risk of a procedure-related miscarriage (0.31 vs 0.36, P = .004). In multivariable linear regression analysis among women younger than age 35 years, the perceived risk of carrying a Down syndrome-affected fetus was higher in women who had not attended college (+0.06, P = .019) or had poor self-perceived health status (+0.08, P = .045). Latinas (+0.11, P = .008), women with an annual income less than $35,000 (+0.09, P = .003), and those who had difficulty conceiving (+0.09, P = .026) had higher perceived procedure-related miscarriage risk. Among women aged 35 years or older, perceived risk of carrying a Down syndrome-affected fetus was associated with the inclination to undergo prenatal diagnosis. Women's perceived risks of carrying a Down syndrome-affected fetus or having a procedure-related miscarriage are associated with numerous characteristics that have not been shown to be associated with the actual risks of these events. These perceived risks are associated with prenatal diagnostic test inclination. Understanding

  20. AAPT Diagnostic Criteria for Chronic Abdominal, Pelvic, and Urogenital Pain: Irritable Bowel Syndrome.

    PubMed

    Zhou, QiQi; Wesselmann, Ursula; Walker, Lynn; Lee, Linda; Zeltzer, Lonnie; Verne, G Nicholas

    2018-03-01

    In conjunction with the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration and the American Pain Society, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society Pain Taxonomy (AAPT) initiative strove to develop the characteristics of a diagnostic system useful for clinical and research purposes across disciplines and types of chronic pain conditions. After the establishment of these characteristics, a working group of clinicians and clinical and basic scientists with expertise in abdominal, pelvic, and urogenital pain began generating core diagnostic criteria and defining the related extraintestinal somatic pain and other symptoms experienced by patients. Systematic diagnostic criteria for several common abdominal, pelvic, and urogenital pain conditions are in development. In this report, we present the proposed AAPT criteria for irritable bowel syndrome (IBS), the most common chronic, noncancer abdominal pain condition. A systematic review and synthesis was conducted to complement the Rome IV Diagnostic Criteria for IBS. Future efforts will subject these proposed AAPT criteria to systematic empirical evaluation of their feasibility, reliability, and validity. The AAPT IBS criteria are part of an evidence-based classification system that provides a consistent vocabulary regarding diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms of the disorder. A similar approach is being applied to other chronic and often debilitating abdominal, pelvic, and urogenital pain conditions. The AAPT's goal is to develop an evidence-based taxonomy for chronic pain on the basis of a consistently applied multidimensional framework, and encourage experts to apply this taxonomy to specific chronic pain conditions. In this report, the taxonomy is

  1. Metacarpophalangeal pattern profile analysis: useful diagnostic tool for differentiating between dyschondrosteosis, Turner syndrome, and hypochondroplasia.

    PubMed

    Laurencikas, E; Sävendahl, L; Jorulf, H

    2006-06-01

    To assess the value of the metacarpophalangeal pattern profile (MCPP) analysis as a diagnostic tool for differentiating between patients with dyschondrosteosis, Turner syndrome, and hypochondroplasia. Radiographic and clinical data from 135 patients between 1 and 51 years of age were collected and analyzed. The study included 25 patients with hypochondroplasia (HCP), 39 with dyschondrosteosis (LWD), and 71 with Turner syndrome (TS). Hand pattern profiles were calculated and compared with those of 110 normal individuals. Pearson correlation coefficient (r) and multivariate discriminant analysis were used for pattern profile analysis. Pattern variability index, a measure of dysmorphogenesis, was calculated for LWD, TS, HCP, and normal controls. Our results demonstrate that patients with LWD, TS, or HCP have distinct pattern profiles that are significantly different from each other and from those of normal controls. Discriminant analysis yielded correct classification of normal versus abnormal individuals in 84% of cases. Classification of the patients into LWD, TS, and HCP groups was successful in 75%. The correct classification rate was higher (85%) when differentiating two pathological groups at a time. Pattern variability index was not helpful for differential diagnosis of LWD, TS, and HCP. Patients with LWD, TS, or HCP have distinct MCPPs and can be successfully differentiated from each other using advanced MCPP analysis. Discriminant analysis is to be preferred over Pearson correlation coefficient because it is a more sensitive and specific technique. MCPP analysis is a helpful tool for differentiating between syndromes with similar clinical and radiological abnormalities.

  2. EAGLE can do Efficient LTL Monitoring

    NASA Technical Reports Server (NTRS)

    Barringer, Howard; Goldberg, Allen; Havelund, Klaus; Sen, Koushik

    2003-01-01

    We briefly present a rule-based framework, called EAGLE, that has been shown to be capable of defining and implementing finite trace monitoring logics, including future and past time temporal logic, extended regular expressions, real-time logics, interval logics, forms of quantified temporal logics, and so on. In this paper we show how EAGLE can do linear temporal logic (LTL) monitoring in an efficient way. We give an upper bound on the space and time complexity of this monitoring.

  3. [Haemolytic uremic syndrome and thrombotic thrombocytopenic purpura: classification based on molecular etiology and review of recent developments in diagnostics].

    PubMed

    Prohászka, Zoltán

    2008-07-06

    Haemolytic uremic syndrome and thrombotic thrombocytopenic purpura are overlapping clinical entities based on historical classification. Recent developments in the unfolding of the pathomechanisms of these diseases resulted in the creation of a molecular etiology-based classification. Understanding of some causative relationships yielded detailed diagnostic approaches, novel therapeutic options and thorough prognostic assortment of the patients. Although haemolytic uremic syndrome and thrombotic thrombocytopenic purpura are rare diseases with poor prognosis, the precise molecular etiology-based diagnosis might properly direct the therapy of the affected patients. The current review focuses on the theoretical background and detailed description of the available diagnostic possibilities, and some practical information necessary for the interpretation of their results.

  4. Prevalence of restless legs syndrome in Ankara, Turkey: an analysis of diagnostic criteria and awareness.

    PubMed

    Yilmaz, Nesrin Helvaci; Akbostanci, Muhittin Cenk; Oto, Aycan; Aykac, Ozlem

    2013-09-01

    The aim of this study was threefold: (1) to investigate the prevalence of restless legs syndrome (RLS), in Ankara, Turkey; (2) to determine the predictive values of diagnostic criteria; and (3) to determine the frequency of physician referrals and the frequency of getting the correct diagnosis. A total of 815 individuals, from randomly selected addresses, above the age of 15, were reached using the questionnaire composed of the four diagnostic criteria. Individuals who responded by answering 'yes' for at least one question were interviewed by neurologists for the diagnosis of RLS. Frequency of physician referrals and frequency of getting the correct diagnosis of RLS were also determined for patients getting the final diagnoses of RLS. Prevalence of RLS in Ankara was 5.52 %; 41.0 % of the individuals diagnosed with RLS had replied 'yes' to either one, two or three questions asked by interviewers. However, only 21.3 % of individuals who replied 'yes' to all four questions received the diagnosis of RLS. Among the patients who had the final diagnosis of RLS, 25.7 % had referred to a physician for the symptoms and 22.2 % got the correct diagnosis. The RLS prevalence in Ankara was somewhere between Western and Far East countries compatible with the geographical location. Diagnostic criteria may not be fully predictive when applied by non-physician pollsters. Physician's probability of correctly diagnosing RLS is still low.

  5. Malory-Weis syndrome based on own experience - diagnostics and modern principles of management.

    PubMed

    Cybułka, Bartosz

    2016-03-01

    Every gastrointestinal bleeding is an immediate threat to life, requiring close supervision in a hospital setting and making it mandatory to perform verification and endoscopic intervention. In some cases of a dynamic course, in order to make up deficiencies, it is necessary to use blood and blood products. One of the causes of bleeding located proximally to the ligament of Treitz is damage to the mucous membrane and deeper layers of the gastroesophageal junction, called Mallory-Weiss syndrome. The aim of the study was retrospective analysis of a selected group of patients with symptomatic upper gastrointestinal bleeding in the course of Mallory-Weiss syndrome, identification of typical characteristics of this disease entity in the studied population as well as demonstration of the effectiveness of endoscopic treatment using argon plasma coagulation (APC). The analysis included 2120 gastroscopy results, with 111 (5.24%) examinations conducted due to symptomatic gastrointestinal bleeding. In the studied group, endoscopic diagnosis of Mallory-Weiss syndrome was made in 22 patients (1.04%). The studied disease entity was the cause of upper gastrointestinal bleeding in 19.82% of cases. Although this condition is usually characterised by a mild and self-limiting course, 59.09% of patients in the studied group required therapeutic endoscopic intervention due to active bleeding. In 54.55%, argon plasma coagulation was successfully used to control the source of bleeding. Early gastroscopy, which remains both a diagnostic and therapeutic intervention, guarantees effective control of the clinical course of Mallory-Weiss syndrome. Endoscopic argon plasma coagulation is an effective way to treat bleeding, used in endoscopic monotherapy or in combination with other procedures.

  6. The changing purpose of Prader-Willi syndrome clinical diagnostic criteria and proposed revised criteria.

    PubMed

    Gunay-Aygun, M; Schwartz, S; Heeger, S; O'Riordan, M A; Cassidy, S B

    2001-11-01

    Prader-Willi syndrome (PWS) is a complex, multisystem disorder. Its major clinical features include neonatal hypotonia, developmental delay, short stature, behavioral abnormalities, childhood-onset obesity, hypothalamic hypogonadism, and characteristic appearance. The genetic basis of PWS is also complex. It is caused by absence of expression of the paternally active genes in the PWS critical region on 15q11-q13. In approximately 70% of cases this is the result of deletion of this region from the paternal chromosome 15. In approximately 28%, it is attributable to maternal uniparental disomy (UPD; inheritance of 2 copies of a chromosome from the mother and no copies from the father, as opposed to the normal 1 copy from each parent) of chromosome 15, and in <2%, it is the result of a mutation, deletion, or other defect in the imprinting center. Clinical diagnostic criteria were established by consensus in 1993. Subsequently, definitive molecular genetic testing became available for laboratory diagnosis of PWS. However, identification of appropriate patients for testing remains a challenge for most practitioners because many features of the disorder are nonspecific and others can be subtle or evolve over time. For example, hypotonic infants who are still in the failure to thrive phase of the disorder often do not have sufficient features for recognition of PWS and often are not tested. Initial screening with these diagnostic criteria can increase the yield of molecular testing for older children and adults with nonspecific obesity and mental retardation. Therefore, the purpose of clinical diagnostic criteria has shifted from assisting in making the definitive diagnosis to raising diagnostic suspicion, thereby prompting testing. We conducted a retrospective review of patients with PWS confirmed with genetic testing to assess the validity and sensitivity of clinical diagnostic criteria published before the widespread availability of testing for all affected patients and

  7. Relationship among physical activity, smoking, drinking and clustering of the metabolic syndrome diagnostic components.

    PubMed

    Katano, Sayuri; Nakamura, Yasuyuki; Nakamura, Aki; Murakami, Yoshitaka; Tanaka, Taichiro; Nakagawa, Hideaki; Takebayashi, Toru; Yamato, Hiroshi; Okayama, Akira; Miura, Katsuyuki; Okamura, Tomonori; Ueshima, Hirotsugu

    2010-06-30

    To examine the relation between lifestyle and the number of metabolic syndrome (MetS) diagnostic components in a general population, and to find a means of preventing the development of MetS components. We examined baseline data from 3,365 participants (2,714 men and 651 women) aged 19 to 69 years who underwent a physical examination, lifestyle survey, and blood chemical examination. The physical activity of each participant was classified according to the International Physical Activity Questionnaire (IPAQ). We defined four components for MetS in this study as follows: 1) high BP: systolic BP > or = 130 mmHg or diastolic BP > or = 85 mmHg, or the use of antihypertensive drugs; 2) dyslipidemia: high-density lipoprotein-cholesterol concentration < 40 mg/dL, triglycerides concentration > or = 150 mg/dL, or on medication for dyslipidemia; 3) Impaired glucose tolerance: fasting blood sugar level > or = 110 mg/d, or if less than 8 hours after meals > or = 140 mg/dL), or on medication for diabetes mellitus; 4) obesity: body mass index > or = 25 kg/m(2). Those who had 0 to 4 MetS diagnostic components accounted for 1,726, 949, 484, 190, and 16 participants, respectively, in the Poisson distribution. Poisson regression analysis revealed that independent factors contributing to the number of MetS diagnostic components were being male (regression coefficient b=0.600, p < 0.01), age (b=0.027, p < 0.01), IPAQ class (b=-0.272, p= 0.03), and alcohol consumption (b=0.020, p=0.01). The contribution of current smoking was not statistically significant (b=-0.067, p=0.76). Moderate physical activity was inversely associated with the number of MetS diagnostic components, whereas smoking was not associated.

  8. Diagnostic characteristics and metabolic risk factors of cases with polycystic ovary syndrome during adolescence.

    PubMed

    Sıklar, Zeynep; Berberoğlu, Merih; Çamtosun, Emine; Kocaay, Pınar

    2015-04-01

    Polycystic ovary syndrome (PCOS) is a disorder without definite consensus on its diagnosis and management during adolescence. According to Amsterdam-2012 consensus, as physiological characteristics of adolescence may overlap with PCOS signs, it has been indicated that all Rotterdam criteria should be met. In this present study, characteristics of adolescents with different phenotypes who were diagnosed with PCOS were evaluated; and presence of differences for metabolic risk factors between phenotypes were investigated. The study was performed on adolescent females. According to phenotypic application models, individuals with all Rotterdam diagnostic criteria [hyperandrogenism (HA), polycystic ovarian morphology (PCOM), and chronic anovulation (CA) on the ultrasonography] were in Group 1 (n = 26); with HA and CA were in Group 2 (n = 10); with HA and PCOM were in Group 3 (n = 7); and with CA and PCOM were in Group 4 (n = 10). The most common application complaint (87%) among 53 cases enrolled in the study was menstrual irregularities, and 57% of cases were not obese. When PCOS was evaluated according to phenotypes, it was realized that cases that meet all 3 diagnostic Rotterdam criteria according to the current recommendation in adolescents. (Group 1) was the most common phenotype. Hyperandrogenism was associated with more metabolic abnormalities. The close monitoring of adolescents, who have 2 diagnostic criteria is advisable among PCOS phenotypes. Potentially Groups 2 and 3 which have hyperandrogenism, in particular should warrant closer follow-up although they do not meet current diagnostic criteria for adolescents. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  9. 76 FR 22393 - Eagle Mountain Pumped Storage Hydroelectric Project, Eagle Crest Energy; Notice of Cancellation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-21

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [P-13123-002-CA] Eagle Mountain Pumped Storage Hydroelectric Project, Eagle Crest Energy; Notice of Cancellation of Teleconference On March 15... Mountain Pumped Storage Hydroelectric Project. This meeting has been cancelled. We will reschedule this...

  10. 77 FR 43280 - Eagle Mountain Pumped Storage Hydroelectric Project, Eagle Crest Energy; Notice of Meeting With...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-24

    ... Storage Hydroelectric Project, Eagle Crest Energy; Notice of Meeting With the Bureau of Land Management a... Bureau of Land Management to improve agency coordination and discuss the agencies' overlapping jurisdictions (pursuant to the Federal Land Policy and Management Act and the Federal Power Act), on the Eagle...

  11. 78 FR 25263 - Eagle Mountain Pumped Storage Hydroelectric Project; Eagle Crest Energy; Notice of Meeting With...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-30

    ... Storage Hydroelectric Project; Eagle Crest Energy; Notice of Meeting With the Bureau of Land Management a.... Purpose of the Meeting: Commission staff will meet with the staff of the Bureau of Land Management to... Land Policy and Management Act and the Federal Power Act), on the Eagle Mountain Pumped Storage...

  12. 78 FR 26358 - Eagle Mountain Pumped Storage Hydroelectric Project, Eagle Crest Energy; Notice of Meeting With...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-06

    ... Storage Hydroelectric Project, Eagle Crest Energy; Notice of Meeting With the Bureau of Land Management a... of the Meeting: Commission staff will meet with the staff of the Bureau of Land Management to improve... Policy and Management Act and the Federal Power Act), on the Eagle Mountain Pumped Storage Hydroelectric...

  13. Preoperative Duplex Scanning is a Helpful Diagnostic Tool in Neurogenic Thoracic Outlet Syndrome.

    PubMed

    Orlando, Megan S; Likes, Kendall C; Mirza, Serene; Cao, Yue; Cohen, Anne; Lum, Ying Wei; Freischlag, Julie A

    2016-01-01

    To evaluate the diagnostic role of venous and arterial duplex scanning in neurogenic thoracic outlet syndrome (NTOS). Retrospective review of patients who underwent duplex ultrasonography prior to first rib resection and scalenectomy (FRRS) for NTOS from 2005 to 2013. Abnormal scans included ipsilateral compression (IC) with abduction of the symptomatic extremity (>50% change in subclavian vessel flow), contralateral (asymptomatic side) compression (CC) or bilateral compression (BC). A total of 143 patients (76% female, average age 34, range 13-59) underwent bilateral preoperative duplex scanning. Ipsilateral compression was seen in 44 (31%), CC in 12 (8%), and BC in 14 (10%). Seventy-three (51%) patients demonstrated no compression. Patients with IC more often experienced intraoperative pneumothoraces (49% vs. 25%, P < .05) and had positive Adson tests (86% vs. 61%, P < .02). Compression of the subclavian vein or artery on duplex ultrasonography can assist in NTOS diagnosis. Ipsilateral compression on abduction often correlates with Adson testing. © The Author(s) 2016.

  14. Psychiatric comorbidities in asperger syndrome and high functioning autism: diagnostic challenges

    PubMed Central

    2012-01-01

    Several psychiatric conditions, both internalizing and externalizing, have been documented in comorbidity with Asperger Syndrome (AS) and High Functioning Autism (HFA). In this review we examine the interplay between psychiatric comorbidities and AS/HFA. In particular, we will focus our attention on three main issues. First, we examine which psychiatric disorders are more frequently associated with AS/HFA. Second, we review which diagnostic tools are currently available for clinicians to investigate and diagnose the associated psychiatric disorders in individuals with AS/HFA. Third, we discuss the challenges that clinicians and researchers face in trying to determine whether the psychiatric symptoms are phenotypic manifestations of AS/HFA or rather they are the expression of a distinct, though comorbid, disorder. We will also consider the role played by the environment in the manifestation and interpretation of these symptoms. Finally, we will propose some strategies to try to address these issues, and we will discuss therapeutic implications. PMID:22731684

  15. [Comparison of diagnostic criteria for the metabolic syndrome among Japanese university faculty].

    PubMed

    Hayashi, Emi; Dote, Tomotaro; Nakayama, Shin; Imanishi, Masafumi; Hirota, Chika; Mitsui, Go; Ohnishi, Keiko; Sugiura, Yumiko; Tanimoto, Yoshimi; Watanabe, Misuzu; Inoue, Sumie; Iida, Norihiko; Kono, Koichi

    2011-04-01

    Diagnostic criteria for the metabolic syndrome (Mets) in Japan have been set by the Medical Committee of the Japanese Association of Medical Sciences (Med), the National Health and Nutrition Examination Survey (Nat), specific health checkups (Ckup), and second medical examination by Worker's Accident Compensation Insurance System (Wor). The purpose of this study was to compare classification of the metabolic syndrome by different organizational criteria and to investigate underlying differences. All faculty members of a university in Osaka, Japan, underwent mandatory health checkups in September 2008. The demographic distribution included 769 males (mean age, 49 +/- 12 years) and 415 females (mean age, 43 +/- 10 years). Using the Med, Nat, Ckup and Wor criteria, individuals were assessed for the MetS and pre-metabolic syndrome (pre-Mets), strongly suspected metabolic syndrome (S-Mets) and assumed pre-metabolic syndrome (A-pre-Mets), as well as a positive support level (PSL) and a motivational support level (MSL). All faculty members were categorized into a morbid group (Mets, S-Mets, PSL, and FB) or a pre-morbid group (pre-Mets, A-pre-Mets, and MSL) based on medical data and smoking habits. The incidence of morbid and pre-morbid individuals was compared across the four criteria and analyzed based on gender and age (under 40 and 40 or over). Male incidences for the morbid and pre-morbid classifications were 17% and 20% with Med, 9% and 23% with Nat, 27% and 14% with Ckup, and 1.4% and 0% with Wor. There were significant differences across criteria sets in both the morbid and pre-morbid groups, with significantly greater numbers of males than females, and higher prevalences in those aged 40 or over than in their younger counterparts. Males aged under 40 classified into the pre-morbid group comprised 18% in Med, 16% in Nat, and 13% in Ckup. The different disease incidences found between Med and Ckup data in males aged 40 or over might be attributed to varying criteria

  16. Emotion Perception in Asperger's Syndrome and High-Functioning Autism: The Importance of Diagnostic Criteria and Cue Intensity

    ERIC Educational Resources Information Center

    Mazefsky, Carla A.; Oswald, Donald P.

    2007-01-01

    This study compared emotion perception accuracy between children with Asperger's syndrome (AS) and high-functioning autism (HFA). Thirty children were diagnosed with AS or HFA based on empirically supported diagnostic criteria and administered an emotion perception test consisting of facial expressions and tone of voice cues that varied in…

  17. Autism Spectrum Conditions in Individuals with Mobius Sequence, CHARGE Syndrome and Oculo-Auriculo-Vertebral Spectrum: Diagnostic Aspects

    ERIC Educational Resources Information Center

    Johansson, Maria; Gillberg, Christopher; Rastam, Maria

    2010-01-01

    As part of multidisciplinary surveys of three Behavioural Phenotype Conditions (BPCs); Mobius sequence (Mobius), CHARGE syndrome (CHARGE) and oculo-auriculo-vertebral spectrum (OAV), autism spectrum conditions (ASCs) was diagnosed in 45%, 68% and 42% of the individuals, respectively. Diagnostic difficulties due to additional dysfunctions such as…

  18. Diagnostic value of mean platelet volume (MPV) to troponin T inpatients with acute coronary syndrome

    NASA Astrophysics Data System (ADS)

    Aryanto, D.; Isnanta, R.; Safri, Z.; Hasan, R.

    2018-03-01

    Acute Coronary Syndrome (ACS) is used to describe the spectrum of coronary artery disease (CAD). Troponin T is the determinant of the most sensitive marker of ACS, but there aren’t all hospitals have this because of expensiveness. Mean Platelet Volume (MPV) is one of the components of a complete blood routine examination and relatively cheap as a marker in ACS. Determining the sensitivity and specificity of MPV in detecting cases of the acute coronary syndrome, 325 subjects’ medical records were from the period of July 2013 to June 2014; 228 ACS patients met the inclusion criteria. 228 subjects showed a risk factor for age ≥45years of more 195 (85.5%). 122 subjects with hypertension (53.5%) and subjects who smoked 118 (51.8%) that suffered most ACS. Subjects with risk factors for diabetes mellitus, obesity, menopause and dyslipidemia in this study was lower than non-diabetic 161 (70.6%), obese189 (82.9%), nonmenopause 196 (86%) and normal lipid 210 (92.1%). But there was norelation between risk factor with MPV and troponin T statistically. The results of diagnostic tests MPV for the evaluation of patients with ACS, sensitivity 92%, specificity 71%, positive predictive value 95% and negative predictive value 58%.

  19. [Craniopharyngioma and Klinefelter syndrome during the pubertal transition: A diagnostic challenge].

    PubMed

    Mocarbel, Yamile; Arébalo de Cross, Graciela; Lebrethon, Marie C; Thiry, Albert; Beckersd, Albert; Valdes-Socin, Hernan

    2017-04-01

    Craniopharyngioma is the most common pituitary tumor in childhood. It can compromise the pubertal development because of its evolution or treatment. Syndrome of Klinefelter is the most common cause of hipergonadotrophic hypogonadism in males. The concomitant presentation of both entities is extremely low (1/109) and the pathophysiological association is questionned. We present the case of a 18-year-old Belgian patient. He had a diagnosis of craniopharyngioma in childhood and he presented with panhypopituitarism after radiotherapy and surgical treatment. At the age of 14, he started pubertal induction with gonadotropin therapy without clinical response. Asociación de craneofaringioma y síndrome de Klinefelter en la transición puberal: un desafío diagnóstico Craniopharyngioma and Klinefelter syndrome during the pubertal transition: A diagnostic challenge A genetic evaluation confirmed a homogeneous 47, XXY karyotype. Failure of exogenous gonadotropin therapy revealed the hidden association of primary and secondary hypogonadism, demonstrating the importance of the followup and a multidisciplinary approach in these patients. Sociedad Argentina de Pediatría.

  20. [Asperger Syndrome and/or Clinical High Risk of Psychosis? A Differential Diagnostic Challenge].

    PubMed

    Schmidt, Stefanie J; Behar, Ayla; Schultze-Lutter, Frauke

    2018-03-01

    Asperger Syndrome and/or Clinical High Risk of Psychosis? A Differential Diagnostic Challenge This case-study deals with the often difficult differential diagnosis of Asperger syndrome and a clinical high risk state of psychosis, in particular as indicated by attenuated psychotic symptoms, as well as with its therapeutic implications. The presented case is a 10-year old girl, who has not been diagnosed with an autism spectrum disorder before being referred to a specialized center for early detection of psychosis due to possible hallucinatory experiences and delusional ideas. We demonstrate how to perform a context-sensitive differential diagnosis to distinguish between specific interests as well as related behaviors and unusual thought content as well as perceptive abnormalities, between paranoid ideas and biased interpretations of the behaviors of others typical for autism, and between disorganized symptoms and autistic unusual communication and social behavior. The resulting dual diagnoses in our case-study formed the basis for a complex differential indication, which considered both the increased stress vulnerability associated with an increased risk for the development of psychosis as well as the rigid thinking style associated with autism. Our case-report shows that such a precise differential indication can lead to stabilization over the long-term, even in patients with dual diagnoses.

  1. Toward an Attention-Based Diagnostic Tool for Patients With Locked-in Syndrome.

    PubMed

    Lesenfants, Damien; Habbal, Dina; Chatelle, Camille; Soddu, Andrea; Laureys, Steven; Noirhomme, Quentin

    2018-03-01

    Electroencephalography (EEG) has been proposed as a supplemental tool for reducing clinical misdiagnosis in severely brain-injured populations helping to distinguish conscious from unconscious patients. We studied the use of spectral entropy as a measure of focal attention in order to develop a motor-independent, portable, and objective diagnostic tool for patients with locked-in syndrome (LIS), answering the issues of accuracy and training requirement. Data from 20 healthy volunteers, 6 LIS patients, and 10 patients with a vegetative state/unresponsive wakefulness syndrome (VS/UWS) were included. Spectral entropy was computed during a gaze-independent 2-class (attention vs rest) paradigm, and compared with EEG rhythms (delta, theta, alpha, and beta) classification. Spectral entropy classification during the attention-rest paradigm showed 93% and 91% accuracy in healthy volunteers and LIS patients respectively. VS/UWS patients were at chance level. EEG rhythms classification reached a lower accuracy than spectral entropy. Resting-state EEG spectral entropy could not distinguish individual VS/UWS patients from LIS patients. The present study provides evidence that an EEG-based measure of attention could detect command-following in patients with severe motor disabilities. The entropy system could detect a response to command in all healthy subjects and LIS patients, while none of the VS/UWS patients showed a response to command using this system.

  2. Next generation sequencing as a useful tool in the diagnostics of mosaicism in Alport syndrome.

    PubMed

    Beicht, Sonja; Strobl-Wildemann, Gertrud; Rath, Sabine; Wachter, Oliver; Alberer, Martin; Kaminsky, Elke; Weber, Lutz T; Hinrichsen, Tanja; Klein, Hanns-Georg; Hoefele, Julia

    2013-09-10

    Alport syndrome (ATS) is a progressive hereditary nephropathy characterized by hematuria and/or proteinuria with structural defects of the glomerular basement membrane. It can be associated with extrarenal manifestations (high-tone sensorineural hearing loss and ocular abnormalities). Somatic mutations in COL4A5 (X-linked), COL4A3 and COL4A4 genes (both autosomal recessive and autosomal dominant) cause Alport syndrome. Somatic mosaicism in Alport patients is very rare. The reason for this may be due to the difficulty of detection. We report the case of a boy and his mother who presented with Alport syndrome. Mutational analysis showed the novel hemizygote pathogenic mutation c.2396-1G>A (IVS29-1G>A) at the splice acceptor site of the intron 29 exon 30 boundary of the COL4A5 gene in the boy. The mutation in the mother would not have been detected by Sanger sequencing without the knowledge of the mutational analysis result of her son. Further investigation of the mother using next generation sequencing showed somatic mosaicism and implied potential germ cell mosaicism. The mutation in the mother has most likely occurred during early embryogenesis. Analysis of tissue of different embryonic origin in the mother confirmed mosaicism in both mesoderm and ectoderm. Low grade mosaicism is very difficult to detect by Sanger sequencing. Next generation sequencing is increasingly used in the diagnostics and might improve the detection of mosaicism. In the case of definite clinical symptoms of ATS and missing detection of a mutation by Sanger sequencing, mutational analysis should be performed by next generation sequencing. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. Preoperative diagnosis of Lynch syndrome with DNA mismatch repair immunohistochemistry on a diagnostic biopsy.

    PubMed

    Warrier, S K; Trainer, A H; Lynch, A C; Mitchell, C; Hiscock, R; Sawyer, S; Boussioutas, A; Heriot, A G

    2011-12-01

    DNA mismatch repair immunohistochemistry on tumor tissue is a simple, readily available, and cost-effective method of identifying patients with Lynch syndrome in the postoperative setting. The aim of the study was to assess whether the mismatch repair status of a colorectal cancer can be confirmed by mismatch repair immunohistochemistry on preoperative biopsy. Germline positive patients with Lynch syndrome were identified from a prospectively collected Familial Cancer Clinic database. Preoperative colorectal cancer biopsy specimens were obtained from the source pathology provider to generate a cohort of matched preoperative and postoperative specimens. The specimens were sectioned and stained for 4 mismatch repair proteins (MLH1, MSH2, MSH6, PMS2). An age-matched cohort to compare specimens was selected from Bethesda positive but mismatch repair immunohistochemistry negative patients. All slides were reviewed by a single blinded pathologist. The Wilson method was used to calculate a true underlying proportion of patients for whom the preoperative result matched the postoperative test result with a 95% confidence interval. Of 128 germline positive mutation carriers, 40 patients (mean age 41, SD 11.3) had colorectal resections. Thirty-three preoperative specimens were retrievable and were matched with biopsies from 33 controls. The germline mutations included in the study were 8 MLH1, 19 MSH2, 3 MSH6, and 2 PMS2. In patients where germline positive status was known, sensitivity was 100% (95% CI 89.2-100) and specificity was 100% (95% CI 89.2-100). Identical sensitivity and specificity were observed in 33 age-matched patients. The sensitivity of the endoscopic biopsy in predicting germline status was 94.9% (95% CI 80.4-98.3). The mismatch repair disease status of a colorectal cancer can be reliably confirmed by mismatch repair immunohistochemistry on a diagnostic colorectal cancer biopsy sample before definitive surgery. Ascertaining a diagnosis of Lynch syndrome

  4. Diagnostic value of MR imaging in the Lewis-Sumner syndrome: a case series.

    PubMed

    Rajabally, Yusuf A; Knopp, Michael J; Martin-Lamb, Darren; Morlese, John

    2014-07-15

    Lewis-Sumner syndrome (LSS) is considered a variant of chronic inflammatory demyelinating polyneuropathy (CIDP), which is more frequently described with exclusive upper limb involvement. The diagnosis of LSS is clinical and electrophysiological. However, these are not always obvious and in view of its rarity, the diagnosis may be missed and patients denied effective immunomodulatory therapy. We herein describe the magnetic resonance imaging (MRI) findings in a series of five consecutive patients with a clinical diagnosis of LSS, using T2 STIR (Short Tau Inversion recovery) images without contrast. We demonstrated hyperintensity with or without hypertrophy of cervical roots and/or brachial plexus on the affected side and/or controlaterally which aided diagnostic confirmation. This helped therapeutic decision making regarding immunotherapy in all cases. MR imaging of the cervical spine/brachial plexus with T2 STIR may be helpful in suspected cases of LSS as it represents a very useful additional diagnostic tool. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Metabolic consequences of obesity and insulin resistance in polycystic ovary syndrome: diagnostic and methodological challenges.

    PubMed

    Jeanes, Yvonne M; Reeves, Sue

    2017-06-01

    Women with polycystic ovary syndrome (PCOS) have a considerable risk of metabolic dysfunction. This review aims to present contemporary knowledge on obesity, insulin resistance and PCOS with emphasis on the diagnostic and methodological challenges encountered in research and clinical practice. Variable diagnostic criteria for PCOS and associated phenotypes are frequently published. Targeted searches were conducted to identify all available data concerning the association of obesity and insulin resistance with PCOS up to September 2016. Articles were considered if they were peer reviewed, in English and included women with PCOS. Obesity is more prevalent in women with PCOS, but studies rarely reported accurate assessments of adiposity, nor split the study population by PCOS phenotypes. Many women with PCOS have insulin resistance, though there is considerable variation reported in part due to not distinguishing subgroups known to have an impact on insulin resistance as well as limited methodology to measure insulin resistance. Inflammatory markers are positively correlated with androgen levels, but detailed interactions need to be identified. Weight management is the primary therapy; specific advice to reduce the glycaemic load of the diet and reduce the intake of pro-inflammatory SFA and advanced glycation endproducts have provided promising results. It is important that women with PCOS are educated about their increased risk of metabolic complications in order to make timely and appropriate lifestyle modifications. Furthermore, well-designed robust studies are needed to evaluate the mechanisms behind the improvements observed with dietary interventions.

  6. Diagnostic performance of osteocalcin measurements in patients with endogenous Cushing's syndrome.

    PubMed

    Belaya, Zhanna E; Iljin, Alexander V; Melnichenko, Galina A; Solodovnikov, Alexander G; Rozhinskaya, Liudmila Y; Dzeranova, Larisa K; Dedov, Ivan I

    2016-01-01

    The aim of this study was to evaluate the diagnostic performance of osteocalcin (OC), as measured by automated electrochemiluminescence immunoassay (ECLIA), in identifying Cushing's syndrome (CS) in two separate populations: among obese and overweight subjects and among women of postmenopausal age with osteoporosis. Among the 106 referral patients with obesity, CS was confirmed in 42 cases. The patients of the referred population provided late-night salivary cortisol (LNSC), underwent low-dose dexamethasone suppression testing (DST) and were further evaluated until CS was pathologically confirmed. A threshold of OC-8.3 ng ml(-1) differentiated CS among obese and overweight subjects with a sensitivity of 73.8% (95% confidence interval (CI) 58.9-84.7) and a specificity of 96.9% (95% CI 89.3-99.1). The total area under the receiver operating characteristic curve (AUC) was 0.859 (95% CI 0.773-0.945), which was lower than LNSC or DST (P=0.01). In the retrospective portion of the study, the OC levels were evaluated in 67 subjects with newly diagnosed postmenopausal osteoporosis and in 23 patients (older than 45) with newly diagnosed CS and osteoporosis (presence of low traumatic fractures or T-score P-2.5). The diagnostic performance of OC for osteoporosis due to CS was within an AUC of 0.959 (95% CI 0.887-1.00). A threshold for OC of 8.3 ng ml-1 yielded a sensitivity of 95.4% (95% CI 78.2-99.2%) and a specificity of 98.5% (95% CI 92.0-99.7%). Thus, osteocalcin could be used in the diagnostic testing for endogenous hypercortisolism in patients referred to exclude CS and to identify CS among patients of postmenopausal age with osteoporosis.

  7. Diagnostic performance of osteocalcin measurements in patients with endogenous Cushing's syndrome

    PubMed Central

    Belaya, Zhanna E; Iljin, Alexander V; Melnichenko, Galina A; Solodovnikov, Alexander G; Rozhinskaya, Liudmila Y; Dzeranova, Larisa K; Dedov, Ivan I

    2016-01-01

    The aim of this study was to evaluate the diagnostic performance of osteocalcin (OC), as measured by automated electrochemiluminescence immunoassay (ECLIA), in identifying Cushing's syndrome (CS) in two separate populations: among obese and overweight subjects and among women of postmenopausal age with osteoporosis. Among the 106 referral patients with obesity, CS was confirmed in 42 cases. The patients of the referred population provided late-night salivary cortisol (LNSC), underwent low-dose dexamethasone suppression testing (DST) and were further evaluated until CS was pathologically confirmed. A threshold of OC—8.3 ng ml−1 differentiated CS among obese and overweight subjects with a sensitivity of 73.8% (95% confidence interval (CI) 58.9–84.7) and a specificity of 96.9% (95% CI 89.3–99.1). The total area under the receiver operating characteristic curve (AUC) was 0.859 (95% CI 0.773–0.945), which was lower than LNSC or DST (P=0.01). In the retrospective portion of the study, the OC levels were evaluated in 67 subjects with newly diagnosed postmenopausal osteoporosis and in 23 patients (older than 45) with newly diagnosed CS and osteoporosis (presence of low traumatic fractures or T-score P–2.5). The diagnostic performance of OC for osteoporosis due to CS was within an AUC of 0.959 (95% CI 0.887–1.00). A threshold for OC of 8.3 ng ml-1 yielded a sensitivity of 95.4% (95% CI 78.2–99.2%) and a specificity of 98.5% (95% CI 92.0–99.7%). Thus, osteocalcin could be used in the diagnostic testing for endogenous hypercortisolism in patients referred to exclude CS and to identify CS among patients of postmenopausal age with osteoporosis. PMID:27347399

  8. Infrared thermography as a diagnostic tool to indicate sick-house-syndrome: a case-study

    NASA Astrophysics Data System (ADS)

    Ljungberg, Sven-Ake

    1996-03-01

    function, manload and demand of air flow. Field control inspections were performed partly from the inside and partly from the outside of the building. Microbial activities were investigated by traditional measurements of the emissions and contamination of indoor air, and by ocular inspections and laboratory tests of building materials. Despite the fact that the building studied has a complicated composition of surface materials, including glass, wood, steel and concrete panels, it was possible to indirectly indicate surface anomalies, related to microbial deterioration of organic materials, through mold and rot activities, due to in-exfiltration of humid air, causing moisture problems within the construction. The result from this case-study shows that thermography can become an important diagnostic tool in order to detect and map sick-house-syndromes. The project is to be continued.

  9. Alternative Fuels Data Center: Golden Eagle Distributors Inc. to Convert

    Science.gov Websites

    several years. Golden Eagle will convert all fleet vehicles to CNG in their six branch operations Entire Fleet to CNG Golden Eagle Distributors Inc. to Convert Entire Fleet to CNG to someone by E-mail Share Alternative Fuels Data Center: Golden Eagle Distributors Inc. to Convert Entire Fleet

  10. Evidence of Bald Eagles feeding on freshwater mussels

    Treesearch

    Teryl G. Grubb; Michael A. Coffey

    1982-01-01

    A 1978 study of the winter habitat of the Bald Eagle (Haliaeetus leucocephalus) in the Coconino National Forest, Arizona, indicated repeated and potentially heavy use of a freshwater mussel (Anodonta corpulenta) in the eagles’ diet. As many as 10 eagles (five adults and five immatures) were observed at Upper Lake Mary near...

  11. Bald eagles nesting in Baja California

    USGS Publications Warehouse

    Henny, Charles J.; Anderson, Daniel W.; Knoder, C.E.

    1978-01-01

    Published records of Bald Eagles (Haliaeetus leucocephalus) nesting in Baja California during the last 50 years are nonexistent to our knowledge, and few records exist prior to that time. Friedmann et al. (1950:61, Pac. Coast Avifauna 29) describe the distribution of Bald Eagles in Baja California as "a scattering of pairs on both the Pacific and Gulf Sides." Nesting Bald Eagles were first reported by Bryant (1889, Proc. Calif. Acad. Sci. 2: 237-320), who found a pair on Isla Santa Margarita (24°25'N, 111°50'W; hereafter abbreviated as 2425-11150) and saw an adult on the "estero" north from Magdalena Bay (the region where one pair was seen in 1977). Other records were reviewed by Grinnell (1928, Univ. Calif. Publ. Zool. 32).

  12. Whooping crane preyed upon by golden eagle

    USGS Publications Warehouse

    Windingstad, Ronald M.; Stiles, Harry E.; Drewien, Roderick C.

    1981-01-01

    The Golden Eagle (Aquila chrysaetos) is the largest predatory bird in North America and is well known for its predatory abilities. Attacks have been reported on mammals such as whitetail jackrabbits (Lepus townsendi) (McGahan 1967, J. Wildl. Mgmt. 31: 496), pronghorn antelope (Antilocapra americana) (Bruhns 1970, Can. Field-Natur. 84: 301), Mallards (Anas platyrhynchos) (Kelleher and O'Malia 1971, Auk 88: 186), and Great Blue Herons (Ardea herodias) (Carnie 1954, Condor 56: 3). This communication describes an attack on an immature Whooping Crane (Grus americana) by a Golden Eagle and the subsequent necropsy findings.

  13. DDE poisoning in an adult bald eagle

    USGS Publications Warehouse

    Garcelon, D.K.; Thomas, N.J.

    1997-01-01

    A 12-year-old female bald eagle (Haliaeetus leucocephalus) was found in May 1993 on Santa Catalina Island, California (USA), in a debilitated condition, exhibiting ataxia and tremors; it died within hours. On necropsy, the bird was emaciated but had no evidence of disease or physical injury. Chemical analyses were negative for organophosphorus pesticides and lead poisoning. High concentrations of DDE (wet weight basis) were found in the brain (212 ppm), liver (838 ppm), and serum (53 ppm). Mobilization of DDE, from depleted fat deposits, probably resulted in the lethal concentration in the eagle's brain.

  14. Suspected lead toxicosis in a bald eagle

    USGS Publications Warehouse

    Jacobson, E.; Carpenter, J.W.; Novilla, M.

    1977-01-01

    An immature bald eagle (Haliaeetus leucocephalus) was submitted to the University of Maryland, College Park, for clinical examination. The bird was thin, had green watery feces, and was unable to maintain itself in upright posture. Following radiography, the bird went into respiratory distress and died. Numerous lead shot were recovered from the gizzard, and chemical analysis of liver and kidney tissue revealed 22.9 and 11.3 ppm lead, respectively. The clinical signs, necropsy findings, and chemical analysis of the eagle were compatible with lead toxicosis.

  15. Diagnostic Accuracy of Chinese Medicine Diagnosis Scale of Phlegm and Blood Stasis Syndrome in Coronary Heart Disease: A Study Protocol.

    PubMed

    Liu, Xiao-Qi; Peng, Dan-Hong; Wang, Yan-Ping; Xie, Rong; Chen, Xin-Lin; Yu, Chun-Quan; Li, Xian-Tao

    2018-05-03

    Phlegm and blood stasis syndrome (PBSS) is one of the main syndromes in coronary heart disease (CHD). Syndromes of Chinese medicine (CM) are lack of quantitative and easyimplementation diagnosis standards. To quantify and standardize the diagnosis of PBSS, scales are usually applied. To evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. Six hundred patients with stable angina pectoris of CHD, 300 in case group and 300 in control group, will be recruited from 5 hospitals across China. Diagnosis from 2 experts will be considered as the "gold standard". The study design consists of 2 phases: pilot test is used to evaluate the reliability and validity, and diagnostic test is used to assess the diagnostic accuracy of the scale, including sensitivity, specififi city, likelihood ratio and area under the receiver operator characteristic (ROC) curve. This study will evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. The consensus of 2 experts may not be ideal as a "gold standard", and itself still requires further study. (No. ChiCTR-OOC-15006599).

  16. [Paraneoplastic Cushing's syndrome, a real diagnostic and therapeutic challenge: A case report and literature review].

    PubMed

    Meftah, A; Moumen, A; Massine El Hammoumi, M; Hajhouji, S; El Jadi, H; Anas Guerboub, A; Elmoussaoui, S; Mayaudon, H; Hassane Kabiri, E; Hakkou, K; Belmejdoub, G

    2015-12-01

    Paraneoplastic Cushing's syndrome is a rare cause of endogenous hypercortisolism attributable to ectopic ACTH secretion by non-pituitary tumors. Imaging and biochemical results are often inconclusive and differential diagnosis with Cushing's disease can then be challenging. Moreover, these tumors may be occult and difficult to find and thus the need of new imaging tools such as (18)FDG-PET scan and (18)DOPA-PET scan. We report a 50-year-old man who presented with very aggressive clinical features related to Cushing's syndrome. Biological work-up confirmed the hypercortisolism and was consistent with an ectopic ACTH secretion. Conventional localization techniques failed to show any tumor and bilateral adrenalectomy was performed because of life-threatening complications. Two years later, thoracic computed tomography reveals an 11 mm mass in the left lower pulmonary lobe, (18)FDG-PET scan found a non-specific mild hypermetabolism of the lung nodule, and the (18)DOPA-PET scan confirmed the high uptake of this nodule suggesting an endocrine carcinoma. Histology confirmed a typical carcinoid tumor. The tumor cells stained positive for ACTH, CD56, chromogranin and synaptophysin. This case illustrates the dilemma between the need for morphological diagnosis of the ectopic ACTH source and control of the life-threatening hypercortisolism. (18)FDG-PET scan and (18)DOPA-PET scan should be considered early as a secondary diagnostic tool when conventional imagery fails to show any tumor. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  17. Familial Recurrence of 3MC Syndrome in Consanguineous Families: A Clinical and Molecular Diagnostic Approach With Review of the Literature.

    PubMed

    Gardner, Olivia K; Haynes, Karla; Schweitzer, Daniela; Johns, Alexis; Magee, William P; Urata, Mark M; Sanchez-Lara, Pedro A

    2017-11-01

    We report four individuals from two unrelated consanguineous families with 3MC syndrome. In the first family, chromosome microarray data revealed that the two affected sisters, born to first-cousin parents, shared a unique homozygous C-terminal deletion in the COLEC11 gene. Two affected brothers from a second family, also born to first-cousin parents, shared a region of homozygosity that included the second gene known to cause the 3MC syndrome, MASP1. We discuss the diagnostic approach of craniofacial disorders born to consanguineous parents and highlight a literature search and reference a helpful dysmorphology solution powered by FDNA (Facial Dysmorphology Novel Analysis) technology.

  18. New diagnostic criteria of adrenal subclinical Cushing's syndrome: opinion from the Japan Endocrine Society.

    PubMed

    Yanase, Toshihiko; Oki, Yutaka; Katabami, Takuyuki; Otsuki, Michio; Kageyama, Kazunori; Tanaka, Tomoaki; Kawate, Hisaya; Tanabe, Makito; Doi, Masaru; Akehi, Yuko; Ichijo, Takamasa

    2018-04-26

    New diagnostic criteria and the treatment policy for adrenal subclinical Cushing's syndrome (SCS) are proposed on behalf of the Japan Endocrine Society. The Japanese version has been published, and the essential contents are presented in this English-language version. The current diagnostic criteria for SCS have elicited two main problems: (i) the relatively low reliability of a low range of serum cortisol essential for the diagnosis by an overnight 1-mg dexamethasone suppression test (DST); (ii) different cutoff values for serum cortisol after a 1-mg DST compared with those of other countries. Thus, new criteria are needed. In the new criteria, three hierarchical cortisol cutoff values, 5.0, 3.0 and 1.8 μg/dL, after a 1-mg DST are presented. Serum cortisol ≥5 μg/dL after a 1-mg DST alone is considered sufficient to judge autonomous cortisol secretion for the diagnosis of SCS, and the current criterion based on serum cortisol ≥3 μg/dL after a 1-mg DST can continue to be used. Clinical evidence suggests that serum cortisol ≥1.8-2.9 μg/dL after a 1-mg DST is not always normal, so cases who meet the cutoff value as well as a basal adrenocorticotropic hormone (ACTH) level <10 pg/mL (or poor ACTH response to corticotropin-releasing hormone (CRH)) and nocturnal serum cortisol ≥5 μg/dL are proposed to have SCS. We suggest surgery if cases show serum cortisol ≥5 μg/dL after a 1-mg DST (or are disheartened by treatment-resistant problems) or suspicious cases of adrenal cancer according to tumor imaging.

  19. Severity of Carpal Tunnel Syndrome and Diagnostic Accuracy of Hand and Body Anthropometric Measures

    PubMed Central

    Mondelli, Mauro; Farioli, Andrea; Mattioli, Stefano; Aretini, Alessandro; Ginanneschi, Federica; Greco, Giuseppe; Curti, Stefania

    2016-01-01

    Objective To study the diagnostic properties of hand/wrist and body measures according to validated clinical and electrophysiological carpal tunnel syndrome (CTS) severity scales. Methods We performed a prospective case-control study. For each case, two controls were enrolled. Two five-stage clinical and electrophysiological scales were used to evaluate CTS severity. Anthropometric measurements were collected and obesity indicators and hand/wrist ratios were calculated. Area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and likelihood ratios were calculated separately by gender. Results We consecutively enrolled 370 cases and 747 controls. The wrist-palm ratio, waist-hip-height ratio and waist-stature ratio showed the highest proportion of cases with abnormal values in the severe stages of CTS for clinical and electrophysiological severity scales in both genders. Accuracy tended to increase with CTS severity for females and males. In severe stage, most of the indexes presented moderate accuracy in both genders. Among subjects with severe CTS, the wrist-palm ratio presented the highest AUC for hand measures in the clinical and electrophysiological severity scales both in females (AUC 0.83 and 0.76, respectively) and males (AUC 0.91 and 0.82, respectively). Among subjects with severe CTS, the waist-stature ratio showed the highest AUC for body measures in the clinical and electrophysiological severity scales both in females (AUC 0.78 and 0.77, respectively) and males (AUC 0.84 and 0.76, respectively). The results of waist-hip-height ratio AUC were similar. Conclusions Wrist-palm ratio, waist-hip-height ratio and waist-stature ratio could contribute to support the diagnostic hypothesis of severe CTS that however has to be confirmed by nerve conduction study. PMID:27768728

  20. Do Different Diagnostic Criteria Impact Polycystic Ovary Syndrome Diagnosis for Adolescents?

    PubMed

    Akgül, Sinem; Düzçeker, Yasemin; Kanbur, Nuray; Derman, Orhan

    2018-06-01

    Although early diagnosis of polycystic ovary syndrome (PCOS) in adolescents might allow for earlier treatment and prevention of chronic disorders, incorrect or premature diagnosis carries risks of unnecessary treatment and psychological distress. There is no consensus concerning which diagnostic criteria to use for adolescents and current criteria vary. The objective of this study was to determine whether using different diagnostic criteria will affect PCOS diagnosis in adolescents. Fifty-two patients aged 13-18 years with at least 2 of the following criteria were included in the study: (1) oligomenorrhea or amenorrhea; (2) Clinical or biochemical hyperandrogenism; and (3) polycystic ovaries on ultrasonography. Patients were then categorized according to the 6 different criteria for PCOS. National Institutes of Health, Rotterdam criteria, Androgen Excess Society, Amsterdam criteria, Endocrine Society criteria, and the Pediatric Endocrine Society criteria. The characteristics of adolescents who were diagnosed with PCOS were also evaluated. Forty-one patients out of 52 (78.8%) received diagnosis with National Institutes of Health and Endocrine Society criteria, all with Rotterdam criteria, 45/52 (86.5%) with Androgen Excess Society criteria, 36/52 (69.2%) with Amsterdam criteria and 34/52 (65.4%) with the Pediatric Endocrine Society criteria. This study shows that the choice of guideline used does have a great effect on whether an adolescent received the PCOS diagnosis or not. For physicians using the broader criteria, care should be taken to ensure the patient does not receive diagnosis because of the physiological changes seen during puberty, which might mimic PCOS. For those using stricter criteria, close monitoring of patients who do not receive diagnosis is necessary to prevent chronic complications. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  1. A diagnostic evolution: surgical experience with popliteal artery entrapment syndrome at a military tertiary referral center.

    PubMed

    Clemens, Michael S; Scott, Daniel J; Watson, John Devin B; Wang, Lin C; Hislop, Sean J; Arthurs, Zachary M

    2015-08-01

    Popliteal artery entrapment syndrome (PAES) is an increasingly encountered disorder that typically presents as claudication in young and active individuals. However, despite the increased recognition, accurate preoperative diagnosis can be difficult. The objective of this study was to describe the surgical assessment and outcomes of patients treated for PAES. Retrospective case series of all patients managed surgically for a diagnosis of PAES at the San Antonio Military Medical Center from 2005 to 2013. Over 8 years, PAES was surgically treated in 25 consecutive limbs of 15 patients (mean age, 35; range, 21-49) in a military tertiary medical center. Type III was the most common variant (n = 13, 52%), followed by type VI (n = 7, 28%). Most patients presented with class I or II ischemia (88%), with anterolateral symptoms (56%), and were referred by orthopedics (66%). Diagnostic work-up included stress ankle-brachial indices, magnetic resonance imaging (MRI) and provocative angiography. Sixty-three percent of limbs with negative MRI demonstrated findings consistent with either type III or V PAES. Tendon release was used in those with types III and V, whereas liberal myectomy was used in those with types I, II, or VI. Two patients required revascularization. At a median follow-up of 126 days (range, 25 days-7 years), 83% of patients with type III demonstrated partial resolution of symptoms. Only 27% of patients without an identifiable muscle slip had clinical improvement. Despite modern imaging, open surgical exploration remains the definitive diagnostic modality for PAES. Patients with a muscular or tendinous slip identified intraoperatively have the best clinical outcomes. Those with no identifiable muscle slip (functional entrapment) are less likely to demonstrate clinical improvement. Further evaluation on outcomes in the management in PAES is warranted. Published by Elsevier Inc.

  2. Delineation and Diagnostic Criteria of Oral-Facial-Digital Syndrome Type VI

    PubMed Central

    2012-01-01

    Oral-Facial-Digital Syndrome type VI (OFD VI) represents a rare phenotypic subtype of Joubert syndrome and related disorders (JSRD). In the original report polydactyly, oral findings, intellectual disability, and absence of the cerebellar vermis at post-mortem characterized the syndrome. Subsequently, the molar tooth sign (MTS) has been found in patients with OFD VI, prompting the inclusion of OFD VI in JSRD. We studied the clinical, neurodevelopmental, neuroimaging, and genetic findings in a cohort of 16 patients with OFD VI. We derived the following inclusion criteria from the literature: 1) MTS and one oral finding and polydactyly, or 2) MTS and more than one typical oral finding. The OFD VI neuroimaging pattern was found to be more severe than in other JSRD subgroups and includes severe hypoplasia of the cerebellar vermis, hypoplastic and dysplastic cerebellar hemispheres, marked enlargement of the posterior fossa, increased retrocerebellar collection of cerebrospinal fluid, abnormal brainstem, and frequently supratentorial abnormalities that occasionally include characteristic hypothalamic hamartomas. Additionally, two new JSRD neuroimaging findings (ascending superior cerebellar peduncles and fused thalami) have been identified. Tongue hamartomas, additional frenula, upper lip notch, and mesoaxial polydactyly are specific findings in OFD VI, while cleft lip/palate and other types of polydactyly of hands and feet are not specific. Involvement of other organs may include ocular findings, particularly colobomas. The majority of the patients have absent motor development and profound cognitive impairment. In OFD VI, normal cognitive functions are possible, but exceptional. Sequencing of known JSRD genes in most patients failed to detect pathogenetic mutations, therefore the genetic basis of OFD VI remains unknown. Compared with other JSRD subgroups, the neurological findings and impairment of motor development and cognitive functions in OFD VI are significantly

  3. Diagnostic Accuracy of a New High-Sensitivity Troponin I Assay and Five Accelerated Diagnostic Pathways for Ruling Out Acute Myocardial Infarction and Acute Coronary Syndrome.

    PubMed

    Greenslade, Jaimi H; Carlton, Edward W; Van Hise, Christopher; Cho, Elizabeth; Hawkins, Tracey; Parsonage, William A; Tate, Jillian; Ungerer, Jacobus; Cullen, Louise

    2018-04-01

    This diagnostic accuracy study describes the performance of 5 accelerated chest pain pathways, calculated with the new Beckman's Access high-sensitivity troponin I assay. High-sensitivity troponin I was measured with presentation and 2-hour blood samples in 1,811 patients who presented to an emergency department (ED) in Australia. Patients were classified as being at low risk according to 5 rules: modified accelerated diagnostic protocol to assess patients with chest pain symptoms using troponin as the only biomarker (m-ADAPT), the Emergency Department Assessment of Chest Pain Score (EDACS) pathway, the History, ECG, Age, Risk Factors, and Troponin (HEART) pathway, the No Objective Testing Rule, and the new Vancouver Chest Pain Rule. Endpoints were 30-day acute myocardial infarction and acute coronary syndrome. Measures of diagnostic accuracy for each rule were calculated. Data included 96 patients (5.3%) with acute myocardial infarction and 139 (7.7%) with acute coronary syndrome. The new Vancouver Chest Pain Rule and No Objective Testing Rule had high sensitivity for acute myocardial infarction (100%; 95% confidence interval [CI] 96.2% to 100% for both) and acute coronary syndrome (98.6% [95% CI 94.9% to 99.8%] and 99.3% [95% CI 96.1% to 100%]). The m-ADAPT, EDACS, and HEART pathways also yielded high sensitivity for acute myocardial infarction (96.9% [95% CI 91.1% to 99.4%] for m-ADAPT and 97.9% [95% CI 92.7% to 99.7%] for EDACS and HEART), but lower sensitivity for acute coronary syndrome (≤95.0% for all). The m-ADAPT, EDACS, and HEART rules classified more patients as being at low risk (64.3%, 62.5%, and 49.8%, respectively) than the new Vancouver Chest Pain Rule and No Objective Testing Rule (28.2% and 34.5%, respectively). In this cohort with a low prevalence of acute myocardial infarction and acute coronary syndrome, using the Beckman's Access high-sensitivity troponin I assay with the new Vancouver Chest Pain Rule or No Objective Testing Rule enabled

  4. Absolute polycythemia in a bald eagle (Haliaeetus leucocephalus).

    PubMed

    Fernandes, Andreia F; Fenton, Heather; Martinson, Shannon; Desmarchelier, Marion; Ferrell, Shannon T

    2014-12-01

    An approximately 6-mo-old female bald eagle (Haliaeetus leucocephalus) was presented for an inability to fly and bilateral drooped wings. Pectoral muscle atrophy with a moderate polycythemia was present. Over the course of 3 wk, there were no improvements in flight capacity, although the bird gained substantial weight. Further investigation revealed a prominent cyanosis that was responsive to oxygen therapy, a chronic respiratory acidosis with hypoxia, a cardiac murmur, and a persistent polycythemia. No obvious antemortem etiology for the clinical findings was discovered on computerized tomography, angiography, or echocardiography. The bird was euthanatized as a result of the poor prognosis. Necropsy and histopathology revealed no significant cardiovascular or pulmonary pathology. No myopathy was evident on electron microscopy of formalin-fixed tissues. Based on these diagnostics, a neuromuscular disorder is suspected as the cause for the blood gas abnormalities, with a resulting polycythemia from the hypoxia.

  5. Differential diagnosis and diagnostic flow chart of joint hypermobility syndrome/ehlers-danlos syndrome hypermobility type compared to other heritable connective tissue disorders.

    PubMed

    Colombi, Marina; Dordoni, Chiara; Chiarelli, Nicola; Ritelli, Marco

    2015-03-01

    Joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT) is an evolving and protean disorder mostly recognized by generalized joint hypermobility and without a defined molecular basis. JHS/EDS-HT also presents with other connective tissue features affecting a variety of structures and organs, such as skin, eye, bone, and internal organs. However, most of these signs are present in variable combinations and severity in many other heritable connective tissue disorders. Accordingly, JHS/EDS-HT is an "exclusion" diagnosis which needs the absence of any consistent feature indicative of other partially overlapping connective tissue disorders. While both Villefranche and Brighton criteria include such an exclusion as a mandatory item, a systematic approach for reaching a stringent clinical diagnosis of JHS/EDS-HT is still lacking. The absence of a consensus on the diagnostic approach to JHS/EDS-HT concerning its clinical boundaries with similar conditions contribute to limit our actual understanding of the pathologic and molecular bases of this disorder. In this review, we revise the differential diagnosis of JHS/EDS-HT with those heritable connective tissue disorders which show a significant overlap with the former and mostly include EDS classic, vascular and kyphoscoliotic types, osteogenesis imperfecta, Marfan syndrome, Loeys-Dietz syndrome, arterial tortuosity syndrome, and lateral meningocele syndrome. A diagnostic flow chart is also offered with the attempt to support the less experienced clinician in stringently recognizing JHS/EDS-HT and stimulate the debate in the scientific community for both management and research purposes. © 2015 Wiley Periodicals, Inc.

  6. Interpretation of diagnostic laboratory tests for severe acute respiratory syndrome: the Toronto experience

    PubMed Central

    Tang, Patrick; Louie, Marie; Richardson, Susan E.; Smieja, Marek; Simor, Andrew E.; Jamieson, Frances; Fearon, Margaret; Poutanen, Susan M.; Mazzulli, Tony; Tellier, Raymond; Mahony, James; Loeb, Mark; Petrich, Astrid; Chernesky, Max; McGeer, Allison; Low, Donald E.; Phillips, Elizabeth; Jones, Steven; Bastien, Nathalie; Li, Yan; Dick, Daryl; Grolla, Allen; Fernando, Lisa; Booth, Timothy F.; Henry, Bonnie; Rachlis, Anita R.; Matukas, Larissa M.; Rose, David B.; Lovinsky, Reena; Walmsley, Sharon; Gold, Wayne L.; Krajden, Sigmund

    2004-01-01

    Background An outbreak of severe acute respiratory syndrome (SARS) began in Canada in February 2003. The initial diagnosis of SARS was based on clinical and epidemiological criteria. During the outbreak, molecular and serologic tests for the SARS-associated coronavirus (SARS-CoV) became available. However, without a “gold standard,” it was impossible to determine the usefulness of these tests. We describe how these tests were used during the first phase of the SARS outbreak in Toronto and offer some recommendations that may be useful if SARS returns. Methods We examined the results of all diagnostic laboratory tests used in 117 patients admitted to hospitals in Toronto who met the Health Canada criteria for suspect or probable SARS. Focusing on tests for SARS-CoV, we attempted to determine the optimal specimen types and timing of specimen collection. Results Diagnostic test results for SARS-CoV were available for 110 of the 117 patients. SARS-CoV was detected by means of reverse-transcriptase polymerase chain reaction (RT-PCR) in at least one specimen in 59 (54.1%) of 109 patients. Serologic test results of convalescent samples were positive in 50 (96.2%) of 52 patients for whom paired serum samples were collected during the acute and convalescent phases of the illness. Of the 110 patients, 78 (70.9%) had specimens that tested positive by means of RT-PCR, serologic testing or both methods. The proportion of RT-PCR test results that were positive was similar between patients who met the criteria for suspect SARS (50.8%, 95% confidence interval [CI] 38.4%–63.2%) and those who met the criteria for probable SARS (58.0%, 95% CI 44.2%–70.7%). SARS-CoV was detected in nasopharyngeal swabs in 33 (32.4%) of 102 patients, in stool specimens in 19 (63.3%) of 30 patients, and in specimens from the lower respiratory tract in 10 (58.8%) of 17 patients. Interpretation These findings suggest that the rapid diagnostic tests in use at the time of the initial outbreak lack

  7. Famphur toxicosis in a bald eagle

    USGS Publications Warehouse

    Franson, J. Christian; Kolbe, E.J.; Carpenter, J.W.

    1985-01-01

    On 24 November 1983, an adult female bald eagle (Haliaeetus leucocephalus L.) was found unable to fly near Lewes, Del-aware. She was kept overnight by U.S. Fish and Wildlife Service personnel at Prime Hook National Wildlife Refuge and transported to the Patuxent Wildlife Research Center, Laurel, Maryland, the following afternoon.

  8. Scaled Eagle Nebula Experiments on NIF

    SciTech Connect

    Pound, Marc W.

    We performed scaled laboratory experiments at the National Ignition Facility laser to assess models for the creation of pillar structures in star-forming clouds of molecular hydrogen, in particular the famous Pillars of the Eagle Nebula. Because pillars typically point towards nearby bright ultraviolet stars, sustained directional illumination appears to be critical to pillar formation. The experiments mock up illumination from a cluster of ultraviolet-emitting stars, using a novel long duration (30--60 ns), directional, laser-driven x-ray source consisting of multiple radiation cavities illuminated in series. Our pillar models are assessed using the morphology of the Eagle Pillars observed with the Hubblemore » Space Telescope, and measurements of column density and velocity in Eagle Pillar II obtained at the BIMA and CARMA millimeter wave facilities. In the first experiments we assess a shielding model for pillar formation. The experimental data suggest that a shielding pillar can match the observed morphology of Eagle Pillar II, and the observed Pillar II column density and velocity, if augmented by late time cometary growth.« less

  9. Bald eagle, United States [chapter 7

    Treesearch

    Teryl G. Grubb

    2010-01-01

    "One of you boys will continue radio-tracking bears, and the other will start climbing trees to band bald eagle nestlings ... " That's how it all began for me back in the summer of 1967, on the Kodiak National Wildlife Refuge in Alaska, my first summer job in the wildlife field. And as it turned out, that inauspicious beginning has led to a fascinating,...

  10. [Procalcitonin as a diagnostic marker in systemic inflammatory response syndrome (SIRS) and sepsis].

    PubMed

    Hryckiewicz, Katarzyna; Juszczyk, Jacek; Samet, Alfred; Arłukowicz, Elzbieta; Sledzińska, Anna; Bolewska, Beata

    2006-01-01

    Evaluation the value of procalcitonin as a diagnostic and prognostic marker in septic patients and patients with systemic inflammatory response syndrome (SIRS). 126 patients were included into the study. The patients were divided into four groups: 1--septic patients with positive blood cultures, 2--septic patients with negative blood cultures, 3--patients with SIRS, 4--patients without sepsis and SIRS. PCT level was measured by imunoluminometric assay (LUMItest) and immunochromatographic assay (PCT-Q). PCT level is higher in patients with sepsis than in patients with SIRS. PCT level is only slightly elevated in patients without sepsis and SIRS. The highest PCT level is found in patients with septic shock. In patients with the clinical improvement the frequency of PCT level increase is approximately twice lower than in patients who died. Measurement of PCT level on the first, second and third day of hospitalization has no prognostic value. There is no significant difference in PCT level in sepsis caused by Gram positive and Gram negative bacteria. PCT is a useful marker in diagnosis of sepsis but its role in monitoring the severity of sepsis requires more clinical studies.

  11. 14th International Congress on Antiphospholipid Antibodies Task Force. Report on antiphospholipid syndrome laboratory diagnostics and trends.

    PubMed

    Bertolaccini, Maria Laura; Amengual, Olga; Andreoli, Laura; Atsumi, Tatsuya; Chighizola, Cecilia B; Forastiero, Ricardo; de Groot, Philip; Lakos, Gabriella; Lambert, Marc; Meroni, Pierluigi; Ortel, Thomas L; Petri, Michelle; Rahman, Anisur; Roubey, Robert; Sciascia, Savino; Snyder, Melissa; Tebo, Anne E; Tincani, Angela; Willis, Rohan

    2014-09-01

    Current classification criteria for definite Antiphospholipid Syndrome (APS) require the use of three laboratory assays to detect antiphospholipid antibodies (aCL, anti-β2GPI and LA) in the presence of at least one of the two major clinical manifestations (i.e. thrombosis or pregnancy morbidity) of the syndrome. However, several other autoantibodies shown to be directed to other proteins or their complex with phospholipids have been proposed to be relevant to APS but their clinical utility and their diagnostic value remains elusive. This report summarizes the findings, conclusions and recommendations of the "APS Task Force 3-Laboratory Diagnostics and Trends" meeting that took place during the 14th International Congress on Antiphospholipid Antibodies (APLA 2013, September 18-21, Rio de Janeiro, RJ, Brazil). Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Rover Landing Hardware at Eagle Crater, Mars

    NASA Image and Video Library

    2017-04-21

    The bright landing platform left behind by NASA's Mars Exploration Rover Opportunity in 2004 is visible inside Eagle Crater, at upper right in this April 8, 2017, observation by NASA's Mars Reconnaissance Orbiter. Mars Reconnaissance Orbiter arrived at Mars in March 2006, more than two years after Opportunity's landing on Jan. 25, 2004, Universal Time (Jan. 24, PDT). This is the first image of Eagle Crater from the orbiter's High Resolution Imaging Science Experiment (HiRISE) camera, which has optics that include the most powerful telescope ever sent to Mars. Eagle Crater is about 72 feet (22 meters) in diameter, at 1.95 degrees south latitude, 354.47 degrees east longitude, in the Meridiani Planum region of Mars. The airbag-cushioned lander, with Opportunity folded-up inside, first hit Martian ground near the crater, then bounced and rolled right into the crater. The lander structure was four triangles, folded into a tetrahedron until after the airbags deflated. The triangular petals then opened, exposing the rover. A week later, the rover drove off (see PIA05214), and the landing platform's job was done. The spacecraft's backshell and parachute, jettisoned during final descent, are visible near the lower left corner of this scene. The blue tint of the backshell is an effect of exaggerated color, because HiRISE combines color information from red, blue-green and infrared portions of the spectrum, rather than three different visible-light colors, so its color images are not true color. Opportunity examined Eagle Crater for more than half of the rover's originally planned three-month mission, before driving east and south to larger craters. At Eagle, it found headline-making evidence that water once flowed over the surface and soaked the subsurface of the area. By the time this orbital image of the landing site was taken, about 13 years after the rover departed Eagle, Opportunity had driven more than 27 miles (44 kilometers) and was actively exploring the rim of

  13. 78 FR 65238 - Proposed Establishment of Class E Airspace; Eagle, AK

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-31

    ...-0777; Airspace Docket No. 12-AAL-16] Proposed Establishment of Class E Airspace; Eagle, AK AGENCY... action proposes to establish Class E airspace at Eagle Airport, Eagle, AK. Controlled airspace is... management of aircraft operations at Eagle Airport, Eagle, AK. DATES: Comments must be received on or before...

  14. Genetics of Type III Bartter Syndrome in Spain, Proposed Diagnostic Algorithm

    PubMed Central

    García Castaño, Alejandro; Pérez de Nanclares, Gustavo; Madariaga, Leire; Aguirre, Mireia; Madrid, Alvaro; Nadal, Inmaculada; Navarro, Mercedes; Lucas, Elena; Fijo, Julia; Espino, Mar; Espitaletta, Zilac; Castaño, Luis; Ariceta, Gema

    2013-01-01

    The p.Ala204Thr mutation (exon 7) of the CLCNKB gene is a "founder" mutation that causes most of type III Bartter syndrome cases in Spain. We performed genetic analysis of the CLCNKB gene, which encodes for the chloride channel protein ClC-Kb, in a cohort of 26 affected patients from 23 families. The diagnostic algorithm was: first, detection of the p.Ala204Thr mutation; second, detecting large deletions or duplications by Multiplex Ligation-dependent Probe Amplification and Quantitative Multiplex PCR of Short Fluorescent Fragments; and third, sequencing of the coding and flanking regions of the whole CLCNKB gene. In our genetic diagnosis, 20 families presented with the p.Ala204Thr mutation. Of those, 15 patients (15 families) were homozygous (57.7% of overall patients). Another 8 patients (5 families) were compound heterozygous for the founder mutation together with a second one. Thus, 3 patients (2 siblings) presented with the c. -19-?_2053+? del deletion (comprising the entire gene); one patient carried the p.Val170Met mutation (exon 6); and 4 patients (3 siblings) presented with the novel p.Glu442Gly mutation (exon 14). On the other hand, another two patients carried two novel mutations in compound heterozygosis: one presented the p.Ile398_Thr401del mutation (exon 12) associated with the c. -19-?_2053+? del deletion, and the other one carried the c.1756+1G>A splice-site mutation (exon 16) as well as the already described p.Ala210Val change (exon 7). One case turned out to be negative in our genetic screening. In addition, 51 relatives were found to be heterozygous carriers of the described CLCNKB mutations. In conclusion, different mutations cause type III Bartter syndrome in Spain. The high prevalence of the p.Ala204Thr in Spanish families thus justifies an initial screen for this mutation. However, should it not be detected further investigation of the CLCNKB gene is warranted in clinically diagnosed families. PMID:24058621

  15. [Diagnostic value of urinary free cortisol in the subclinical Cushing's syndrome in patients with adrenal incidentaloma].

    PubMed

    Li, L L; Zhao, L; Dou, J T; Yang, G Q; Gu, W J; Lü, Z H; Ba, J M; Mu, Y M

    2017-12-12

    Objective: To evaluate the efficacy of 24 h urinary free cortisol (24 h UFC) in the diagnosis of subclinical Cushing's syndrome (SCS), and explore the best diagnostic cut-off value. Methods: The clinical data of patients with adrenal incidentaloma in Chinese PLA General Hospital between January 2008 and December 2016 was retrospectively reviewed and analyzed. All SCS patients were diagnosed based on the current Cushing's syndrome (CS) guidelines and confirmed by histopathology and then treated as study group, and additional patients with non-functional adrenal adenoma (NFA) were enrolled as control group. ROC curve was used to evaluate efficacy of 24 h UFC and 24 h UFC to creatinine ratio (UFCCR), and explore their best cut-off values. Results: There were 161 patients with NFA, of which contained 84 males and 77 females, with a mean age of (51.02±10.49) years old. There were 88 patients with SCS, of which contained 26 males and 62 females, with a mean age of (51.74±10.29) years old. The 24 h UFC and UFCCR levels were significant higher in SCS group than those in NFA group[510 (363, 698) nmol vs 335 (209, 467) nmol for 24 h UFC, and 7.82(4.79, 12.13) ml vs 4.82(2.41, 6.57)ml for UFCCR, both P <0.05]. ROC analysis showed that the optimal cut-off for 24 h UFC was 480 nmol (AUC 0.716, 95% CI: 0.648-0.784, with a sensitivity of 58.0% and a specificity of 79.4%) and the optimal cut-off for UFCCR was 6.84 ml (AUC 0.729, 95% CI: 0.662-0.796, with a sensitivity of 59.1% and a specificity of 78.7%). Conclusions: The recommended cut-off points of 24 h UFC and UFCCR for diagnosing SCS in AI patients were 480 nmol and 6.84 ml, respectively.

  16. Genetics of type III Bartter syndrome in Spain, proposed diagnostic algorithm.

    PubMed

    García Castaño, Alejandro; Pérez de Nanclares, Gustavo; Madariaga, Leire; Aguirre, Mireia; Madrid, Alvaro; Nadal, Inmaculada; Navarro, Mercedes; Lucas, Elena; Fijo, Julia; Espino, Mar; Espitaletta, Zilac; Castaño, Luis; Ariceta, Gema

    2013-01-01

    The p.Ala204Thr mutation (exon 7) of the CLCNKB gene is a "founder" mutation that causes most of type III Bartter syndrome cases in Spain. We performed genetic analysis of the CLCNKB gene, which encodes for the chloride channel protein ClC-Kb, in a cohort of 26 affected patients from 23 families. The diagnostic algorithm was: first, detection of the p.Ala204Thr mutation; second, detecting large deletions or duplications by Multiplex Ligation-dependent Probe Amplification and Quantitative Multiplex PCR of Short Fluorescent Fragments; and third, sequencing of the coding and flanking regions of the whole CLCNKB gene. In our genetic diagnosis, 20 families presented with the p.Ala204Thr mutation. Of those, 15 patients (15 families) were homozygous (57.7% of overall patients). Another 8 patients (5 families) were compound heterozygous for the founder mutation together with a second one. Thus, 3 patients (2 siblings) presented with the c. -19-?_2053+? del deletion (comprising the entire gene); one patient carried the p.Val170Met mutation (exon 6); and 4 patients (3 siblings) presented with the novel p.Glu442Gly mutation (exon 14). On the other hand, another two patients carried two novel mutations in compound heterozygosis: one presented the p.Ile398_Thr401del mutation (exon 12) associated with the c. -19-?_2053+? del deletion, and the other one carried the c.1756+1G>A splice-site mutation (exon 16) as well as the already described p.Ala210Val change (exon 7). One case turned out to be negative in our genetic screening. In addition, 51 relatives were found to be heterozygous carriers of the described CLCNKB mutations. In conclusion, different mutations cause type III Bartter syndrome in Spain. The high prevalence of the p.Ala204Thr in Spanish families thus justifies an initial screen for this mutation. However, should it not be detected further investigation of the CLCNKB gene is warranted in clinically diagnosed families.

  17. Measured parental height in Turner syndrome-a valuable but underused diagnostic tool.

    PubMed

    Ouarezki, Yasmine; Cizmecioglu, Filiz Mine; Mansour, Chourouk; Jones, Jeremy Huw; Gault, Emma Jane; Mason, Avril; Donaldson, Malcolm D C

    2018-02-01

    Early diagnosis of Turner syndrome (TS) is necessary to facilitate appropriate management, including growth promotion. Not all girls with TS have overt short stature, and comparison with parental height (Ht) is needed for appropriate evaluation. We examined both the prevalence and diagnostic sensitivity of measured parental Ht in a dedicated TS clinic between 1989 and 2013. Lower end of parental target range (LTR) was calculated as mid-parental Ht (correction factor 12.5 cm minus 8.5 cm) and converted to standard deviation scores (SDS) using UK 1990 data, then compared with patient Ht SDS at first accurate measurement aged > 1 year. Information was available in 172 girls of whom 142 (82.6%) were short at first measurement. However, both parents had been measured in only 94 girls (54.6%). In 92 of these girls age at measurement was 6.93 ± 3.9 years, Ht SDS vs LTR SDS - 2.63 ± 0.94 vs - 1.77 ± 0.81 (p < 0.001), Ht SDS < LTR in 78/92 (85%). Eleven of the remaining 14 girls were < 5 years, while karyotype was 45,X/46,XX in 2 and 45,X/47,XXX in 3. This study confirms the sensitivity of evaluating height status against parental height but shows that the latter is not being consistently measured. What is Known: • Girls with Turner syndrome are short in relation to parental heights, with untreated final height approximately 20 cm below female population mean. • Measured parental height is more accurate than reported height. What is New: • In a dedicated Turner clinic, there was 85% sensitivity when comparing patient height standard deviation score at first accurate measurement beyond 1 year of age with the lower end of the parental target range standard deviation. • However, measured height in both parents had been recorded in only 54.6% of the Turner girls attending the clinic. This indicates the need to improve the quality of growth assessment in tertiary care.

  18. Postural orthostatic tachycardia is not a useful diagnostic marker for chronic fatigue syndrome.

    PubMed

    Roerink, M E; Lenders, J W M; Schmits, I C; Pistorius, A M A; Smit, J W; Knoop, H; van der Meer, J W M

    2017-02-01

    Postural orthostatic tachycardia syndrome (POTS) is considered a diagnostic marker for chronic fatigue syndrome (CFS). The aims of this study were to (i) compare POTS prevalence in a CFS cohort with fatigued patients not meeting CFS criteria, and (ii) assess activity, impairment and response to cognitive behavioural therapy (CBT) in CFS patients with POTS (POTS-CFS) and without POTS (non-POTS-CFS). Prospective cohort study at the Radboud University Medical Centre in the Netherlands. Between June 2013 and December 2014, 863 consecutive patients with persistent fatigue were screened. Patients underwent an active standing test, filled out questionnaires and wore an activity-sensing device for a period of 12 days. A total of 419 patients with CFS and 341 non-CFS fatigued patients were included in the study. POTS prevalence in adult patients with CFS was 5.7% vs. 6.9% in non-CFS adults (P = 0.54). In adolescents, prevalence rates were 18.2% and 17.4%, respectively (P = 0.93). Adult patients with POTS-CFS were younger (30 ± 12 vs. 40 ± 13 years, P = 0.001) and had a higher supine heart rate (71 ± 11 vs. 65 ± 9 beats per min, P = 0.009) compared with non-POTS-CFS patients. Severity and activity patterns did not differ between groups. In patients with CFS, criteria for Systemic Exertion Intolerance Disease (SEID) were met in 76% of adults and 67% of adolescents. In these patients with CFS fulfilling the SEID criteria, the prevalence of POTS was not different from that in the overall CFS population. POTS-CFS adolescents had less clinically significant improvement after CBT than non-POTS-CFS adolescents (58% vs. 88%, P = 0.017). In adults with CFS, the prevalence of POTS was low, was not different from the rate in non-CFS fatigued patients and was not related to disease severity or treatment outcome. In POTS-CFS adolescents, CBT was less successful than in non-POTS-CFS patients. The evaluation of POTS appears to be of limited value for the diagnosis of CFS. © 2016 The

  19. Pediatric post-thrombotic syndrome in children: Toward the development of a new diagnostic and evaluative measurement tool.

    PubMed

    Avila, M L; Brandão, L R; Williams, S; Ward, L C; Montoya, M I; Stinson, J; Kiss, A; Lara-Corrales, I; Feldman, B M

    2016-08-01

    Our goal was to conduct the item generation and piloting phases of a new discriminative and evaluative tool for pediatric post-thrombotic syndrome. We followed a formative model for the development of the tool, focusing on the signs/symptoms (items) that define post-thrombotic syndrome. For item generation, pediatric thrombosis experts and subjects diagnosed with extremity post-thrombotic syndrome during childhood nominated items. In the piloting phase, items were cross-sectionally measured in children with limb deep vein thrombosis to examine item performance. Twenty-three experts and 16 subjects listed 34 items, which were then measured in 140 subjects with previous diagnosis of limb deep vein thrombosis (70 upper extremity and 70 lower extremity). The items with strongest correlation with post-thrombotic syndrome severity and largest area under the curve were pain (in older children), paresthesia, and swollen limb for the upper extremity group, and pain (in older children), tired limb, heaviness, tightness and paresthesia for the lower extremity group. The diagnostic properties of the items and their correlations with post-thrombotic syndrome severity varied according to the assessed venous territory. The information gathered in this study will help experts decide which item should be considered for inclusion in the new tool. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Limited Diagnostic Utility of Plasma Adrenocorticotropic Hormone for Differentiation between Adrenal Cushing Syndrome and Cushing Disease.

    PubMed

    Hong, A Ram; Kim, Jung Hee; Hong, Eun Shil; Kim, I Kyeong; Park, Kyeong Seon; Ahn, Chang Ho; Kim, Sang Wan; Shin, Chan Soo; Kim, Seong Yeon

    2015-09-01

    Measurement of the plasma adrenocorticotropic hormone (ACTH) level has been recommended as the first diagnostic test for differentiating between ACTH-independent Cushing syndrome (CS) and ACTH-dependent CS. When plasma ACTH values are inconclusive, a differential diagnosis of CS can be made based upon measurement of the serum dehydroepiandrosterone sulfate (DHEA-S) level and results of the high-dose dexamethasone suppression test (HDST). The aim of this study was to assess the utility of plasma ACTH to differentiate adrenal CS from Cushing' disease (CD) and compare it with that of the HDST results and serum DHEA-S level. We performed a retrospective, multicenter study from January 2000 to May 2012 involving 92 patients with endogenous CS. The levels of plasma ACTH, serum cortisol, 24-hour urine free cortisol (UFC) after the HDST, and serum DHEA-S were measured. Fifty-seven patients had adrenal CS and 35 patients had CD. The area under the curve of plasma ACTH, serum DHEA-S, percentage suppression of serum cortisol, and UFC after HDST were 0.954, 0.841, 0.950, and 0.997, respectively (all P<0.001). The cut-off values for plasma ACTH, percentage suppression of serum cortisol, and UFC after HDST were 5.3 pmol/L, 33.3%, and 61.6%, respectively. The sensitivity and specificity of plasma ACTH measurement were 84.2% and 94.3%, those of serum cortisol were 95.8% and 90.6%, and those of UFC after the HDST were 97.9% and 96.7%, respectively. Significant overlap in plasma ACTH levels was seen between patients with adrenal CS and those with CD. The HDST may be useful in differentiating between these forms of the disease, especially when the plasma ACTH level alone is not conclusive.

  1. [Diagnostic concordance between seven definitions of metabolic syndrome in overweight and obese adults].

    PubMed

    Cabrera-Rode, Eduardo; Stusser, Beatriz; Cálix, Wenny; Orlandi, Neraldo; Rodríguez, Janet; Cubas-Dueñas, Ileana; Echevarría, Ragmila; Álvarez, Aimee

    2017-01-01

    The aim of this study was to determine the level of diagnostic concordance between seven definitions of metabolic syndrome (MS) in a group of overweight and obese adults. 350 subjects aged from 19 to 70 years were recruited for study from a clinic for overweight and obese subjects. The definitions of MS used were those given by the WHO (World Health Organization), EGIR (European Group for the Study of Insulin Resistance), NCEP- ATPIII (Adult Treatment Panel), AHA/NHLBI (American Heart Association), IDF (International Diabetes Federation), and JIS (Joint Interim Statement) as well as the Szabo criteria. Concordance between the definitions was calculated with the Kappa coefficient. Insulin resistance (IR) was assessed using the HOMA-IR index. According to the Szabo, WHO, EGIR, NCEP-ATPIII, AHA/NHLBI, IDF, and JIS criteria, MS frequency was 74.3%, 42.0%, 46.8%, 56.0%, 52.9%, 58.6%, and 58.6%, respectively. The concordance between the Szabo and AHA/NHLBI criteria was 0.559, while the Kappa coefficient between the Szabo criteria and the rest of the guides (NCEP-ATPIII, IDF, and JIS) was from 0.612 to 0.657, respectively. The concordance of the WHO with the EGIR was 0.602, but it was between 0.358 and 0.422 with the other guidelines. IR was distributed similarly in all guidelines. There is a considerable concordance between the NCEP-ATPIII, IDF, and JIS guidelines and the Szabo criteria. The Szabo criteria could be an option for the active surveillance of MS in populations.

  2. Self-reported dietary fructose intolerance in irritable bowel syndrome: Proposed diagnostic criteria.

    PubMed

    Berg, Leif Kyrre; Fagerli, Erik; Myhre, Arnt-Otto; Florholmen, Jon; Goll, Rasmus

    2015-05-14

    To study the criteria for self-reported dietary fructose intolerance (DFI) and to evaluate subjective global assessment (SGA) as outcome measure. Irritable bowel syndrome (IBS) patients were randomized in an open study design with a 2 wk run-in on a habitual IBS diet, followed by 12 wk with/without additional fructose-reduced diet (FRD). Daily registrations of stool frequency and consistency, and symptoms on a visual analog scale (VAS) were performed during the first 4 wk. SGA was used for weekly registrations during the whole study period. Provocation with high-fructose diet was done at the end of the registration period. Fructose breath tests (FBTs) were performed. A total of 182 subjects performed the study according to the protocol (88 FRD, 94 controls). We propose a new clinically feasible diagnostic standard for self-reported fructose intolerance. The instrument is based on VAS registrations of symptom relief on FRD combined with symptom aggravation upon provocation with fructose-rich diet. Using these criteria 43 of 77 patients (56%) in the present cohort of IBS patients had self-reported DFI. To improve the concept for clinical evaluation, we translated the SGA scale instrument to Norwegian and validated it in the context of the IBS diet regimen. The validation procedures showed a sensitivity, specificity and κ value for SGA detecting the self-reported DFI group by FRD response within the IBS patients of 0.79, 0.75 and 0.53, respectively. Addition of the provocation test yielded values of 0.84, 0.76 and 0.61, respectively. The corresponding validation results for FBT were 0.57, 0.34 and -0.13, respectively. FRD improves symptoms in a subgroup of IBS patients. A diet trial followed by a provocation test evaluated by SGA can identify most responders to FRD.

  3. Diagnostic utility of daytime salivary melatonin levels in Smith-Magenis syndrome.

    PubMed

    Chik, Constance L; Rollag, Mark D; Duncan, Wallace C; Smith, Ann C M

    2010-01-01

    An inverted circadian rhythm of melatonin (MT) likely contributes to the sleep disturbance in patients with Smith-Magenis syndrome (SMS). Plasma MT levels have documented this altered rhythm, but daytime levels of salivary MT has not been determined. Daytime measures of salivary MT might have utility in home/outpatient settings for assessing MT levels in undiagnosed patients with clinical features of SMS. The objective of this study was to determine the utility of daytime salivary MT as a diagnostic test in SMS. Thirty individuals with confirmed SMS [28 with del 17p11.2 and 2 with the retinoic acid induced 1 (RAI1) gene mutation] and five controls were studied. Single or serial daytime salivary MT levels were measured. The mean midday salivary MT level was 79.0 pg/ml in SMS patients, compared with 16.3 pg/ml in controls, with nine patients having values similar to controls. The median MT level in SMS patients was 49.0 pg/ml (first and third quartile values = 15.5 and 106.8 pg/ml). Twenty-six (90%) of 29 patients had at least one MT value >15.5 pg/ml, including 70 (78%) of 90 samples from patients with del 17p11.2 and one (20%) of five samples from the two patients with the RAI1 mutation. Neither the pattern of medication use nor age had an effect on daytime salivary MT levels. Although most SMS patients had elevated daytime salivary MT levels, multiple sampling appears necessary to distinguish patients with SMS from other conditions.

  4. Self-reported dietary fructose intolerance in irritable bowel syndrome: Proposed diagnostic criteria

    PubMed Central

    Berg, Leif Kyrre; Fagerli, Erik; Myhre, Arnt-Otto; Florholmen, Jon; Goll, Rasmus

    2015-01-01

    AIM: To study the criteria for self-reported dietary fructose intolerance (DFI) and to evaluate subjective global assessment (SGA) as outcome measure. METHODS: Irritable bowel syndrome (IBS) patients were randomized in an open study design with a 2 wk run-in on a habitual IBS diet, followed by 12 wk with/without additional fructose-reduced diet (FRD). Daily registrations of stool frequency and consistency, and symptoms on a visual analog scale (VAS) were performed during the first 4 wk. SGA was used for weekly registrations during the whole study period. Provocation with high-fructose diet was done at the end of the registration period. Fructose breath tests (FBTs) were performed. A total of 182 subjects performed the study according to the protocol (88 FRD, 94 controls). RESULTS: We propose a new clinically feasible diagnostic standard for self-reported fructose intolerance. The instrument is based on VAS registrations of symptom relief on FRD combined with symptom aggravation upon provocation with fructose-rich diet. Using these criteria 43 of 77 patients (56%) in the present cohort of IBS patients had self-reported DFI. To improve the concept for clinical evaluation, we translated the SGA scale instrument to Norwegian and validated it in the context of the IBS diet regimen. The validation procedures showed a sensitivity, specificity and κ value for SGA detecting the self-reported DFI group by FRD response within the IBS patients of 0.79, 0.75 and 0.53, respectively. Addition of the provocation test yielded values of 0.84, 0.76 and 0.61, respectively. The corresponding validation results for FBT were 0.57, 0.34 and -0.13, respectively. CONCLUSION: FRD improves symptoms in a subgroup of IBS patients. A diet trial followed by a provocation test evaluated by SGA can identify most responders to FRD. PMID:25987795

  5. Mercury contamination in Idaho bald eagles, Haliaeetus leucocephalus.

    PubMed

    Bechard, Marc J; Perkins, Dusty N; Kaltenecker, Gregory S; Alsup, Steve

    2009-11-01

    Because mercury contamination is potentially threatening to bald eagle (Haliaeetus leucocephalus) populations, we collected molted feathers at nests to determine the level of contamination in bald eagles in the state of Idaho, USA. Eagle feathers contained measurable amounts of cadmium (Cd), chromium (Cr), selenium (Se), lead (Pb), as well as mercury (Hg). Cadmium, Cr, Se, and Pb levels averaged 0.17, 4.68, 2.02, and 1.29 mg/kg dry weight, respectively, and were at or below concentrations indicated as causing reproductive failure in bald eagles. Mercury contamination was found to be the highest averaging 18.74 mg/kg dry weight. Although a concentration of only 7.5 mg/kg dry weight Hg in bird feathers can cause reduced productivity and even sterility, all of the eagles we sampled bred successfully and the population of bald eagles continues to grow annually throughout the state.

  6. Eagle-i: Making Invisible Resources, Visible

    PubMed Central

    Haendel, M.; Wilson, M.; Torniai, C.; Segerdell, E.; Shaffer, C.; Frost, R.; Bourges, D.; Brownstein, J.; McInnerney, K.

    2010-01-01

    RP-134 The eagle-i Consortium – Dartmouth College, Harvard Medical School, Jackson State University, Morehouse School of Medicine, Montana State University, Oregon Health and Science University (OHSU), the University of Alaska, the University of Hawaii, and the University of Puerto Rico – aims to make invisible resources for scientific research visible by developing a searchable network of resource repositories at research institutions nationwide. Now in early development, it is hoped that the system will scale beyond the consortium at the end of the two-year pilot. Data Model & Ontology: The eagle-i ontology development team at the OHSU Library is generating the data model and ontologies necessary for resource indexing and querying. Our indexing system will enable cores and research labs to represent resources within a defined vocabulary, leading to more effective searches and better linkage between data types. This effort is being guided by active discussions within the ontology community (http://RRontology.tk) bringing together relevant preexisting ontologies in a logical framework. The goal of these discussions is to provide context for interoperability and domain-wide standards for resource types used throughout biomedical research. Research community feedback is welcomed. Architecture Development, led by a team at Harvard, includes four main components: tools for data collection, management and curation; an institutional resource repository; a federated network; and a central search application. Each participating institution will populate and manage their repository locally, using data collection and curation tools. To help improve search performance, data tools will support the semi-automatic annotation of resources. A central search application will use a federated protocol to broadcast queries to all repositories and display aggregated results. The search application will leverage the eagle-i ontologies to help guide users to valid queries via auto

  7. EAGLE CAP WILDERNESS AND ADJACENT AREAS, OREGON.

    USGS Publications Warehouse

    Kilsgaard, Thor H.; Tuchek, Ernest T.

    1984-01-01

    On the basis of a mineral survey of the Eagle Cap Wilderness and adjacent areas a probable mineral-resources potential was identified in five areas in the eastern part of the wilderness. Mineral resources are most likely to occur in tactite deposits in sedimentary rocks at or near contacts with intrusive granitic rocks that could contain copper and small amounts of other metals; however, there is little promise for the occurrence of energy resources.

  8. Wintering bald eagle trends in northern Arizona, 1975-2000

    Treesearch

    Teryl G. Grubb

    2003-01-01

    Between 1975 and 2000, 4,525 sightings of wintering bald eagles (Haliaeetus leucocephalus) were recorded at Mormon Lake in northern Arizona. Numbers of wintering eagles fluctuated little in the 20 years from 1975 through 1994 (5.5 ± 3.0 mean sightings per day). However, during the winters of 1995 through 1997 local record highs of 59 to 118 eagles...

  9. Program Monitoring with LTL in EAGLE

    NASA Technical Reports Server (NTRS)

    Barringer, Howard; Goldberg, Allen; Havelund, Klaus; Sen, Koushik

    2004-01-01

    We briefly present a rule-based framework called EAGLE, shown to be capable of defining and implementing finite trace monitoring logics, including future and past time temporal logic, extended regular expressions, real-time and metric temporal logics (MTL), interval logics, forms of quantified temporal logics, and so on. In this paper we focus on a linear temporal logic (LTL) specialization of EAGLE. For an initial formula of size m, we establish upper bounds of O(m(sup 2)2(sup m)log m) and O(m(sup 4)2(sup 2m)log(sup 2) m) for the space and time complexity, respectively, of single step evaluation over an input trace. This bound is close to the lower bound O(2(sup square root m) for future-time LTL presented. EAGLE has been successfully used, in both LTL and metric LTL forms, to test a real-time controller of an experimental NASA planetary rover.

  10. Wintering Golden Eagles on the coastal plain of South Carolina

    DOE PAGES

    Vukovich, Mark; Turner, Kelsey L.; Grazia, Tracy E.; ...

    2015-10-01

    Golden Eagles (Aquila chrysaetos) are rare winter residents in eastern North America, with most found along the Appalachian Mountains and few reported on the coastal plain of the Carolinas. We used remote cameras baited with wild pig (Sus scrofa) and white-tailed deer (Odocoileus virginianus) carcasses to detect, age, and individually identify Golden Eagles on the U.S. Department of Energy’s Savannah River Site on the coastal plain of South Carolina. We identified eight individual Golden Eagles during the winters of 2013–2014 and 2014–2015, with one detected during both winters. We detected eagles for 19 and 66 calendar days during the wintersmore » of 2013–2014 and 2014–2015, respectively, with two adult eagles detected for 30 and 31 calendar days in 2014–2015. Eagles typically scavenged on carcasses for a few days, left, and then returned when cameras were baited with another carcass, suggesting they had remained in the area. These observations suggest that large tracts of forests on the coastal plain may be important wintering areas for some Golden Eagles and, further, that other areas in the coastal plain of the southeastern United States may also harbor wintering eagles. Identification of wintering areas of Golden Eagles in the east will be an important step in the conservation of this protected species, and camera traps baited with carcasses can be an effective tool for such work.« less

  11. Modeling climate change impacts on overwintering bald eagles.

    PubMed

    Harvey, Chris J; Moriarty, Pamela E; Salathé, Eric P

    2012-03-01

    Bald eagles (Haliaeetus leucocephalus) are recovering from severe population declines, and are exerting pressure on food resources in some areas. Thousands of bald eagles overwinter near Puget Sound, primarily to feed on chum salmon (Oncorhynchus keta) carcasses. We used modeling techniques to examine how anticipated climate changes will affect energetic demands of overwintering bald eagles. We applied a regional downscaling method to two global climate change models to obtain hourly temperature, precipitation, wind, and longwave radiation estimates at the mouths of three Puget Sound tributaries (the Skagit, Hamma Hamma, and Nisqually rivers) in two decades, the 1970s and the 2050s. Climate data were used to drive bald eagle bioenergetics models from December to February for each river, year, and decade. Bald eagle bioenergetics were insensitive to climate change: despite warmer winters in the 2050s, particularly near the Nisqually River, bald eagle food requirements declined only slightly (<1%). However, the warming climate caused salmon carcasses to decompose more rapidly, resulting in 11% to 14% less annual carcass biomass available to eagles in the 2050s. That estimate is likely conservative, as it does not account for decreased availability of carcasses due to anticipated increases in winter stream flow. Future climate-driven declines in winter food availability, coupled with a growing bald eagle population, may force eagles to seek alternate prey in the Puget Sound area or in more remote ecosystems.

  12. Wintering Golden Eagles on the coastal plain of South Carolina

    SciTech Connect

    Vukovich, Mark; Turner, Kelsey L.; Grazia, Tracy E.

    Golden Eagles (Aquila chrysaetos) are rare winter residents in eastern North America, with most found along the Appalachian Mountains and few reported on the coastal plain of the Carolinas. We used remote cameras baited with wild pig (Sus scrofa) and white-tailed deer (Odocoileus virginianus) carcasses to detect, age, and individually identify Golden Eagles on the U.S. Department of Energy’s Savannah River Site on the coastal plain of South Carolina. We identified eight individual Golden Eagles during the winters of 2013–2014 and 2014–2015, with one detected during both winters. We detected eagles for 19 and 66 calendar days during the wintersmore » of 2013–2014 and 2014–2015, respectively, with two adult eagles detected for 30 and 31 calendar days in 2014–2015. Eagles typically scavenged on carcasses for a few days, left, and then returned when cameras were baited with another carcass, suggesting they had remained in the area. These observations suggest that large tracts of forests on the coastal plain may be important wintering areas for some Golden Eagles and, further, that other areas in the coastal plain of the southeastern United States may also harbor wintering eagles. Identification of wintering areas of Golden Eagles in the east will be an important step in the conservation of this protected species, and camera traps baited with carcasses can be an effective tool for such work.« less

  13. Modeling climate change impacts on overwintering bald eagles

    PubMed Central

    Harvey, Chris J; Moriarty, Pamela E; Salathé Jr, Eric P

    2012-01-01

    Bald eagles (Haliaeetus leucocephalus) are recovering from severe population declines, and are exerting pressure on food resources in some areas. Thousands of bald eagles overwinter near Puget Sound, primarily to feed on chum salmon (Oncorhynchus keta) carcasses. We used modeling techniques to examine how anticipated climate changes will affect energetic demands of overwintering bald eagles. We applied a regional downscaling method to two global climate change models to obtain hourly temperature, precipitation, wind, and longwave radiation estimates at the mouths of three Puget Sound tributaries (the Skagit, Hamma Hamma, and Nisqually rivers) in two decades, the 1970s and the 2050s. Climate data were used to drive bald eagle bioenergetics models from December to February for each river, year, and decade. Bald eagle bioenergetics were insensitive to climate change: despite warmer winters in the 2050s, particularly near the Nisqually River, bald eagle food requirements declined only slightly (<1%). However, the warming climate caused salmon carcasses to decompose more rapidly, resulting in 11% to 14% less annual carcass biomass available to eagles in the 2050s. That estimate is likely conservative, as it does not account for decreased availability of carcasses due to anticipated increases in winter stream flow. Future climate-driven declines in winter food availability, coupled with a growing bald eagle population, may force eagles to seek alternate prey in the Puget Sound area or in more remote ecosystems. PMID:22822430

  14. Corneal Deformation Response and Ocular Geometry: A Noninvasive Diagnostic Strategy in Marfan Syndrome.

    PubMed

    Beene, Lauren C; Traboulsi, Elias I; Seven, Ibrahim; Ford, Matthew R; Sinha Roy, Abhijit; Butler, Robert S; Dupps, William J

    2016-01-01

    To evaluate corneal air-puff deformation responses and ocular geometry as predictors of Marfan syndrome. Prospective observational clinical study. Sixteen investigator-derived, 4 standard Ocular Response Analyzer (ORA), and geometric variables from corneal tomography and optical biometry using Oculus Pentacam and IOL Master were assessed for discriminative value in Marfan syndrome, measuring right eyes of 24 control and 13 Marfan syndrome subjects. Area under the receiver operating characteristic (AUROC) curve was assessed in univariate and multivariate analyses. Six investigator-derived ORA variables successfully discriminated Marfan syndrome. The best lone disease predictor was Concavity Min (Marfan syndrome 47.5 ± 20, control 69 ± 14, P = .003; AUROC = 0.80). Corneal hysteresis (CH) and corneal resistance factor (CRF) were decreased (Marfan syndrome CH 9.45 ± 1.62, control CH 11.24 ± 1.21, P = .01; Marfan syndrome CRF 9.77 ± 1.65, control CRF 11.03 ± 1.72, P = .01) and corneas were flatter in Marfan syndrome (Marfan syndrome Kmean 41.25 ± 2.09 diopter, control Kmean 42.70 ± 1.81 diopter, P = .046). No significant differences were observed in central corneal thickness, axial eye length, or intraocular pressure. A multivariate regression model incorporating corneal curvature and hysteresis loop area (HLA) provided the best predictive value for Marfan syndrome (AUROC = 0.85). This study describes novel biodynamic features of corneal deformation responses in Marfan syndrome, including increased deformation, decreased bending resistance, and decreased energy dissipation capacity. A predictive model incorporating HLA and corneal curvature shows greatest potential for noninvasive clinical diagnosis of Marfan syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Corneal Deformation Response and Ocular Geometry: A Non-invasive Diagnostic Strategy in Marfan Syndrome

    PubMed Central

    Beene, Lauren C.; Traboulsi, Elias I.; Seven, Ibrahim; Ford, Matthew R.; Roy, Abhijit Sinha; Butler, Robert S.; Dupps, William J.

    2015-01-01

    Purpose To evaluate corneal air-puff deformation responses and ocular geometry as predictors of Marfan syndrome. Design Prospective observational clinical study Methods Sixteen investigator-derived, 4 standard Ocular Response Analyzer (ORA), and geometric variables from corneal tomography and optical biometry using Oculus Pentacam and IOL Master were assessed for discriminative value in Marfan syndrome, measuring right eyes of 24 control and 13 Marfan syndrome subjects. Area under the receiver operating characteristic (AUROC) curve was assessed in univariate and multivariate analyses Results Six investigator-derived ORA variables successfully discriminated Marfan syndrome. The best lone disease predictor was Concavity Min (Marfan syndrome 47.5 ± 20, control 69 ± 14, p = 0.003; AUROC = 0.80). Corneal hysteresis and corneal resistance factor were decreased (Marfan syndrome CH 9.45 ± 1.62, control CH 11.24 ± 1.21, p = 0.01; Marfan syndrome CRF 9.77 ± 1.65, control CRF 11.03 ± 1.72, p = 0.01) and corneas were flatter in Marfan syndrome (Marfan syndrome Kmean 41.25 ± 2.09 D, control Kmean 42.70 ± 1.81 D, p = 0.046). No significant differences were observed in central corneal thickness, axial eye length, or intraocular pressure. A multivariate regression model incorporating corneal curvature and hysteresis loop area (HLA) provided the best predictive value for Marfan syndrome (AUROC = 0.85). Conclusions This study describes novel biodynamic features of corneal deformation responses in Marfan syndrome, including increased deformation, decreased bending resistance, and decreased energy dissipation capacity. A predictive model incorporating HLA and corneal curvature shows greatest potential for non-invasive clinical diagnosis of Marfan syndrome. PMID:26432567

  16. Diagnostic values of different definitions of metabolic syndrome to detect poor health status in Iranian adults without diabetes.

    PubMed

    Amiri, P; Deihim, T; Hosseinpanah, F; Barzin, M; Hasheminia, M; Montazeri, A; Azizi, F

    2014-07-01

    This study aimed to compare the diagnostic impact of four definitions of the metabolic syndrome for detection of poor health status in adults without diabetes living in Tehran. A representative sample of 950 individuals (64% women), aged ≥ 20 years, participants of the Tehran Lipid and Glucose Study in 2005-2007, were recruited for the study. Health status was assessed using the Iranian version of the 36-item Short Form Health Survey. We assessed the detectability of poor health status by definitions of the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation, the American Heart Association/National Heart, Lung, and the Blood Institute and the Joint Interim Statement. Compared with other definitions, the Joint Interim Statement identified more participants (46.9%) having the metabolic syndrome. Using the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation and the Joint Interim Statement, the metabolic syndrome was significantly related to poor physical health status, even after adjustment for confounding variables, in women, but not in men. None of the four definitions of the metabolic syndrome was related to the mental health status in either gender. The receiver operating characteristic curves showed no significant difference in the discriminative power of the metabolic syndrome definitions in detecting poor health status in either gender. However, women showed a higher area under the curve for all definitions, in comparison with men. There was no difference in the four different definitions of the metabolic syndrome in detecting poor health status among Iranian adults. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

  17. Daedalus Project's Light Eagle - Human powered aircraft

    NASA Technical Reports Server (NTRS)

    1987-01-01

    The Michelob Light Eagle is seen here in flight over Rogers Dry Lake at the NASA Dryden Flight Research Center, Edwards, California. The Light Eagle and Daedalus human powered aircraft were testbeds for flight research conducted at Dryden between January 1987 and March 1988. These unique aircraft were designed and constructed by a group of students, professors, and alumni of the Massachusetts Institute of Technology within the context of the Daedalus project. The construction of the Light Eagle and Daedalus aircraft was funded primarily by the Anheuser Busch and United Technologies Corporations, respectively, with additional support from the Smithsonian Air and Space Museum, MIT, and a number of other sponsors. To celebrate the Greek myth of Daedalus, the man who constructed wings of wax and feathers to escape King Minos, the Daedalus project began with the goal of designing, building and testing a human-powered aircraft that could fly the mythical distance, 115 km. To achieve this goal, three aircraft were constructed. The Light Eagle was the prototype aircraft, weighing 92 pounds. On January 22, 1987, it set a closed course distance record of 59 km, which still stands. Also in January of 1987, the Light Eagle was powered by Lois McCallin to set the straight distance, the distance around a closed circuit, and the duration world records for the female division in human powered vehicles. Following this success, two more aircraft were built, the Daedalus 87 and Daedalus 88. Each aircraft weighed approximately 69 pounds. The Daedalus 88 aircraft was the ship that flew the 199 km from the Iraklion Air Force Base on Crete in the Mediterranean Sea, to the island of Santorini in 3 hours, 54 minutes. In the process, the aircraft set new records in distance and endurance for a human powered aircraft. The specific areas of flight research conducted at Dryden included characterizing the rigid body and flexible dynamics of the Light Eagle, investigating sensors for an

  18. Media hype, diagnostic fad or genuine disorder? Professionals' opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emetophobia.

    PubMed

    Vandereycken, Walter

    2011-01-01

    Many "new" syndromes have been proposed for inclusion in the DSM-V. Some disorders acquired popularity through the Internet, but will they be taken seriously and get accepted by the scientific community? We organized an opinion poll among professionals in the field of eating disorders by presenting them a provisional set of diagnostic criteria of four "new" disorders: Night Eating Syndrome, Orthorexia, Muscle Dysmorphia, and Emetophobia. In general, the opinions did not differ much according to the characteristics of the 111 respondents. Among these professionals, Orthorexia is the best known and Night Eating Syndrome the least. Although the majority is familiar with the concept of Muscle Dysmorphia, it is most often viewed as a creation of the popular media and rarely observed in daily practice. In contrast, the other three disorders seem to be taken more seriously in the sense of "genuine" syndromes, which should receive more attention in research and clinical practice. Emetophobia appears to be the least "fashionable" of the four. The findings are discussed in the light of medialization and medicalization.

  19. MR-defecography in obstructed defecation syndrome (ODS): technique, diagnostic criteria and grading.

    PubMed

    Piloni, V; Tosi, P; Vernelli, M

    2013-10-01

    The aim of this study was to evaluate the use of a magnetic resonance (MR)-based classification system of obstructive defecation syndrome (ODS) to guide physicians in patient management. The medical records and imaging series of 105 consecutive patients (90 female, 15 male, aged 21-78 years, mean age 46.1 ± 5.1 years) referred to our center between April 2011 and January 2012 for symptoms of ODS were retrospectively examined. After history taking and a complete clinical examination, patients underwent MR imaging according to a standard protocol using a 0.35 T permanent field, horizontally oriented open-configuration magnet. Static and dynamic MR-defecography was performed using recognized parameters and well-established diagnostic criteria. Sixty-seven out of 105 (64 %) patients found the prone position more comfortable for the evacuation of rectal contrast while 10/105 (9.5 %) were unable to empty their rectum despite repeated attempts. Increased hiatus size, anterior rectocele and focal or extensive defects of the levator ani muscle were the most frequent abnormalities (67.6, 60.0 and 51.4 %, respectively). An MR-based classification was developed based on the combinations of abnormalities found: Grade 1 = functional abnormality, including paradoxical contraction of the puborectalis muscle, without anatomical defect affecting the musculo-fascial structures; Grade 2 = functional defect associated with a minor anatomical defect such as rectocele ≤ 2 cm in size and/or first-degree intussusception; Grade 3 = severe defects confined to the posterior anatomical compartment, including >2 cm rectocele, second- or higher-degree intussusception, full-thickness external rectal prolapse, poor mesorectal posterior fixation, rectal descent >5 cm, levator ani muscle rupture, ballooning of the levator hiatus and focal detachment of the endopelvic fascia; Grade 4 = combined defects of two or three pelvic floor compartments, including cystocele, hysterocele, enlarged urogenital

  20. Acute Respiratory Distress Syndrome diagnosis after coronary artery bypass: comparison between diagnostic criteria and clinical picture.

    PubMed

    Vakili, Manzar; Shirani, Shapour; Paknejad, Omalbanin; Yousefshahi, Fardin

    2015-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a potential complication of cardiac surgery, given that patients undergoing CABG frequently have hypoxemia and pulmonary dysfunction during initial hours after surgery. Thus, ARDS criteria in these patients are more likely to be positive while these criteria may not match the patient`s clinical picture. We aimed to investigate frequency of rapid onset hypoxemia in Pressure of Arterial Oxygen to Fractional Inspired Oxygen Concentration (PaO2/FiO2) less than 200 and diffuse pulmonary infiltrates as two diagnostic criteria forwards and compared these criteria with the clinical picture of the patients after Coronary Artery Bypass Graft (CABG) in this study. The study was prospective case series which carried out in about six months. All patients admitted to intensive care unit of Tehran Heart Center, who had undergone CABG on cardiopulmonary pump (CPB) recruited in the study. After considering inclusion criteria, age, sex, duration of intubation, arterial blood gas and chest radiography, on 24 hours and 48 hours after admission to the ICU were recorded. Then, patients with rapid onset of hypoxemia (PaO2/FiO2≤200mmHg) and diffuse pulmonary infiltrates and without sign or symptoms of obvious heart failure (probable positive ARDS cases) criteria were recorded and comparison between these probable positive cases with clinician`s clinical diagnosis (blinded to the study) was performed. In this study, a total of 300 patients after on-pump coronary artery bypass surgery were included. Postoperatively, 2 (0.66 %) in the 24 hours and 4 (1.33%) patients in 48 hours after surgery were positive for the two ARDS criteria according to the checklists, but; nobody had saved persistently ARDS criteria persistently during 48 hours after surgery. At the same time, clinician did not report any case of ARDS among 300 patients. In this study patients with ARDS criteria had no significant differences in age (P.value=0.937) and sex (P.value=0

  1. Inguinal ovary as a rare diagnostic sign of Mayer-Rokitansky-Küster-Hauser syndrome.

    PubMed

    Demirel, Fatma; Kara, Ozlem; Esen, Ihsan

    2012-01-01

    Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare syndrome characterized by complete or partial agenesis of the uterus and vagina, due to a congenital defect of the Mullerian duct. Affected individuals have a 46,XX karyotype and a normal female phenotype. MRKH syndrome may be isolated (type I MRKH syndrome) or associated with renal, cardiac, and skeletal anomalies, short stature, and auditory defects. The latter is defined as type II MRKH syndrome or the Müllerian duct aplasia/hypoplasia, renal agenesis/ectopy, and cervicothoracic somite dysplasia (MURCS) association. The majority of patients with MRKH syndrome present with primary amenorrhea. We report a case of type II MRKH syndrome who has been referred by a pediatric surgeon for detection of gonadal function. During an inguinal hernia operation, the left ovary had been observed in the hernia sac. Clinical and radiological evaluation of the patient showed an absence of the uterus and left kidney, and cervical hemi vertebra. Based on these findings, the patient was diagnosed as having type II MRKH syndrome.

  2. Diagnostic criteria for constitutional mismatch repair deficiency syndrome: suggestions of the European consortium 'care for CMMRD' (C4CMMRD).

    PubMed

    Wimmer, Katharina; Kratz, Christian P; Vasen, Hans F A; Caron, Olivier; Colas, Chrystelle; Entz-Werle, Natacha; Gerdes, Anne-Marie; Goldberg, Yael; Ilencikova, Denisa; Muleris, Martine; Duval, Alex; Lavoine, Noémie; Ruiz-Ponte, Clara; Slavc, Irene; Burkhardt, Brigit; Brugieres, Laurence

    2014-06-01

    Constitutional mismatch repair deficiency (CMMRD) syndrome is a distinct childhood cancer predisposition syndrome that results from biallelic germline mutations in one of the four MMR genes, MLH1, MSH2, MSH6 or PMS2. The tumour spectrum is very broad, including mainly haematological, brain and intestinal tract tumours. Patients show a variety of non-malignant features that are indicative of CMMRD. However, currently no criteria that should entail diagnostic evaluation of CMMRD exist. We present a three-point scoring system for the suspected diagnosis CMMRD in a paediatric/young adult cancer patient. Tumours highly specific for CMMRD syndrome are assigned three points, malignancies overrepresented in CMMRD two points and all other malignancies one point. According to their specificity for CMMRD and their frequency in the general population, additional features are weighted with 1-2 points. They include multiple hyperpigmented and hypopigmented skin areas, brain malformations, pilomatricomas, a second childhood malignancy, a Lynch syndrome (LS)-associated tumour in a relative and parental consanguinity. According to the scoring system, CMMRD should be suspected in any cancer patient who reaches a minimum of three points by adding the points of the malignancy and the additional features. The diagnostic steps to confirm or refute the suspected diagnosis are outlined. We expect that application of the suggested strategy for CMMRD diagnosis will increase the number of patients being identified at the time when they develop their first tumour. This will allow adjustment of the treatment modalities, offering surveillance strategies for second malignancies and appropriate counselling of the entire family. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain: a prospective diagnostic study

    PubMed Central

    Gräni, Christoph; Senn, Oliver; Bischof, Manuel; Cippà, Pietro E; Hauffe, Till; Zimmerli, Lukas; Battegay, Edouard; Franzen, Daniel

    2015-01-01

    Objectives Acute chest pain (ACP) is a leading cause of hospital emergency unit consultation. As there are various underlying conditions, ranging from musculoskeletal disorders to acute coronary syndrome (ACS), thorough clinical diagnostics are warranted. The aim of this prospective study was to assess whether reproducible chest wall tenderness (CWT) on palpation in patients with ACP can help to rule out ACS. Methods In this prospective, double-blinded diagnostic study, all consecutive patients assessed in the emergency unit at the University Hospital Zurich because of ACP between July 2012 and December 2013 were included when a member of the study team was present. Reproducible CWT on palpation was the initial step and was recorded before further examinations were initiated. The final diagnosis was adjudicated by a study-independent physician. Results 121 patients (60.3% male, median age 47 years, IQR 34–66.5 years) were included. The prevalence of ACS was 11.6%. Non-reproducible CWT had a high sensitivity of 92.9% (95% CI 66.1% to 98.8%) for ACS and the presence of reproducible CWT ruled out ACS (p=0.003) with a high negative predictive value (98.1%, 95% CI 89.9% to 99.7%). Conversely non-reproducible CWT ruled in ACS with low specificity (48.6%, 95% CI 38.8% to 58.5%) and low positive predictive value (19.1%, 95% CI 10.6% to 30.5%). Conclusions This prospective diagnostic study supports the concept that reproducible CWT helps to rule out ACS in patients with ACP in an early stage of the evaluation process. However, ACS and other diagnoses should be considered in patients with a negative CWT test. Trial registration number ClinicalTrial.gov: NCT01724996. PMID:25631316

  4. Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain: a prospective diagnostic study.

    PubMed

    Gräni, Christoph; Senn, Oliver; Bischof, Manuel; Cippà, Pietro E; Hauffe, Till; Zimmerli, Lukas; Battegay, Edouard; Franzen, Daniel

    2015-01-28

    Acute chest pain (ACP) is a leading cause of hospital emergency unit consultation. As there are various underlying conditions, ranging from musculoskeletal disorders to acute coronary syndrome (ACS), thorough clinical diagnostics are warranted. The aim of this prospective study was to assess whether reproducible chest wall tenderness (CWT) on palpation in patients with ACP can help to rule out ACS. In this prospective, double-blinded diagnostic study, all consecutive patients assessed in the emergency unit at the University Hospital Zurich because of ACP between July 2012 and December 2013 were included when a member of the study team was present. Reproducible CWT on palpation was the initial step and was recorded before further examinations were initiated. The final diagnosis was adjudicated by a study-independent physician. 121 patients (60.3% male, median age 47 years, IQR 34-66.5 years) were included. The prevalence of ACS was 11.6%. Non-reproducible CWT had a high sensitivity of 92.9% (95% CI 66.1% to 98.8%) for ACS and the presence of reproducible CWT ruled out ACS (p=0.003) with a high negative predictive value (98.1%, 95% CI 89.9% to 99.7%). Conversely non-reproducible CWT ruled in ACS with low specificity (48.6%, 95% CI 38.8% to 58.5%) and low positive predictive value (19.1%, 95% CI 10.6% to 30.5%). This prospective diagnostic study supports the concept that reproducible CWT helps to rule out ACS in patients with ACP in an early stage of the evaluation process. However, ACS and other diagnoses should be considered in patients with a negative CWT test. ClinicalTrial.gov: NCT01724996. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. 77 FR 22267 - Eagle Permits; Changes in the Regulations Governing Eagle Permitting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-13

    ... with rotating wind turbines. Permit Duration and Transferability In February 2011, we published draft... permit applicants, because of the known risk to eagles from collisions with wind turbines and electric..., shoot at, poison, wound, kill, capture, trap, collect, destroy, molest, or disturb'' (Sec. 22.3). The...

  6. Wintering Golden Eagles on the coastal plain of South Carolina

    Treesearch

    Mark Vukovich; K.L. Turner; T.E. Grazia; T. Mims; J.C. Beasley; John Kilgo

    2015-01-01

    Golden Eagles (Aquila chrysaetos) are rare winter residents in eastern North America, with most found along the Appalachian Mountains and few reported on the coastal plain of the Carolinas. We used remote cameras baited with wild pig (Sus scrofa) and white-tailed deer (Odocoileus virginianus) carcasses to detect, age, and individually identify Golden Eagles on the U.S...

  7. Conservation significance of alternative nests of golden eagles

    Treesearch

    Brian A. Millsap; Teryl G. Grubb; Robert K. Murphy; Ted Swem; James W. Watson

    2015-01-01

    Golden eagles (Aquila chrysaetos) are long-lived raptors that maintain nesting territories that may be occupied for a century or longer. Within occupied nesting territories there is one nest in which eagles lay their eggs in a given year (i.e., the used nest), but there are usually other nests (i.e., alternative nests). Conservation plans often protect used nests, but...

  8. Leaders Hit the Battlefield for Education's Future: 2009 Eagle Institute

    ERIC Educational Resources Information Center

    Verardi, Nicole

    2010-01-01

    More than 40 esteemed school business officials traveled to Washington, D.C., for the 2009 Eagle Institute which was held on July 14-17. They examined the past and the future to uncover leadership insights. Eagle Institute participants shared a powerful experience of camaraderie, reflection, and optimism for the future. This article describes the…

  9. Kindler syndrome: a case report and proposal for clinical diagnostic criteria.

    PubMed

    Fischer, Irena Angelova; Kazandjieva, Jana; Vassileva, Snejina; Dourmishev, Assen

    2005-06-01

    Kindler syndrome is a rare hereditary disorder characterized by acral blister formation in infancy and childhood, progressive poikiloderma, cutaneous atrophy and increased photosensitivity. Since it was first described in 1954, less than 100 cases have been reported worldwide. Recently it has been reported that Kindler syndrome is the first genodermatosis caused by a defect in the actin-extracellular matrix linkage, and the gene was mapped to chromosome 20p12.3. The clinical features of the syndrome have been annotated by different authors but the definite of criteria to confirm the diagnosis have not yet been generally accepted. We report a case of Kindler syndrome that presents a full spectrum of clinical manifestations, and we propose a set of clinical criteria for diagnosis.

  10. Autoimmune Hepatitis: Diagnostic Dilemma When It Is Disguised as Iron Overload Syndrome.

    PubMed

    Acharya, Gyanendra K; Liao, Hung-I; Frunza-Stefan, Simona; Patel, Ronakkumar; Khaing, Moe

    2017-09-01

    Elevated serum ferritin level is a common finding in iron overload syndrome, autoimmune and viral hepatitis, alcoholic and nonalcoholic fatty liver diseases. High transferrin saturation is not a common finding in above diseases except for iron overload syndrome. We encountered a challenging case of 73-year-old female who presented with yellowish discoloration of skin, dark color urine and dull abdominal pain. Initial laboratory tests reported mild anemia; elevated bilirubin, liver enzymes, and transferrin saturation. We came to the final diagnosis of autoimmune hepatitis after extensive workups. Autoimmune hepatitis is a rare disease, and the diagnosis can be further complicated by a similar presentation of iron overload syndrome. Markedly elevated transferrin saturation can simulate iron overload syndrome, but a liver biopsy can guide physicians to navigate the diagnosis.

  11. Phenotypic and genotypic heterogeneity of Lynch syndrome: a complex diagnostic challenge.

    PubMed

    Lynch, Henry T; Lanspa, Stephen; Shaw, Trudy; Casey, Murray Joseph; Rendell, Marc; Stacey, Mark; Townley, Theresa; Snyder, Carrie; Hitchins, Megan; Bailey-Wilson, Joan

    2018-07-01

    Lynch syndrome is the hereditary disorder that most frequently predisposes to colorectal cancer as well as predisposing to a number of extracolonic cancers, most prominently endometrial cancer. It is caused by germline mutations in the mismatch repair genes. Both its phenotype and genotype show marked heterogeneity. This review gives a historical overview of the syndrome, its heterogeneity, its genomic landscape, and its implications for complex diagnosis, genetic counseling and putative implications for immunotherapy.

  12. Clinical Diagnosis of the Dampness and Mold Hypersensitivity Syndrome: Review of the Literature and Suggested Diagnostic Criteria

    PubMed Central

    Valtonen, Ville

    2017-01-01

    A great variety of non-specific symptoms may occur in patients living or working in moisture-damaged buildings. In the beginning, these symptoms are usually reversible, mild, and present irritation of mucosa and increased morbidity due to respiratory tract infections and asthma-like symptoms. Later, the disease may become chronic and a patient is referred to a doctor where the assessment of dampness and mold hypersensitivity syndrome (DMHS) often presents diagnostic challenges. Currently, unanimously accepted laboratory tests are not yet available. Therefore, the diagnosis of DMHS is clinical and is based on the patient’s history and careful examination. In this publication, I reviewed contemporary knowledge on clinical presentations, laboratory methods, and clinical assessment of DMHS. From the literature, I have not found any proposed diagnostic clinical criteria. Therefore, I propose five clinical criteria to diagnose DMHS: (1) the history of mold exposure in water-damaged buildings, (2) increased morbidity to due infections, (3) sick building syndrome, (4) multiple chemical sensitivity, and (5) enhanced scent sensitivity. If all the five criteria are met, the patient has a very probable DMHS. To resolve the current problems in assigning correct DMHS diagnosis, we also need novel assays to estimate potential risks of developing DMHS. PMID:28848553

  13. Clinical Diagnosis of the Dampness and Mold Hypersensitivity Syndrome: Review of the Literature and Suggested Diagnostic Criteria.

    PubMed

    Valtonen, Ville

    2017-01-01

    A great variety of non-specific symptoms may occur in patients living or working in moisture-damaged buildings. In the beginning, these symptoms are usually reversible, mild, and present irritation of mucosa and increased morbidity due to respiratory tract infections and asthma-like symptoms. Later, the disease may become chronic and a patient is referred to a doctor where the assessment of dampness and mold hypersensitivity syndrome (DMHS) often presents diagnostic challenges. Currently, unanimously accepted laboratory tests are not yet available. Therefore, the diagnosis of DMHS is clinical and is based on the patient's history and careful examination. In this publication, I reviewed contemporary knowledge on clinical presentations, laboratory methods, and clinical assessment of DMHS. From the literature, I have not found any proposed diagnostic clinical criteria. Therefore, I propose five clinical criteria to diagnose DMHS: (1) the history of mold exposure in water-damaged buildings, (2) increased morbidity to due infections, (3) sick building syndrome, (4) multiple chemical sensitivity, and (5) enhanced scent sensitivity. If all the five criteria are met, the patient has a very probable DMHS. To resolve the current problems in assigning correct DMHS diagnosis, we also need novel assays to estimate potential risks of developing DMHS.

  14. Rectal sensory threshold for pain is a diagnostic marker of irritable bowel syndrome and functional abdominal pain in children.

    PubMed

    Halac, Ugur; Noble, Angela; Faure, Christophe

    2010-01-01

    To evaluate the diagnostic value of the rectal sensory threshold for pain (RSTP) in children and adolescents with chronic abdominal pain. Fifty-one patients (25 girls; median age 14.2 years; range 8.4-17.6) with abdominal pain >2 months underwent a series of rectal distensions with an electronic barostat. RSTP and viscerosomatic referrals were assessed. Three months after the barostat, the final diagnosis was documented. Thirty-five patients had a functional gastrointestinal disorder (FGID) (irritable bowel syndrome or functional abdominal pain), and 16 had an organic disease. RSTP was lower in the FGID group than in the organic disease group (25.4mm Hg vs 37.1mm Hg; P = .0002). At the cutoff of 30mm Hg, the RSTP measurement for the diagnosis of FGID had a sensitivity of 94% and a specificity of 77%. Both groups similarly reported aberrant viscerosomatic projections. In children, RSTP is a diagnostic marker of irritable bowel syndrome and functional abdominal pain. Viscerosomatic referrals are similar in children with FGID and organic diseases.

  15. Kleptoparasitism by bald eagles wintering in south-central Nebraska

    USGS Publications Warehouse

    Jorde, Dennis G.; Lingle, G.R.

    1988-01-01

    Kleptoparasitism on other raptors was one means by which Bald Eagles (Haliaeetus leucocephalus) secured food along the North Platte and Platte rivers during the winters of 1978-1980. Species kelptoparasitized were Ferruginous Hawk (Buteo regalis), Red-tailed Hawk (B. jamaicensis), Rough-legged Hawk (B. lagopus), Golden Eagle (Aquila chrysaetos), and Bald Eagle. Stealing of prey occurred more often during the severe winter of 1978-1979 when ice cover restricted eagles from feeding on fish than during the milder winter of 1979-1980. Kleptoparasitism occurred principally in agricultural habitats where large numbers of Mallards (Anas platyrhynchos) were foraging. Subadults watched adults steal food and participated in food-stealing with adults, which indicated interspecific kleptoparasitism may be a learned behavior. We suggest factors that may favor interspecific kleptoparasitism as a foraging strategy of Bald Eagles in obtaining waterfowl during severe winters.

  16. Interactive effects of prey and weather on golden eagle reproduction

    USGS Publications Warehouse

    Steenhof, Karen; Kochert, Michael N.; McDonald, T.L.

    1997-01-01

    1. The reproduction of the golden eagle Aquila chrysaetos was studied in southwestern Idaho for 23 years, and the relationship between eagle reproduction and jackrabbit Lepus californicus abundance, weather factors, and their interactions, was modelled using general linear models. Backward elimination procedures were used to arrive at parsimonious models.2. The number of golden eagle pairs occupying nesting territories each year showed a significant decline through time that was unrelated to either annual rabbit abundance or winter severity. However, eagle hatching dates were significantly related to both winter severity and jackrabbit abundance. Eagles hatched earlier when jackrabbits were abundant, and they hatched later after severe winters.3. Jackrabbit abundance influenced the proportion of pairs that laid eggs, the proportion of pairs that were successful, mean brood size at fledging, and the number of young fledged per pair. Weather interacted with prey to influence eagle reproductive rates.4. Both jackrabbit abundance and winter severity were important in predicting the percentage of eagle pairs that laid eggs. Percentage laying was related positively to jackrabbit abundance and inversely related to winter severity.5. The variables most useful in predicting percentage of laying pairs successful were rabbit abundance and the number of extremely hot days during brood-rearing. The number of hot days and rabbit abundance were also significant in a model predicting eagle brood size at fledging. Both success and brood size were positively related to jackrabbit abundance and inversely related to the frequency of hot days in spring.6. Eagle reproduction was limited by rabbit abundance during approximately twothirds of the years studied. Weather influenced how severely eagle reproduction declined in those years.7. This study demonstrates that prey and weather can interact to limit a large raptor population's productivity. Smaller raptors could be affected more

  17. The population impact of screening for Down syndrome: audit of 19 326 invasive diagnostic tests in England and Wales in 2008.

    PubMed

    Morris, Joan K; Waters, Jonathan J; de Souza, E

    2012-06-01

    Pregnant women who receive a high screening risk result for Down, Edwards or Patau syndrome are offered diagnostic tests that carry a risk of miscarriage. This study determined how many women had such tests per syndrome diagnosis. The number of tests per Down, Edwards or Patau syndrome diagnosis adjusted for maternal and gestational age at diagnosis was calculated using routine data from 18 (95%) cytogenetic laboratories in England and Wales in 2008. There were 19,326 tests that identified 1118 diagnoses of Down syndrome and 615 of Edwards and Patau syndromes. There were eight chorionic villus samplings (CVS) per syndrome diagnosis compared with 16 amniocenteses (gestational age adjusted). The lowest number of tests per diagnosis (three for CVSs and for amniocentesis) resulted from an abnormal ultrasound scan. Among pregnant women, 2.9% had an invasive diagnostic test. If a CVS and an amniocentesis increase the risk of a miscarriage by 1% and 0.5%, respectively, approximately one miscarriage for every 14 Down, Edwards or Patau syndrome diagnosis would have occurred. A simple measurement of the population impact of screening for Down syndrome can be calculated using data already collected. Annual estimates should be produced to monitor the national fetal anomaly screening programme. © 2012 John Wiley & Sons, Ltd. © 2012 John Wiley & Sons, Ltd.

  18. Diagnostic difficulty of beta-thalassemia syndrome in a multi-transfused patient: contribution of myelogram and studying parents.

    PubMed

    Trawinski, Élisabeth; Fenneteau, Odile; Le Mouel, Lou; Ithier, Ghislaine; Couque, Nathalie

    2017-10-01

    We report the case of a 5 year old, initially followed for congenital sideroblastic anemia, whose explorations reveal a complex family hemoglobinopathy. Myelogram performed in children, reveals dystrophic mature erythroblasts with hemoglobinization defect and basophil punctuations. These abnormalities point towards an abnormal synthesis of heme or globin chains. Iterative transfusions in child do not allow interpreting a search for abnormal hemoglobin. However, the analysis carried out in his parents, with increased HBA2 rate and microcytosis concluded in beta-thalassemia trait for father and mother. Knowing that beta-thalassemia syndrome is a genetic condition, usually recessive, the presence of beta-thalassemia trait in parents is in favor of a beta-thalassemia syndrome in child. This diagnostic hypothesis is confirmed by molecular study of globin genes that will reveal a complex hemoglobinopathie for all family's members. The parents are carriers for heterozygous mutation of β + thalassemia that the sick child presents in homozygous state supporting the diagnosis of beta-thalassemia syndrome. Moreover, a triple α globin gene is present respectively at heterozygous state for mother and at homozygous state for father and child. The triple α globin gene is a known factor of aggravation of beta-thalassemia and this clinical case with continuum observed, perfectly illustrates the intricacies between α and β globin genes.

  19. Genetic predisposition to peripheral nerve neoplasia: Diagnostic criteria and pathogenesis of neurofibromatoses, Carney complex, and related syndromes

    PubMed Central

    Rodriguez, Fausto J.; Stratakis, Constantine A.; Evans, D Gareth

    2013-01-01

    Neoplasms of the peripheral nerve sheath represent essential clinical manifestations of the syndromes known as the neurofibromatoses. Although involvement of multiple organ systems, including skin, central nervous system and skeleton, may also be conspicuous, peripheral nerve neoplasia is often the most important and frequent cause of morbidity in these patients. Clinical characteristics of neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2) have been extensively described and studied during the last century, and the identification of mutations in the NF1 and NF2 genes by contemporary molecular techniques have created a separate multidisciplinary field in genetic medicine. In schwannomatosis, the most recent addition to the neurofibromatosis group, peripheral nervous system involvement is the exclusive (or almost exclusive) clinical manifestation. Although the majority of cases of schwannomatosis are sporadic, approximately a third occur in families and a subset of these has recently been associated with germline mutations in the tumor suppressor gene SMARCB1/INI1. Other curious syndromes that involve the peripheral nervous system are associated with predominant endocrine manifestations, and include Carney Complex and MEN2b, secondary to inactivating mutations in the PRKAR1A gene in a subset, and activating mutations in RET respectively. In this review, we provide a concise update on the diagnostic criteria, pathology and molecular pathogenesis of these enigmatic syndromes in relation to peripheral nerve sheath neoplasia. PMID:22210082

  20. Genetic predisposition to peripheral nerve neoplasia: diagnostic criteria and pathogenesis of neurofibromatoses, Carney complex, and related syndromes.

    PubMed

    Rodriguez, Fausto J; Stratakis, Constantine A; Evans, D Gareth

    2012-03-01

    Neoplasms of the peripheral nerve sheath represent essential clinical manifestations of the syndromes known as the neurofibromatoses. Although involvement of multiple organ systems, including skin, central nervous system, and skeleton, may also be conspicuous, peripheral nerve neoplasia is often the most important and frequent cause of morbidity in these patients. Clinical characteristics of neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2) have been extensively described and studied during the last century, and the identification of mutations in the NF1 and NF2 genes by contemporary molecular techniques have created a separate multidisciplinary field in genetic medicine. In schwannomatosis, the most recent addition to the neurofibromatosis group, peripheral nervous system involvement is the exclusive (or almost exclusive) clinical manifestation. Although the majority of cases of schwannomatosis are sporadic, approximately one-third occur in families and a subset of these has recently been associated with germline mutations in the tumor suppressor gene SMARCB1/INI1. Other curious syndromes that involve the peripheral nervous system are associated with predominant endocrine manifestations, and include Carney complex and MEN2b, secondary to inactivating mutations in the PRKAR1A gene in a subset, and activating mutations in RET, respectively. In this review, we provide a concise update on the diagnostic criteria, pathology and molecular pathogenesis of these enigmatic syndromes in relation to peripheral nerve sheath neoplasia.

  1. Diagnostic Accuracy of Copeptin in the Differential Diagnosis of the Polyuria-polydipsia Syndrome: A Prospective Multicenter Study.

    PubMed

    Timper, Katharina; Fenske, Wiebke; Kühn, Felix; Frech, Nica; Arici, Birsen; Rutishauser, Jonas; Kopp, Peter; Allolio, Bruno; Stettler, Christoph; Müller, Beat; Katan, Mira; Christ-Crain, Mirjam

    2015-06-01

    The polyuria-polydipsia syndrome comprises primary polydipsia (PP) and central and nephrogenic diabetes insipidus (DI). Correctly discriminating these entities is mandatory, given that inadequate treatment causes serious complications. The diagnostic "gold standard" is the water deprivation test with assessment of arginine vasopressin (AVP) activity. However, test interpretation and AVP measurement are challenging. The objective was to evaluate the accuracy of copeptin, a stable peptide stoichiometrically cosecreted with AVP, in the differential diagnosis of polyuria-polydipsia syndrome. This was a prospective multicenter observational cohort study from four Swiss or German tertiary referral centers of adults >18 years old with the history of polyuria and polydipsia. A standardized combined water deprivation/3% saline infusion test was performed and terminated when serum sodium exceeded 147 mmol/L. Circulating copeptin and AVP levels were measured regularly throughout the test. Final diagnosis was based on the water deprivation/saline infusion test results, clinical information, and the treatment response. Fifty-five patients were enrolled (11 with complete central DI, 16 with partial central DI, 18 with PP, and 10 with nephrogenic DI). Without prior thirsting, a single baseline copeptin level >21.4 pmol/L differentiated nephrogenic DI from other etiologies with a 100% sensitivity and specificity, rendering a water deprivation testing unnecessary in such cases. A stimulated copeptin >4.9 pmol/L (at sodium levels >147 mmol/L) differentiated between patients with PP and patients with partial central DI with a 94.0% specificity and a 94.4% sensitivity. A stimulated AVP >1.8 pg/mL differentiated between the same categories with a 93.0% specificity and a 83.0% sensitivity. This study was limited by incorporation bias from including AVP levels as a diagnostic criterion. Copeptin is a promising new tool in the differential diagnosis of the polyuria-polydipsia syndrome

  2. Diagnostic Approach to Viral Acute Encephalitis Syndrome (AES) in Paediatric Age Group: A Study from New Delhi.

    PubMed

    Goel, Shipra; Chakravarti, Anita; Mantan, Mukta; Kumar, Surinder; Ashraf, Md Anzar

    2017-09-01

    Acute Encephalitis Syndrome has heralded the emergence of multiple virulent pathogens, which may result in severe morbidity and mortality. In India, encephalitis is not notified and there has been a dearth of analysis for trends in encephalitis death rates and causation. A downward trend has been observed in encephalitis deaths, due to 'known' causes, which can be largely explained by improvement in diagnostic, treatment, and prevention methods. There is still a very high proportion of encephalitis deaths in developing countries, where the aetiological diagnosis of the pathogen is not established and thus, lies the importance of monitoring encephalitis morbidity and mortality with a view to improve pathogen diagnosis and identify emerging infectious diseases. To formulate a diagnostic approach to viral acute encephalitis syndrome in paediatric age group. A cross-sectional study including 50 paediatric patients, clinically diagnosed with acute encephalitis syndrome using WHO criteria was conducted. The CSF of all the patients was evaluated to diagnose the aetiology for viral pathogens. ELISA was used for diagnosing Japanese encephalitis and dengue encephalitis; and multiplex real time PCR was used for detecting HSV-1, HSV-2, Varicella zoster virus, Mumps virus, Enterovirus and Parechovirus. Confirmed diagnosis was established in 11 (22%) of 50 cases. A confirmed or probable viral agent of encephalitis was found in 7 (14%), bacterial agent was found in 2 (4%), non-infectious aetiology was found in 2 (4%). Fatal outcome was independently associated with patient age. Despite extensive testing, the aetiologies of more than three fourth of the cases remains elusive. Nevertheless the result from the present study may be useful for future design of early diagnosis and treatment of the disease. New strategies for pathogen identification and continued analysis of clinical features and case histories should help us improve our ability to diagnose, treat and prevent

  3. Spectrum of novel mutations found in Waardenburg syndrome types 1 and 2: implications for molecular genetic diagnostics

    PubMed Central

    Wildhardt, Gabriele; Zirn, Birgit; Graul-Neumann, Luitgard M; Wechtenbruch, Juliane; Suckfüll, Markus; Buske, Annegret; Bohring, Axel; Kubisch, Christian; Vogt, Stefanie; Strobl-Wildemann, Gertrud; Greally, Marie; Bartsch, Oliver; Steinberger, Daniela

    2013-01-01

    Objectives Till date, mutations in the genes PAX3 and MITF have been described in Waardenburg syndrome (WS), which is clinically characterised by congenital hearing loss and pigmentation anomalies. Our study intended to determine the frequency of mutations and deletions in these genes, to assess the clinical phenotype in detail and to identify rational priorities for molecular genetic diagnostics procedures. Design Prospective analysis. Patients 19 Caucasian patients with typical features of WS underwent stepwise investigation of PAX3 and MITF. When point mutations and small insertions/deletions were excluded by direct sequencing, copy number analysis by multiplex ligation-dependent probe amplification was performed to detect larger deletions and duplications. Clinical data and photographs were collected to facilitate genotype–phenotype analyses. Setting All analyses were performed in a large German laboratory specialised in genetic diagnostics. Results 15 novel and 4 previously published heterozygous mutations in PAX3 and MITF were identified. Of these, six were large deletions or duplications that were only detectable by copy number analysis. All patients with PAX3 mutations had typical phenotype of WS with dystopia canthorum (WS1), whereas patients with MITF gene mutations presented without dystopia canthorum (WS2). In addition, one patient with bilateral hearing loss and blue eyes with iris stroma dysplasia had a de novo missense mutation (p.Arg217Ile) in MITF. MITF 3-bp deletions at amino acid position 217 have previously been described in patients with Tietz syndrome (TS), a clinical entity with hearing loss and generalised hypopigmentation. Conclusions On the basis of these findings, we conclude that sequencing and copy number analysis of both PAX3 and MITF have to be recommended in the routine molecular diagnostic setting for patients, WS1 and WS2. Furthermore, our genotype–phenotype analyses indicate that WS2 and TS correspond to a clinical spectrum

  4. Spectrum of novel mutations found in Waardenburg syndrome types 1 and 2: implications for molecular genetic diagnostics.

    PubMed

    Wildhardt, Gabriele; Zirn, Birgit; Graul-Neumann, Luitgard M; Wechtenbruch, Juliane; Suckfüll, Markus; Buske, Annegret; Bohring, Axel; Kubisch, Christian; Vogt, Stefanie; Strobl-Wildemann, Gertrud; Greally, Marie; Bartsch, Oliver; Steinberger, Daniela

    2013-03-18

    Till date, mutations in the genes PAX3 and MITF have been described in Waardenburg syndrome (WS), which is clinically characterised by congenital hearing loss and pigmentation anomalies. Our study intended to determine the frequency of mutations and deletions in these genes, to assess the clinical phenotype in detail and to identify rational priorities for molecular genetic diagnostics procedures. Prospective analysis. 19 Caucasian patients with typical features of WS underwent stepwise investigation of PAX3 and MITF. When point mutations and small insertions/deletions were excluded by direct sequencing, copy number analysis by multiplex ligation-dependent probe amplification was performed to detect larger deletions and duplications. Clinical data and photographs were collected to facilitate genotype-phenotype analyses. All analyses were performed in a large German laboratory specialised in genetic diagnostics. 15 novel and 4 previously published heterozygous mutations in PAX3 and MITF were identified. Of these, six were large deletions or duplications that were only detectable by copy number analysis. All patients with PAX3 mutations had typical phenotype of WS with dystopia canthorum (WS1), whereas patients with MITF gene mutations presented without dystopia canthorum (WS2). In addition, one patient with bilateral hearing loss and blue eyes with iris stroma dysplasia had a de novo missense mutation (p.Arg217Ile) in MITF. MITF 3-bp deletions at amino acid position 217 have previously been described in patients with Tietz syndrome (TS), a clinical entity with hearing loss and generalised hypopigmentation. On the basis of these findings, we conclude that sequencing and copy number analysis of both PAX3 and MITF have to be recommended in the routine molecular diagnostic setting for patients, WS1 and WS2. Furthermore, our genotype-phenotype analyses indicate that WS2 and TS correspond to a clinical spectrum that is influenced by MITF mutation type and position.

  5. Hematocrit and plasma chemistry values in adult collared scops owls (Otus lettia) and crested serpent eagles (Spilornis cheela hoya).

    PubMed

    Chan, Fang-Tse; Lin, Pei-I; Chang, Geng-Ruei; Wang, Hsien-Chi; Hsu, Tien-Huan

    2012-07-01

    In this study, we report hematocrit and plasma chemistry values for adult captive collared scops owls (Otus lettia) and crested serpent eagles (Spilornis cheela hoya). In particular, we address the gender-specific differences within these values. We measured hematocrit (HCT) and plasma chemistry values for uric acid (UA), plasma urea nitrogen (BUN), total protein (TP), albumin (ALB), glucose (GLU), cholesterol (CHO), triglyceride (TG), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), total bilirubin (TBIL), creatine (CRE), creatine phosphokinase (CPK), amylase (AMY), calcium (CA), ionic phosphorous (IP) and sodium (NA), potassium (K) and chloride ions (CL) in 37 adult captive collared scops owls and 39 adult captive crested serpent eagles. Significant differences between the sexes were found for UA, GLU and CPK in the collared scope owls. UA and GLU concentrations were significantly higher (P<0.01 and P<0.05) among males than females, while the CPK concentration was significantly lower (P<0.05) in males. There were no significant differences in of all of the measured parameters between male and female eagles. These finding suggested that HCT and plasma chemistry values of raptors vary individually according to species and sex. Our results provide the 1st available reference data for ranges of plasma values in adult captive collared scops owls and crested serpent eagles, making them a potentially useful complementary diagnostic tool for veterinary care of individuals for both species in captivity.

  6. Improvement in diagnostic performance of the revised total testosterone measuring system in Japanese women with polycystic ovary syndrome.

    PubMed

    Niki, Hirobumi; Matsuzaki, Toshiya; Kinouchi, Riyo; Iwasa, Takeshi; Kawami, Takako; Kato, Takeshi; Kuwahara, Akira; Irahara, Minoru

    2014-01-01

    Hyperandrogenemia has become an important factor in the diagnosis of polycystic ovary syndrome (PCOS), in Japan as well as Western countries, since the Japanese PCOS diagnostic criteria were revised in 2007. The revised electrochemiluminescence immunoassay (ECLIA) reagent for total testosterone (T) (ECLusys TESTO II; New T assay), which has lower cross-reactivity with DHEA-S than the previous reagent (ECLusys TESTO I; Old T assay), has recently been developed. We studied the improvement between New and Old T assays in regards to the diagnostic performance of serum T for patients with PCOS. Serum T levels were measured in both normal women (Control, n=92) and PCOS patients (n=86). The rate of elevated T using each kit was significantly higher in the PCOS group than in the Control group, and significantly higher using New T assay (38/86, 44.2%) compared with Old T assay (26/86, 30.2%). A significant correlation was found between T level and body mass index, but not LH level. Furthermore, higher detection rates of hormonal abnormalities were seen in PCOS patients using combined measurement of both T and LH (63/80) compared with single measurement of either T (37/80) or LH (36/80). Therefore, the serum T assay is essential for the diagnosis of PCOS, and New T assay combined with the LH assay may improve the diagnostic process for PCOS. J. Med. Invest. 61: 65-71, February, 2014.

  7. 76 FR 65507 - Notice of Petition for Rate Approval; Eagle Ford Midstream, LP

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-21

    ... Petition for Rate Approval; Eagle Ford Midstream, LP Take notice that on October 11, 2011, (Eagle Ford..., and its initial baseline Statement of Operating Conditions. Eagle Ford states that it is an existing..., currently providing intrastate services to its customers. Eagle Ford proposed rates for Section 311...

  8. Final Report Bald and Golden Eagle Territory Surveys for the Lawrence Livermore National Laboratory

    SciTech Connect

    Fratanduono, M. L.

    2014-11-25

    Garcia and Associates (GANDA) was contracted by the Lawrence Livermore National Laboratory (LLNL) to conduct surveys for bald eagles (Haliaeetus leucocephalus) and golden eagles (Aquila chrysaetos) at Site 300 and in the surrounding area out to 10-miles. The survey effort was intended to document the boundaries of eagle territories by careful observation of eagle behavior from selected viewing locations throughout the study area.

  9. Clinics in diagnostic imaging. 159. Jejunal intussusception due to Peutz-Jeghers syndrome.

    PubMed

    Krishnan, Vijay; Chawla, Ashish; Wee, Eric; Peh, Wilfred C G

    2015-02-01

    A 21-year-old woman presented with acute onset of upper abdominal pain. A diagnosis of Peutz-Jeghers syndrome (PJS) was made based on the clinical picture of perioral pigmentation with imaging findings of transient jejunojejunal intussusceptions and small bowel polyps, and confirmed by characteristic histopathological appearances of Peutz-Jeghers polyps. PJS is a rare hereditary condition characterised by unique hamartomatous polyps, perioral mucocutaneous pigmentations, and increased susceptibility to gastrointestinal and extraintestinal neoplasms. Patients usually present with recurrent abdominal pain due to intussusception caused by polyps. Other modes of presentations include rectal bleeding and melaena. We describe the imaging findings of PJS and provide a brief review of bowel polyposis syndromes. The latter are relatively rare disorders characterised by multiple polyps in the large or small intestine, with associated risk of malignancies and other extraintestinal manifestations. Awareness of the manifestations and early diagnosis of these syndromes is crucial to prevent further complications.

  10. Clinics in diagnostic imaging (178). Wünderlich syndrome and pseudoaneurysm.

    PubMed

    Chung, Raymond; Chawla, Ashish; Peh, Wilfred Cg

    2017-06-01

    Wünderlich syndrome is a rare entity characterised by spontaneous retroperitoneal haemorrhage with renal origin. We present a case of Wünderlich syndrome secondary to clotting dyscrasia in a 64-year-old woman. The patient experienced a second Wünderlich haemorrhagic event with metachronous pseudoaneurysm formation, which was likely secondary to the large subcapsular haematoma stripping the renal capsule and tearing the cortical arteries. Selective pseudoaneurysm embolisations were successfully performed on both occasions. This clinical entity, its imaging differential diagnoses and management are discussed. Copyright: © Singapore Medical Association.

  11. [Diagnostics and treatment of Wernicke-Korsakoff syndrome patients with an alcohol abuse].

    PubMed

    Nilsson, Maria; Sonne, Charlotte

    2013-04-01

    Wernicke-Korsakoff syndrome is a condition with high morbidity and mortality and occurs as a consequence of thiamine deficiency. Clinical symptoms are often ambiguous and post-mortem examinations show that the syndrome is underdiagnosed and probably undertreated. There is sparse clinical evidence concerning optimal dosage and duration of treatment. This article reviews the current literature and concludes that all patients with a history of alcohol abuse should be treated with high dosage IV thiamine for an extended period of time, albeit further research is needed.

  12. Mercury concentrations in tissues of Florida bald eagles

    SciTech Connect

    Wood, P.B.; Wood, J.M.; White, J.H.

    1996-01-01

    We collected 48 blood and 61 feather samples from nestling bald eagles at 42 nests and adult feather samples from 20 nests in north and central Florida during 1991-93. We obtained 32 liver, 10 feather, and 5 blood samples from 33 eagle carcasses recovered in Florida during 1987-93. For nestlings, mercury concentrations in blood (GM = 0.16 ppm wet wt) and feather (GM = 3.23 ppm) samples were correlated (r = 0.69, P = 0.0001). Although nestlings had lower mercury concentrations in feathers than did adults (GM = 6.03 ppm), the feather mercury levels in nestlings and adults from themore » same nest were correlated (r = 0.63, P < 0.02). Mercury concentrations in blood of captive adult eagles (GM = 0.23 ppm) was similar to Florida nestlings but some Florida nestlings had blood mercury concentrations up to 0.61 ppm, more than twice as high as captive adults. Feather mercury concentrations in both nestlings and adults exceeded those in captive eagles, but concentrations in all tissues were similar to, or lower than, those in bald eagles from other wild populations. Although mercury concentrations in Florida eagles are below those that cause mortality, they are in the range of concentrations that can cause behavioral changes or reduce reproduction. We recommend periodic monitoring of mercury in Florida bald eagles for early detection of mercury increases before negative effects on reproduction occur. 26 refs., 5 figs., 2 tabs.« less

  13. Infrasonic analysis of carotid vibration as a diagnostic method in carotid insufficiency syndrome.

    PubMed

    Anastassiades, A J; Petounis, A D

    1976-01-01

    The infrasonic part of the spectrum of the carotid artery wall vibration in the neck was obtained. Differences between the spectral content and vibrational amplitude in normal and occluded carotids were found. The application of this technique in clinical practice could be useful in the detection of the carotid insufficiency syndrome.

  14. Interradicular dentin dysplasia associated with amelogenesis imperfecta with taurodontism or trichodentoosseous syndrome: a diagnostic dilemma.

    PubMed

    Hegde, Veda; Srikanth, K

    2014-01-01

    Amelogenesis imperfecta is a hereditary disorder with diverse clinical presentation, where enamel is the tissue that is primarily affected either quantitatively or qualitatively. Hypomaturation/hypoplastic amelogenesis imperfecta with taurodontism is a rare variant of amelogenesis imperfecta which is often confused with trichodentoosseous syndrome. We report a rare case of hereditary enamel defect with taurodontism associated with interradicular dentin dysplasia.

  15. THE INTERACTIVE AUTOMATIC SYNDROME DIAGNOSTIC PROGRAM OF DIGESTIVE SYSTEM DISEASES "ELECTRONIC POLICLINIC".

    PubMed

    Mishlanov, V Yu; Katkova, A V; Dugina, A A; Kuznetzova, V D; Tepanyan, A T; Zhygulev, A N

    The aim of the study was to estimate clinical efficiency of the interactive automatic program of digestive system diseases diagnostics "Electronic policlinic". Material was presented by 22 patients with different gastroenterological diseases (duodenal ulcer, chronical gastritis, chronical pancreatitis) and the comparative group consisted of 20 healthy people. The plan of the research included the interactive questionnaire using diagnostic module digestive system diseases of the digestive system of the automated program "Electronic policlinic" (Certificate No. 2012614202 from 12.05.12) posted on the Internet (http://klinikcity.ru). For the purpose of verification of diagnosis patients underwent fibrogastroduodenoscopy, ultrasound examination of abdominal cavity organs, CT scan, sigmoidoscopy, colonoscopy, barium enema. As the result of the study there were showed that interactive automated system was able to reveal 85,7% of patients with chronical gastritis, duodenal ulcer and chronical pancreatitis and 75% of patients with colonopathy. The specify of diagnostic procedure was 80% in the first case and 100% in the second. Prevalence of digestive system diseases basic symptoms was studied too. The conclusion of the study demonstrated interactive questionnaire good ability in preliminary digestive problem patient examination procedure for individual diagnostic plan making.

  16. [Epidemiology, diagnostics, and treatment of complications after neuroinfections: chronic fatigue syndrome].

    PubMed

    Verner, O M; Murashko, N K

    2012-01-01

    Epidemiology information which testify to prevalence syndrome of chronic ustalostti (SV) is resulted in the article, and from some data this diagnosis is covered at more than 20% patients which carried neyroinfection. SV meets more frequent only in age 40-59, thus for women a disease is marked in 4 times more frequent, than for men. Today etiology of disease remains unknown, but the value of genetic, immunological factors, pathogens, neurogenic violations and features of feed is examined. Possibility of infectious etiology SV causes considerable interest of researchers, but at first this syndrome was examined as a sharp viral infection, where the most reliable exciter is consider the virus of Epshteyna-barr. Using of intravenous introduction of globulin for SV carries experimental character and grounded on a hypothesis about immunological or infectious etiology of this disease.

  17. Burning mouth syndrome: A review on its diagnostic and therapeutic approach

    PubMed Central

    Aravindhan, R.; Vidyalakshmi, Santhanam; Kumar, Muniapillai Siva; Satheesh, C.; Balasubramanium, A. Murali; Prasad, V. Srinivas

    2014-01-01

    Burning mouth syndrome (BMS), a chronic and intractable orofacial pain syndrome is characterized by the presence of burning sensation of the oral mucosa in the absence of specific oral lesion. This condition affects chiefly of middle aged and elderly woman with hormonal changes or psychological disorders. In addition to burning sensation, patient with BMS also complains of oral mucosal pain, altered taste sensation, and dry mouth. This condition is probably of multifactorial origin, often idiopathic and its exact etiopathogenesis remains unclear. So far, there is no definitive cure for this condition and most of the treatment approaches, medications remains unsatisfactory. An interdisciplinary and systematic approach is required for better patient management. The purpose of this article is to present a review of epidemiology, clinical presentation, classification, etiopathogenesis, diagnosis and management of BMS. PMID:25210377

  18. The Effect of Diagnostic Labels on the Affective Responses of College Students towards Peers with "Asperger's Syndrome" and "Autism Spectrum Disorder"

    ERIC Educational Resources Information Center

    Brosnan, Mark; Mills, Elizabeth

    2016-01-01

    Given the removal of Asperger's Syndrome label in "Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition," the impact of clinical labels upon the affective responses of college students was explored. A total of 120 college students read two vignettes depicting social interactions typical of a person with autism spectrum…

  19. Star Formation in the Eagle Nebula

    NASA Astrophysics Data System (ADS)

    Oliveira, J. M.

    2008-12-01

    M16 (the Eagle Nebula) is a striking star forming region, with a complex morphology of gas and dust sculpted by the massive stars in NGC 6611. Detailed studies of the famous ``elephant trunks'' dramatically increased our understanding of the massive star feedback into the parent molecular cloud. A rich young stellar population (2-3 Myr) has been identified, from massive O-stars down to substellar masses. Deep into the remnant molecular material, embedded protostars, Herbig-Haro objects and maser sources bear evidence of ongoing star formation in the nebula, possibly triggered by the massive cluster members. M 16 is a excellent template for the study of star formation under the hostile environment created by massive O-stars. This review aims at providing an observational overview not only of the young stellar population but also of the gas remnant of the star formation process.

  20. [Diagnostic performance of echocardiography in the follow-up of patients with toxic oil syndrome].

    PubMed

    Plaza Cano, María M; García de Albéniz Martínez, Xabier A; de Andrés Copa, Pilar; Braun Saro, Beatriz; Suárez Alvarez, Carmen; García de Aguinaga, María L; Estirado de Cabo, Eva; Guinea Esquerdo, Juan; Posada de la Paz, Manuel

    2003-12-01

    Toxic oil syndrome is an epidemic, multisystemic disease that appeared in Spain in 1981, and was caused by the consumption of rapeseed oil denatured with 2% aniline. The disease is similar to eosinophilia-myalgia syndrome. One of the cardiovascular disorders caused by this syndrome is pulmonary hypertension. We conducted a study to assess the validity of our indications for echocardiography in the follow-up of cardiovascular disorders in patients with this disease. These patients are followed at our center with a standardized protocol for annual check-ups. From December 1997 through July 2002, a total of 1993 patients were examined. In this period we performed a total of 487 echocardiographic studies in 424 patients. The clinical records were reviewed to assess the indications for echocardiography according to the most recent guidelines for the clinical application of echocardiography of the American College of Cardiology and American Heart Association, and the indications were grouped into several categories. The diagnosis was recorded from the cardiologist's reports at the hospital where echocardiography was done. We calculated the sensitivity, specificity and positive likelihood ratio. 67% of the echocardiographic examinations were indicated to investigate possible pulmonary hypertension. About one-tenth of the studies (476 studies, 9.9%) led to a diagnosis of pulmonary hypertension. Sensitivity was highest (83%) for suspected pulmonary hypertension. Specificity was very high for most of the other indications. This study does not allow us to draw general conclusions about the cardiovascular disorders associated with toxic oil syndrome. However, echocardiography appears to be a good follow-up technique to diagnose complications such as pulmonary hypertension in these patients.

  1. Sudden arrhythmic death syndrome: diagnostic yield of comprehensive clinical evaluation of pediatric first-degree relatives.

    PubMed

    Giudici, Valentina; Spanaki, Adriani; Hendry, Jennifer; Mead-Regan, Sarah; Field, Ella; Zuccotti, Gian Vincenzo; Abrams, Dominic; Lowe, Martin; Kaski, Juan Pablo

    2014-12-01

    Sudden arrhythmic death syndrome (SADS) is most often caused by heritable cardiac diseases. Studies in adults have identified evidence of inherited cardiovascular diseases in up to 53% of families, but data on the prevalence of familial disease in children are scarce. The aim of this study was to evaluate the yield of clinical screening in pediatric first-degree relatives of victims of SADS using a systematic and comprehensive protocol. Patients referred for family screening after sudden cardiac death (SCD) of a family member were, retrospectively, enrolled into the study. Systematic evaluation of the children included clinical examination, family history, electrocardiogram (ECG), echocardiogram, 24-hour tape, and signal-averaged ECG. Older patients also underwent exercise testing, cardiac magnetic resonance imaging, and ajmaline provocation testing. A total of 90 children from 52 consecutive families were included in the study. An inherited cardiac disease was identified in seven first-degree children from seven (13.5%) families (five children were diagnosed with Brugada syndrome, one with long QT syndrome, and one with catecholaminergic polymorphic ventricular tachycardia). Two further children had late potentials on signal-averaged ECGs with no other abnormalities. These data show a high prevalence of inherited heart disease in pediatric first-degree relatives of SADS victims. The results highlight the importance of a systematic, comprehensive approach and ongoing screening of pediatric family members. ©2014 Wiley Periodicals, Inc.

  2. Early diagnosis of amyotrophic lateral sclerosis mimic syndromes: pros and cons of current clinical diagnostic criteria.

    PubMed

    Cortés-Vicente, Elena; Pradas, Jesús; Marín-Lahoz, Juan; De Luna, Noemi; Clarimón, Jordi; Turon-Sans, Janina; Gelpí, Ellen; Díaz-Manera, Jordi; Illa, Isabel; Rojas-Garcia, Ricard

    2017-08-01

    To describe the frequency and clinical characteristics of patients referred to a tertiary neuromuscular clinic as having amyotrophic lateral sclerosis (ALS) but who were re-diagnosed as having an ALS mimic syndrome, and to identify the reasons that led to the revision of the diagnosis. We reviewed the final diagnosis of all patients prospectively registered in the Sant Pau-MND register from 1 January 2004 to 31 December 2015. A detailed clinical evaluation and a clinically-guided electrophysiological study were performed at first evaluation. Twenty of 314 (6.4%) patients included were re-diagnosed as having a condition other than ALS, in 18 cases already at first evaluation. An alternative specific diagnosis was identified in 17 of those 20, consisting of a wide range of conditions. The main finding leading to an alternative diagnosis was the result of the electrophysiological study. Fifty per cent did not fulfil the El Escorial revised criteria (EECr) for ALS. The most common clinical phenotype at onset in patients with ALS mimic syndromes was progressive muscular atrophy (PMA). Misdiagnosing ALS is still a common problem. Early identification of ALS mimic syndromes is possible based on atypical clinical features and a clinically-guided electrophysiological study. Patients should be attended in specialised centres. The application of EECr helps to identify ALS misdiagnoses.

  3. Prevalence of rheumatic regional pain syndromes in adults from Mexico: a community survey using COPCORD for screening and syndrome-specific diagnostic criteria.

    PubMed

    Alvarez-Nemegyei, Jose; Peláez-Ballestas, Ingris; Rodríguez-Amado, Jacqueline; Sanin, Luz Helena; Garcia-Garcia, Conrado; Garza-Elizondo, Mario A; Loyola-Sanchez, Adalberto; Burgos-Vargas, Rubén; Goycochea-Robles, Maria-Victoria

    2011-01-01

    To assess the prevalence of rheumatic regional pain syndromes (RRPS) in 3 geographical areas of México using the Community Oriented Program in the Rheumatic Diseases (COPCORD) screening methodology and validate by expert consensus on case-based definitions. By means of an address-based sample generated through a multistage, stratified, randomized method, a cross-sectional survey was performed on adult residents (n = 12,686; age 43.6 ± 17.3 yrs; women 61.9%) of the states of Nuevo León, Yucatán, and México City. Diagnostic criteria for specific upper (Southampton group criteria) and lower limb (ad hoc expert consensus) RRPS were applied to all subjects with limb pain as detected by COPCORD questionnaire. The overall prevalence of RRPS was 5.0% (95% CI 4.7-5.4). The most frequent syndrome was rotator cuff tendinopathy (2.36%); followed by inferior heel pain (0.64%); lateral epicondylalgia (0.63%); medial epicondylalgia (0.52%); trigger finger (0.42%); carpal tunnel syndrome (0.36%); anserine bursitis (0.34%); de Quervain's tendinopathy (0.30%); shoulder bicipital tendinopathy (0.27%); trochanteric syndrome (0.11%); and Achilles tendinopathy (0.10%). There were anatomic regional variations in the prevalence of limb pain: Yucatán 3.1% (95% CI 2.5-3.6); Nuevo León 7.0% (95% CI 6.3-7.7); and México City 10.8% (95% CI 9.8-11.8). Similarly, the prevalence of RRPS showed marked geographical variation: Yucatán 2.3% (95% CI 1.8-2.8); Nuevo León 5.6% (95% CI 5.0-6.3); and México City 6.9% (95% CI 6.2-7.7). The overall prevalence of RRPS in México was 5.0%. Geographical variations raise the possibility that the prevalence of RRPS is influenced by socioeconomic, ethnic, or demographic factors.

  4. Diagnostic and pathogenetic role of café-au-lait macules in nevoid basal cell carcinoma syndrome

    PubMed Central

    2012-01-01

    Café au lait spots (CALS) are common dermatologic findings that can at the same time arise in a variety of pathologic conditions such as Neurofibromatosis type 1 (NF1), together with numerous hereditary syndromes for which they represent either diagnostic criteria or associated elements (McCune Albright, Silver-Russell, LEOPARD, Ataxia-Telangiectasia). A review of the literature also revealed two cases of association with NBCCS. We report here the case of a female proband with CALS associated to Nevoid Basal Cell Carcinoma Syndrome (NBCCS) with known PTCH1 germline mutation (C.1348-2A>G) who had been misdiagnosed with NF1 in her childhood because of 5 CALS and cutaneous nodules. The patient presented a giant cell tumor of the skin, palmar and calcaneal epidermoidal cystic nodules, odontogenic keratocystic tumors and deformity of the jaw profile. Her family history brought both her brother and father to our attention because of the presence of KCOTs diagnosed at early age: after genetic testing, the same PTCH1 germline mutation was identified in the three family members. Clinical criteria are used for discerning NF1 diagnosis (size, number and onset age), while there are no definite guidelines concerning CALS except for their presence. In our experience, we have noted an association of CALS with NBCCS; this seems interesting because we already know clinical criteria are a dynamic entity and can be modified by epidemiologic evidences. PMID:23107377

  5. Evolving Identification of Blood Cells Associated with Clinically Isolated Syndrome: Importance of Time since Clinical Presentation and Diagnostic MRI

    PubMed Central

    Trend, Stephanie; Jones, Anderson P.; Geldenhuys, Sian; Byrne, Scott N.; Fabis-Pedrini, Marzena J.; Nolan, David; Booth, David R.; Carroll, William M.; Lucas, Robyn M.; Kermode, Allan G.; Hart, Prue H.

    2017-01-01

    It is not clear how the profile of immune cells in peripheral blood differs between patients with clinically isolated syndrome (CIS) and healthy controls (HC). This study aimed to identify a CIS peripheral blood signature that may provide clues for potential immunomodulatory approaches early in disease. Peripheral blood mononuclear cells (PBMCs) were collected from 18 people with CIS, 19 HC and 13 individuals with other demyelinating conditions (ODC) including multiple sclerosis (MS). Individuals with CIS separated into two groups, namely those with early (≤14 days post-diagnostic magnetic resonance imaging (MRI); n = 6) and late (≥27 days; n = 12) blood sampling. Transitional B cells were increased in the blood of CIS patients independently of when blood was taken. However, there were two time-dependent effects found in the late CIS group relative to HC, including decreased CD56bright NK cells, which correlated significantly with time since MRI, and increased CD141+ myeloid dendritic cell (mDC2) frequencies. Higher CD1c+ B cells and lower non-classical monocyte frequencies were characteristic of more recent demyelinating disease activity (ODC and early CIS). Analysing cell populations by time since symptoms (subjective) and diagnostic MRI (objective) may contribute to understanding CIS. PMID:28617321

  6. Single nucleotide polymorphism array karyotyping: a diagnostic and prognostic tool in myelodysplastic syndromes with unsuccessful conventional cytogenetic testing.

    PubMed

    Arenillas, Leonor; Mallo, Mar; Ramos, Fernando; Guinta, Kathryn; Barragán, Eva; Lumbreras, Eva; Larráyoz, María-José; De Paz, Raquel; Tormo, Mar; Abáigar, María; Pedro, Carme; Cervera, José; Such, Esperanza; José Calasanz, María; Díez-Campelo, María; Sanz, Guillermo F; Hernández, Jesús María; Luño, Elisa; Saumell, Sílvia; Maciejewski, Jaroslaw; Florensa, Lourdes; Solé, Francesc

    2013-12-01

    Cytogenetic aberrations identified by metaphase cytogenetics (MC) have diagnostic, prognostic, and therapeutic implications in myelodysplastic syndromes (MDS). However, in some MDS patients MC study is unsuccesful. Single nucleotide polymorphism array (SNP-A) based karyotyping could be helpful in these cases. We performed SNP-A in 62 samples from bone marrow or peripheral blood of primary MDS with an unsuccessful MC study. SNP-A analysis enabled the detection of aberrations in 31 (50%) patients. We used the copy number alteration information to apply the International Prognostic Scoring System (IPSS) and we observed differences in survival between the low/intermediate-1 and intermediate-2/high risk patients. We also saw differences in survival between very low/low/intermediate and the high/very high patients when we applied the revised IPSS (IPSS-R). In conclusion, SNP-A can be used successfully in PB samples and the identification of CNA by SNP-A improve the diagnostic and prognostic evaluation of this group of MDS patients. Copyright © 2013 Wiley Periodicals, Inc.

  7. Evolving Identification of Blood Cells Associated with Clinically Isolated Syndrome: Importance of Time since Clinical Presentation and Diagnostic MRI.

    PubMed

    Trend, Stephanie; Jones, Anderson P; Geldenhuys, Sian; Byrne, Scott N; Fabis-Pedrini, Marzena J; Nolan, David; Booth, David R; Carroll, William M; Lucas, Robyn M; Kermode, Allan G; Hart, Prue H

    2017-06-15

    It is not clear how the profile of immune cells in peripheral blood differs between patients with clinically isolated syndrome (CIS) and healthy controls (HC). This study aimed to identify a CIS peripheral blood signature that may provide clues for potential immunomodulatory approaches early in disease. Peripheral blood mononuclear cells (PBMCs) were collected from 18 people with CIS, 19 HC and 13 individuals with other demyelinating conditions (ODC) including multiple sclerosis (MS). Individuals with CIS separated into two groups, namely those with early (≤14 days post-diagnostic magnetic resonance imaging (MRI); n = 6) and late (≥27 days; n = 12) blood sampling. Transitional B cells were increased in the blood of CIS patients independently of when blood was taken. However, there were two time-dependent effects found in the late CIS group relative to HC, including decreased CD56bright NK cells, which correlated significantly with time since MRI, and increased CD141+ myeloid dendritic cell (mDC2) frequencies. Higher CD1c+ B cells and lower non-classical monocyte frequencies were characteristic of more recent demyelinating disease activity (ODC and early CIS). Analysing cell populations by time since symptoms (subjective) and diagnostic MRI (objective) may contribute to understanding CIS.

  8. 36 CFR 71.15 - The Golden Eagle Insignia.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... contribute to the public's information and education about the Federal recreation fee program. (5) The term... other Federal agencies. (6) The Golden Eagle program refers to the Federal outdoor recreation fee...

  9. 36 CFR 71.15 - The Golden Eagle Insignia.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... contribute to the public's information and education about the Federal recreation fee program. (5) The term... other Federal agencies. (6) The Golden Eagle program refers to the Federal outdoor recreation fee...

  10. 36 CFR 71.15 - The Golden Eagle Insignia.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... contribute to the public's information and education about the Federal recreation fee program. (5) The term... other Federal agencies. (6) The Golden Eagle program refers to the Federal outdoor recreation fee...

  11. 36 CFR 71.15 - The Golden Eagle Insignia.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... contribute to the public's information and education about the Federal recreation fee program. (5) The term... other Federal agencies. (6) The Golden Eagle program refers to the Federal outdoor recreation fee...

  12. Detail view of bracket, arched window and eagle from building ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Detail view of bracket, arched window and eagle from building 18 section. Jet Lowe, Haer staff photographer, summer 1995 - Naval Base Philadelphia-Philadelphia Naval Shipyard, Machine Shops, League Island, Philadelphia, Philadelphia County, PA

  13. 50 CFR 22.27 - Removal of eagle nests.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... when the Service determines it is necessary to prevent eagles from re-nesting in the vicinity. (7) You... Migratory Bird Permit Office (http://www.fws.gov/permits/mbpermits/addresses.html) at the earliest possible...

  14. 50 CFR 22.27 - Removal of eagle nests.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... when the Service determines it is necessary to prevent eagles from re-nesting in the vicinity. (7) You... Migratory Bird Permit Office (http://www.fws.gov/permits/mbpermits/addresses.html) at the earliest possible...

  15. 50 CFR 22.27 - Removal of eagle nests.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... when the Service determines it is necessary to prevent eagles from re-nesting in the vicinity. (7) You... Migratory Bird Permit Office (http://www.fws.gov/permits/mbpermits/addresses.html) at the earliest possible...

  16. 50 CFR 22.27 - Removal of eagle nests.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... when the Service determines it is necessary to prevent eagles from re-nesting in the vicinity. (7) You... Migratory Bird Permit Office (http://www.fws.gov/permits/mbpermits/addresses.html) at the earliest possible...

  17. EAGLE Monitors by Collecting Facts and Generating Obligations

    NASA Technical Reports Server (NTRS)

    Barrnger, Howard; Goldberg, Allen; Havelund, Klaus; Sen, Koushik

    2003-01-01

    We present a rule-based framework, called EAGLE, that has been shown to be capable of defining and implementing a range of finite trace monitoring logics, including future and past time temporal logic, extended regular expressions, real-time and metric temporal logics, interval logics, forms of quantified temporal logics, and so on. A monitor for an EAGLE formula checks if a finite trace of states satisfies the given formula. We present, in details, an algorithm for the synthesis of monitors for EAGLE. The algorithm is implemented as a Java application and involves novel techniques for rule definition, manipulation and execution. Monitoring is achieved on a state-by-state basis avoiding any need to store the input trace of states. Our initial experiments have been successful as EAGLE detected a previously unknown bug while testing a planetary rover controller.

  18. Adaptive EAGLE dynamic solution adaptation and grid quality enhancement

    NASA Technical Reports Server (NTRS)

    Luong, Phu Vinh; Thompson, J. F.; Gatlin, B.; Mastin, C. W.; Kim, H. J.

    1992-01-01

    In the effort described here, the elliptic grid generation procedure in the EAGLE grid code was separated from the main code into a subroutine, and a new subroutine which evaluates several grid quality measures at each grid point was added. The elliptic grid routine can now be called, either by a computational fluid dynamics (CFD) code to generate a new adaptive grid based on flow variables and quality measures through multiple adaptation, or by the EAGLE main code to generate a grid based on quality measure variables through static adaptation. Arrays of flow variables can be read into the EAGLE grid code for use in static adaptation as well. These major changes in the EAGLE adaptive grid system make it easier to convert any CFD code that operates on a block-structured grid (or single-block grid) into a multiple adaptive code.

  19. [Clinical picture, diagnostics and prophylaxis of a syndrome in conditions of the Far North].

    PubMed

    Ukhocskiĭ, D M; Tegza, V Iu; Rezvantsev, M V; Vasil'chenko, V V; Belikova, T M

    2014-10-01

    The analysis of a clinical picture barometeosensitivity in a seaside zone of the Far North is carried out in the article. A diagnostic test included the following laboratory assessments: complete blood count, complete urinary analysis, biomedical measurement assessment, immunology blood research and functional renal test; analysis of the level of an electrolyte in the blood and hormone receptor status; and the following instrumental diagnostics: The auscultatory Korotkov's method of determining blood pressure, electrocardiography, variational pulsometry, chest X-ray, mechanocardiography, echocardiography and abdominal ultrasound; and also consultation of ophthalmologist and neuropathologist. Every patient should keep a diary "weather - health" before and after the treatment. Peculiarities of cardiovascular system, vegetative systems and neuroendocrine system of servicemen, coming to the Far North and mechanisms of development of barometeosensivity were revealed. It has been established that atmospheric pressure variation affects systolic and diastolic blood pressure, heart rate, systolic discharge, Kerdo index, effectiveness of myocardial function, end-diastolic and end-systolic volume, level of cholesterol, triglycerides, kalium, adrenalin, triiodothyronine, blood plasma and plasma renin activity in barometeosensetiv servicemen. The criteria of diagnostics of barometeosensivity in conditions of the Far North are suggested. The influence of baromemteosensivity on the combat capability of serviceman is researched.

  20. Diagnostic imaging in paraneoplastic autoimmune multiorgan syndrome: retrospective single site study and literature review of 225 patients.

    PubMed

    Lehman, Vance T; Barrick, Benjamin J; Pittelkow, Mark R; Peller, Patrick J; Camilleri, Michael J; Lehman, Julia S

    2015-04-01

    The utility of diagnostic imaging in paraneoplastic autoimmune multiorgan syndrome (PAMS) is unknown. We examined the role of diagnostic imaging in patients with PAMS evaluated at our tertiary referral center (at Mayo Clinic, Rochester, MN, USA) and in the English literature between January 1, 1996, and August 31, 2012. We included 17 patients from our institution and 208 patients from the literature review. Of these 225 patients, 113 (50.2%) were not known to have a malignancy diagnosis at the time of PAMS diagnosis. Of the 123 patients from our institution and from the literature reported to undergo imaging studies, conventional computed tomography (CT) was the predominant imaging modality (n = 110; 89.4%); 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT was also used, albeit infrequently (n = 12; 9.8%). When CT was included in imaging to identify or confirm the presence of a malignancy, imaging was successful in all patients who ultimately were diagnosed with an associated malignancy. At our institution, a relatively high percentage (n = 7; 41%) of patients had 18F-FDG PET/CT, which not only identified all tumors found on CT but also facilitated staging of lymphoma and guided biopsy procedures. Diagnostic imaging is frequently utilized in PAMS with unknown malignancy. Both conventional CT and 18F-FDG PET/CT are likely to detect the typical underlying neoplasms. Relative to conventional CT, 18F-FDG PET/CT may provide additional useful information regarding prognosis for the likely underlying malignancies, although there is a paucity of reports describing the use of this modality for this purpose. © 2014 The International Society of Dermatology.

  1. Golden Eagle predation on experimental Sandhill and Whooping Cranes

    USGS Publications Warehouse

    Ellis, D.H.; Clegg, K.R.; Lewis, J.C.; Spaulding, E.

    1999-01-01

    There are very few published records of Golden Eagles preying upon cranes, especially in North America. During our experiments to lead cranes on migration behind motorized craft in the western United States, we experienced 15 attacks (four fatal) and believe many more attacks would have occurred (and more would have been fatal) without human intervention. We recognize eagle predation as an important risk to cranes especially during migration.

  2. Leptin and insulin growth factor 1: diagnostic markers of the refeeding syndrome and mortality.

    PubMed

    Elnenaei, Manal O; Alaghband-Zadeh, Jamshid; Sherwood, Roy; Awara, Mahmoud A; Moniz, Caje; le Roux, Carel W

    2011-09-01

    Refeeding syndrome is difficult to diagnose since the guidelines for identifying those at risk are largely based on subjective clinical parameters and there are no predictive biochemical markers. We examined the suitability of insulin-like growth factor 1 (IGF1) and leptin as markers to identify patients at risk of the refeeding syndrome before initiation of parenteral nutrition (PN). A total of thirty-five consecutive patients referred for commencement of PN were included. Serum leptin and IGF1 were measured before starting PN. Electrolytes, liver and renal function tests were conducted before and daily for 1 week after initiating PN. The primary outcome was a decrease in phosphate 12-36 h after initiating PN. 'Refeeding index' (RI) was defined as leptin × IGF1 divided by 2800 to produce a ratio of 1·0 in patients who are well nourished. RI had better sensitivity (78 %; 95 % CI 40, 97 %) and specificity (78 %; 95 % CI 40, 97 %) with a likelihood ratio of 3·4, at a cut-off value of 0·19 for predicting a ≥ 30 % decrease in phosphate concentration within 12-36 h after starting PN, compared with IGF1 or leptin alone. However, IGF1 was a better predictor of mortality than either leptin or the RI. The present study is the first to derive and test the 'RI', and find that it is a sensitive and specific predictor of the refeeding syndrome in hospitalised patients before starting PN.

  3. Prader-Willi Syndrome: Clinical Genetics and Diagnostic Aspects with Treatment Approaches.

    PubMed

    Butler, Merlin G; Manzardo, Ann M; Forster, Janice L

    2016-01-01

    Prader-Willi syndrome (PWS) is a neuro-developmental genetic disorder due to lack of expression of genes inherited from the paternal chromosome 15q11-q13 region with three main genetic subtypes. These include paternal 15q11-q13 deletion (about 70% of cases), maternal uniparental disomy 15 or both 15s from the mother (20-30% of cases), and defects in the imprinting center (1-3%) which controls the expression of imprinted genes in this chromosome region. Clinical manifestations include infantile hypotonia with a poor suck resulting in failure to thrive, short stature, small hands/feet and hypogonadism/hypogenitalism due to growth and other hormone deficiencies, hyperphagia and excessive weight gain with obesity and cognitive and behavioral problems including obsessive compulsions, tantrums and self-injury. The phenotype is likely related to hypothalamic dysfunction. Hyperphagia and obesity with related complications are major causes of morbidity and mortality in PWS requiring accurate diagnosis, appropriate medical management and treatment; the major objective of our report. An extensive review of the literature was undertaken including genetics, clinical and behavioral aspects, and updated health-related information addressing the importance of early diagnosis and treatment of individuals with Prader-Willi syndrome. A searchable, bulleted and formatted list of topics related to this obesity syndrome was provided utilizing a Table of Contents approach for the clinical practitioner. Physicians and other health care providers can use this review with clinical, genetic and treatment summaries divided into sections that are pertinent in the context of clinical practice. Finally, frequently asked questions by clinicians, families and other interested participants will be addressed.

  4. [The hand-arm vibration syndrome: (II). The diagnostic aspects and fitness criteria].

    PubMed

    Bovenzi, M

    1999-01-01

    Part II of this paper reviews the clinical and laboratory methods to diagnose the neurological, vascular and osteoarticular components of the hand-arm vibration syndrome. The prognosis and reversibility of vibration-induced neurological and vascular disorders after cessation of vibration exposure or the introduction of powered tools equipped with vibration isolation systems are discussed on the basis of the results of follow-up clinical investigations and longitudinal epidemiologic studies. Finally, the review debates some of the methodological aspects connected with the health surveillance of vibration-exposed workers and considers the possible medical contra-indications for prolonged exposure to hand-transmitted vibration.

  5. Correlates of immune defenses in golden eagle nestlings

    USGS Publications Warehouse

    MacColl, Elisabeth; Vanesky, Kris; Buck, Jeremy A.; Dudek, Benjamin; Eagles-Smith, Collin A.; Heath, Julie A.; Herring, Garth; Vennum, Chris; Downs, Cynthia J.

    2017-01-01

    An individual's investment in constitutive immune defenses depends on both intrinsic and extrinsic factors. We examined how Leucocytozoon parasite presence, body condition (scaled mass), heterophil-to-lymphocyte (H:L) ratio, sex, and age affected immune defenses in golden eagle (Aquila chrysaetos) nestlings from three regions: California, Oregon, and Idaho. We quantified hemolytic-complement activity and bacterial killing ability, two measures of constitutive immunity. Body condition and age did not affect immune defenses. However, eagles with lower H:L ratios had lower complement activity, corroborating other findings that animals in better condition sometimes invest less in constitutive immunity. In addition, eagles with Leucocytozoon infections had higher concentrations of circulating complement proteins but not elevated opsonizing proteins for all microbes, and eagles from Oregon had significantly higher constitutive immunity than those from California or Idaho. We posit that Oregon eagles might have elevated immune defenses because they are exposed to more endoparasites than eagles from California or Idaho, and our results confirmed that the OR region has the highest rate of Leucocytozoon infections. Our study examined immune function in a free-living, long-lived raptor species, whereas most avian ecoimmunological research focuses on passerines. Thus, our research informs a broad perspective regarding the evolutionary and environmental pressures on immune function in birds.

  6. Spizaetus hawk-eagles as predators of arboreal colobines.

    PubMed

    Fam, S D; Nijman, V

    2011-04-01

    The predation pressure put on primates by diurnal birds of prey differs greatly between continents. Africa and South America have specialist raptors (e.g. crowned hawk-eagle Stephanoaetus coronatus and harpy eagle Harpia harpyja) whereas in Asia the only such specialist's (Philippine eagle Pithecophaga jefferyi) distribution is largely allopatric with primates. The almost universal absence of polyspecific groups in Asia (common in Africa and South America) may indicate reduced predation pressure. As such there is almost no information on predation pressures on primates in Asia by raptors. Here we report successful predation of a juvenile banded langur Presbytis femoralis (~2 kg) by a changeable hawk-eagle Spizaetus cirrhatus. The troop that was attacked displayed no signs of being alarmed, and no calls were made before the event. We argue that in insular Southeast Asia, especially, large Spizaetus hawk-eagles (~2 kg) are significant predators of arboreal colobines. Using data on the relative size of sympatric Spizaetus hawk-eagles and colobines we make predictions on where geographically we can expect the highest predation pressure (Thai-Malay Peninsula) and which colobines are least (Nasalis larvatus, Trachypithecus auratus, P. thomasi) and most (P. femoralis, T. cristatus) affected.

  7. Migration of Florida sub-adult Bald Eagles

    USGS Publications Warehouse

    Mojica, E.K.; Meyers, J.M.; Millsap, B.A.; Haley, K.L.

    2008-01-01

    We used satellite telemetry locations accurate within 1 km to identify migration routes and stopover sites of 54 migratory sub-adult Bald Eagles (Haliaeetus leucocephalus) hatched in Florida from 1997 to 2001. We measured number of days traveled during migration, path of migration, stopover time and locations, and distance traveled to and from winter and summer areas for each eagle (1?5 years old). Eagles used both Coastal Plain (n = 24) and Appalachian Mountain (n = 26) routes on their first migration north. Mountain migrants traveled farther (X = 2,112 km; 95% CI: 1,815-2,410) than coastal migrants (X = 1,397 km; 95% CI: 1,087?1,706). Eagles changed between migration routes less often on northbound and southbound movements as they matured (X2 = 13.22, df = 2, P < 0.001). One-year-old eagles changed routes between yearly spring and fall migrations 57% of the time, 2-year-olds 30%, and 3-5-year-olds changed only 17% of the time. About half (n = 25, 46%) used stopovers during migration and stayed 6-31 days (X = 14.8 days; 95% CI: 12.8-16.8). We recommend that migratory stopover site locations be added to GIS data bases for improving conservation of Bald Eagles in the eastern United States.

  8. [Reactive airway dysfunction syndrome: more flexible application of diagnostic criteria are important for occupational accident victims].

    PubMed

    Testud, F; Lambert-Chhum, R

    2004-06-01

    Reactive airway dysfunction syndrome (RADS), or Brooks syndrome, is a complication observed after inhalation of caustic or highly irritating substances. The diagnosis is based on a group of criteria which include the absence of prior respiratory disease. Strict application of these criteria could have a prejudicial effect for certain victims. Three serious cases of RADS were observed in workers who were exposed to massive inhalation of caustic substances. The products implicated (phosphoric oxychloride, titanium tetrachloride, and trichloroacetyl chloride) hydrolyze to hydrochloric acid when they come in contact with the airway mucosa. After an initial period of acute respiratory distress, the patients encountered serious difficulties in achieving an appropriate diagnosis, and in having their sequellae recognized as resulting from an occupational accident. The problem was that these patients had a history of cured allergic asthma or smoking-related COPD. The presence of prior respiratory disorders must not exclude the diagnosis of RADS. A prior respiratory disorder cannot be used as an argument to exclude such victims from indemnities for occupational accident sequelae.

  9. Haemophagocytic lymphohistiocytosis presenting as HELLP syndrome: a diagnostic and therapeutic challenge.

    PubMed

    Kerley, Robert Noel; Kelly, Raymond Michael; Cahill, Mary Rose; Kenny, Louise Clare

    2017-04-22

    Haemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal, haematological disorder, which can be clinically challenging to diagnose and manage. We report a case of HLH in a previously healthy 33-year-old primigravida. The patient presented at 22 weeks gestation with dyspnoea, abdominal pain, anaemia, thrombocytopenia and elevated liver enzymes suggestive of HELLP syndrome.HELLP, a syndrome characterised by haemolysis, elevated liver enzymes and low platelets is considered a severe form of pre-eclampsia. Despite delivery of the fetus, her condition deteriorated over 3-4 days with high-grade fever, worsening thrombocytopenia and anaemia requiring transfusion support. A bone marrow biopsy showed haemophagocytosis and a diagnosis of HLH was made. Partial remission was achieved with etoposide-based chemotherapy and complete remission following bone marrow transplantation. Eleven months post-transplant, the disease aggressively recurred, and the patient died within 3 weeks of relapse. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Boundary of the Eagle River Watershed Valley-Fill Aquifer, Eagle County, North-Central Colorado, 2006-2007

    USGS Publications Warehouse

    Rupert, Michael G.; Plummer, Niel

    2009-01-01

    This vector data set delineates the approximate boundary of the Eagle River watershed valley-fill aquifer (ERWVFA). This data set was developed by a cooperative project between the U.S. Geological Survey, Eagle County, the Eagle River Water and Sanitation District, the Town of Eagle, the Town of Gypsum, and the Upper Eagle Regional Water Authority. This project was designed to evaluate potential land-development effects on groundwater and surface-water resources so that informed land-use and water management decisions can be made. The boundary of the ERWVFA was developed by combining information from two data sources. The first data source was a 1:250,000-scale geologic map of the Leadville quadrangle developed by Day and others (1999). The location of Quaternary sediments was used as a first approximation of the ERWVFA. The boundary of the ERWVFA was further refined by overlaying the geologic map with Digital Raster Graphic (DRG) scanned images of 1:24,000 topographic maps (U.S. Geological Survey, 2001). Where appropriate, the boundary of the ERWVFA was remapped to correspond with the edge of the valley-fill aquifer marked by an abrupt change in topography at the edge of the valley floor throughout the Eagle River watershed. The boundary of the ERWVFA more closely resembles a hydrogeomorphic region presented by Rupert (2003, p. 8) because it is based upon general geographic extents of geologic materials and not on an actual aquifer location as would be determined through a rigorous hydrogeologic investigation.

  11. Churg-Strauss syndrome presenting with eosinophilic myocarditis: a diagnostic challenge.

    PubMed

    Correia, Ana Sofia; Gonçalves, Alexandra; Araújo, Vítor; Almeida e Silva, João; Pereira, José Manuel; Rodrigues Pereira, Pedro; Pizarro, Manuel; Silva, João Carlos; Maciel, Maria Júlia

    2013-09-01

    Churg-Strauss syndrome (CSS) is an unusual disease that presents as systemic vasculitis and peripheral eosinophilia in patients with an atopic constitution. Cardiac involvement is unusual and often not prominent on initial presentation, but is an important cause of morbidity and mortality in patients with CSS. We report the case of a young woman with severe acute myocarditis. Coronary arteriography demonstrated extensive focal vasculopathy, consistent with coronary vasculitis, and myocardial biopsy showed eosinophilic myocarditis. This presentation led to an initial diagnosis of CSS in this patient and appropriate therapy resulted in a spectacular remission of disease activity. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  12. [Chronic tics and Tourette syndrome in children and adolescents: diagnostic and treatment characteristics].

    PubMed

    Zavadenko, N N; Doronina, O B; Nesterovsky, Yu E

    2015-01-01

    Chronic tics (CT) are observed in 3-4% population, Tourette syndrome (TS) in 0.1-3.0%. In most cases, tic disorders start at age 2-15 years, but frequently they are diagnosed late. Clinical presentations of tics and comorbid disorders are various and depend on child's age. Difficulties in treatment of CT are associated with their persistence and those for TS with the fluctuating course of tics and probable onset of the disease in the form of behavioral disorders. Treatment of CT and TS is individual. Methods of behavioral and psychotherapy are recommended for a certain period of time if tics do not hamper everyday life. Increase in tick frequency and severity indicate the necessity of using pharmacological treatment. The European recommendations on pharmacotherapy of tic disorders and the drugs available in Russia are considered. Results of the studies on the efficacy of antiepileptic drugs and tenoten children in CT and TS are presented.

  13. Diagnostic utility of F waves in clinically diagnosed patients of carpal tunnel syndrome.

    PubMed

    Joshi, Anand G; Gargate, Ashwini R

    2013-01-01

    Sensory nerve conduction velocity (SNCV) of median nerve measured across the carpal tunnel, difference between distal sensory latencies (DSLs) of median and ulnar nerves and difference between distal motor latencies (DMLs) of median and ulnar nerves are commonly used nerve conduction parameters for diagnosis of carpal tunnel syndrome (CTS). These are having high degree of sensitivity and specificity. Study of median nerve F-wave minimal latency (FWML) and difference between F-wave minimal latencies (FWMLs) of median and ulnar nerves have also been reported to be useful parameters for diagnosis of CTS. However, there is controversy regarding superiority of F-wave study for diagnosis of CTS. So the aim of present study was to compare sensitivity and specificity of median FWML and difference between FWMLs of median and ulnar nerves with that of above mentioned electrophysiological parameters and to find out which parameters are having more sensitivity and specificity, for early diagnosis of CTS. Median and ulnar nerves sensory and motor conduction, median and ulnar nerves F-wave studies were carried out bilaterally in 125 clinically diagnosed patients of carpal tunnel syndrome. These parameters were also studied in 45 age matched controls. Difference between DSLs of median and ulnar nerves, median SNCV and difference between DMLs of median and ulnar nerves were having highest sensitivity and specificity while median FWML and difference between FWMLs of median and ulnar nerves was having lowest sensitivity and specificity for diagnosis of CTS. So in conclusion F-wave study is not superior parameter for diagnosis of CTS.

  14. Role of microsatellite instability-low as a diagnostic biomarker of Lynch syndrome in colorectal cancer.

    PubMed

    Vilar, Eduardo; Mork, Maureen E; Cuddy, Amanda; Borras, Ester; Bannon, Sarah A; Taggart, Melissa W; Ying, Jun; Broaddus, Russell R; Luthra, Rajyalakshmi; Rodriguez-Bigas, Miguel A; Lynch, Patrick M; You, Yi-Qian Nancy

    2014-01-01

    Lynch syndrome is the most common Mendelian disorder predisposing persons to hereditary colorectal cancer. Carriers of MSH6 mutations constitute less than 10% of the total of cases with Lynch syndrome and present with a weaker clinical phenotype, including low levels of microsatellite instability (MSI-L) in colorectal tumors. The frequency of MSH6 mutation carriers among patients presenting with MSI-L colorectal cancer has yet to be determined, as has the appropriate genetic workup in this context. We have reviewed here the clinicopathologic characteristics, immunohistochemistry, and genetic testing results for 71 patients at a single institution diagnosed with MSI-L colorectal cancers. Of 71 patients with MSI-L tumors, 21 underwent genetic testing for MSH6 mutations, three of whom presented with loss of staining of MSH6 and only one of whom carried a pathogenic germline MSH6 mutation in exon 4 (c.2677_2678delCT; p.Leu893Alafs*6). This latter patient had a significant family history of cancer and had a rectal primary tumor that showed instability only in mononucleotide markers. In this cohort of MSI-L patients, we detected no notable clinicopathologic or molecular characteristic that would help to distinguish a group most likely to harbor germline MSH6 mutations. Therefore, we conclude that the prevalence of MSH6 mutations among patients with MSI-L tumors is very low. Microsatellite instability analysis combined with immunohistochemistry of mismatch repair proteins adequately detects potential MSH6 mutation carriers among MSI-L colorectal cancers. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Prevalence of Premorbid Metabolic Syndrome in Spanish Adult Workers Using IDF and ATPIII Diagnostic Criteria: Relationship with Cardiovascular Risk Factors

    PubMed Central

    Tauler, Pedro; Bennasar-Veny, Miquel; Morales-Asencio, Jose M.; Lopez-Gonzalez, Angel A.; Vicente-Herrero, Teofila; De Pedro-Gomez, Joan; Royo, Vanessa; Pericas-Beltran, Jordi; Aguilo, Antoni

    2014-01-01

    Background Metabolic Syndrome (MetS) is a complex disorder defined as a cluster of interconnected risk factors such as hypertension, dyslipidemia, obesity and high blood glucose levels. Premorbid metabolic syndrome (PMetS) is defined by excluding patients with previously diagnosed cardiovascular disease or diabetes mellitus from those suffering MetS. We aimed to determine the prevalence of PMetS in a working population, and to analyse the relationship between the diagnostic criteria of the International Diabetes Federation (IDF) and of the National Cholesterol Education Program Adult Treatment Panel III (ATPIII). The relationship between the presence of PMetS and cardiovascular risk factors was also analysed. Research Methodology/Findings A cross-sectional study was conducted in 24,529 male and 18,736 female Spanish (white western European) adult workers (20–65 years) randomly selected during their work health periodic examinations. Anthropometrics, blood pressure and serum parameters were measured. The presence of MetS and PMetS was ascertained using ATPIII and IDF criteria. Cardiovascular risk was determined using the Framingham-REGICOR equation. The results showed MetS had an adjusted global prevalence of 12.39% using ATPIII criteria and 16.46% using IDF criteria. The prevalence of PMetS was slightly lower (11.21% using ATPIII criteria and 14.72% using IDF criteria). Prevalence in males was always higher than in females. Participants with PMetS displayed higher values of BMI, waist circumference, blood pressure, glucose and triglycerides, and lower HDL-cholesterol levels. Logistic regression models reported lower PMetS risk for females, non-obese subjects, non-smokers and younger participants. Cardiovascular risk determined with Framingham-REGICOR was higher in participants with PMetS. Conclusions PMetS could be a reliable tool for the early identification of apparently healthy individuals who have a significant risk for developing cardiovascular events and

  16. Prevalence of premorbid metabolic syndrome in Spanish adult workers using IDF and ATPIII diagnostic criteria: relationship with cardiovascular risk factors.

    PubMed

    Tauler, Pedro; Bennasar-Veny, Miquel; Morales-Asencio, Jose M; Lopez-Gonzalez, Angel A; Vicente-Herrero, Teofila; De Pedro-Gomez, Joan; Royo, Vanessa; Pericas-Beltran, Jordi; Aguilo, Antoni

    2014-01-01

    Metabolic Syndrome (MetS) is a complex disorder defined as a cluster of interconnected risk factors such as hypertension, dyslipidemia, obesity and high blood glucose levels. Premorbid metabolic syndrome (PMetS) is defined by excluding patients with previously diagnosed cardiovascular disease or diabetes mellitus from those suffering MetS. We aimed to determine the prevalence of PMetS in a working population, and to analyse the relationship between the diagnostic criteria of the International Diabetes Federation (IDF) and of the National Cholesterol Education Program Adult Treatment Panel III (ATPIII). The relationship between the presence of PMetS and cardiovascular risk factors was also analysed. A cross-sectional study was conducted in 24,529 male and 18,736 female Spanish (white western European) adult workers (20-65 years) randomly selected during their work health periodic examinations. Anthropometrics, blood pressure and serum parameters were measured. The presence of MetS and PMetS was ascertained using ATPIII and IDF criteria. Cardiovascular risk was determined using the Framingham-REGICOR equation. The results showed MetS had an adjusted global prevalence of 12.39% using ATPIII criteria and 16.46% using IDF criteria. The prevalence of PMetS was slightly lower (11.21% using ATPIII criteria and 14.72% using IDF criteria). Prevalence in males was always higher than in females. Participants with PMetS displayed higher values of BMI, waist circumference, blood pressure, glucose and triglycerides, and lower HDL-cholesterol levels. Logistic regression models reported lower PMetS risk for females, non-obese subjects, non-smokers and younger participants. Cardiovascular risk determined with Framingham-REGICOR was higher in participants with PMetS. PMetS could be a reliable tool for the early identification of apparently healthy individuals who have a significant risk for developing cardiovascular events and type 2 diabetes.

  17. Diagnostic and surgical challenge: middle ear dermoid cyst in 12 month old with branchio-oto-renal syndrome and multiple middle-ear congenital anomalies.

    PubMed

    Johnston, D R; Whittemore, K; Poe, D; Robson, C D; Perez-Atayde, A R

    2011-10-01

    Described is the first case report, to our knowledge, of a middle-ear dermoid in a child with branchio-oto-renal (BOR) syndrome. Radiographic, pathologic, and intraoperative figures are shown. This was a diagnostic and surgical challenge as the presentation was similar to a congenital cholesteatoma and the child had numerous significant temporal bone abnormalities. After the intraoperative findings suggested a non-destructive process, the treatment strategy was altered. This case reiterates the need for a cautious, flexible operative approach in a syndromic child. Included is a relevant review of the literature and a detailed clinical analysis. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  18. WATERSHED INFARCTION IN HYPEREOSINOPHILIC SYNDROME: A DIAGNOSTIC DILEMMA IN FIP1L1-PDGFR ALPHA-ASSOCIATED MYELOID NEOPLASM.

    PubMed

    Marton, Imelda; Pósfai, Éva; Annus, János Kristóf; Borbényi, Zita; Nemes, Attila; Vecsei, László; Vörös, Erika

    2015-05-30

    The FIP1L1-PDGFR alpha-positive, hypereosinophilic syndrome (HES) is a new category of hematological entities. Various clinical symptoms may occur, with no specific characteristics in either the clinical picture or the neuroimaging findings, and this may give rise to a diagnostic dilemma. A report on a long follow-up period (10 years) in a case of HES that presented with neuropsychiatric symptoms appears to be unique. Besides the complexity of the diagnostic process, the successful treatment is discussed. The HES was diagnosed in a male patient at the age of 33 years, with involvement of the central nervous system and the myocardium. After the onset of the clinical signs, the MRI indicated bilateral cerebral and cerebellar cortico-subcortical lesions involving the watershed areas, mainly in the parieto-occipital regions. High-dose intravenous steroid (methylprednisolone 500 mg/day) alleviated the neurological symptoms within a few weeks, and the administration of imatinib (200 mg/day) resulted in an impressive regression of the hypereosinophilia and splenomegaly within 6 weeks. During the follow-up, the patient has continued to receive imatinib. The molecular remission has persisted, no new complaints have developed and the condition of the patient has remained stable. The timely recognition of the HES and identification of the disease subtype which led to the administration of imatinib may be the key to successful treatment. The long stable follow-up period gives rise to a new dilemma in the treatment of the HES in these special cases: for how long should a patient receive a tyrosine kinase inhibitor, and may the treatment be suspended?

  19. Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists.

    PubMed

    Kuehlmeyer, Katja; Racine, Eric; Palmour, Nicole; Hoster, Eva; Borasio, Gian Domenico; Jox, Ralf J

    2012-10-01

    Diagnosis and decisions on life-sustaining treatment (LST) in disorders of consciousness, such as the vegetative state (VS) and the minimally conscious state (MCS), are challenging for neurologists. The locked-in syndrome (LiS) is sometimes confounded with these disorders by less experienced physicians. We aimed to investigate (1) the application of diagnostic knowledge, (2) attitudes concerning limitations of LST, and (3) further challenging aspects in the care of patients. A vignette-based online survey with a randomized presentation of a VS, MCS, or LiS case scenario was conducted among members of the German Society for Neurology. A sample of 503 neurologists participated (response rate 16.4%). An accurate diagnosis was given by 86% of the participants. The LiS case was diagnosed more accurately (94%) than the VS case (79%) and the MCS case (87%, p < 0.001). Limiting LST for the patient was considered by 92, 91, and 84% of the participants who accurately diagnosed the VS, LiS, and MCS case (p = 0.09). Overall, most participants agreed with limiting cardiopulmonary resuscitation; a minority considered limiting artificial nutrition and hydration. Neurologists regarded the estimation of the prognosis and determination of the patients' wishes as most challenging. The majority of German neurologists accurately applied the diagnostic categories VS, MCS, and LiS to case vignettes. Their attitudes were mostly in favor of limiting life-sustaining treatment and slightly differed for MCS as compared to VS and LiS. Attitudes toward LST strongly differed according to circumstances (e.g., patient's will opposed treatment) and treatment measures.

  20. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome: ultrasonography as a diagnostic tool.

    PubMed

    Agarwal, Vikas; Dabra, Ajay Kumar; Kaur, Ravinder; Sachdev, Atul; Singh, Ram

    2005-09-01

    Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is characterized by symmetrical synovitis and swelling of both the upper and lower extremities. The anatomical determinant of RS3PE is predominantly extensor tenosynovitis as revealed by magnetic resonance imaging (MRI). Given the cost constraints, time, and expertise required in carrying out MRI and ease in diagnosing tenosynovitis by ultrasound, we utilized high-frequency ultrasonography (USG) for evidence of tenosynovitis of the distal tendons in patients with RS3PE. Diagnosis of tenosynovitis was made on the basis of anechoic or hypoechoic signals around the tendon sheaths in both transverse and longitudinal planes. Flexor and extensor tendons at the wrist and metacarpal heads and extensor digitorum longus (EDL) tendons at the ankle were evaluated with a 7.5-10-MHz linear probe. There were ten patients (seven males) with a mean age of 59.5 years (range: 52-78 years) and mean disease duration of 6.1 months (range: 1.5-12 months). Disease onset was acute in all of the cases. Pitting edema of the hands was present in all except two patients whereas four patients, in addition, had edema of the feet. Edema was symmetrical in seven patients. Inability to make a complete fist was noted in all. Tenosynovitis of extensor and flexor tendons at the wrist and the metacarpal heads was documented in all patients with edema of the hands. In seven cases extensor tendon tenosynovitis was more prominent compared to the flexor tendons. Tenosynovitis of EDL tendons was detected in six cases. Dramatic relief with low-dose prednisolone was noted in all patients within 6 weeks of therapy. At a mean follow-up of 10.1 months all patients had marked relief in edema of extremities and improvement in the grip strength. Our study confirms that tenosynovitis of both flexor and extensor tendons at the wrist and extensor tendons of the feet is the hallmark of RS3PE syndrome. USG is a reliable and cost

  1. Eagle Nebula Flaunts its Infrared Feathers

    NASA Technical Reports Server (NTRS)

    2007-01-01

    [figure removed for brevity, see original site] Figure 1 [figure removed for brevity, see original site] [figure removed for brevity, see original site] Figure 2 Figure 3

    This set of images from NASA's Spitzer Space Telescope shows the Eagle nebula in different hues of infrared light. Each view tells a different tale. The left picture shows lots of stars and dusty structures with clarity. Dusty molecules found on Earth called polycyclic aromatic hydrocarbons produce most of the red; gas is green and stars are blue.

    The middle view is packed with drama, because it tells astronomers that a star in this region violently erupted, or went supernova, heating surrounding dust (orange). This view also reveals that the hot dust is shell shaped, another indication that a star exploded.

    The final picture highlights the contrast between the hot, supernova-heated dust (green) and the cooler dust making up the region's dusty star-forming clouds and towers (red, blue and purple).

    The left image is a composite of infrared light with the following wavelengths: 3.6 microns (blue); 4.5 microns (green); 5.8 microns (orange); and 8 microns (red). The right image includes longer infrared wavelengths, and is a composite of light of 4.5 to 8.0 microns (blue); 24 microns (green); and 70 microns (red). The middle image is made up solely of 24-micron light.

  2. Diagnostic criteria and staging of hand-arm vibration syndrome in the United Kingdom.

    PubMed

    McGeoch, Kenneth L; Lawson, Ian J; Burke, Frank; Proud, George; Miles, Jeremy

    2005-07-01

    In the United Kingdom the diagnosis of Hand-arm Vibration Syndrome varies depending on the purpose of that diagnosis. The criteria differ in three situations. More than 100,000 miners and ex-miners with claims for HAVS have been examined using a Medical Assessment Process which included the use of standardised tests. This contract is unique but it has had significant effects on the two other processes. The Industrial Injuries Disablement Benefit Scheme provides a benefit that can be paid to an employed earner because of an accident or Prescribed Disease. New recommendations have been published to remove the anomalies in the present format for assessing HAVS. If implemented the new scheme will recognise the Stockholm Workshop Scales and workers with neurological problems will also be compensated. The Health and Safety Executive will issue new guidance in the near future on the hazards of hand-arm vibration. Health surveillance in the workplace will be fundamental and the HSE propose a tiered approach with levels 1 to 5. Specialist occupational nurses and doctors with training in the diagnosis and assessment of HAVS will be needed for levels 3 and 4. Only at this level may a diagnosis of HAVS be made. The Medical Assessment Process has demonstrated that it is possible to examine a large number of claimants in a standardised manner. The IIAC and HSE recommendations contain very important improvements on the existing positions in the UK and it must be hoped that they will be implemented in the near future.

  3. Development of diagnostics in the search for an explanation of aerotoxic syndrome.

    PubMed

    Schopfer, Lawrence M; Furlong, Clement E; Lockridge, Oksana

    2010-09-01

    Aerotoxic syndrome is assumed to be caused by exposure to tricresyl phosphate, an additive in engine lubricants and hydraulic fluids that is activated to the toxic 2-(ortho-cresyl)-4H-1,3,2-benzodioxaphosphoran-2-one (CBDP). Currently, there is no laboratory evidence to support intoxication of airline crew members by CBDP. Our goal was to develop methods for testing in vivo exposure by identifying and characterizing biomarkers. Mass spectrometry was used to study the reaction of CBDP with human albumin, free tyrosine, and human butyrylcholinesterase. Human albumin made a covalent bond with CBDP, adding a mass of 170amu to Tyr411 to yield the o-cresyl phosphotyrosine derivative. Human butyrylcholinesterase made a covalent bond with CBDP on Ser198 to yield five adducts with added masses of 80, 108, 156, 170, and 186amu. The most abundant adduct had an added mass of 80amu from phosphate (HPO(3)), a surprising result given that no pesticide or nerve agent is known to yield phosphorylated serine with an added mass of 80amu. The next most abundant adduct had an added mass of 170amu to form o-cresyl phosphoserine. It is concluded that toxic gases or oil mists in cabin air may form adducts on plasma butyrylcholinesterase and albumin, detectable by mass spectrometry. 2010 Elsevier Inc. All rights reserved.

  4. The utility of Next Generation Sequencing for molecular diagnostics in Rett syndrome.

    PubMed

    Vidal, Silvia; Brandi, Núria; Pacheco, Paola; Gerotina, Edgar; Blasco, Laura; Trotta, Jean-Rémi; Derdak, Sophia; Del Mar O'Callaghan, Maria; Garcia-Cazorla, Àngels; Pineda, Mercè; Armstrong, Judith

    2017-09-25

    Rett syndrome (RTT) is an early-onset neurodevelopmental disorder that almost exclusively affects girls and is totally disabling. Three genes have been identified that cause RTT: MECP2, CDKL5 and FOXG1. However, the etiology of some of RTT patients still remains unknown. Recently, next generation sequencing (NGS) has promoted genetic diagnoses because of the quickness and affordability of the method. To evaluate the usefulness of NGS in genetic diagnosis, we present the genetic study of RTT-like patients using different techniques based on this technology. We studied 1577 patients with RTT-like clinical diagnoses and reviewed patients who were previously studied and thought to have RTT genes by Sanger sequencing. Genetically, 477 of 1577 patients with a RTT-like suspicion have been diagnosed. Positive results were found in 30% by Sanger sequencing, 23% with a custom panel, 24% with a commercial panel and 32% with whole exome sequencing. A genetic study using NGS allows the study of a larger number of genes associated with RTT-like symptoms simultaneously, providing genetic study of a wider group of patients as well as significantly reducing the response time and cost of the study.

  5. Marfan Syndrome: new diagnostic criteria, same anesthesia care? Case report and review.

    PubMed

    Araújo, Maria Rita; Marques, Céline; Freitas, Sara; Santa-Bárbara, Rita; Alves, Joana; Xavier, Célia

    2016-01-01

    Marfan's Syndrome (MFS) is a disorder of connective tissue, mainly involving the cardiovascular, musculoskeletal, and ocular systems. The most severe problems include aortic root dilatation and dissection. Anesthetic management is vital for the improvement on perioperative morbidity. 61-year-old male with MFS, presenting mainly with pectus carinatum, scoliosis, ectopia lens, previous spontaneous pneumothorax and aortal aneurysm and dissection submitted to thoracoabdominal aortic prosthesis placement. Underwent routine laparoscopic cholecystectomy due to lithiasis. Important findings on preoperative examination were thoracolumbar kyphoscoliosis, metallic murmur on cardiac exam. Chest radiograph revealed Cobb angle of 70°. Echocardiogram showed evidence of aortic mechanical prosthesis with no deficits. Preoperative evaluation should focus on cardiopulmonary abnormalities. The anesthesiologist should be prepared for a potentially difficult intubation. Proper positioning and limb support prior to induction is crucial in order to avoid joint injuries. Consider antibiotic prophylaxis for subacute bacterial endocarditis. The patient should be carefully positioned to avoid joint injuries. Intraoperatively cardiovascular monitoring is mandatory: avoid maneuvers that can lead to tachycardia or hypertension, control airway pressure to prevent pneumothorax and maintain an adequate volemia to decrease chances of prolapse, especially if considering laparoscopic surgery. No single intraoperative anesthetic agent or technique has demonstrated superiority. Adequate postoperative pain management is vitally important to avoid the detrimental effects of hypertension and tachycardia. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  6. Development of diagnostics in the search of an explanation for toxic airline syndrome 1

    PubMed Central

    Schopfer, Lawrence M.; Furlong, Clement E.; Lockridge, Oksana

    2010-01-01

    Toxic airline syndrome is assumed to be caused by exposure to tri-cresyl phosphate, an additive in engine lubricants and hydraulic fluids, which is activated to the toxic 2-(o-cresyl)-4H-1,3,2-benzodioxaphosphoran-2-one (CBDP). At present there is no laboratory evidence to support intoxication of airline crew by CBDP. Our goal was to develop methods for testing in vivo exposure by identifying and characterizing biomarkers. Mass spectrometry was used to study the reaction of CBDP with human albumin, free tyrosine, and human butyrylcholinesterase. Human albumin made a covalent bond with CBDP, adding a mass of 170 to tyrosine 411 to yield the ortho-cresyl phosphotyrosine derivative. Human butyrylcholinesterase made a covalent bond with CBDP on serine 198 to yield 5 adducts with added masses of 80, 108, 156, 170, and 186. The most abundant adduct had an added mass of 80 from phosphate (HPO3), a surprising result since no pesticide or nerve agent is known to yield phosphorylated serine with an added mass of 80. The next most abundant adduct had an added mass of 170 to form ortho-cresyl phosphoserine. It is concluded that toxic gases or oil mists in cabin air may form adducts on plasma butyrylcholinesterase and albumin, detectable by mass spectrometry. PMID:20447373

  7. Role of microsatellite instability-low as a diagnostic biomarker of Lynch syndrome in colorectal cancer

    PubMed Central

    Vilar, Eduardo; Mork, Maureen E.; Cuddy, Amanda; Borras, Ester; Bannon, Sarah A.; Taggart, Melissa W.; Ying, Jun; Broaddus, Russell R.; Luthra, Rajyalakshmi; Rodriguez-Bigas, Miguel A.; Lynch, Patrick M.; You, Y. Nancy

    2014-01-01

    Lynch syndrome is the most common Mendelian disorder predisposing to hereditary colorectal cancer. Carriers of MSH6 mutations constitute less than 10% of total cases and present with a weaker clinical phenotype, including low levels of microsatellite instability (MSI-L) in colorectal tumors. The frequency of MSH6 mutation carriers among patients presenting with MSI-L colorectal cancer has yet to be determined, as has the appropriate genetic work-up in this context. We have reviewed here the clinicopathological characteristics, immunohistochemistry and genetic testing results for 71 patients at a single institution diagnosed with MSI-L colorectal cancers. Of 71 patients with MSI-L tumors, 21 underwent genetic testing for MSH6 mutations, three of them presented with loss of staining of MSH6 and only one carried a pathogenic germline MSH6 mutation in exon 4 (c.2677_2678delCT; p.Leu893Alafs*6). This latter patient had a significant family history and had a rectal primary that showed instability only in mononucleotide markers. In this cohort of MSI-L patients, we detected no notable clinicopathological and molecular characteristics that would help to distinguish a group most likely to harbor germline MSH6 mutations. Therefore, we conclude that the prevalence of MSH6 mutations among subjects with MSI-L tumors is very low. MSI analysis combined with immunohistochemistry of mismatch repair proteins adequately detects potential MSH6 carriers among MSI-L colorectal cancers. PMID:25432668

  8. Soluble CD30 levels as a diagnostic marker for bronchiolitis obliterans syndrome following human lung transplantation

    PubMed Central

    Golocheikine, Anjali .S.; Saini, Deepti; Ramachandran, Sabarinathan; Trulock, Elbert P.; Patterson, Alexander; Mohanakumar, T.

    2007-01-01

    The long term survival of human lung allograft is hampered by the occurrence of chronic rejection, Bronchiolitis Obliterans Syndrome (BOS). This end-stage disease is normally diagnosed clinically by using the pulmonary function tests. This results in delay of BOS diagnosis and consequently prevents early intervention. It is generally accepted that alloimmunity plays an important role in chronic rejection of the allograft. In this study we analyzed serial serum samples from BOS+ and BOS− patients for sCD30 levels to determine the role of sCD30 to predict the onset of BOS. In contrast to BOS negative patients and normal subjects, 6 out of 9 BOS+ patients (P<0.05) studied had an increase in the sCD30 levels. Significantly, the rise was noted 7.57 ±2.63 months before the clinical diagnosis was evident. Therefore, we propose that the rise in serum sCD30 levels can be used as a marker for the detection of patients who are at risk of development of BOS. PMID:18047935

  9. Soluble CD30 levels as a diagnostic marker for bronchiolitis obliterans syndrome following human lung transplantation.

    PubMed

    Golocheikine, Anjali S; Saini, Deepti; Ramachandran, Sabarinathan; Trulock, Elbert P; Patterson, Alexander; Mohanakumar, T

    2008-01-01

    The long term survival of human lung allograft is hampered by the occurrence of chronic rejection, Bronchiolitis Obliterans Syndrome (BOS). This end-stage disease is normally diagnosed clinically by using the pulmonary function tests. This results in delay of BOS diagnosis and consequently prevents early intervention. It is generally accepted that alloimmunity plays an important role in chronic rejection of the allograft. In this study we analyzed serial serum samples from BOS+ and BOS- patients for sCD30 levels to determine the role of sCD30 to predict the onset of BOS. In contrast to BOS negative patients and normal subjects, 6 out of 9 BOS+ patients (p<0.05) studied had an increase in the sCD30 levels. Significantly, the rise was noted 7.57+/-2.63 months before the clinical diagnosis was evident. Therefore, we propose that the rise in serum sCD30 levels can be used as a marker for the detection of patients who are at risk of development of BOS.

  10. [Marfan Syndrome: new diagnostic criteria, same anesthesia care? Case report and review].

    PubMed

    Araújo, Maria Rita; Marques, Céline; Freitas, Sara; Santa-Bárbara, Rita; Alves, Joana; Xavier, Célia

    2016-01-01

    Marfan's Syndrome (MFS) is a disorder of connective tissue, mainly involving the cardiovascular, musculoskeletal, and ocular systems. The most severe problems include aortic root dilatation and dissection. Anesthetic management is vital for the improvement on perioperative morbidity. 61-year-old male with MFS, presenting mainly with pectus carinatum, scoliosis, ectopia lens, previous spontaneous pneumothorax and aortal aneurysm and dissection submitted to thoracoabdominal aortic prosthesis placement. Underwent routine laparoscopic cholecystectomy due to lithiasis. Important findings on preoperative examination were thoracolumbar kyphoscoliosis, metallic murmur on cardiac exam. Chest radiograph revealed Cobb angle of 70°. Echocardiogram showed evidence of aortic mechanical prosthesis with no deficits. Preoperative evaluation should focus on cardiopulmonary abnormalities. The anesthesiologist should be prepared for a potentially difficult intubation. Proper positioning and limb support prior to induction is crucial in order to avoid joint injuries. Consider antibiotic prophylaxis for subacute bacterial endocarditis. The patient should be carefully positioned to avoid joint injuries. Intraoperatively cardiovascular monitoring is mandatory: avoid maneuvers that can lead to tachycardia or hypertension, control airway pressure to prevent pneumothorax and maintain an adequate volemia to decrease chances of prolapse, especially if considering laparoscopic surgery. No single intraoperative anesthetic agent or technique has demonstrated superiority. Adequate postoperative pain management is vitally important to avoid the detrimental effects of hypertension and tachycardia. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  11. Diagnostic and prognostic value of H-FABP in acute coronary syndrome: Still evidence to bring.

    PubMed

    Bivona, Giulia; Agnello, Luisa; Bellia, Chiara; Lo Sasso, Bruna; Ciaccio, Marcello

    2018-04-24

    The assessment of chest pain patients presenting to the emergency area (EA) is still a clinical challenge, as the majority of patients are not diagnosed with acute coronary syndrome (ACS). New generation high sensitivity c-Tn (hs-cTn) assays have showed better performances compared to the standard c-Tn. However, hs-Tn still presents some limitations. Hence, novel, early biomarkers are needed in this setting. Among all, heart-type fatty acid binding protein (H-FABP) has been largely investigated. This article reviews the studies evaluating H-FABP performance in diagnosing acute myocardial infarction (AMI) and stratifying chest pain patients by risk. H-FABP optimal performances in ACS have been reported by studies that used low threshold for positivity, or compared the biomarker to cTn at 3-6 h, or by studies with small sample size. Literature review allows stating that H-FABP is clearly not a reliable marker in ACS, as it is unable to diagnose AMI, neither as a stand-alone test nor combined with hs-cTn. Few evidence supports its incremental value in ruling-out AMI and its risk stratification ability for chest pain patients presenting to EA. Thus, available data may not encourage going on investigating. Copyright © 2018. Published by Elsevier Inc.

  12. A Southern Bald Eagle perches on a pole at KSC.

    NASA Technical Reports Server (NTRS)

    2000-01-01

    A Southern Bald Eagle perched on top of a utility pole searches the area. About a dozen bald eagles live in the Merritt Island National Wildlife Refuge, which shares a boundary with Kennedy Space Center. The Southern Bald Eagle ranges throughout Florida and along the coasts of California, Texas, Louisiana, and the south Atlantic states. Bald Eagles are listed as endangered in the U.S., except in five states where they are listed as threatened. The number of nesting pairs of the southern race once numbered several thousand; recent estimates are only 350-375. Most of the southern race nest in Florida. Eagles arrive at KSC during late summer and leave for the north in late spring. They move to nest sites in October and November and lay one to three eggs. The young fledge from February to April. The Refuge encompasses 92,000 acres that are a habitat for more than 331 species of birds, 31 mammals, 117 fishes, and 65 amphibians and reptiles. The marshes and open water of the refuge provide wintering areas for 23 species of migratory waterfowl, as well as a year-round home for great blue herons, great egrets, wood storks, cormorants, brown pelicans and other species of marsh and shore birds, as well as a variety of insects.

  13. A Southern Bald Eagle perches on a pole at KSC.

    NASA Technical Reports Server (NTRS)

    2000-01-01

    A Southern Bald Eagle perches on top of a utility pole at Kennedy Space Center. About a dozen bald eagles live in the Merritt Island National Wildlife Refuge, which shares a boundary with Kennedy Space Center. The Southern Bald Eagle ranges throughout Florida and along the coasts of California, Texas, Louisiana, and the south Atlantic states. Bald Eagles are listed as endangered in the U.S., except in five states where they are listed as threatened. The number of nesting pairs of the southern race once numbered several thousand; recent estimates are only 350-375. Most of the southern race nest in Florida. Eagles arrive at KSC during late summer and leave for the north in late spring. They move to nest sites in October and November and lay one to three eggs. The young fledge from February to April. The Refuge encompasses 92,000 acres that are a habitat for more than 331 species of birds, 31 mammals, 117 fishes, and 65 amphibians and reptiles. The marshes and open water of the refuge provide wintering areas for 23 species of migratory waterfowl, as well as a year-round home for great blue herons, great egrets, wood storks, cormorants, brown pelicans and other species of marsh and shore birds, as well as a variety of insects.

  14. Bald eagles view their territory from high tower at KSC

    NASA Technical Reports Server (NTRS)

    2000-01-01

    A pair of Florida bald eagles take advantage of a tower to rest and view the landscape near the intersection of the NASA Causeway and Kennedy Parkway North at Kennedy Space Center. This pair of eagles nests near Kennedy Parkway and is seen frequently by KSC commuters and visitors. The Southern Bald Eagle ranges throughout Florida and along the coasts of California, Texas, Louisiana and the south Atlantic states. Bald Eagles are listed as endangered in the U.S., except in five states where they are listed as threatened. The number of nesting pairs of the southern race once numbered several thousand; recent estimates are only 350-375. Most southern Florida eagles nesting at KSC arrive during late summer and leave for the north in late spring. They move to nest sites in October and November and lay one to three eggs. The young fledge from February to April. . Kennedy Space Center shares a boundary with the Merritt Island National Wildlife Refuge, which encompasses 92,000 acres that are a habitat for more than 331 species of birds, 31 mammals, 117 fishes, and 65 amphibians and reptiles. The marshes and open water of the refuge provide wintering areas for 23 species of migratory waterfowl, as well as a year-round home for great blue herons, great egrets, wood storks, cormorants, brown pelicans and other species of marsh and shore birds, as well as a variety of insects.

  15. Eagle RTS: A design for a regional transport aircraft

    NASA Technical Reports Server (NTRS)

    Bryer, Paul; Buckles, Jon; Lemke, Paul; Peake, Kirk

    1992-01-01

    This university design project concerns the Eagle RTS (Regional Transport System), a 66 passenger, twin turboprop aircraft with a range of 836 nautical miles. It will operate with a crew of two pilots and two flight attendents. This aircraft will employ the use of aluminum alloys and composite materials to reduce the aircraft weight and increase aerodynamic efficiency. The Eagle RTS will use narrow body aerodynamics with a canard configuration to improve performance. Leading edge technology will be used in the cockpit to improve flight handling and safety. The Eagle RTS propulsion system will consist of two turboprop engines with a total thrust of approximately 6300 pounds, 3150 pounds thrust per engine, for the cruise configuration. The engines will be mounted on the aft section of the aircraft to increase passenger safety in the event of a propeller failure. Aft mounted engines will also increase the overall efficiency of the aircraft by reducing the aircraft's drag. The Eagle RTS is projected to have a takeoff distance of approximately 4700 feet and a landing distance of 6100 feet. These distances will allow the Eagle RTS to land at the relatively short runways of regional airports.

  16. Eagle RTS: A design of a regional transport

    NASA Technical Reports Server (NTRS)

    Bryer, Paul; Buckles, Jon; Lemke, Paul; Peake, Kirk

    1992-01-01

    The Eagle RTS (Regional Transport System) is a 66-passenger aircraft designed to satisfy the need for accessible and economical regional travel. The first design objective for the Eagle RTS is safety. Safety results primarily from avoidance of the hub airport air traffic, implementation of anti-stall characteristics by tailoring the canard, and proper positioning of the engines for blade shedding. To provide the most economical aircraft, the Eagle RTS will use existing technology to lower production and maintenance costs by decreasing the amount of new training required. In selecting the propulsion system, the effects on the environment were a main consideration. Two advantages of turbo-prop engines are the high fuel efficiency and low noise levels produced by this type of engine. This ensures the aircraft's usage during times of rising fuel costs and growing aircraft noise restrictions. The design of the Eagle RTS is for spoke-to-spoke transportation. It must be capable of landing on shorter runways and have speeds comparable to that of the larger aircraft to make its service beneficial to the airlines. With the use of turbo-prop engines and high lift devices, the Eagle RTS is highly adaptable to regional airports. The design topics discussed include: aerodynamics, stability, structures and materials, propulsion, and cost.

  17. From a genetic innovation to mass health programmes: the diffusion of Down's Syndrome prenatal screening and diagnostic techniques in France.

    PubMed

    Vassy, Carine

    2006-10-01

    Down's Syndrome prenatal diagnostic and screening techniques have spread widely in France over the last 30 years and are now part of the routine clinical practice of prenatal care. These techniques, which originated in the field of genetics, ultrasonography and biochemistry, were the first to provide the possibility of choosing the features of the foetus, or at least to reject some of its characteristics. They lead to new norms of healthy foetuses and a progressive acceptance of medical abortions. The aim of this paper is to understand how the use of these tests has been generalised in France despite scientific controversies about their risks and ethical questioning about a potential renewal of eugenics. It analyses the representations of public needs that have been articulated by key players in the scientific and medical fields. This research explores political and administrative decision making processes to understand how progressively widening public access to prenatal testing has been organised and funded. The results highlight the scientific and political role of biomedical researchers, the forms of involvement of health authorities and politicians, and the passive participation of the vast majority of the users. The paper also examines the characteristics of the French health system that facilitated the generalised use of the technology.

  18. Asperger syndrome in males over two decades: Quality of life in relation to diagnostic stability and psychiatric comorbidity.

    PubMed

    Helles, Adam; Gillberg, I Carina; Gillberg, Christopher; Billstedt, Eva

    2017-05-01

    This study examined objective quality of life (work, academic success, living situation, relationships, support system) and subjective quality of life (Sense of Coherence and Short-Form Health Survey-36) in an adult sample of males ( n = 50, mean age: 30 years) with Asperger syndrome diagnosed in childhood and followed prospectively over two decades. The association between long-term diagnostic stability of an autism spectrum disorder and/or comorbid psychiatric disorders with quality of life was also examined. The results showed great variability as regards quality of life. The subsample that no longer fulfilled an autism spectrum disorder had full-time jobs or studies (10/11), independent living (100%), and reported having two or more friends (100%). In the stable autism spectrum disorder group, 41% had full-time job or studies, 51% lived independently, and 33% reported two or more friends, and a significant minority had specialized employments, lived with support from the government, or had no friends. Academic success was positively correlated with IQ. A majority of the total group scored average Sense of Coherence scores, and the mean for Short-Form Health Survey-36 was above average regarding psychical health and below average regarding mental health. Stability of autism spectrum disorder diagnosis was associated with objective but not subjective quality of life, while psychiatric comorbidity was associated with subjective but not objective quality of life.

  19. Comparison of diagnostic criteria to detect undiagnosed diabetes in hyperglycaemic patients with acute coronary syndrome.

    PubMed

    de Mulder, Maarten; Oemrawsingh, Rohit M; Stam, Frank; Boersma, Eric; Umans, Victor A

    2012-01-01

    Elevated plasma glucose levels on admission (APG) are very common in patients with acute coronary syndrome (ACS) and can be the first indication of diabetes mellitus. To provide insight into the prevalence of previously undiagnosed diabetes and to compare different methods of diagnosing diabetes in patients with ACS. Patients with ACS with elevated APG who participated in the BIOMArCS 2 glucose trial underwent an oral glucose tolerance test (OGTT) prior to discharge. 130 patients were included who underwent metabolic assessment. Of these, 109 had an OGTT and 13 patients had pre-existing diabetes. The OGTT results were categorised as (previously) undiagnosed diabetes in 35% of patients (fasting plasma glucose (FPG) ≥7.0 mmol/l or 2-h post-load glucose ≥11.1 mmol/l) and impaired glucose metabolism in 44% (FPG 6.1-6.9 mmol/l or post-load glucose 7.8-11.0 mmol/l), so only 21% had a normal glucose metabolism. Undiagnosed diabetes could not be adequately predicted with APG, FPG or HbA1c (area under the ROC curve 0.61, 0.75 and 0.72, respectively). Patients with abnormal glucose metabolism were significantly older, had higher admission HbA1c values, a higher Killip classification and more often had a prior stroke than patients with normal glucose metabolism. 79% of hyperglycaemic patients with ACS were found to have abnormal glucose metabolism. As APG, HbA1c and FPG had a low sensitivity to detect undiagnosed diabetes, an OGTT appears to be the best test to assess the presence of previously undiagnosed diabetes or impaired glucose metabolism in hyperglycaemic patients with ACS.

  20. Diagnostic delays in 537 symptomatic cases of Middle East respiratory syndrome coronavirus infection in Saudi Arabia.

    PubMed

    Ahmed, Anwar E

    2017-09-01

    Although the literature indicates that patient delays in seeking medical support for Middle East respiratory syndrome coronavirus (MERS-CoV) infections are associated with poor clinical outcomes, delays in the diagnosis itself remain poorly understood in these patients. This study aimed to determine the median time interval from symptom onset to a confirmed diagnosis and to identify the potential predictors of this interval in Saudi Arabian MERS patients. This was a retrospective study of patients with confirmed MERS who were publicly reported by the World Health Organization (WHO). Five hundred and thirty-seven symptomatic cases of MERS-CoV infection were included. The median time interval between symptom onset and confirmation of the MERS diagnosis was 4 days (interquartile range 2-7 days), ranging from 0 to 36 days. According to the negative binomial model, the unadjusted rate ratio (RR) of delays in the diagnosis was significantly higher in older patients (>65 years) (RR 1.42), non-healthcare workers (RR 1.74), patients with severe illness (RR 1.22), those with an unknown source of infection (RR 1.84), and those who had been in close contact with camels (RR 1.74). After accounting for confounders, the adjusted rate ratio (aRR) of delays in the diagnosis was independently associated with unknown source of infection (aRR 1.68) and close contact with camels (aRR 1.58). The time interval from symptom onset to diagnosis was greater in older patients, non-healthcare workers, patients with severe illness, patients with an unknown source of infection, and patients who had been in close contact with camels. The findings warrant educational interventions to raise general public awareness of the importance of early symptom notification. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  1. What is in a name? Comparing diagnostic criteria for chronic fatigue syndrome with or without fibromyalgia.

    PubMed

    Meeus, Mira; Ickmans, Kelly; Struyf, Filip; Kos, Daphne; Lambrecht, Luc; Willekens, Barbara; Cras, Patrick; Nijs, Jo

    2016-01-01

    The current study had two objectives. (1) to compare objective and self-report measures in patients with chronic fatigue syndrome (CFS) according to the 1994 Center for Disease Control (CDC) criteria, patients with multiple sclerosis (MS), and healthy controls, and (2) to contrast CFS patients who only fulfill CDC criteria to those who also fulfill the criteria for myalgic encephalomyelitis (ME), the 2003 Canadian criteria for ME/CFS, or the comorbid diagnosis of fibromyalgia (FM). One hundred six participants (48 CFS patients diagnosed following the 1994 CDC criteria, 19 MS patients, and 39 healthy controls) completed questionnaires assessing symptom severity, quality of life, daily functioning, and psychological factors. Objective measures consisted of activity monitoring, evaluation of maximal voluntary contraction and muscle recovery, and cognitive performance. CFS patients were screened whether they also fulfilled ME criteria, the Canadian criteria, and the diagnosis of FM. CFS patients scored higher on symptom severity, lower on quality of life, and higher on depression and kinesiophobia and worse on MVC, muscle recovery, and cognitive performance compared to the MS patients and the healthy subjects. Daily activity levels were also lower compared to healthy subjects. Only one difference was found between those fulfilling the ME criteria and those who did not regarding the degree of kinesiophobia (lower in ME), while comorbidity for FM significantly increased the symptom burden. CFS patients report more severe symptoms and are more disabled compared to MS patients and healthy controls. Based on the present study, fulfillment of the ME or Canadian criteria did not seem to give a clinically different picture, whereas a diagnosis of comorbid FM selected symptomatically worse and more disabled patients.

  2. Clinical application of a novel diagnostic scheme including pancreatic β‑cell dysfunction for traumatic multiple organ dysfunction syndrome.

    PubMed

    Wang, Zhan-Ke; Chen, Rong-Jian; Wang, Shi-Liang; Li, Guang-Wei; Zhu, Zhong-Zhen; Huang, Qiang; Chen, Zi-Li; Chen, Fan-Chang; Deng, Lei; Lan, Xiao-Peng; Hu, Tian

    2018-01-01

    A novel diagnostic scheme that includes pancreatic β‑cell dysfunction analysis for the diagnosis of traumatic multiple organ dysfunction syndrome (MODS) was investigated to assist in the early diagnosis and detection of MODS. Early intervention and treatment of MODS has been associated with a reduced mortality rate. A total of 2,876 trauma patients (including patients post‑major surgery) were admitted to the intensive care unit of the authors' hospital between December 2010 and December 2015 and enrolled in the present study. There were 205 cases where the patient succumbed to their injuries. In addition to the conventional diagnostic scheme for traumatic MODS, indexes of pancreatic β‑cell dysfunction [fasting blood‑glucose (FBG), homeostatic model assessment‑β and (blood insulin concentration 30 min following glucose loading‑fasting insulin concentration)/(blood glucose concentration 30 min following glucose loading‑FBG concentration)] were included to establish an improved diagnostic scheme for traumatic MODS. The novel scheme was subsequently used in clinical practice alongside the conventional scheme and its effect was evaluated. The novel scheme had a significantly higher positive number of MODS diagnoses for all trauma patients compared with the conventional scheme (12.48 vs. 8.87%; P<0.01). No significant difference was identified in the final percentage of positive of MODS diagnoses for trauma‑associated mortality patients between the novel (88.30%) and the conventional scheme (86.34%). The novel scheme had a significantly higher positive number of MODS diagnoses for trauma‑associated mortality patients 3 days prior to patients succumbing to MODS compared with the conventional scheme (80.98 vs. 64.39%; P<0.01). The consensus of the MODS diagnosis of all trauma patients between the novel scheme and the conventional scheme was 100%; however, out of the patients diagnosed as positive by novel scheme 71.03% were positive by the

  3. Surgical treatment of bumblefoot in a captive golden eagle (Aquila chrysaetos)

    PubMed Central

    Poorbaghi, Seyedeh Leila; Javdani, Moosa; Nazifi, Saeed

    2012-01-01

    The golden eagle is one of the world's largest living birds. Footpad dermatitis, also known as plantar pododermatitis or bumblefoot, is a condition characterized by lesions due to contact with unhealthy "perching" conditions, such as plastic perches, sharp-cornered perches on the ventral footpad of birds. A young female golden eagle (Aquila chrysaetos) in Fars province of Iran was presented to veterinary clinics of Shiraz University with clinical signs of lameness. The bird was examined clinically and a variety of complementary diagnostic procedures such as blood analysis, X-ray and bacteriological culture were performed. Then a surgical method was pick out for removing of scab, pus and necrotic tissues from abscess on the plantar aspect of bird's feet and healing the skin of area. After surgery, specific bandage, systemic antibiotics and vitamins were used. Corynebacterium, a gram negative bacterium, was isolated in the pus from the abscess. After the surgical operation, swelling in the digital pad reduced, the skin of pad healed and the signs of lameness vanished. To prevent developing bumblefoot, good bedding for proper "perching" conditions is necessary. Additionally, vitamin therapy to promote a healthy integument is advised. PMID:25653750

  4. Post electrical or lightning injury syndrome: a proposal for an American Psychiatric Association's Diagnostic and Statistical Manual formulation with implications for treatment.

    PubMed

    Andrews, Christopher J; Reisner, Andrew D; Cooper, Mary Ann

    2017-09-01

    In the past, victims of electrical and lightning injuries have been assessed in a manner lacking a systematic formulation, and against ad hoc criteria, particularly in the area of neuropsychological disability. In this manner patients have, for example, only been partially treated, been poorly or incorrectly diagnosed, and have been denied the full benefit of compensation for their injuries. This paper contains a proposal for diagnostic criteria particularly for the neuropsychological aspects of the post injury syndrome. It pays attention to widely published consistent descriptions of the syndrome, and a new cluster analysis of post electrical injury patients. It formulates a proposal which could be incorporated into future editions of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM). The major neuropsychological consequences include neurocognitive dysfunction, and memory subgroup dysfunction, with ongoing consequences, and sometimes including progressive or delayed psychiatric, cognitive, and/or neurological symptoms. The proposed diagnostic criteria insist on a demonstrated context for the injury, both specifying the shock circumstance, and also physical consequences. It allows for a certain delay in onset of symptoms. It recognizes exclusory conditions. The outcome is a proposal for a DSM classification for the post electrical or lightning injury syndrome. This proposal is considered important for grounding patient treatment, and for further treatment trials. Options for treatment in electrical or lightning injury are summarised, and future trials are foreshadowed.

  5. Post electrical or lightning injury syndrome: a proposal for an American Psychiatric Association's Diagnostic and Statistical Manual formulation with implications for treatment

    PubMed Central

    Andrews, Christopher J.; Reisner, Andrew D.; Cooper, Mary Ann

    2017-01-01

    In the past, victims of electrical and lightning injuries have been assessed in a manner lacking a systematic formulation, and against ad hoc criteria, particularly in the area of neuropsychological disability. In this manner patients have, for example, only been partially treated, been poorly or incorrectly diagnosed, and have been denied the full benefit of compensation for their injuries. This paper contains a proposal for diagnostic criteria particularly for the neuropsychological aspects of the post injury syndrome. It pays attention to widely published consistent descriptions of the syndrome, and a new cluster analysis of post electrical injury patients. It formulates a proposal which could be incorporated into future editions of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM). The major neuropsychological consequences include neurocognitive dysfunction, and memory subgroup dysfunction, with ongoing consequences, and sometimes including progressive or delayed psychiatric, cognitive, and/or neurological symptoms. The proposed diagnostic criteria insist on a demonstrated context for the injury, both specifying the shock circumstance, and also physical consequences. It allows for a certain delay in onset of symptoms. It recognizes exclusory conditions. The outcome is a proposal for a DSM classification for the post electrical or lightning injury syndrome. This proposal is considered important for grounding patient treatment, and for further treatment trials. Options for treatment in electrical or lightning injury are summarised, and future trials are foreshadowed. PMID:29089977

  6. From the inside out: Eagle Rock School Producing a New Generation of CES Teachers

    ERIC Educational Resources Information Center

    Condon, Dan

    2008-01-01

    In this article, the author gives an overview of Eagle Rock School's Teaching Fellowship Program which he founded in collaboration with Public Allies, Inc. and under the auspices of Eagle Rock's Professional Development Center. Eagle Rock's Teaching Fellowship has two perspectives: (1) local; and (2) global. Locally, Fellows contribute skills,…

  7. World Eagle, The Monthly Social Studies Resource: Data, Maps, Graphs. 1990-1991.

    ERIC Educational Resources Information Center

    World Eagle, 1991

    1991-01-01

    This document consists of the 10 issues of "World Eagle" issued during the 1990-1991 school year. World Eagle is a monthly social studies resource in which demographic and geographic information is presented in the forms of maps, graphs, charts, and text. Each issue of World Eagle has a section that focuses on a particular topic, along with other…

  8. Development and Initial Validation of the Macrophage Activation Syndrome/Primary Hemophagocytic Lymphohistiocytosis Score, a Diagnostic Tool that Differentiates Primary Hemophagocytic Lymphohistiocytosis from Macrophage Activation Syndrome.

    PubMed

    Minoia, Francesca; Bovis, Francesca; Davì, Sergio; Insalaco, Antonella; Lehmberg, Kai; Shenoi, Susan; Weitzman, Sheila; Espada, Graciela; Gao, Yi-Jin; Anton, Jordi; Kitoh, Toshiyuki; Kasapcopur, Ozgur; Sanner, Helga; Merino, Rosa; Astigarraga, Itziar; Alessio, Maria; Jeng, Michael; Chasnyk, Vyacheslav; Nichols, Kim E; Huasong, Zeng; Li, Caifeng; Micalizzi, Concetta; Ruperto, Nicolino; Martini, Alberto; Cron, Randy Q; Ravelli, Angelo; Horne, AnnaCarin

    2017-10-01

    To develop and validate a diagnostic score that assists in discriminating primary hemophagocytic lymphohistiocytosis (pHLH) from macrophage activation syndrome (MAS) related to systemic juvenile idiopathic arthritis. The clinical, laboratory, and histopathologic features of 362 patients with MAS and 258 patients with pHLH were collected in a multinational collaborative study. Eighty percent of the population was assessed to develop the score and the remaining 20% constituted the validation sample. Variables that entered the best fitted model of logistic regression were assigned a score, based on their statistical weight. The MAS/HLH (MH) score was made up with the individual scores of selected variables. The cutoff in the MH score that discriminated pHLH from MAS best was calculated by means of receiver operating characteristic curve analysis. Score performance was examined in both developmental and validation samples. Six variables composed the MH score: age at onset, neutrophil count, fibrinogen, splenomegaly, platelet count, and hemoglobin. The MH score ranged from 0 to 123, and its median value was 97 (1st-3rd quartile 75-123) and 12 (1st-3rd quartile 11-34) in pHLH and MAS, respectively. The probability of a diagnosis of pHLH ranged from <1% for a score of <11 to >99% for a score of  ≥123. A cutoff value of ≥60 revealed the best performance in discriminating pHLH from MAS. The MH score is a powerful tool that may aid practitioners to identify patients who are more likely to have pHLH and, thus, could be prioritized for functional and genetic testing. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Double-survey estimates of bald eagle populations in Oregon

    USGS Publications Warehouse

    Anthony, R.G.; Garrett, Monte G.; Isaacs, F.B.

    1999-01-01

    The literature on abundance of birds of prey is almost devoid of population estimates with statistical rigor. Therefore, we surveyed bald eagle (Haliaeetus leucocephalus) populations on the Crooked and lower Columbia rivers of Oregon and used the double-survey method to estimate populations and sighting probabilities for different survey methods (aerial, boat, vehicle) and bald eagle ages (adults vs. subadults). Sighting probabilities were consistently 20%. The results revealed variable and negative bias (percent relative bias = -9 to -70%) of direct counts and emphasized the importance of estimating populations where some measure of precision and ability to conduct inference tests are available. We recommend use of the double-survey method to estimate abundance of bald eagle populations and other raptors in open habitats.

  10. Bald Eagle nestling mortality associated with Argas radiatus and Argas ricei tick infestation and successful management with nest removal in Arizona, USA

    USGS Publications Warehouse

    Justice-Allen, Anne; Orr, Kathy; Schuler, Krysten L.; McCarty, Kyle; Jacobson, Kenneth; Meteyer, Carol U.

    2016-01-01

    Eight Bald Eagle (Haliaeetus leucocephalus) nestlings heavily infested with larval ticks were found in or under a nest near the confluence of the Verde and Salt rivers in Arizona in 2009-11. The 8-12-wk-old nestlings were slow to respond to stimuli and exhibited generalized muscle weakness or paresis of the pelvic limbs. Numerous cutaneous and subcutaneous hemorrhages were associated with sites of tick attachment. Ticks were identified as Argas radiatus and Argas ricei. Treatment with acaricides and infection with West Nile virus (WNV) may have confounded the clinical presentation in 2009 and 2010. However, WNV-negative birds exhibited similar signs in 2011. One nestling recovered from paresis within 36 h after the removal of all adult and larval ticks (>350) and was released within 3 wk. The signs present in the heavily infested Bald Eagle nestlings resembled signs associated with tick paralysis, a neurotoxin-mediated paralytic syndrome described in mammals, reptiles, and wild birds (though not eagles). Removal of the infested nest and construction of a nest platform in a different tree was necessary to break the cycle of infection. The original nesting pair constructed a new nest on the man-made platform and successfully fledged two Bald Eagles in 2012.

  11. Diagnostic and Prognostic Significance of DSM-5 Attenuated Psychosis Syndrome in Services for Individuals at Ultra High Risk for Psychosis.

    PubMed

    Fusar-Poli, Paolo; De Micheli, Andrea; Cappucciati, Marco; Rutigliano, Grazia; Davies, Cathy; Ramella-Cravaro, Valentina; Oliver, Dominic; Bonoldi, Ilaria; Rocchetti, Matteo; Gavaghan, Lauren; Patel, Rashmi; McGuire, Philip

    2018-02-15

    The diagnostic and prognostic significance of the DSM-5-defined Attenuated Psychosis Syndrome (DSM-5-APS) in individuals undergoing an ultra high risk (UHR) clinical assessment for suspicion of psychosis risk is unknown. Prospective cohort study including all consecutive help-seeking individuals undergoing both a DSM-5-APS and a Comprehensive Assessment of At Risk Mental States (CAARMS 12/2006) assessment for psychosis risk at the Outreach and Support in South London (OASIS) UHR service (March 2013-April 2014). The diagnostic significance of DSM-5-APS was assessed with percent overall agreement, prevalence bias adjusted kappa, Bowker's test, Stuart-Maxwell test, residual analysis; the prognostic significance with Cox regression, Kaplan-Meier failure function, time-dependent area under the curve (AUC) and net benefits analysis. The impact of specific revisions of the DSM-5-APS was further tested. In 203 help-seeking individuals undergoing UHR assessment, the agreement between the DSM-5-APS and the CAARMS 12/2006 was only moderate (kappa 0.59). Among 142 nonpsychotic cases, those meeting DSM-5-APS criteria had a 5-fold probability (HR = 5.379) of developing psychosis compared to those not meeting DSM-5-APS criteria, with a 21-month cumulative risk of psychosis of 28.17% vs 6.49%, respectively. The DSM-5-APS prognostic accuracy was acceptable (AUC 0.76 at 24 months) and similar to the CAARMS 12/2006. The DSM-5-APS designation may be clinically useful to guide the provision of indicated interventions within a 7%-35% (2-year) range of psychosis risk. The removal of the criterion E or C of the DSM-5-APS may improve its prognostic performance and transdiagnostic value. The DSM-5-APS designation may be clinically useful in individuals accessing clinical services for psychosis prevention. © The Author 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com

  12. Diagnostic accuracy of blood sucrose as a screening test for equine gastric ulcer syndrome (EGUS) in adult horses.

    PubMed

    Hewetson, Michael; Sykes, Ben William; Hallowell, Gayle Davina; Tulamo, Riitta-Mari

    2017-03-11

    Equine gastric ulcer syndrome (EGUS) is common in adult horses, particularly those involved in performance disciplines. Currently, detection of EGUS by gastroscopy is the only reliable ante mortem method for definitive diagnosis; however it is unsuitable as a screening test because it is expensive, time consuming, and is not readily available to most veterinarians. Sucrose permeability testing represents a simple, economical alternative to gastroscopy for screening purposes, and the feasibility of this approach in the horse has been previously reported. The aim of this study was to determine the diagnostic accuracy of blood sucrose as a screening test for EGUS in a large group of adult horses with and without naturally occurring gastric disease. One hundred and one adult horses with or without naturally occurring gastric ulceration were studied. The diagnostic accuracy of blood sucrose for diagnosis of gastric lesions (GL), glandular lesions (GDL), squamous lesions (SQL), and clinically significant lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasogastric intubation was assessed using receiver operator characteristics (ROC) curves and calculating the area under the curve (AUC). For each lesion type, sucrose concentration in blood was compared to gastroscopy, as the gold standard, and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Ulcer grading was performed blindly by one observer; and the results were validated by comparing them with that of two other observers, and calculating the level of agreement. Cut-off values were selected manually to optimize Se. The prevalence of GL, GDL, SQL, and CSL was 83, 70, 53 and 58% respectively. At the selected cut-offs, Se ranged from 51 to 79% and Sp ranged from 43 to 72%, depending upon the lesion type and time of sampling. Blood sucrose is neither a sensitive or specific test for detecting EGUS in this population of adult horses with

  13. Molecular-genetic diagnostics of von Hippel-Lindau syndrome (VHL) in Bulgaria: first complex mutation event in the VHL gene.

    PubMed

    Glushkova, Maria; Dimova, Petia; Yordanova, Iglika; Todorov, Tihomir; Tourtourikov, Ivan; Mitev, Vanyo; Todorova, Albena

    2018-02-01

    Von Hippel-Lindau syndrome is an autosomal-dominant disease characterized by the formation of various tumours and cysts in many different parts of the body. Von Hippel-Lindau syndrome is caused by VHL gene mutations leading to production of impaired tumor suppressor Von Hippel-Lindau syndrome protein or its complete absence. To study five patients with clinically suspected Von Hippel-Lindau syndrome, who were referred for molecular genetic testing. Sanger sequencing of the coding regions of the VHL gene. Five clinically relevant germline mutations were detected. One of the pathogenic variants has not been previously reported. This novel mutation is a complex mutation event combining a duplication and an indel, rearranging exon 3 of the VHL gene - c. [516_517dupGTCAAGCCT; 532_542delCTGGACATCGTinsATTA], p. (Glu173Serfs*4). Overall, our results showed that the diagnosis of Von Hippel-Lindau syndrome in our country is difficult most probably because of its heterogeneous clinical manifestation and insufficient knowledge on the diagnostic criteria for the disease. From genetic point of view our results add some novel data on the mutation profile of the VHL gene. In order to prove or revise the diagnosis, early genetic testing is strongly recommended in affected patients and their family members to ensure appropriate follow-up and treatment of the malignancies.

  14. Not all glucocorticoid-induced obesity is the same: differences in adiposity among various diagnostic groups of Cushing syndrome.

    PubMed

    London, E; Lodish, M; Keil, M; Lyssikatos, C; de la Luz Sierra, M; Nesterova, M; Stratakis, C A

    2014-11-01

    The cAMP signaling pathway is implicated in bilateral adrenocortical hyperplasias (BAHs), which are often associated with ACTH-independent Cushing syndrome (CS). Although CS is invariably associated with obesity and is frequently associated with PKA signaling defects, we recently reported that its different forms appear to also present with variable weight gain and adiposity. The present study was aimed at characterizing further the phenotypic and molecular differences in periadrenal adipose tissue (PAT) among patients with subtypes of CS, by anthropometric/biochemical analyses and quantification of PKA expression and activity in BAHs in comparison to a non-CS group with aldosterone producing adenomas (APAs). Glucocorticoid levels, serum parameters, and BMI were analyzed among a larger patient cohort including those with different forms of CS, APAs, and Cushing disease. Abdominal CT scans were available for a small subset of patients examined for fat distribution. PAT collected during adrenalectomy was assayed for PKA activity, cAMP, and PKA expression. BMI and BMI z-score were lower in adults with PPNAD with PRKAR1A mutations and in pediatric patients with PPNAD with and without PRKAR1A mutations, respectively. Patients with PPNAD had higher cAMP levels in PAT and different fat distribution. Thus, PKA activity in PAT differed between CS diagnostic groups. Increased cAMP and PKA activity may have contributed to phenotypic differences among subtypes of CS. In agreement with the known roles of cAMP signaling in the regulation of adiposity, patients with PPNAD were less obese than other patients with CS. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Diagnostic contribution of cardiac magnetic resonance in patients with acute coronary syndrome and culprit-free angiograms.

    PubMed

    Kawecki, Damian; Morawiec, Beata; Monney, Pierre; Pellaton, Cyril; Wojciechowska, Celina; Jojko, Joanna; Basiak, Marcin; Przywara-Chowaniec, Brygida; Fournier, Stephane; Nowalany-Kozielska, Ewa; Schwitter, Juerg; Muller, Olivier

    2015-01-14

    In spite of robust knowledge about underlying ischemic myocardial damage, acute coronary syndromes (ACS) with culprit-free angiograms raise diagnostic concerns. The present study aimed to evaluate the additional value of cardiac magnetic resonance (CMR) over commonly available non-CMR standard tests, for the differentiation of myocardial injury in patients with ACS and non-obstructed coronary arteries. Patients with ACS, elevated hs-TnT, and a culprit-free angiogram were prospectively enrolled into the study between January 2009 and July 2013. After initial evaluation with standard tests (ECG, echocardiography, hs-TnT) and provisional exclusion of acute myocardial infarction (AMI) in coronary angiogram, patients were referred for CMR with the suspicion of myocarditis or Takotsubo cardiomyopathy (TTC). According to the result of CMR, patients were reclassified as having myocarditis, AMI, TTC, or non-injured myocardium as assessed by late gadolinium enhancement. Out of 5110 patients admitted with ACS, 75 had normal coronary angiograms and entered the study; 69 of them (92%) were suspected for myocarditis and 6 (8%) for TTC. After CMR, 49 patients were finally diagnosed with myocarditis (65%), 3 with TTC (4%), 7 with AMI (9%), and 16 (21%) with non-injured myocardium. The provisional diagnosis was changed or excluded in 23 patients (31%), with a 9% rate of unrecognized AMI. The study results suggest that the evaluation of patients with ACS and culprit-free angiogram should be complemented by a CMR examination, if available, because the initial work-up with non-CMR tests leads to a significant proportion of misdiagnosed AMI.

  16. The Diagnostic Value of Anti-Müllerian Hormone in Early Post Menarche Adolescent Girls with Polycystic Ovarian Syndrome.

    PubMed

    Kocaay, Pınar; Siklar, Zeynep; Buyukfirat, Sema; Berberoglu, Merih

    2018-02-17

    Polycystic ovarian syndrome (PCOS) is a common endocrine disorder characterized by hyperandrogenism and chronic anovulation, which affects 5%-10% of reproductive-age women. Diagnosis of adult patients with PCOS is made easily with clinical and laboratory methods and the anti-Müllerian hormone (AMH) level are accepted as a good indicator. However, there is still no complete consensus on the diagnosis of PCOS in adolescents. Prospective cohort study, December 2013 to November 2014. The study was conducted on adolescent girls with oligomenorrhea, with at least 2 years since menarche. The study group consisted of adolescent girls with complete PCOS and incomplete PCOS. A control group was formed of healthy adolescent girls. Complete PCOS was diagnosed according to the Rotterdam criteria, as the presence of all the following characteristics: oligomenorrhea, hyperandrogenism, and polycystic ovarian morphology on ultrasound image. Incomplete PCOS was accepted as "oligomenorrhea and polycystic ovarian morphology," or "oligomenorrhea and hyperandrogenism." All patients underwent a physical examination and the anthropometric assessments, insulin resistance, and acanthosis nigricans were recorded. It was also noted whether or not the patient had an acne score. The Ferriman-Gallwey score was applied to evaluate hirsutism. The results of this study showed that no statistically significant difference was found between the PCOS and incomplete PCOS groups and the control group with respect to AMH levels. The use of adult-specific diagnostic methods in adolescence might result in an incomplete diagnosis and inadequate treatment plan. Although the serum AMH level clearly facilitates the diagnosis of PCOS, the use of the AMH level in adolescence in PCOS diagnosis is still controversial and further studies are needed. Copyright © 2018 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. Serum soluble ST2 as diagnostic marker of systemic inflammatory reactive syndrome of bacterial etiology in children.

    PubMed

    Calò Carducci, Francesca Ippolita; Aufiero, Lelia Rotondi; Folgori, Laura; Vittucci, Anna Chiara; Amodio, Donato; De Luca, Maia; Li Pira, Giuseppina; Bergamini, Alberto; Pontrelli, Giuseppe; Finocchi, Andrea; D'Argenio, Patrizia

    2014-02-01

    Accurate and timely diagnosis of community-acquired bacterial versus viral infections in children with systemic inflammatory response syndrome (SIRS) remains challenging both for clinician and laboratory. In the quest of new biochemical markers to distinguish bacterial from viral infection, we have explored the possible role of the soluble secreted form of ST2 (sST2). This explorative prospective cohort study included children with SIRS who were suspected of having community-acquired infections. Plasma samples for sST2 measurement were obtained from 64 hospitalized children, 41 of whom had SIRS of bacterial etiology and 23 SIRS of viral etiology, and from 20 healthy, age- and sex-matched control children. sST2 measurement was carried out by enzyme-linked immunosorbent assay in parallel with standard measurements of procalcitonin (PCT) and C reactive protein (CRP). Our findings demonstrate that children with SIRS associated with bacterial infection present significantly increased levels of sST2, when compared with patients with SIRS of viral etiology and healthy children. More important, receiver operating characteristic curve analysis indicated that sST2 has a significant diagnostic performance with respect to early identification of SIRS of bacterial etiology, which was similar to that of PCT and greater than that of CRP. Finally, the combination of sST2 plus PCT and/or CRP, and PCT plus CRP increased their sensitivity and negative predictive value compared with sST2, PCT and CRP alone. In conclusion, sST2 level may prove useful in predicting bacterial etiology in children with SIRS.

  18. Residues of organochlorine pesticides and polychlorinated biphenyls and autopsy data for bald eagles, 1971-72

    USGS Publications Warehouse

    Cromartie, E.; Reichel, W.L.; Locke, L.N.; Belisle, A.A.; Kaiser, T.E.; Lamont, T.G.; Mulhern, B.M.; Prouty, R.M.; Swineford, D.M.

    1975-01-01

    Thirty-seven bald eagles found sick or dead in 18 States during 1971-72 were analyzed for organochlorine pesticides and polychlorinated biphenyls (PCB's). DDE and PCB's were detected in all bald eagle carcasses; 30 carcasses contained DDD and 28 contained dieldrin. Four eagles contained possibly lethal levels of dieldrin and nine eagles had been poisoned by thallium. Autopsies revealed that illegal shooting was the most common cause of mortality. Since 1964 when data were first collected, 8 of the 17 eagles obtained from Maryland, Virginia, South Carolina, and Florida possibly died from dieldrin poisoning; all four specimens from Maryland and Virginia were from the Chesapeake Bay Tidewater area.

  19. 75 FR 56093 - Eagle Rock Desoto Pipeline, LP; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-15

    ... pipelines to extend the cycle for such reviews from three to five years.\\1\\ Therefore, Eagle Rock requests... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR09-1-002] Eagle Rock... notice that on September 8, 2010, Eagle Rock Desoto Pipeline, L.P. (Eagle Rock) filed a request to extend...

  20. 77 FR 61661 - Price for the American Eagle Silver Proof and Uncirculated Coins and the America the Beautiful...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-10

    ... DEPARTMENT OF THE TREASURY United States Mint Price for the American Eagle Silver Proof and... price of silver, the United States Mint is raising the price of its American Eagle Silver Proof and... price 2012 American Eagle Silver Proof $59.95 2012 American Eagle Silver Uncirculated 50.95 2011...

  1. Nationwide trends in use and timeliness of diagnostic coronary angiography in acute coronary syndromes from 2005 to 2011: Does distance to invasive heart centres matter?

    PubMed

    Hansen, Kim W; Sørensen, Rikke; Madsen, Mette; Madsen, Jan K; Jensen, Jan S; von Kappelgaard, Lene M; Mortensen, Poul E; Galatius, Søren

    2015-08-01

    To examine trends in the use of diagnostic coronary angiography according to distance from home to the nearest invasive heart centre following implementation of fast-track protocols and extensive pre-hospital triaging of acute coronary syndrome patients. We performed a register-based cohort study of all patients admitted to Danish hospitals with incident acute coronary syndrome in 2005-2011. Diagnostic coronary angiography within 60 days of admission was investigated according to distance tertiles (DTs) calculated as range from each patient's home to the nearest invasive heart centre (short DT: <22 km, medium DT: 22-65 km, long DT: >65 km). Cox proportional hazards models were applied.Among the 52,409 patients included, diagnostic coronary angiography was increasingly used during 2005-2011 (short DT: 76% to 81%; medium DT: 74% to 81%; long DT: 69% to 78%; all p-values for trend <0.001). Using the short DT as reference the adjusted hazard ratios for medium DT were 0.87 (0.84-0.89) for 2005-2007, 0.94 (0.90-0.98) for 2008-2009 and 0.94 (0.90-0.98) for 2010-2011. Corresponding figures for long DT were 0.74 (0.72-0.76) for 2005-2007, 0.87 (0.83-0.90) for 2008-2009 and 0.94 (0.90-0.98) for 2010-2011. Length of hospital stay, time to coronary angiography, and 60-day mortality decreased in all DT. This nationwide study found significant increases in diagnostic coronary angiography use over time in incident acute coronary syndrome patients with a relatively larger increase in patients residing farthest from an invasive heart centre. Additionally, selected quality of care measures improved in the entire cohort, suggesting a benefit of national clinical protocols. © The European Society of Cardiology 2014.

  2. Relationship of diets and environmental contaminants in wintering bald eagles. [Haliaeetus leucocephalus

    SciTech Connect

    Frenzel, R.W.; Anthony, R.G.

    1989-07-01

    We investigated the relationship between diets and potential hazards in contaminants of wintering bald eagles (Haliaeetus leucocephalus) in the Klamath Basin of northern California and southern Oregon. We studied diets by identifying remains of 913 prey items found at perches, examining 341 castings collected from communal night roots, and observing foraging eagles. We determined residues of organochlorine compounds, lead (Pb), and mercury (Hg) in bald eagles and their prey by analyzing eagle blood samples and carcasses and 8 major prey species. Bald eagles fed largely on waterfowl by scavenging cholera-killed ducks and geese and on microtine rodents during mid- tomore » late winter. Residues of organochlorine pesticides and Hg in prey were low, and polychlorinated biphenyls (PCB's) were detected in low concentrations in 9% of prey samples. Means Pb concentrations in prey ranged from 0.15 to 4.79 ppm. Mercury was detected in all eagle blood samples, and Pb was detected in 41% of the bald eagle blood samples. Mean Pb concentration in livers of dead eagles was 2.09 ppm and ranged as high as 27 ppm in an eagle that died of Pb poisoning. Prey of the eagles were relatively free of contaminants with the possible exception of embedded Pb shot in waterfowl, which may present a potential for Pb poisoning of eagles.« less

  3. Detection of paroxysmal nocturnal hemoglobinuria clones in patients with myelodysplastic syndromes and related bone marrow diseases, with emphasis on diagnostic pitfalls and caveats

    PubMed Central

    Wang, Sa A.; Pozdnyakova, Olga; Jorgensen, Jeffrey L.; Medeiros, L. Jeffrey; Stachurski, Dariusz; Anderson, Mary; Raza, Azra; Woda, Bruce A.

    2009-01-01

    Background The presence of paroxysmal nocturnal hemoglobinuria clones in the setting of aplastic anemia or myelodysplastic syndrome has been shown to have prognostic and therapeutic implications. However, the status of paroxysmal nocturnal hemoglobinuria clones in various categories of myelodysplastic syndrome and in other bone marrow disorders is not well-studied. Design and Methods By using multiparameter flow cytometry immunophenotypic analysis with antibodies specific for four glycosylphosphatidylinositol-anchored proteins (CD55, CD59, CD16, CD66b) and performing an aerolysin lysis confirmatory test in representative cases, we assessed the paroxysmal nocturnal hemoglobinuria-phenotype granulocytes in 110 patients with myelodysplastic syndrome, 15 with myelodysplastic/myeloproliferative disease, 5 with idiopathic myelofibrosis and 6 with acute myeloid leukemia. Results Paroxysmal nocturnal hemoglobinuria-phenotype granulocytes were detected in nine patients with low grade myelodysplastic syndrome who showed clinicopathological features of bone marrow failure, similar to aplastic anemia. All paroxysmal nocturnal hemoglobinuria-positive cases demonstrated loss of the four glycosylphosphatidylinositol-anchored proteins, with CD16−CD66b− clones being larger than those of CD55−CD59− (p<0.05). Altered glycosylphosphatidylinositol-anchored protein expression secondary to granulocytic hypogranulation, immaturity, and/or immunophenotypic abnormalities was present in a substantial number of cases and diagnostically challenging. Conclusions These results show that routine screening for paroxysmal nocturnal hemoglobinuria clones in patients with an intrinsic bone marrow disease who show no clinical evidence of hemolysis has an appreciable yield in patients with low grade myelodysplastic syndromes. The recognition of diagnostic caveats and pitfalls associated with the underlying intrinsic bone marrow disease is essential in interpreting paroxysmal nocturnal

  4. Detection of paroxysmal nocturnal hemoglobinuria clones in patients with myelodysplastic syndromes and related bone marrow diseases, with emphasis on diagnostic pitfalls and caveats.

    PubMed

    Wang, Sa A; Pozdnyakova, Olga; Jorgensen, Jeffrey L; Medeiros, L Jeffrey; Stachurski, Dariusz; Anderson, Mary; Raza, Azra; Woda, Bruce A

    2009-01-01

    The presence of paroxysmal nocturnal hemoglobinuria clones in the setting of aplastic anemia or myelodysplastic syndrome has been shown to have prognostic and therapeutic implications. However, the status of paroxysmal nocturnal hemoglobinuria clones in various categories of myelodysplastic syndrome and in other bone marrow disorders is not well-studied. By using multiparameter flow cytometry immunophenotypic analysis with antibodies specific for four glycosylphosphatidylinositol-anchored proteins (CD55, CD59, CD16, CD66b) and performing an aerolysin lysis confirmatory test in representative cases, we assessed the paroxysmal nocturnal hemoglobinuria-phenotype granulocytes in 110 patients with myelodysplastic syndrome, 15 with myelodysplastic/myeloproliferative disease, 5 with idiopathic myelofibrosis and 6 with acute myeloid leukemia. Paroxysmal nocturnal hemoglobinuria-phenotype granulocytes were detected in nine patients with low grade myelodysplastic syndrome who showed clinicopathological features of bone marrow failure, similar to aplastic anemia. All paroxysmal nocturnal hemoglobinuria-positive cases demonstrated loss of the four glycosylphosphatidylinositol-anchored proteins, with CD16(-)CD66b(-) clones being larger than those of CD55(-)CD59(-) (p<0.05). Altered glycosylphosphatidylinositol-anchored protein expression secondary to granulocytic hypogranulation, immaturity, and/or immunophenotypic abnormalities was present in a substantial number of cases and diagnostically challenging. These results show that routine screening for paroxysmal nocturnal hemoglobinuria clones in patients with an intrinsic bone marrow disease who show no clinical evidence of hemolysis has an appreciable yield in patients with low grade myelodysplastic syndromes. The recognition of diagnostic caveats and pitfalls associated with the underlying intrinsic bone marrow disease is essential in interpreting paroxysmal nocturnal hemoglobinuria testing correctly. In our experience, the CD

  5. Annual movements of a steppe eagle (Aquila nipalensis) summering in Mongolia and wintering in Tibet

    USGS Publications Warehouse

    Ellis, D.H.; Moon, S.L.; Robinson, J.W.

    2001-01-01

    An adult female steppe eagle (Aquila nipalensis Hodgson) was captured and fitted with a satellite transmitter in June 1995 in southeastern Mongolia. In fall, it traveled southwest towards India as expected, but stopped in southeastern Tibet and wintered in a restricted zone within the breeding range of the steppe eagle. In spring, the bird returned to the same area of Mongolia where it was captured. These observations, though derived from the movements of a single bird, suggest three things that are contrary to what is generally believed about steppe eagle biology. First, not all steppe eagles move to warmer climes in winter. Second, not all steppe eagles are nomadic in winter. Finally, because our bird wintered at the periphery of the steppe eagle breeding range in Tibet, perhaps birds that breed in this same area also winter there. If so, not all steppe eagles are migratory.

  6. Food habits of Bald Eagles breeding in the Arizona desert

    Treesearch

    Teryl G. Grubb

    1995-01-01

    Of 1814 foraging attempts, prey captures, or nest deliveries by Bald Eagles (Haliaeetus leucocephalus) in 14 Arizona breeding areas during 1983-1985, 1471 observations were identifiable to at least class: fish (76%), mammal (18%), bird (4%), and reptile/amphibian (2%). Forty-five species were recorded: catfish (Ictalurus punctatus, Pylodictis olivaris), suckers (...

  7. Evaluating Great Lakes bald eagle nesting habitat with Bayesian inference

    Treesearch

    Teryl G. Grubb; William W. Bowerman; Allen J. Bath; John P. Giesy; D. V. Chip Weseloh

    2003-01-01

    Bayesian inference facilitated structured interpretation of a nonreplicated, experience-based survey of potential nesting habitat for bald eagles (Haliaeetus leucocephalus) along the five Great Lakes shorelines. We developed a pattern recognition (PATREC) model of our aerial search image with six habitat attributes: (a) tree cover, (b) proximity and...

  8. Why Did the Bald Eagle Almost Become Extinct?

    ERIC Educational Resources Information Center

    Glassman, Sarah J.; Sterling, Donna R.

    2012-01-01

    The activity described in this article poses a question, provides evidence needed to answer the question, and uses a cooperative learning structure within which students analyze the evidence and create their own questions. Students see how a single cause can interact with two natural systems--the water cycle and the bald eagle food chain--to…

  9. Food habits of bald eagles wintering in northern Arizona

    Treesearch

    Teryl G. Grubb; Roy G. Lopez

    2000-01-01

    We used pellets collected from roosts to supplement incidental foraging observations to identify prey species of Bald Eagles (Haliaeetus leucoughalus) and to evaluate spatial and temporal trends in their food habits while wintering in northern Arizona between 1994-96. We analyzed 1057 pellets collected from 14 roosts, and identified five mammal and...

  10. "The Story of Running Eagle" and "The Cause of Things."

    ERIC Educational Resources Information Center

    Schultz, James Willard

    The two illustrated children's stories are part of a series about the Blackfeet Indians. The first story, originally published in 1916, is the story of Weasel Woman, an orphaned girl who stole her way into a raiding party and became a successful warrior and, ultimately, a war chief named Running Eagle. The second story is a Blackfeet creation tale…

  11. Eagles, Otters, and Unicorns: An Anatomy of Innovation.

    ERIC Educational Resources Information Center

    Grossman, Stephen R.; King, Margaret J.

    1990-01-01

    This article describes three archetypal workers: eagles who innovate by improvements, otters who innovate by extension, and unicorns who innovate by paradigm. Each of these innovators is discussed in terms of domain-relevant skills, manipulative skills, and motivation. Needs of each type in terms of business culture are discussed. (PB)

  12. Research resources: curating the new eagle-i discovery system

    PubMed Central

    Vasilevsky, Nicole; Johnson, Tenille; Corday, Karen; Torniai, Carlo; Brush, Matthew; Segerdell, Erik; Wilson, Melanie; Shaffer, Chris; Robinson, David; Haendel, Melissa

    2012-01-01

    Development of biocuration processes and guidelines for new data types or projects is a challenging task. Each project finds its way toward defining annotation standards and ensuring data consistency with varying degrees of planning and different tools to support and/or report on consistency. Further, this process may be data type specific even within the context of a single project. This article describes our experiences with eagle-i, a 2-year pilot project to develop a federated network of data repositories in which unpublished, unshared or otherwise ‘invisible’ scientific resources could be inventoried and made accessible to the scientific community. During the course of eagle-i development, the main challenges we experienced related to the difficulty of collecting and curating data while the system and the data model were simultaneously built, and a deficiency and diversity of data management strategies in the laboratories from which the source data was obtained. We discuss our approach to biocuration and the importance of improving information management strategies to the research process, specifically with regard to the inventorying and usage of research resources. Finally, we highlight the commonalities and differences between eagle-i and similar efforts with the hope that our lessons learned will assist other biocuration endeavors. Database URL: www.eagle-i.net PMID:22434835

  13. 1. EAGLE MILL EXTERIOR FROM NORTHWEST, c. 1907. SHOWS INITIAL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. EAGLE MILL EXTERIOR FROM NORTHWEST, c. 1907. SHOWS INITIAL MILL CONFIGURATION WITH FULLY EXPOSED CRUDE ORE BIN CONCRETE RETAINING WALL, SINGLE (SOUTH) CRUDE ORE BIN, AND EXPOSED CRUSHER HOUSE. NOTE THE LACK OF MACHINE SHOP OR SNOW SHEDS. CREDIT JW. - Bald Mountain Gold Mill, Nevada Gulch at head of False Bottom Creek, Lead, Lawrence County, SD

  14. 3. EAGLE MILL, DETAIL OF CRUDE ORE BIN FROM NORTH, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. EAGLE MILL, DETAIL OF CRUDE ORE BIN FROM NORTH, c. 1908-10. SHOWS EXPOSED CRUSHER HOUSE IN FRONT OF (SOUTH) CRUDE ORE BIN AND SNOW SHED ADDED OVER TRAM TRACKS. NOTE LACK OF EAST OR WEST CRUDE ORE BINS. CREDIT JW. - Bald Mountain Gold Mill, Nevada Gulch at head of False Bottom Creek, Lead, Lawrence County, SD

  15. The "Oklahoma Eagle": A Study of Black Press Survival.

    ERIC Educational Resources Information Center

    Brown, Karen F.

    Analyzing the history of the "Oklahoma Eagle" provides insight into the problems and the opportunities involved in operating a black newspaper and reveals the factors responsible for the paper's longevity. The paper has been owned and operated by members of the Edward Lawrence Goodwin family since 1938 and has been staffed by excellent…

  16. Organochlorine and heavy metal residues in bald eagle eggs

    USGS Publications Warehouse

    Krantz, W.C.; Mulhern, B.M.; Bagley, George E.; Sprunt, A.; Ligas, F.J.; Robertson, W.B.

    1970-01-01

    Bald eagle eggs collected in 1968 from nests in Wisconsin, Maine, and Florida all contained residues of DDE, DDD, dieldrin, heptachlor epoxide, and polychlorinated biphenyls. Many also contained traces of DDT. Eggs from five nonproductive nests sampled in Maine contained much higher residues than did eggs collected from either productive or nonproductive nests in Wisconsin and Florida.

  17. Erysipelothrix rhusiopathiae infection in a captive bald eagle (Haliaeetus leucocephalus)

    USGS Publications Warehouse

    Franson, J. Christian; Galbreath, Elizabeth J.; Wiemeyer, Stanley N.; Abell, John M.

    1994-01-01

    An adult bald eagle (Haliaeetus leucocephalus) kept in captivity for nearly 7 yr at the Patuxent Wildlife Research Center, Laurel, Maryland, died suddenly with gross and microscopic lesions characteristic of septicemia. Erysipelothrix rhusiopathiae was isolated from the liver. Fish comprised part of the bird's diet and may have been the source of the organism.

  18. Bald Eagle Nesting in the Superior National Forest

    Treesearch

    James P. Mattson; Alfred H. Grewe

    1976-01-01

    Sixteen years (1959-1974) of bald eagle nesting data representing 102 nests were examined. Nest survey intensity increased in the late 1960''s and was most comprehensive during 1972, 1973, and 1974. Some nests were used for at least 15 years. Most nest trees were white pines, reflecting availability. IN 1974 the number of active and successful nests and...

  19. Some helminth parasites of the American bald eagle

    USGS Publications Warehouse

    Kocan, A.A.; Locke, L.N.

    1974-01-01

    Bald eagles (Haliaeetus leucocephalus) found dead or moribund in the United States and Canada and submitted to Patuxent Wildlife Research Center were examined for helminth parasites. Nine genera of helminths were reported which include new host records for Clinostomum complanatum, Neogogatea pandionis, Centrorhynchus sp., Serratospiculum amaculata, Capillaria contorta, and Habronema americanum.

  20. The Eagle’s Talons. The American Experience at War

    DTIC Science & Technology

    1988-12-01

    carrying American passengers (for 143 EAGLE’S TALONS example, the Lusitania ), became the most volatile issue be- tween the United States and Germany. It...99, 103-4, 108, 118-22 Lusitania : 144, 374 McClernand, John Alexander: Lys River: 163 103 McDowell, Irvin: 105, 114-15, MacArthur, Douglas: xv, 16

  1. Lead exposure in bald eagles from big game hunting, the continental implications and successful mitigation efforts.

    PubMed

    Bedrosian, Bryan; Craighead, Derek; Crandall, Ross

    2012-01-01

    Studies suggest hunter discarded viscera of big game animals (i.e., offal) is a source of lead available to scavengers. We investigated the incidence of lead exposure in bald eagles in Wyoming during the big game hunting season, the influx of eagles into our study area during the hunt, the geographic origins of eagles exposed to lead, and the efficacy of using non-lead rifle ammunition to reduce lead in eagles. We tested 81 blood samples from bald eagles before, during and after the big game hunting seasons in 2005-2010, excluding 2008, and found eagles had significantly higher lead levels during the hunt. We found 24% of eagles tested had levels indicating at least clinical exposure (>60 ug/dL) during the hunt while no birds did during the non-hunting seasons. We performed driving surveys from 2009-2010 to measure eagle abundance and found evidence to suggest that eagles are attracted to the study area during the hunt. We fitted 10 eagles with satellite transmitters captured during the hunt and all migrated south after the cessation of the hunt. One returned to our study area while the remaining nine traveled north to summer/breed in Canada. The following fall, 80% returned to our study area for the hunting season, indicating that offal provides a seasonal attractant for eagles. We fitted three local breeding eagles with satellite transmitters and none left their breeding territories to feed on offal during the hunt, indicating that lead ingestion may be affecting migrants to a greater degree. During the 2009 and 2010 hunting seasons we provided non-lead rifle ammunition to local hunters and recorded that 24% and 31% of successful hunters used non-lead ammunition, respectively. We found the use of non-lead ammunition significantly reduced lead exposure in eagles, suggesting this is a viable solution to reduce lead exposure in eagles.

  2. Lead Exposure in Bald Eagles from Big Game Hunting, the Continental Implications and Successful Mitigation Efforts

    PubMed Central

    Bedrosian, Bryan; Craighead, Derek; Crandall, Ross

    2012-01-01

    Studies suggest hunter discarded viscera of big game animals (i.e., offal) is a source of lead available to scavengers. We investigated the incidence of lead exposure in bald eagles in Wyoming during the big game hunting season, the influx of eagles into our study area during the hunt, the geographic origins of eagles exposed to lead, and the efficacy of using non-lead rifle ammunition to reduce lead in eagles. We tested 81 blood samples from bald eagles before, during and after the big game hunting seasons in 2005–2010, excluding 2008, and found eagles had significantly higher lead levels during the hunt. We found 24% of eagles tested had levels indicating at least clinical exposure (>60 ug/dL) during the hunt while no birds did during the non-hunting seasons. We performed driving surveys from 2009–2010 to measure eagle abundance and found evidence to suggest that eagles are attracted to the study area during the hunt. We fitted 10 eagles with satellite transmitters captured during the hunt and all migrated south after the cessation of the hunt. One returned to our study area while the remaining nine traveled north to summer/breed in Canada. The following fall, 80% returned to our study area for the hunting season, indicating that offal provides a seasonal attractant for eagles. We fitted three local breeding eagles with satellite transmitters and none left their breeding territories to feed on offal during the hunt, indicating that lead ingestion may be affecting migrants to a greater degree. During the 2009 and 2010 hunting seasons we provided non-lead rifle ammunition to local hunters and recorded that 24% and 31% of successful hunters used non-lead ammunition, respectively. We found the use of non-lead ammunition significantly reduced lead exposure in eagles, suggesting this is a viable solution to reduce lead exposure in eagles. PMID:23284837

  3. Le syndrome du canal d’Alcock ou névralgie pudendale : un diagnostic à ne pas méconnaître

    PubMed Central

    Ziouziou, Imad; Bennani, Hassan; Zizi, Mohamed; Karmouni, Tarik; Khader, Khalid El; Koutani, Abdellatif; Andaloussi, Ahmed Iben Attya

    2013-01-01

    Résumé Le syndrome du canal d’Alcock – ou névralgie pudendale – est lié à la compression chronique du nerf pudendal dans la fossette ischiorectale ou au niveau du ligament sacroépineux. Le diagnostic du syndrome d’Alcock est surtout clinique. Les examens complémentaires sont dominés par les explorations électrophysiologiques et le test de bloc anesthésique. Le diagnostic repose sur des critères bien précis, soit les critères de Nantes. La prise en charge doit être globale, comprenant un traitement médicamenteux, des infiltrations, des techniques de neuromodulation, et dans les cas graves ou résistants, un traitement chirurgical qui consiste à libérer le nerf pudendal. Les névralgies pudendales peuvent être rencontrées après traitement d’une incontinence urinaire d’effort par bande-lettes sous-urétrales (TVT). Ce syndrome motive des consultations en urologie, car la douleur intéresse le territoire du périnée et des organes génitaux. Des signes urinaires peuvent aussi accompagner cette douleur. Il est donc judicieux de connaître cette pathologie. PMID:23914265

  4. Visual Detection of Human Antibodies Using Sugar Chain-Immobilized Fluorescent Nanoparticles: Application as a Point of Care Diagnostic Tool for Guillain-Barré Syndrome.

    PubMed

    Shinchi, Hiroyuki; Yuki, Nobuhiro; Ishida, Hideharu; Hirata, Koichi; Wakao, Masahiro; Suda, Yasuo

    2015-01-01

    Sugar chain binding antibodies have gained substantial attention as biomarkers due to their crucial roles in various disorders. In this study, we developed simple and quick detection method of anti-sugar chain antibodies in sera using our previously developed sugar chain-immobilized fluorescent nanoparticles (SFNPs) for the point-of-care diagnostics. Sugar chain structure on SFNPs was modified with the sugar moieties of the GM1 ganglioside via our original linker molecule to detect anti-GM1 antibodies. The structures and densities of the sugar moieties immobilized on the nanoparticles were evaluated in detail using lectins and sera containing anti-GM1 antibodies from patients with Guillain-Barré syndrome, a neurological disorder, as an example of disease involving anti-sugar chain antibodies. When optimized SFNPs were added to sera from patients with Guillain-Barré syndrome, fluorescent aggregates were able to visually detect under UV light in three hours. The sensitivity of the detection method was equivalent to that of the current ELISA method used for the diagnosis of Guillain-Barré syndrome. These results suggest that our method using SFNPs is suitable for the point-of-care diagnostics of diseases involving anti-sugar chain antibodies.

  5. Environmental contaminants in bald eagle eggs from the Aleutian archipelago

    USGS Publications Warehouse

    Anthony, R.G.; Miles, A.K.; Ricca, M.A.; Estes, J.A.

    2007-01-01

    We collected 136 fresh and unhatched eggs from bald eagle (Haliaeetus leucocephalus) nests and assessed productivity on eight islands in the Aleutian archipelago, 2000 to 2002. Egg contents were analyzed for a broad spectrum of organochlorine (OC) contaminants, mercury (Hg), and stable isotopes of carbon (??13C) and nitrogen (??15N). Concentrations of polychlorinated biphenyls (??PCBs), p,p???- dichlorodiphenyldichloroethylene (DDE), and Hg in bald eagle eggs were elevated throughout the archipelago, but the patterns of distribution differed among the various contaminants. Total PCBs were highest in areas of past military activities on Adak and Amchitka Islands, indicating local point sources of these compounds. Concentrations of DDE and Hg were higher on Amchitka Island, which was subjected to much military activity during World War II and the middle of the 20th century. Concentrations of ??PCBs also were elevated on islands with little history of military activity (e.g., Amlia, Tanaga, Buldir), suggesting non-point sources of PCBs in addition to point sources. Concentrations of DDE and Hg were highest in eagle eggs from the most western Aleutian Islands (e.g., Buldir, Kiska) and decreased eastward along the Aleutian chain. This east-to-west increase suggested a Eurasian source of contamination, possibly through global transport and atmospheric distillation and/or from migratory seabirds. Eggshell thickness and productivity of bald eagles were normal and indicative of healthy populations because concentrations of most contaminants were below threshold levels for effects on reproduction. Contrary to our predictions, contaminant concentrations were not correlated with stable isotopes of carbon (??13C) or nitrogen (??15N) in eggs. These latter findings indicate that contaminant concentrations were influenced more by point sources and geographic location than trophic status of eagles among the different islands. ?? 2007 SETAC.

  6. Quantifying Emissions from the Eagle Ford Shale Using Ethane Enhancement

    NASA Astrophysics Data System (ADS)

    Roest, G. S.; Schade, G. W.

    2014-12-01

    Emissions from unconventional oil and natural gas exploration in the Eagle Ford Shale have been conjectured as a contributing factor to increasing ozone concentrations in the San Antonio Metropolitan Area, which is on track to be designated as a nonattainment area by the EPA. Primary species found in natural gas emissions are alkanes, with C3 and heavier alkanes acting as short-lived VOCs contributing to regional ozone formation. Methane emissions from the industry are also a forcing mechanism for climate change as methane is a potent greenhouse gas. Recent studies have highlighted a high variability and uncertainties in oil and natural gas emissions estimates in emissions inventories. Thus, accurately quantifying oil and natural gas emissions from the Eagle Ford Shale is necessary to assess the industry's impacts on climate forcing and regional air quality. We estimate oil and natural gas emissions in the Eagle Ford Shale using in situ ethane measurements along southwesterly trajectories from the Gulf of Mexico, dominantly during the summertime. Ethane enhancement within the drilling area is estimated by comparing ethane concentrations upwind of the shale, near the Texas coastline, to downwind measurements in the San Antonio Metropolitan Area, Odessa, and Amarillo. Upwind ethane observations indicate low background levels entering Texas in the Gulf of Mexico air masses. Significant ethane enhancement is observed between the coast and San Antonio, and is attributed to oil and natural gas operations due to the concurrent enhancements of heavier alkanes. Using typical boundary layer depths and presuming homogenous emissions across the Eagle Ford shale area, the observed ethane enhancements are used to extrapolate an estimate of oil and natural gas industry emissions in the Eagle Ford. As oil and natural gas production in the area is projected to grow rapidly over the coming years, the impacts of these emissions on regional air quality will need to be thoroughly

  7. Golden Eagle Migratory Behaviors in Response to Arctic Warming

    NASA Astrophysics Data System (ADS)

    LaPoint, S.; Bohrer, G.; Davidson, S. C.; Gurarie, E.; Mahoney, P.; Boelman, N.

    2017-12-01

    Understanding how animals adapt to climate change is a conservation priority, particularly in arctic landscapes where these changes are accelerated. Doing so however, remains challenging because animal behavior datasets are typically conducted at site- or population-specific scales and are often short term (e.g., 2-3 years). We have overcome this challenge by compiling a long-term (25 years), large-scale (northwestern North America) dataset of > 0.5 million locations collected via 86 adult-aged golden eagles (Aquila chrysaetos) fitted with satellite and GPS data loggers. We used mechanistic range shift analyses to identify the locations and dates when each eagle performed a behavioral switch from a stationary phase (e.g., over-wintering or breeding) to migration and vice-versa. We annotated these spatio-temporal data with a suite of environmental data, including: %snow cover, time-to snow cover, time-to greening, air temperature, and wind direction and magnitude. Preliminary generalized additive mixed-models suggest these eagles have performed significant shifts in their departure dates, yet their arrival dates have remained relatively consistent. We will use a survival analysis (e.g., Cox proportional-hazard regression model) to quantify the influence of the environmental variables on these dates. It appears golden eagles migrating across northwestern North America are adapting to changes in the timing and duration of artic winters, by arriving to their northern breeding grounds earlier every spring, presumably to extend their breeding and chick rearing phases. Golden eagles exhibit some resiliency to changes in the arctic climate, but further work is warranted across other taxa and populations.

  8. A Predictive Model to Estimate Cost Savings of a Novel Diagnostic Blood Panel for Diagnosis of Diarrhea-predominant Irritable Bowel Syndrome.

    PubMed

    Pimentel, Mark; Purdy, Chris; Magar, Raf; Rezaie, Ali

    2016-07-01

    A high incidence of irritable bowel syndrome (IBS) is associated with significant medical costs. Diarrhea-predominant IBS (IBS-D) is diagnosed on the basis of clinical presentation and diagnostic test results and procedures that exclude other conditions. This study was conducted to estimate the potential cost savings of a novel IBS diagnostic blood panel that tests for the presence of antibodies to cytolethal distending toxin B and anti-vinculin associated with IBS-D. A cost-minimization (CM) decision tree model was used to compare the costs of a novel IBS diagnostic blood panel pathway versus an exclusionary diagnostic pathway (ie, standard of care). The probability that patients proceed to treatment was modeled as a function of sensitivity, specificity, and likelihood ratios of the individual biomarker tests. One-way sensitivity analyses were performed for key variables, and a break-even analysis was performed for the pretest probability of IBS-D. Budget impact analysis of the CM model was extrapolated to a health plan with 1 million covered lives. The CM model (base-case) predicted $509 cost savings for the novel IBS diagnostic blood panel versus the exclusionary diagnostic pathway because of the avoidance of downstream testing (eg, colonoscopy, computed tomography scans). Sensitivity analysis indicated that an increase in both positive likelihood ratios modestly increased cost savings. Break-even analysis estimated that the pretest probability of disease would be 0.451 to attain cost neutrality. The budget impact analysis predicted a cost savings of $3,634,006 ($0.30 per member per month). The novel IBS diagnostic blood panel may yield significant cost savings by allowing patients to proceed to treatment earlier, thereby avoiding unnecessary testing. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Co-existence of Blau syndrome and NAID? Diagnostic challenges associated with presence of multiple pathogenic variants in NOD2 gene: a case report.

    PubMed

    Dziedzic, Magdalena; Marjańska, Agata; Bąbol-Pokora, Katarzyna; Urbańczyk, Anna; Grześk, Elżbieta; Młynarski, Wojciech; Kołtan, Sylwia

    2017-07-27

    Pediatric autoinflammatory diseases are rare and still poorly understood conditions resulting from defective genetic control of innate immune system, inter alia from anomalies of NOD2 gene. The product of this gene is Nod2 protein, taking part in maintenance of immune homeostasis. Clinical form of resultant autoinflammatory condition depends on NOD2 genotype; usually patients with NOD2 defects present with Blau syndrome, NOD2-associated autoinflammatory disease (NAID) or Crohn's disease. We present the case of a 7-year-old girl with co-existing symptoms of two rare diseases, Blau syndrome and NAID. Overlapping manifestations of two syndromes raised a significant diagnostic challenge, until next-generation molecular test (NGS) identified presence of three pathogenic variants of NOD2 gene: P268S, IVS8 +158 , 1007 fs, and established the ultimate diagnosis. Presence of multiple genetical abnormalities resulted in an ambiguous clinical presentation with overlapping symptoms of Blau syndrome and NAID. Final diagnosis of autoinflammatory disease opened new therapeutic possibilities, including the use of biological treatments.

  10. Atrial fibrillation with wide QRS tachycardia and undiagnosed Wolff-Parkinson-White syndrome: diagnostic and therapeutic dilemmas in a pediatric patient.

    PubMed

    Panduranga, Prashanth; Al-Farqani, Abdullah; Al-Rawahi, Najib

    2012-11-01

    A 10-year-old girl presented to the emergency department of a regional hospital with 1 episode of generalized tonic-clonic seizures. Postictal monitoring followed by a 12-lead electrocardiogram showed fast atrial fibrillation with intermittent wide QRS regular tachycardia. Immediately following this, her rhythm changed to wide QRS irregular tachycardia without hemodynamic compromise. She was suspected to have ventricular tachycardia and was treated with intravenous amiodarone with cardioversion to sinus rhythm. Subsequent electrocardiogram in sinus rhythm showed typical features of manifest Wolff-Parkinson-White (WPW) accessory pathway. This case illustrates the diagnostic and therapeutic dilemmas in patients with atrial fibrillation, wide QRS tachycardia, and undiagnosed WPW syndrome with antidromic conduction of atrial arrhythmias through the accessory pathway. Furthermore, this case demonstrates that undiagnosed wide QRS tachycardias need to be treated with drugs acting on the accessory pathway, thus keeping in mind underlying WPW syndrome as a possibility to avoid potentially catastrophic events.

  11. Plasma Lactate Dehydrogenase Levels Predict Mortality in Acute Aortic Syndromes: A Diagnostic Accuracy and Observational Outcome Study.

    PubMed

    Morello, Fulvio; Ravetti, Anna; Nazerian, Peiman; Liedl, Giovanni; Veglio, Maria Grazia; Battista, Stefania; Vanni, Simone; Pivetta, Emanuele; Montrucchio, Giuseppe; Mengozzi, Giulio; Rinaldi, Mauro; Moiraghi, Corrado; Lupia, Enrico

    2016-02-01

    In acute aortic syndromes (AAS), organ malperfusion represents a key event impacting both on diagnosis and outcome. Increased levels of plasma lactate dehydrogenase (LDH), a biomarker of malperfusion, have been reported in AAS, but the performance of LDH for the diagnosis of AAS and the relation of LDH with outcome in AAS have not been evaluated so far.This was a bi-centric prospective diagnostic accuracy study and a cohort outcome study. From 2008 to 2014, patients from 2 Emergency Departments suspected of having AAS underwent LDH assay at presentation. A final diagnosis was obtained by aortic imaging. Patients diagnosed with AAS were followed-up for in-hospital mortality.One thousand five hundred seventy-eight consecutive patients were clinically eligible, and 999 patients were included in the study. The final diagnosis was AAS in 201 (20.1%) patients. Median LDH was 424 U/L (interquartile range [IQR] 367-557) in patients with AAS and 383 U/L (IQR 331-460) in patients with alternative diagnoses (P < 0.001). Using a cutoff of 450 U/L, the sensitivity of LDH for AAS was 44% (95% confidence interval [CI] 37-51) and the specificity was 73% (95% CI 69-76). Overall in-hospital mortality for AAS was 23.8%. Mortality was 32.6% in patients with LDH ≥ 450 U/L and 16.8% in patients with LDH < 450 U/L (P = 0.006). Following stratification according to LDH quartiles, in-hospital mortality was 12% in the first (lowest) quartile, 18.4% in the second quartile, 23.5% in the third quartile, and 38% in the fourth (highest) quartile (P = 0.01). LDH ≥ 450 U/L was further identified as an independent predictor of death in AAS both in univariate and in stepwise logistic regression analyses (odds ratio 2.28, 95% CI 1.11-4.66; P = 0.025), in addition to well-established risk markers such as advanced age and hypotension. Subgroup analysis showed excess mortality in association with LDH ≥ 450 U/L in elderly, hemodynamically stable and in nonsurgically

  12. Diagnostic and prognostic value of cardiac troponin I assays in patients admitted with symptoms suggestive of acute coronary syndrome.

    PubMed

    Apple, Fred S; Quist, Heidi E; Murakami, MaryAnn M

    2004-04-01

    Increasing numbers of patients are presenting to emergency departments with symptoms suggestive of an acute myocardial infarction. To demonstrate the comparative performance of the Ortho Vitros Troponin I and Beckman Access AccuTnI assays used to detect myocardial infarction and to develop risk stratification schemes for all-cause death in patients who presented with myocardial ischemia symptoms that were suggestive of acute coronary syndrome (ACS). The prospective enrollment of patients with ACS and the measurement of serial plasma samples by 2 commercial cardiac troponin I (cTnI) assays. A metropolitan medical center that admitted patients with ACS during a 2-month period. The study population consisted of 200 consecutively admitted patients who presented with symptoms that were suggestive of ACS. Correlation scatterplots showed no significant bias between cTnI assays based on 659 specimens across the dynamic range of each assay. Only minor differences in slopes and intercepts were observed between assays when correlations were based across selected concentration ranges. The receiver operating characteristic curve areas for the detection of myocardial infarction were not significantly different (Ortho,.991; Beckman,.995). At the 99th percentile (Beckman, 0.04 microg/L; Ortho, 0.08 microg/L), each assay demonstrated 100% sensitivity with 78% and 80% specificity, respectively. Kaplan-Meier survival curves and the log-rank test were used to compare time-to-event data. Patients with increased baseline cTnI values had higher odds ratios of death than did those with normal concentrations. For Ortho, the 99th percentile cutoff was 5.9, and the 10% coefficient of variation cutoff was 10.3; for Beckman, the 99th percentile cutoff was 31.4, and the 10% coefficient of variation cutoff was 15.3. Comparable diagnostic and risk stratification abilities were demonstrated in patients with ACS by the Ortho Vitros and Beckman Access cTnI assays, with no significant analytic bias

  13. Subthreshold Conditions as Precursors for Full Syndrome Disorders: A 15-Year Longitudinal Study of Multiple Diagnostic Classes

    ERIC Educational Resources Information Center

    Shankman, Stewart A.; Lewinsohn, Peter M.; Klein, Daniel N.; Small, Jason W.; Seeley, John R.; Altman, Sarah E.

    2009-01-01

    Background: There has been increasing interest in the distinction between subthreshold and full syndrome disorders and specifically whether subthreshold conditions escalate or predict the onset of full syndrome disorders over time. Most of these studies, however, examined whether a single subthreshold condition escalates into the full syndrome…

  14. Causes of mortality in eagles submitted to the National Wildlife Health Center 1975-2013

    USGS Publications Warehouse

    Russell, Robin E.; Franson, J. Christian

    2014-01-01

    We summarized the cause of death for 2,980 bald eagles (Haliaeetus leucocephalus) and 1,427 golden eagles (Aquila chrysaetos) submitted to the National Wildlife Health Center in Madison, Wisconsin, USA, for diagnosis between 1975 and the beginning of 2013. We compared the proportion of eagles with a primary diagnosis as electrocuted, emaciated, traumatized, shot or trapped, diseased, poisoned, other, and undetermined among the 4 migratory bird flyways of the United States (Atlantic, Mississippi, Central, and Pacific). Additionally, we compared the proportion of lead-poisoned bald eagles submitted before and after the autumn 1991 ban on lead shot for waterfowl hunting. Trauma and poisonings (including lead poisoning) were the leading causes of death for bald eagles throughout the study period, and a greater proportion of bald eagles versus golden eagles were diagnosed as poisoned. For golden eagles, the major causes of mortality were trauma and electrocution. The proportion of lead poisoning diagnoses for bald eagles submitted to the National Wildlife Health Center displayed a statistically significant increase in all flyways after the autumn 1991 ban on the use of lead shot for waterfowl hunting. Thus, lead poisoning was a significant cause of mortality in our necropsied eagles, suggesting a continued need to evaluate the trade-offs of lead ammunition for use on game other than waterfowl versus the impacts of lead on wildlife populations. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

  15. Methylation-sensitive high-resolution melting-curve analysis of the SNRPN gene as a diagnostic screen for Prader-Willi and Angelman syndromes.

    PubMed

    White, Helen E; Hall, Victoria J; Cross, Nicholas C P

    2007-11-01

    Angelman syndrome (AS) and Prader-Willi syndrome (PWS) are 2 distinct neurodevelopmental disorders caused primarily by deficiency of specific parental contributions at an imprinted domain within the chromosomal region 15q11.2-13. Lack of paternal contribution results in PWS either by paternal deletion (approximately 70%) or maternal uniparental disomy (UPD) (approximately 25%). Most cases of AS result from the lack of a maternal contribution from this same region, by maternal deletion (70%) or paternal UPD (approximately 5%). Analysis of allelic methylation differences at the small nuclear ribonucleoprotein polypeptide N (SNRPN) locus differentiates the maternally and paternally inherited chromosome 15 and can be used as a diagnostic test for AS and PWS. Methylation-sensitive high-resolution melting-curve analysis (MS-HRM) using the DNA binding dye EvaGreen was used to analyze methylation differences at the SNRPN locus in anonymized DNA samples from individuals with PWS (n = 39) or AS (n = 31) and from healthy control individuals (n = 95). Results from the MS-HRM assay were compared to those obtained by use of a methylation-specific PCR (MSP) protocol that is used commonly in diagnostic practice. With the MS-HRM assay 97.6% of samples were unambiguously assigned to the 3 diagnostic categories (AS, PWS, normal) by use of automated calling with an 80% confidence percentage threshold, and the failure rate was 0.6%. One PWS sample showed a discordant result for the MS-HRM assay compared to MSP data. MS-HRM is a simple, rapid, and robust method for screening methylation differences at the SNRPN locus and could be used as a diagnostic screen for PWS and AS.

  16. Cost-effectiveness analysis of rapid diagnostic test, microscopy and syndromic approach in the diagnosis of malaria in Nigeria: implications for scaling-up deployment of ACT.

    PubMed

    Uzochukwu, Benjamin S C; Obikeze, Eric N; Onwujekwe, Obinna E; Onoka, Chima A; Griffiths, Ulla K

    2009-11-23

    The diagnosis and treatment of malaria is often based on syndromic presentation (presumptive treatment) and microscopic examination of blood films. Treatment based on syndromic approach has been found to be costly, and contributes to the development of drug resistance, while microscopic diagnosis of malaria is time-consuming and labour-intensive. Also, there is lack of trained microscopists and reliable equipment especially in rural areas of Nigeria. However, although rapid diagnostic tests (RDTs) have improved the ease of appropriate diagnosis of malaria diagnosis, the cost-effectiveness of RDTs in case management of malaria has not been evaluated in Nigeria. The study hence compares the cost-effectiveness of RDT versus syndromic diagnosis and microscopy. A total of 638 patients with fever, clinically diagnosed as malaria (presumptive malaria) by health workers, were selected for examination with both RDT and microscopy. Patients positive on RDT received artemisinin-based combination therapy (ACT) and febrile patients negative on RDT received an antibiotic treatment. Using a decision tree model for a hypothetical cohort of 100,000 patients, the diagnostic alternatives considered were presumptive treatment (base strategy), RDT and microscopy. Costs were based on a consumer and provider perspective while the outcome measure was deaths averted. Information on costs and malaria epidemiology were locally generated, and along with available data on effectiveness of diagnostic tests, adherence level to drugs for treatment, and drug efficacy levels, cost-effectiveness estimates were computed using TreeAge programme. Results were reported based on costs and effects per strategy, and incremental cost-effectiveness ratios. The cost-effectiveness analysis at 43.1% prevalence level showed an incremental cost effectiveness ratio (ICER) of 221 per deaths averted between RDT and presumptive treatment, while microscopy is dominated at that level. There was also a lesser cost of

  17. Carpal tunnel syndrome: Investigating the sensitivity of initial-diagnosis with electro-diagnostic tests in 600 cases and associated risk factors especially manual milking.

    PubMed

    Tunç, Abdulkadir; Güngen, Belma Doğan

    2017-01-01

    Electro-diagnostic studies are the most reliable methods in diagnosis of carpal tunnel syndrome (CTS). Although there are many risk factors associated with CTS, there are a limited number of studies in the literature indicating that manual milking, which is frequently seen in Turkey, is a risk factor for CTS. The purpose of this study was to evaluate demographic findings of cases referred due to initial diagnosis of CTS as well as aetiological data especially manual milking and to investigate the sensitivity of initial diagnosis of CTS. Six hundred patients, who were referred to our electromyography laboratory due to initial diagnosis of CTS, were included. Demographic findings, duration of complaints, existence of diabetes mellitus, and manual milking histories of all patients were recorded. Sensitivity of initial diagnosis was investigated based on electro-diagnostic test results. According to electro-diagnostic test results, 289 of the patients were diagnosed with CTS (48.17%). 110 (18.3%) of 600 patients had a history of manual milking. In 94 of this group (85.4%), CTS was detected. Statistically significant correlation was found between CTS and age, female gender, duration of complaints, obesity and manual milking. This study confirms that manual milking is an important risk factor for CTS in addition to female gender, age, symptom duration and obesity. The fact that sensitivity of initial diagnosis of CTS was found to be low according to electro-diagnostic test results indicates importance of detailed clinical evaluation.

  18. Asbestos occurrence in the Eagle C-4 quadrangle, Alaska

    USGS Publications Warehouse

    Foster, Helen Laura

    1969-01-01

    An asbestos occurrence was discovered in a remote part of the Eagle quadrangle, Alaska, in the summer of 1968 during geologic reconnaissance in connection with the U.S. Geological Survey's Heavy Metals program. The exposed part of the deposit consists of large joint blocks of serpentine which are cut by closely spaced subparallel veins. Most of the veins are about ? inch thick, and they consist of cross-fiber chrysotile asbestos. The asbestos appears to be of commercial quality, but the total quantity is unknown. The asbestos occurs in a serpentinized ultramafic mass which appears to intrude metamorphic rocks. Many other serpentinized ultramafic masses are known in the Eagle quadrangle, but this is the first one in which considerable asbestos has been found. The deposit is of importance because it shows that geologic conditions are locally favorable for the formation of asbestos in the Yukon-Tanana Upland, and hope of finding commercial asbestos deposits thus seems possible.

  19. Captive and field-tested radio attachments for bald eagles

    USGS Publications Warehouse

    Buehler, D.A.; Fraser, J.D.; Fuller, M.R.; McAllister, L.S.; Seegar, J.K.D.

    1995-01-01

    The effects of two radio transmitter attachment techniques on captive and one attachment technique on wild Bald Eagles (Haliaeetus leucocephalus) were studied. A Y-attachment method with a 160-g dummy transmitter was less apt to cause tissue damage on captive birds than an X-attachment method, and loosely fit transmitters caused less damage than tightly fit transmitters Annual survival of wild birds fitted with 65-g transmitters via an X attachment was estimated at 90-95%. As a result of high survival, only five wild birds marked as nestlings were recovered.Two of these birds had superficial pressure sores from tight-fitting harnesses It is recommended that a 1.3-cm space be left between the transmitter and the bird's b ack when radio-tagging post-fiedging Bald Eagles. Additional space, perhaps up to 2.5 cm, is required for nestlings to allow for added growth and development.

  20. Time and Space Partitioning the EagleEye Reference Misson

    NASA Astrophysics Data System (ADS)

    Bos, Victor; Mendham, Peter; Kauppinen, Panu; Holsti, Niklas; Crespo, Alfons; Masmano, Miguel; de la Puente, Juan A.; Zamorano, Juan

    2013-08-01

    We discuss experiences gained by porting a Software Validation Facility (SVF) and a satellite Central Software (CSW) to a platform with support for Time and Space Partitioning (TSP). The SVF and CSW are part of the EagleEye Reference mission of the European Space Agency (ESA). As a reference mission, EagleEye is a perfect candidate to evaluate practical aspects of developing satellite CSW for and on TSP platforms. The specific TSP platform we used consists of a simulated LEON3 CPU controlled by the XtratuM separation micro-kernel. On top of this, we run five separate partitions. Each partition runs its own real-time operating system or Ada run-time kernel, which in turn are running the application software of the CSW. We describe issues related to partitioning; inter-partition communication; scheduling; I/O; and fault-detection, isolation, and recovery (FDIR).

  1. World`s first SPB LNG carrier ``POLAR EAGLE``

    SciTech Connect

    Aoki, Eiji; Nakajima, Yoshiyuki; Yamada, Koichiro

    1994-12-31

    The world`s first Self-supporting Prismatic-shape IMO type B (SPB) LNG Carrier named ``POLAR EAGLE`` has been delivered to Phillips 66 Natural Gas Company and Marathon Oil Company in June, 1993. The cargo containment system installed onboard the vessel, SPB cargo containment system, was developed by Ishikawajima-Harima Heavy Industries Co., Ltd. (IHI) and fully complies with IMO Gas Carrier Code for a type B independent tank. ``POLAR EAGLE`` was constructed in the authors` Aichi works and delivered 34 months after the contract of the vessel. Its performance was confirmed through various kinds of tests and inspections during construction of the vessel.more » Results of typical tests and inspections are introduced.« less

  2. Coming to terms about describing Golden Eagle reproduction

    USGS Publications Warehouse

    Steenhof, Karen; Kochert, Michael N.; McIntyre, Carol L.; Brown, Jessi L.

    2017-01-01

    Clearly defined terms are essential for reporting and understanding research findings, and inconsistent terminology can complicate efforts to compare findings from different studies. In this article, we reiterate and clarify recommended terms for describing Golden Eagle (Aquila chrysaetos) territory occupancy and reproduction. Several authors have provided recommendations for reporting data on raptor reproduction, but our literature review showed that authors continue to use different, often ambiguous and undefined, terms. The inconsistent use of terminology by researchers has been continued and expanded by lawmakers, regulators, and managers, perpetuating confusion. We recommend that authors clearly define and reference all terminology that they use, and we caution against use of the term “active” to describe a nest or nesting territory, because it is tainted with a history of inconsistent use. We provide a glossary of recommended terms for Golden Eagles and other large, long-lived raptors.

  3. On the galaxy-halo connection in the EAGLE simulation

    NASA Astrophysics Data System (ADS)

    Desmond, Harry; Mao, Yao-Yuan; Wechsler, Risa H.; Crain, Robert A.; Schaye, Joop

    2017-10-01

    Empirical models of galaxy formation require assumptions about the correlations between galaxy and halo properties. These may be calibrated against observations or inferred from physical models such as hydrodynamical simulations. In this Letter, we use the EAGLE simulation to investigate the correlation of galaxy size with halo properties. We motivate this analysis by noting that the common assumption of angular momentum partition between baryons and dark matter in rotationally supported galaxies overpredicts both the spread in the stellar mass-size relation and the anticorrelation of size and velocity residuals, indicating a problem with the galaxy-halo connection it implies. We find the EAGLE galaxy population to perform significantly better on both statistics, and trace this success to the weakness of the correlations of galaxy size with halo mass, concentration and spin at fixed stellar mass. Using these correlations in empirical models will enable fine-grained aspects of galaxy scalings to be matched.

  4. [Diagnostic image (113). A neonate blowing bubbles. Esophageal atresia with tracheoesophageal fistula, Hirschsprung disease and suspected Down's syndrome].

    PubMed

    Postema, R R; Meradji, M; Langemeijer, R A Th M

    2002-11-09

    In a male neonate 'blowing bubbles', three diagnoses were seen on a combined thoracic and abdominal X-ray: esophageal atresia with tracheoesophageal fistula, Hirschsprung's disease, and suspected Down's syndrome (because of the presence of II pairs of ribs).

  5. Enhancement of surface definition and gridding in the EAGLE code

    NASA Technical Reports Server (NTRS)

    Thompson, Joe F.

    1991-01-01

    Algorithms for smoothing of curves and surfaces for the EAGLE grid generation program are presented. The method uses an existing automated technique which detects undesirable geometric characteristics by using a local fairness criterion. The geometry entity is then smoothed by repeated removal and insertion of spline knots in the vicinity of the geometric irregularity. The smoothing algorithm is formulated for use with curves in Beta spline form and tensor product B-spline surfaces.

  6. Postfledging nest dependence period for bald eagles in Florida

    USGS Publications Warehouse

    Wood, P.B.; Collopy, Michael W.; Sekerak, C.M.

    1998-01-01

    We studied the postfledging dependency period in bald eagles (Haliaeetus leucocephalus), a little studied but important period in the life cycle of avian species. Bald eagles in Florida had a postfledging dependency period of 4-11 weeks (15-22 weeks old). The length of the dependency period did not vary by year of study, sex, number of fledgings, timing of fledging, or hatch order (P > 0.05). Mean distance fledglings ranged from the nest increased with age, but they were observed in the nest or nest tree throughout the postfledging dependency period. Distance from the nest did not vary by sex, number of fledglings, or timing of fledging (P > 0.05). Over 80% of the fledgling observations were within 229 m of the nest. The boundary of the primary protection zone specified in the bald eagle habitat management guidelines for the southeastern United States is 229 m. Restrictions on human disturbance around nest sites should remain in place during the postfledging dependency period because of the close association of fledglings with the nest site. Restrictions also should be flexible because of the varying length of the dependency period.

  7. Looking Back at 'Eagle Crater'(Left-eye)

    NASA Technical Reports Server (NTRS)

    2004-01-01

    This is the left-eye version of the first 360-degree view from the Mars Exploration Rover Opportunity's new position outside 'Eagle Crater,' the small crater where the rover landed about two months ago. Scientists are busy analyzing Opportunity's new view of the plains of Meridiani Planum. The plentiful ripples are a clear indication that wind is the primary geologic process currently in effect on the plains. The rover's tracks can be seen leading away from Eagle Crater. At the far left are two depressions--each about a meter (about 3.3 feet) across---that feature bright spots in their centers. One possibility is that the bright material is similar in composition to the rocks in Eagle Crater's outcrop and the surrounding darker material is what's referred to as 'lag deposit,' or erosional remnants, which are much harder and more difficult to wear away. These twin dimples might be revealing pieces of a larger outcrop that lies beneath. The depression closest to Opportunity is whimsically referred to as 'Homeplate' and the one behind it as 'First Base.' The rover's panoramic camera is set to take detailed images of the depressions today, on Opportunity's 58th sol. The backshell and parachute that helped protect the rover and deliver it safely to the surface of Mars are also visible near the horizon, at the left of the image. This image was taken by the rover's navigation camera.

  8. Frequency of nest use by golden eagles in southwestern Idaho

    USGS Publications Warehouse

    Kochert, Michael N.; Steenhof, Karen

    2012-01-01

    We studied nest use by Golden Eagles (Aquila chrysaetos) from 1966 to 2011 to assess nest reuse within territories, ascertain the length of time that elapses between uses of nests, and test the hypotheses that reproductive success and adult turnover influence nest switching. Golden Eagles used 454 nests in 66 territories and used individual nests 1 to 26 times during 45 continuous years of observation. Time between reuse ranged from 1 to 39 yr. Distances between nearest adjacent alternative nests within territories ranged between 5 times. Two nests were unused for 21 and 27 yr after 1971 before being used every 1 to 3 yr thereafter. Eagles used 43% of the nests in series of consecutive years (range 3 to 20 consecutive nestings). Protecting unused nests for a proposed 10 yr after the last known use would not have protected 34% of all 300 nests that were reused during the study and 49% of 37 reused nests monitored consistently for 41 yr. The 102 nests that would not have received protection were in 56 of the 66 territories.

  9. The influence of weather on Golden Eagle migration in northwestern Montana

    USGS Publications Warehouse

    Yates, R.E.; McClelland, B.R.; Mcclelland, P.T.; Key, C.H.; Bennetts, R.E.

    2001-01-01

    We analyzed the influence of 17 weather factors on migrating Golden Eagles (Aquila chrysaetos) near the Continental Divide in Glacier National Park, Montana, U.S.A. Local weather measurements were recorded at automated stations on the flanks of two peaks within the migration path. During a total of 506 hr of observation, the yearly number of Golden Eagles in autumn counts (1994-96) averaged 1973; spring counts (1995 and 1996) averaged 605 eagles. Mean passage rates (eagles/hr) were 16.5 in autumn and 8.2 in spring. Maximum rates were 137 in autumn and 67 in spring. Using generalized linear modeling, we tested for the effects of weather factors on the number of eagles counted. In the autumn model, the number of eagles increased with increasing air temperature, rising barometric pressure, decreasing relative humidity, and interactions among those factors. In the spring model, the number of eagles increased with increasing wind speed, barometric pressure, and the interaction between these factors. Our data suggest that a complex interaction among weather factors influenced the number of eagles passing on a given day. We hypothesize that in complex landscapes with high topographic relief, such as Glacier National Park, numerous weather factors produce different daily combinations to which migrating eagles respond opportunistically. ?? 2001 The Raptor Research Foundation, Inc.

  10. Residues of organochlorine pesticides and polychlorinated biphenyls and autopsy data for bald eagles, 1973-74

    USGS Publications Warehouse

    Prouty, R.M.; Reichel, W.L.; Locke, L.N.; Belisle, A.A.; Cromartie, E.; Kaiser, T.E.; Lamont, T.G.; Mulhern, B.M.; Swineford, D.M.

    1977-01-01

    Thirty-nine bald eagles found sick or dead in 13 States during 1969 and 1970 were analyzed for pesticide residues. Residues of DDE, dieldrin, polychlorinated biphenyls (PCB's), and mercury were detected in all bald eagle carcasses; DDD residues were detected in 38; DDT, heptachlor epoxide, and dichlorobenzophenone (DCBP) were detected less frequently. Six eagles contained possible lethal levels of dieldrin in the brain, and one contained a lethal concentration of DDE (385 ppm) in the brain together with 235 ppm of PCB's. Autopsy revealed that 18 bald eagles were illegally shot; other causes of death were impact injuries, electrocution, emaciation, and infectious diseases.

  11. Movements and landscape use of Eastern Imperial Eagles Aquila heliaca in Central Asia

    USGS Publications Warehouse

    Poessel, Sharon; Bragin, Evgeny A.; Sharpe, Peter B.; Garcelon, David K.; Bartoszuk, Kordian; Katzner, Todd E.

    2018-01-01

    Capsule: We describe ecological factors associated with movements of a globally declining raptor species, the Eastern Imperial Eagle Aquila heliaca.Aims: To describe the movements, habitat associations and resource selection of Eastern Imperial Eagles marked in Central Asia.Methods: We used global positioning system (GPS) data sent via satellite telemetry devices deployed on Eastern Imperial Eagles captured in Kazakhstan to calculate distances travelled and to associate habitat and weather variables with eagle locations collected throughout the annual cycle. We also used resource selection models to evaluate habitat use of tracked birds during autumn migration. Separately, we used wing-tagging recovery data to broaden our understanding of wintering locations of eagles.Results: Eagles tagged in Kazakhstan wintered in most countries on the Arabian Peninsula, as well as Iran and India. The adult eagle we tracked travelled more efficiently than did the four pre-adults. During autumn migration, telemetered eagles used a mixture of vegetation types, but during winter and summer, they primarily used bare and sparsely vegetated areas. Finally, telemetered birds used orographic updrafts to subsidize their autumn migration flight, but they relied on thermal updrafts during spring migration.Conclusion: Our study is the first to use GPS telemetry to describe year-round movements and habitat associations of Eastern Imperial Eagles in Central Asia. Our findings provide insight into the ecology of this vulnerable raptor species that can contribute to conservation efforts on its behalf.

  12. High risk of false positive results in a widely used diagnostic test for detection of the porcine reproductive and respiratory syndrome virus (PRRSV).

    PubMed

    Fetzer, C; Pesch, S; Ohlinger, V F

    2006-06-15

    During 2003 and 2004, increasing numbers of positive PRRSV RT-PCR results were reported from herds negative for PRRSV infection. Interestingly, three herds represent nucleus herds with no animal contacts from outside and without clinical symptoms of PRRS until now. Since these positive results that were obtained using a PCR protocol adapted to routine laboratory conditions could not be reproduced with other PRRSV specific RT-PCRs, controlled negative and positive samples were used to examine this phenomenon. A RT-PCR assay for detection and differential diagnosis of the European and North American genotypes of the porcine reproductive and respiratory syndrome virus (PRRSV) according to the method previously published by Oleksiewicz et al. [Oleksiewicz, M.B., Botner, A., Madsen, K.G., Storgaard, T., 1998. Sensitive detection and typing of porcine reproductive and respiratory syndrome virus by RT-PCR amplification of whole viral genes. Vet. Microbiol. 64, 7-22] was investigated in parallel to another recently published method [Pesch, S., 2003. Etablierung einer Nachweismethode für die zwei Genotypen von dem porcine reproductive and respiratory syndrome virus (PRRSV) und ein Beitrag zu seiner molekularen Epidemiologie. Thesis, Institute of Virology, Faculty of Veterinary Medicine, University of Leipzig]. A panel of 228 clinical samples sent in for PRRSV routine diagnostics served as test panel. It was found that both methods have similar analytical sensitivity. However, the primers published by Oleksiewicz were shown to yield a very high proportion of false positive results under routine diagnostic laboratory conditions, i.e. they resulted in RT-PCR products with non-PRRSV sequences, that were indistinguishable from truly positive reagents in standard gel electrophoresis settings. The reason for and possible implications of this finding as well as the risk of modifying published methods without control are discussed.

  13. Ultrasound elastography-based assessment of the elasticity of the supraspinatus muscle in impingement syndrome: does elastography has any diagnostic value?

    PubMed

    Demirel, Adnan; Baykara, Murat; Koca, Tuba Tülay; Berk, Ejder

    2018-06-01

    Ultrasound elastography (UE) is a new ultrasound-based imaging technique that provides information about elasticity and stiffness of tissues. This cross-sectional study aimed to identify the diagnostic importance of UE in supraspinatus impingement syndrome. Forty-one subjects, aged 38-70 years, were included in the study. UE was used to determine the elasticity of the supraspinatus muscle. The strain ratio was calculated as the evaluation criteria to measure the elasticity of the muscle. High strain ratio indicated low elasticity. The measurements were made by the blinded radiologist while the patients sat with their shoulder in a neutral position. The diagnostic value of the strain ratio was evaluated using the receiver operating characteristic (ROC) analysis. The mean strain value of the supraspinatus muscle on the intact and pathological shoulders determined by UE was 0.74 ± 0.33 and 0.31 ± 0.24, respectively. A low strain ratio value in the supraspinatus muscle on the side with impingement syndrome was measured. When the test variable was evaluated as "strain ratio" according to ROC curve analysis, it was found to be above the reference line [0.849 (> 0.5)] (P = 0.00). When the cutoff value was selected as 0.495, the sensitivity and specificity were found to be 75.6 and 78% (the strain ratio value > 0.495), respectively. Measurement of strain ratio with UE can be used as a noninvasive, inexpensive, and practical diagnostic test for the shoulder impingement disease.

  14. Pain symptoms and stooling patterns do not drive diagnostic costs for children with functional abdominal pain and irritable bowel syndrome in primary or tertiary care.

    PubMed

    Lane, Mariella M; Weidler, Erica M; Czyzewski, Danita I; Shulman, Robert J

    2009-03-01

    The objectives of this study were to (1) compare the cost of medical evaluation for children with functional abdominal pain or irritable bowel syndrome brought to a pediatric gastroenterologist versus children who remained in the care of their pediatrician, (2) compare symptom characteristics for the children in primary versus tertiary care, and (3) examine if symptom characteristics predicted the cost of medical evaluation. Eighty-nine children aged 7 to 10 years with functional abdominal pain or irritable bowel syndrome seen by a gastroenterologist (n = 46) or seen only by a pediatrician (n = 43) completed daily pain and stool diaries for 2 weeks. Mothers provided retrospective reports of their children's symptoms in the previous year. Cost of medical evaluation was calculated via chart review of diagnostic tests and application of prices as if the patients were self-pay. Child-reported diary data reflected no significant group differences with respect to pain, interference with activities, or stool characteristics. In contrast, mothers of children evaluated by a gastroenterologist viewed their children as having higher maximum pain intensity in the previous year. Excluding endoscopy costs, cost of medical evaluation was fivefold higher for children evaluated by a gastroenterologist, with higher cost across blood work, stool studies, breath testing, and diagnostic imaging. Symptom characteristics did not predict cost of care for either group. Despite the lack of difference in symptom characteristics between children in primary and tertiary care, a notable differential in cost of evaluation exists in accordance with level of care. Symptom characteristics do not seem to drive diagnostic evaluation in either primary or tertiary care. Given the lack of differences in child-reported symptoms and the maternal perspective that children evaluated by a gastroenterologist had more severe pain, we speculate that parent perception of child symptoms may be a primary factor in

  15. Diagnostic utility of sonography and correlation between sonographic and clinical findings in patients with carpal tunnel syndrome.

    PubMed

    Tajika, Tsuyoshi; Kobayashi, Tsutomu; Yamamoto, Atsushi; Kaneko, Tetsuya; Takagishi, Kenji

    2013-11-01

    First, we investigated the accuracy of carpal tunnel syndrome diagnosis by comparing the cross-sectional area of the median nerve measured at the level of proximal inlet of the carpal tunnel with that measured at the level of the distal radioulnar joint on sonography. Second, we evaluated the correlation between sonographic and neurophysiologic findings and clinical findings assessed by the Carpal Tunnel Syndrome Instrument of the Japanese Society for Surgery of the Hand (JSSH). Fifty wrists in 34 patients and 81 wrists in 45 healthy volunteers were examined. The proximal cross-sectional area and the difference (Δ) between the proximal and distal cross-sectional areas were calculated for each wrist. Nerve conduction velocity tests were performed for all patients with carpal tunnel syndrome. The proximal, distal, and Δ cross-sectional areas were compared for the two groups. We examined the correlation between the proximal, distal, and Δ areas, nerve conduction velocity findings, and JSSH scores in the patients. The diagnosis of carpal tunnel syndrome determined by the Δ cross-sectional area was more accurate than the diagnosis determined by the proximal area on receiver operating characteristic curve analysis (P = .006). Statistically significant correlations were found between proximal area, Δ area, and nerve conduction velocity findings (proximal, r = 0.45; P = .0013; Δ, r = 0.44; P = .001). The proximal and distal areas were positively correlated with the JSSH symptom severity score (proximal, r= 0.39; P= .005; distal, r = 0.35; P = .014). The cross-sectional area method using sonography has excellent performance for diagnosing carpal tunnel syndrome. It was useful for measuring the proximal and distal cross-sectional areas to evaluated the symptom severity and for calculating the Δ cross-sectional area to assess motor nerve damage in patients with carpal tunnel syndrome.

  16. Michelin tire baby syndrome: a review of the literature and a proposal for diagnostic criteria with adoption of the name circumferential skin folds syndrome.

    PubMed

    Rothman, Ilene L

    2014-01-01

    The term Michelin tire baby (MTB), named for the cartoon mascot of the Michelin Tire Company, has been used to describe babies with multiple symmetric circumferential rings of folded skin. In those reported with this phenotype who had skin biopsies, pathology has shown nevus lipomatosis, smooth muscle hamartoma, degenerative collagen, and scarring. Others did not undergo biopsy or had normal skin. Many individuals with the MTB phenotype have had a variety of other congenital anomalies. I review the literature on MTB and the history of the designation Michelin tire baby Syndrome (MTBS). Because the term MTBS has been poorly defined or not defined at all, I propose strict criteria for diagnosis. In doing so, it is recommended that the syndrome be renamed to avoid further confusion. © 2014 Wiley Periodicals, Inc.

  17. 75 FR 74038 - Twin Eagle Resource Management, LLC; Supplemental Notice That Initial Market-Based Rate Filing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-30

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. ER11-2154-000] Twin Eagle Resource Management, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes Request for... proceeding, of Twin Eagle Resource Management, LLC's [[Page 74039

  18. 50 CFR 22.26 - Permits for eagle take that is associated with, but not the purpose of, an activity.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... of the Region in which the disturbance would occur—Attention: Migratory Bird Permit Office. You can... the eagle's nest, roost, or foraging perches; and (iii) Whether alternative suitable eagle nesting...

  19. Biotelemetery data for golden eagles (Aquila chrysaetos) captured in coastal southern California, February 2016–February 2017

    USGS Publications Warehouse

    Tracey, Jeff A.; Madden, Melanie C.; Sebes, Jeremy B.; Bloom, Peter H.; Katzner, Todd E.; Fisher, Robert N.

    2017-05-12

    Because of a lack of clarity about the status of golden eagles (Aquila chrysaetos) in coastal southern California, the USGS, in collaboration with local, State, and other Federal agencies, began a multi-year survey and tracking program of golden eagles to address questions regarding habitat use, movement behavior, nest occupancy, genetic population structure, and human impacts on eagles. Golden eagle trapping and tracking efforts began in September 2014. During trapping efforts from September 29, 2014, to February 23, 2016, 27 golden eagles were captured. During trapping efforts from February 24, 2016, to February 23, 2017, an additional 10 golden eagles (7 females and 3 males) were captured in San Diego, Orange, and western Riverside Counties. Biotelemetry data for 26 of the 37 golden eagles that were transmitting data from February 24, 2016, to February 23, 2017 are presented. These eagles ranged as far north as northern Nevada and southern Wyoming, and as far south as La Paz, Baja California, Mexico.

  20. Asperger Syndrome in Males over Two Decades: Quality of Life in Relation to Diagnostic Stability and Psychiatric Comorbidity

    ERIC Educational Resources Information Center

    Helles, Adam; Gillberg, I. Carina; Gillberg, Christopher; Billstedt, Eva

    2017-01-01

    This study examined objective quality of life (work, academic success, living situation, relationships, support system) and subjective quality of life (Sense of Coherence and Short-Form Health Survey-36) in an adult sample of males (n = 50, mean age: 30 years) with Asperger syndrome diagnosed in childhood and followed prospectively over two…

  1. Diagnostic Dilemma: Lymphocytopenia in a Patient with Thymoma – Side Effect due to Irradiation Treatment or Development of Good's Syndrome?

    PubMed Central

    Raaschou-Jensen, Klas; Katzenstein, Terese L.; Marquart, Hanne; Ryder, Lars; Daugaard, Gedske

    2010-01-01

    A case of persistent B-cell lymphocytopenia in a 40-year-old woman with lymphoid-epithelial thymoma treated with chemotherapy, surgery and irradiation is described. The possible diagnosis of Good's syndrome (hypogammaglobulinaemia and thymoma) is discussed. PMID:20740204

  2. The Need for Control/Comparison Studies in Establishing Diagnostic Indicators: Prader-Willi Syndrome as a Case in Point.

    ERIC Educational Resources Information Center

    Taylor, Ronald L.; Caldwell, Mary Lou

    1990-01-01

    The psychometric characteristics of 12 adults with Prader-Willi syndrome (PWS) and a group without PWS but with other similar traits were compared. Results found cognitive, behavioral and educational traits often associated with PWS to be present in both groups, illustrating the importance of control/comparison groups in research establishing…

  3. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis.

    PubMed

    Ford, Alexander C; Chey, William D; Talley, Nicholas J; Malhotra, Ashish; Spiegel, Brennan M R; Moayyedi, Paul

    2009-04-13

    Individuals with irritable bowel syndrome (IBS) report abdominal pain, bloating, and diarrhea, symptoms similar to those in celiac disease. Studies suggest that the prevalence of celiac disease is increased in individuals with IBS; however, evidence is conflicting, and current guidelines do not always recommend screening for celiac disease in these individuals. We conducted a systematic review and meta-analysis to estimate prevalence of celiac disease in unselected adults who met diagnostic criteria for IBS. MEDLINE (1950 to May 31, 2008) and EMBASE (1980 to May 31, 2008) were searched. Case series and case-control studies that used serologic tests for celiac disease were eligible for inclusion. Prevalence of positive serologic indications of celiac disease and biopsy-proved celiac disease were extracted and pooled for all studies and were compared between cases and controls using an odds ratio and 95% confidence interval. Fourteen studies were identified comprising 4204 individuals, of whom 2278 (54%) met diagnostic criteria for IBS. Pooled prevalence of positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease were 4.0% (95% confidence interval, 1.7-7.2), 1.63% (0.7-3.0), and 4.1% (1.9-7.0), respectively. Pooled odds ratios (95% confidence intervals) for positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS compared with controls without IBS were 3.40 (1.62-7.13), 2.94 (1.36-6.35), and 4.34 (1.78-10.6). Prevalence of biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS was more than 4-fold that in controls without IBS.

  4. Diagnostic standards for dopaminergic augmentation of restless legs syndrome: report from a World Association of Sleep Medicine-International Restless Legs Syndrome Study Group consensus conference at the Max Planck Institute.

    PubMed

    García-Borreguero, Diego; Allen, Richard P; Kohnen, Ralf; Högl, Birgit; Trenkwalder, Claudia; Oertel, Wolfgang; Hening, Wayne A; Paulus, Walter; Rye, David; Walters, Arthur; Winkelmann, Juliane; Earley, Christopher J

    2007-08-01

    Augmentation of symptom severity is the main complication of dopaminergic treatment of restless legs syndrome (RLS). The current article reports on the considerations of augmentation that were made during a European Restless Legs Syndrome Study Group (EURLSSG)-sponsored Consensus Conference in April 2006 at the Max Planck Institute (MPI) in Munich, Germany, the conclusions of which were endorsed by the International RLS Study Group (IRLSSG) and the World Association of Sleep Medicine (WASM). The Consensus Conference sought to develop a better understanding of augmentation and generate a better operational definition for its clinical identification. Current concepts of the pathophysiology, clinical features, and therapy of RLS augmentation were evaluated by subgroups who presented a summary of their findings for general consideration and discussion. Recent data indicating sensitivity and specificity of augmentation features for identification of augmentation were also evaluated. The diagnostic criteria of augmentation developed at the National Institutes of Health (NIH) conference in 2002 were reviewed in light of current data and theoretical understanding of augmentation. The diagnostic value and criteria for each of the accepted features of augmentation were considered by the group. A consensus was then developed for a revised statement of the diagnostic criteria for augmentation. Five major diagnostic features of augmentation were identified: usual time of RLS symptom onset each day, number of body parts with RLS symptoms, latency to symptoms at rest, severity of the symptoms when they occur, and effects of dopaminergic medication on symptoms. The quantitative data available relating the time of RLS onset and the presence of other features indicated optimal augmentation criteria of either a 4-h advance in usual starting time for RLS symptoms or a combination of the occurrence of other features. A paradoxical response to changes in medication dose also indicates

  5. Tourette Syndrome

    MedlinePlus

    ... trials, epidemiology, neurophysiology, neuroimmunology, and descriptive/diagnostic clinical science. Findings from these studies will provide clues for more effective therapies. Information from the National Library of Medicine’s MedlinePlus Tourette Syndrome × What research is ...

  6. Prevalence of rheumatic regional pain syndromes in Latin-American indigenous groups: a census study based on COPCORD methodology and syndrome-specific diagnostic criteria.

    PubMed

    Alvarez-Nemegyei, José; Peláez-Ballestas, Ingris; Goñi, Mario; Julián-Santiago, Flor; García-García, Conrado; Quintana, Rosana; Silvestre, Adriana M R; García-Olivera, Imelda; Mathern, Nora A; Loyola-Sanchez, Adalberto; Conti, Silvana; Sanabria, Alvaro J; Pons-Estel, Bernardo A

    2016-07-01

    This study assessed the overall and specific prevalence of the main rheumatic regional pain syndromes (RRPS) in four Latin-American indigenous groups. A Community Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology-based census study was performed in 4240 adults (participation rate: 78.88 %) in four indigenous groups: Chontal (Oaxaca, Mexico, n = 124), Mixteco (Oaxaca, Mexico; n = 937), Maya-Yucateco (Yucatán, Mexico; n = 1523), and Qom (Rosario, Argentina; n = 1656). Subjects with musculoskeletal pain were identified using a cross-cultural, validated COPCORD questionnaire administered by bilingual personnel, and reviewed by general practitioners or rheumatologists using standardized case definitions for the 12 most frequent RRPS. The overall prevalence of RRPS was confirmed in 239 cases (5.64 %, 95 % CI: 4.98-6.37). The prevalence in each group was Chontal n = 19 (15.32 %, 95 % CI: 10.03-22.69); Maya-Yucateco n = 165 (10.83 %, 95 % CI: 9.37-12.49); Qom n = 48 (2.90 %, 95 % CI: 2.19-3.82); and Mixteco n = 7 (0.75 %, 95 % CI: 0.36-1.53). In the whole sample, the syndrome-specific prevalence was rotator cuff tendinopathy: 1.98 % (95 % CI: 1.60-2.45); lateral epicondylalgia: 0.83 % (95 % CI: 0.59-1.15); medial epicondylalgia: 0.73 % (95 % CI: 0.52-1.04); biceps tendinopathy: 0.71 % (95 % CI: 0.50-1.01); anserine syndrome: 0.64 % (95 % CI: 0.44-0.92); inferior heel pain: 0.61 % (95 % CI: 0.42-0.90); trochanteric syndrome: 0.49 % (95 % CI: 0.25-0.64); de Quervain's tendinopathy: 0.45 % (95 % CI: 0.29-0.70); trigger finger: 0.42 % (95 % CI: 0.27-0.67); carpal tunnel syndrome: 0.28 % (95 % CI: 0.16-0.49); Achilles tendinopathy (insertional): 0.12 % (95 % CI: 0.05-0.28); and Achilles tendinopathy (non-insertional): 0.07 % (95 % CI: 0.02-0.21). Leaving aside the comparison between Maya-Yucateco and Chontal groups (p = 0.18), we found significant differences (p < 0.001) in

  7. Does training improve diagnostic accuracy and inter-rater agreement in applying the Berlin radiographic definition of acute respiratory distress syndrome? A multicenter prospective study.

    PubMed

    Peng, Jin-Min; Qian, Chuan-Yun; Yu, Xiang-You; Zhao, Ming-Yan; Li, Shu-Sheng; Ma, Xiao-Chun; Kang, Yan; Zhou, Fa-Chun; He, Zhen-Yang; Qin, Tie-He; Yin, Yong-Jie; Jiang, Li; Hu, Zhen-Jie; Sun, Ren-Hua; Lin, Jian-Dong; Li, Tong; Wu, Da-Wei; An, You-Zhong; Ai, Yu-Hang; Zhou, Li-Hua; Cao, Xiang-Yuan; Zhang, Xi-Jing; Sun, Rong-Qing; Chen, Er-Zhen; Du, Bin

    2017-01-20

    Poor inter-rater reliability in chest radiograph interpretation has been reported in the context of acute respiratory distress syndrome (ARDS), although not for the Berlin definition of ARDS. We sought to examine the effect of training material on the accuracy and consistency of intensivists' chest radiograph interpretations for ARDS diagnosis. We conducted a rater agreement study in which 286 intensivists (residents 41.3%, junior attending physicians 35.3%, and senior attending physician 23.4%) independently reviewed the same 12 chest radiographs developed by the ARDS Definition Task Force ("the panel") before and after training. Radiographic diagnoses by the panel were classified into the consistent (n = 4), equivocal (n = 4), and inconsistent (n = 4) categories and were used as a reference. The 1.5-hour training course attended by all 286 intensivists included introduction of the diagnostic rationale, and a subsequent in-depth discussion to reach consensus for all 12 radiographs. Overall diagnostic accuracy, which was defined as the percentage of chest radiographs that were interpreted correctly, improved but remained poor after training (42.0 ± 14.8% before training vs. 55.3 ± 23.4% after training, p < 0.001). Diagnostic sensitivity and specificity improved after training for all diagnostic categories (p < 0.001), with the exception of specificity for the equivocal category (p = 0.883). Diagnostic accuracy was higher for the consistent category than for the inconsistent and equivocal categories (p < 0.001). Comparisons of pre-training and post-training results revealed that inter-rater agreement was poor and did not improve after training, as assessed by overall agreement (0.450 ± 0.406 vs. 0.461 ± 0.575, p = 0.792), Fleiss's kappa (0.133 ± 0.575 vs. 0.178 ± 0.710, p = 0.405), and intraclass correlation coefficient (ICC; 0.219 vs. 0.276, p = 0.470). The radiographic diagnostic accuracy and

  8. 77 FR 5505 - Eagle Crest Energy Company; Notice of Availability of the Final Environmental Impact Statement...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-03

    ... Energy Projects has reviewed the application for license for the Eagle Mountain Pumped Storage... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Project No. 13123-002--California] Eagle Crest Energy Company; Notice of Availability of the Final Environmental Impact Statement for the...

  9. 76 FR 1149 - Eagle Crest Energy Company; Notice of Availability of the Draft Environmental Impact Statement...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-07

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Project No. 13123-002--California] Eagle Crest Energy Company; Notice of Availability of the Draft Environmental Impact Statement for the Eagle Mountain Pumped Storage Hydroelectric Project and Notice of Public Meetings December 23, 2010. In...

  10. 77 FR 25164 - Adequacy Status of the Eagle River, Alaska Particulate Matter Limited Maintenance Plan for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-27

    ... ENVIRONMENTAL PROTECTION AGENCY [EPA-R10-OAR-2010-1914; FRL-9664-7] Adequacy Status of the Eagle River, Alaska Particulate Matter Limited Maintenance Plan for Transportation Conformity Purposes AGENCY... notifying the public of its finding that the Eagle River, Alaska, Particulate Matter (PM 10 ) Limited...

  11. 77 FR 40704 - Price for the 2012 American Eagle Silver Uncirculated Coin

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-10

    ... DEPARTMENT OF THE TREASURY United States Mint Price for the 2012 American Eagle Silver... States Mint is announcing the price of the 2012 American Eagle Silver Uncirculated Coin. The coin will be offered for sale at a price of $45.95. FOR FURTHER INFORMATION CONTACT: B. B. Craig, Associate Director...

  12. 77 FR 43662 - Price for the 2012 American Eagle Silver Proof Coin

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-25

    ... DEPARTMENT OF THE TREASURY United States Mint Price for the 2012 American Eagle Silver Proof Coin... is lowering the price of the 2012 American Eagle Silver Proof Coin. The product will now be offered for sale at a price of $54.95. FOR FURTHER INFORMATION CONTACT: B. B. Craig, Associate Director for...

  13. 77 FR 28375 - Eagle Rock Desoto Pipeline, L.P.; Notice of Petition for Rate Approval

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-14

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR12-25-000] Eagle Rock Desoto Pipeline, L.P.; Notice of Petition for Rate Approval Take notice that on May 1, 2012, Eagle Rock Desoto Pipeline, L.P. (Desoto) filed a Rate Election pursuant to 284.123(b)(1) of the Commissions...

  14. 76 FR 20971 - Eagle Rock Desoto Pipeline, L.P.; Notice of Filing

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-14

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR10-120-001] Eagle Rock Desoto Pipeline, L.P.; Notice of Filing Take notice that on April 7, 2011, Eagle Rock Desoto Pipeline, L.P. filed a revised Statement of Operating Conditions to comply with an unpublished delegated letter...

  15. 75 FR 27774 - Eagle Rock Desoto Pipeline, L.P.; Notice of Rate Election

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-18

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR10-22-000] Eagle Rock Desoto Pipeline, L.P.; Notice of Rate Election May 11, 2010. Take notice that on May 3, 2010, Eagle Rock Desoto Pipeline, L.P., (Desoto) filed a Notice of Rate Election pursuant to section 284.123(b)(1)(ii) of...

  16. 75 FR 62184 - Notification of United States Mint Silver Eagle Bullion Coin Premium Increase

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-07

    ... Bullion Coin Premium Increase ACTION: Notification of United States Mint Silver Eagle Bullion Coin Premium Increase. SUMMARY: The United States Mint is increasing the premium charged to Authorized Purchasers for... will increase the premium charged to Authorized Purchasers for American Eagle Silver Bullion Coins...

  17. Lead and mercury in fall migrant golden eagles from western North America.

    PubMed

    Langner, Heiko W; Domenech, Robert; Slabe, Vincent A; Sullivan, Sean P

    2015-07-01

    Lead exposure from ingestion of bullet fragments is a serious environmental hazard to eagles. We determined blood lead levels (BLL) in 178 golden eagles (Aquila chrysaetos) captured during fall migration along a major North American flyway. These eagles spent the breeding season distributed over a large range and are the best currently available representation of free flying golden eagles on the continent. We found 58 % of these eagles containing increased BLL > 0.1 mg/L; 10 % were clinically lead poisoned with BLL > 0.6 mg/L; and 4 % were lethally exposed with BLL > 1.2 mg/L. No statistical difference in BLL existed between golden and bald eagles (Haliaeetus leucocephalus). Golden eagles captured on carrion had higher BLL than those captured using live bait suggesting differences in feeding habits among individuals. Median BLL increased with age class. We propose a conceptual model for the long-term increase in BLL after ingestion of lead particles. The mean blood mercury level in golden eagles was 0.023 mg/L. We evaluate a field test for BLL that is based on anodic stripping voltammetry. This cost-effective and immediate method correlated well with results from inductively coupled plasma-mass spectrometry, although results needed to be corrected for each calibration of the test kit.

  18. 75 FR 11937 - Eagle Sportswear, Inc.; New York, NY; Notice of Termination of Investigation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-12

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,023] Eagle Sportswear, Inc.; New York, NY; Notice of Termination of Investigation Pursuant to Section 223 of the Trade Act of 1974... company official on behalf of workers of Eagle Sportswear, Inc., New York, New York. The petitioner has...

  19. Known breeding distribution and abundance of golden eagles in Eastern North America

    Treesearch

    Francois Morneau; Junior A. Tremblay; Charles Todd; Tony E. Chubbs; Charles Maisonneuve; Jerome Lemaitre; Todd Katzner

    2015-01-01

    Aquila chrysaetos (Golden Eagle) breeds in both eastern and western North America. However, the former population has received much less attention than the latter. The purpose of this paper is to document the known distribution and abundance of eastern Golden Eagles within their breeding range and to identify gaps in knowledge for future studies....

  20. The genome sequence of a widespread apex Predator, the golden eagle (Aquila chrysaetos)

    Treesearch

    Jacqueline M. Doyle; Todd E. Katzner; Peter H. Bloom; Yanzhu Ji; Bhagya K. Wijayawardena; J. Andrew DeWoody; Ludovic Orlando

    2014-01-01

    Biologists routinely use molecular markers to identify conservation units, to quantify genetic connectivity, to estimate population sizes, and to identify targets of selection. Many imperiled eagle populations require such efforts and would benefit from enhanced genomic resources. We sequenced, assembled, and annotated the first eagle genome using DNA from a male...

  1. 75 FR 34530 - Nittany & Bald Eagle Railroad Company-Temporary Trackage Rights Exemption-Norfolk Southern...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-17

    ... Eagle Railroad Company--Temporary Trackage Rights Exemption--Norfolk Southern Railway Company Norfolk Southern Railway Company (NSR), pursuant to a written trackage rights agreement dated April 13, 2010, has agreed to grant nonexclusive overhead temporary trackage rights to Nittany & Bald Eagle Railroad Company...

  2. 77 FR 18881 - Nittany & Bald Eagle Railroad Company-Temporary Trackage Rights Exemption-Norfolk Southern...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... Eagle Railroad Company--Temporary Trackage Rights Exemption--Norfolk Southern Railway Company Norfolk Southern Railway Company (NSR), pursuant to a written trackage rights agreement dated February 3, 2012, has agreed to grant nonexclusive overhead temporary trackage rights to Nittany & Bald Eagle Railroad Company...

  3. Research note: isolation of a herpesvirus from a bald eagle nestling

    USGS Publications Warehouse

    Docherty, D.E.; Romaine, R.I.; Knight, R.L.

    1983-01-01

    Cloacal swabs collected from wild bald eagle nestlings (Haliaeetus leucocephalus) were tested for viruses. A virus isolated from one of these samples had a lipid coat and contained DNA. Electron microscopy confirmed that it was a herpesvirus. This appears to be the first report of a herpesvirus isolation from a wild bald eagle.

  4. Assessment of exposure of fish to emerging contaminants in the Eagle Creek Watershed

    EPA Science Inventory

    The Eagle Creek Watershed (ECW) encompasses 162 square miles in central Indiana upstream of the Eagle Creek Reservoir, a public drinking water source for the city of Indianapolis. The dominant land-cover is agriculture, although some portions are undergoing urbanization, with th...

  5. 77 FR 839 - Pricing for 2011 American Eagle Silver Uncirculated Coins

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-06

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for 2011 American Eagle Silver Uncirculated Coins Agency: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the re-pricing of the 2011 American Eagle Silver Uncirculated Coins. The price of...

  6. 76 FR 27182 - Pricing for American Eagle and American Buffalo Bullion Presentation Cases

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for American Eagle and American Buffalo Bullion Presentation Cases AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price increase of the American Eagle/Buffalo Bullion...

  7. 76 FR 67799 - Pricing for the American Eagle 25th Anniversary Silver Coin Set

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-02

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for the American Eagle 25th Anniversary Silver Coin Set AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of the American Eagle 25th Anniversary Silver Coin Set. The...

  8. 77 FR 15457 - Pricing for the 2012 American Eagle Silver Proof Coin

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-15

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for the 2012 American Eagle Silver Proof Coin AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of the 2012 American Eagle Silver Proof Coin. The coins will be offered...

  9. 76 FR 53717 - Pricing for the 2011 American Eagle Silver Uncirculated Coin

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-29

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for the 2011 American Eagle Silver Uncirculated Coin AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the pricing of the 2011 American Eagle Silver Uncirculated Coin. The price of...

  10. 76 FR 65563 - Pricing for 2011 American Eagle Silver Proof and Uncirculated Coins

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-21

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for 2011 American Eagle Silver Proof and Uncirculated Coins AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the re-pricing of the 2011 American Eagle Silver Proof and Uncirculated Coins...

  11. 76 FR 53717 - Pricing for the 2011 American Eagle Silver Proof Coin

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-29

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for the 2011 American Eagle Silver Proof Coin AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the re-pricing of the 2011 American Eagle Silver Proof Coin. The price of the coins...

  12. 76 FR 33026 - Pricing for the 2011 American Eagle Silver Proof Coin

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-07

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for the 2011 American Eagle Silver Proof Coin AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of the 2011 American Eagle Silver Proof Coin. The coin will be offered for...

  13. 78 FR 24816 - Pricing for the 2013 American Eagle West Point Two-Coin Silver Set

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-26

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for the 2013 American Eagle West Point Two-Coin Silver Set AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of the 2013 American Eagle West Point Two-Coin Silver Set. The...

  14. 76 FR 27753 - American Eagle Savings Bank, Boothwyn, PA; Approval of Conversion Application

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-12

    ... DEPARTMENT OF THE TREASURY Office of Thrift Supervision [AC-61: OTS Nos. 07212] American Eagle Savings Bank, Boothwyn, PA; Approval of Conversion Application Notice is hereby given that on May 3, 2011, the Office of Thrift Supervision approved the application of American Eagle Savings Bank, Boothwyn...

  15. 76 FR 387 - Atomic Safety and Licensing Board; AREVA Enrichment Services, LLC (Eagle Rock Enrichment Facility)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-04

    ... and Licensing Board; AREVA Enrichment Services, LLC (Eagle Rock Enrichment Facility) December 17, 2010... construction and operation of a gas centrifuge uranium enrichment facility--denoted as the Eagle Rock... site at http://www.nrc.gov/materials/fuel-cycle-fac/arevanc.html . These and other documents relating...

  16. Growing Leaders in Native American Communities: An Interview with Gerald Eagle Bear

    ERIC Educational Resources Information Center

    Hill, Sara

    2006-01-01

    In the summer of 2005, I interviewed Gerald Eagle Bear about his work to promote civic and cultural engagement among Native American youth. Eagle Bear is program manager of the Oyate Networking Project, an affiliate of Christian Children's Fund, in Mission, South Dakota. The organization focuses on early childhood education, youth violence…

  17. Using nestling feathers to assess spatial and temporal concentrations of mercury in bald eagles at Voyageurs National Park, Minnesota, USA

    Treesearch

    H. T. Pittman; W. W. Bowerman; L. H. Grim; Teryl Grubb; W. C. Bridges

    2011-01-01

    Bald eagles (Haliaeetus leucocephalus) have been utilized as a biosentinel of aquatic ecosystem health in the Great Lakes Region since the early 1960s. Bald eagle populations have been monitored at Voyageurs National Park (VNP), Minnesota, since 1973. For the past 20 years, researchers have collected feathers from nestling bald eagles to assess their dietary exposure...

  18. 78 FR 57444 - Eagle Fund III, L.P.; Notice Seeking Exemption Under the Small Business Investment Act, Conflicts...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-18

    ... SMALL BUSINESS ADMINISTRATION [License No. 07/07-0116] Eagle Fund III, L.P.; Notice Seeking Exemption Under the Small Business Investment Act, Conflicts of Interest Notice is hereby given that Eagle... Constitute Conflicts of Interest, of the Small Business Administration (``SBA'') Rules and Regulations. Eagle...

  19. 76 FR 34103 - In the Matter of Areva Enrichment Services, LLC (Eagle Rock Enrichment Facility); Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-10

    .... 10-899-02-ML-BD01] In the Matter of Areva Enrichment Services, LLC (Eagle Rock Enrichment Facility... gas centrifuge uranium enrichment facility--denoted as the Eagle Rock Enrichment Facility (EREF)--in... Information for Contention Preparation; In the Matter of Areva Enrichment Services, LLC (Eagle Rock Enrichment...

  20. Pre-main sequence stars with disks in the Eagle Nebula observed in scattered light

    NASA Astrophysics Data System (ADS)

    Guarcello, M. G.; Damiani, F.; Micela, G.; Peres, G.; Prisinzano, L.; Sciortino, S.

    2010-10-01

    Context. NGC 6611 and its parental cloud, the Eagle Nebula (M 16), are well-studied star-forming regions, thanks to their large content of both OB stars and stars with disks and the observed ongoing star formation. In our previous studies of the Eagle Nebula, we identified 834 disk-bearing stars associated with the cloud, after detecting their excesses in NIR bands from J band to 8.0 μ m. Aims: In this paper, we study in detail the nature of a subsample of disk-bearing stars that show peculiar characteristics. They appear older than the other members in the V vs. V-I diagram, and/or they have one or more IRAC colors at pure photospheric values, despite showing NIR excesses, when optical and infrared colors are compared. Methods: We confirm the membership of these stars to M 16 by a spectroscopic analysis. The physical properties of these stars with disks are studied by comparing their spectral energy distributions (SEDs) with the SEDs predicted by models of T Tauri stars with disks and envelopes. Results: We show that the age of these stars estimated from the V vs. V-I diagram is unreliable since their V-I colors are altered by the light scattered by the disk into the line of sight. Only in a few cases their SEDs are compatible with models with excesses in V band caused by optical veiling. Candidate members with disks and photospheric IRAC colors are selected by the used NIR disk diagnostic, which is sensitive to moderate excesses, such as those produced by disks with low masses. In 1/3 of these cases, scattering of stellar flux by the disks can also be invoked. Conclusions: The photospheric light scattered by the disk grains into the line of sight can affect the derivation of physical parameters of Class II stars from photometric optical and NIR data. Besides, the disks diagnostic we defined are useful for selecting stars with disks, even those with moderate excesses or whose optical colors are altered by veiling or photospheric scattered light. Table with the

  1. The EAGLE simulations: atomic hydrogen associated with galaxies

    NASA Astrophysics Data System (ADS)

    Crain, Robert A.; Bahé, Yannick M.; Lagos, Claudia del P.; Rahmati, Alireza; Schaye, Joop; McCarthy, Ian G.; Marasco, Antonino; Bower, Richard G.; Schaller, Matthieu; Theuns, Tom; van der Hulst, Thijs

    2017-02-01

    We examine the properties of atomic hydrogen (H I) associated with galaxies in the Evolution and Assembly of GaLaxies and their Environments (EAGLE) simulations of galaxy formation. EAGLE's feedback parameters were calibrated to reproduce the stellar mass function and galaxy sizes at z = 0.1, and we assess whether this calibration also yields realistic H I properties. We estimate the self-shielding density with a fitting function calibrated using radiation transport simulations, and correct for molecular hydrogen with empirical or theoretical relations. The `standard-resolution' simulations systematically underestimate H I column densities, leading to an H I deficiency in low-mass (M⋆ < 1010 M⊙) galaxies and poor reproduction of the observed H I mass function. These shortcomings are largely absent from EAGLE simulations featuring a factor of 8 (2) better mass (spatial) resolution, within which the H I mass of galaxies evolves more mildly from z = 1 to 0 than in the standard-resolution simulations. The largest volume simulation reproduces the observed clustering of H I systems, and its dependence on H I richness. At fixed M⋆, galaxies acquire more H I in simulations with stronger feedback, as they become associated with more massive haloes and higher infall rates. They acquire less H I in simulations with a greater star formation efficiency, since the star formation and feedback necessary to balance the infall rate is produced by smaller gas reservoirs. The simulations indicate that the H I of present-day galaxies was acquired primarily by the smooth accretion of ionized, intergalactic gas at z ≃ 1, which later self-shields, and that only a small fraction is contributed by the reincorporation of gas previously heated strongly by feedback. H I reservoirs are highly dynamic: over 40 per cent of H I associated with z = 0.1 galaxies is converted to stars or ejected by z = 0.

  2. Spatial structure in the diet of imperial eagles Aquila heliaca in Kazakhstan

    USGS Publications Warehouse

    Katzner, T.E.; Bragin, E.A.; Knick, S.T.; Smith, A.T.

    2006-01-01

    We evaluated the relationship between spatial variability in prey and food habits of eastern imperial eagles Aquila heliaca at a 90,000 ha national nature reserve in north-central Kazakhstan. Eagle diet varied greatly within the population and the spatial structure of eagle diet within the population varied according to the scale of measurement. Patterns in dietary response were inconsistent with expectations if either ontogenetic imprinting or competition determined diet choice, but they met expectations if functional response determined diet. Eagles nesting near a high-density prey resource used that resource almost exclusively. In contrast, in locations with no single high-density prey species, eagles' diet was more diverse. Our results demonstrate that spatial structuring of diet of vertebrate predators can provide important insight into the mechanisms that drive dietary decisions. ?? OIKOS.

  3. Flight Testing of Guidance, Navigation and Control Systems on the Mighty Eagle Robotic Lander Testbed

    NASA Technical Reports Server (NTRS)

    Hannan, Mike; Rickman, Doug; Chavers, Greg; Adam, Jason; Becker, Chris; Eliser, Joshua; Gunter, Dan; Kennedy, Logan; O'Leary, Patrick

    2015-01-01

    During 2011 a series of progressively more challenging flight tests of the Mighty Eagle autonomous terrestrial lander testbed were conducted primarily to validate the GNC system for a proposed lunar lander. With the successful completion of this GNC validation objective the opportunity existed to utilize the Mighty Eagle as a flying testbed for a variety of technologies. In 2012 an Autonomous Rendezvous and Capture (AR&C) algorithm was implemented in flight software and demonstrated in a series of flight tests. In 2012 a hazard avoidance system was developed and flight tested on the Mighty Eagle. Additionally, GNC algorithms from Moon Express and a MEMs IMU were tested in 2012. All of the testing described herein was above and beyond the original charter for the Mighty Eagle. In addition to being an excellent testbed for a wide variety of systems the Mighty Eagle also provided a great learning opportunity for many engineers and technicians to work a flight program.

  4. [Atypical Guillain-Barre syndrome clustering: is it necessary to reconsider the diagnostic criteria and microbiological protocol?

    PubMed

    Dominguez-Mayoral, A; Gutierrez, C; Lopez-Dominguez, J M; Eichau, S; Abril, J; Navarro-Mascarell, G; Quesada-Garcia, M A; Ramos, M; Alvarez-Lopez, M; Menendez-De Leon, C; Izquierdo, G

    2017-05-01

    Guillain-Barre syndrome is classically defined as a symmetrical ascending acute polyradiculoneuropathy, although there are atypical variants that make diagnosis difficult. The medical data of six patients in our hospital area are collected during the first quarter of 2013. Lumbar punctures, imaging, neurophysiological studies, ganglioside antibodies and serologies have been proposed in all cases. We focus on the atypical features as late hyporeflexia, increased frequency of asymmetry and distal paresis and initial fever. From a neurophysiological point of view, all patients presented sensorimotor axonal forms. The most consistent datas in early studies is the F wave's alteration. A Miller Fisher variant associated with faciocervicobraquial paresis and cerebral reversible vasoconstriction syndrome has been detected. A bilateral brachial paresis and lumbar polyradiculopathy in the context of influenza A infection is other interesting case. The saltatory variant with cranial nerve involvement and lower limbs paresis has been demonstrated in one patient. Bands in cerebrospinal fluid are positive in three cases and anti-ganglioside antibodies in one patient. The syndrome of inappropriate secretion of antidiuretic hormone may explain some of the hyponatremias registered. The first line of treatment are inmunoglobulins in all patients. Plasmapheresis exchanges has been used as an additional therapy in four cases. These clusters of six axonal cases with atypical clinical features justifies the need for knowledge of these variants in order to achieve an early treatment. Late hyporeflexia and brachialfaciocervico, saltatory and lumbar forms should be considered in the spectrum of Guillain-Barre syndrome. The etiological study should rule out a lots of pathogens as influenza A.

  5. Prostatitis Syndromes

    PubMed Central

    Nickel, J. Curtis

    1991-01-01

    The many prostatitis syndromes remain a frustrating enigma to family physicians as well as specialists. An understanding of the etiology and pathophysiology of these syndromes and a rigorous diagnostic plan to properly classify the patients at first presentation are essential to a successful treatment outcome. ImagesFigure 1 PMID:21229071

  6. Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome: the Nambour Short Low-Intermediate Chest pain project.

    PubMed

    George, Terry; Ashover, Sarah; Cullen, Louise; Larsen, Peter; Gibson, Jason; Bilesky, Jennifer; Coverdale, Steven; Parsonage, William

    2013-08-01

    Emergency physicians can feel pressured by opposing forces of clinical reality and the need to publish successful key performance indicators in an environment of increasing demands and cost containment. This is particularly relevant to management of patients with undifferentiated chest pain and possible acute coronary syndrome. Unreliability of clinical assessment and high risk of adverse outcomes for all concerned exist, yet national guidelines are at odds with efforts to reduce ED crowding and access block. We report findings from the Nambour Short Low-Intermediate Chest pain risk trial, which safely introduced an accelerated diagnostic protocol with reduced ED length of stay and high patient acceptability. Over a 7-month period, there were no major adverse cardiac events by 30 days in 19% of undifferentiated chest pain presentations with possible acute coronary syndrome discharged after normal sensitive cardiac troponin taken 2 h after presentation and scheduled to return for outpatient exercise stress test. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  7. A Chromosome 7 Pericentric Inversion Defined at Single-Nucleotide Resolution Using Diagnostic Whole Genome Sequencing in a Patient with Hand-Foot-Genital Syndrome.

    PubMed

    Watson, Christopher M; Crinnion, Laura A; Harrison, Sally M; Lascelles, Carolina; Antanaviciute, Agne; Carr, Ian M; Bonthron, David T; Sheridan, Eamonn

    2016-01-01

    Next generation sequencing methodologies are facilitating the rapid characterisation of novel structural variants at nucleotide resolution. These approaches are particularly applicable to variants initially identified using alternative molecular methods. We report a child born with bilateral postaxial syndactyly of the feet and bilateral fifth finger clinodactyly. This was presumed to be an autosomal recessive syndrome, due to the family history of consanguinity. Karyotype analysis revealed a homozygous pericentric inversion of chromosome 7 (46,XX,inv(7)(p15q21)x2) which was confirmed to be heterozygous in both unaffected parents. Since the resolution of the karyotype was insufficient to identify any putatively causative gene, we undertook medium-coverage whole genome sequencing using paired-end reads, in order to elucidate the molecular breakpoints. In a two-step analysis, we first narrowed down the region by identifying discordant read-pairs, and then determined the precise molecular breakpoint by analysing the mapping locations of "soft-clipped" breakpoint-spanning reads. PCR and Sanger sequencing confirmed the identified breakpoints, both of which were located in intergenic regions. Significantly, the 7p15 breakpoint was located 523 kb upstream of HOXA13, the locus for hand-foot-genital syndrome. By inference from studies of HOXA locus control in the mouse, we suggest that the inversion has delocalised a HOXA13 enhancer to produce the phenotype observed in our patient. This study demonstrates how modern genetic diagnostic approach can characterise structural variants at nucleotide resolution and provide potential insights into functional regulation.

  8. Use of noninvasive genetics to assess nest and space use by white-tailed eagles

    USGS Publications Warehouse

    Bulut, Zafer; Bragin, Evgeny A.; DeWoody, J. Andrew; Braham, Melissa A.; Katzner, Todd E.; Doyle, Jacqueline M.

    2016-01-01

    Movement and space use are important components of animal interactions with the environment. However, for hard-to-monitor raptor species, there are substantial gaps in our understanding of these key determinants. We used noninvasive genetic tools to evaluate the details of space use over a 3-yr period by White-tailed Eagles (Haliaeetus albicilla) at the Naurzum Zapovednik in northern Kazakhstan. We genotyped, at 10 microsatellite markers and one mitochondrial marker, 859 eagle feathers and assigned naturally shed feathers to individuals. We identified 124 White-tailed Eagles, including both members of 5–10 pairs per year, and were able to monitor birds across years. Distances between eagle nests and hunting perches were always greater than nearest neighbor distances, eagles never used the closest available hunting perch, and hunting perches were always shared with other eagles. When eagles switched nests between years, the nests they chose were almost always well outside the space that theory predicted they defended the prior year. Our data are inconsistent with classical territorial and colonial models of resource use; they more closely resemble semi-colonial behavior. It is unlikely that standard methods of animal tracking (e.g., marking and telemetry), would have provided a similarly cost-effective mechanism to gain these insights into spatial and temporal aspects of eagle behavior. When combined with existing information on space use of other local species, these data suggest that partitioning of spatial resources among White-tailed Eagles and other eagles at the Zapovednik may be facilitated by the alternative strategies of space use they employ.

  9. Probability of Elevated Volatile Organic Compound (VOC) Concentrations in Groundwater in the Eagle River Watershed Valley-Fill Aquifer, Eagle County, North-Central Colorado, 2006-2007

    USGS Publications Warehouse

    Rupert, Michael G.; Plummer, Niel

    2009-01-01

    This raster data set delineates the predicted probability of elevated volatile organic compound (VOC) concentrations in groundwater in the Eagle River watershed valley-fill aquifer, Eagle County, North-Central Colorado, 2006-2007. This data set was developed by a cooperative project between the U.S. Geological Survey, Eagle County, the Eagle River Water and Sanitation District, the Town of Eagle, the Town of Gypsum, and the Upper Eagle Regional Water Authority. This project was designed to evaluate potential land-development effects on groundwater and surface-water resources so that informed land-use and water management decisions can be made. This groundwater probability map and its associated probability maps was developed as follows: (1) A point data set of wells with groundwater quality and groundwater age data was overlaid with thematic layers of anthropogenic (related to human activities) and hydrogeologic data by using a geographic information system to assign each well values for depth to groundwater, distance to major streams and canals, distance to gypsum beds, precipitation, soils, and well depth. These data then were downloaded to a statistical software package for analysis by logistic regression. (2) Statistical models predicting the probability of elevated nitrate concentrations, the probability of unmixed young water (using chlorofluorocarbon-11 concentrations and tritium activities), and the probability of elevated volatile organic compound concentrations were developed using logistic regression techniques. (3) The statistical models were entered into a GIS and the probability map was constructed.

  10. Probability of Elevated Nitrate Concentrations in Groundwater in the Eagle River Watershed Valley-Fill Aquifer, Eagle County, North-Central Colorado, 2006-2007

    USGS Publications Warehouse

    Rupert, Michael G.; Plummer, Niel

    2009-01-01

    This raster data set delineates the predicted probability of elevated nitrate concentrations in groundwater in the Eagle River watershed valley-fill aquifer, Eagle County, North-Central Colorado, 2006-2007. This data set was developed by a cooperative project between the U.S. Geological Survey, Eagle County, the Eagle River Water and Sanitation District, the Town of Eagle, the Town of Gypsum, and the Upper Eagle Regional Water Authority. This project was designed to evaluate potential land-development effects on groundwater and surface-water resources so that informed land-use and water management decisions can be made. This groundwater probability map and its associated probability maps was developed as follows: (1) A point data set of wells with groundwater quality and groundwater age data was overlaid with thematic layers of anthropogenic (related to human activities) and hydrogeologic data by using a geographic information system to assign each well values for depth to groundwater, distance to major streams and canals, distance to gypsum beds, precipitation, soils, and well depth. These data then were downloaded to a statistical software package for analysis by logistic regression. (2) Statistical models predicting the probability of elevated nitrate concentrations, the probability of unmixed young water (using chlorofluorocarbon-11 concentrations and tritium activities), and the probability of elevated volatile organic compound concentrations were developed using logistic regression techniques. (3) The statistical models were entered into a GIS and the probability map was constructed.

  11. The diagnostic value of finger systolic blood pressure and cold-provocation testing for the vascular component of hand-arm vibration syndrome in health surveillance.

    PubMed

    Poole, K; Elms, J; Mason, H J

    2004-12-01

    Hand-arm vibration syndrome (HAVS) is a complex condition with vascular, sensorineural and musculoskeletal components. A number of quantitative tests have been used for assisting in the diagnosis of HAVS and grading disease severity. To investigate and compare the diagnostic value of finger systolic blood pressure (FSBP) and rewarming of finger skin temperature (FST) following cold-provocation testing, in the assessment of vascular HAVS. Twenty-four individuals with vascular HAVS (Stockholm Workshop stage 2 or 3V) and 22 control subjects underwent FSBP measurements at 30, 15 and 10 degrees C and monitoring of FST following immersion of the hands in water at 15 degrees C for 5 min. There was a significant reduction in median FSBP% in the vascular HAVS group in the change in FSBP from 30 to 15 degrees C adjusted for brachial blood pressure (FSBPC%). There was no difference in the median time for FST to rewarm by 4 degrees C between HAVS cases and controls. The sensitivity and specificity of FSBP to discriminate between the groups varied between 44 and 61% and 91 and 95%, respectively. The sensitivity and specificity for the time for FST to rewarm by 4 degrees C were 71 and 77%. There is little evidence that the described form of finger rewarming after cold-provocation testing is a useful diagnostic test for vascular HAVS, although it may have some moderate influence in ruling out vascular problems. Based on our data, the FSBP may also have limited use in confirming a positive diagnosis of vibration-induced vascular problems. The higher specificity of the FSBP test suggests it may have some value in ruling out the vascular component of HAVS. The data from this study do not confirm the diagnostic power of FSBP for the vascular component of HAVS reported by a few other investigators.

  12. The combination of ovarian volume and outline has better diagnostic accuracy than prostate-specific antigen (PSA) concentrations in women with polycystic ovarian syndrome (PCOs).

    PubMed

    Bili, Eleni; Bili, Authors Eleni; Dampala, Kaliopi; Iakovou, Ioannis; Tsolakidis, Dimitrios; Giannakou, Anastasia; Tarlatzis, Basil C

    2014-08-01

    The aim of this study was to determine the performance of prostate specific antigen (PSA) and ultrasound parameters, such as ovarian volume and outline, in the diagnosis of polycystic ovary syndrome (PCOS). This prospective, observational, case-controlled study included 43 women with PCOS, and 40 controls. Between day 3 and 5 of the menstrual cycle, fasting serum samples were collected and transvaginal ultrasound was performed. The diagnostic performance of each parameter [total PSA (tPSA), total-to-free PSA ratio (tPSA:fPSA), ovarian volume, ovarian outline] was estimated by means of receiver operating characteristic (ROC) analysis, along with area under the curve (AUC), threshold, sensitivity, specificity as well as positive (+) and negative (-) likelihood ratios (LRs). Multivariate logistical regression models, using ovarian volume and ovarian outline, were constructed. The tPSA and tPSA:fPSA ratio resulted in AUC of 0.74 and 0.70, respectively, with moderate specificity/sensitivity and insufficient LR+/- values. In the multivariate logistic regression model, the combination of ovarian volume and outline had a sensitivity of 97.7% and a specificity of 97.5% in the diagnosis of PCOS, with +LR and -LR values of 39.1 and 0.02, respectively. In women with PCOS, tPSA and tPSA:fPSA ratio have similar diagnostic performance. The use of a multivariate logistic regression model, incorporating ovarian volume and outline, offers very good diagnostic accuracy in distinguishing women with PCOS patients from controls. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. Validity of the ATP III diagnostic criteria for the metabolic syndrome in an elderly Italian Caucasian population: the Italian Longitudinal Study on Aging.

    PubMed

    Maggi, Stefania; Noale, Marianna; Zambon, Alberto; Limongi, Federica; Romanato, Giovanna; Crepaldi, Gaetano

    2008-04-01

    The metabolic syndrome (MetS) is represented by the co-occurrence of multiple metabolic and physiologic risk factors for both type 2 diabetes mellitus and atherosclerotic cardiovascular diseases. In spite of its high frequency and association with morbidity and mortality in the adult population, very little is known about its magnitude in the elderly and about the validity of the diagnostic criteria commonly used. The objective of this paper is to assess the prevalence rate of MetS and the validity of the Adult Treatment Panel III (ATP III) diagnostic criteria in an elderly Caucasian cohort, considering data from the Italian Longitudinal Study on Aging (ILSA), a population-based study with a sample of 5632 individuals aged 65-84 years at baseline (1992). Logistic regression models and ROC curve were used to test the validity of the cut off levels proposed. The prevalence of MetS was 31.5% in men, and 59.8% in women. The cut off levels suggested for both men and women by the ATP III panel indicated a significant association with the MetS for all components. Actually, the ROC analysis would suggest lower levels for glycaemia (106 mg/dl) in men, and higher levels for blood pressure in both men and women (145/95 and 135/90, respectively). Concluding, MetS is very common in the aged Caucasians and the diagnostic criteria proposed by the ATP III panel seem to be appropriate in older individuals. Small adjustments in the cut off levels could be suggested for glycaemia (men) and in blood pressure (men and women).

  14. Diagnostic value of a heart-type fatty acid-binding protein (H-FABP) bedside test in suspected acute coronary syndrome in primary care.

    PubMed

    Bruins Slot, M H E; Rutten, F H; van der Heijden, G J M G; Doevendans, P A; Mast, E G; Bredero, A C; van der Spoel, O P; Glatz, J F C; Hoes, A W

    2013-09-30

    To determine the diagnostic accuracy of a rapid heart-type fatty acid-binding protein (H-FABP) test in patients suspected of acute coronary syndrome (ACS) in primary care. General practitioners included 298 patients suspected of ACS. In all patients, whether referred to hospital or not, ECG and cardiac biomarker testing was performed. ACS was determined in accordance with international guidelines. Multivariate analysis was used to determine the value of H-FABP in addition to clinical findings. Mean patient age was 66 years (SD 14), 52% was female and 66 patients (22%) were diagnosed with ACS. The H-FABP bedside test was performed within 24h (median 3.1, IQR 1.5 to 7.1) after symptom onset. The positive predictive value (PPV) of H-FABP was 65% (95% confidence interval (CI) 50-78). The negative predictive value (NPV) was 85% (95% CI 80-88). Sensitivity was 39% (29-51%) and specificity 94% (90-96%). Within 6h after symptom onset, the PPV was 72% (55-84) and the NPV was 83% (77-88), sensitivity 43% (31-57%) and specificity 94% (89-97%). Adding the H-FABP test to a diagnostic model for ACS led to an increase in the area under the receiver operating curve from 0.66 (95% CI 0.58-0.73) to 0.75 (95% CI 0.68-0.82). The H-FABP rapid test provides modest additional diagnostic certainty in primary care. It cannot be used to safely exclude rule out ACS. The test can only be used safely in patients otherwise NOT referred to hospital by the GP, as an extra precaution not to miss ACS ('rule in'). Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Harpy eagle (Harpia harpyja) nesting in manipulated forests

    USGS Publications Warehouse

    Alvarez, E.; Ellis, D.H.

    1994-01-01

    Continental records point to shooting, removal of young and destruction of nests as the primary conservation problems for harpy eagles (Harpia harpyja); bird-observer visits are a new source of concern. Nesting events are roughly 3 yr apart. Nests are used during and after intensive manipulation of the surrounding habitat, and minimum distance between active sites was 3-5 km. In nine nesting sites along a 100-km stretch of the Imalaca Mountains in Venezuela, we fitted five fledglings with satellite-tracked tags from NASA. One of these birds was hacked with the help of the loggers who destroyed its nest. All these nests were active while logging ensued. Out of three renesting attempts, one failed when the nest collapsed. We salvaged two additional fledglings found in captivity. We are monitoring five nests in the buffer area of the Darien National Park in Panama, all within 3 km of human settlements where trees are regularly felled for firewood, lumber, and to clear more cropland. Eagles have been killed at two sites, a third site remains inactive since 1991, and the other two nests currently have fledglings.

  16. On the galaxy–halo connection in the EAGLE simulation

    DOE PAGES

    Desmond, Harry; Mao, Yao -Yuan; Wechsler, Risa H.; ...

    2017-06-13

    Empirical models of galaxy formation require assumptions about the correlations between galaxy and halo properties. These may be calibrated against observations or inferred from physical models such as hydrodynamical simulations. In this Letter, we use the EAGLE simulation to investigate the correlation of galaxy size with halo properties. We motivate this analysis by noting that the common assumption of angular momentum partition between baryons and dark matter in rotationally supported galaxies overpredicts both the spread in the stellar mass–size relation and the anticorrelation of size and velocity residuals, indicating a problem with the galaxy–halo connection it implies. We find themore » EAGLE galaxy population to perform significantly better on both statistics, and trace this success to the weakness of the correlations of galaxy size with halo mass, concentration and spin at fixed stellar mass. Here by, using these correlations in empirical models will enable fine-grained aspects of galaxy scalings to be matched.« less

  17. On the galaxy–halo connection in the EAGLE simulation

    SciTech Connect

    Desmond, Harry; Mao, Yao -Yuan; Wechsler, Risa H.

    Empirical models of galaxy formation require assumptions about the correlations between galaxy and halo properties. These may be calibrated against observations or inferred from physical models such as hydrodynamical simulations. In this Letter, we use the EAGLE simulation to investigate the correlation of galaxy size with halo properties. We motivate this analysis by noting that the common assumption of angular momentum partition between baryons and dark matter in rotationally supported galaxies overpredicts both the spread in the stellar mass–size relation and the anticorrelation of size and velocity residuals, indicating a problem with the galaxy–halo connection it implies. We find themore » EAGLE galaxy population to perform significantly better on both statistics, and trace this success to the weakness of the correlations of galaxy size with halo mass, concentration and spin at fixed stellar mass. Here by, using these correlations in empirical models will enable fine-grained aspects of galaxy scalings to be matched.« less

  18. Heart fatty acid binding protein (H-FABP) as a diagnostic biomarker in patients with acute coronary syndrome.

    PubMed

    Gururajan, Priya; Gurumurthy, Prema; Nayar, Pradeep; Srinivasa Nageswara Rao, G; Babu, Sai; Cherian, K M

    2010-11-01

    Diagnosis of myocardial ischaemia at an early stage in the emergency department is often difficult. A recently proposed biomarker, heart fatty acid binding protein (H-FABP) has been found to appear in the circulation superior to that of cardiac troponins in the early hours of acute coronary syndrome. We proposed to evaluate the levels of H-FABP and ascertain its utility as an early biomarker for acute coronary syndrome (ACS). The present study was carried out in 485 subjects, of whom 297 were diagnosed as patients with ACS, 89 were diagnosed as non-cardiac chest pain (NCCP) and 99 people served as healthy controls. H-FABP levels were measured in comparison with standard markers such as troponin I and CK-MB in all subjects enrolled in the study. The levels of H-FABP were significantly raised in patients when compared to controls and NCCP (P<0.001). Receiver Operator Characteristic Curve (ROC) analysis showed H-FABP to be a good discriminator between patients with ischaemic heart disease and patients without ischaemic heart disease. The area under the curve was found to be 0.965 with 95% CI (0.945-0.979). The cut-off value above which H-FABP can be considered positive was found to be 17.7ng/ml. H-FABP is a promising biomarker for the early detection of patients with acute coronary syndrome. Copyright © 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier B.V. All rights reserved.

  19. The diagnostic impact of testicular biopsies for intratubular germ cell neoplasia in cryptorchid boys and the subsequent risk of testicular cancer in men with prepubertal surgery for syndromic or non-syndromic cryptorchidism.

    PubMed

    Osterballe, Lene; Clasen-Linde, Erik; Cortes, Dina; Engholm, Gerda; Hertzum-Larsen, Rasmus; Reinhardt, Susanne; Thorup, Jorgen

    2017-04-01

    Cryptorchidism is a risk factor for testicular cancer in adult life. It remains unclear how prepubertal surgery for cryptorchidism impacts later development of adult testicular cancer. The aim of study was to investigate tools to identify the cryptorchid boys who later develop testicular cancer. The study cohort consisted of 1403 men operated prepubertally/pubertally for undescended testis between 1971 and 2003. At surgery testicular biopsies were taken from the cryptorchid testes. The boys were followed for occurrence of testicular cancer. The testicular cancer risk was compared to the risk in the Danish Population. Testicular biopsies from the boys who developed testicular cancer during follow-up underwent histological examination with specific diagnostic immunohistochemical markers for germ cell neoplasia. The cohort was followed for 33,627 person years at risk. We identified 16 cases with testicular cancer in adulthood. The standardized incidence ratio was 2.66 (95% CI: 1.52-4.32). At time of primary surgery in prepubertal/pubertal age Intratubular Germ Cell Neoplasia (ITGCN) was diagnosed in 5 cases and the boys were unilaterally orchiectomized. At follow-up new immunohistochemical staining indicated ITGCN in two of the 16 cancer cases at reevaluation of the original biopsies from time of prepubertal/pubertal surgery. One had syndromic cryptorchid and developed seminoma, and another showed nonsyndromic cryptorchidism and developed embryonic teratocarcinoma. Totally, ITGCN was diagnosed in 0.5% (7/1403) of prepubertal cryptorchid boys, whereof 57% (4/7) in syndromic-cryptorchidism. ITGCN is predominantly observed prepubertally in boys with syndromic-cryptorchidism. In nonsyndromic cryptorchidism testicular cancer develops postpubertally, generally not based on dormant germ cells of ITGCN caused by an early fetal maldevelopment. LEVEL I. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome.

    PubMed

    Montenigro, Philip H; Baugh, Christine M; Daneshvar, Daniel H; Mez, Jesse; Budson, Andrew E; Au, Rhoda; Katz, Douglas I; Cantu, Robert C; Stern, Robert A

    2014-01-01

    The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms such as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by boxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s and has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American football players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma, including concussions and subconcussive trauma. This article reviews the literature of the clinical manifestations of CTE from 202 published cases. The clinical features include impairments in mood (for example, depression and hopelessness), behavior (for example, explosivity and violence), cognition (for example, impaired memory, executive functioning, attention, and dementia), and, less commonly, motor functioning (for example, parkinsonism, ataxia, and dysarthria). We present proposed research criteria for traumatic encephalopathy syndrome (TES) which consist of four variants or subtypes (TES behavioral/mood variant, TES cognitive variant, TES mixed variant, and TES dementia) as well as classifications of 'probable CTE' and 'possible CTE'. These proposed criteria are expected to be modified and updated as new research findings become available. They are not meant to be used for a clinical diagnosis. Rather, they should be viewed as research criteria that can be employed in studies of the underlying causes, risk factors, differential diagnosis, prevention, and treatment of CTE and related disorders.

  1. Landscapes for Energy and Wildlife: Conservation Prioritization for Golden Eagles across Large Spatial Scales

    PubMed Central

    Tack, Jason D.; Fedy, Bradley C.

    2015-01-01

    Proactive conservation planning for species requires the identification of important spatial attributes across ecologically relevant scales in a model-based framework. However, it is often difficult to develop predictive models, as the explanatory data required for model development across regional management scales is rarely available. Golden eagles are a large-ranging predator of conservation concern in the United States that may be negatively affected by wind energy development. Thus, identifying landscapes least likely to pose conflict between eagles and wind development via shared space prior to development will be critical for conserving populations in the face of imposing development. We used publically available data on golden eagle nests to generate predictive models of golden eagle nesting sites in Wyoming, USA, using a suite of environmental and anthropogenic variables. By overlaying predictive models of golden eagle nesting habitat with wind energy resource maps, we highlight areas of potential conflict among eagle nesting habitat and wind development. However, our results suggest that wind potential and the relative probability of golden eagle nesting are not necessarily spatially correlated. Indeed, the majority of our sample frame includes areas with disparate predictions between suitable nesting habitat and potential for developing wind energy resources. Map predictions cannot replace on-the-ground monitoring for potential risk of wind turbines on wildlife populations, though they provide industry and managers a useful framework to first assess potential development. PMID:26262876

  2. Landscapes for energy and wildlife: conservation prioritization for golden eagles across large spatial scales

    USGS Publications Warehouse

    Tack, Jason D.; Fedy, Bradley C.

    2015-01-01

    Proactive conservation planning for species requires the identification of important spatial attributes across ecologically relevant scales in a model-based framework. However, it is often difficult to develop predictive models, as the explanatory data required for model development across regional management scales is rarely available. Golden eagles are a large-ranging predator of conservation concern in the United States that may be negatively affected by wind energy development. Thus, identifying landscapes least likely to pose conflict between eagles and wind development via shared space prior to development will be critical for conserving populations in the face of imposing development. We used publically available data on golden eagle nests to generate predictive models of golden eagle nesting sites in Wyoming, USA, using a suite of environmental and anthropogenic variables. By overlaying predictive models of golden eagle nesting habitat with wind energy resource maps, we highlight areas of potential conflict among eagle nesting habitat and wind development. However, our results suggest that wind potential and the relative probability of golden eagle nesting are not necessarily spatially correlated. Indeed, the majority of our sample frame includes areas with disparate predictions between suitable nesting habitat and potential for developing wind energy resources. Map predictions cannot replace on-the-ground monitoring for potential risk of wind turbines on wildlife populations, though they provide industry and managers a useful framework to first assess potential development.

  3. Landscapes for Energy and Wildlife: Conservation Prioritization for Golden Eagles across Large Spatial Scales.

    PubMed

    Tack, Jason D; Fedy, Bradley C

    2015-01-01

    Proactive conservation planning for species requires the identification of important spatial attributes across ecologically relevant scales in a model-based framework. However, it is often difficult to develop predictive models, as the explanatory data required for model development across regional management scales is rarely available. Golden eagles are a large-ranging predator of conservation concern in the United States that may be negatively affected by wind energy development. Thus, identifying landscapes least likely to pose conflict between eagles and wind development via shared space prior to development will be critical for conserving populations in the face of imposing development. We used publically available data on golden eagle nests to generate predictive models of golden eagle nesting sites in Wyoming, USA, using a suite of environmental and anthropogenic variables. By overlaying predictive models of golden eagle nesting habitat with wind energy resource maps, we highlight areas of potential conflict among eagle nesting habitat and wind development. However, our results suggest that wind potential and the relative probability of golden eagle nesting are not necessarily spatially correlated. Indeed, the majority of our sample frame includes areas with disparate predictions between suitable nesting habitat and potential for developing wind energy resources. Map predictions cannot replace on-the-ground monitoring for potential risk of wind turbines on wildlife populations, though they provide industry and managers a useful framework to first assess potential development.

  4. Lead and eagles: demographic and pathological characteristics of poisoning, and exposure levels associated with other causes of mortality

    USGS Publications Warehouse

    Franson, J. Christian; Russell, Robin E.

    2014-01-01

    We conducted a retrospective analysis to evaluate demographic and pathologic characteristics in 484 bald eagles (Haliaeetus leucocephalus) and 68 golden eagles (Aquila chrysaetos) diagnosed with lead poisoning at the U.S. Geological Survey National Wildlife Health Center. As part of our analysis, we compared characteristics of lead poisoned eagles with those that died of other causes. Odds of lead poisoning were greater for bald eagles versus golden eagles, females versus males, adults versus juveniles, and eagles from the Mississippi and Central flyways versus the Atlantic and Pacific flyways. In addition to spatial, species, and demographic associations, we detected a distinct temporal trend in the collection date of lead poisoned bald eagle carcasses. These carcasses were found at greater frequency in late autumn and winter than spring and summer. Lesions in lead poisoned birds included emaciation, evidence of bile stasis, myocardial degeneration and necrosis, and renal tubular nephrosis and necrosis. Ingested lead ammunition or fragments were found in 14.2 % of bald eagles and 11.8 % of golden eagles. The overall mean liver lead concentration (wet weight basis) for eagles diagnosed with lead poisoning was 28.9 ± 0.69 SE mg/kg in bald eagles and 19.4 ± 1.84 SE mg/kg in golden eagles. In eagles diagnosed with collision trauma, electrocution, poisoning (other than lead), emaciation, infectious disease, trapping death, other, and undetermined causes, average liver lead concentrations were low (<1 mg/kg) and did not differ among causes of mortality. Thus, based on our data, we found no evidence that lead exposure of eagles predisposed them to other causes of mortality.

  5. Golden Eagle Monitoring Plan for the Desert Renewable Energy Conservation Plan

    USGS Publications Warehouse

    Wiens, David; Kolar, Patrick; Katzner, Todd

    2018-01-01

    This report describes options for monitoring the status and population trends of the golden eagle (Aquila chrysaetos) within the Desert Renewable Energy Conservation Plan (DRECP) area of Southern California in maintaining stable or increasing population in the planning area. The report profiles the ecology of golden eagles in the region and provides a range of potential sampling options to address monitoring needs and objectives. This approach also focused on links between changes in human land-use, golden eagle nesting and foraging habitat conditions, and population dynamics. The report outlines how monitoring data from demographic, prey, and habitat studies were used to develop a predictive demographic model for golden eagles in the DRECP area. Results from the model simulations suggest increases in renewable energy development could have negative consequences for population trajectories. Results also suggest site-specific conservation actions could reduce the magnitude of negative impacts to the local population of eagles. A monitoring framework is proposed including: (1) annual assessments of site-occupancy and reproduction by territorial pairs of golden eagles (including rates at which sites become colonized or vacated over time); (2) estimates of survival, movements, and intensity of use of landscapes by breeding and non-breeding golden eagles; (3) periodic (conducted every two to four years) assessments of nesting and foraging habitats, prey populations, and associations with land-use and management activities; and (4) updating the predictive demographic model with new information obtained on eagles and associated population stressors. The results of this research were published in the Journal of Rapture Research, Wiens, David,Inman, Rich D., Esque, Todd C., Longshore, Kathleen M. and Nussear, Kenneth (2017). Spatial Demographic Models to Inform Conservation Planning of Golden Eagles in Renewable Energy Landscapes. 51(3):234-257.

  6. Does the order of invasive species removal matter? The case of the eagle and the pig.

    PubMed

    Collins, Paul W; Latta, Brian C; Roemer, Gary W

    2009-09-14

    Invasive species are recognized as a primary driver of native species endangerment and their removal is often a key component of a conservation strategy. Removing invasive species is not always a straightforward task, however, especially when they interact with other species in complex ways to negatively influence native species. Because unintended consequences may arise if all invasive species cannot be removed simultaneously, the order of their removal is of paramount importance to ecological restoration. In the mid-1990s, three subspecies of the island fox Urocyon littoralis were driven to near extinction on the northern California Channel Islands owing to heightened predation by golden eagles Aquila chrysaetos. Eagles were lured to the islands by an abundant supply of feral pigs Sus scrofa and through the process of apparent competition pigs indirectly facilitated the decline in foxes. As a consequence, both pigs and eagles had to be removed to recover the critically endangered fox. Complete removal of pigs was problematic: removing pigs first could force eagles to concentrate on the remaining foxes, increasing their probability of extinction. Removing eagles first was difficult: eagles are not easily captured and lethal removal was politically distasteful. Using prey remains collected from eagle nests both before and after the eradication of pigs, we show that one pair of eagles that eluded capture did indeed focus more on foxes. These results support the premise that if the threat of eagle predation had not been mitigated prior to pig removal, fox extinction would have been a more likely outcome. If complete eradication of all interacting invasive species is not possible, the order in which they are removed requires careful consideration. If overlooked, unexpected consequences may result that could impede restoration.

  7. A pilot golden eagle population study in the Altamont Pass Wind Resource Area, California

    SciTech Connect

    Hunt, G.

    1995-05-01

    Orloff and Flannery (1992) estimated that several hundred reports are annually killed by turbine collisions, wire strikes, and electrocutions at the Altamont Pass Wind Resource Area (WRA). The most common fatalities were those of red-tailed hawks (Buteo jamaicensis), American kestrels (Falco sparvatius), and golden eagles (Aquila chrysaetos), with lesser numbers of turkey vultures (Cathartes aura), common ravens (Corvus corax), bam owls (Tyto alba), and others. Among the species of raptors killed at Altamont Pass, the one whose local population is most likely to be impacted is the golden eagle. Besides its being less abundant than the others, the breeding andmore » recruitment rates of golden eagles are naturally slow, increasing their susceptibility to decline as a result of mortality influences. The golden eagle is a species afforded special federal protection because of its inclusion within the Bald Eagle Protection Act as amended in 1963. There are no provisions within the Act which would allow the killing ``taking`` of golden eagles by WRA structures. This report details the results of field studies conducted during 19941. The primary purpose of the investigation is to lay the groundwork for determining whether or not turbine strikes and other hazards related to energy at Altamont Pass may be expected to affect golden eagles on a population basis. We also seek an understanding of the physical and biotic circumstances which attract golden eagles to the WRA within the context of the surrounding landscape and the conditions under which they are killed by wind turbines. Such knowledge may suggest turbine-related or habitat modifications that would result in a lower incidence of eagle mortality.« less

  8. Features of childhood Sjögren's syndrome in comparison to adult Sjögren's syndrome: considerations in establishing child-specific diagnostic criteria.

    PubMed

    Yokogawa, Naoto; Lieberman, Scott M; Sherry, David D; Vivino, Frederick B

    2016-01-01

    To describe the clinical features of childhood Sjögren's syndrome (SS) in comparison to adult SS and to evaluate possible child-specific modifications to existing adult criteria for use in diagnosing childhood SS. We retrospectively identified children (age <18 years) with SS and compared the clinical, laboratory, and histopathological features of these children based on presence or absence of parotitis. We compared these features to adults with SS and evaluated the applicability of existing classification criteria in diagnosing childhood SS. Child-specific modifications to existing criteria were evaluated. Twenty-six children were included in our childhood SS group. Sixteen children had parotitis at or before presentation. Absence of parotitis was associated with greater degree of organ damage based on SS disease damage index. Compared to 413 adult SS patients, childhood SS was more commonly associated with parotitis, positive serologies, neurologic and nephrologic manifestations, and non-specific features (fever, lymphadenopathy) but less commonly associated with dry mouth and dry eyes. Only a minority of these children met previously established criteria for adult SS. Inclusion of child-specific features such as parotitis and the presence of any focal lymphocytic sialadenitis on minor salivary gland biopsy increased the proportion of children meeting these criteria. Childhood SS features may be different than adult SS features necessitating child-specific criteria for better diagnosis of childhood SS, a key step towards better understanding the features, prognosis, and outcomes in this disease.

  9. Organochlorine residues and autopsy data from bald eagles 1966-68

    USGS Publications Warehouse

    Mulhern, B.M.; Reichel, W.L.; Locke, L.N.; Lamont, T.G.; Belisle, A.A.; Cromartie, E.; Bagley, George E.; Prouty, R.M.

    1970-01-01

    Sixty-nine bald eagles found moribund or dead in 25 States during 1966-68 were analyzed for pesticide residues. Residues of polychlorinated biphenyls and DDE were detected in all samples of eagle carcasses; residues of dieldrin were detected in 68 and residues of DDD in 64; DDT, heptachlor epoxide, and DCBP were detected less frequently. Eight specimens had levels of dieldrin in the brain within the lethal range, and another probably died of DDT poisoning. Autopsy revealed that illegal shooting was the most frequent cause of mortality of these eagles; electrocution, impact injuries, probable lead poisoning, and infectious avian diseases were other causes of mortality.

  10. Reduction of Genetic Diversity of the Harpy Eagle in Brazilian Tropical Forests.

    PubMed

    Banhos, Aureo; Hrbek, Tomas; Sanaiotti, Tânia M; Farias, Izeni Pires

    2016-01-01

    Habitat loss and fragmentation intensify the effects of genetic drift and endogamy, reducing genetic variability of populations with serious consequences for wildlife conservation. The Harpy Eagle (Harpia harpyja) is a forest dwelling species that is considered near threatened and suffers from habitat loss in the forests of the Neotropical region. In this study, 72 historical and current samples were assessed using eight autosomal microsatellite markers to investigate the distribution of genetic diversity of the Harpy Eagle of the Amazonian and Atlantic forests in Brazil. The results showed that the genetic diversity of Harpy Eagle decreased in the regions where deforestation is intense in the southern Amazon and Atlantic Forest.

  11. Caribou antlers as nest materials for golden eagles in northwestern Alaska

    USGS Publications Warehouse

    Ellis, D.H.; Bunn, R.L.

    1998-01-01

    There are few published records of antlers in golden eagle (Aquila chrysaetos) nests. This note reports extensive use of caribou (Rangifer tarandus) antlers in three golden eagle nests in the Cape Kruzenstern region of northwestern Alaska. The importance of antlers to this population of eagles can be explained at least in part by (1) the lack of suitable woody vegetation on the open tundra, (2) the similarity of antlers to sticks, and (3) the abundance of antlers, especially cow caribou antlers, in the region.

  12. Reduction of Genetic Diversity of the Harpy Eagle in Brazilian Tropical Forests

    PubMed Central

    2016-01-01

    Habitat loss and fragmentation intensify the effects of genetic drift and endogamy, reducing genetic variability of populations with serious consequences for wildlife conservation. The Harpy Eagle (Harpia harpyja) is a forest dwelling species that is considered near threatened and suffers from habitat loss in the forests of the Neotropical region. In this study, 72 historical and current samples were assessed using eight autosomal microsatellite markers to investigate the distribution of genetic diversity of the Harpy Eagle of the Amazonian and Atlantic forests in Brazil. The results showed that the genetic diversity of Harpy Eagle decreased in the regions where deforestation is intense in the southern Amazon and Atlantic Forest. PMID:26871719

  13. Geologic map of the Vail West quadrangle, Eagle County, Colorado

    USGS Publications Warehouse

    Scott, Robert B.; Lidke, David J.; Grunwald, Daniel J.

    2002-01-01

    This new 1:24,000-scale geologic map of the Vail West 7.5' quadrangle, as part of the USGS Western Colorado I-70 Corridor Cooperative Geologic Mapping Project, provides new interpretations of the stratigraphy, structure, and geologic hazards in the area on the southwest flank of the Gore Range. Bedrock strata include Miocene tuffaceous sedimentary rocks, Mesozoic and upper Paleozoic sedimentary rocks, and undivided Early(?) Proterozoic metasedimentary and igneous rocks. Tuffaceous rocks are found in fault-tilted blocks. Only small outliers of the Dakota Sandstone, Morrison Formation, Entrada Sandstone, and Chinle Formation exist above the redbeds of the Permian-Pennsylvanian Maroon Formation and Pennsylvanian Minturn Formation, which were derived during erosion of the Ancestral Front Range east of the Gore fault zone. In the southwestern area of the map, the proximal Minturn facies change to distal Eagle Valley Formation and the Eagle Valley Evaporite basin facies. The Jacque Mountain Limestone Member, previously defined as the top of the Minturn Formation, cannot be traced to the facies change to the southwest. Abundant surficial deposits include Pinedale and Bull Lake Tills, periglacial deposits, earth-flow deposits, common diamicton deposits, common Quaternary landslide deposits, and an extensive, possibly late Pliocene landslide deposit. Landscaping has so extensively modified the land surface in the town of Vail that a modified land-surface unit was created to represent the surface unit. Laramide movement renewed activity along the Gore fault zone, producing a series of northwest-trending open anticlines and synclines in Paleozoic and Mesozoic strata, parallel to the trend of the fault zone. Tertiary down-to-the-northeast normal faults are evident and are parallel to similar faults in both the Gore Range and the Blue River valley to the northeast; presumably these are related to extensional deformation that occurred during formation of the northern end of the

  14. Is the Eagle Nebula powered by a hidden supernova remnant ?

    NASA Astrophysics Data System (ADS)

    Boulanger, Francois

    2008-10-01

    Spitzer observations of the Eagle nebula (M16) reveal the presence of a large (8 pc diameter) shell of dust heated to anomalously high temperatures. Modeling of dust excitation shows that the shell emission cannot be powered by the cluster UV radiation but that it can be accounted for by collisionally heated dust in a young (a few 1000 yrs) supernova remnant. We have re-analyzed deep Chandra observations that show diffuse emission consistent with this hypothesis, but also with galactic ridge emission. We propose a 50 ksec XMM observation to probe the spatial extent of the diffuse X-ray emission beyond the Spitzer shell. Absence of emission outside of this shell will strongly support the supernova remnant interpretation

  15. Near-Infrared Polarimetry of the Eagle Nebula (M 16)

    NASA Astrophysics Data System (ADS)

    Sugitani, Koji; Watanabe, Makoto; Tamura, Motohide; Kandori, Ryo; Hough, James H.; Nishiyama, Shogo; Nakajima, Yasushi; Kusakabe, Nobuhiko; Hashimoto, Jun; Nagayama, Takahiro; Nagashima, Chie; Kato, Daisuke; Fukuda, Naoya

    2007-06-01

    We carried out deep and wide (˜ 8 × 8) JHKs imaging polarimetry in the southern region of the Eagle Nebula (M 16). The polarization intensity map reveals that two YSOs with near-IR reflection nebulae are located at the tips of two famous molecular pillars (Pillars 1 and 2) facing toward the exciting stars of M 16. The centrosymmetric polarization pattern are consistent with those around Class I objects having circumstellar envelopes, confirming that star formation is now taking place at the two tips of the pillars under the influence of UV radiation from the exciting stars. Polarization measurements of point sources show that magnetic fields are aligned along some of the pillars, but in a direction that is quite different to the global structure in M 16.

  16. Cortisol production rates in subjects with suspected Cushing's syndrome: assessment by stable isotope dilution methodology and comparison to other diagnostic methods.

    PubMed

    Samuels, M H; Brandon, D D; Isabelle, L M; Cook, D M; Graham, K E; Purnell, J Q; Loriaux, D L

    2000-01-01

    It can be difficult to establish the diagnosis of Cushing's Syndrome (CS) in patients with mild or nonspecific clinical and biochemical findings, because available diagnostic tests have limited predictive values. We hypothesized that measurement of 24-h cortisol production rates (CPRs) might be a more sensitive indicator of CS in such patients. We measured CPRs in 28 patients with suspected CS (but equivocal biochemical findings) and in 22 healthy control subjects, by infusing tracer amounts of deuterated cortisol, with simultaneous measurements of 24-h urine free cortisol (UFC) levels; and we frequently sampled serum cortisol levels. CPRs were calculated from the ratio of isotopic enrichment to isotopic dilution of cortisol measured by gas chromatography-negative ion chemical ionization mass spectrometry. Nine of the patients proved to have CS by surgery (CS-Yes), whereas 19 patients were determined not to have CS by biochemical testing (CS-No). Mean 24-h UFCs, nocturnal serum cortisol levels, and CPRs were higher in CS-Yes, compared with CS-No and normal subjects. However, one CS-Yes patient had a normal 24-h UFC, two had normal nocturnal serum cortisol levels, and two had normal 24-h CPRs. There was extensive overlap in all of the biochemical parameters between the CS-Yes and the CS-No groups. Thus, measurement of CPR does not seem to offer any diagnostic advantage over available tests for the diagnosis of CS. Patients with proven CS can have normal UFC levels, normal CPRs, or normal nocturnal cortisol levels, whereas patients not thought to have CS may have elevated levels of any one or more these parameters.

  17. The Eagle Nebula: a spectral template for star forming regions

    NASA Astrophysics Data System (ADS)

    Flagey, Nicolas; Boulanger, Francois; Carey, Sean; Compiegne, Mathieu; Dwek, Eli; Habart, Emilie; Indebetouw, Remy; Montmerle, Thierry; Noriega-Crespo, Alberto

    2008-03-01

    IRAC and MIPS have revealed spectacular images of massive star forming regions in the Galaxy. These vivid illustrations of the interaction between the stars, through their winds and radiation, and their environment, made of gas and dust, still needs to be explained. The large scale picture of layered shells of gas components, is affected by the small scale interaction of stars with the clumpy medium that surrounds them. To understand spatial variations of physical conditions and dust properties on small scales, spectroscopic imaging observations are required on a nearby object. The iconic Eagle Nebula (M16) is one of the nearest and most observed star forming region of our Galaxy and as such, is a well suited template to obtain this missing data set. We thus propose a complete spectral map of the Eagle Nebula (M16) with the IRS/Long Low module (15-38 microns) and MIPS/SED mode (55-95 microns). Analysis of the dust emission, spectral features and continuum, and of the H2 and fine-structure gas lines within our models will provide us with constraints on the physical conditions (gas ionization state, pressure, radiation field) and dust properties (temperature, size distribution) at each position within the nebula. Only such a spatially and spectrally complete map will allow us to characterize small scale structure and dust evolution within the global context and understand the impact of small scale structure on the evolution of dusty star forming regions. This project takes advantage of the unique ability of IRS at obtaining sensitive spectral maps covering large areas.

  18. Source apportionment of hydrocarbons measured in the Eagle Ford shale

    NASA Astrophysics Data System (ADS)

    Roest, G. S.; Schade, G. W.

    2016-12-01

    The rapid development of unconventional oil and gas in the US has led to hydrocarbon emissions that are yet to be accurately quantified. Emissions from the Eagle Ford Shale in southern Texas, one of the most productive shale plays in the U.S., have received little attention due to a sparse air quality monitoring network, thereby limiting studies of air quality within the region. We use hourly atmospheric hydrocarbon and meteorological data from three locations in the Eagle Ford Shale to assess their sources. Data are available from the Texas commission of environmental quality (TCEQ) air quality monitors in Floresville, a small town southeast of San Antonio and just north of the shale area; and Karnes city, a midsize rural city in the center of the shale. Our own measurements were carried out at a private ranch in rural Dimmit County in southern Texas from April to November of 2015. Air quality monitor data from the TCEQ were selected for the same time period. Non-negative matrix factorization in R (package NMF) was used to determine likely sources and their contributions above background. While the TCEQ monitor data consisted mostly of hydrocarbons, our own data include both CO, CO2, O3, and NOx. We find that rural Dimmit County hydrocarbons are dominated by oil and gas development sources, while central shale hydrocarbons at the TCEQ monitoring sites have a mix of sources including car traffic. However, oil and gas sources also dominate hydrocarbons at Floresville and Karnes City. Toxic benzene is nearly exclusively due to oil and gas development sources, including flaring, which NMF identifies as a major hydrocarbon source in Karnes City. Other major sources include emissions of light weight alkanes (C2-C5) from raw natural gas emissions and a larger set of alkanes (C2-C10) from oil sources, including liquid storage tanks.

  19. Thinking about feathers: Adaptations of Golden Eagle rectrices

    USGS Publications Warehouse

    Ellis, D.H.; Lish, J.W.

    2006-01-01

    The striking black and white plumage of the juvenile Golden Eagle (Aquila chrysaetos) provides an excellent opportunity to examine the possible selective forces influencing the strategic placement of dark pigment in birds. The conflict between opposing selective pressures (first, toward large white patches, which may allay aggression in adults, and second, toward dark plumage to promote camouflage and limit solar and abrasive wear) provides the stage whereon are revealed a score of pigmentation traits of potential adaptive value. The general pigmentation trend is for zones that are more exposed to the sun to be darker than elsewhere. More specifically: (1) for rectrices and remiges, outer webs are darker than inner; (2) for those few feathers (e.g., central rectrices, some scapulars, and some tertials), where both inner and outer webs are heavily and nearly equally solar exposed, pigmentation is supplied similarly on both webs; (3) outermost primaries and rectrices are darkest of all and are structurally similar; (4) for central rectrices, subject to high levels of abrasion with substrate, the tip is paler (resultant flexibility may limit breakage); and (5) pigment is heavier along or on the rachis than on the webs. Many of the traits listed above for the Golden Eagle are also found in other families of birds. Traits of the tail common to many species were a terminal pale tip, a subterminal dark band, rachis darker than vane, and outer webs darker than inner for both remiges and rectrices. The most widespread traits likely have adaptive value. ?? 2006 The Raptor Research Foundation, Inc.

  20. Intratumoral peripheral small papillary tufts: a diagnostic clue of renal tumors associated with Birt-Hogg-Dubé syndrome.

    PubMed

    Kuroda, Naoto; Furuya, Mitsuko; Nagashima, Yoji; Gotohda, Hiroko; Moritani, Suzuko; Kawakami, Fumi; Imamura, Yoshiaki; Bando, Yoshimi; Takahashi, Masayuki; Kanayama, Hiro-omi; Ota, Satoshi; Michal, Michal; Hes, Ondrej; Nakatani, Yukio

    2014-06-01

    In this article, we searched for the common histologic characteristic of renal tumors in patients with Birt-Hogg-Dubé syndrome (BHDS). We selected 6 patients with histologically confirmed renal tumor in BHDS. Germline FLCN gene mutation has been identified in 5 patients. Multifocality and bilaterality of the renal tumors were pathologically or radiologically confirmed in 5 and 2 cases, respectively. Histologic subtypes of the dominant tumor included 3 previously described hybrid oncocytic tumors, one composite chromophobe/papillary/clear cell renal cell carcinoma (RCC) and one unclassified RCC resembling hybrid chromophobe/clear cell RCC. In one case, chromophobe RCC and clear cell RCC were separately observed. Small papillary lesions located in the peripheral area of the tumor, which we designated as intratumoral peripheral small papillary tufts, were identified in all patients. In conclusion, multifocality/bilaterality of renal tumors, discordance of histologic subtypes, and the presence of intratumoral peripheral small papillary tufts may be important clues to identify BHDS-associated renal tumors. Copyright © 2014 Elsevier Inc. All rights reserved.