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– The amount of plastic in our oceans is now popping up as gigantic islands and set to outpace the global fish population by 2050. But it's also settling ever so slowly on the ocean floor in the form of plankton poop. And because plastic-laden poop is lighter and falls more slowly than poop that is free of plastic, it has more time to be eaten up by other marine life in the process, report researchers from the University of Exeter in the journal Environmental Science & Technology. "This could be an important route by which floating plastic litter is removed from the sea surface down to the ocean depths," says the lead researcher of the lab experiments. "The magnitude of change observed here is concerning." The researchers observed zooplankton ingesting microscopic bits of plastic floating around and then pooping what is, essentially, plastic-filled feces. Ordinarily such poop pellets help transport carbon and nutrients down to the ocean depths, but as researchers report in a press release, this plankton feces is not only not doing that, it's transporting plastic into the mouths of the marine life that ingest it as a food source. It's unclear what this means, and whether the team's lab tests will play out in real life, but as Grist reports, "We’ve already got a serious problem on our hands, and these slow-moving, structurally unsound fecal dumbwaiters aren’t helping." (See how one young man wants to clean up the plastic in our waters.)

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Plastic waste could find its way deep into the ocean through the faeces of plankton, new research from the University of Exeter and Plymouth Marine Laboratory shows. The study is further evidence of the widespread impact plastic pollution could have on the marine environment. Researchers have found tiny marine creatures called zooplankton readily ingest "microplastics", plastic debris smaller than one mm in size. This plastic is later egested within their faecal pellets. In the marine environment, faecal pellets help transport carbon and nutrients into deeper waters, helping the ocean store carbon and providing food for animals living within the water column. This new study showed plankton that ate polystyrene microplastics produced faeces that were lighter than normal and therefore sank more slowly. Because these pellets sink slower there will be greater opportunity for them to be eaten by animals. This is the first evidence that plastic polluting the ocean alters the structure, density and sinking rates of animals' faecal pellets. Project leader Dr Matthew Cole, from the College of Life and Environmental Sciences said: "As these faecal pellets sink, they take the plastic with them. This could be an important route by which floating plastic litter is removed from the sea surface down to the ocean depths. We now need to determine whether this is evident in the field. "The magnitude of change observed here is concerning. We believe the impact of plastic contamination in the ocean deserves more detailed investigation and the team now hope to carry out further work in the natural environment." Researchers modelled the implications of the plastic contamination in laboratory conditions using copepods, an ecologically important group of zooplankton, which play an important role in the food web, consuming faeces to support their nutritional needs. Dr Cole and ecologists from Plymouth Marine Laboratory, also provided microplastic-laden faecal pellets to zooplankton. They readily ate them, and inadvertently ingested the plastic too. It shows that microplastics can be indirectly ingested by other animals who consume these faecal pellets. Dr Pennie Lindeque from Plymouth Marine Laboratory said: "The work is particularly interesting having identified faecal pellets as a novel mechanism for transporting plastics between animals. Our next step is to see if this holds true in their natural habitat." Microplastic contamination stems from tiny plastics used in exfoliating products and the fragmentation of plastic litter, including plastic bags and bottles. A vast range of marine organisms, including fish, turtles, seabirds, invertebrates, and zooplankton, are known to consume plastic debris. Other researchers have estimated there are over five trillion bits of microplastics floating in the ocean, and microplastics have been found in the intestinal tracts in a quarter of fish and a third of shellfish sold at markets in the U.S. and Indonesia. Previous studies have shown ingesting microplastic can lead to adverse health effects in a number of marine organisms. These include reduced feeding, energy reserves and activity to rework sediments. The NERC funded research, Microplastics Alter the Properties and Sinking Rates of Zooplankton Faecal Pellets is published in the journal Environmental Science and Technology. ### ||||| Few things in this world are more terrifying than free-floating poop. It ranks just below megalodons, Carnival cruises, and tequila shots as the biggest threat to swimmers worldwide. The mere sight of a floater is enough to ruin a perfectly good day at the beach. But a new study published in the journal Environmental Science and Technology suggests that it might actually be the dookie we can’t see that should worry us the most. According to the study, microscopic poop pellets that come from plankton can be chock full of plastic pollution. And when those pellets sink to the ocean depths, they bring that plastic with them, delivering it straight to the mouths of fish, crustaceans, and other organisms. Indeed, the researchers found that fecal pellets containing plastic tended to have lower densities and thus sank slower than non-polluted poop, providing more time for passing feeders to scoop them up. The plastic also appeared to hurt the poop’s structural integrity, causing it to break apart more on the way down. Normally, this poop-as-transporter paradigm is a good thing. Like little fecal dumbwaiters, plankton poo has long been known to sink carbon and deliver nutrients and other bits of organic matter to organisms living at the bottom of the ocean. But when it comes to plastic, which has no business being in the ocean in the first place, such efficient dispersal is a problem. As the researchers point out, plastic is disturbingly present in the marine food web. Plastic has a way of making its way back to human’s food supply, too. One study published last year in Scientific Reports found microplastics in the intestines of 25 percent of fish and 33 percent of shellfish sampled in California markets and 28 percent of fish sampled in Indonesia markets, and according to a 2014 study in Environmental Pollution, European consumers of shellfish could be ingesting up to 11,000 bits of microplastics each year. And things only seem to be getting worse. A recent report from the World Economic Forum estimated that there could be more plastic in the ocean than fish (by weight) by 2050. We’ve already got a serious problem on our hands, and these slow-moving, structurally unsound fecal dumbwaiters aren’t helping. That said, there’s still a lot that we don’t know about poop’s role in plastic dispersal. This study is based on laboratory observations of plankton, and things tend to play out differently in the real world. That’s why the researchers conclude that an “analysis of field collected fecal pellets and marine snows are now urgently required,” which can only mean one thing: Someone call Bill Murray:

frontotemporal dementia ( ftd ) is the most common form of primary degenerative dementia after alzheimer s disease that affects people in middle age . the average delay in reaching an accurate diagnosis has been reported to be around 3 years . we report a case of ftd in a 35-year - old female who presented with complex symptoms and no clear physical signs . this case draws attention to the problems inherent in the traditional functional organic divide that continues to characterize investigation and diagnosis in modern psychiatric practice , and highlights the importance of reevaluating the results of previous normal investigations in the light of the developing clinical picture .

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a 35-year - old female with a previous history of long - term high - dose benzodiazepine use presented in 2001 following an overdose of ibuprofen . she had concurrent symptoms of depression , persecutory ideas , and bizarre , chaotic behavior ( eg , wandering the streets claiming she was being poisoned ) . physical examination was normal , except for an extensor left plantar reflex , as were her urea and electrolytes ( u&es ) , full blood count ( fbc ) , thyroid function tests ( tfts ) , liver function tests ( lfts ) , and random blood glucose ( rbg ) . ct and mri brain scans and an eeg were reported as normal , and hence an organic etiology was excluded . a diagnosis of severe psychotic depression was made and she was treated with a variety of antidepressant , antipsychotic , and mood stabilizing agents for over twelve months , together with electroconvulsive therapy without significant response . she displayed behavioral difficulties including poor self care , agitation , and she was intrusive and demanding . twelve months later , a second opinion was sought at which time the patient had intermittent paranoid ideas , mood congruent auditory hallucinations , and psychological pillow . a diagnosis of schizophrenia was made and clozapine was commenced , again with no significant impact . in july 2002 , her family relocated and she was transferred to another psychiatric hospital . her presentation was unchanged except for the emergence of hypochondriacal ideas and worsening behavioral difficulties such as disinhibition , coarsening of social skills , and deteriorating self care . the patient was referred for a further opinion in november 2003 at which time her main difficulties were a mixture of depressive , psychotic , and anxious symptoms with marked behavioral disturbance . physical examination revealed a left extensor plantar reflex , a pout , and palmomental primitive reflexes but no other neurological signs . a battery of investigations was arranged , including u&es , fbc ( including screen for acanthocytes ) , tfts , lfts , rbg , c - reactive protein test , calcium , phosphate , copper , ferritin b12 and folate , pituitary hormones , autoantibodies , chest x - ray , and ecg . an eeg recording revealed a slightly slow posterior rhythm suggestive of a mild non - specific cortical disturbance . the previous ct scans from 2001 were reviewed , and despite a normal report , there were significant atrophic changes which had progressed ( figures 1 and 2 ) . the initial report did not identify any abnormality , but mild atrophy particularly in the frontal regions is evident . a lumbar puncture revealed normal cerebrospinal fluid , glucose , protein , angiotensin - converting enzyme , and cytology . on neuropsychological assessment she scored 68/100 on the extended mental state examination , having deficits in mental reversal , orientation , verbal fluency , and recall . a clinical diagnosis of frontotemporal dementia ( ftd ) was made , in accordance with the consensus diagnostic criteria ( neary et al 1999 ) . arnold pick described clinical syndromes associated with frontal and temporal lobe degeneration over a century ago , but for many years these conditions were unrecognized as specific subtypes of dementia . in recent years , these conditions have been rediscovered ( gustafason 1987 ) and diagnostic criteria have been developed . ftd comprises a pathologically heterogeneous group of disorders characterized by behavioral change . only a minority of patients exhibit pick - type histological changes , which includes loss of large cortical nerve cells with widespread gliosis and swollen neurons or inclusions positive for both tau and ubiquitin . is the official classification for these forms of dementia in icd-10 and dsm - iv . ftd is the most common form of primary degenerative dementia after alzheimer s disease that affects people in middle age . it occurs most commonly between the ages of 45 and 65 years ( snowden et al 2002 ) . there is an equal incidence in men and women ( gustafason 1987 ) . from the onset of symptoms the delay in diagnosis has been reported to be on average 3 years , and death usually occurs within 6 years of the development of symptoms ( hodges et al 2003 ) . when viewed with the wisdom of hindsight , the emerging clinical characteristics of ftd in this case are clear . however , the age of onset is unusual , and we highlight the complexity of reaching a diagnosis in the absence of clear physical signs and when investigations are reported to be normal . this case draws attention to the problems inherent in the traditional functional organic divide that continues to characterize investigation and diagnosis in modern psychiatry . the presenting symptoms in this case caused diagnostic uncertainty , and a variety of functional diagnoses were made , even though the symptomology was atypical and did not fit neatly into any diagnostic category . although clinicians may be reassured of the absence of an underlying organic etiology following normal neuroimaging and electrophysiological studies in psychiatric patients presenting with atypical features , this is clearly not always the case . once the momentum behind a functional diagnosis has been established , consideration of alternative etiologies is often abandoned and reappraisal of the biological underpinnings of the disorder may be neglected . we advocate that physical investigations are repeated if patients continue to present a diagnostic challenge . the reevaluation of the results of previous normal investigations , in the light of the developing clinical picture , may further aid the diagnostic process .

objective interleukin-1 receptor antagonist ( il-1ra ) , a natural inhibitor of interleukin-1 , has been shown to improve -cell function and glycemic control in patients with type 2 diabetes . the aim of this study was to investigate whether baseline systemic levels of il-1ra are associated with incident type 2 diabetes during more than 10 years of follow-up.research design and methods we measured serum il-1ra concentrations in a nested case - control study ( 181 case and 376 age- , sex- , and bmi - matched normoglycemic control subjects ) within the whitehall ii cohort ( u.k.).results il-1ra concentrations were higher in case subjects ( p = 0.0006 ) and associated with incident type 2 diabetes ( odds ratio for a 1-sd increase of il-1ra 1.48 [ 95% ci 1.211.80 ] ) . this association remained significant after adjustment for multiple potential confounders but was attenuated by adjusting for 2-h glucose.conclusionsour findings indicate that individuals who will develop type 2 diabetes are characterized by a complex immune activation that also includes upregulation of the anti - inflammatory cytokine il-1ra .

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we present results from a nested case - control study within the whitehall ii cohort , which was established in 1985 and included 10,308 civil servants age 3555 years ( 11 ) . phase 3 ( 19911994 ) of the study was the first phase where glucose tolerance was assessed by a 75-g oral glucose tolerance test and is the baseline for the current study ( n = 7,537 ) . participants were followed through postal questionnaires at 2.5-year intervals ( phases 48 ) and further clinical examinations ( including an oral glucose tolerance test ) in 19971999 ( phase 5 ) and 20032004 ( phase 7 ) ( 12 ) . individuals without type 2 diabetes at baseline and with incident type 2 diabetes during the follow - up period of 11.5 3.0 years served as case subjects ( n = 181 ) . the control subjects ( n = 376 ) , with normal glucose tolerance at baseline and during the follow - up , were frequency matched to case subjects for age ( 5-year bands ) , sex , and bmi ( 5 kg / m bands ) . further details on the selection criteria for this nested case - control study and information on the collection of anthropometric , metabolic , socioeconomic , and immunological variables and on statistical analysis are given in an online appendix ( available at http://dx.doi.org/10.2337/dc08-1161 ) . characteristics of case and control subjects are shown in table a1 of the online appendix . the comparison of the included and excluded diabetic case subjects revealed only a few significant differences : selected case subjects were less likely to be women and smokers , were more likely to be ex - smokers , and had a marginally lower bmi . other comparisons between the two groups were not significant ( data not shown ) . characteristics of control subjects in our selection mainly reflected the selection criteria ( normal glucose tolerance throughout the study and matching for age , sex , and bmi to case subjects ) : they were slightly older and had a higher bmi , waist circumference , and diastolic blood pressure but lower fasting and 2-h glucose compared with the rest of the cohort who were nondiabetic at baseline and follow - up ( data not shown ) . il-1ra concentrations at baseline were higher in case subjects ( median 232.8 pg / ml [ 25th75th percentiles 180.7342.2 ] ) than in control subjects ( 207.6 pg / ml [ 159.3274.8 ] ) ( p = 0.0006 ) . a 1-sd increase of il-1ra ( 157.7 pg / ml ) was associated with incident type 2 diabetes in models that adjusted for multiple potential confounders , including age , sex , waist circumference , cardiovascular risk factors , socioeconomic status , proinflammatory mediators , and fasting glycemia ( table 1 ) . further inclusion of bmi had virtually no impact on odds ratio ( model 2 plus bmi odds ratio 1.41 [ 95% ci 1.131.77 ] ; p = 0.0027 ) . however , addition of 2-h glucose led to reduced effect sizes and loss of statistical significance ( table 1 ) . elevated levels of il-1ra were associated with an increased risk of developing type 2 diabetes in this nested case - control study . we found a slight attenuation of this association when adjusting for waist circumference , which is consistent with il-1ra production in adipose tissue ( 13 ) . it is remarkable that the association was stable to adjustment for a range of further potential confounders , including fasting glucose and insulin . this finding could be interpreted to indicate that increased il-1ra levels are a reaction to and not a cause of early postprandial hyperglycemia before the onset of diabetes . studies with measurements of glycemic markers and il-1ra at multiple time points and analysis of their trajectories will be needed to clarify this point . our findings expand observations from cross - sectional studies that reported elevated levels of il-1ra in the circulation of individuals with obesity and insulin resistance ( 810 ) . thus , individuals who will develop type 2 diabetes are characterized not only by an upregulation of proinflammatory immune mediators ( 13 ) but also by the upregulation of at least one anti - inflammatory immune marker . because animal studies and a recent clinical trial indicated that administration of il-1ra attenuates subclinical inflammation , supports -cell function / insulin secretion , and may also improve insulin sensitivity ( 6,14 ) , it is tempting to speculate that elevated il-1ra levels in individuals at risk of type 2 diabetes may be an attempt to counteract the proinflammatory effects of interleukin-1 and to preserve insulin secretion and insulin sensitivity an effort that eventually fails . however , our data can not rule out the alternative interpretation that il-1ra has additional metabolic effects beyond the inhibition of interleukin-1 that could lead to insulin resistance and type 2 diabetes . as a potential limitation of the study , it should be mentioned that point estimates and cis are derived from nonweighted data from a nested case - control study and , therefore , their statistical inference may be restricted and may not represent the best available estimate within the context of the original cohort . thus , further studies will be needed to support our hypothesis that individuals with high risk of type 2 diabetes are characterized by the presence of an early compensatory , anti - inflammatory response that precedes the development of the disease . this hypothesis could be tested by the analysis of further , mainly anti - inflammatory immune mediators , such as interleukin-10 or transforming growth factor- in additional cohorts .

– A 68-year-old New Jersey man appears to have fallen to his death Monday while trying to photograph the sunset, according to officials at Maine's Acadia National Park. The Bangor Daily News reports Mark Simon was visiting the park with his wife, who waited in the car in a nearby parking lot while he walked to a bluff to take photos. She got concerned when the sun went down and stopped a park ranger who was driving by, according to the Portland Press Herald. Her husband had been gone for more than two hours. The ranger found Simon's backpack at the top of a nearby cliff, WCSH reports. His body was 40 feet below at the water's edge. The tide carried Simon's body away from shore before rescuers could get to it, and the Coast Guard was called to pull it from the water. While Simon's death is believed to be accidental, the National Park Service is investigating and an autopsy is underway. Simon is the second person to die in Acadia National Park this year. A hiker was found dead of acute intoxication in January. And while falls are frequent in the park, there hasn't been a fatal one since 2012.

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Park officials are investigating how and why a 68-year-old man fell to his death in Acadia National Park on Monday, the National Park Service said Tuesday. Mark Simon of Glen Ridge, New Jersey, fell from a bluff between Sand Beach and Thunder Hole. Simon was a summer resident of Southwest Harbor. He and his wife had stopped on the Park Loop Road so he could photograph the sunset from an area off the Ocean Path. Simon’s wife waited for him in the car, but became concerned after the sun had set, and waved down a passing park ranger. Rangers located Simon’s backpack, and then saw his body at the bottom of a 40-foot drop. He was lying motionless at the water’s edge. Because of the steep terrain, park rangers could not reach him, and the U.S. Coast Guard was called to assist in recovering Simon’s body, which was only reached once the rising tide carried it into the water. While the fall appears accidental, the National Park Service said it would continue to investigate the circumstances Tuesday. Share ||||| Bill Trotter | BDN Bill Trotter | BDN By Bill Trotter , BDN Staff • June 7, 2016 12:32 pm Updated: June 7, 2016 4:59 pm ACADIA NATIONAL PARK, Maine — A New Jersey man died Monday night after falling from a seaside cliff in Acadia, according to park officials. Mark Simon, 68, a resident of Glen Ridge, New Jersey, who spent summers on Mount Desert Island in Southwest Harbor, is believed to have fallen from a cliff near Thunder Hole after going out on the rocks to take photographs of the sunset, Acadia National Park spokesman John Kelly said Tuesday. Simon’s wife stayed in their car in a nearby parking lot when Simon walked to the shore shortly after 7 p.m. to take photographs, Kelly said. After her husband did not return, she waved down a park ranger, who was driving by a few minutes after 9:30 p.m., he added. About a half-hour later, rangers found Simon’s backpack at the top of the cliff, which is about 40 feet tall, Kelly said. They saw him lying at the bottom of the cliff, but he was unresponsive to their calls. Because of Simon’s location, rangers requested assistance from the U.S. Coast Guard and from Mount Desert Island Search & Rescue, but the incoming tide carried Simon’s body offshore, Kelly said. The Coast Guard, which sent two boats to assist in the search, located and pulled Simon’s body from the water around 11:30 p.m. Simon’s body was taken to the Bar Harbor town pier, then was taken to the state medical examiner’s office in Augusta, according to Kelly. Mark Belserene, spokesman for the medical examiner’s office, said Tuesday afternoon that an autopsy has been performed on Simon but the cause of death is not expected to be determined for at least a few weeks, pending the results of lab tests. Kelly said that though Simon’s fall appears to be accidental, the National Park Service is investigating the circumstances of the incident. Falls are not uncommon in Acadia and, according to Kelly, are the main cause of injury in the park, whether they result in a twisted ankle or a fatality. During the busy summer months, park rangers have been known to deal with multiple simultaneous calls about hikers who have fallen and injured themselves. Most of those instances in which rangers provide assistance involve injuries that are not life-threatening and are considered relatively minor, according to Kelly. The last time someone is known to have died after taking a serious fall in Acadia was in 2012, when a University of Maine student fell off Precipice Trail. It is the second fatality in the park this year. In January, Ellsworth resident Timothy Philpott went missing while hiking in Acadia, prompting several searches over the ensuing days and weeks as weather conditions allowed. His remains were found in mid-April. Belserene said Tuesday that the medical examiner’s office subsequently determined that Philpott’s cause of death was “acute intoxication” from multiple prescription medications. ||||| BAR HARBOR, Maine (NEWS CENTER) — A man from Glen Ridge, N.J., fell to his death Monday at Acadia National Park. Park officials said 68 year old Mark Simon, a summer resident of nearby Southwest Harbor, visited Acadia with his wife Monday night so he could photograph the sunset from a location off Ocean Path across from Old Soaker. Simon's wife waited for him in their vehicle parked along Park Loop Road and became concerned after more than two hours had passed since he had left. She flagged down a passing park ranger vehicle around 9:30 p.m. Park rangers located Simon's backpack at the top of a bluff and discovered that he had fallen approximately 40 feet to the edge of the water below. They were unable to reach him initially due to the steep terrain, and verbal contact was attempted but no response was returned. Simon's body was recovered around 11:30 p.m. by the U.S. Coast Guard within 50 yards of the shore into Newport Cove. It's now with the Chief Medical Examiners' office, which will conduct an autopsy to determine the cause of death. "Falls in Acadia are the number one source of injury for visitors. People should be sure to have the proper footwear, watch out for drop offs stay back from ledges be aware of wet spots or gravely spots that might be very slippery and just really pay attention," said John Kelly, Management Assistant at Acadia National Park. While officials said the fall appears accidental, an investigation has been launched. Copyright 2016 WCSH

a 28-year - old woman was referred to our hospital because of abdominal pain , weight loss and a palpable intra - abdominal mass . a ct scan revealed a tumor with a diameter of 7 cm with sharp margins , intra - tumoral fatty components and enhancing soft tissue . after initial workup , which suggested an inflammatory myofibroblastic tumor ( imt ) , she underwent laparotomy with complete resection . pathological examination indeed revealed imt . imt is a rare benign neoplasm and has been described in nearly the entire body . it presents with nonspecific symptoms . the therapy of abdominal imt consists of radical surgery because of high local recurrence rates . in this case report clinical , surgical , radiological and histological features with a review of the relevant literature are described .

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inflammatory myofibroblastic tumor ( imt ) , also known as inflammatory ( myo)fibroblastic pseudotumor or inflammatory pseudotumor , is a rare benign neoplasm , often mistaken for malignancy or teratoma . the exact etiology of imt is unknown , though it is suggested to occur secondary to infection , trauma or surgery . it can be located in the entire body and has a preference for children and young adults . the differential diagnosis consists of teratoma , liposarcoma and lymphoma . up to date , therapy consists of radical surgery with long - term follow - up . in this article we describe a case of abdominal imt with clinical , surgical , radiological and histological features and present a review of the relevant literature . a 28-year - old woman was referred to our hospital because of abdominal pain and weight loss . during 4 weeks she had pre - existent constipation , but no rectal bleeding , nor did she experience any night sweating . ultrasound revealed a 6-cm hypoechogenic tumorous mass with sharp margins . a ct scan of the chest and abdomen showed an inhomogeneous round tumor of 73 61 mm with sharp margins and with hypodense fatty components in combination with enhancing soft tissue . the mass was located mesenterially , ventrally of the musculus iliopsoas with surrounding enlarged lymph nodes ( maximum diameter 12 mm ) ( fig . an additional pet scan revealed paratracheal lymph nodes which were interpreted as reactive , and the known left paraumbilical mass with only capsular fdg uptake . ultrasound - guided biopsies were taken which revealed spindle cell proliferation with a mixed inflammatory cell infiltrate , in which immunohistochemical analysis showed positivity for vimentin , pankeratin ( not uniform ) , and focally smooth muscle actin and calponin , suggesting an imt . given the clinical presentation and the pathological findings , it was decided to perform an explorative laparotomy with total resection of the tumor . macroscopic inspection showed a tumor with a diameter of 10 cm with a smooth capsular outer surface ( fig . due to locally aggressive growth , both a section of the colon and the jejunum had to be resected . microscopy showed a mesenteric tumor comprising diffuse , not sharply delineated and unencapsulated spindle cell proliferation with lymph node involvement per continuitatem but without involvement of the colon or jejunum and without atypia . this spindle cell proliferation was accompanied by a cell - rich mixed inflammatory infiltrate with for instance many plasma cells , lymphocytes and eosinophilic granulocytes . immunohistochemical analysis did not reveal signs of a specific spindle cell tumor , carcinoma or malignant lymphoma ( fig . 3 ) . the diagnosis was imt ( differential diagnosis : primary fat necrosis surrounded by a pseudocapsule of extensive reactive fibrosis with organization ) . the postoperative period was uncomplicated and the patient could be discharged from the hospital after 4 days . imt , also known as inflammatory ( myo)fibroblastic pseudotumor or inflammatory pseudotumor , is a rare benign neoplasm , often mistaken for malignancy or teratoma . the etiology of imt is unknown , though it is suggested to occur secondary to infection like mycobacteria , epstein - barr virus , cytomegalovirus , actinomycetes , nocardia or an autoimmune reaction [ 1 , 2 , 3 , 4 , 5 ] . furthermore it has been described after trauma or surgery , which was not the case in our patient [ 5 , 6 , 7 ] . imt occurs at any age , though it is mainly described in children and young adults . imt most commonly involves the lung and orbit , though it has been described in nearly the entire body . known cases of abdominal imt include the liver , pancreas , mesentery , retroperitoneum , diaphragm , bladder , kidney , adrenal gland , esophagus , stomach , small intestine , colon , appendix and meckel 's diverticulum [ 8 , 9 ] . clinical presentation is variable according to the location of the tumor . these nonspecific symptoms can include fever , weight loss , abdominal pain or palpable abdominal mass with nonspecific laboratory findings such as iron deficiency anemia [ 3 , 7 , 10 , 11 ] . like its clinical presentation , after contrast enhancement , moderate or marked homogeneous or heterogeneous enhancement is seen in the solid part of the tumor [ 11 , 12 ] . non - enhancement , calcification and fatty components have been described . because of the high uptake of tracer in imt on pet scan , imt is often difficult to differentiate from other neoplasms . the differential diagnosis includes lymphoma , soft tissue sarcoma , metastatic disease and benign fibrous mesenteric tumor . histologically imt is characterized by myofibroblastic spindle cells and inflammatory cells consisting of lymphocytes , histiocytes and eosinophils [ 1 , 2 , 14 , 15 ] . staining for smooth muscle and vimentin are positive [ 5 , 15 , 16 ] . furthermore imt contains both b and t cells , in contradistinction to lymphomas , which contain only ( clonal ) b or t cells . the treatment of abdominal imt consists of complete surgical resection ; moreover , this will confirm the diagnosis imt by histological examination [ 18 , 19 ] . adjuvant therapies have been used without great success , though for local recurrences or inoperable tumors , radiotherapy and chemotherapy consisting of cisplatin , doxorubicin and methotrexate may be indicated [ 1 , 15 , 18 ] . because of a significant local recurrence rate , long - term follow - up is mandatory .

– Good news, Tina Fey fans: The 30 Rock star is producing a new sitcom, and NBC just gave it a rare straight-to-series order for 13 episodes to premiere next fall. The as-yet-untitled single-camera comedy stars The Office star Ellie Kemper, Variety reports. It's about a woman starting over in New York after escaping a doomsday cult. "We have been lucky enough to work at NBC for our entire careers (except when Robert worked at The Dana Carvey Show, now available on DVD) and we thank Bob [Greenblatt] and Jen [Salke] for their continued support," say Fey and co-producer Robert Carlock in a statement, according to the Hollywood Reporter.

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Fey and Robert Carlock will write and EP the Kemper vehicle, about a woman who escapes from a doomsday cult and starts life over in New York City. Tina Fey is back in business at NBC. The 30 Rock creator, along with her producing partner Robert Carlock, has been granted a 13-episode straight-to-series order for a comedy starring The Office’s Ellie Kemper. The single-camera effort, which is set to debut in the fall of 2014, will center on a woman (Kemper) who escapes from a doomsday cult and starts life over in New York City. “We have been lucky enough to work at NBC for our entire careers (except when Robert worked at The Dana Carvey Show, now available on DVD) and we thank Bob [Greenblatt] and Jen [Salke] for their continued support,” Fey and Carlock said in a joint statement Thursday. The half-hour series is being produced by Little Stranger and Universal Television, where Fey is under a rich, four-year overall deal. Fey and Carlock, who co-wrote the tightly guarded spec script for which the offer was made, will write, executive produce and co-run the series. 3 Arts’ David Miner, Fey’s longtime manager, will join the pair as an executive producer. PHOTOS: Exclusive Portraits of Tina Fey and More Emmy Icons “Tina and Robert, who cemented their partnership on 30 Rock, have created a new signature comedy for us that is audacious, emotional, and clever,” said Greenblatt, chairman of NBC Entertainment, adding: “While tapping into very relatable themes, there isn’t anything like this anywhere else on television. NBC has been their home for many years and we’re so happy that they’ve found another way to push the comedy envelope for us.” Added Salke, president of NBC Entertainment: “Original voices like Tina and Robert don’t come along very often and we wanted them back on the air as soon as possible. And to have them working with Ellie Kemper — who we watched grow up on The Office from supporting player to leading actress — puts the whole package together. We feel fortunate to be in business with this entire creative team on something so funny, unique, and attention-getting.” The news caps off a particularly strong couple of months for Fey, who recently won an Emmy for co-writing the 30 Rock finale and, weeks later, was tapped to return as co-host of the Golden Globes. The eight-time Emmy winner and Saturday Night Live vet has been active as a producer this season, having garnered a series commitment for a women’s-college-themed comedy at Fox after a multinetwork bidding war broke out. Additionally, she and Carlock are reteaming with 30 Rock writer-producer Colleen McGuinness for a workplace comedy in which a woman reconnects with her estranged father and finds a new home and family on Fire Island. The latter is set up at NBC. The move marks a reunion for Kemper, too, who spent several seasons at NBC as a co-star on the Greg Daniels comedy The Office. Her profile rose still more thanks to her comedic turn in breakout hit Bridesmaids, which generated nearly $170 million at the domestic box office when it bowed in 2011. Since The Office wrapped, Kemper has found herself at the top of casting wish lists. For his part, Carlock served as an executive producer on 30 Rock for all seven seasons, picking up three Emmys in the process. Prior to the Fey half-hour, he was a writer on SNL and Friends, among other series. While both noteworthy and significant, the straight-to-series strategy is becoming an increasingly popular way for broadcast networks to secure big projects as competition for original scripted series intensifies. In addition to Fey and Carlock's college comedy, Fox is moving forward with both fantastical drama Hieroglyph and Batman prequel Gotham as series. CBS recently announced that it, too, would bypass the pilot stage with a 13-episode order for Vince Gilligan's cop drama Battle Creek, which House's David Shore is attached to run. Fey is repped by WME, 3 Arts and Ziffren Brittenham; Carlock is repped by WME; Kemper is repped by WME and Mosaic. E-mail: [email protected] Twitter: @LaceyVRose ||||| NBC has given a 13-episode straight to series order for a comedy starring “The Office” alum Ellie Kemper, produced by Tina Fey and Robert Carlock. Series is produced by Universal TV through Tina Fey’s overall deal with the studio. The single-camera comedy about a woman who escapes from a doomsday cult and starts life over in Gotham is targeted to bow next fall, NBC said. Kemper (pictured left) has been highly sought after for comedy development prospects since “The Office” wrapped its nine-season run on the Peacock this past spring. Fey (pictured right) and Carlock worked shoulder to shoulder as exec producers on “30 Rock,” which ended in January after seven years. PHOTOS: ’30 Rock’ and ‘The Office’ Stars: Where Are They Now? Fey and Carlock will exec produce the untitled Kemper vehicle and serve as showrunners on the series, which will lense in New York. That’s a major commitment for the pair who have no shortage of other opportunities, particularly Fey. David Miner also exec produces. “Tina and Robert, who cemented their partnership on ’30 Rock,’ have created a new signature comedy for us that is audacious, emotional, and clever,” said NBC Entertainment chairman Bob Greenblatt. “While tapping into very relatable themes, there isn’t anything like this anywhere else on television. NBC has been their home for many years and we’re so happy that they’ve found another way to push the comedy envelope for us.” Straight to series orders for comedies are still rare, though NBC set a high benchmark last year with its 22-episode throwdown for “The Michael J. Fox Show.”

systemic sclerosis ( ss ) is a connective tissue disease and cardiac involvement is common . primary cardiac involvement such as conduction system disturbances and arrhythmias can also occur . however , reports of sustained ventricular tachycardia ( vt ) are rare . we report a case of catheter ablation of sustained ventricular tachycardia in a patient with systemic sclerosis using a conventional mapping system . a 64-yr - old woman with a 10-yr history of ss was referred for management of her ventricular tachycardia . there was no structural abnormality in cardiac chambers . however , electrophysiologic study revealed electrical substrate of ventricular tachycardia which could be ablated with pacemapping and substrate mapping . this case demonstrated successful conventional mapping and catheter ablation in a hemodynamically unstable patient with ss .

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systemic sclerosis ( ss ) is a fibrotic condition characterized by immunological abnormalities , vascular injury and increased accumulation of extracellular matrix proteins ( 2 ) . the heart is one of the major organs involved in ss and cardiac involvement has been a common finding at postmortem examination ( 3 ) . conduction disturbances as well as supraventricular tachycardia or ventricular extrasystoles commonly occur during holter monitoring ( 4 ) . . the mechanisms underlying ventricular arrhythmias in systemic sclerosis have not been well studied . in this report , we describe a case of successful treatment of hemodynamically unstable ventricular tachycardia in a patient with ss by catheter ablation with substrate mapping . a 64-yr - old woman with a 10-yr history of ss was referred for management of her ventricular tachycardia . the manifestations of ss included pulmonary interstitial fibrosis and mild pulmonary hypertension managed by prednisolone and azathioprine . she was admitted to the emergency department on july 17 , 2009 and the initial electrocardiogram ( ecg ) revealed monomorphic wide qrs tachycardia which was well tolerated despite a rate of 243 beats per minute ( fig . wide qrs tachycardia observed in the ecg showed a left bundle branch block , left axis deviation and atrioventricular dissociation . a profile of routine chemistry including myocardiac markers did not reveal any specific abnormalities . antinuclear antibody screening and specific tests for antitopoisomerase iii ( anti - scl-70 ) were positive and esr was 94 mm / hr . chest x - ray showed basal - predominant reticular abnormality . sinus rhythm with normal qt interval ( qtc : 453 ms ) was restored with electrical cardioversion ( fig . echocardiography showed preserving lv ejection fraction and normal cardiac chamber size without structural abnormality of both ventricle . mild pulmonary hypertension was monitored as 35 mmhg pulmonary artery pressure . on the 2nd day after admission , electrical cardioversion was urgently performed and sinus rhythm was recovered . a coronary angiogram and electrophysiological study with radiofrequency catheter ablation there was no significant stenosis in coronary artery . during the electrophysiological test , sustained ventricular tachycardia of the same morphology with clinically documented tachycardia was reproducibly induced by two ventricular extra stimuli ( fig . the induced vts were hemodynamically unstable and do not permit activation mapping or entrainment during prolonged periods of tachycardia . therefore , we performed a substrate mapping during sinus rhythm and pace mapping instead of activation mapping or entrainment . during substrate mapping , delayed and isolated potential was found at the posterior base of the right ventricle ( fig . pacemapping in the area showed satisfactory 12-lead qrs matching with induced ventricular tachycardia ( fig . ablation was started at the vicinity of the area , where the typical delayed and isolated potentials were found . twelve radiofrequency currents were delivered at these sites in a temperature - controlled mode at 60 with power limited to 50 w. after the final rf application , ventricular tachycardia was not induced either by the programmed extrastimuli or isoproterenol infusion up to 10 g / mim . after the procedure , there was no further inter / intraventricular conduction delay on ecg . telemetry monitoring revealed that the ventricular tachycardia did not recur and normal sinus rhythm was maintained . follow - up observations are ongoing , and neither vt nor any cardiac symptoms have recurred . this report describes a successful catheter ablation of a hemodynamically unstable vt arising from the posterior base of right ventricle in a patient with ss . cardiovascular involvement is common in ss . tachyarrhythmia appears as a frequent clinical manifestation of ss - associated cardiovascular damage and a possible cause of sudden death ( 5 ) . in one study , premature ventricular contraction was the most common arrhythmia and noted in 67% including pvcs in pairs in 20% , vt in 7% . our case was thought rare and interesting with a high possibility of sudden death due to sustained vt associated with ss . . among them , a re - entry mechanism due to diffuse myocardial fibrosis would provide sustained monomorphic vt ( 7 , 8) . the implantable cardioverter defibrillator has been used in survivors of cardiac arrest ( 8 , 9 ) . in our case , unlike vts in previous reports , the vt was associated with hemodynamic instability . therefore , we could not use activation mapping or entrainment mapping during prolonged periods of tachycardia due to the hemodynamically unstable nature . in scar based reentrant vt , slow conduction takes place on the border of the scar tissue ; therefore , abnormal and low amplitude electrograms have been recorded during sinus rhythm at these sites . as low - amplitude electrograms are recorded all along the scarred endocardial surface , they have low specificity for vt substrate identification . the exit site of the vt should be identified and targeted with ablation using pace - mapping at the border of the scar . furthermore , a recent study ( 10 ) suggested that the contribution of scar to the electrophysiological abnormalities targeted for ablation of unstable vt differs between ischemic cardiomyopathy ( icm ) and nonischemic cardiomyopathy ( nicm ) . mean total low voltage area in patients with icm was larger than in nicm . within the total low voltage area , late potentials therefore , an approach incorporating late potential ablation and pace - mapping can be considered and electroanatomical mapping can be an alternative in patients with nicm . this case demonstrated successful conventional mapping and catheter ablation in a patient with ss , despite a hemodynamically unstable state . in the future

introduction : neonatal parotitis is a rare disease . neonatal suppurative parotitis commonly presents with facial swelling , irritability , tenderness of parotid region , and with or without fever . acute neonatal suppurative parotitis is one of the differential diagnoses of facial swelling with a prevalence of 3.8/10000 of neonatal admission.case presentation : a 32-day - old girl with fever and restlessness was admitted in the hospital . left facial swelling was found during physical examination . redness was observed in the face . prenatal history was normal . birth weight was 3500 g. body weight , length , and head circumference were 4300 g ( 75 th percentile ) , 52 cm ( 50 th percentile ) , and 38 cm ( 75 th percentile ) , respectively . she was breastfed . pulse and respiratory rates were 130/min and 50/min , respectively . axillary temperature was 37.8c . head examination revealed normal sized fontanel ( 1.5 1.5 cm ) without bulging . eye and ear were normal . abdominal examination revealed no abnormal findings . results of urine analysis and culture were normal . blood urea nitrogen , sodium , potassium , and blood sugar were normal . blood amylase was 10 u / l . bilateral multiple reactive lymph node ( size = 6 10 mm ) at anterior cervical chain with a left facial swelling was observed in ultrasonography report . pus was obtained following gentle pressure on stensen s duct . staphylococcus aureus was detected in the microscopic and microbiological evaluations.the patient received a seven - day treatment course with vancomycin and amikacin . neonate was discharged in a good condition.conclusions:acute suppurative parotitis should be suspected in infants with fever , and irritability in pre - auricular region ; and should be treated with appropriate antibiotics .

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neonatal suppurative parotitis commonly presents with facial swelling , irritability , tenderness of parotid region , and with or without fever . acute neonatal suppurative parotitis is one of the differential diagnoses of facial swelling with a prevalence of 3.8/10000 of neonatal admission . a 32-day - old girl with fever and restlessness was admitted in the hospital . left facial swelling birth weight was 3500 g. body weight , length , and head circumference were 4300 g ( 75 th percentile ) , 52 cm ( 50 th percentile ) , and 38 cm ( 75 th percentile ) , respectively . bilateral multiple reactive lymph node ( size = 6 10 mm ) at anterior cervical chain with a left facial swelling was observed in ultrasonography report . staphylococcus aureus was detected in the microscopic and microbiological evaluations.the patient received a seven - day treatment course with vancomycin and amikacin . acute suppurative parotitis should be suspected in infants with fever , and irritability in pre - auricular region ; and should be treated with appropriate antibiotics . neonatal suppurative parotitis is rare ( 1 ) and commonly presents with facial swelling , irritability , tenderness of parotid region , and with or without fever . acute neonatal suppurative parotitis is one of differential diagnoses of facial swelling with a prevalence of 3.8/10,000 of neonatal admission ( 2 ) . staphylococcus aureus was the most frequent offending organism , but other gram - positive , gram - negative and anaerobic organism may be involved ( 2 ) . intravenous antibiotic therapy is recommended for treatment . surgical treatment is needed in complicated cases such as intra - glandular abscess ( 3 ) . the current report is regarding a 32 day - old girl infant with suppurative parotitis . limited published case reports were found from our country after searching pubmed and google scholar with keywords of neonatal parotitis , suppurative parotitis , and infant . a 32- day - old girl with fever and restlessness was admitted in the hospital . birth weight was 3500 g. body weight , length , and head circumference were 4300 g ( 75 th percentile ) , 52 cm ( 50 th percentile ) , and 38 cm ( 75 th percentile ) , respectively . red blood cell ( rbc ) and white blood cell ( wbc ) counts were 3.1 10 cells / l and 12.6 10/l ( neutrophil : 60% ) , respectively . erythrocyte sedimentation rate and c - reactive protein were 20 mm / l and negative , respectively . results of urine analysis and culture were normal . bilateral multiple reactive lymph node ( size = 610 mm ) at anterior cervical chain with a left facial swelling was observed in ultrasonography report . due to suspected neonatal parotitis , with gentle pressure on stensen s duct , pus was evacuated and transferred to the laboratory . neonatal suppurative parotitis is a rare disease . since 2004 , 16 additional cases were reported ( 3 ) . neonatal suppurative parotitis is one of the differential diagnoses of facial swelling which include trauma , lipoma , and adenomas ( 1 ) . ascending bacteria from the oral cavity is the commonest source of infection ( 4 ) . the most common presentation of neonatal parotitis is fever , swelling , and erythema in the pre - auricular area . leuckocytosis above 1510/l with the neutrophil predominance was found in 71% of the cases , and erythrocyte sedimentation rate ( esr ) was elevated in 20% of the cases ( 5 ) . the patient under study had normal esr , wbc count was less than 1510/l , and serum amylase within the normal limit . insufficient breast feeding , hot weather ( 6 ) , excessive oral suctioning , naso - gastric tube feeding , and maternal breast abscess are the possible risk factors ( 7 ) . low birth weight , immunosuppression and oral trauma were reported as the risk factors for parotitis ( 1 ) . neonatal suppurative parotitis is more common among males , with a rate of 3:1 ( 2 ) . of the 16 cases reported since 2004 , escherichia coli , klebsiella pneumonia , and pseudomonas aeruginosa were also reported ( 4 ) . microscopic and microbiological evaluations showed s. aureus which was consistent with most of the reports . the present report found methicillin resistant s. aureus ( mrsa ) as a cause of neonatal suppurative parotitis ( 8) . the patient had unilateral swelling which was similar to that of similar literature ( 2 , 3 ) . penicillinase - resistant penicillins or first - generation cephalosporin are the good initial choices to effectively control s. aureus , along with clindamycin or a similar medication to control possible anaerobic infections . the present patient received a seven - day treatment . the shortest duration reported in treating s. aureus parotitis in neonatal suppurative parotitis is more prevalent among boys ( 2 , 10 ) . in the current report , antimicrobial treatment lead to clinical improvement in majority of the patients in the study by spiegel et al . complications such as facial palsy , mediastinitis , salivary fistula and extension to external ear are infrequent due prompt antibiotic therapy ( 12 ) . parotid swelling , purulent exudates from the stensen 's duct and growth of the pathogenic bacteria in the parotid plus culture were the diagnostic criteria ( 2 ) . in conclusion , acute suppurative parotitis should be suspected in infants presenting facial swelling , redness of pre - auricular region , and fever .

– Mary Kay Letourneau now works as a paralegal, but the former Seattle schoolteacher apparently didn't know much about law in the 1990s. She told an Australian TV station Sunday that when she had sex with 12-year-old student Vili Fualaau, she had no idea it was a crime, Fox reports. "If someone had told me, if anyone had told me, there is a specific law that says this is a crime," she told Channel Seven. "I did not know. I've said this over and over again. Had I’d known, if anyone knows my personality. Just the idea, this would count as a crime." Letourneau, who served more than seven years in prison and married Fualaau after her release in 2005, said she "absolutely felt wrongfully convicted." She is trying to get her name removed from the sex offenders' register. After interviewer Matt Doran tried to get her to admit that she "should have known better," the former teacher, who is 22 years older than Fualaau, said he was the one who pursued her and had been "the boss" back then, news.com.au reports. Letourneau—who was living with her husband and four children when the affair with Fualaau began—has two daughters with her former student, one born after her initial arrest and one born while she was in prison. The elder daughter, 21-year-old Audrey, told the station that their upbringing didn't feel strange. "It's kind of surprising to people but it's normal for us because we've adapted to it," she said. (Fualaau filed for legal separation last year, but the filing was later withdrawn.)

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Mary Kay Letourneau, the Seattle elementary school teacher who was convicted of raping her sixth-grade student before she ultimately married him and had two daughters, said in a new interview she didn't know the love affair was a crime. “If someone had told me, if anyone had told me, there is a specific law that says this is a crime,” she said on “Sunday Night” on Australia’s Channel Seven. “I did not know. I’ve said this over and over again. Had I’d known, if anyone knows my personality. Just the idea, this would count as a crime.” She also said she felt “absolutely” wrongfully convicted. She added that although Vili Fualaau was 12 years old at the time, 22 years her junior, she claimed he “was the boss” and pursued her, as news.com.au reported. Letourneau, now 56, became tabloid fodder when she pleaded guilty in 1997 to child rape. She was 34 and a married mother of four when her relationship with Fualaau began. The couple married on May 20, 2005, in Woodinville, Wash., after she served over seven years in prison. Fualaau asked the court for a legal separation from Letourneau in May 2017, but they have reconciled since. Letourneau told “Sunday Night” she’s still in love with her husband. Their daughter Audrey, 21, was born after Letourneau’s initial arrest, while Georgia, 19, was born during Letourneau’s prison time, news.com.au reported. “It’s kind of surprising to people but it’s normal for us because we’ve adapted to it,” Audrey said about their family’s controversy. Now a paralegal at the same court where she faced trial 21 years ago, Letourneau said she's looking to be removed from the sex offenders’ registry. The Associated Press contributed to this report. ||||| American schoolteacher Mary Kay Letourneau made headlines around the world for her secret affair with a 12-year-old student still insists today she had no idea what she did was a crime. Video: Sunday Night Convicted pedophile says she didn’t know it was a crime 0:18 MARY Kay Letourneau was a 34-year-old teacher when she made headlines for having sex with one of her grade six students. To this day the now 56-year-old insists she had no idea what she did was a crime. Letourneau was a mother of four and still married to her first husband when she was convicted of the rape Vilo Fualaau. He was age 12 at the time — and just 13 when Letourneau had his first baby. She pleaded guilty to two counts of felony second-degree rape of a child in 1997 and was sentenced to seven years in prison. Despite all this, Letourneau said she “did not know” she was committing was a crime. In an interview with Channel 7’s Sunday Night, the former Seattle primary school teacher was quick to defend her actions — a defence she’s held from the beginning of the affair. “I’ve said this over and over again. Had I’d known, if anyone knows my personality. Just the idea, this would count as a crime,” she said. “If someone had told me, if anyone had told me, there is a specific law that says this is a crime.” When journalist Matt Doran asked her if she believed she was wrongly imprisoned, she adamantly responded, “absolutely”. After six months in jail, Letourneau was granted parole on the condition she did not see Fualaau, who was just 1.5 years older than her eldest son. Less than a month later, police interrupted the couple having sex in a car. She was then sent back to jail after violating her condition, and ordered to serve out the balance of her sentence. But by then she was already pregnant with Fualaau’s second child — her sixth — and gave birth in prison. Audrey, 21, was born after Letourneau’s initial arrest, while Georgia, 19, was born behind bars. Both girls were raised by Mr Fualaau’s mother up until Letourneau’s release. Letourneau and Mr Fualaau then married in 2005. But last year, he allegedly filed for separation however withdrew the request, despite admitting to Sunday Night there are problems within their marriage. He said he had thought about leaving the relationship but Letourneau said she was still madly in love with her husband, now age 35. “Anyone that’s married knows that it’s a labour in love,” she said. During the Sunday Night interview, Letourneau jumped on the defence again when pressured by Doran to admit she “should have known better”. Letourneau turned to her husband and repeatedly asked him “who was the boss, who was the boss back then”, saying that he had pursued her. “He did say he was in love with me,” she said. “Flaw me, I did the best I could.” She had previously claimed how Mr Fualaau instigated the sexual relationship with his increasingly aggressive advances. For the first time, the couple’s daughters spoke about growing up in such a famous household. Audrey said it didn’t feel different to her and her sister because it wasn’t brought to their attention. “It’s kind of surprising to people but it’s normal for us because we’ve adapted to it,” she said. The 21-year-old then said her father, who is just 13 years her senior, was like a “friend dad”. Both Audrey and Georgia recently moved out of the family home. Letourneau and Mr Fualaau still live together. Today, Letourneau works as a paralegal at the same court where she faced trial 21 years ago. She hopes use her new skills in her fight to remove her name from the sex offenders’ registry.

acute kidney injury ( aki ) is a common problem , especially in critically ill patients . in critical care , kolhe and colleagues report that 6.3% of 276,731 patients in 170 intensive care units ( icus ) in the uk had evidence of severe aki within the first 24 hours of admission to icu . icu and hospital mortality as well as length of stay in hospital were significantly increased . in light of this serious burden on individuals and the health system in general , the following commentary discusses the current state of knowledge of aki in icu and calls for more attention to preventive strategies .

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acute kidney injury ( aki ) has been the focus of numerous publications and research projects in the past 5 years [ 1 - 4 ] , including the study by kolhe and colleagues in critical care . interestingly , as facts about aki and its impact on prognosis emerged , areas of uncertainty and controversy became apparent . it is now well known that aki affects a large number of patients ( although the exact incidence is variable ) , that aki per se is associated with an increased risk of death , and that patients who need renal replacement therapy ( rrt ) have a higher risk of dying [ 2 - 4,7,8 ] . there is also evidence that aki is a dynamic process , with many patients progressing through different stages of severity , and that early aki appears to have a better prognosis than late aki . numerous studies have identified factors that influence the prognosis of patients with aki , including inherent patient characteristics as well as modifiable factors ( ie , nephrotoxic drugs , fluid status , haemodynamics ) and non - patient related aspects like size of icu and type of hospital [ 2 - 4 ] . despite this progress , several areas in the field of aki remain uncertain , the issue of rrt being a particularly controversial one . there is wide variation in clinical practice regarding mode , indication , timing , dose and provision of rrt . despite a widely held perception that a continuous mode may be better for critically ill patients with aki , especially those with haemodynamic instability , clinical studies have failed to show a consistent survival advantage for patients on continuous rrt compared to intermittent haemodialysis . the hemodiafe study ( randomized controlled trial comparing intermittent haemodialysis with continuous haemodiafiltration in 21 centres in france ) not only showed similar mortality rates in both groups but also confirmed that nearly all patients with aki as part of multiple - organ dysfunction syndrome could be treated with intermittent haemodialysis provided strict guidelines were used to achieve tolerance and metabolic control . in a landmark study , ronco and colleagues made a strong case for dosing rrt ( the more the better ) . however , when challenged in subsequent studies , this conclusion could not always be confirmed . most recently , the acute renal failure trial network study demonstrated in a randomized controlled multicenter fashion that intensive renal support in critically ill patients with aki did not decrease mortality , improve recovery of kidney function or reduce the rate of non - renal organ failure compared to less intensive therapy . in view of these uncertainties about ' best clinical practice ' it is not surprising that the mortality associated with aki in critically ill patients has not substantially changed during the past few decades despite increasing international efforts and advances in medical knowledge . lack of a uniform definition for aki and lack of evidence - based guidelines have been blamed for some of the inconsistencies and poor progress . formation of the international aki network group , design of the rifle criteria and later the aki classification and plans for streamlined focussed research are major steps in the right direction to tackle the problems associated with established aki . the study by kolhe and colleagues in critical care illustrates that we may need to focus our attention also on the time before aki has developed . kolhe and colleagues show that 6.3% of 276,731 patients admitted to 170 icus in the uk during a 10 year period had evidence of severe aki ( serum creatinine 300 mol / l and/or urea 40 mmol / l ) during the first 24 hours in icu . as addressed by the authors , the study has some weaknesses ( arbitrary definition of severe aki , potential risk that some patients classified as aki in fact had advanced chronic kidney disease , and no information on the number of patients treated with rrt ) . however , there are important messages : 6.3% of all icu patients were admitted with severe derangement of renal function . the exact reasons for renal dysfunction are not given and may not be known but the question remains whether aki could have been prevented prior to transfer to icu . chertow and colleagues previously showed that even small changes in serum creatinine by 0.3 mg / dl ( 26 mol / l ) whilst in hospital were independently associated with an increased risk of dying . given the serious implications of any degree of aki on the individual and the health system , and the lack of curative therapies for aki , it may be necessary to shift our attention more to the actual way we look after patients at risk of aki , that is , how we recognise high - risk patients and prevent aki . this call for ' attention to basics ' includes general measures like education and training of nursing and medical staff , emphasis on the importance of the clinical examination , attention to drugs , drug dosing and nutrition , and early consultation with specialists in the field . the success of these simple non - technical steps depends on combined efforts by anybody looking after patients in hospital . the overall action plan to reduce the burden of aki needs to incorporate these preventive strategies as well as regular review of clinical practice , in parallel with international collaboration and focussed research into drug therapies and technologies . aki : acute kidney injury ; icu : intensive care unit ; rrt : renal replacement therapy .

– What are North Korean workers doing when not preparing for a nuclear test? Letting loose on the volleyball court, apparently. "Unusual" satellite images of the Punggye-ri nuclear test site, snapped on Sunday and described in a 38 North report, reveal not the expected preparations for the country's sixth nuclear test but rather three concurrent games of volleyball, reports the New York Times. Since North Korea knows when satellites zip overhead, analysts say the games at the main administrative area, guard barracks, and support area of the command center—plus an apparently unused volleyball net at the command center—were likely meant to convey some sort of message, though they aren't exactly sure what. "They're either sending us a message that they've put the facility on standby, or they're trying to deceive us," according to one expert. "We really don't know." The games could also signal a "tactical pause," per CNN. Analysts still believe the site is ready for another nuclear test at any time. But they say much of the activity seen at the site over the last eight weeks appears to have ended. Vehicles and trailers have disappeared from roads. And though there are minor signs of tunneling, "the pumping of water out of the tunnel to maintain an optimal environment for instrumentation and stemming seems to have ceased," the report states. Still, the games aren't new: Per the 38 North report, "Personnel playing volleyball at the Punggye-ri nuclear test facility have also been identified on a number of occasions as far back as 2006 prior to the first nuclear test and more recently in February."

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Analysts who examine satellite images of North Korea reported on Wednesday that they had spotted some unexpected activity at the country’s nuclear test site: active volleyball games in three separate areas. The surprising images were taken on Sunday as tensions between the United States and North Korea seemed to spike. The Korean Peninsula pulsed with news that the North was preparing for its sixth atomic detonation and that American warships had been ordered into the Sea of Japan as a deterrent, even though the ships turned out to have sailed in the opposite direction. The volleyball games, played in the middle of that international crisis, were probably intended to send a message, analysts said, as the North Koreans are aware that the nuclear test site is under intense scrutiny. But what meaning the North wanted the games to convey is unclear. “It suggests that the facility might be going into a standby mode,” Joseph Bermudez told reporters on a conference call organized by 38 North, a research institute at the Johns Hopkins University School of Advanced International Studies. “It also suggests that these volleyball games are being conducted with the North Koreans knowing that we’ll be looking and reporting on it.” ||||| Story highlights Satellite images show what appears to be volleyball games being played on nuclear site Analysis suggests that the test site is ready, or that tests have been put off for now (CNN) After readying a possible nuclear test, it seems that North Korea's nuclear technicians are entitled to some downtime. North Korean monitoring service 38 North says satellite images from April 16 show what appears to be "three volleyball games underway at different locations throughout" at the Punggye-ri nuclear test site. The analysts say the games could indicate the test site has "transitioned to a stand-by status" and that personnel were "being allowed some downtime for recreation." Or, they say, it could be a "tactical pause" until leader Kim Jong Un gives his orders. Just one week ago, the monitoring agency said the site was " primed and ready " for a sixth nuclear test. 38 North says this images show a "probable volleyball game seen at the command center support area" at the North Korea nuclear test site. Read More ||||| A 38 North exclusive with analysis by Joseph S. Bermudez Jr., Jack Liu and Frank Pabian. After almost eight weeks of elevated activity at the Punggye-ri Nuclear Test Site, commercial satellite imagery from April 16 indicates little activity around the North Portal, the tunnel that North Korea appears to have been preparing for another nuclear test. Imagery does show what may be three volleyball games underway at different locations throughout the facility, and possibly another volleyball net set up at the command center area.[1] At the North Portal, the pumping of water out of the tunnel to maintain an optimal environment for instrumentation and stemming seems to have ceased. This could mean that the tunnel has been completely sealed or that the North may have installed drainage pipes instead of using open ditches. The vehicles or trailers that were previously observed near the portal or on nearby roads are gone. Three mining carts are present on the spoil pile and there appears to have been some minor dumping of material there in the past few days. Based on available imagery, the status of the test site remains unclear. While activities over the past few weeks are similar to those seen prior to previous tests, possible explanations for the most recent developments are: The site and associated preparations for a sixth nuclear test have transitioned to a “stand-by” status, with personnel being allowed some down-time for recreation. Since the North Koreans are aware of when commercial satellites will fly overhead, the presence of personnel at play (with what looks like the normal six players on each side) may be a way of signaling that a decision has been made to place the test on hold.[2] Pyongyang has initiated a tactical pause in activity at the test site as part of an overall deception plan, delaying the sixth nuclear test until a time when a detonation would achieve the greatest political advantage. The North has engaged in such practices in the past. The most notable instance was the satellite launch from the Sohae Satellite Launching Station in December 2012, when North Korean press reported technical problems with the Unha space launch vehicle after it was loaded onto the launch pad, but then proceeded to launch it the next day. Regardless, satellite imagery continues to indicate that the Punggye-ri nuclear test site appears able to conduct a sixth nuclear test at any time once the order is received from Pyongyang. Figure 1. Only minor activity seen at the North Portal. Figure 2. Recent dumping seen on the North Portal’s spoil pile. Figure 3. Probable volleyball game seen at the Main Administrative Area. Figure 4. Probable volleyball game seen at the command center support area. Figure 5. Probable volleyball game seen near the guard barracks. Figure 6. Possible volleyball net seen in the command center area. ————— [1] Volleyball is a popular sport in North Korea and satellite imagery often identifies games in progress throughout the nation. Personnel playing volleyball at the Punggye-ri nuclear test facility have also been identified on a number of occasions as far back as 2006 after the first nuclear test and more recently in February. To date, however, there have been no instances of three concurrent volleyball games. [2] The orbital timetables of commercial imaging satellites are well known and available on the internet. There is even an Android or iOS App for it.

– Prince William has appeared on the cover of the UK gay magazine Attitude to speak out against bullying people because of their sexuality. The second-in-line to the throne is the first member of the royal family to appear on the cover of a gay publication, the AP reports. William called on young people being bullied for their sexuality to seek help. "No one should be bullied for their sexuality or any other reason and no one should have to put up with the kind of hate that these young people have endured in their lives," he said. William had revealed his magazine appearance on Tuesday after signing a condolence book for victims of the gay nightclub shooting in Orlando which killed 49 people and wounded dozens.

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Britain's Prince William and Kate, Duchess of Cambridge attend the Secretary of State for Northern Ireland Theresa Villiers' garden party at the royal residence at Hillsborough Castle, Northern Ireland,... (Associated Press) Britain's Prince William and Kate, Duchess of Cambridge attend the Secretary of State for Northern Ireland Theresa Villiers' garden party at the royal residence at Hillsborough Castle, Northern Ireland, Tuesday June 14, 2016. (Brian Lawless/PA via AP) UNITED KINGDOM OUT (Associated Press) Britain's Prince William and Kate, Duchess of Cambridge attend the Secretary of State for Northern Ireland Theresa Villiers' garden party at the royal residence at Hillsborough Castle, Northern Ireland, Tuesday June 14, 2016. (Brian Lawless/PA via AP) UNITED KINGDOM OUT (Associated Press) Britain's Prince William and Kate, Duchess of Cambridge attend the Secretary of State for Northern Ireland Theresa Villiers' garden party at the royal residence at Hillsborough Castle, Northern Ireland,... (Associated Press) LONDON (AP) — Prince William has appeared on the cover of the U.K. gay magazine, "Attitude" to speak out against bullying people because of their sexuality. The second-in-line to the throne is the first member of the royal family to appear on the cover of a gay publication. William called on young people being bullied for their sexuality to seek help. "No one should be bullied for their sexuality or any other reason and no one should have to put up with the kind of hate that these young people have endured in their lives," he said. William had revealed his magazine appearance on Tuesday after signing a book of condolence for victims of the gay nightclub shooting in Orlando which left 49 people dead and dozens wounded. ||||| On Thursday 12 May 2016, His Royal Highness The Duke of Cambridge invited Attitude magazine to bring members of the LGBT+ community to Kensington Palace to hear their experiences of homophobic, bi-phobic and transphobic bullying, and discuss the mental health implications it has. Attitude editor Matthew Todd facilitated the discussion. After meeting with the nine delegates, Prince William then posed for the cover of Attitude magazine, photographed by Leigh Keily. The cover marks the first time a member of the Royal Family has been photographed for the cover of a gay publication. Of course, most LGBT+ people do not suffer with such problems and live happy, successful lives. But, sadly, statistics show that the LGBT+ community is one that continues to suffer disproportionately from mental health issues, while bullying in schools is still an issue too many young LGBT+ people are exposed to. Prince William met with individuals who explained how bullying had led to low self-esteem, suicide attempts, eating disorders, depression and drug addiction including, in one case, the death of a young man after an unintentional overdose. In 2015, LGBT+ mental health charity PACE (since shut down because of government cuts) produced an extensive report into the mental health issues faced by the LGBT+ community. It found that 33.9% of young LGB people had made at least one suicide attempt compared with 17.9% of young straight people, while 48.1% of trans young people had attempted suicide. The study also found that 57.1 % of LGB people had self-harmed at least once compared with 38.3% of heterosexual young people. 85.2% of trans young people had self-harmed as opposed to 47.4% of cisgender young people. After the discussion, HRH The Duke of Cambridge made the following statement: “No one should be bullied for their sexuality or any other reason and no one should have to put up with the kind of hate that these young people have endured in their lives. The young gay, lesbian and transgender individuals I met through Attitude are truly brave to speak out and to give hope to people who are going through terrible bullying right now. Their sense of strength and optimism should give us all encouragement to stand up to bullying wherever we see it. What I would say to any young person reading this who’s being bullied for their sexuality: don’t put up with it – speak to a trusted adult, a friend, a teacher, Childline, Diana Award or some other service and get the help you need. You should be proud of the person you are and you have nothing to be ashamed of.” Attitude editor Matthew Todd says: “During my time as editor of Attitude I have met parents whose child has taken or lost their life after being bullied for being LGBT+ or just perceived to be LGBT. I am very happy that the future King of the United Kingdom agrees this must stop and I would urge parents in particular to raise their voices in their communities to ensure that every school protects – really protects – all children.” This issue of Attitude magazine went to press on Wednesday 8 June, just days before the devastating shooting in Orlando which saw 49 LGBT+ people lose their lives. Attitude sends our most heartfelt condolences to those affected by this atrocity. Around the world, LGBT+ people experience hatred and violence every day. Such violence does not exist in a vacuum but snowballs from intolerance and bullying that begins in classrooms, too often comes from politicians or religious leaders and is often not treated with respect by the media. You can read our full feature with the Duke of Cambridge and see his exclusive shoot in Attitude’s July Issue, available to download now from pocketmags.com/attitude. It’s in shops next Wednesday (June 22), and print copies are available to order globally from newsstand.co.uk/attitude. If you have been affected by any of these issues, please ask for help from: switchboard.lgbt samaritans.org childline.org.uk More stories: From shootings to suicide: Why homophobia remains as deadly as ever Orlando gay club shooting: The victims

– In case you had forgotten that celebrities are not just like you, we have a bunch of recent evidence for you: Madonna’s daughter Lourdes turned 16 recently, and as we all know, 16 is a big deal. So of course her mum bought her … an apartment, the Daily Star reports. It seems the teen has been rebelling lately, and for some reason Madonna figured the solution would be to let her move out. But don’t worry, the apartment is only a few blocks away from Madonna’s in Manhattan, and is of course close to the Kabbalah Centre. Most of us spend about 30 bucks on our Halloween costumes, but not Kim Kardashian. She went to a party Saturday night as the mermaid Daryl Hannah played in Splash, and her blonde wig—made from real human hair, of course—set her back $2,000. No word on how much she paid boyfriend Kanye West, who carried the tail of her costume around so she wouldn’t trip, the New York Daily News reports. Usher may take the cake: On Thursday, he spent $12,000 on a puppy, Us reports. But don’t fret, he bought the goldendoodle at a charity gala, so at least that 12 grand is going to a good cause. Click for even more crazy celebrity purchases.

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Usher Raymond IV attends the second annual Pencils of Promise Gala in New York City. Credit: Mike Coppola/Getty Images for Pencils of Promise) Usher sure has expensive taste! Attending the Oct. 25 Pencils of Promise gala in New York City, the singer and new Voice mentor outbid former Gossip Girl actress Jessica Szohr in order to take home an adorable -- and coveted -- Goldendoodle puppy. PHOTOS: Music's most stylish stars A cross-bred dog that is a mix between a golden retriever and a poodle, Usher's new pet came with a price tag of $12,000 -- money that goes to the Justin Bieber-endorsed organization that builds schools in impoverished nations. (Not to be ignored, Szohr bid an impressive $11,000 in an attempt to take the animal home, according to reports.) PHOTOS: Stars' good deeds "Poppy Raymond is what I'm think of namin' her . . . however there are two gregarious 3- and 4-year-olds that will have the last say -- and the responsibility that comes with her," the singer, 34, tweeted after taking home the animal, referring to his two sons, Usher Raymond V and Naviyd Raymond, who will likely be bowled over by their dad's latest purchase. PHOTOS: Usher's life as a dad Donating funds to adopt a new pet wasn't the only kind gesture Usher made at the event. The "Numb" singer also donated a private dance lesson as an auction item. Following a bidding war between Bieber's manager, Scooter Braun -- the brother of Pencils of Promise founder Adam Braun -- and two families in attendance, Braun let the families take the prize after they each bid $65,000 for the lesson. ||||| Kim Kardashian might not have the fondest memories of Halloween — she filed for divorce from her husband, Kris Humphries, on the holiday last year — but the bootylicious reality star didn’t let it show at the 2nd Annual Midori Green Halloween at Avenue on Saturday night. Dressed as a blond-wigged mermaid reminiscent of Daryl Hannah in “Splash,” Kardashian cuddled up to beau Kanye West in a roped-off booth after making it through throngs of friends and fans that packed the Chelsea club. Capt. Kanye did little to embrace Kardashian’s nautical theme, except sport a striped shirt. But he did step in to pick up the tail of her costume and ensured that she wouldn’t trip. Meanwhile, her bodyguards had trouble pushing away overeager fans from the 32-year-old reality phenomenon as she and West headed for their private booth, where pals La La Anthony, Simon Huck and Joyce Bonelli waited. “Kanye kept bragging to their friends how beautiful Kim looked and that he loved her being a blond,” says an eyewitness. The rapper wigged out over Kardashian’s new ’do for the evening, which cost $2,000 and was made from real human hair. A source in the Kardashian camp says it’s no surprise that Kim K. is “in a much better place” this Halloween season, despite still being locked in a divorce battle with the Brooklyn Nets player. While the rapper and reality star have been riddled with all kinds of engagement rumors as of late, the couple have indeed discussed a future together. “It would be a problem for everyone for her to get engaged while she’s still technically married to Kris,” explains the insider. “But [Kim and Kanye] have already talked about it, and Kim is in the driver’s seat on this one.” But maybe not entirely: “Announcing her engagement to the public could depend on the filming of her reality show (‘Keeping Up With the Kardashians’),” the source elaborates. The cameras were aimed at the couple and their comrades last night, but not for the E! reality show. That doesn’t mean KimYe, who are staying together at his NYC apartment, turned off the PDA. They whispered in each other’s ears and exchanged multiple kisses, breaking their embrace only for West to throw his hands in the air when DJ Kiss put on the rapper’s ode to Kardashian, “Perfect Bitch.” HALLOW-TEEN NIGHT Peter Brant II had a new Halloween wingman with him at Rose Bar Saturday night. Sources told Confidenti@l that instead of partying with his younger brother, Harry, the 18-year-old son of billionaire art baron Peter Brant showed up to his All Hallow’s Eve party with Wolf Fleetwood-Ross. The teenage model — who appeared in a campaign for Tory Burch earlier this year alongside Ruby Aldridge and Dree Hemingway — can boast Fleetwood Mac founder Mick Fleetwood as a grandfather, Oscar-winning rocker Atticus Ross as a father and model Liberty Ross as an aunt. The duo showed up after midnight and mingled with fellow co-host Amanda Hearst. WEATHER OR NOT Matt Damon didn’t let NYC’s threat of bad weather scare him late Sunday morning. While storm clouds lingered overhead and the streets were clearing out in the West Village, the actor, sporting a shaved head, calmly walked his 5-year-old daughter, Isabella, who was dressed up in a princess Halloween costume, along 10th St. and Greenwich Ave. AN OFF-THE-WALL COSTUME Socialite Allison Sarofim made sure none of her own guests could top her costume at her annual Halloween bash held in her swanky West Village townhouse on Saturday night. A guest tells us the wealthy brunette beauty’s party was Picasso-themed this year, and Sarofim “took it to the max.” When attendees complimented their host on her getup, we hear she simply thanked them and said her costume was inspired by the painting she purchased, which was currently hanging above her fireplace. Tres chic. Contact Confidential: Carson Griffith: [email protected] Brian Niemietz: [email protected] Lisa Lang: [email protected] Nate Freeman: [email protected] Follow us on Twitter: @nyc@Confidential

this paper highlights the need for carriers to be followed up by health professionals who understand the complexities of the brca syndrome . a brca carrier clinic has been established in london and regular follow up is an essential part of the care for families . an open door policy has been set up for patients who may meet or telephone the cancer genetic nurse specialist for support and care at any time . an example of the follow up work is discussed in the format of a case of a young woman with a brca1 alteration who developed a primary peritoneal cancer following prophylactic oophorectomy . this case illustrates the work of the multi - disciplinary team caring for brca carriers .

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families who harbour deleterious genetic alterations in a brca gene react differently according to their situation . health professionals provide time and understanding within the genetic testing programme to help individuals consider their options before proceeding to genetic testing . once the test result is confirmed , the affected person may consider new prevention options to reduce the risk of another cancer developing . these options may be discussed with the medical team who are trained in oncology and genetics . patients who are gene mutation carriers and who have developed cancer have a risk to develop further primaries . gene carriers who have developed cancer are managed under different units with specialists who may not have an in - depth understanding of the brca syndrome . the brca gene mutation carrier clinic of the royal marsden hospital / institute of cancer research has a threefold purpose : 1 . ongoing support of gene carrier families and patients . annual appointments are made for these patients as well as access to a ' ' virtual telephone clinic '' . the latter clinic is run by the nursing team who are trained in oncology and genetics and who probably know the family well . 2 . clinical management issues : discussions related to further surgical prevention procedures i.e. mastectomy , prophylactic oophorectomy . the opportunity for family members to participate in research . within the carrier clinic of the royal marsden hospital / institute of cancer research there are several ongoing collaborative studies ( as shown in figure 1 ) and patients have the options to be involved in studies after full informed consent . there are nearly 200 patients who have brca gene mutations who are participating in this clinic . for some people , years later , the effort of attending a clinic diminishes its attraction , especially if they are unaffected and have chosen prophylactic surgery as an option . a ' ' virtual '' clinic has therefore been established as part of the ' ' carrier clinic '' . it offers regular follow up support and access for gene carriers who are worried about their medical health . the service involves discussions with nurses who are trained in oncology and genetics and who have experience in working with brca gene mutation carriers . families with mutations in the brca genes know that they can contact the ' ' virtual clinic '' at any time for support or advice . if a patient is already under another unit / hospital , then contact is made with the appropriate medical person accompanied by a follow up letter and appropriate investigations . in some instances , preliminary investigations such as blood tests she was keen to be tested as so many of her female relations had died prematurely from cancer . information from another centre provided her with the knowledge that there was a deleterious mutation present in the brca1 gene in her family . at the age of 33 she underwent predictive genetic testing and had several sessions with the clinical nurse specialist and the medical team before deciding to proceed . this she hoped would reduce her life time risk of ovarian cancer of 50% by about 96% and reduce her risk of developing breast cancer by 50% . after serious consideration following several counselling sessions she had a medical history of endometriosis and decided along with her gynaecologist to have a total hysterectomy as she was troubled by menstrual problems . furthermore , she had two children and was adamant that she did not wish to have any more children . she was followed up in the breast unit for annual screening . as part of the " virtual clinic " for gene carriers , ongoing support was available for this young lady who had a limited family support structure . on one of the regular follow up calls , she sounded depressed and was therefore invited in to the nurse who led follow up clinic . during this session , she informed the nurse that she was feeling tired and " not herself " . this young lady was known well to the nurse through the predictive genetic testing programme . the nurse was concerned that there maybe something medical that needed serious consideration . furthermore , as part of the brca clinic protocol , patients who have undergone prophylactic oophorectomy are offered a ca125 test with the knowledge that this test 's predictive value in this situation is uncertain . in this particular case , the consultant and the nurse were in discussion about the management of this young lady and a ca125 test was arranged along with a few other blood tests . a transvaginal ultrasound scan and another ca125 test was arranged along with an appointment to the gynaecology clinic . unfortunately , this young woman was found to have an early stage primary peritoneal cancer . she has undergone intensive chemotherapy and is currently being followed up in the onco - gynaecology unit for her cancer care . the ongoing follow up for this young woman as part of the carrier clinic has shown the benefits of this follow up service both from a medical management perspective and a psychological support service . it is essential that there are professionals who understand the brca syndrome in the fullest sense , including both genetic and oncological perspectives and the possible associated further cancer risks . as it is such a specialist area of knowledge , the patient is well served with qualified professionals who will liaise with the appropriate health professionals . we would like to thank professor martin gore and his team ; mr d barton and his team .

to avoid the complications associated with endotracheal intubation , noninvasive positive - pressure ventilation ( nppv ) has been proposed in the management of ventilator weaning in patients with acute respiratory failure ( arf ) of various etiologies . several studies have been performed to assess the benefit of nppv in various weaning strategies , including permitting early extubation in patients who fail to meet standard extubation criteria ( facilitation use ) , avoiding reintubation in patients who fail extubation ( curative use ) , and preventing extubation failure in nonselected and selected patients ( preventive use ) . nppv has been successfully used in facilitating early extubation , particularly in patients with chronic obstructive pulmonary disease . in contrast , applying curative nppv to treat postextubation arf in nonselected populations may not be effective and could even be deleterious . early use of nppv was successful in preventing arf after extubation , and decreased the need for reintubation in selected patients at risk of developing postextubation arf . it is important that caregivers clearly differentiate among these application modalities of nppv . the skills and expertise of both medical and nonmedical personnel are crucial predictive factors for the success of nppv in the ventilator weaning process .

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in the present issue of critical care , the use of noninvasive positive - pressure ventilation ( nppv ) as a facilitative weaning technique has been clinically assessed by trevisan and colleagues . sixty - five patients on invasive mechanical ventilation for > 48 hours and with t - piece weaning trial failure were randomly assigned to receive bilevel nppv by facemask or to continue the weaning process with invasive ventilation . chronic obstructive pulmonary disease ( copd ) aggravation , postoperative acute respiratory failure ( arf ) , and heart disease were the most frequent causes for the use of invasive ventilation support in both groups . the results of the trial showed that patients of the two groups had similar gas measurements throughout the study . the length of stay in the intensive care unit , the duration of mechanical ventilation after randomization , and the mortality were not statistically different when comparing the groups . furthermore , the percentage of complications in the nppv group was lower ( 28.6% versus 75.7% ) , with a lower incidence of pneumonia ( 3.6% versus 45.9% ) and tracheotomy ( 0% versus 18.9% ) , than in the invasive ventilation group . these results led the authors to conclude that early extubation and nppv is a valid alternative for ventilation in a group of heterogeneous patients that initially failed weaning . nppv is increasingly being proposed in the management of the ventilator weaning process , to avoid the complications of endotracheal intubation , and thereby to potentially lower morbidity and mortality rates in selected patients with arf . the first report to assess the role of nppv as a weaning technique dates back to 1992 , when nppv was successfully used in assisting the return of spontaneous breathing in a small group of 22 patients with chronic respiratory insufficiency and weaning difficulties . several trials have been performed thereafter to further determine the benefit of nppv in permitting early extubation in patients who fail to meet standard extubation criteria [ 6 - 9 ] ( facilitation technique ) , in avoiding reintubation in patients who fail extubation [ 10 - 13 ] ( rescue or curative technique ) , and in preventing extubation failure in nonselected patients and selected patients ( preventive or prophylactic technique ) . a recent meta - analysis of five studies enrolling a total of 171 patients was performed to investigate the role of nppv in facilitating early extubation . compared with weaning strategies that involved invasive mechanical ventilation alone , noninvasive weaning was associated with a significant decrease in mortality , in the incidence of ventilator - associated pneumonia , and in the total duration of mechanical ventilation . in a subgroup analysis , earlier trials on postextubation arf in copd patients and in postoperative patients after lung resection showed a significant decrease in the need for reintubation using nppv compared with standard medical treatment . despite these encouraging results , two subsequent studies evaluating the effectiveness of nppv as a curative or rescue technique to treat the occurrence of postextubation arf in nonselected populations failed to show improved outcomes . a number of trials have investigated the preventive or prophylactic use of nppv immediately after extubation in avoiding extubation failure in comparison with standard medical therapy . in one early study on the indiscriminate use of nppv in extubated patients , no significant difference in the rate of reintubation for either strategy was found . in two subsequent studies , nppv was found to prevent arf after extubation and to decrease the need for reintubation in selected patients at risk of developing postextubation arf , especially those patients with hypercapnia during their spontaneous breathing trial . it is important that caregivers clearly differentiate among these application modalities of nppv ( facilitative , curative and preventive ) in the management of patients with tracheal intubation in clinical practice , and be aware of the benefit that each of these modalities can provide . trevisan and colleagues have made an important contribution to the continually evolving research on the use of nppv in the management of weaning from mechanical ventilation . their results extend the conclusions of other authors that nppv can be a useful adjunct to conventional weaning strategies [ 6 - 9 ] . in their study , trevisan and colleagues aim to assess the nppv benefits in the weaning process of a heterogeneous group of patients . despite the great interest of these findings for all practicing clinicians , the number of patients enrolled in the study was small , hence limiting the generalizability of its conclusions . currently available data suggest that the potential effectiveness of nppv for facilitating ventilator weaning and early extubation varies across patient population , and that the benefit seems greatest for copd patients . further studies are needed to better identify those subcategories of patients with non - copd arf who are most likely to benefit from nppv during the weaning process and those who are at highest risk of adverse consequences . the skills and expertise of both medical and nonmedical personnel represent some of the most important factors for the success of nppv in the ventilator weaning process . it is crucial that caregivers can identify patients who are likely to benefit from early extubation with nppv and exclude those patients for whom this approach would be unsafe . once the decision to institute nppv has been taken , an interface and ventilatory mode must be chosen , and close monitoring in an appropriate hospital location must be provided . finally , arf = acute respiratory failure ; copd , chronic obstructive pulmonary disease ; nppv = noninvasive positive - pressure ventilation .

– Suzanne Jovin was found near the Yale campus in New Haven, Conn., with 17 stab wounds to her neck and head and the tip of a knife lodged in her skull. Nineteen years later, investigators and an assistant state's attorney are still devoting eight hours each week to the murder case—and may be close to solving it. Recently, the team submitted Jovin's clothing for touch DNA analysis, sought help from the FBI, interviewed new and old witnesses across the country, and hired a hypnotist to work with a witness who might've seen the Yale student minutes before she was killed, reports the Hartford Courant. The new strides were revealed in a recent Freedom of Information hearing after documentary filmmakers requested case files be released. In denying the request, an FOI hearing officer noted the files could compromise the ongoing investigation, adding "a prospective law enforcement action is a reasonable possibility." She did not elaborate. Several suspects have surfaced since Jovin, 21, was found on Dec. 4, 1998, two miles from the Yale campus, a location authorities believe she was driven to, A&E noted when highlighting the case earlier this year. Among them is Jovin's professor and thesis adviser, James Van de Velde, though he maintains his innocence and won at least $200,000 in a 2013 settlement with Yale and New Haven over damage to his reputation. A witness also described a man with "blondish hair” and "chiseled features" running from the scene. (Jovin's murder isn't the only one to haunt Yale.)

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The Victim Suzanne Jovin, 21, a political science major at Yale, described by friends as beautiful, smart, and compassionate. She volunteered often and was director of Best Buddies, a charity working with intellectually and developmentally disabled adults. The Crime On an unseasonably warm winter day in New Haven on December 4th, 1998, Jovin finished cleaning up after a pizza party for Best Buddies. A friend who saw her on campus at about 9:25 PM recalled that she said she was very tired. She also mentioned needing to pick up some borrowed GRE study materials. Around a half-hour later, she was found about two miles away from campus with multiple stab wounds to her head and neck. Passersby and neighbors said they heard a woman’s screams. The 911 call came in just before 10 PM. Jovin died at Yale New Haven Hospital later that night. The Evidence The knife tip of the murder weapon was found lodged in Jovin’s skull. Reportedly a Fresca bottle with Jovin’s fingerprints was near her body, and DNA was recovered from under her fingernails. The distance from where Jovin was last seen was almost two miles. The police say it was virtually impossible for her to walk or run there, so they think she was driven there, likely by someone she knew. A tan or brown van was seen parked near where her body was found. The Investigation The parents: In 1999, Suzanne’s mother Donna wrote an open letter to local newspapers begging the killer’s mother to come forward. “Only you can imagine the pain and anguish which I have felt,” she wrote. In 2009, both parents wrote a letter (that was much covered in the press) to Connecticut Governor M. Jodi Rell asking her to help rectify what they saw as the shortcomings of the state forensic lab. The Jovin Investigative Team: In 2007, the New Haven State Attorney gathered a group of retired Connecticut State Police detectives to delve into the cold case (they’re still on it — as unpaid consultants). In 2014, the Team (which includes representatives from the New Haven police, the Division of Criminal Justice Cold Case Division, and the Office of New Haven State’s Attorney) held a community meeting asking locals for leads. Her teacher: Soon after the murder, police looked at James Van de Velde, a Yale Class of ’82 graduate and a lecturer in the Political Science department. He was also Jovin’s senior essay advisor. On his Linkedin profile, Van de Velde describes himself as a “cyber warfare, WMD and counterterrorism analyst…” With police naming him as a suspect, Yale dropped his classes that spring. Van de Velde was never charged, and later sued both the university and the city of New Haven for damage to his reputation. According to a New Haven Register article, the city and Yale agreed to settle in 2013. The “running man“: David Cameron, a political science professor at Yale and a member of the state’s Eyewitness Identification Task Force (established to examine issues related to criminal lineups), has studied and written about the case. “The investigation continues,” he wrote to A&E in an email. He thinks that it’s “pretty obvious” who did it: the “running man.” An eyewitness saw a man running across Whitney Avenue and told the police shortly after the murder, according to published reports. The team of former state police investigators had a police artist sketch made. “The woman was a thoroughly reliable witness but the police at the time (and thereafter) wrote her off as uncooperative for several reasons,” Cameron told us. Cameron believes that one reason could be that she did not identify James Van de Velde as the runner. Her senior essay: Another theory buzzing around the web was that Jovin’s senior essay on Osama bin Laden had something to do with her murder. She had handed in a final draft to Van de Velde on that last day. This has spawned blogs posts and speculative comments that her murder was somehow related to 9/11. A troubled grad student: Others have seized upon as a suspect a (unnamed in the press) Yale School of Architecture grad student who reportedly told friends he was “obsessed with” Jovin’s murder. The student died in a car accident or potential suicide in 2012. The two were not known to be acquainted. The GRE study buddy: Another lead seems to be the so-far-unidentified person from whom she was retrieving the borrowed GRE exam prep materials that night. Where it Stands Jovin’s friends and members of the Yale community have continued to commemorate the anniversary of her death, according to the Yale Daily News. In what looks like a studio yearbook photo, she smiles prettily from the cold case file on the website of the Connecticut Division of Criminal Justice. The caption reads: “We are interested in all available information or leads, no matter how remote or trivial that information may seem…We want to hear from anyone who has heard something, seen something, or may even have repressed the knowledge of something” related to the murder. Next year [2018] will be the 20th anniversary of Suzanne Jovin’s death. Yale and the state of Connecticut are offering a reward of up to $150,000 for information leading to the arrest and conviction of her killer. A&E’s Real Crime gets closer to the people and the stories behind the crime headlines. (Image: News 8 /Getty Images) ||||| The seed for this crawl was a list of every host in the Wayback Machine This crawl was run at a level 1 (URLs including their embeds, plus the URLs of all outbound links including their embeds) The WARC files associated with this crawl are not currently available to the general public.

rotating antibiotics in the intensive care unit may result in less infections caused by resistant organisms and in even less mortality . the selection of super - resistant organisms associated with the rotation strategy can not be excluded , however , and many practical issues will have to be addressed before antibiotic rotation can be routinely recommended .

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usa published work into rotating empirical antibiotics in an intensive care unit in june 2001 . this was the first time that a quarterly rotation of empirical antibiotics used for 1 year was compared with the previous year of non - protocol - driven use in critically ill patients . the research showed that rotation was associated with a significant reduction in infection episodes caused by gram - negative , antibiotic - resistant organisms . the paper also showed that rotating antibiotics resulted in a lower incidence of gram - positive coccal infections , less methicillin - resistant staphylococcus aureus ( mrsa ) and gentamicin - resistant enterococci infections , and a clear reduction in mortality associated with infection . in fact , antibiotic rotation was an independent predictor of survival . the raymond et al . bacterial resistance is progressing faster than the number of new antibiotics available to the clinician , resulting in higher costs and poorer outcomes . to meet this challenge , new strategies that optimise the use of available antimicrobials while the basic principle of rotating antibiotics is simple , behind it lie a number of conceptual and practical issues that are much more complex . a first antibiotic regimen is chosen for a group of patients during a specific period of time , then a second regimen is selected for another period , and then perhaps a third , and even a fourth , regimen may follow . the same sequence of antibiotic regimen is then repeated . the basic idea is that a bacterium that becomes resistant to the first regimen would remain susceptible to the second regimen . if it is resistant to the second regimen , the third regimen should cope with the resistance , and so on . for instance , if the resistance comes from a plasmid , the bacterium may require more energy during bacterial multiplication or for producing large amounts of beta - lactamases . it may alternatively lead to variations in the bacterium 's ability to take up nutrients . the multiplication of resistance mechanisms in the same bacterial cell line should hence be detrimental to its optimal propagation , allowing sensitive bacteria ( with supposedly better fitness ) to take over . the expected consequence would be a decline in resistance and easier management of infected patients . bacteria possess mechanisms that allow them to become resistant to several structurally unrelated antibiotics at once . mobile genetic elements that encode for numerous resistance mechanisms can become incorporated into the stable genetic structures of bacteria . besides the well - known plasmids , bacteriophages , and transposons , the more recently described integrons can capture multiple gene cassettes , express them , and then integrate them into the chromosome . the genes found in integrons often encode antibiotic resistance , including proteins such as efflux pumps , acetyl - transferases , dihydro - folate reductases , and beta - lactamases . furthermore , co - selection of resistance determinants can be achieved by numerous other molecular mechanisms of resistance , representing additional threats to the rotation strategy . for instance , the combination of quinolone and methicillin resistance is often observed in s. aureus . multidrug active efflux systems can pump out an astonishing number of unrelated antibiotics , any of these substrates acting as a potential trigger . for example , activation of the mexe - mexf - oprn multidrug efflux system generates an oprd ( the carbapenem porin ) deficiency , so that ciprofloxacin , for instance , can select resistance to carbapenems in the absence of carbapenem exposure . extended - spectrum cephalosporin use is associated with infection and colonisation with vancomycin - resistant enterococci . klebsiella pneumoniae strains producing extended - spectrum beta - lactamases often harbour plasmids that encode resistance to other antibiotics and that cross - resist to quinolones by mechanisms that are currently unclear . moreover , the metabolic consequences of some multiple resistances are questionable considering the remarkable stability of meca in the mrsa , vancomycin - resistant determinants in the enterococci , or integrons in nature , even in the absence of antibiotic pressure . a general consensus has to be obtained between hospital administration , health carers , and pharmacists : all prescribers have to follow the guidelines ; the different regimens used in the rotation must be chosen in the light of recent scientific knowledge ; the duration of each cycle must be between the ' too short ' , the ' difficult to implement ' , and the ' too long ' , allowing the selection of resistance during therapy despite the rotation policy ; and , above all , optimal infection control measures have to be ensured . for example , an influence of the aminoglycoside in use on aminoglycoside resistance patterns was reported , and a diminution in the rates of ventilated associated pneumonia , including those caused by mrsa , was observed . a decline in faecal vancomycin - resistant enterococci colonisation was also reported . none of these studies , however , investigated an actual rotation policy including a sufficient number of cycles ; that is why the paper by raymond et al . antibiotic rotation is feasible and apparently beneficial , but many questions remain unanswered . all the studies published , including that of raymond et al . , used historical controls ( before versus after studies ) , which is inappropriate considering the variable nature of bacterial epidemiology . the risk of selecting ' super - resistant bugs ' during the rotations has not been specifically addressed . the time has come for large , co - operative international studies on these important issues .

amebic liver abscess ( ala ) in pediatric age group is rare . we describe a successful thrombectomy and open drainage of a large left lobe ala associated with thrombus in the hepatic veins and inferior vena cava extending into the right atrium in a 6-year - old boy .

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amebic liver abscess ( ala ) is a common entity especially in an endemic region . it can present in a myriad fashion with various complications with significant morbidity and mortality . or may remain asymptomatic . ala as a cause of inferior vena cava ( ivc ) thrombosis is exceedingly rare . herein , we describe a successful management of a 6-year - old child with ala and ivc thrombosis with an aggressive surgical approach . a 6-year - old malnourished boy was referred with a history of fever of 1-month duration , pain in right upper abdomen , loose motions , and vomitings for 14 days . there was hepatomegaly with tenderness and guarding in the upper abdomen with ascites . on chest auscultation , an ultrasound showed a large single abscess of 94 ml in the left lobe of liver closely abutting the intra - hepatic vena cava . contrast - enhanced computed tomography of abdomen revealed left lobe liver abscess in segments ii and iii . the thrombus was visible in the middle and left hepatic veins together with a thrombus in the ivc which extended up to the right atrium [ figure 1 ] . laboratory investigations of patient contrast - enhanced computed tomography ( cect ) scan images showing ( a ) thrombus in inferior vena cava ( ivc ) , ( b ) thrombus in right atrium , ( c ) abscess in left liver lobe in reconstructed coronal section , and ( d ) abscess in left liver lobe in axial section two - dimensional - echocardiography confirmed the above findings . the patient tested positive for amebic antibody by enzyme - linked immunosorbent assay ( elisa ) test . thrombus extracted from inferior vena cava ( ivc ) and atrium the ivc was thoroughly irrigated with normal saline . after reversal of systemic heparinization , the abdomen was opened by a roof top incision and the falciform ligament was divided . the abscess was palpable in the postero - superior aspect of segment ii lying just left of the divided falciform ligament . it was adhered to the diaphragm which was dissected free and then the abscess was de - roofed . lavage was performed followed by placement of tube drain in left sub - diaphragmatic space . pus was sent for examination which failed to reveal any trophozoites on microscopic examination and was negative for pyogenic organisms . the patient is on regular follow - up and he is in good health at 6 months from the date of operation . ala occurs because of hematogenous spread of the trophozoites of entameba histolytica from the intestinal mucosa to the liver through the portal vein . ala is most common in the tropical and sub - tropical regions . in the pediatric age group , the incidence of ala is relatively rare and only 21 - 30% of liver abscesses are of amebic type . left lobe lesions are less common , accounting for only 10 - 35% of all alas . this skewed distribution is thought to be due to the greater width and the more linear course of the right branch of the portal vein . ala is usually clinically suspected in any patient with characteristic features of pain in right upper abdomen , fever , and tender hepatomegaly . diagnosis is confirmed radiologically by demonstrating a space occupying lesion in the liver supported by a positive amebic serological test . the usual course of an ala is favorable and predictable if early diagnosis and management are initiated . ivc and/or hepatic vein thrombosis are among them which are very rare and reported scarcely in the literature . the proposed mechanisms are external compression together with a contiguous spread of inflammation over the vessel wall . the resultant endotheliitis predisposes to stasis and thrombosis and this ongoing process is the cause of extension of thrombosis into the vascular system . on this backdrop , respiratory movements of the diaphragm and coughing can cause further damage to the endothelial lining of the ivc , and this may predispose to thrombus formation in this part of the ivc . ala causing ivc thrombosis and extending into the atrium has been reported in adults by a few authors . hodkinson et al . reported ivc thrombosis with atrial extension as a complication of ala in a 50-year - old patient . barcat et al . , sodhi et al . , khan et al . , and zia - ur - rehman et al . have described cases with similar presentation as ours in adults . managed it with thrombolysis alone , whereas a percutaneous drainage with pig tail was required by sodhi et al . surgical removal was resorted to by the last two authors . in our case , the distinctive points were ( i ) involvement of the left lobe , ( ii ) a prolonged trial of conservative management could not have been given , and ( iii ) precarious and close relation to the pericardium and ivc precluded us to try percutaneous drainage . hence , a laparotomy was done after thrombus extraction which resulted in a thorough and controlled drainage . to conclude , our case is the first pediatric case of ala reported in english literature , to be managed in this manner . this report highlights the importance of promptly diagnosing these exceptional cases and also emphasizes individualizing the management based on patient 's clinical profile and available multimodality expertise for optimum outcome . an early aggressive surgical approach may prove life saving and crucial in preventing pulmonary embolism or budd chiari syndrome which may have an overall poor outcome .

lethal midline granuloma is a relatively rare disease characterized by destruction and mutilation of the nose and other structures of respiratory passages . the nonspecificity of symptoms obscures the correct diagnosis and is responsible for the delay in treatment which can be detrimental as this grave disease calls for urgent intervention . we present a case report of this disease in a 35 year old male who gave a short two month history of the clinical symptoms .

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lethal midline granuloma is a midfacial necrotizing lesion that is characterized by destructive , mucosal lesions of the upper aero digestive tract . the underlying mucosa is thickened and the patient usually develops extensive midfacial destructive lesions , perforated nasal septum and erosion of the nasal bone . the disease is localized to the upper aerodigestive tract at presentation but dissemination to distant sites may occur . constitutional symptoms may develop . also referred to as polymorphic reticulosis , midline malignant reticulosis , stewart s granuloma most of the lethal midline granulomas are nk / t cell lymphomas . here , we present a case of nk cell lymphoma in a 35 year old male who came with a short clinical history . a 35 year old male presented with swelling in the right side of neck since two months . this was followed by pain and swelling on the dorsum of nose since one and a half months . patient also gave a two week history of stuffiness in the right nostril and bilateral nasal mucopurulent discharge . , there was a 5 4 cm swelling on the right side of dorsum of nose and nasolabial fold . there was no history of epistaxis , anosmia , post nasal drip , oral bleed or cough . clinical photo showing swelling and erythema on the dorsum of the nose all routine hematological and biochemical investigations were normal . hiv , hbsag and vdrl were negative . a contrast enhanced computed tomogram ( cect ) of the paransal sinuses showed right sided superficial medial canthus related right sided nasolabial disease with metastatic right sided cervical and submandibular lymphadenopathy . a biopsy was taken from the mass and sent to national institute of pathology for histopathological examination . a diffuse lymphomatous infiltrate having an angiocentric and angiodestructive pattern plasma cells , histiocytes and eosinophils were present admixed with atypical lymphocytes [ figure 2c ] . immunohistochemistry was performed and the lymphomatous infiltrate was found to be positive for lca [ figure 3a ] , cd56 [ figure 3b ] and cd3 [ figure 3c ] . however fungal stains , periodic acid schiff ( pas ) were done to exclude fungal disease . based on these findings a diagnosis of extranodal nk cell lymphoma was made . the patient was referred to the oncology department for further management and he received four cycles of multidrug chemotherapy ( chop regimen ) . follow - up the mass had slightly reduced in size , there was relief from episodes of epistaxis and nasal discharge had stopped . ( a ) photomicrograph showing diffuse lymphomatous infiltrate destroying the hair follicles ( h and e , 40 ) ; ( b ) photomicrograph showing extensive areas of necrosis ( h and e , 100 ) ; ( c ) photomicrograph showing atypical lymphocytes admixed with histiocytes , plasma cells and eosinophils ( h and e , 400 ) ( a ) ihc showing atypical lymphocytes positive for lca ( h and e , 100 ) , ( b ) ihc showing atypical lymphocytes positive for cd56 ( h and e , 100 ) , ( c ) ihc showing atypical lymphocytes positive for cd3 ( h and e , 100 ) malignant lymphomas of the sinonasal region and nasopharynx are majorly of non - hodgkins lymphoma type and fall either into nk / t cell type , b cell type or peripheral t cell type . the most common of the so called nasal type in which the nasal cavity is the prototype site of involvement are the extranodal nk / t cell lymphomas . in the past this entity has been referred to as lethal midline granuloma , polymorphic reticulosis , malignant midline reticulosis . macroscopically the lesions usually look like necrotic granulomas and are characterized by ulceration and destruction of the nose and paranasal sinuses with erosion of soft tissues , bone and cartilage of the region . the patients show an aggressive and lethal course with rapid destruction of the nose and face ( midline ) , therefore the term lethal midline granuloma . this disease occurs around the fourth decade and the male to female ratio is 8:1 to 2:1 . morphologically it is characterized by extensive ulceration of mucosal sites with a lymphomatous infiltrate that is diffuse , but has an angiocentric and angiodestructive growth pattern . nk cells are active against tumor cells and cells infected with bacteria or viruses without prior sensitization . these develop from precursor cells that can differentiate into nk / t cells and this explains why some of the nk cells can also express t cell markers . the most common immunophenotype of the is cd56 + , cd2 + and surface cd20-.[357 ] seen mostly in adults in the asian and mexican region , skin involvement is seen in 10 - 20% of patients . our patient was a 35 year old male with short history of right sided nasal obstruction and discharge with same sided tender erythematous lesion with lesional biopsy showing atypical lymphoid cells that were positive for cd56 on ihc . nasal nk / t cell lymphoma is an aggressive disease with a rapid downhill course . untreated , this disease has a very high mortality reaching almost 100% due to septicemia , perforation into blood vessels or penetration into brain leading to abscess . wang et al . , reported combined chemotherapy followed by involved field external radiation beam to be beneficial in patients and prolonged progression free survival rates . the confusing clinical picture of this disease calls for a high degree of suspicion for correct diagnosis and early intervention to prolong the patient survival .

we report the case of a 46-year old patient in whom an electrophysiology study ( ep ) was performed due to paroxysmal supraventricular tachycardia documented in 12-lead ecg . during the ep study , supraventricular tachycardia was induced easily and it corresponded to orthodromic av reentry tachycardia ( avrt ) using a concealed left free wall accessory pathway . however , during the study avrt spontaneously and repeatedly converted to the typical slow - fast av node reentry tachycardia ( avnrt ) . both accessory and av nodal slow pathways were ablated , due to the finding that both avrt and avnrt were independently inducible during the ep study .

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electrophysiology ( ep ) study with catheter ablation is the favourable method in treatment of patients with paroxysmal supraventricular tachycardia ( svt ) according to current acc / aha / esc guidelines , with high success and low complication rates . the two most common paroxysmal svts are atrioventricular nodal reentry tachycardia ( avnrt ) and orthodromic atrioventricular reentry tachycardia ( avrt ) using an accessory pathway ( ap ) , . however , both types of tachycardias can rarely be found in the same patient , . we describe a patient with both orthodromic avrt and slow - fast avnrt , in whom the avrt spontaneously and repeatedly converted to the typical slow - fast avnrt and both tachycardias were independently inducible during the ep study . a 46-year old woman , with history of hypertension and documented regular , narrow qrs tachycardia , was referred to our institution for ep study . in the last five months she was treated 6 times in the emergency room ( er ) , always presenting with palpitations , dizziness , hypotension and narrow qrs complex tachycardia . in available ecgs during the tachycardia , there were no visible p waves . , ecg showed normal sinus rhythm without pre - excitation and echocardiography demonstrated no structural heart disease except mild left ventricular hypertrophy with grade i diastolic dysfunction . paul , minnesota , usa ) were positioned in high right atrium , right ventricular apex and his area , and steerable decapolar catheter ez steer ( biosense webster , diamond bar , california , usa ) was positioned into coronary sinus . at baseline , sinus cycle length , ah and hv intervals were normal . during atrial programmed stimulation jump was induced at 500/280 ms . supraventricular tachycardia was induced repeatedly with atrial and ventricular pacing and it corresponded to orthodromic av re - entrant tachycardia avrt ( cycle length 330 ms ) using a concealed , left free wall accessory pathway ( ap ) . after cessation of ventricular overdrive pacing , the same tachycardia resumed with a measurement that correlated to avrt ( vav pattern , post - pacing interval ( ppi ) tachycardia cycle length ( tcl ) = 100 ms , his synchronous extra - stimulus advanced the atrial activation ) ( fig . 1 ) however , during the ep study the avrt spontaneously converted ( fig . 2 ) to the typical slow - fast avnrt ( cycle length 360 ms ) , with characteristics : va < 30 ms , ppi tcl > 150 ms , jump noted at programmed pacing ( 500/280 ms ) from right atrium as well as the echo beat . noteworthy , both tachycardias were independently inducible during atrial and ventricular pacing ( fig . 3 ) , without conversion of avnrt to avrt . a slow pathway was localized and then ablated using radio - frequent ( rf ) catheter ablation ( temperature controlled mode 50c/30 w ; blazer ii xp standard curve , boston scientific , massachusetts , usa ) , with slow - rate junctional rhythm observed during ablation and no signs of slow av node pathway after ablation ( erp n antegrade 260 ms , antegrade suprahisian av block < 300 ms ) . after rf ablation , avnrt could not be induced ; however the avrt was repeatedly induced without conversion to avnrt . by performing a transseptal puncture of the interatrial septum guided by fluoroscopy , the left lateral wall ap was also successfully localized and then ablated using rf catheter ablation ( temperature controlled mode 50c/30 w ; blazer ii xp standard curve , boston scientific , massachusetts , usa ) ( fig . after the rf ablation , neither avrt nor avnrt could be induced at baseline nor after the infusion of isoproterenol ( up to 6 mcg / min iv . ) . no procedure - related complications occurred during or immediately after the procedure , as well as during 1-year follow - up after ablation . during avrt and avnrt have prevalence of 2.25/1000 persons and the incidence of 35/100000 person - years in general population , with the fact that these two most common supraventricular tachycardias can occasionally be found together in a single patient , , . some authors achieved complete cure by ablating the common limb of both tachycardias : slow av node pathway or only ap in patient in whom the avnrt did not seem to be the patient 's clinical tachycardia but tachycardia - induced tachycardia . in this case , the ablation of both pathways was done due to two facts . first , both tachycardias were independently inducible , which is very rare , therefore determining the clinical tachycardia was rather difficult . although the ecgs from the er correspond most likely to avnrt ( no p waves visible ) the tachycardia which was induced more easily in the ep lab was avrt which spontaneously converted to avnrt . second , the spontaneous and immediate transition from one tachycardia into another is rather uncommon . proved that the conversion of one tachycardia into another is most common with tachycardia whose cycle lengths difference is < 25 ms with 80% positive predictive value , whereas in our case the difference was 30 ms . it is recommended that during each ep study a complete ep protocol should be applied and every possible manoeuvre should be made in order to obtain a confident diagnosis since multiple tachycardia can appear in one patient and in different combinations , , , .

anti - neutrophil cytoplasmic antibody ( anca)-associated vasculitis is traditionally viewed as a small vessel disease . we report a patient with canca antibodies directed against proteinase-3 with asymptomatic aortic involvement , in combination with diffuse alveolar haemorrhage and pauci - immune , necrotizing crescentic glomerulonephritis . a review of the literature is discussed .

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the chapel hill consensus conference classification system classifies vasculitis according to vessel size and characteristic clinical and histopathological features . anti - neutrophil cytoplasmic antibodies ( anca ) have been used to further characterize the small - vessel vasculitides . large - vessel vasculitis comprises fewer clinical syndromes than medium- or small - vessel vasculitides , most commonly giant cell arteritis and takayasu s arteritis . large vessel involvement in anca - associated vasculitis is uncommon and , when present , often portends a poor prognosis , with outcomes involving aortic dissection , rupture and , possibly , stenosing arteritis . we describe a case of asymptomatic large vessel involvement in a biopsy - proven canca - associated small - vessel vasculitis . a 64-year - old greek man , previously well , presented with a 4-week history of fever , malaise , dysuria and haematuria . a trial of antibiotics ( roxithromycin and cephalexin ) from his local doctor had not improved his symptoms . at presentation relevant physical findings included crackles at the left lower lung field and minimal oedema in the lower extremities . initial laboratory investigations demonstrated a serum creatinine of 92 mol / l , with elevated inflammatory markers ( c - reactive protein 29 mg / l ; erythrocyte sedimentation rate 93 mm / h ) . initial urine microscopy revealed heavy isomorphic haematuria without cellular casts and an escherichia coli infection on culture . after treatment of the infection , urine microscopy demonstrated > 1000 10/l dysmorphic red cells and 24-h urine collection revealed significant proteinuria ( 1.05 g / day ) , with a creatinine clearance of 33 ml / min . a blurred outline of the abdominal aorta was revealed on computerized tomography ( ct ) scan , and subsequent ct aortogram revealed near circumferential soft tissue oedema of both the thoracic arch and inferior to the origin of the renal arteries . ( b ) ct scan of abdominal aorta at 2 months ( inflammation indicated by arrowheads ) . renal biopsy confirmed the presence of a pauci - immune , necrotizing crescentic glomerulonephritis with fibrocellular crescents present in 40% of the glomeruli . a positive anca titre was subsequently detected with granular cytoplasmic staining showing specificity for proteinase-3 ( 55 u / ml ) . oral cyclophosphamide ( 1.5 mg / kg / day ) and intravenous methylprednisolone ( 500 mg / day ) were commenced ; however , within a week , the patient developed diffuse alveolar haemorrhage . he required a total of six plasma exchanges > 10 days . despite treatment , the serum creatinine continued to rise ( peaking at 650 the patient was discharged on cyclophosphamide ( 1.5 mg / kg / day ) and prednisolone ( 60 mg / day ) . two months after discharge , investigations revealed a serum creatinine of 167 mol / l ( canca 30 u / ml ) , figure 2 . clinical remission was evident after 3 months treatment with cyclophosphamide , and methotrexate was commenced after the patient proved intolerant to azathioprine . twenty months later , the patient has remained well with a serum creatinine of 115 mol / l , with negligible haematuria ( 5 10/l erythrocytes on urine microscopy ) and proteinuria ( protein : creatinine ratio 0.010 g / mmol ) . there is no evidence of aortic vasculitis on ct scan , although the mid - thoracic and abdominal aorta remain mildly tortuous and ectatic . rbc , red blood cells ; hpf , high power field ; pcr , protein : creatinine ratio ; esr , erythrocyte sedimentation rate ; crp , c - reactive protein . anca - associated large - vessel vasculitis ( alv ) has rarely been reported in european and north american populations . it is possible that common pathological processes are involved in both large- and small - vessel vasculitis . intimal injury may be the initial insult , progressing to inflammation of the medial layer and then adventitia , with resulting transmural aortitis . alternatively , the large vessel wall changes seen on imaging may be a result of vasculitis of the vasa vasorum of the aortic wall [ 35 ] . the presentation of anca - associated large - vessel vasculitis is diverse but appears intrinsically different from the stenosing lesions of takayasu s vasculitis [ 69 ] . case reports of wegener s granulomatosis with large vessel involvement also include periaortitis , with resultant aortic aneurysm and dissection [ 2 , 10 ] . given the infrequent number of reports , there is no consensus on the management of patients with alv . however , apart from surgical intervention for dissection or rupture , the finding of large vessel involvement does not appear to require additional treatment . most patients have been managed with an extended period of immunosuppression using corticosteroids and cyclophosphamide , following similar regimens for small vessel disease . our patient underwent a follow - up ct aortogram 2 and 20 months after diagnosis . for patients with significant renal impairment , contrast ct scans may risk contrast - induced nephropathy , and alternative options include magnetic resonance imaging or positron emission tomography scanning . while anca - associated disease is often considered to be limited to small vessels , this case highlights that large vessels can also be affected . its true frequency is unknown as involvement appears to be asymptomatic ; however , though not seen in our patient , it can be associated with a poor outcome due to vessel rupture or dissection . this case illustrates the need for awareness of potential large vessel involvement in anca - associated small vessel disease .

– It hasn't been a great month for Taylor Swift: She lost her latest boyfriend, lost a potential Golden Globe to Adele (and looked pretty unhappy about it), and now Radar reports that she also lost a chance to snag the next guy on her list. Seems Swift had a little crush on Bradley Cooper, and asked her friend and Cooper's Silver Linings Playbook co-star Jennifer Lawrence to hook the two of them up. But when Lawrence talked to Cooper, he shot down the idea. Awkward. "First of all, her reputation precedes her. Bradley is very wary of dating someone who is a bit of a serial dater like Taylor," a source explains. Plus, "he thinks she's far too young for him." He also thinks Lawrence herself is too young for him: Rumors had been swirling that the co-stars were an item, but at the Golden Globes Cooper was quick to shoot them down. "That's very funny," the 38-year-old told Entertainment Tonight. "First of all, I could be her father. ... She's amazing, but no."

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You just know there’s another song that’s going to written from this: Taylor Swift wants to hook up with Bradley Cooper, RadarOnline.com has learned exclusively. And now the superstar singer has asked pal Jennifer Lawrence to introduce her to Silver Linings Playbook co-star Bradley. The newly single 23-year-old country music singer desperately wants to date the hunky Hangover actor and has begged Jennifer, 22, to set up them up. PHOTOS: Taylor Swift And Harry Styles In The Park However, when Jennifer sounded Bradley, 38, out about Taylor he said he wasn’t interested and that she was too young for him! “Bradley has absolutely no intention of getting together with Taylor,” a source told RadarOnline.com. PHOTOS: Taylor Swift And Conor Kennedy Hold Hands At The Beach “First of all, her reputation precedes her. Bradley is very wary of dating someone who is a bit of a serial dater like Taylor. “He thinks she’s far too young for him and wants to date someone his own age, not 16-years younger because he’s ready for something serious. PHOTOS: Selena Gomez & Taylor Swift Hang Out “It was a little awkward for Bradley . Jennifer came to him and told him that Taylor was interested in getting together. “He had to politely decline, knowing full well that Jennifer and Taylor are friends. PHOTOS: Taylor Swift In December’s Cosmo “It was an ambitious move from Taylor, but she’s going to have fixate on someone else as Bradley’s just not that into her,” the source divulged. As RadarOnline.com previously reported, Taylor’s back on the market again after she was dumped by One Direction’s Harry Styles because she wouldn’t, um, keep up with him sexually. PHOTOS: Stars Who’ve Slammed Their Exes In Songs “Taylor is so concerned that the public will think she’s promiscuous because she dates around, that she doesn’t put out,” a pal close to the We Are Never Ever Getting Back Together singer told RadarOnline.com. “What she doesn’t get is that the guys keep dumping her because she’s being a prude.” PHOTOS: Taylor Swift At Kennedy Event IN NYC Another source says the fact that she constantly talked about antiques was another turn-off for the young singer! “Harry found Taylor a little sexually uninterested,” a source close to the star revealed. PHOTOS: Taylor Swift Is Morphing Into A Kennedy! While it was clear she obviously had a thing for Harry, Taylor didn’t want to put out as often as he would’ve liked. Harry is a young boy, with ladies throwing themselves at him and has had a string of relationships with older women. “It’s no secret he’s sexually active and is enjoying his fame at the moment. But Taylor just wasn’t up for it as much as he is. They were sexually incompatible.” RELATED STORIES: Recording A Hate Song For Harry? Taylor Swift Hightails It To The Studio After Styles Split Harry Styles Dumped Taylor Swift Because She’s ‘Asexual & Wouldn’t Put Out,’ Says Insider Poor Taylor! Olivia Munn Gives Swift The Kanye West Treatment! Jack Osbourne’s Wife Slams ‘Bat S**t Crazy’ Taylor Swift ||||| Silver Linings Playbook stars Jennifer Lawrence and Bradley Cooper arrived separately at the Golden Globes red carpet on Sunday amid gossip that they might be romantically involved -- rumors that they both claimed to ET's Nancy O'Dell are completely false. RELATED: 2013 Golden Globes Winners "We've done two movies together," said Bradley, who also stars alongside J.Law in the upcoming film Serena. "If it didn't happen by now, it's not going to happen." "I concur," said Jennifer, who appeared at the awards show despite her 100-degree fever. "I'm fine," Jennifer said, going on to explain, "It's the flu ... I had the doctor come over and give me a shot of something in my butt today and tell me I had the flu." Silver Linings racked up four nominations on the night, while individually Bradley was nominated for Best Performance by an Actor in a Motion Picture - Musical or Comedy, and Jennifer has already won for Best Performance by an Actress in a Motion Picture - Musical or Comedy. ||||| CTRL-C or CMD-C, then press Enter. Click/tap elsewhere to exit, or press ESC. Youtube Why do we get the feeling Taylor Swift 's not impressed after Adele beat her out for a Golden Globe for Best Original Song? Maybe that's because at the moment her rival won for "Skyfall" and waxed ecstatic onstage during her acceptance speech, TV cameras caught the pop superstar looking not so gracious in defeat. Taylor, however, should have saved the mad face for a few minutes later. Because once Adele was done at the podium, the songstress found herself the butt of a joke from Globes host Tina Fey, who, drink in hand, jabbed, "You know what, Taylor Swift? You stay away from Michael J. Fox's son." Of course, the funnylady was referencing the 23-year-old Swift's penchant for short-lived romances, most recently her two-month fling with One Direction hottie Harry Styles which reportedly ended last week. But the singer, who was nominated for her song "Safe & Sound" from The Hunger Games, did receive some sympathy from cohost Amy Poehler, who urged Swift to "go for it." Cracked Fey in reply, "No, she needs some me time to learn about herself." Well, maybe Taylor will write a song about them too. Share Tweet Share Email <> Embed CTRL-C or CMD-C, then press Enter. Click/tap elsewhere to exit, or press ESC.

– For more than 50 years, scientists from across the globe have been painstakingly mapping both poles, trying to get an accurate sense of the rock hidden beneath the ice sheets. Now, thanks to satellite data from multiple organizations and "serendipitous reconnaissance radio-echo sounding data" over the canyons of Antarctica, scientists report in the journal Geology that a canyon system lurks beneath the ice in a largely unexplored region of eastern Antarctica, and it's so massive it appears to dwarf the Grand Canyon. A year ago some of the same scientists announced the discovery of another giant chasm beneath the ice in western Antarctica, the Ellsworth Trough, which is 200 miles long and in some places nearly 2 miles deep. The latest finding is in an almost completely unknown region of Antarctica called Princess Elizabeth Land—"in fact, the bed of Antarctica is less well known than the surface of Mars," lead researcher Dr. Stewart Jamieson says in a press release. Along with the Recovery Basin, the two regions have been dubbed the "Poles of Ignorance." This latest survey was prompted by satellite imaging that, "because the ice is flowing over that landscape," as one researcher tells the BBC, hinted at the grand topography beneath. Though it still needs to be confirmed, this canyon system looks to be more than 600 miles long and as deep as half a mile in places. (The Grand Canyon, by comparison, is 277 miles long and up to a mile deep.) The canyons appear to connect to a subglacial lake that's nearly 800 square miles in area, which is 80 times the size of the largest lake in England. (Life can exist that far below the ice.)

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Abstract The subglacial landscape of Princess Elizabeth Land (PEL) in East Antarctica is poorly known due to a paucity of ice thickness measurements. This is problematic given its importance for understanding ice sheet dynamics and landscape and climate evolution. To address this issue, we describe the topography beneath the ice sheet by assuming that ice surface expressions in satellite imagery relate to large-scale subglacial features. We find evidence that a large, previously undiscovered subglacial drainage network is hidden beneath the ice sheet in PEL. We interpret a discrete feature that is 140 × 20 km in plan form, and multiple narrow sinuous features that extend over a distance of ∼1100 km. We hypothesize that these are tectonically controlled and relate to a large subglacial basin containing a deep-water lake in the interior of PEL linked to a series of long, deep canyons. The presence of 1-km-deep canyons is confirmed at a few localities by radio-echo sounding data, and drainage analysis suggests that these canyons will direct subglacial meltwater to the coast between the Vestfold Hills and the West Ice Shelf. ||||| The world's largest canyon may lie under the Antarctic ice sheet, according to analysis of satellite data by a team of scientists, led by Durham University. Although the discovery needs to be confirmed by direct measurements, the previously unknown canyon system is thought to be over 1,000km long and in places as much as 1km deep, comparable in depth to the Grand Canyon in USA, but many times longer. The canyon system is made up of a chain of winding and linear features buried under several kilometres of ice in one of the last unexplored regions of the Earth's land surface: Princess Elizabeth Land (PEL) in East Antarctica. Very few measurements of the ice thickness have been carried out in this particular area of the Antarctic, which has led to scientists dubbing it one of Antarctica's two 'Poles of Ignorance'. The researchers believe that the landscape beneath the ice sheet has probably been carved out by water and is either so ancient that it was there before the ice sheet grew or it was created by water flowing and eroding beneath the ice. Although not visible to the naked eye, the subglacial landscape can be identified in the surface of the ice sheet. Faint traces of the canyons were observed using satellite imagery and small sections of the canyons were then found using radio-echo sounding data, whereby radio waves are sent through the ice to map the shape of the rock beneath it. These are very large features which appear to reach from the interior of Princess Elizabeth Land to the coast around the Vestfold Hills and the West Ice Shelf. The canyons may be connected to a previously undiscovered subglacial lake as the ice surface above the lake shares characteristics with those of large subglacial lakes previously identified. The data suggests the area of the lake could cover up to 1250km², more than 80 times as big as Lake Windermere in the English Lake District. An airborne survey taking targeted radio-echo sounding measurements over the whole buried landscape is now underway with the aim of unambiguously confirming the existence and size of the canyon and lake system, with results due later in 2016. Lead researcher, Dr Stewart Jamieson, from the Department of Geography at Durham University in the UK, said: "Our analysis provides the first evidence that a huge canyon and a possible lake are present beneath the ice in Princess Elizabeth Land. It's astonishing to think that such large features could have avoided detection for so long. "This is a region of the Earth that is bigger than the UK and yet we still know little about what lies beneath the ice. In fact, the bed of Antarctica is less well known than the surface of Mars. If we can gain better knowledge of the buried landscape we will be better equipped to understand how the ice sheet responds to changes in climate." Co-Author Dr Neil Ross from Newcastle University in the UK, said: "Antarctic scientists have long recognised that because the way ice flows, the landscape beneath the ice sheet was subtly reflected in the topography of the ice sheet surface. Despite this, these vast deep canyons and potential large lake had been overlooked entirely. "Our identification of this landscape has only been possible through the recent acquisition, compilation and open availability of satellite data by many different organisations (e.g. NASA, ESA and the US National Snow and Ice Data Center), to whom we are very grateful, and because of some serendipitous reconnaissance radio-echo sounding data acquired over the canyons by the ICECAP project during past Antarctic field seasons." Co-Author Professor Martin Siegert, from the Grantham Institute at Imperial College London, UK, said: "Discovering a gigantic new chasm that dwarfs the Grand Canyon is a tantalising prospect. Geoscientists on Antarctica are carrying out experiments to confirm what we think we are seeing from the initial data, and we hope to announce our findings at a meeting of the ICECAP2 collaboration, at Imperial, later in 2016. "Our international collaboration of US, UK, Indian, Australian and Chinese scientists are pushing back the frontiers of discovery on Antarctica like nowhere else on earth. But the stability of this understudied continent is threatened by global warming, so all the countries of the world now must rapidly reduce their greenhouse gas emissions and limit the damaging effects of climate change." ### The research is published in Geology. The research team was made up of scientists from Newcastle University, Imperial College London and Durham University in the UK, University of Texas at Austin, USA, University of Western Australia, Australian Antarctic Division, University of Tasmania in Australia, and the Polar Research Institute of China.

– Curiosity has identified a type of rock that no rover had previously spotted on Mars. It has the same chemical composition as rocks relatively common on Earth, found in rift zones like Hawaii's volcanoes, Wired reports. They develop in high-pressure conditions, often near water, though it's unclear if that's how this one formed, notes USA Today. The discovery of the rock, nicknamed "Jake Matijevic" in honor of a late NASA engineer, doesn't quite fit with the rover's mission to find conditions for life; Curiosity was analyzing it primarily in order to test instruments like an X-ray spectrometer and a laser blaster. Meanwhile, the "bright object" that Curiosity earlier found is probably just a piece of the rover itself, engineers say—either tubing or bonding material that fell off the rover. Either way, "it’s completely inconsequential to the rover’s function," says a scientist working on the mission.

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After shooting it with lasers and X-rays, NASA’s Curiosity rover has determined that a rock nicknamed “Jake Matijevic” is of a variety that no other rover has ever spotted on Mars. The rock, a highly fractionated alkalic rock type, is relatively well known to geologists because it is common in rift zones on Earth and island chains such as the Hawaiian Islands. “This is a rock type which had not been seen before” by previous Mars rovers including Spirit and Opportunity, said Roger Weins, principle investigator for Curiosity’s ChemCam instrument, during a NASA press conference Oct. 11. It forms under relatively high pressure and often in the presence of water. While Curiosity is mostly focused on sedimentary rocks that could indicate the presence of past conditions for life, Matijevic is an igneous rock that likely formed about 5 miles under the Martian surface. The rover had been investigating Matijevic mostly as an early test of the instruments on its arm, such as the Alpha Particle X-Ray Spectrometer (APXS), which bombards a sample with X-rays to determine its chemical composition. Curiosity also used its ChemCam instrument to shoot the rock with more than 400 laser blasts, vaporizing microscopic amounts and then analyzing the resulting dust and plasma. This investigation showed that the rock contained a lot of elements such as silicon, aluminium, sodium, and potassium. “This was surprising because it differed from the composition from what we know of rocks on Mars,” said Edward Stolper, Curiosity science team co-investigator, during the conference. Scientists think this rock formed in the interior of Mars when magma moved up through cooler rock. As the magma cooled, elements including nickel, iron, and magnesium crystallized out of it first, leaving behind a material rich in silicon, aluminum, sodium, and potassium, as well as a higher fraction of dissolved water. Though the rock was unusual, the Curiosity team was careful to point out that it was just one isolated sample and not to extrapolate too much about early Martian geology based on it. Engineers also discussed the case of the mysterious plastic object that Curiosity had spotted several days ago while scooping bits of Martian soil. They concluded that it is likely a bit of bonding material that fell off the rover or a piece of tubing that came off the descent stage and was recently blown off the probe. In either case, “it’s completely inconsequential to the rover’s function” and no further pieces have been seen, said engineer Chris Roumeliotis, the lead turret rover planner. Curiosity is continuing to go through its Martian dust rinse and repeat cycle to clean out its sample delivery instrument of any left-over contaminants from Earth. ||||| NASA's Curiosity rover successfully performed its first laser-chemistry tests and resumed sand-scooping tests, after determining a mystery "bright object" in the sand probably fell from the rover. A Martian volcanic rock dubbed "Jake Matijevic" was zapped by a laser aboard the Mars Curiosity rover. (Photo: NASA/JPL-Caltech/MSSS) Story Highlights A mystery object looks like a bit of plastic from rover wire bundles Scientists presented results from tests of a rock named "Jake Matijevic" Rover will head for a rock bed Scientists at the controls of NASA's Curiosity rover report that its first chemistry tests of a Martian rock revealed a surprise. The Mars rock looks a lot like volcanic ones found on Earth. In a briefing Thursday, NASA scientists said they base the observation on the rover's first laser-beam-aided chemistry tests of a Martian rock. The triangular rock dubbed "Jake Matijevic," named after a recently deceased engineer from the Jet Propulsion Laboratory in Pasadena, Calif., received about 30 small laser beam blasts aimed at revealing its interior chemistry. Unlike the volcanic rocks spotted by past Mars rovers, the 2-foot-wide rock has a familiar chemical composition resembling ones found on Hawaii and other volcanic islands, reports team scientist Edward Stolper of Caltech. "It is a very close match in its chemical composition to ones that are unusual but are well-known on Earth," he says. On Earth, such rocks form in volcanoes about 5 miles deep, typically in magma suffused with water, Stolper said. He said the team cannot say whether the Jake Matijevic rock formed the same way on Mars, or even what kind of asteroid impact or eruption carried it into Gale Crater, the 96-mile wide depression on Mars that the rover is exploring. NASA's Mars rover Curiosity collected a scoop of soil on Mars. (Photo: NASA/JPL-Caltech/MSSS) The team performed the investigation of the Mars rock as a first test of its laser chemistry sensors. It also resumed tests of the $2.5 billion rover's scoop. The sand scooping tests are similarly intended for cleaning and calibration of chemistry sensors on the end of the rover's 7-foot arm, says Chris Roumeliotis of NASA's Jet Propulsion Laboratory. The rover has vibrated and dumped one soil sample, another first on Mars, and will take at least one more before sand is allowed to enter a test chamber on the rover arm. In the next few weeks, the rover will head for a rock bed that is expected to shed light on the geology of the rocks underlying Gale Crater. Mission scientists report that a mysterious "bright object" spotted in a Martian sandpit that briefly delayed the rover's investigations this week is very likely a tiny bit of plastic shed from the rover itself. "Probably it happened to fall from the rover," says Chris Roumeliotis of NASA's Jet Propulsion Laboratory in Pasadena, Calif. Plastic ties bundle electric wires on the rover, and the team has noticed flakes missing from them, he said, adding that the team doesn't expect to see such flakes delaying future operations. "We do plan to take more images of it," Roumeliotis said.

a secondary aortoenteric fistula ( aef ) is a direct communication between the gastrointestinal tract and the aorta in a patient who has undergone major surgery on the aorta , often an aorta graft operation . we experienced a patient who had undergone graft interposition for abdominal aortic aneurysm and was admitted due to three episodes of hematemesis and following hamatochezia . gastroscopy , colonoscopy , and radioactive iodine scan failed to identify the bleeding site in the patient . he was diagnosed with aef by double balloon enteroscopy and recovered after surgical intervention .

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an aortoenteric fistula ( aef ) is an abnormal communication between a portion of the gastrointestinal ( gi ) tract and the aorta . it is classified as primary and secondary according to the presence of prior aortic surgery . the prognosis of aef mainly depends on the time interval between the first clinical manifestations and operative treatment . therefore early diagnosis is essential for elective surgery since reconstruction in the massive bleeding stage has a mortality of up to 80% . a 48-year - old man was admitted to our institution because of three episodes of abrupt hematemesis . four years ago , he underwent graft interposition for abdominal aortic aneurysm . on initial examination his blood pressure was 110/70 mm hg , pulse rate 120/min , respiratory rate 20/min , and body temperature was 36.5. laboratory tests revealed hemoglobin ( hb ) , 12.0 g / dl ( normal , 15.33.0 ) ; platelet count , 368,000/l ( normal , 220,000100,000 ) ; and white blood count , 11,100/l ( normal , 7,5003,500 ) . emergency esophagogastroduodenoscopy ( egd ) was performed to detect the bleeding focus in the upper gi tract ; however , there were no specific findings in egd . hematochezia occurred again on the second day , but we could not find the bleeding site in the lower gi tract by colonoscopy . also there were no specific findings in ileoscopy with a standard colonoscope and radioactive iodine bleeding scan . severe hematochezia occurred on the third hospital day , and the level of hb dropped to 8.4 g / dl . immediately , we performed a dbe via the oral route , which disclosed flat elevated erosion with silk in the proximal jejunum ( fig . 1 ) . endoscopic findings showed a fistula that opened and closed on the central portion ( fig . the patient was finally diagnosed with secondary aef by emergency multidetector computed tomography ( mdct ) ( fig . nagy and marshall1 have defined primary aef as a communication between the aorta and the gi tract caused by a disease , mainly due to an abdominal aortic aneurysm . in contrast , secondary aef develop following aortic reconstructive surgery and abdominal bypass procedures.1 - 3 secondary aefs were first described by de castro et al.4 in 1956 and successfully reconstructed by heberer5 in 1957 . the initial bleeding episodes of secondary aef can occur on the average between 14 and 52 months after vascular reconstruction.6,7 mechanisms include direct mechanical erosion of the suture line into the bowel as well as proximal suture line disruption with pseudoaneurysm formation and fistulization . graft infections from intraoperative contamination , bacterial translocation after pressure necrosis of the bowel , or transient bacteremia seeding the graft are the usual sources.7 more recently there have also been reports of aef formation after the newer percutaneous angioplasty techniques with migration or kinking of the stent grafts with subsequent erosion directly through the aortic wall.8 - 10 several predisposing factors have been studied and postulated to lead to a higher incidence of aef formation . deterioration in certain types of suture has been associated with pseudoaneurysm formation leading to aefs.11 silk , which is absorbable over a period of 7 to 8 years , has been implicated in increased aef formation over other suture material including dacron ( dupont , wilmington , de , usa ) , polypropylene , or polytetrafluorourethane . in our case , preoperatively a full history and physical examination should alert physicians to previous aortic surgery that might result in an aef . however , only one third of patients with aefs are diagnosed preoperatively.12 an upper gi endoscopy may help localize the source of bleeding ; blood clots , ragged mucosa , pus inside the bowel , or even graft material may be visualized . however , this procedure is diagnostic in fewer than 25% of cases , and its value lies in the ruling out of other sources of bleeding.13 in our case , upper and lower endoscopic findings were normal but hematochezia and dropped hb level happened abruptly again . so we performed dbe for detection and management of unknown bleeding focus in the small bowel . recent literature on the use of mdct scans with three - dimensional reconstruction report a high sensitivity.14 angiograms are useful for surgical planning , but they are generally not helpful in making the diagnosis of an aef . in our case , if mdct was used as the initial diagnostic tool in our case , aef could be detected earlier . but aef is a less frequent cause of obscure gi bleeding , which is why we did not recognize aef . although it is not easy to detect aef by endoscopy , we could diagnose aef by dbe . push enteroscopy ( pe ) traditionally has been used to examine the proximal part of the small bowel when initial gastroscopy and colonoscopy failed to detect the source of bleeding . looking at the results , we considered that pe might be useful for the detection of aef in our case . we could n't find any blood clot by gastroscopy and colonoscopy despite the history of hematemesis in the patient ; however , hematochezia happened again with dropped hb level . we needed to exam the entire small bowel because obscure gi bleeding may occur anywhere throughout the small bowel . we performed dbe to detect the source of obscure bleeding because antegrade dbe is superior to pe in the length of insertion and dbe can be used via antegrade or retrograde routes . in conclusion , in our case , aef was diagnosed in the proximal jejunum by dbe and was treated with surgery immediately .

rare @xmath0-based heavy - fermion behaviors have been revealed recently in pr - based filled skutterudites prfe@xmath1p@xmath2 and pros@xmath1sb@xmath2 . recent studies on the thermal properties on both compounds are reported , putting emphasis on the field - induced ordered phase found in pros@xmath1sb@xmath2 .

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the 4@xmath3 configuration of pr ions in intermetallic compounds had been considered to be quite stable in view of no observation of strongly correlated electron behaviors until recent discovery of heavy fermion ( hf ) behaviors in some of pr - based compounds .such unprecedented examples are prinag@xmath4 @xcite and filled skutterudites prfe@xmath1p@xmath2 @xcite and pros@xmath1sb@xmath2 @xcite . in the latter group ,not all pr - based compounds show such unconventional behavior as summarized in table [ table:1 ] and at this stage it is not clear whether there is a systematic trend or not . in this article , we report recent studies on the thermal properties in the two pr - based compounds and discuss the nature of the hf ground states .c|ccc & & & + fe & .thermal properties of prt@xmath1x@xmath2 .see text for abbreviation . roughly estimated @xmath5 ( or @xmath6 at phase transitions ) are given in the unit of j / k@xmath7mol .[ cols= " < " , ] + [ table:1 ]in prfe@xmath1p@xmath2 , hf behavior is evidenced by the largely - enhanced electronic specific - heat - coefficient ( @xmath8 j / k@xmath7mol ) @xcite and cyclotron masses in dhva studies @xcite in applied fields where an anomalous ordered state ( ods ) , appearing below @xmath9 k , is suppressed .non - magnetic nature of the ods has been revealed by the @xmath10pr - nuclear specific heat and nuclear scattering studies @xcite .a possible order parameter of the ods is an antiferro - quadrupole ( afq ) @xcite , which couples to the observed lattice distortion @xcite and consequently to the expected fermi surface instability @xcite . in this scenario ,a gap opening suggested from the electrical resistivity @xmath11 and hall coefficient @xmath12 @xcite and a field - induced staggered magnetic component observed in neutron scattering experiments @xcite can be naturally understood .this scenario might point to a possibility that the quadrupole fluctuation is essential for the hf behavior in the high fields .we have extended our study to la - substituted system ( pr@xmath13la@xmath14)fe@xmath1p@xmath2 .it is found that the ods smears out rapidly with the la doping and a new magnetic transition appears for @xmath15 at @xmath16 k ( depending on @xmath17 ) , suggesting an competition between the quadrupole and the magnetic interactions in this compound ( reported elsewhere ) .interestingly , after the suppression of the ods by the la doping , the hf behavior is recovered even in zero field and the @xmath5 value below @xmath18 is @xmath19 j / k@xmath7mol - pr at @xmath20 @xcite , indicating the compatibility between the magnetic ordering and the hf behavior .compelling evidence for the hf superconductivity ( hfsc ) in pros@xmath1sb@xmath2 was given by a large specific heat jump @xmath21 j / k@xmath7 mol at @xmath22 k on a pellet of compressed powdered single crystals @xcite .the jump is superimposed on a schottky - like anomaly appearing at @xmath23 k , which could be interpreted as a crystalline - electric - field ( cef ) excitation or a strongly energy - dependent quasiparticle excitation . in order to study the nature of the anomalous normal state, we have measured specific heat in magnetic fields using a single crystal of high quality , which has been ensured by an observation of the dhva oscillations @xcite .the schottky - like anomaly was found to be drastically suppressed with increasing magnetic field , i.e. , the downward curvature in @xmath24 disappears in 5 t or higher @xcite , indicating that the low - lying excitation leading to the anomaly has a magnetic character .another important finding in our @xmath24 data is a clear thermodynamical evidence for the existence of a field - induced ordered phase ( fiop ) above 4.5 t. as shown in fig .[ fig ] ( a ) , a distinct anomaly evidencing a field - induced phase transition develops with increasing field .the transition temperature @xmath25 is plotted in a @xmath26-vs-@xmath27 phase diagram of fig .[ fig ] ( b ) . below 8 t, @xmath28 is positive and the ehrenfest s theorem suggests that magnetization @xmath29 is enhanced in the fiop . this behavior is actually reflected in the field dependence of the @xmath10pr - nuclear contribution @xcite , which causes the upturn in @xmath24 below 0.5 k ( see fig . [ fig ] ( a ) ) .we speculate that the order parameter is of an afq accompanied by a field - induced antiferromagnetic ( af ) component , as observed in ceb@xmath30 @xcite and tmte @xcite , since af correlations inferred from @xmath31 could energetically stabilize the fiop in magnetic fields leading to @xmath32 .bauer _ et al ._ pointed out a possibility that the hf behavior in pros@xmath1sb@xmath2 involves a quadrupole kondo interaction on pr ions based on their cef model , which has a non - kramers doublet ground state @xcite .from this view point , it is essentially important to clarify whether any residual entropy is hidden below 0.1 k since , for example , a residual entropy of @xmath33 is predicted for a single - site quadrupole kondo model @xcite . to check this, we performed quantitative measurements of magnetocaloric effect , which have worked satisfactorily to study the thermal properties of the metamagnetic - like anomaly in ceru@xmath4si@xmath4 @xcite .no anomalous entropy ( @xmath34 ) has been detected in @xmath35 t @xcite .we can not deny , however , a possibility that pr ions in pros@xmath1sb@xmath2 form a quadrupole kondo lattice with an effective singlet ground state .determination of the order parameter of the fiop is essential to understand the anomalous nature of the normal state , which provides the background of the rare @xmath0-based hfsc in pros@xmath1sb@xmath2 .

– Two children, ages two and three, have been hospitalized after a bouncy house got picked up by the wind and carried them 60 feet through the air, WCVB reports. The younger of the boys is critically hurt; the other appears to be recovering. The kids entered the inflatable structure before it was fully inflated, says a worker at the New Hampshire farm where the incident took place. The giant toy was then picked up by the wind, says a fire official. "The wind gust was strong enough to take the house right over this fence," he notes. The farm worker, Gary Bergeron, who owns the bouncy house, says it was in a closed-off area while it was being inflated, WHDH reports; it wasn't due to be used for a week. "It was missing spikes to go into the ground and it only had three tethers on it, and it's supposed to have four," he says, noting that it was supposed to be used for a fundraiser. "I turned it on to dry it out (after a rainy weekend), and then we blocked it off with a couple of hay bales." But the kids managed to get in, and a witness describes the event to CBS: "I saw the bouncy house fly into the air as high as the building behind me, and as soon as it went up, it flipped and came crashing down." (Meanwhile, a Maine haunted house hayride also turned tragic.)

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2 boys injured after bouncy house accident in Nashua Posted: Sunday, October 12, 2014 5:12 PM EDT Updated: Monday, November 24, 2014 5:27 PM EST Posted:Updated: Two young boys in Nashua, New Hampshire were transported to area hospitals after the bouncy house they were playing in became airborne. The boys, aged 2 and 3, were in a bouncy house at Sullivan Farm when it became airborne and traveled over a fence and approximately 50 feet. Gary Bergeron owns the bouncy house and says he bought it the other day. It wasn't meant for anyone to use for at least another week. He said that it was in a closed off section of the farm. "It was missing spikes to go into the ground and it only had three tethers on it and it's supposed to have four," he said. "This was meant to be a fundraiser to help the Boy's Club and the Salvation Army and it was just something I was just trying to help out special with." The 2-year-old was critically injured and was transported by medflight to Tufts Medical Center in Boston. The other boy was transported to St. Joseph's Hospital in Nashua. Their conditions are unknown at this time. “The investigation will go deeper into what really happened and how the bouncy house ended up from point A to point B,” Assistant Fire Chief Steve Palipeau said. Ellen Smith is a registered nurse who saw the accident unfold in front of her. "As fast as it went up it kind of flipped and just right down," she said. "The children, you never want to see anyone get hurt." New Hampshire state officials are working on the investigation, including how the two children got inside the bouncy house. ||||| A bouncy house in Nashua was picked up by the wind and flew through the air while two children were inside Sunday. Two children injured in Nashua bouncy house accident A bouncy house in Nashua was picked up by the wind and flew through the air while two children were inside Sunday. More Images: Two children injured in Nashua bouncy house accident The bouncy house was being inflated Sunday at Sullivan Farm in Nashua when two children, a 2-year-old and 3-year-old, entered before it was ready, according to an employee at the farm. The wind picked the bouncy house up while the two children were inside, and carried it 60 feet through the air, according to Nashua Fire Department Deputy Chief Michael O'Brien. The 2-year-old boy was critically injured and flown by helicopter to Tuft's Medical in Boston. The 3-year-old boy was also injured. He was transported to St. Joseph's Hospital and is expected to be OK. "The wind gust was strong enough to take the house right over this fence," O'Brien said. "That's correct. It did travel at least 50 feet- and it was over that fence." Co-farmer Gary Bergeron said the bouncy house was inflated in order to dry out after a weekend rain. It was not open for use at the time of the accident. The kids were able to get inside, then wind took the house into the air. Fire officials believe the structure traveled between 50 and 60 feet. "I turned it on to dry it out, and then we blocked it off with a couple of hay bales," Bergeron said. When the bouncy house hit the ground- the boy's were trapped. Their parents were able to rescue them. The bouncy house was not tied down. ""He was able to move his head and his arms and that stuff, so I just hope that he's OK," Bergeron said. This accident is under investigation. . ||||| NASHUA, N.H. (AP/CBS) — Two toddlers were injured — one critically — when a bouncy house they had crawled into at a New Hampshire orchard went airborne. A 2-year-old boy was flown by helicopter to Tufts Medical Center in Boston. A 3-year-old boy was taken to St. Joseph’s Hospital with non-life-threatening injuries. The accident occurred at Sullivan Farm Greenhouse and Orchard in Nashua on Sunday. Ellen Smith was at the farm when she saw something in the air. “I saw the bouncy house fly into the air as high as the building behind me and as soon as it went up it flipped and came crashing down,” she said. “It’s just a freak very, very sad incident that happened.” Nashua fire officials say the structure sailed 50-60 feet before crashing to the ground, trapping the youngsters inside. Their parents were able to rescue them. Farmer Gary Bergeron, who bought the bouncy house for use in a fundraiser, said it was inflated to dry it out after recent rain and was not officially in use at the time of the accident. “It was off in a restricted area,” Bergeron told WBZ. “It wasn’t supposed to be in operation, and somehow two children got inside it.” Bergeron said the house was missing some key safety features, and was off-limits. “There is supposed to be four tethers and there was only three and no spikes,” he said. The accident remains under investigation. (TM and © Copyright 2014 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2014 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.) MORE LOCAL NEWS FROM CBS BOSTON

– If you happened to be up late after the Super Bowl (and also follow the National Weather Service Chicago's Twitter account), you would have gotten a sneak peek at the natural phenomenon that the rest of the world is now seeing. "Check out this INCREDIBLE video," the NWS tweeted, directing viewers to a seven-second clip of a meteor, described by the Chicago Tribune as a "bright blue-green fireball," streaking through the sky, as captured by a dashcam in a Lisle, Ill., police vehicle. USA Today reports the sky show could be seen across the Midwest, including in Wisconsin, Indiana, and Iowa. Check out USA Today to see other videos of the meteor. (Hundreds of people called in after a meteor over the Northeast in May.)

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As a regular on the night shift, Lisle police Officer Jim Dexter is used to seeing the occasional shooting star or lunar eclipse, though mostly he's a witness to what he called “the odd behavior of animals and humans.” A meteor seen across Wisconsin and northern Illinois was recorded by the east camera on the roof of the Atmospheric, Oceanic & Space Sciences Building at the University of Wisconsin at Madison. A meteor seen across Wisconsin and northern Illinois was recorded by the east camera on the roof of the Atmospheric, Oceanic & Space Sciences Building at the University of Wisconsin at Madison. SEE MORE VIDEOS But early Monday morning, Dexter was on routine patrol near Interstate 88 when he saw “a giant green-lighted orb” streaking across the sky. He made sure his dash camera had captured the fireball, then told other officers on patrol. Working up in the old control tower at O'Hare when this huge meteor/space junk lit up the night sky. Working up in the old control tower at O'Hare when this huge meteor/space junk lit up the night sky. SEE MORE VIDEOS Soon after, the National Weather Service was tweeting his video of a meteor that lit up the skies across the Midwest around 1:30 a.m. “It was too good not to share,” Dexter said. “I thought about how few people actually saw it, but then there’s the amount of people I got to share it with.” The American Meteor Society, which monitors meteor showers, said it had received more than 380 reports of sightings Monday. “The fireball was seen primarily from Illinois and Wisconsin, but witnesses from Michigan, Indiana, Ohio, Iowa, New York, Kentucky, Minnesota and Ontario (Canada) also reported the event,” the society said on its website. The society said preliminary information from witness reports suggests the meteor ended its flight in Lake Michigan between the shores of Sheboygan, Wis. and Manitowoc, Wis. The fireball seen Monday was similar in size and brightness to another observed in 2003 in Park Forest, where meteorite fragments fell onto south suburban homes, said Philipp Heck, the Robert A. Pritzker associate curator of meteoritics and polar studies at the Field Museum. In 2010, a smaller and dimmer fireball was visible from Chicago and landed near Mifflin, Wis., he said. A meteor forms when a meteoroid — which is a fragment of an asteroid — enters Earth’s atmosphere after orbiting the sun. The atmosphere’s hot air helps the meteor evaporate, and what ends up on the ground or in the water — called a meteorite — is much smaller than what initially entered the atmosphere, Heck said. About 60,000 meteorites, which can be as small as pebbles, have been discovered on Earth, and some are on display at the Field Museum. “It’s unusual that it was visible from a metropolitan area,” said Heck, adding that most fly over unpopulated areas or over oceans. Although the National Weather Service’s office in Green Bay said the meteor was accompanied by a sonic boom that shook houses in the region, Heck said the meteor was not big enough to cause damage. Weather radar, seismometers, video footage of the fireball and eyewitness reports will help determine how big the meteor was and how fast it traveled, according to Heck. Officer Patrick Murphy of the Chillicothe Police Department near Peoria, was alone in his squad car in the middle of his patrol shift when he saw the green fireball as he was passing a traffic light. His dashcam, which is constantly recording, captured the meteor. “It definitely caught me off guard a little bit. Obviously, I was not expecting to see that,” Murphy said. “I figured it was probably a meteor because I don’t know what else it could possibly be.” He said he drove to the northeast part of town where it looked like the meteor had fallen, but there were no flames anywhere. Murphy, who reported the meteor sighting to his sergeant, said the fireball surprised him. He said he has seen falling stars but “nothing this big, nothing even close to this big.” [email protected] Twitter @lvivanco ||||| CLOSE Skip in Skip x Embed x Share A Lisle, Illinois police officer captured the moment all on his cruiser's dashcam. USA TODAY NETWORK A police dashcam captured jaw-dropping footage of what appears to be a meteor streaking across the sky in Illinois. (Photo: Screenshot) A police dashcam captured jaw-dropping footage of what appears to be a meteor streaking across the sky in Illinois. The National Weather Service Chicago tweeted a video of the meteor provided by the Lisle Police Department on Monday morning. “Check out this INCREDIBLE video of the #meteor this morning as viewed from a Lisle, IL police car dash cam,” The Weather service said in a tweet. Check out this INCREDIBLE video of the #meteor this morning as viewed from a Lisle, IL police car dash cam! Thanks to Lisle PD for sharing! pic.twitter.com/uYELKkBxRO — NWS Chicago (@NWSChicago) February 6, 2017 The weather service tweeted early Monday asking for people to send videos and photos of the meteor, which was reportedly spotted from Iowa across Wisconsin, Illinois and into Indiana. Twitter user @NateGelber tweeted that it was visible in Chicago. “I saw it in Chicago,” @NateGelber tweeted. “Blue streak across the sky going northeast and then a bright green flash. 1:25 am.” The National Weather Service Milwaukee also shared video taken in Plover, Wis. Follow @MaryBowerman on Twitter: @MaryBowerman Read or Share this story: http://usat.ly/2kEFA1L ||||| We've detected that JavaScript is disabled in your browser. Would you like to proceed to legacy Twitter? Yes

– Serial is taking on the criminal courts. Breaking from its format for the first two seasons of focusing on a single story, the investigative podcast will follow several cases from inside the Cleveland criminal court system for its third season, per Entertainment Weekly. Some stories will be wrapped up in one episode while others will span multiple episodes. "For the past year I've had this urgent feeling of wanting to kind of hold open the courthouse door, and wave people inside. Because things are happening—shocking things, fascinating things—in plain sight," says host Sarah Koenig, who joins reporter Emmanuel Dzotsi on the trip inside courtrooms, judges' chambers, and attorneys' offices. The first two of 10 expected episodes are out Sept. 20, per Variety.

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The investigative podcast that became a cultural phenomenon is finally coming back with a brand new season. Serial initially explored the 1999 murder of Hae Min Lee and the subsequent imprisonment of her ex-boyfriend Adnan Syed. Its sophomore season followed American Army soldier Sergeant Bowe Bergdahl, who was held for five years by the Taliban and later charged with desertion. Now, the series is set to tackle the entire criminal justice system by illustrating a year inside Cleveland criminal courts for season 3. Hosted by journalist Sarah Koenig, the Peabody Award-winning Serial has more than 16 million downloads per episode, making it the most popular podcast ever released. With such a wide reach, Koenig chose to use the show’s tremendous platform to expose shocking behind the scenes details of criminal court procedures. The radio personality and reporter Emmanuel Dzotsi spent a year working on the forthcoming season, for which they were given permission to record inside courtrooms, judges’ chambers, back hallways, and attorneys’ offices. The show will take listeners through the sometimes unsettling ways in which crimes are investigated and tried. “Every case Emmanuel and I followed, there came a point where we thought: No, this can’t be how it works,” said Koenig in a press release. “And then we were like, Oh! Oh my god. This is how it works! This is how it happens! People who work in the system, or have been through the system, they know this. But millions more people do not. And for the past year I’ve had this urgent feeling of wanting to kind of hold open the courthouse door, and wave people inside. Because things are happening — shocking things, fascinating things — in plain sight.” The first two episodes will debut on Sep 20, with each additional episode premiering weekly on Thursdays. Several stories will be highlighted over the course of the season, with some being wrapped into a single episode and others unveiled over multiple installments. Serial is heading back to court—this time, in Cleveland. Season Three, coming September 20. https://t.co/0O60tPrtxS — Serial (@serial) September 5, 2018 Get a sneak peek of the new season at the link above. Listeners can hear Serial for free via podcast apps such as Apple Podcasts, Google Podcasts, and Pandora. ||||| The team behind podcast hit “Serial” are premiering the latest season of the investigative series — digging into the inner workings of Cleveland’s criminal-court system — later this month. The first two episodes of “Serial” season 3 will debut Sept. 20, with subsequent episodes to be released weekly on Thursdays. Instead of telling a single story over the course of the show, as the first two seasons did, the third run will follow many different stories with some spanning two or even three episodes. When “Serial” first launched in 2014, the spinoff of NPR’s “This American Life” became an overnight podcasting success. In the first season, Sarah Koenig narrated an investigation into the 2000 conviction of Adnan Syed for the murder of his girlfriend, Hae Min Lee, in Baltimore. (The show led to a judge’s ruling granting Syed a retrial, which remains pending.) Season 2 of “Serial” documented the story of Bowe Bergdahl, a U.S. soldier who was captured by the Taliban. The first two seasons of “Serial” have been downloaded more than 340 million times. Now, with season 3, “Serial” tells the stories of ordinary cases as they wind through the justice system in Cleveland. Producers said they chose Cleveland because they were given an unusual level of access to record inside courtrooms, judges’ chambers, hallways and attorneys’ offices. For the latest season, Koenig and reporter Emmanuel Dzotsi — an Ohio native and former “This American Life” fellow — spent more than a year in the city, looking at small criminal cases like marijuana possession and disorderly conduct and more serious ones including felonies. The duo say they documented various manipulations, distortions and justifications that they say produced a disparity between what people did and what they were punished for. Related 'Serial' Podcast Exposes Epic Dysfunction in Cleveland’s Criminal Justice System YouTube Stars Alisha Marie, Remi Cruz Launch Dishy New Podcast (EXCLUSIVE) The show comes from Serial Productions, formed by the podcast’s original producers in 2017, and is partnered with “This American Life,” which is produced in collaboration with Chicago Public Media. The executive producer of “Serial” is Julie Snyder, who also created the company’s “S-Town” podcast with Brian Reed that launched last year. “Every case Emmanuel and I followed, there came a point where we thought: ‘No, this can’t be how it works,’” Koenig said in a prepared statement. “People who work in the system, or have been through the system, they know this. But millions more people do not. And for the past year I’ve had this urgent feeling of wanting to kind of hold open the courthouse door and wave people inside. Because things are happening — shocking things, fascinating things — in plain sight.” Ira Glass, host of “This American Life” who serves as an editor for “Serial,” commented that even the early drafts of season 3 left him with “this dumbass, fanboy ‘OMG it’s ‘Serial’! feeling” that reflected Koenig’s “deeply ‘Serial’-ish, super-methodical, annoyingly well-reasoned investigation into the deeper truths that underlie all the stories.” “Serial” season 3 will be available as a free download via apps including Apple Podcasts and Google Podcasts, and also will be available free on Pandora via an exclusive streaming partnership. After subscribing, listeners will automatically receive all episodes as they are released. The new season is exclusively sponsored by jobs site ZipRecruiter. The third season of “Serial” is expected to be around 10 episodes, but that’s subject to change. Listen to the audio trailer for season 3 at serialpodcast.org. Pictured above: Emmanuel Dzotsi (l.) and Sarah Koenig

– Your luck held: NASA's dead six-ton satellite came down without apparent harm somewhere over the Pacific between 11:23pm EDT and 1:09am, the agency says. The exact spot isn't yet known, but the UARS craft likely broke up along a 500-mile path, notes AP. Most of the pieces presumably fell into the ocean, and no reports of damage have surfaced. Multiple reports of fireballs emerged, but a NASA spokesman complained on Twitter about "a lot of hoax data and false info going viral," notes MSNBC.

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After days of worldwide suspense, NASA declared Saturday that its six-ton Upper Atmosphere Research Satellite came apart during a fiery fall over the Pacific Ocean. The space agency said the decommissioned spacecraft fell back to Earth between 11:23 p.m. ET Friday and 1:09 a.m. ET Saturday. NASA spokesman Bob Jacobs said the Joint Space Operations Center, headquartered at California's Vandenberg Air Force Base, reported that the satellite entered the atmosphere over the Pacific. "Precise time and locale aren't yet known," he added in a Twitter update. Hours after the satellite's demise, it was still occasionally hard to separate the truth from the fakery. There were multiple reports of fireballs and bright debris being sighted over Canada, but one of those reports turned out to be a "War of the Worlds" prank — which led Jacobs to complain on Twitter about "a lot of hoax data and false info going viral." Determining the precise time and place of impact was difficult because of the uncertainties surrounding the satellite's altitude toward the end. Any surviving wreckage was expected to be sparsely distributed across a 500-mile-long (800-kilometer-long) ellipse. "The risk to public safety was very remote," NASA said in a statement. Delayed demise The projected time of re-entry was pushed later and later during the satellite's final hours. "It just doesn't want to come down," said Jonathan McDowell of the Harvard-Smithsonian Center for Astrophysics. McDowell said the satellite's delayed demise demonstrates how unreliable predictions can be. Until Friday, increased solar activity was causing the atmosphere to expand and the 35-foot, bus-size satellite to free fall more quickly. But late Friday morning, NASA said the sun was no longer the major factor in the rate of descent and that the satellite's position, shape or both had changed by the time it slipped down to a 100-mile (160-kilometer) orbit. "In the last 24 hours, something has happened to the spacecraft," said NASA orbital debris scientist Mark Matney. Uncontrolled re-entry The Upper Atmosphere Research Satellite, or UARS, was the biggest NASA spacecraft to crash back to Earth, uncontrolled, since the post-Apollo 75-ton Skylab space station and the more than 10-ton Pegasus 2 satellite, both in 1979. Russia's 135-ton Mir space station slammed through the atmosphere in 2001, but that was a controlled dive into the Pacific. NASA expected about two dozen pieces of the UARS satellite — representing 1,200 pounds of heavy metal — to survive re-entry. The biggest surviving chunk should have been around 300 pounds (150 kilograms). Earthlings can take comfort in the fact that no one has ever been hurt by falling space junk — to anyone's knowledge — and there has been no serious property damage. NASA put the chances that somebody somewhere on Earth would get hurt at 1-in-3,200. But any one person's odds of being struck were estimated at 1-in-22 trillion, given that there are 7 billion people on the planet. "Keep in mind that we have bits of debris re-entering the atmosphere every single day," Matney said in brief remarks broadcast on NASA TV. In any case, finders definitely aren't keepers. Any surviving wreckage belongs to NASA. If someone finds a piece of it, NASA has the right to ask for its return. There are no toxic chemicals on board, but sharp edges could be dangerous, so the space agency warned the public to keep hands off and call the authorities. Minimizing space junk The $740 million UARS was launched in 1991 from the space shuttle Discovery to study the atmosphere and the ozone layer. At the time, the rules weren't as firm for safe satellite disposal; now a spacecraft must be built to burn up upon re-entry or have a motor to propel it into a much higher, long-term orbit. NASA shut UARS down in 2005 after lowering its orbit to hurry its end. A potential satellite-retrieval mission was ruled out following the 2003 shuttle Columbia disaster, and NASA did not want the satellite hanging around orbit posing a debris hazard. Space junk is a growing problem in low-Earth orbit. More than 20,000 pieces of debris, at least 4 inches in diameter, are being tracked on a daily basis. These objects pose a serious threat to the International Space Station. This report includes information from The Associated Press and msnbc.com. ||||| Details were still sketchy, but the U.S. Air Force's Joint Space Operations Center and NASA say that the bus-sized satellite first penetrated Earth's atmosphere somewhere over the Pacific Ocean. That doesn't necessarily mean it all fell into the sea. NASA's calculations had predicted that the former climate research satellite would fall over a 500-mile (800 kilometer) swath. The two government agencies say the 35-foot (11-meter) satellite fell sometime between 0123 GMT and 0509 GMT. NASA said it didn't know the precise time or location yet. Some 26 pieces of the satellite _ representing 1,200 pounds (550 kilograms) of heavy metal _ were expected to rain down somewhere. The biggest surviving chunk should be no more than 300 pounds (135 kilograms) . The Upper Atmosphere Research Satellite is the biggest NASA spacecraft to crash back to Earth, uncontrolled, since the Skylab space station and the more than Pegasus 2 satellite, both in 1979. Russia's 135-ton Mir space station slammed through the atmosphere in 2001, but it was a controlled dive into the Pacific. Before UARS fell, no one had ever been hit by falling space junk and NASA expected that not to change. NASA put the chances that somebody somewhere on Earth would get hurt at 1-in-3,200. But any one person's odds of being struck were estimated at 1-in-22 trillion, given there are 7 billion people on the planet.

– Kerry Washington says she was thrilled to be invited to appear on the cover of Adweek—but "taken aback" when the photo was so altered she barely recognized herself. "I'm no stranger to Photoshopping. It happens a lot," the Scandal star writes in an Instagram post with a picture of the cover, explaining that she doesn't "always take these adjustments to task," but she felt "weary" after seeing the Adweek image. "It felt strange to look at a picture of myself that is so different from what I look like when I look in the mirror," she writes. "It's an unfortunate feeling." She stresses that she has a lot of respect for the magazine and is pleased with the interview and images inside. Washington doesn't spell out the changes she's unhappy with, though Ashley Weatherford at New York notes that "the incomparably beautiful actress" has been unrecognizable on previous magazine covers. She urges future photographic teams to "ease up on the Photoshop" and "include people who celebrate, instead of muzzle, the beauty that is black skin." ABC News reports that according to Adweek Editorial Director James Cooper, the magazine only made "minimal adjustments," including adding volume to her hair. "We are honored to have her grace our pages," he says. "To clarify, we made minimal adjustments, solely for the cover's design needs."

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With her ABC political drama Scandal in its third and most successful season, Kerry Washington seems to be covering practically every magazine these days. The 36-year-old appeared on Ebony's March 2013 cover, Elle Magazine's June 2013 cover, Vanity Fair's August 2013 cover, Glamour Magazine's October 2013 cover, Essence's November 2013 cover, and now Lucky's December 2013/January 2014 cover. PHOTOS: Kerry Washington's red carpet evolution But this most recent image makes Washington's face practically unrecognizable. The Django Unchained star's eyes seem to be narrower and the lighting on her face appears to have distorted her features. PHOTOS: Kerry Washington and other hot celebs of 2013 Washington's hair was cut in an edgy, shoulder-length style with bangs, and she wore a white and purple two-piece ensemble covered with a sheer, patterned dress. Jason Merritt/Getty Images But if Washington is concerned by her cover look, she's not saying so publicly. Less than an hour after the cover was unveiled, she tweeted the image with the caption, "WOOO HOOO!" and even made the cover her Twitter avatar. PHOTOS: Worst celeb Photoshop disasters ever The recent Saturday Night Live host has plenty to celebrate these days. Us Weekly broke the news in late October that Washington was pregnant with her first child after secretly marrying NFL player Nnamdi Asomugha in June 2013. ||||| Kerry Washington believes her cover of AdWeek doesn't accurately reflect how she looks. In a Facebook post, the "Scandal" star praised the magazine and the profile of her that was published in it, but admitted that she was "taken aback" when she saw the cover. As a result, she added, she's having trouble celebrating it completely. "Look, I'm no stranger to Photoshopping. It happens a lot. In a way, we have become a society of picture adjusters - who doesn't love a filter?!? And I don't always take these adjustments to task but I have had the opportunity to address the impact of my altered image in the past and I think it's a valuable conversation," she wrote. "Yesterday, however, I just felt weary. It felt strange to look at a picture of myself that is so different from what I look like when I look in the mirror. It's an unfortunate feeling. "That being said. You all have been very kind and supportive. Also, as I've said, I'm very proud of the article," she added. James Cooper, the editorial director of the magazine, acknowledged in a statement obtained by ABC News that her photo was altered, but minimally so. In a tweet, he wrote that his team added volume to her hair "for dramatic effect." "Kerry Washington is a class act. We are honored to have her grace our pages. To clarify, we made minimal adjustments, solely for the cover's design needs," he stated. "We meant no disrespect, quite the opposite. We are glad she is enthusiastic about the piece and appreciate her honest comments." ||||| There are many things to admire about Kerry Washington, but what I love most is that sometimes people say I favor her. It’s a silly, vain thing, but it’s true. Our lips, our eyes, and even our hairline draw comparisons. Every week on Scandal, I get to see someone who looks like me negotiating deals with heads of state, combating the abuse of power, and, sometimes, saving lives. But even if Kerry and I looked nothing alike, she would still mean something to me, as she does to many black women. As they say in the #BlackGirlMagic corners of the internet, representation matters. So it hurt, in 2013, when a poorly portrayed Washington landed on the cover of Lucky. She was practically unrecognizable. And then it happened again, in 2015, with Instyle, and most recently, with Adweek. It raises the question: At what step along the way did these magazines fail her? “For shooting black skin, it's all about tone,” photographer Andre Wagner told me. The subjects of Wagner’s photography, mostly black people, often make their way onto his Instagram page. “Tone and lighting are the most important parts in not trying to distort black skin. Sometimes photographers overexpose subjects to hide blemishes and skin imperfections, but with black people it's not so successful because you can't just wash out black skin.” But there’s more to consider than the photographer, of course. There’s the art director, the makeup artists, the editors, the post-production re-touchers – all of whom play a part in the final image. When it comes to Kerry Washington, sometimes this team gets it right. Her 2013 covers of Glamour and Vanity Fair are testaments to that. But when this team of artists and editors attempt to morph Washington into someone else, the images fall flat. In Washington’s case, bad lighting and Photoshop bear the brunt of the blame. Her Lucky cover might have benefited with a softer light source. “With black skin, natural light does wonders,” Wagner said. “Andrew Dosunmu and Bradford Young [a director and cinematographer responsible for the films Restless City and Selma, respectively] are known for shooting in natural light, which is opposite the industry standard.” Overzealous Photoshopping also appears to be an issue. On the cover of Self, Washington looks like a wax figure of herself, and on Lucky, a vigorous attempt to smooth over Washington’s under-eye circles went horribly awry. Little tweaks are one thing, but when you try to strip away what makes Kerry Washington Kerry Washington, those tweaks become a problem. So for the next team that photographs the incomparably beautiful actress: Don’t erase the tiny shadows that fall under her eyes. Use a softer light that hugs her skin. Ease up on the Photoshop. And above all else, include people who celebrate, instead of muzzle, the beauty that is black skin.

– No wonder the moon has such a youthful complexion (well, it vaguely resembles a teenager's spotty face)—new research suggests it isn't quite as old as previously thought. The standard theory was that the moon formed some 4.56 billion years ago, after another planet slammed into Earth. But a new analysis by a geochemist at the Carnegie Institution for Science suggests the rock is actually somewhere between 4.4 billion and 4.45 billion years old, reports Space.com. "Back in the 1970s, you couldn't distinguish between 4.45 and 4.55 billion years," says the scientist, Richard Carlson, per the LA Times. "Today, we can, and everything we are seeing suggests the 4.4 billion number." That raises "several" new questions, notes Carlson. "For example," he tells Space.com, "if the Earth was already differentiated prior to the giant impact, would the impact have blown off the primordial atmosphere that formed from this earlier epoch of Earth history?"

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How old is the moon? Not as old as we once thought. The moon is likely to be 4.4 billion to 4.45 billion years old, or about 100 million years younger than previously thought, according to new research by geochemist Richard Carlson of the Carnegie Institution of Washington. It may be the closest body to us in space, but scientists are still not sure exactly how, or when, it formed. PHOTOS: Mysterious moons of the solar system The current working theory suggests that the moon formed when a large proto-planet plowed into the early Earth, creating a major explosion that sent huge amounts of rocky debris into space. While most of that material returned to Earth, the theory suggests some of it stayed in space, forming a disk around the Earth that eventually grew together to form the moon. While other scientists continue to improve their models of what this giant impact may have looked like, Carlson is trying to determine when it happened. Like other scientists before him, he has been using radioactive dating to determine the age of lunar rocks collected during the Apollo missions. Previous work in this area had a large margin of error, but Carlson says improved technology has allowed him to narrow that margin significantly. "Back in the 1970s, you couldn't distinguish between 4.45 and 4.55 billion years," he told the Los Angeles Times. "Today, we can, and everything we are seeing suggests the 4.4 billion number." One of the most interesting implications of Carlson's research is to imagine what the Earth might have been like before it had a moon. "We know the age of the solar system very well -- 4.568 billion years," Carlson said. "So the Earth may have had two phases of its life -- one before the giant impact, and another one greatly modified by the impact." Carlson presented his research this week at the "Origins of the Moon" meeting of the Royal Society. For more cool moon stories, follow me on Twitter. ALSO: Earth too hot for life in 1.75 billion years? Try Mars instead Look! One of the biggest structures in our known universe, the Coma How a comet impact may have jump-started life on Earth -- and elsewhere ||||| This artist's conception of a planetary smashup whose debris was spotted by NASA's Spitzer Space Telescope in 2009 gives an impression of the carnage that would have been caused when a similar impact created Earth's moon. The moon is quite a bit younger than scientists had previously believed, new research suggests. The leading theory of how the moon formed holds that it was created when a mysterious planet — one the size of Mars or larger — slammed into Earth about 4.56 billion years ago, just after the solar system came together. But new analyses of lunar rocks suggest that the moon, which likely coalesced from the debris blasted into space by this monster impact, is actually between 4.4 billion and 4.45 billion years old. The finding, which would make the moon 100 million years younger than previously thought, could reshape scientists' understanding of the early Earth as well as its natural satellite, researchers said. [The Moon: 10 Surprising Lunar Facts] "There are several important implications of this late moon formation that have not yet been worked out," Richard Carlson, of the Carnegie Institution for Science in Washington, D.C., said in a statement. "For example, if the Earth was already differentiated prior to the giant impact, would the impact have blown off the primordial atmosphere that formed from this earlier epoch of Earth history?" added Carlson, who is presenting the new results Monday (Sept. 23) in London at a meeting organized by the Royal Society called "Origin of the Moon." Scientists know the solar system's age (4.568 billion years) quite well. And they can pin down the formation times of relatively small bodies such as asteroids precisely, too, by noting when these objects underwent extensive melting — a consequence, in part, of the heat generated by the collision and fusion of these objects' building-block "planetesimals." For example, analysis of meteorites that came from the asteroid Vesta and eventually rained down on Earth reveals that the 330-mile-wide (530 kilometers) space rock is 4.565 billion years old. Vesta cooled relatively quickly and is too small to have retained enough internal heat to drive further melting or volcanism, Carlson explained. But it's tougher to nail down the age of larger solar-system bodies, he said. "Ask the same question of the Earth or moon, and you don't get a very precise answer," Carlson said. "Earth likely took longer to grow to full size compared to a small asteroid like Vesta, and every step in its growth tends to erase, or at least cloud, the memory of earlier events." Scientists keep getting better and better estimates, however, as they refine their techniques and technology improves. And those estimates are pushing the moon's formation date farther forward in time. The moon is thought to have harbored a global ocean of molten rock shortly after its dramatic formation. Currently, the most precisely determined age for the lunar rocks that arose from that ocean is 4.360 billion years, the researchers said. And here on Earth, scientists have found signs in several locations of a major melting event that occurred around 4.45 billion years ago. So, evidence is building that the catastrophic collision that formed the moon and reshaped Earth occurred around that time, rather than 100 million years or so before, the researchers said. Follow Mike Wall on Twitter @michaeldwall and Google+. Follow us @Spacedotcom, Facebook or Google+. Originally published on SPACE.com.

– A month ago, no one would have said boo about the name chosen by a Japanese zoo for its new baby monkey. But a month ago, Princess Charlotte Elizabeth Diana hadn't yet entered the world, and now Takasakiyama Natural Zoological Garden is fielding a "barrage of complaints" about a public vote to also name its new macaque Charlotte, the BBC reports. It's a tradition for the first macaque born each year at the Oita zoo to have its name chosen by the public. Though voting took place over more than a month, a zoo official tells the AFP that "Charlotte" had zero votes before the princess's name was announced on Monday. But between that name revelation and the discovery of the female macaque's birth on Wednesday, "Charlotte" jumped to the lead with 59 out of 853 votes, reports the Kyodo news agency. Japanese citizens complained the name disrespects England's royal family and that their fellow Japanese wouldn't like it if the Brits named a monkey after a member of Japanese royalty. This moniker madness could have been avoided if the zoo had simply chosen one of the other contenders that emerged during the vote, such as Kei (for well-known Japanese tennis ace Kei Nishikori) or Elsa (a tip of the hat to the Frozen character). The zoo now says it's stepping back to consider other names. "We deeply apologize for causing trouble to many people over the naming of the first baby [monkey]," a zoo statement said, per the AP. "We take these opinions seriously." A zoo rep tells the AP he hasn't heard of any complaints from British citizens yet. (Here's why Princess Charlotte is historic.)

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A zoo in southwestern Japan was forced to backpedal on its decision to name a baby Japanese monkey “Charlotte” in honour of the newborn British princess after protests that the move was disrespectful to the royal family. The Takasakiyama Natural Zoological Garden, popular among visitors as a feeding ground for wild macaques inhabiting the surrounding area, launches a public poll for naming the first macaque born each year. The name had been inspired by Charlotte Elizabeth Diana, the newborn second child of Britain’s Prince William and his wife Catherine. She is the younger sister to Prince George, who is in line to inherit the British throne. It was the top choice with 59 of 853 total votes. Also in the running were Kei, after Japanese tennis player Kei Nishikori, and Elsa, a character in the Disney film Frozen. ”The name was publicly solicited and Charlotte suddenly became the most popular choice – with 59 votes out of the total 853 – after the British baby princess’s name was announced,” a zoo official said. “There was no vote for ‘Charlotte’ before the Monday night announcement.” The zoo announced the naming after a zookeeper spotted this year’s firstborn, a healthy baby girl, clinging to her mother yesterday. But the zoo soon met a barrage of phone calls and emails demanding a retraction and asking the zoo to imagine what the Japanese people would think if a British monkey were named after a member of Japan’s imperial family. “Since we announced the name we’ve been receiving calls and emails from people mostly complaining that it is rude to British people” to give a monkey the same name as a member of their royal family, the zoo official said. “This morning a TV commentator said he thinks it is alright, but most voices are against the idea,” he added. A zoo official reached for comment said they are discussing a possible name change for the baby macaque. Princess Charlotte’s birth caused an outbreak of patriotic fervour in Britain, where the press and public lauded her names, seen as a triple homage to her grandfather Prince Charles, great-grandmother Queen Elizabeth II and William’s late mother Diana. Britain’s royals are immensely popular in Japan, where their easy familiarity with the public stands in marked contrast to the austere image of the country’s own imperial clan. A recent visit by Prince William – who left heavily pregnant Kate at home – was followed in minute detail by Japan’s media, which revelled in the chance to show pictures of him dressed as a samurai lord. ||||| TOKYO (AP) — A Japanese zoo has apologized for naming a baby monkey Charlotte after the newborn British princess following complaints at home. In this Wednesday, May 6, 2015 photo released by the Takasakiyama Natural Zoological Garden, a newborn baby monkey named Charlotte clings to her mother at the zoo in Oita, southern Japan. The Japanese... (Associated Press) In this Wednesday, May 6, 2015 photo released by the Takasakiyama Natural Zoological Garden, a newborn baby monkey named Charlotte clings to her mother at the zoo in Oita, southern Japan. The Japanese... (Associated Press) The Takasakiyama Natural Zoological Garden said Thursday it was considering renaming the macaque. It was flooded with angry calls and emails Wednesday hours after announcing the name for its first monkey born this year, a tradition at the city-run zoo in southern Japan. Charlotte was the favorite in a public ballot, receiving 59 out of 853 votes in just over a month until Wednesday, when the female monkey was born. Opponents largely said giving the princess' name to a monkey is disrespectful to British royals. According to zoo official Akira Asano, some of them said that the Japanese people would feel offended if a monkey were named after Japanese princesses. He said the zoo has also received support for Charlotte, and the views are now largely divided. "We deeply apologize for causing trouble to many people over the naming of the first baby (monkey)," said a statement posted on the zoo website. "We take these opinions seriously." Asano said he was not aware of any complaints from British citizens. Officials of the zoo and the city of Oita were still discussing what to do with the monkey's name. The British Embassy in Tokyo declined to comment, while Japan's foreign ministry said it was not involved with the issue. ||||| Image copyright AFP Image caption More than 1,300 monkeys roam freely at the zoo in southern Japan A Japanese zoo has apologised after naming a baby monkey Charlotte in honour of the newborn British princess, it's reported. The Takasakiyama Zoo, in southern Japan, was inundated with complaints after announcing the female macaque monkey's name on Wednesday, the Kyodo news agency reports. The zoo says the name was chosen after a public vote, a tradition for their first newborn macaque monkey each year. Charlotte received the most votes, although it wasn't exactly a runaway winner, with 59 out of 853 people choosing it. But other members of the public felt that it was disrespectful to the British royal family to name a monkey after a princess. The zoo faced a "barrage" of complaints from people wanting them to re-name the macaque, with some noting that the Japanese people might not be best pleased if a British monkey were named after one of their own royal family, Kyodo reports. The zoo has apologised in a statement on its website. It says it takes people's concerns seriously and is discussing a potential name change for the newborn animal. Next story: Fringe candidates enliven Polish presidential race Use #NewsfromElsewhere to stay up-to-date with our reports via Twitter.

Protecting Workers From Imminent Dangers Act of 2009 - Amends the Occupational Safety and Health Act of 1970 to require the Department of Labor to: (1) inform employers and employees and their representatives when a condition or practice in a place of employment is such that an imminent danger to safety or health exists that could reasonably be expected to cause death, serious physical harm, or permanent impairment of the health or functional capacity of employees if not corrected immediately or before the danger can be eliminated through prescribed enforcement procedures; and (2) request that the condition or practice be corrected immediately or that employees be immediately removed from exposure to such danger. Requires the Department, if an employer refuses to comply with such request, to immediately issue an order requiring the employer to cause all persons to be withdrawn from, and to be prohibited from entering, such area until the Department determines that such imminent danger and the conditions or practices which caused it no longer exist. Declares that such an order shall not preclude issuing a citation or proposing a penalty for a violation under such Act. Prohibits the Department from preventing: (1) the entry or continued activity of employees whose presence is necessary to avoid, correct, or remove such imminent danger or to maintain the capacity of a continuous process operation to resume normal operations without a complete cessation of operations; and (2) a necessary cessation of operations from being accomplished in a safe and orderly manner. Prohibits persons from discharging or discriminating against an employee for the refusal to perform a duty that has been identified by an order as the source of an imminent danger. Sets forth penalties for violations.

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SECTION 1. SHORT TITLE. This Act may be cited as the ``Protecting Workers From Imminent Dangers Act of 2009''.SEC. 2. STREAMLINED PROCEDURES TO COUNTERACT IMMINENT DANGERS. (a) Procedures.--Section 13 of the Occupational Safety and Health Act of 1970 (29 U.S.C. 662) is amended-- (1) by striking subsections (a), (b), and (c) and inserting the following: ``(a)(1) If the Secretary determines, on the basis of an inspection or investigation under this Act, that a condition or practice in a place of employment is such that an imminent danger to safety or health exists that could reasonably be expected to cause death or serious physical harm or permanent impairment of the health or functional capacity of employees if not corrected immediately or before the imminence of such danger can be eliminated through the enforcement procedures otherwise provided by this Act, the Secretary shall inform the employer and the affected employees and their representative of such imminent danger and shall request that the condition or practice be corrected immediately or that employees be immediately removed from exposure to such danger. ``(2) The Secretary shall not prevent the entry or continued activity of employees whose presence is necessary to avoid, correct, or remove such imminent danger or to maintain the capacity of a continuous process operation to resume normal operations without a complete cessation of operations or, where a cessation of operations is necessary, to permit such to be accomplished in a safe and orderly manner. ``(3) If the employer refuses to comply with the request under paragraph (1), the Secretary shall immediately issue an order requiring the employer to cause all persons, except those employees referred to in paragraph (2), to be withdrawn from, and to be prohibited from entering, such area until an authorized representative of the Secretary determines that such imminent danger and the conditions or practices which caused such imminent danger no longer exist. The issuance of an order under this subsection shall not preclude the issuance of a citation under section 9 or the proposing of a penalty under section 17. The fact that an order under paragraph (3) has been issued shall be noted in any citation issued pursuant to section 9 with respect to the hazard involved. ``(4) Each finding made and order issued under this section shall be given promptly to the employer by the person making such finding or order. All such findings and orders shall be in writing, and shall be signed by the person making them and shall contain a detailed description of the conditions or practices which cause and constitute an imminent danger and a description of the area of the place of employment from which persons must be withdrawn and prohibited from entering. ``(5) Any order issued pursuant to subsection (a) may be modified or terminated by an authorized representative of the Secretary following consultation with the employer and any representative of the affected employees. Any order issued under subsection (a) shall remain in effect until vacated, modified, or terminated by the Secretary, or modified or vacated by the Commission pursuant to subsection (d).''; and (2) by redesignating subsection (d) as subsection (b) and after such subsection inserting the following: ``(c) No person shall discharge or in any manner discriminate against any employee because such employee has refused to perform a duty that has been identified as the source of an imminent danger by any order issued under subsection (a). The right to refuse to perform such a duty shall be in addition to any other right to refuse to perform hazardous work that is afforded to employees by this Act, by standards or regulations issued pursuant to this Act, by contract, or by other applicable law. ``(d)(1) Any employer notified of an order under subsection (a) or any affected employees or representative of affected employees notified of the issuance, modification, or termination of such an order may apply to the Commission within 30 days of such notification for reinstatement, modification or vacation of such order. The Commission shall forthwith afford an opportunity for a hearing (in accordance with section 554 of title 5, United States Code, but without regard to subsection (a)(3) of such section) and thereafter shall issue an order, based upon findings of fact, vacating, affirming, modifying, or terminating the Secretary's order. The Commission may not grant temporary relief from the issuance of any order under subsection (a). ``(2) The Commission shall take whatever action is necessary to expedite proceedings under this subsection. ``(e) The Secretary may institute a civil action for relief, including a permanent or temporary injunction, restraining order, or any other appropriate order in the district court of the United States for the district in which a place of employment is located or in which the employer has his principal office, whenever such employer or his agent violates or fails or refuses to comply with any order or decision issued under this section.''. (b) Penalties.--Section 17 of such Act is amended by redesignating subsections (h) through (l) as subsections (i) through (m), respectively, and by inserting after subsection (g) the following: ``(h) Any employer who fails to remove all employees from exposure to a hazard referenced in orders issued under section 13(a) shall be assessed a civil penalty of not less than $10,000 and not more than $50,000 for each day during which an employee continues to be exposed to the hazard, unless the Commission or the district court determines the condition or practice is not of such nature as to be covered by section 13(a).''.

patients with a porencephalic cyst frequently develop intractable temporal lobe epilepsy ( tle ) . we report a surgically - treated male patient with intractable mesial tle ( mtle ) secondary to a porencephalic cyst . although magnetic resonance imaging showed no hippocampal abnormalities , long - term video - electrocorticography revealed seizure onset discharges in the hippocampus . temporal lobectomy brought an end to the patient 's seizures . hippocampal sclerosis was histopathologically confirmed ( dual pathology ) . careful evaluation of hippocampal epileptogenicity is required , and temporal lobectomy , which is less invasive than hemispherectomy , can be a treatment of choice for patients with mtle secondary to a porencephalic cyst .

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the traditional neurosurgical approach has been hemispherectomy because of the difficulty in localizing precise epileptogenic foci . although hemispherectomy is highly successful at eliminating seizures , it also shows higher morbidity than temporal lobectomy [ 25 ] . recent studies have shown that hippocampal sclerosis ( hs ) frequently coexists with porencephalic cysts , and these patients with intractable temporal lobe epilepsy ( tle ) are good surgical candidates for temporal lobectomy . the coexistence of hs with extrahippocampal lesions with epilepsy has been described as dual pathology and requires detailed presurgical evaluation to localize the epileptogenic focus . determining the optimal treatment for patients who present with tle and negative magnetic resonance imaging ( nmri ) is more challenging . we successfully treated a patient with intractable nmri tle secondary to a porencephalic cyst with temporal lobectomy , after a useful presurgical electrocorticography ( ecog ) to localize the precise epileptogenic focus , avoiding invasive hemispherectomy . a 29-year - old right - handed man suffered from intractable epilepsy from the age of 12 . habitual seizures manifested as loss of consciousness , staring , and automatism , followed by postictal confusion . seizures occurred several times a week and were not controlled by 6 prior antiepileptic drugs . the patient had a history of lumbar myelomeningocele , which was surgically treated soon after his birth . at 26 years of age , he underwent resection of a lumbar lipoma and filum terminale . magnetic resonance imaging revealed a large porencephalic cyst in the left parietotemporal region with atrophic changes in the surrounding cortex , no cortical dysgenesis , and , importantly , no atrophy or abnormal signal alteration in the bilateral hippocampi ( fig . 1 ) . long - term video - electroencephalography ( eeg ) monitoring revealed interictal epileptiform discharges in the left anterior temporal lesion ( fig . interictal tc - ethyl cysteinate dimer ( tc - ecd ) single - photon emission computed tomography ( spect ) revealed decreased cerebral blood flow in the mesial left temporal lobe . although clinical features , eeg , and interictal spect suggested that the patient 's seizures were due to mesial tle ( mtle ) , mri showed no abnormalities in the hippocampus , suggesting that the porencephalic cyst was the potential epileptogenic focus . to further determine the epileptogenic focus , long - term ecog was performed , using subdural grid electrodes covering the left mesial temporal region , lateral temporal cortex , and parietal cortex surrounding the porencephalic cyst . all ictal discharges originated from the left mesial temporal region , and none originated in the area surrounding the porencephalic cyst ( fig . 3 ) . histopathological examination revealed hippocampal neural loss at the ca1 area and granule cell dispersion , confirming a diagnosis of grade ii five years after surgery , the patient is completely seizure - free ( engel class i ) without any morbidity . porencephalic cysts occur as a component of vascular cerebral infarction during the prenatal or perinatal period and commonly manifest as congenital hemiplegia , intellectual impairment , and epilepsy . it is generally assumed that the seizures originate in proximity to the porencephalic lesion , and surgical intervention is often discouraged because of the difficulty in accurately localizing the seizure foci . however , if the seizure manifestation and scalp and further invasive ecog suggest a specific epileptogenic focus in a patient with a porencephalic cyst , a more restricted resection might be preferable in view of anticipated motor function losses and perioperative morbidity and mortality . the seizure semiology , interictal eeg , and interictal spect of the present patient suggested mtle , but mri findings showed no abnormalities in the hippocampus , i.e. , hippocampal atrophy or signal alterations indicative of hs . thus , we could not exclude the possibility that epileptogenic discharges around the porencephalic cyst propagated to the left mesial temporal lobe . subsequent ecog showed that the epileptogenic focus was the hippocampus and not the area surrounding the porencephalic cyst . there have been a total of 4 reports on 14 patients undergoing temporal lobectomy due to intractable tle secondary to a porencephalic cyst ( table 1 ) . all 14 cases had a good clinical course , and hs was histopathologically confirmed . of these 14 cases , in addition , mr - based volumetry has revealed hippocampal atrophy in 95% of patients with porencephaly - related epilepsy . while most patients with mtle may show the characteristic features of hs on mri , including an atrophic hippocampus with a hyperintense signal on long repetition time sequences , up to 15% of patients with mtle may have normal mri . mri was negative for hs , but histology confirmed mild hs . in a report by immonen et al . , the surgical specimens of 26 ( 68% ) of 38 patients with nmri tle undergoing temporal lobectomy did not display any pathological alteration , while 2 cases ( 5.2% ) showed hs . another report found that 38 ( 49% ) of the 78 patients had mild to moderate hs , but no severe hs was identified . the authors suggest that subtle pathology may not have been detected on mri . of the 14 reported patients with porencephalic cyst and tle ( table 1 ) , 13 showed hippocampal atrophy on mri , indicating hs . the remaining patient had no abnormal mri findings in the hippocampus , but hs was confirmed by histopathological examination after temporal lobectomy , as in the present case . we emphasize that the absence of radiological changes in the hippocampus does not preclude hippocampal epileptogenicity in mtle with a porencephalic cyst .

Civil Rights Procedures Protection Act of 1994 - Amends specified Federal civil rights statutes (including Title VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act of 1967, the Rehabilitation Act of 1973, the Americans With Disabilities Act of 1990, the equal pay requirement under the Fair Labor Standards Act of 1938, and the Family and Medical Leave Act of 1993) to prevent the involuntary application of arbitration to claims that arise from unlawful employment discrimination based on race, color, religion, sex, national origin, age, or disability.

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SECTION 1. SHORT TITLE. This Act may be cited as the ``Civil Rights Procedures Protection Act of 1994''.SEC. 2. AMENDMENT TO TITLE VII OF THE CIVIL RIGHTS ACT OF 1964. Title VII of the Civil Rights Act of 1964 (42 U.S.C. 2000e et seq.) is amended by adding at the end the following: ``exclusivity of powers and procedures ``Sec. 719. Notwithstanding any Federal statute of general applicability that would modify any of the powers and procedures expressly applicable to a claim arising under this title, such powers and procedures shall be the exclusive powers and procedures applicable to such claim unless after such claim arises the claimant voluntarily enters into an agreement to resolve such claim through arbitration or another procedure.''.SEC. 3. AMENDMENT TO THE AGE DISCRIMINATION IN EMPLOYMENT ACT OF 1967. The Age Discrimination in Employment Act of 1967 (29 U.S.C. 621 et seq.) is amended-- (1) by redesignating sections 16 and 17 as sections 17 and 18, respectively, and (2) by inserting after section 15 the following: ``exclusivity of powers and procedures ``Sec. 16. Notwithstanding any Federal statute of general applicability that would modify any of the powers and procedures expressly applicable to a right or claim arising under this Act, such powers and procedures shall be the exclusive powers and procedures applicable to such right or such claim unless after such right or such claim arises the claimant voluntarily enters into an agreement to resolve such right or such claim through arbitration or another procedure.''.SEC. 4. AMENDMENT TO THE REHABILITATION ACT OF 1973. Section 505 of the Rehabilitation Act of 1973 (29 U.S.C. 795) is amended by adding at the end the following: ``(c) Notwithstanding any Federal statute of general applicability that would modify any of the procedures expressly applicable to a claim based on right under section 501, such procedures shall be the exclusive procedures applicable to such claim unless after such claim arises the claimant voluntarily enters into an agreement to resolve such claim through arbitration or another procedure.''.SEC. 5. AMENDMENT TO THE AMERICANS WITH DISABILITIES ACT OF 1990. Section 107 of the Americans With Disabilities Act of 1990 (42 U.S.C. 12117) is amended by adding at the end the following: ``(c) Notwithstanding any Federal statute of general applicability that would modify any of the powers and procedures expressly applicable to a claim based on a violation described in subsection (a), such powers and procedures shall be the exclusive powers and procedures applicable to such claim unless after such claim arises the claimant voluntarily enters into an agreement to resolve such claim through arbitration or another procedure.''.SEC. 6. AMENDMENT TO SECTION 1977 OF THE REVISED STATUTES OF THE UNITED STATES. Section 1977 of the Revised Statutes of the United States is amended by adding at the end the following: ``(d) Notwithstanding any Federal statute of general applicability that would modify any of the procedures expressly applicable to a right to make and enforce a contract of employment under this section, such procedures shall be the exclusive procedures applicable to a claim based on such right unless after such claim arises the claimant voluntarily enters into an agreement to resolve such claim through arbitration or another procedure.''.SEC. 7. AMENDMENT TO THE EQUAL PAY REQUIREMENT UNDER THE FAIR LABOR STANDARDS ACT OF 1938-. Section 6(d) of the Fair Labor Standards Act of 1938 (29 U.S.C. 206(d)) is amended by adding at the end the following: ``(5) Notwithstanding any Federal statute of general applicability that would modify any of the powers or procedures expressly applicable to a claim based on violation of this subsection, such powers and procedures shall be the exclusive procedures applicable to such claim unless after such claim arises the claimant voluntarily enters into an agreement to resolve such claim through arbitration or another procedure.''.SEC. 8. AMENDMENT TO THE FAMILY AND MEDICAL LEAVE ACT OF 1993. Title IV of the Family and Medical Leave Act of 1993 (29 U.S.C. 2561 et seq.) is amended by adding at the end the following:``SEC. 406. EXCLUSIVITY OF REMEDIES. ``Notwithstanding any Federal statute of general applicability that would modify any of the procedures expressly applicable to a claim based on right provided under this Act or under an amendment made by this Act, such procedures shall be the exclusive procedures applicable to such claim unless after such claim arises the claimant voluntarily enters into an agreement to resolve such claim through arbitration or another procedure.''.SEC. 9. AMENDMENT TO TITLE 9 OF THE UNITED STATES CODE. Section 14 of title 9, United States Code, is amended-- (1) by inserting ``(a)'' before ``This'', and (2) by adding at the end the following: ``(b) This chapter shall not apply with respect to a claim of unlawful discrimination in employment if such claim arises from discrimination based on race, color, religion, sex, national origin, age, or disability.''.SEC. 10. APPLICATION OF AMENDMENTS. The amendments made by this Act shall apply with respect to claims arising on and after the date of the enactment of this Act.

– Today's Walk of Shame is brought to you by Julia Pierson, director of the bumbling Secret Service currently being grilled by frothing members of the House Oversight Committee on the not-inconsequential matter of how a heavily-armed Omar Gonzalez was able to get deep inside the White House. Calling the lapse "unacceptable," Pierson fell on her sword, adding that "I take full responsibility" and vowing that it "would not happen again." Pierson also noted a seemingly obvious security upgrade that's more surprising for not being in place earlier: The front doors of the White House now lock automatically, reports the AP. If Pierson was the piñata, members on both sides of the aisle were eager to take a swing, notes Politico. Highlights/lowlights, also via the National Review: Stephen Lynch, D-Mass.: "I wish to God you protected the White House like you’re protecting your reputation here today. I wish you spent that time and that effort to protect the American president, and his family, like I’m hearing people covering for the lapses of the Secret Service on these several occasions. I really do." Then: "I have very low confidence in the Secret Service under your leadership." Darrell Issa, R-Calif.: "Common sense tells us this was a significant security failure—not an instance of praiseworthy restraint. This failure has once again tested the trust of the American people in the Secret Service—a trust already strained by a string of recent scandals." Jason Chaffetz, R-Utah: "If you project weakness, you invite attacks. Don’t let somebody get close to the president … don’t let them get close to the White House, ever. If they have to take action that’s lethal, I will have their back."

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Representative Stephen Lynch (D., Mass.) could scarcely contain his scorn for Secret Service director Julia Pierson’s evasive testimony before the House Oversight Committee on Tuesday, saying “I wish to God you protected the White House like you’re protecting your reputation here today.” The Massachusetts lawmaker upbraided Pierson for her agency’s inability to stop one man, armed only with a knife, from jumping a fence and penetrating deep into the White House earlier this month. And he found her repeated justifications for the breach inexcusable. “I’ve listened to your testimony very deliberately here this morning,” he said, “and I wish to God you protected the White House like you’re protecting your reputation here today. I wish you spent that time and that effort to protect the American president, and his family, like I’m hearing people covering for the lapses of the Secret Service on these several occasions. I really do.” After Lynch’s time expired, Pierson tried to explain that “the United States Secret Service does not take any of these incidents lightly. They are all –” “With all due respect, that’s my point,” Lynch interrupted angrily. “I don’t think the Secret Service is taking their duty to protect the American president and his family at the White House very seriously. That’s exactly my point.” “I have very low confidence in the Secret Service under your leadership,” he added. “I have to say that.” ||||| The head of the U.S. Secret Service did little to assuage concerns from lawmakers during a tense and testy congressional hearing Tuesday that the agency is not up to the task of protecting the White House. Secret Service Director Julia Pierson said the agency is reviewing its security protocols after a Sept. 19 incident where an armed intruder jumped the White House fence and vowed that such a security lapse would “never happen again.” Text Size - + reset “It’s clear that our security plan was not properly executed,” Pierson said during a four-hour House Oversight Committee hearing. “This is unacceptable, and I take full responsibility.” Even after a classified briefing that offered more in-depth information, members said they had little confidence in the agency’s leadership but stopped just short of asking for Pierson’s resignation. (Also on POLITICO: Rick Perry: Don’t try to enter my house) “I’m not saying that yet, but I can say that the agency overall has a leadership problem,” said Rep. Jason Chaffetz (R-Utah). “We’re getting to the point that the president is going to have to make some dramatic changes.” White House press secretary Josh Earnest said Tuesday that the White House continues to have confidence in the Secret Service. Lawmakers have been intensely critical of the agency since Omar Gonzalez breached the White House compound and entered the Green Room before being apprehended by officers last month. He was arrested and on Tuesday was indicted on three charges, including unlawfully entering a restricted building. There was strong, bipartisan criticism of the agency from committee leaders even before Pierson spoke — and the tone never got better. “Common sense tells us this was a significant security failure — not an instance of praiseworthy restraint,” said Committee Chairman Darrell Issa (R-Calif.). “This failure has once again tested the trust of the American people in the Secret Service — a trust already strained by a string of recent scandals.” Rep. Elijah Cummings — the top Democrat on the panel — echoed those sentiments, saying several incidents, including a 2011 incident recently revealed by The Washington Post in which it took days for the Secret Service to realize that eight shots had been fired at the White House, tested the “credibility” of the agency. (Also on POLITICO: Darrell Issa hits Secret Service protection) “This recent incident unfortunately causes many people to ask whether there is a much broader problem with the Secret Service,” the Maryland Democrat said. Neither Cummings nor Issa asked for Pierson to resign her post but said they planned to call for an independent investigation into the break-in. Cummings said the “jury is still out” on whether Pierson should remain as head of the embattled agency. “The director did not get a clean bill of health at the end of this hearing,” Issa said. “It is up to the president and the secretary to determine if she is the person to respond. Right now, I was not satisfied with this hearing.” Separately, Rep. Mike McCaul, the chairman of the Homeland Security Committee, announced plans to create a blue-ribbon commission to review the Secret Service. He said he is “deeply concerned with the lack of transparency” from the agency. (Also on POLITICO: Intruder made it deep into White House) During the hearing, committee members focused on what they described as a breakdown in security after agents failed to release security dogs to stop Gonzalez and a system of alarms failed to alert officers inside that an intruder was on the grounds. The Washington Post reported on Monday that initial reports from the Secret Service that Gonzalez only made it through the front doors were incorrect and that he had, in fact, had access to much of the White House’s main floor. Pierson also said that Secret Service agents had previously stopped and questioned Gonzalez, who in one case was carrying a hatchet, near the White House in the weeks before Sept. 19 but ultimately released him as he had not committed a crime. Pierson also said that officers recognized Gonzalez on Sept. 19 before he jumped the fence but did not detain him. “We all are outraged within the Secret Service about how this incident came to pass,” Pierson said. “It is self-evident that mistakes were made.”

perfluorocarbons accumulate in the dependent regions of the lungs , which may result in regional hypoxia if ventilation with oxygen is insufficient to oxygenate the dependent perfluorocarbon - filled alveoli . in this issue of critical care , max et al present data that demonstrate a decrease in arterial oxygen tension ( pao2 ) at 30 min compared to that observed at 5min after administration of fc 3280 . these data suggest failure of on - going attributed to the oxygen ventilation / oxygenation to support the initial increase in pao2dissolved in the administered perfluorocarbon . studies such as this one demonstrate that development of the optimal partial liquid ventilation ( plv ) technique is ongoing .

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plv has piqued the fascination of critical care practitioners since it was described in 1991 . it was proposed to enhance gas exchange in the setting of the acute respiratory distress syndrome , and laboratory studies quickly demonstrated that alveolar recruitment and redistribution of pulmonary blood flow , presumably due to the presence of the high - density perfluorocarbons in the dependent regions of the lungs , contributed to the observed improvement in gas exchange . it was also noted , both in the laboratory and the clinical settings , that perfluorocarbons accumulated predominately in the dependent regions of the lungs . this observation led to the concern that areas of relative hypoxia might exist if ventilation with oxygen was insufficient to oxygenate the perfluorocarbon - filled alveoli in these regions . it is worthwhile to note that oxygenation of the perfluorocarbon - filled alveolus is likely dependent on convection , rather than diffusion , because the diffusion of oxygen in a liquid is several orders of magnitude less than that in a gas . whether this dependent hypoxic phenomenon occurs tutuncu et al demonstrated a reduction in oxygenation in normal rabbits in which pulmonary perfluorocarbon was administered . that ventilation - perfusion matching may be compromised in these normal animals suggests that oxygenation of the liquid - filled alveolus may be incomplete . in this issue of critical care , max et al examine the time course of changes in arterial oxygenation after administration of 7.5 ml / kg of the perfluorocarbon fc 3280 into the lungs of saline lavage lung - injured pigs . specifically , the authors measured pao2 and other physiologic parameters at 5 and 30 min after perfluorocarbon instillation , with the hypothesis that a time - dependent decrease in pao2 would suggest failure of ongoing ventilation - oxygenation to support the initial increase in pao2 attributed to the oxygen dissolved in the administered perfluorocarbon . indeed , the authors observed two important findings : first , a dose - dependent increase in pao2 was observed ; and second , pao2 at 30 min was significantly less than that observed at 5 min after administration of 22.5 and 30 ml / kg fc 3280 . the latter is an intriguing observation that suggests that oxygenation of the perfluorocarbon may be insufficient after initial administration . there are , however , a number of issues that need to be considered in the interpretation of these findings . one premise of the derived conclusions is that the administered perfluorocarbon was sufficiently oxygenated so as to have a substantial impact on pao2 . we have no information on the oxygenation status of the perfluorocarbon at the time of administration , however . even so , the theoretic amount of oxygen contributed by fully saturated fc 3280 would be fairly small ( approximately 3 ml o2/kg ) . one enhancement to the study by max et al might be to assess the effect of hyperoxygenated , room air , and deoxygenated perfluorocarbon on pulmonary gas transport at 5 min and 30 min after dosing . these data would provide more convincing evidence that an increase in oxygenation at 5 min and the subsequent decrease at 30 min were due to changes in perfluorocarbon oxygen content . other confounding variables that may affect the difference in pao2 between 5 and 30 min include evaporation of fc 3280 and changes in other physiologic variables , such as cardiac output , which might independently affect pao2 . for instance , oxygen delivery , probably the most important parameter of oxygen dynamics , is not significantly different between the 5-min and 30-min time periods in the study . studies such as that by max et al contribute toward refining the plv technique ; these data might suggest that application of higher levels of peak inspiratory pressure or positive end - expiratory pressure could enhance gas distribution and minimize the effects observed . the technique of perfluorocarbon administration and the amount dosed may need to be altered . it would be intriguing to consider whether similar findings would be observed in newborn animals in which the relatively small height of the chest is less likely to provide regional differences in perfluorocarbon and gas distribution . a randomized , controlled , multicentered study evaluating plv in adults with the acute respiratory distress syndrome is underway . however , the pilot study preceding that trial failed to demonstrate an enhancement in parameters of oxygenation in the plv group when compared with the conventional mechanical ventilation group . we have much to learn about plv and , even though it is currently undergoing clinical trials , we are still defining the optimal application of this technique .

– A Canadian man is headed to jail after secretly poking holes in his girlfriend's condoms and making her pregnant, reports the BBC. Craig Hutchinson, 43, admitted doing so because he was worried she was about to leave him, and he thought her being pregnant would keep them together. Instead, she got an abortion and went to police, who charged Hutchinson with aggravated sexual assault. Canada's highest court upheld the conviction and his 18-month sentence today, reports the CBC. "A person consents to how she will be touched, and she is entitled to decide what sexual activity she agrees to engage in for whatever reason she wishes," says the ruling. "Because of the deliberate deceit of her partner, the sexual activity was not carried out in the manner that the complainant had agreed to." Hutchinson not only goes to jail, his name goes on the nation's sex-offender registry. His scheme may sound far-fetched, but it might be more common than you think.

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Image copyright Getty Images Image caption Hutchinson began piercing the condoms after his girlfriend expressed doubts about staying in the relationship, according to court documents The Canadian Supreme Court has upheld the sexual assault conviction of a man who poked holes in the condoms he wore during sex with his girlfriend. Craig Hutchinson sabotaged the condoms his partner insisted he wear in a bid to impregnate her and thus encourage her to stay with him, prosecutors said. Hutchinson argued deceiving his partner about the condoms did not invalidate her consent to have sex with him. He faces up to 18 months in prison and will be registered as a sex offender. "A person consents to how she will be touched, and she is entitled to decide what sexual activity she agrees to engage in for whatever reason she wishes," the high court wrote in its decision on Friday. "Because of the deliberate deceit of her partner, the sexual activity was not carried out in the manner that the complainant had agreed to." According to court documents, Hutchinson, 43, began piercing the condoms in the summer of 2006 after his girlfriend expressed doubts about the months-old relationship. She learned of his deceit after she became pregnant and he revealed what he had done in a series of text messages. The woman, who was not identified by the court, obtained an abortion and went to the police. Hutchinson of Nova Scotia was charged with aggravated sexual assault in July 2007. He was first acquitted by a trial judge, but prosecutors appealed and he was convicted at a second trial. He appealed against that verdict. ||||| A Nova Scotia man who admitted he tampered with his girlfriend's condoms resulting in her pregnancy has lost his Supreme Court appeal and must now serve the balance of his 18-month jail sentence on a charge of sexual assault. Canada's top court unanimously upheld Craig Jaret Hutchinson's sexual assault conviction on Friday morning. Hutchinson's lawyer Luke Craggs said, "It has been a very long battle. "This matter has been going on for close to seven years. It’s been hard fought and it’s been draining and so obviously it’s a disappointing outcome. But, at the very least, there’s a measure of closure in it.” In the summer of 2006, Hutchinson thought he could save his flagging relationship by getting his girlfriend pregnant. He surreptitiously poked holes in her condoms. She eventually became pregnant, but asked for time to think. It was during that period that Hutchinson told her in a series of text messages what he'd done. She called police and had an abortion. A publication ban protects her identity. “I don’t know if there are going to be any other cases like this. It’s not every day that we normally hear about someone sabotaging the birth control that a woman was counting on," said Craggs. In Friday's 7-0 decision, the Supreme Court ruled that Hutchinson deprived the woman of her ability to consent to sex. "The accused's condom sabotage constituted fraud … the result that no consent was obtained," Chief Justice Beverley McLachlin and Justice Thomas Cromwell wrote on behalf of the court. "A person consents to how she will be touched, and she is entitled to decide what sexual activity she agrees to engage in for whatever reason she wishes. The fact that some of the consequences of her motives are more serious than others, such as pregnancy, does not in the slightest undermine her right to decide how the sexual activity she chooses to engage in is carried out. It is neither her partner’s business nor the state’s," read the ruling. "We conclude that where a complainant has chosen not to become pregnant, deceptions that deprive her of the benefit of that choice by making her pregnant, or exposing her to an increased risk of becoming pregnant by removing effective birth control, may constitute a sufficiently serious deprivation for the purposes of fraud vitiating consent." Questions about consent Crown prosecutor Jim Gumpert said Hutchinson used fraud to get the victim to consent. “The victim had consented to protected sex. Condom-protected sex. She did not consent to unprotected sex,” he said. Gumpert stressed the decision didn’t hinge on lying, but the risk of serious bodily harm. “Someone lying about their age or their social status or where they worked, on that basis being able to convince someone to have sex with them, that is not enough to be convicted of sexual assault. There has to be the second component, not just fraud, but a significant risk of serious bodily harm," he said. 'Dastardly' actions Hutchinson's case has been moving through the Nova Scotia court system for more than six years, including two trials and two appeals. The judge at Hutchinson's first trial called his actions "dastardly" but acquitted him. The Crown appealed that decision, and Hutchinson was convicted in December 2011 at his second trial. In January 2013, the Nova Scotia Supreme Court rejected Hutchinson's appeal that the sentence was harsh and excessive and that the woman voluntarily consented to have sex with him. The conviction was upheld on appeal, but the Nova Scotia Court of Appeal split its decision, with one justice dissenting. That gave Hutchinson an automatic right to appeal, leading to his appearance before the Supreme Court. Canada's highest court heard arguments on the case in November. Hutchinson was taken into custody on Thursday night. At his trial, he was sentenced to 18 months in jail. He also gave a DNA sample and his name was placed on the national sex offender registry.

– EgyptAir's in-flight magazine is apologizing "for any misunderstanding" resulting from its much-ridiculed interview with Drew Barrymore, which it maintains happened despite claims that quotes were taken from a press conference. Horus publisher Ahram Advertising Agency says Barrymore agreed to the interview with Aida Takla O'Reilly "not knowing" it would appear in the magazine, per the BBC. It explained much of the kerfuffle thusly: The text—including an introduction addressing Barrymore's "unstable relationships," penned by an editor—was translated from English to Arabic and back again. "The translator is responsible solely for the accuracy of the translation to English," ABC News quotes from the statement.

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Image copyright Getty Images Image caption Barrymore's recent credits include the Netflix series Santa Clarita Diet EgyptAir's in-flight magazine has apologised over an interview with actress Drew Barrymore that was slated on social media after being published. The article went viral after being posted online, with many questioning whether the interview was real. Barrymore's representatives said she "did not participate" in the interview, which was notable for a number of grammatical and spelling errors. The publisher now says the confusion was due to translation issues. Ahram Advertising Agency, which publishes the EgyptAir's inflight magazine Horus, said the interview was conducted in English by its Hollywood reporter Aida Takla O'Reilly, then translated into Arabic and subsequently translated back into English. "We apologise for any misunderstanding that might be interpreted as an offence to the great artist," the agency said. The "surreal" article was spotted last week. The piece opens with observations about Barrymore's romantic history, saying she has been "unstable in her relationships" and has had "several unsuccessful marriages". The introduction goes on to say the "beautiful American Hollywood actress... has recently decided to temporary [sic] take an unlimited vacation to play her most crucial role as a mother". The Charlie's Angels actress was then quoted as saying she didn't "intentionally follow certain parenting methods" with her daughters, Olive and Frankie. "I do not consult with psychologists," she went on to say, according to the magazine. "I focus on nurturing their minds as well as their small bodies." The article went on to praise the 43-year-old for "her previous graceful body" after giving birth. The actress is quoted as saying: "I feel overwhelmed when someone tells me that I have regained my image and managed to lose that extra weight. "However, I find this a great opportunity to encourage every woman who is overweight to work on regaining her beauty and body, especially that it is not as hard as one may think." The quotes led many to question whether the interview was genuine. Last week, EgyptAir defended the article as a "professional magazine interview", while the article's author Aida Takla O'Reilly also insisted it was "genuine and far from fake". However, Barrymore's representatives said she did not "technically... sit down with EgyptAir for an interview" but that the quotes were drawn from a press conference. On Tuesday, Ahram Advertising Agency said Barrymore's representatives had agreed to the interview "not knowing" that Ms O'Reilly worked for the in-flight magazine and other publications. The controversial introduction of the article was not written by Ms O'Reilly, the agency added. "As is generally accepted, the lead is not part of the text of the article. It is a product of the editor's creativity produced on the condition that it contains no information that is contrary to the truth," it said. "We are about to investigate this by checking thoroughly the source material that the translator depended on to write the interview." Aida Takla O'Reilly is an Egypt-born former president of the Hollywood Foreign Press Association (HFPA), which organises the annual Golden Globes awards. Follow us on Facebook, on Twitter @BBCNewsEnts, or on Instagram at bbcnewsents. If you have a story suggestion email [email protected]. ||||| The Egyptian publisher of a now-viral in-flight magazine interview with Drew Barrymore issued a statement on Tuesday insisting the interview was real. According to the statement, Aida Takla, the writer, is a member of the Hollywood Foreign Press Association (HFPA) and conducted the interview with Barrymore during a meeting between the actress and other HFPA members. Takla, the statement explains, was a four-time elected president of the HFPA and a voting member of the Golden Globe Awards. The piece, which focuses on "Barrymore the mother," opens with a one-page introduction that labels the popular actress as being famous for "unstable relationships" and "unsuccessful marriages." The interview was widely assumed by readers to be fake. Jordan Strauss/Invision/AP Photo A statement from the publisher said that the introduction of the article was not written by the author of the interview. "As is generally accepted, the lead is not part of the text of the article. It is a product of the editor’s creativity produced on the condition that it contains no information that is contrary to the truth," argued the statement by Horus magazine and Al-Ahram advertising agency — the state run publication that handles editing and publishing the magazine. The text of the interview was translated from English to Arabic, and then back into English for publication in both versions of the magazine, the publisher's statement said. "The translator is responsible solely for the accuracy of the translation to English," according to the statement. The publisher later explained that Barrymore’s representative was unaware that Takla also writes for Horus magazine in addition to the other publications. A representative for Barrymore did not respond to a request for comment from ABC News. Evan Agostini/Invision/AP, FILE The HFPA issued a statement this week apologizing for the the interview, according to the New York Post. "As an organization comprised of journalists, the HFPA expects its members to uphold the highest degree of integrity in their journalistic activities. Based on our preliminary investigation, we understand that parts of the article in question were not written by Dr. Takla-O’Reilly and that other portions of the article may have come from other sources. We regret any distress caused to Ms. Barrymore by this article," the statement added. The HFPA did not respond to a request for comment from ABC News. ABC News' Lesley Messer contributed reporting from Los Angeles.

spontaneous perirenal hematoma following ruptured microaneurysm is an unusual but serious complication of polyarteritis nodosa . we describe a young male who presented with spontaneous perirenal hematoma and was subsequently diagnosed to have polyarteritis nodosa . he was managed with immunosuppressive medications with no recurrence of symptoms .

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polyarteritis nodosa ( pan ) is a systemic necrotizing vasculitis of small and medium - sized muscular arteries . the renal arteries are often involved and intrarenal microaneurysms may be found in 4760% of cases . it occurs in up to 413% of cases[36 ] and can be unilateral or bilateral . we reported here a young male who presented with right flank pain and was diagnosed to have spontaneous perinephric hemorrhage secondary to pan . a 26-years - old student was detected to have hypertension 6 months prior to admission . since the last 3 months , he complained of mild to moderate intermittent fever along with generalized myalgia and arthralgia of small joints . over the last 1 month , he developed right flank pain that was dull , persistent , without any aggravating or relieving factor . though there was moderate weight loss , he denied nausea , vomiting , or black stools and had no history of trauma , bleeding diathesis , or anticoagulant therapy . there was also no history of oliguria , hematuria , graveluria , cough , or shortness of breath . physical examination revealed moderate pallor and a blood pressure of 110/70 mmhg ( on two antihypertensive drugs ) . there was moderate hepatosplenomegaly and a palpable mass in the right para - umbilical region that was firm , mildly tender , nonmobile with vague margins . laboratory evaluation revealed hemoglobin 7.2 gm / dl , white blood cell count 10,000 cell / cmm with normal differential count and platelets 3.05 lacs / cmm . biochemical parameters were urea 51mg / dl , creatinine 1.5 mg / dl , bilirubin 0.8 mg / dl , sgot / sgpt 36/298 iu , total protein / albumin 7.6/4.3 gm / dl , alkaline phosphatase 71u / l , ca / p 9.1/3.5 mg / dl . urinalysis showed microscopic hematuria and 2 + proteinuria and 24 h urine protein was 0.8 gm . hepatitis b surface antigen , antinuclear antibody ( ana ) and antineutrophil cytoplasmic antibodies ( anca ) were negative . abdominal ultrasonography and contrast enhanced computed tomography ( ct ) revealed a right subcapsular renal hematoma with partially thrombosed pseudoaneurysm at the lower pole [ figure 1 ] . ct scan and ct - angiography also revealed bilateral , multiple aneurysms in kidneys and infarcts in both kidneys and spleen [ figure 2 ] . a pigtail drainage of the perirenal hematoma was done but did not drain much blood and so was removed . he was given three doses of intravenous methyl prednisolone ( 1 gm each ) followed by intravenous cyclophosphamide ( 750 mg / m ) . after three pulses of intravenous cyclophosphamide , he was shifted to azathioprine along with low - dose steroids . he remained asymptomatic with no recurrence of symptoms at 6 months of follow up and his blood pressure was controlled on one drug . cect scan showing a large right perinephric hematoma pushing kidney anteriorly with infarction in both kidneys and spleen ct angiogram indicating multiple microaneurysms and one large aneurysm ( arrow ) in the right kidney with pigtail in situ the 1994 chapel hill consensus conference on systemic vasculitides defined classic pan as necrotizing inflammation of medium sized or small arteries that spares the smallest blood vessels ( arterioles , venules , and capillaries ) and is not associated with glomerulonephritis . most cases of pan occur in the fourth or fifth decade , although it can occur at any age and there is male preponderance . livedo reticularis , nodules , mononeuritis multiplex , abdominal pain , and testicular involvement are well - described features . renal involvement in pan is in the form of microaneurysms , multiple renal infarcts , proteinuria , hypertension , and renal insufficiency . either demonstration of vasculitis on biopsy of involved organs or microaneurysms in involved vessels on angiography are sufficient to make the diagnosis . the american college of rheumatology criteria ( 1990 ) for pan ( 3 or more acr criteria yield 82% sensitivity and 87% specificity for diagnosis ) are also useful for diagnosing pan . other causes are vascular diseases , infections , cystic diseases , hydronephrosis , preeclampsia , and blood dyscrasias . among vascular diseases , polyarteritis nodosa is an important cause , others being renal artery dissection , rupture or post renal biopsy . factors that may enhance the risk of rupture include severe uncontrolled hypertension , thrombocytopenia , and pregnancy . the common clinical presentation of these patients are acute onset flank or upper abdominal pain , gross hematuria , a palpable abdominal mass or signs of blood loss . in addition to kidneys , spontaneous bleeding may occur in many organs in pan following rupture of microaneurysm or focal arteritis with consequent infarction . massive pulmonary hemorrhage and subarachnoid hemorrhage has also been reported when it involves lung and brain . sigmoid perforation and mesocolic hematoma has also been reported in a patient with polyarteritis nodosa . most of the cases of spontaneous bleeding in association with pan were established antemortem but in few cases diagnosis could be established only post autopsy . our patient was diagnosed as pan in view of fever , weight loss , abdominal pain , hypertension , and multiple , bilateral renal microaneurysms on angiography . involvement of the splenic arteries is a rare occurrence in polyarteritis nodosa . in our patient a ruptured aneurysm resulting in a huge perirenal hematoma usually necessitates an emergency operation . sometimes urgent nephrectomy is life - saving . but few cases can be treated by a conservative drainage of the hematoma as in our case or by selective arterial embolization .

– This might take a little time to wrap your head around: South African authorities have charged 270 miners with murder after police shot dead more than 30 of their co-workers during a protest earlier this month, reports the Guardian. To do so, prosecutors dusted off an obscure law often used during the apartheid era. Essentially, they argue that the miners' actions forced the police to open fire, and thus the miners are the ones to blame. "It's the police who were shooting, but they were under attack by the protesters, who were armed, so today the 270 accused are charged with the murders," a spokesman for national prosecutors tells AP. To which an opposition politician responds: "The policemen who killed those people are not in custody, not even one of them. This is madness. The whole world saw the policemen kill those people."

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About 270 miners were charged Thursday with the murders of 34 striking colleagues who were shot by South African police officers, authorities said, a development that could further infuriate South Africans already shocked and angered by the police action. An unidentified mine workers sing a dance during their meeting at the Lonmin Platinum Mine near Rustenburg, South Africa, Wednesday, Aug. 29, 2012. Two weeks ago 34 miners were shot and killed by police... (Associated Press) The decision to charge the miners comes under an arcane Roman-Dutch common purpose law, and it suggests President Jacob Zuma's government wants to shift blame for the killings from police to the striking miners. Firebrand politician Julius Malema, who has seized on the shootings to score political points, told supporters of miners outside the courthouse that the charges were "madness." "The policemen who killed those people are not in custody, not even one of them. This is madness," said Malema, who was expelled from the governing African National Congress in April. "The whole world saw the policemen kill those people." National Prosecuting Authority spokesman Frank Lesenyego told The Associated Press that "It's the police who were shooting, but they were under attack by the protesters, who were armed, so today the 270 accused are charged with the murders" of those who were shot. More than 150 of the arrested miners have filed complaints that they have been beaten up in police cells by officers, the Independent Police Complaints Directorate reported earlier this week. Directorate spokesman Moses Dlamini said the complainants accused police of beating them with batons and fists and kicking and slapping them to force them to give the names of miners who hacked two police officers to death in a week of violence preceding the shootings. Eight other people were killed, including three miners and two mine security guards whom striking miners burned alive in their vehicle. The strike, apparently rooted in rivalry between two trade unions, had rock drill operators demanding a minimum wage of 12,500 rand ($1,560) and complaining that their take-home pay was only about 5,500 rand ($688). On Aug. 16, police said they had failed to persuade the strikers to disarm and that it was "D-Day" to end the strike at the London-registered Lonmin PLC platinum mine. That afternoon, striking miners armed with clubs, machetes and at least one gun allegedly charged at police, who opened fire, killing 34 and wounding at least 78. Some survivors said many of the miners were fleeing police tear gas and water cannons when they were shot. Dlamini has refused to comment on local news reports that autopsies show many of those killed were shot in the back. Police Commissioner Gen. Riah Phiyega has been criticized for saying her officers "did nothing wrong." She said they acted in self-defense, using live bullets only after they were fired upon and had failed to stop a charge of miners with water cannons, stun grenades, tear gas and rubber bullets. Prosecution spokesman Lesenyego said the 270 miners were charged under Roman-Dutch law that held sway in South Africa before a new liberal constitution was adopted after apartheid ended in 1994. He said it was case law, meaning it has been used in previous cases and that there is legal precedent even though it is not in the constitution. The police killings were the worst public display of state-sponsored violence since apartheid was overthrown and have traumatized a nation that hoped it had seen the last of such scenes. The common purpose law being used to charge the miners was fought by the African National Congress when it was a liberation movement, accusing the white minority government of using it to make victims of a crime its perpetrators. The ANC has been in power for 18 years and the miserable living conditions of miners has highlighted its failure to transform the wealth of Africa's richest nation into better lives for the majority of its 48 million citizens, who continue to battle unemployment, housing shortages and poor health and education services. In the fallout from the killings, the bitter mine strike has strengthened. Lonmin reported an average of 6.6 percent of workers showed up across various shifts Thursday, down from 13 percent on Monday and 50 percent on Saturday. Lonmin said many workers were being intimidated and feared for their safety if they returned to work. The company has suffered a serious hit to its share price and has said it probably cannot meet debt payments, due next month, because of the strike that started Aug. 10. ||||| The 270 miners arrested during violent strikes in South Africa have been charged with the murder of their 34 colleagues who were shot dead by police. The murder charge – and associated charges for the attempted murder of 78 miners injured at the Marikana mine near Johannesburg – was brought by the national prosecuting authority under an obscure Roman-Dutch common law previously used by the apartheid government. The move came as the men appeared in court charged with public violence over the clashes at the Lonmin platinum mine on 16 August when striking miners armed with clubs, machetes and at least one gun allegedly charged police, who opened fire. It suggests President Jacob Zuma's government is trying to shift the blame for the killings to the striking miners. The prosecuting authority said all 270 miners had been charged. Less than one in 10 Lonmin miners turned up for work at the mine on Tuesday, the lowest level since workers returned to work following the clashes. Violence has since spread to Lonmin's other operations. The firm said 8% of its 28,000 workers showed up as union protests continued. Lonmin had initially threatened to sack striking workers.

we confirm a natural infection of dromedaries with glanders . multilocus variable number tandem repeat analysis of a burkholderia mallei strain isolated from a diseased dromedary in bahrain revealed close genetic proximity to strain dubai 7 , which caused an outbreak of glanders in horses in the united arab emirates in 2004 .

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on a small private farm , 2 of 7 horses had positive serologic reactions and showed typical clinical signs of glanders . on the same premises , 6 dromedaries were kept several meters away from the sick horses in a separate enclosure . three dromedaries that showed clinical signs of glanders , including severe mucopurulent discharge from both nostrils ( figure 1 , panel a ) , fever , emaciation , and fatigue , died . serum samples from this dromedary tested positive for glanders with both the oie - acknowledged complement fixation test ( titer 10+++ ) and with the central veterinary research laboratory developed in - house competitive elisa ( 7 ) with an inhibition of 57% . a ) severe mucopurulent discharge from both nostrils of a glanderous dromedary ( camelus dromedarius ) , bahrain . an edta blood sample was incubated for 11 days in a blood culture system ( oxoid , cambridge , uk ) until it became positive . this fluid was then cultured on sheep blood agar at 37c for 72 h. the isolate stained poorly gram - negative , was rod shaped , and tested oxidase positive . suspected b. mallei colonies were analyzed with the api 20 ne - test ( biomrieux , marcy letoile , france ) and were positive for nitrate , glucose assimilation , arginine dehydrolase ( after 4 days of incubation ) , n the api 20 ne - test identified the colonies as b. mallei because the same api i d number ( 1140504 ) occurred as in the previously isolated dubai 7 strain ( 1 ) . during necropsy , typical glanderous lesions in the lung , choanae , and nasal septae were observed . golf ball sized reddish - gray nodules resembling tubercles with a central gray necrotic zone were detected in the lungs . in the choanae and nasal septae , stellate scars , ulcers , and honeycomb necrotic patches covered with yellow pus ( figure 1 , panel b ) were seen . the presence of b. mallei in lung and choanae specimens was examined by using standard culturing techniques as described by wittig et al . sheep blood agar plates were incubated at 37c for 72 h. b. mallei was directly isolated from the pus , which had accumulated in the choanae , but not from nasal and eye swabs and not from the lung lesions . however , the tissue samples were stored at 20c for > 20 days before incubation . for molecular analysis , total dna was extracted by using the dna - purification kit ( qiagen , hilden , germany ) . sequence analysis of the 16s rrna ( 1,400 pb ) gene displayed the b. mallei specific single nucleotide polymorphism that differentiates b. mallei from b. pseudomallei ( 8) ( not shown ) . specific sequence type 40 ( alleles 1 , 12 , 3 , 4 , 1 , 18 , 1 ) , as previously described by godoy et al . ( 9 ) . multilocus variable number tandem repeat analysis based on 23 different loci ( 10 ) was used for further subtyping through sequencing of the variable number tandem repeat regions ( table a1 ) . ( 10 ) and compared with existing b. mallei strains ( figure 2 ) . in this analysis , the strain ( thsk2 ) isolated from the dromedary clustered with b. mallei strain dubai 7 ( figure 2 ) that had been isolated from a horse in the united arab emirates ( 11 ) . unrooted neighbor - joining tree based on 23 variable number tandem repeat loci demonstrating the genetic relationship of the camel strain ( thsk2 ) to other existing strains of burkholderia mallei . the most closely related b. mallei strain to thsk2 is dubai 7 , which was isolated from a horse in the united arab emirates in 2004 . old world camels , the dromedary ( c. dromedarius ) , and the bactrian camel ( c. bactrianus ) are susceptible to b. mallei ( glanders ) and b. pseudomallei ( melioidosis ) infection ( 12,13 ) . however , reports of b. mallei infection in dromedaries have described artificial infections ( 4,5 ) . we report natural b. mallei infection in a dromedary that occurred during a glanders outbreak in horses . clinical signs as well as gross pathologic and microscopic lesions of the diseased dromedary were similar to changes seen in equids . these changes were dominated by severe mucopurulent nasal discharge , nodules and ulcers with pus in the choanae and nasal septae , and granulomas in the lungs that resembled tubercle lesions ( pseudo tubercles ) . the pathogen was also directly isolated from the pus , which had accumulated in the choanae , but not from nasal and eye swabs and , unexpectedly not from the lung lesions . a possible explanation for the failure to isolate b. mallei from the nasal swabs was the heavy growth of various other contaminating bacteria because no selective culture medium exists for b. mallei . it could also be explained by storage of the samples at 20c for > 20 days , which probably destroyed the bacteria . the genetic relatedness of the strain isolated from the dromedary to the strain isolated in 2004 from horses in the united arab emirates suggests that this strain might be endemic to this region . it also appears to be genetically distinct from a recent outbreak in pakistan , demonstrating the persistence of multiple strains on a larger geographic scale . isolation of this pathogen from both camels and horses poses new challenges to the international trade of equids from and to countries where camels are raised .

– Business partners including NBC, Macy's, and now NASCAR have been rapidly backing away from Donald Trump, and the candidate admits he has been taken off guard by the ferocity of the backlash against his comments about Mexican immigrants. "I didn't know it was going to be this severe," he told Fox News over the weekend, though he continued to defend his remarks, pointing to the murder of a woman in San Francisco and the arrest of a suspect who has been deported five times. "It seems like I'm sort of the whipping post because I bring it up," he said. "The crime is raging. It's violent, and people don't want to even talk about it. If you talk about it, you are a racist. I don't understand it." Several of Trump's fellow GOP candidates have also denounced his comments, including Rick Perry, who says he found the remarks offensive, CNN reports. And in New Hampshire on Saturday, an angry Jeb Bush made his strongest criticisms of Trump yet, the New York Times reports. "To make these extraordinarily ugly kind of comments is not reflective of the Republican Party," Bush told reporters. "He's doing this—he's not a stupid guy, so I don't assume he thinks that every Mexican crossing the border is a rapist. He's doing this to inflame and incite and to draw attention, which seems to be the organizing principle of his campaign." Trump fired back, saying Bush is "out of touch" and doesn't "understand anything about the border or border security."

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Photo MERRIMACK, N.H. – Jeb Bush, whose wife is Mexican and three children were raised to celebrate their bicultural roots, showed a flash of anger on Saturday as he said that he “absolutely” took personal offense when Donald Trump recently described Mexican immigrants coming to the United States as “rapists” and criminals. Mr. Bush, a former Florida governor, used his strongest language yet to denounce Mr. Trump, a rival for the 2016 Republican presidential nomination and the second-place finisher behind Mr. Bush in a New Hampshire poll that was conducted after Mr. Trump made those remarks. Mr. Bush, after marching in an Independence Day parade here with two of his children, George and Noelle, said that Mr. Trump’s views are “way out of the mainstream” of the party. “To make these extraordinarily ugly kind of comments is not reflective of the Republican Party,” Mr. Bush said about Mr. Trump, whose comments caused NBC, Univision, Macy’s and others to cut ties with him. “He’s doing this — he’s not a stupid guy, so I don’t assume he thinks that every Mexican crossing the border is a rapist. He’s doing this to inflame and incite and to draw attention, which seems to be the organizing principle of his campaign,” Mr. Bush said. Asked if he took Mr. Trump’s remarks personally, given his family, Mr. Bush became a little cross. “Yeah, of course it — absolutely — and a lot of other people” did as well, he said. “But politically, we’re going to win when we’re hopeful and optimistic and big and broad rather than errrrr, grrrr, just angry all the time. This is an exaggerated form of that, and there is no tolerance for it.” Another Republican candidate, Gov. Chris Christie of New Jersey, gave a different answer on Friday when asked about Mr. Trump, a longtime friend. He criticized Mr. Trump’s remarks but then appeared to vouch for him. “I like Donald. He’s a good guy,” Mr. Christie said. “And as I said right from the beginning, he’ll be as serious a candidate as he wants to be. Those are his choices.” Mr. Trump issued a statement in response to the criticism, saying, “Today, Jeb Bush once again proves that he is out of touch with the American people. Just like the simple question asked of Jeb on Iraq, where it took him five days and multiple answers to get it right, he doesn’t understand anything about the border or border security. In fact, Jeb believes illegal immigrants who break our laws when they cross our border come “out of love.” ” ||||| Republican presidential candidate and real estate mogul Donald Trump on Saturday stood by statements he made recently that too many illegal immigrants from Mexico are criminals but said he was surprised by the backlash and that his comments are causing financial concerns. “The crime is raging and it’s violent. And if you talk about it, it’s racist,” Trump told Fox News, three days after a purported illegal Mexican immigrant deported five previous times allegedly killed a woman in San Francisco. Trump first made his inflammatory remarks during his non-scripted, June 16 presidential announcement speech. “When Mexico sends its people, they're not sending the best,” he said during the announcement. “They're not sending you, they're sending people that have lots of problems and they're bringing those problems. They're bringing drugs, they're bringing crime. They're rapists and some, I assume, are good people, but I speak to border guards and they're telling us what we're getting." Since then, a list of businesses have announced plans to cut ties with Trump’s vast business empire, while fellow Republican candidates and others have questioned Trump’s remarks. NBC and Univision, for example, have decided not to air the Trump-owned Miss Universe Pageant, Macy’s is dropping his signature clothing line, New York Democratic Mayor Bill de Blasio has ordered a review of Trump's city contracts and NASCAR is moving an annual banquet from the Trump National Doral resort in Miami. “I didn’t know it was going to be this severe,” Trump said Saturday, adding that he was surprised by the NASCAR decision, considering he has a good relationship with the group. “I am a whipping post.” Still, Trump has drawn support from Americans who say he is openly confronting the severity of the immigration problem that others won’t publicly knowledge. Trump also said Saturday that the problem isn’t limited to Mexico, that everybody entering the United States is not criminal or problematic and that his concerns are rooted in national security. “It’s about safety,” he said. “Some of the people coming here are very violent people, not all.” Trump and fellow GOP White House candidate and Florida Sen. Marco Rubio have publicly exchanged remarks since Trump’s presidential announcement, with Rubio saying Trump’s comments about Mexicans were “offensive, inaccurate and divisive.” After Mexican illegal immigrant Francisco Sanchez apparently killed 32-year-old Kathryn Steinle in San Francisco in a random attack Wednesday, Trump, who has proposed build a wall on the U.S.-Mexico border, sent a direct tweet to Rubio, the son of Cuban parents who has made immigration reform a part of his presidential campaign. “What do you say to the family of Kathryn Steinle in CA who was viciously killed b/c we can’t secure our border? Stand up for US,” Trump tweeted. Federal officials said local authorities repeatedly released Sanchez, who was in their custody as recently as this spring. On Saturday, Trump said Rubio was “weak on immigration” and that fellow GOP White House candidate and former Texas Gov. Rick Perry “could have done a lot more.” He praised what he considers fellow candidate and Texas GOP Sen. Ted Cruz’s tough immigration stance, calling him “very brave.”

Canyon Ferry Recreation, Tourism, and Economic Development Management Act - Authorizes the Secretary of the Interior, acting through the Bureau of Reclamation (BOR) and the Bureau of Land Management (BLM), to enter into cooperative management agreements necessary to manage the Canyon Ferry Recreation Area, Montana. Directs that such management agreement provide that the management responsibilities given to the BLM for lands withdrawn or acquired for reclamation purposes shall be accomplished in accordance with the statutory authority generally exercised by BLM in the management of public lands. Directs the Secretary to manage all lands and facilities in the Area associated with recreation, tourism, and related economic development pursuant to the Canyon Ferry Resources Management Plan of 1993. Provides that provisions of the Federal Water Project Recreation Act that limit or prescribe costs that may be incurred by Federal and non-Federal entities for recreation, planning, management, or facilities or that require non-Federal management of recreation facilities or programs shall not apply to the Area. Requires all recreation user fees collected from the Area to be retained by the managing agencies and used exclusively to fund the operation, maintenance, and development of the Area for recreation, tourism, and economic development. Authorizes appropriations.

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SECTION 1. SHORT TITLE. This Act may be cited as the ``Canyon Ferry Recreation, Tourism, and Economic Development Management Act''.SEC. 2. FINDINGS. Congress finds and declares that-- (1) there is a Federal responsibility to provide opportunities for public recreation, tourism, and economic development at Federal water projects, in partnership with other Federal and non-Federal interests; (2) certain provisions of the Federal Water Project Recreation Act (Public Law 89-72 as amended) unduly restrict the management of the Canyon Ferry Recreation Management Area because the provisions do not allow for the increasing economic burden that construction and management of recreational facilities are placing on managing entities, especially at the State and local levels; (3) non-Federal responsibility for a significant portion of all costs of operation, maintenance, and replacement of facilities on Federal lands at the Canyon Ferry Recreation Management Area as well as total management responsibility is an unfair burden on non-Federal managers, especially in instances where the facilities are old, underdesigned, do not provide adequate access for the disabled, and are utilized by national and international publics, and responsibilities for complex fisheries reservoir management and for wildlife and wetlands management have been borne solely by the non-Federal entities, further increasing the overall management burden; and (4) the recreational, tourism, and economic development needs at the Canyon Ferry Recreation Area can best be met through cooperative management efforts by the Bureau of Reclamation, the Bureau of Land Management, the State of Montana, and other appropriate entities.SEC. 3. COOPERATIVE AGREEMENTS. (a) Authorization.--The Secretary of the Interior (hereafter in this Act referred to as the ``Secretary''), acting through the Bureau of Reclamation and the Bureau of Land Management, may enter into such agreements as are necessary to carry out the purposes of this Act. (b) Contents of Agreements.--Any management agreement entered into under this Act shall provide that the management responsibilities given to the Bureau of Land Management for lands withdrawn or acquired for reclamation purposes shall be accomplished in accordance with the statutory authority generally exercised by the Bureau of Land Management in the management of the public lands.SEC. 4. PROTECTION OF AUTHORIZED PURPOSES OF RECLAMATION PROJECTS. (a) No Alteration of Purposes of Canyon Ferry Unit.--Nothing in this Act is intended to change, modify, or expand the authorized purposes of the Canyon Ferry Unit. (b) Original Purpose of Canyon Ferry Dam and Reservoir Unaffected.--Nothing in this Act shall change the responsibility of the Bureau of Reclamation to meet the needs for which the Canyon Ferry Dam and Reservoir were originally constructed. (c) No Authorization to Affect Water Supply.--This Act is not intended to authorize any action or inaction by any person, including any person who has contracted for the water supply from a reclamation project, that reduces the quantity, or modifies the time and manner of availability, of the water supply from the Canyon Ferry Unit to project beneficiaries.SEC. 5. MANAGEMENT. (a) Management Under the Plan.--The Secretary shall manage all lands and facilities in the area associated with recreation, tourism, and related economic development pursuant to the Canyon Ferry Resources Management Plan, of 1993, and any amendments thereto. (b) Exemption From Provisions of the Federal Water Project Recreation Act.--Provisions of the Federal Water Project Recreation Act (16 U.S.C. 4601-12) that limit or prescribe costs that may be incurred by Federal and non-Federal entities for recreation planning, management, or facilities, or that require non-Federal management of recreation facilities or programs do not apply to the Area. (c) Recreation User Fees.--All recreation user fees collected from the Canyon Ferry Recreation Area by the managing agency(ies) shall be retained by the managing agency(ies) and used exclusively to fund the operation, maintenance, and development of the Canyon Ferry Recreation Area for recreation, tourism, and economic development. Fees collected for cabin site permits, concession operations, entrance fees, and other special use fees are all considered to be recreation user fees. (d) Contents of Agreement.--The cooperative agreements shall provide that the responsibilities given to the Bureau of Land Management for the area will be carried out in accordance with the statutory authority generally exercised by the Bureau of Land Management in the management of the public lands.SEC. 6. AUTHORIZATION OF APPROPRIATIONS. There are authorized to be appropriated such sums as may be necessary to carry out this Act, to remain available until expended. Especially critical are the first 10 years of the interagency project management agreement when major management, maintenance, replacement, and construction must occur.

abstracta 72yearold woman with history of breast cancer only treated surgically was referred to our department for pulmonary hypertension ( ph ) suspicion . echocardiogram revealed elevated right ventricular systolic pressure . computed tomography ( ct ) angiogram showed no pulmonary embolism ( pe ) , but lung scan revealed two ventilationperfusion mismatch areas . right cardiac catheterization established precapillary ph . despite treatment with ph specific therapy ( sildenafil , ambrisentan , and epoprostenol ) , her condition worsened rapidly with acute right heart failure ( rhf ) . she died 22 days after admission . postmortem microscopic examination showed a rare combination of ph etiologies consistent with metastasis of breast cancer in pulmonary vasculature including the rare pulmonary tumour thrombotic microangiopathy ( pttm ) .

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among the many causes of dyspnea associated with ph in a patient with history of cancer , paraneoplastic thrombotic pe is the most common aetiology and must be considered in priority . but tumour cells can metastasize in the pulmonary vasculature in three mechanisms : occlusion of the small pulmonary arteries , pulmonary tumour thrombotic microangiopathy , or reach the lymphatic system . a 72yearold woman was admitted to a hospital 2 months ago for exerciseinduced dyspnea . she had history of left breast cancer pt2pn1m0 treated 2 years before with mastectomy , chemotherapy , and chest radiation . ddimer serum level was elevated , so a ct angiogram was performed and showed no evidence of pulmonary embolus , whereas ventilation perfusion lung scan revealed two perfusion defects throughout superiors lobes with normal ventilation . distal pe was suspected , and oral anticoagulation therapy was initiated and the patient discharged . two months later , an echocardiogram revealed elevated right ventricular systolic pressure at 78 mmhg . the right ventricle was moderately dilated ( 30 mm ) , nonhypertrophic , with good systolic function . she had severe hypoxemia of 52 mmhg , a ph of 7.46 , a pc02 of 34 , and hco3 of 24 mmol / l with 10 l / min of oxygen . the pulmonary function tests , the viral serologies , and the immune checkup were normal . a second chest ct showed nonspecific groundglass opacities and lung fibrosis consistent with previous radiation therapy but no sign of pe , nor interlobular septal thickening , adenopathy , or mass . right cardiac catheterization established precapillary ph with mean pa pressure of 48 mmhg and not elevated pulmonary wedge pressure ( 4 mmhg ) . atrial pressure was low ( 5 mmhg ) , cardiac output was normal ( 2.66 l / min / m ) , and pulmonary vascular resistance were increased at 8.6 wood units . a specific ph tritherapy was administrated ( sildenafil , ambrisartan , and epoprostenol ) , but her condition worsened rapidly with acute rhf , respiratory distress , acute renal failure , and microangiopathic hemolytic anaemia . in this context , in absence of diagnostic , we decided to withhold invasive ventilator support . the autopsy showed three etiologies of ph consistent with hematogenous metastasis of breast cancer in pulmonary vasculature : carcinomatous cell inside lymph vessels ( lymphangitis carcinomatosis ) ( figure 1 ) , tumour cell embolization inside small arteries ( tumoural cells emboli ) ( figure 2 ) and pulmonary tumour thrombotic microangiopathy ( pttm ) ( figures 3 and 4).this latter is histologically characterized by intimal and medial fibromuscular thickening with accumulation of carcinomatous cells in the residual lumen of the small arteries and arterioles . ( haematoxylin and eosin ) : tumoural cells inside lymph vessels ( black arrow ) ; pleura ( dotted arrow ) . ( haematoxylin and eosin ) : tumoural cells inside arteriole lumen ( black arrow ) ; intimal fibroblastic proliferation ( black star ) ; fibrinrich thrombus ( * ) ; internal elastic lamina destruction . ( haematoxylin and eosin ) : tumoural cells inside arteriole lumen ( black arrow ) ; intimal fibroblastic proliferation ( black star ) ; internal elastic lamina destruction ( dotted black arrow ) ; hypertrophic arteriole wall ( double black arrow ) . it was first described in 1990 in 3.3% of an autopsic series of patients , who had died of metastatic adenocarcinoma , mostly of gastric origin.1 recently , a large case series estimated the incidence of 1.4% among 2215 autopsy patients with carcinoma and confirmed the stomach as the primary site of cancer associated with pttm . most of the time , there is evidence of metastatic disease , but many occult cancers have been reported as in our description . previous studies have shown that tumour cells have the abilities to activate coagulation pathway and local thrombus formation and trigger fibroblastic intimal proliferation via production of cytokines such as tissue factor,2 vascular growth factor , or plateletderived growth factor.3 high vegf expression associated with gastric cancer could explain the high incidence of pttm . in addition to mechanical occlusion , these phenomena rapidly lead to arterioles remodelling and stenosis , increased pulmonary vascular resistance , and ph . the tumoural cells are beyond the resolution of the ct angiogram , but their presence explains the perfusion defect on lung scan . recently , a treeinbud pattern , usually seen in bronchiolitis and characterized by small centrilobular nodules and branching linear opacities , was reported on thinsection ct of pttm patients.4 disseminated intravascular coagulation5 or cancer associated hemolytic anaemia has often been described consistent with elevated ddimer . a study has estimated the median survival as 5 days from admission to hospital.6 pttm may be identified using videoassisted thoracoscopic surgery , transbronchial biopsy , right heart catheterization , and ctguided biopsy.7 in the rare antemortem diagnosis case , specific chemotherapy was administrated often associated with empiric treatment such as corticosteroids or anticoagulation . the best survival reported was 15 months probably because diagnosis was made prior to the development of ph.8 chronic pe is the main cause of unexplained progressive dyspnea with precapillary ph in the context of cancer . but when large proximal pe is absent in ct angiogram whereas lung scan show multiple perfusion defects , clinicians must consider other tumoural embolic causes in the differential , especially pttm . thereby , they will be able to perform pulmonary cytology or biopsy before the patient 's condition deterioration . a rapid specific chemotherapy administration is the only way to improve the survival of patients .

– John Kasich is the real "action hero" and would be a better choice for the GOP nomination than Donald Trump, according to Arnold Schwarzenegger, Trump's successor as host of Celebrity Apprentice. The former California governor, who was in Columbus for the Arnold Classic bodybuilding competition, endorsed the Ohio governor at a Sunday afternoon rally in the city, saying Kasich had "kicked serious butt" during his years in Congress, reports the Guardian. Kasich—who appeared alongside Arnie wearing a "Governator" jacket—has been campaigning hard in his home state ahead of its March 15 winner-take-all primary, CBS News reports. He is currently trailing Trump by a few points in the Ohio polls and says he will probably drop out of the race if he doesn't carry the state.

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Hundreds packed the Franklin Park Conservatory Sunday afternoon as Arnold Schwarzenegger officially endorsed longtime comrade, John Kasich at a campaign rally in Columbus, Ohio. Schwarzenegger, sporting a Kasich campaign jacket, called Kasich an "action hero" who "kicked some serious butt" as a congressman in Washington, citing his record as Chair of the House Budget Committee. And recounting his journey to America in 1968 when he arrived with "absolutely nothing", Schwarzenegger said, "the land of opportunity" that's afforded him great success, needs Kasich to "take charge and be at the White House." Kasich often mentions his fellow Republican governor on the trail while recounting the times he's complained to him about negative ads. Schwarzenegger, Kasich is fond of saying, advises him to "love the beatings." Schwarzenegger, who was in town for his annual Arnold Sports Festival, had previously expressed his support for Kasich but stopped short of a formal endorsement during a tele-town hall days before the New Hampshire primary when he lauded his "refreshing campaign" and characterized him as a "great leader" who is a "uniter and not a divider". The two-term former Californian governor will host the next season of NBC's "Celebrity Apprentice" replacing Republican front-runner Donald Trump. Kasich spent the day campaigning in his home state ahead of the March 15 winner-take-all primary which he deems to be critical in his survival in the 2016 race. Kasich hopes to garner enough delegates to move forward to the GOP convention hosted this year in Cleveland but mentioned that a loss in his home state would seal his fate ultimately forcing him to drop out. The Ohio governor continues to lean on his pledge to run a positive campaign and during today's rally, encouraged voters today work together to form a "beautiful mosaic", fix the issues that plague the country and move America forward. ||||| The Terminator star and former California governor described the Republican candidate as ‘an action hero’ who ‘kicked serious butt’ in Congress John Kasich needs to display some political muscle in advance of Ohio’s winner take all primary next week. So who better to endorse him than Arnold Schwarzenegger? At a chilly outdoor rally in a Columbus park, Kasich received the backing of the action movie star and former California governor on Saturday. Schwarzenegger warmly endorsed Kasich, telling the crowd of almost 1,000: “We need John Kasich to now take charge and be in the White House. The former governor, who will replace Republican frontrunner Donald Trump as host of The Apprentice, described Kasich as “an action hero” who “kicked some serious butt” during his time in Congress. Kasich celebrated the endorsement by wearing a “governator” jacket, which he said was a gift from Schwarzenegger. Kasich spent most of his speech sticking to his insistence on “a positive message” and avoiding “name calling and sliming”. However, he did retell a favorite story about how he was “whining to [Schwarzenegger] about negative campaigning in Ohio” during Kasich’s first campaign for governor in 2010. He said the then-governor of California looked him straight in the eye and said: “Love the beatings. Love them.” But, without winning a single state and with only a pair of second place finishes to his name so far, Kasich has had a lot of beatings to enjoy in the 2016 primary. However, while the Ohio governor is campaigning hard in Michigan’s primary on Tuesday, he has staked his entire campaign on the winner-take-all Ohio contest on 15 March, and Schwarzenegger’s endorsement added hometown credibility in addition to celebrity luster. The Terminator star was in Columbus for the Arnold Classic, a world-renowned bodybuilding competition that is held in Ohio’s capital city annually. However, at the rally on Sunday, many of the attendees seemed to be there for Kasich, rather than Schwarzenegger. Henry Rosenstein, a high schooler from Dublin, Ohio, told the Guardian: “I always kind of thought Kasich has made the most sense out of the Republican candidates ... I like his temperament.” Rosenstein added that although there were a lot of Trump supporters in his high school, he did not expect many of them to vote. Cindy Bond of Columbus said: “I wouldn’t come to see Schwarzenegger,” adding: “But it’s nice.” Mary Knight of Westerville, Ohio, praised Kasich as “a moderate” and noted: “What he says is sensible. He doesn’t say crazy things, over-the-top things, and grew up as a lower-middle-class person.” The Kasich campaign is hoping to bank on this local appeal as well as their strong organization in the Buckeye State to notch up a big win on 15 March. Matt Borges, the chair of the Ohio Republican Party, said that the Kasich campaign was working with candidates in competitive local primaries to make sure that the presidential hopeful’s literature was being handed out by them and even to get local candidates to identify potential Kasich supporters for the Ohio governor. In contrast, Borges said Trump had simply flown in for a campaign stop and claimed he had heard anecdotally of exactly one person whose door had been knocked by the Ted Cruz campaign. Kasich, who was five points behind Trump in a recent poll of the state, just needed “to remind Ohio voters why they wanted him to be governor in first place,” Borges said. Kasich “can win, will win and everything changes when he carries Ohio.” With all this organization behind him – at the rally on Sunday, a parade of Ohio Republicans including a former senator took the state to warm up the crowd – Kasich should be a favorite in his home state. However, with only one recent poll and a volatile electorate, anything could happen. As Mary Knight told the Guardian: “This is the most difficult [election] to gauge because of that idiot Trump.”

– Remember that victim of Whitey Bulger who dropped dead suspiciously last month as the mob boss' trial was underway? Turns out, Stephen Rakes was murdered, say authorities in Boston. But, surprise, they don't think Bulger had anything to do with it. Instead, the local DA says a business partner who owed Rakes lots of money poisoned his iced coffee at a McDonald's, reports the Boston Globe. The suspect is 69-year-old William Camuti, and he is under arrest, reports CNN. He allegedly lured Rakes to a local McDonald's to talk about a fake business deal, then dropped two teaspoons of potassium cyanide into Rakes' drink. Authorities say he drove around with Rakes in his vehicle for several hours afterward—as Rakes died from the poisoning—then dumped his body in the woods. The Middlesex DA says Camuti acted alone, and her office sees no connection to Bulger. Rakes had hoped to testify at Bulger's trial to allege that Bulger and one of his henchmen essentially stole his liquor store through strong-arm tactics decades ago. (Meanwhile, Bulger today angrily told the judge that he would not be taking the stand in his own defense in his murder and racketeering trial.)

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(CNN) -- A 69-year-old Massachusetts man was arrested and charged Friday in Boston in connection with the death of Stephen Rakes, a regular at James "Whitey" Bulger's trial before he was found dead last month near a walking trail, authorities said. William Camuti was taken into custody in Boston and charged with attempted murder, misleading police and unlawful disposition of human remains, the Middlesex District Attorney's office announced in a press release. His attorney couldn't be immediately reached for comment. The body of the 59-year-old Rakes was found July 17 in a wooded area in Lincoln, Massachusetts, about 30 miles from his home in Quincy. Rakes had been an alleged extortion victim of Bulger's, and had learned shortly before his death that prosecutors no longer planned to call him to testify, according to a friend. Bulger, a reputed Irish mob boss in south Boston, is now standing trial in that city for allegedly participating in 19 murders, racketeering, money laundering and extortion over a two-decade period. Widow yells at Bulger after he won't take the stand Camuti and Rakes were longtime business associates, and Camuti allegedly poisoned Rakes at a time when Camuti owed money to Rakes. "We allege this defendant intentionally put poison in the victim's iced coffee and then disposed of his body," Middlesex District Attorney Marian Ryan said in a statement. In a phone call on July 16, Camuti asked Rakes for a meeting to discuss a potential investment property in Wilmington, Massachusetts, authorities said. In fact, the investment deal was fake, authorities said. On the same day, surveillance video showed Rakes leaving the federal courthouse where he regularly attended Bulger's murder trial. Rakes appeared to be wearing the same clothing in which his body was found, authorities said. The two men met that afternoon in a McDonald's in Waltham, and Camuti bought two iced coffees, one of which he allegedly laced with two teaspoons of potassium cyanide and gave to Rakes, who drank it, authorities said. Camuti allegedly drove Rakes around the cities of Waltham, Woburn, Burlington and Lincoln for several hours. Investigators alleged Camuti dumped Rakes' body in the wooded area, where it was found the next day. The medical examiner's office has yet to determine the cause of Rakes' death, authorities said. CNN's Michael Martinez and Greg Botelho contributed to this report. ||||| WOBURN — Middlesex District Attorney Marian T. Ryan said today that Stephen “Stippo” Rakes was allegedly murdered by a Sudbury man who poisoned his iced coffee at McDonald’s after several business deals went awry, leaving the man heavily in debt to Rakes. Stephen Rakes was allegedly killed by a man who owed him money. The slaying was not related to the James “Whitey” Bulger case. (Michael Dwyer/AP) AP William Camuti, 69, was arrested in Boston today and arraigned this afternoon in Concord District Court on attempted murder and other charges. Judge J. Elizabeth Cremens ordered him held without bail and slated a dangerousness hearing for Tuesday. Ryan said the charge would be upgraded to murder when the state medical examiner completes an autopsy. Camuti also faces charges of misleading police and unlawful disposal of human remains. Advertisement - Continue Reading Below “The investigation showed us that Mr. Rakes and the defendant have known each other for many years and had been involved in a number of business transactions,” Ryan said. “We developed evidence showing Mr. Camuti owed Mr. Rakes a significant amount of money.” At a press conference this afternoon, Ryan said officials believe Camuti “acted alone’’ and that there was no connection to the James “Whitey” Bulger case. Rakes was an alleged victim of the notorious gangster nearly three decades ago. Rakes told the Globe that Bulger and his allies, Stephen “The Rifleman” Flemmi and Kevin Weeks, extorted a South Boston liquor store from him at gunpoint in 1984 while Rakes’s two young daughters were in the same room. Rakes had wanted to testify at Bulger’s high-profile trial, which is nearing its end in US District Court in Boston, but he had been notified by prosecutors that he wouldn’t be called to the witness stand. Ryan said today that Camuti contacted Rakes by telephone on July 16 and asked to meet so they could discuss a business deal Camuti had underway in Wilmington — a deal that Ryan said did not, in fact, exist. “Mr. Rakes was lured to this meeting on the promise of a real estate deal in which he could invest to make a significant amount of money,’’ Ryan said. “However, that deal, did not, in fact, exist.” Ryan said the two men met around 1:45 p.m. at a McDonald’s restaurant in Waltham. At some point, Camuti purchased two cups of iced coffee. “We allege that the defendant, Mr. Camuti, laced one of those iced coffees with two teaspoons of potassium cyanide,” Ryan said. She said that after Rakes, 59, ingested the fatal dose of poison, Camuti drove around for several hours with Rakes in a vehicle before eventually dropping Rakes’s body off in a wooded area in Lincoln, where it was found July 17 without keys, a wallet, or cellphone. Many of Rakes’s friends and relatives had questioned the circumstances of his death, given that he was physically fit and without a wallet when found. His body was found the day after US Attorney Carmen Ortiz’s office informed him that he would not be called as a witness against Bulger in his US District Court trial. A South Boston native and a retired MBTA worker, Rakes was living in Quincy at the time of his death. Mobile users unable to see the video, click here.

textiloma is an inflammatory mass containing surgical sponges that are unintentionally left behind in a surgical wound . this complication has been most commonly described by abdominal and gynecologic surgeons . however , the occurrence of textiloma after intracranial procedures especially under the temporalis muscle has not been documented . the author reports a rare case of textiloma of the pterion in a patient who presented with a subcutaneous tumor developed eight years after frontotemporal craniotomy for aneurysm clipping .

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textiloma is a term used to describe a foreign - body reaction to the retained material routinely used during operations such as cotton or gauze . textilomas are inflammatory granulomas that often mimic residual or recurrent tumors or abscesses clinically or radiologically . a study involving 254 cases of textilomas showed common occurrences in the order of abdomen ( 56% ) , pelvis ( 18% ) , thorax ( 11% ) , and limb ( 7% ) , spine ( 4% ) , and head and neck ( 4%)10 ) . in contrast , the existence of textilomas after craniotomies has been observed in a limited number of studies . the author reports the first case of textiloma due to retained gauze that was left under the temporalis muscle eight years ago in a patient who underwent pterional craniotomy for ruptured aneurysm . a 64-year - old woman complained of a painful expansion in the temporal region that she had first noticed five months previously . there were no complications at the time of her operation . on examination , a well - circumscribed , firm , computed tomography ( ct ) showed a tomb - like isodense lesion having a moderate enhancement under the musculo - cutaneous flap ( fig . a piece of gauze encapsulated by a large amount of granulation tissue was found at the layer between temporalis muscle and dura through surgical defect of calvarium ( fig . retention of surgical materials within wounds has been reported to occur with a frequency of one in 5000 for all operations3 ) . among them , textilomas in the fields of neurosurgery have been found to appear after spinal surgery7 ) , craniotomies for trauma6 ) , tumor resection1 ) , clot evacuation9 ) , cotton wrapping of aneurysms5 ) , and microvascular decompression2 ) . intraoperatively applied foreign materials can cause infection or abscess formation in the early stage , whereas others mostly remain asymptomatic for many years8 ) . chronic cases of fibrinous textiloma like the present one involves slow adhesion formation such as encapsulation and granuloma . they are often overlooked or can be confused with other soft - tissue masses . time to discovery in this case , 8 years , was much longer because of the high likelihood of intracranial textilomas related complications within the first 2 years after surgery1,2,5,6,9 ) . being sterile , the surgical cottons do not initiate an infective reaction and thus remain clinically silent and missed for a long duration in the postoperative period until they are thought of . after a certain period , when the patient 's resistance decreases or a bout of bacteremia ensues , organisms will lodge into the area of the foreign body and a sterile inflammatory reaction will turn symptomatic . this may be associated with tooth extraction or throat infection or after a flu - like syndrome . a continuing foreign body granulomatous reaction may be speculative explanation for this case that presents late as a progressively enlarging mass in the temporalis muscle . in contrast with other lesions , intracranial and spinal textilomas sometimes show early severe symptoms like neurologic deficit , pain or seizure . patients with textilomas after craniotomy for tumors are at risk of unnecessary treatment because these lesions manifest as recurrent tumors . patients with textilomas could in fact show more aggravated symptoms due to the mass effect of granuloma after microvascular decompression for cranial rhizopathy . furthermore , spine surgeons may mistake textilomas for recurrent disc herniations in some cases . however , the present case showed only bulging on the surgical wound without neurological deterioration . this was quite different from most patients who underwent pterional craniotomy and experienced remarkable depression in the frontozygomatic fossa . imaging is essential to the workup for textilomas , and the common differential diagnosis includes primary , metastatic , recurrent tumor , radiation necrosis or abscess . suggested ct findings are low - density heterogeneous masses with a hyperdense rim that was further enhanced after contrast injection like the present case , and sometimes they present with a spongiform pattern containing air bubbles6 ) . the signal intensity of magnetic resonance imaging may vary according to aging , histologic composition , and its fluid content . almost all lesions are hypointense on t1-weighted images and hyperintense on t2-weighted images , but textilomas can not be easily distinguished from a recurrent tumor or abscess due to their less characteristics8 ) . therefore , careful history taking about previous operations and being aware of textiomas are very important for imaging diagnosis . an increased risk of a foreign body retainment after craniotomy was highly correlated with emergency cases , unexpected changes in operations , and inaccurate counts of sponges and instruments , involvement of more than one surgical team , and patients with a high body - mass index4 ) . although textilomas are rarely encountered under the temporalis muscle , these must always be considered in the differential diagnosis of cranial masses arising after craniotomy . early second - look surgery may be advised to ascertain the diagnosis for certain cases , especially when unusual progression of the intra- and extracranial lesion is seen during treatment or routine follow - up . this lifts the burden of uncertainty from both the patient and the physician and allows for a more conservative treatment . the author reports a case of textiloma under the temporalis muscle found in the second surgery performed 8 years after the first . the rarity of postcraniotomy extracranial textilomas and their nonspecificities in the imaging features preclude preoperative diagnosis . the occurrence of a textiloma following craniotomy can only be avoided by surgeons who are aware of this uncommon but clinically significant event .

Detroit Growth and Stability Act of 2012 - Authorizes the Secretary of the Treasury to: (1) make loans to a financing agent authorized by the state of Michigan to act on behalf of the city of Detroit, Michigan, for which the financing agent and the city shall be jointly and severally liable; and (2) require the city and the financing agent to provide security for such loans. Limits the aggregate amount of loans outstanding to $500 million. Terminates the authority of the Secretary to make such loans on January 1, 2016. Establishes in the Treasury the City of Detroit Growth and Stability Fund for purposes of making such loans.

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SECTION 1. SHORT TITLE. This Act may be cited as the ``Detroit Growth and Stability Act of 2012''.SEC. 2. FINDINGS. The Congress makes the following findings: (1) The City of Detroit is an essential part of the Nation's economy and, in particular, the Nation's manufacturing sector. (2) Absent decisive action from the Federal Government, the City of Detroit risks bankruptcy and loan default. (3) A bankruptcy or default of the City of Detroit would have broad negative economic consequences on the State of Michigan and the Nation.SEC. 3. DEFINITIONS. In this Act: (1) The term ``city'' means the city of Detroit, Michigan. (2) The term ``State'' means the State of Michigan. (3) The term ``financing agent'' means any agency duly authorized by State law, and approved by the city, to act on behalf or in the interest of the city with respect to the city's financial affairs. (4) The term ``Secretary'' means the Secretary of the Treasury.SEC. 4. LOANS. (a) In General.--Upon written request of a financing agent, the Secretary may make loans to such agent subject to the provisions of this Act and the city and such agent shall be jointly and severally liable thereon. (b) Maturity.--Each such loan shall mature not later than 30 years after the last day of the city's fiscal year in which it was made, and shall bear interest at an annual rate equal to the current average market yield on outstanding marketable obligations of the United States with remaining periods to maturity comparable to the maturities of such loan, as determined by the Secretary at the time of the loan. (c) Prepayment.--The Secretary may not charge any prepayment penalties with respect to any loan made under this Act.SEC. 5. SECURITY FOR LOANS. In connection with any loan made under this Act, the Secretary may require the city and a financing agent and, where the Secretary deems necessary, the State, to provide such security as the Secretary deems appropriate. The Secretary may take such steps as such Secretary deems necessary to realize upon any collateral in which the United States has a security interest pursuant to this section to enforce any claim the United States may have against the city or any financing agent pursuant to this Act. Notwithstanding any other provision of law, Acts making appropriations may provide for the withholding of any payments from the United States to the city, either directly or through the State, which may be or may become due pursuant to any law and offset the amount of such withheld payments against any claim the Secretary may have against the city or any financing agent pursuant to this Act. With respect to debts incurred pursuant to this Act, for the purposes of section 3466 of the Revised statutes (31 U.S.C. 181) the term ``person'' includes any financing agent.SEC. 6. LIMITATIONS. At no time shall the amount of loans outstanding under this Act exceed in the aggregate $500,000,000.SEC. 7. REMEDIES. The remedies of the Secretary prescribed in this Act shall be cumulative and not in limitation of or substitution for any other remedies available to the Secretary or the United States.SEC. 8. FUNDING. (a) Establishment of Fund.--There is hereby established in the Treasury a fund to be known as the ``City of Detroit Growth and Stability Fund'', which shall be administered by the Secretary. The fund shall be used for the purpose of making loans pursuant to this Act. There is authorized to be appropriated to such fund the sum of $500,000,000. (b) Administrative Costs.--There are authorized to be appropriated such sums as may be necessary to pay the expenses of administration of this Act.SEC. 9. INSPECTION OF DOCUMENTS. At any time a request for a loan is pending or a loan is outstanding under this Act, the Secretary is authorized to inspect and copy all accounts, books, records, memorandums, correspondence, and other documents of the city or any financing agent relating to its financial affairs.SEC. 10. AUDITS. No loan may be made under this Act for the benefit of any State or city unless the General Accounting Office is authorized to make such audits as may be deemed appropriate by either the Secretary or the General Accounting Office of all accounts, books, records, and transactions of the State, the political subdivision, if any, involved, and any agency or instrumentality of such State or political subdivision. The General Accounting Office shall report the results of any such audit to the Secretary and to the Congress.SEC. 11. TERMINATION. The authority of the Secretary to make any loan under this Act terminates on January 1, 2016. Such termination does not affect the carrying out of any transaction entered into pursuant to this Act prior to that date, or the taking of any action necessary to preserve or protect the interests of the United States arising out of any loan under this Act.

epithelioid sarcoma is a rare soft tissue sarcoma and usually resistant to chemotherapy . it has high rates of local recurrence and distant metastasis , and the prognosis after metastasis is poor . we report a case of multiple lung metastases of an epithelioid sarcoma originating in the inguinal area that we treated with the multikinase inhibitor pazopanib . the patient was a 38-year - old male who began to experience discomfort in his left inguinal area . magnetic resonance imaging showed a tumor extended from the medial aspect of the wing of the left ilium along the iliopsoas muscle to its site of insertion on the femur . the histopathological diagnosis with a biopsy was proximal - type epithelioid sarcoma . although a positron emission tomography examination showed fluorodeoxyglucose accumulation in the left inguinal tumor , there was no distant metastasis . wide resection by a combined iliac resection procedure was performed . twelve months after surgery , computed tomography revealed multiple nodules and a diagnosis of bilateral multiple lung metastases was made . treatment with pazopanib 800 mg was started . after 2.5 months of treatment , a clear reduction in the size of the pulmonary metastases was shown . thirty months after the start of pazopanib treatment , most of the metastases have disappeared , and no development of new lesions has been seen . therefore , it appeared that pazopanib was capable of serving as one of the choices of therapeutic agents that should be taken into consideration for the treatment of advanced epithelioid sarcoma .

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epithelioid sarcoma is a rare soft tissue sarcoma of unknown origin , and it is said to have high rates of local recurrence and distant metastasis . epithelioid sarcoma is usually resistant to chemotherapy , and the prognosis after metastasis is poor . we report a case of multiple lung metastases of an epithelioid sarcoma originating in the inguinal area that we treated with the multikinase inhibitor pazopanib . the patient was a 38-year - old male who began to experience discomfort in his left inguinal area at around 2010 , and since around november 2010 , he had difficulty walking . he was told that magnetic resonance imaging ( mri ) during a thorough examination by his previous physician in july 2011 revealed a mass in his left iliopsoas muscle , and he was examined in our department for the first time in august 2011 . the physical findings during the initial examination revealed that both flexion and extension were limited . mri showed a tumor mass measuring approximately 11 5 5 cm that extended from the medial aspect of the wing of the left ilium along the iliopsoas muscle to its site of insertion on the femur . the tumor was in contact with the ilium , but there was no clear bone invasion . although left inguinal lymph node enlargement was observed , it was considered to be a reactive lesion . bone scintigraphy and chest computed tomography ( ct ) showed no evidence of metastasis , and although a positron emission tomography examination showed fluorodeoxyglucose accumulation in the left inguinal tumor , there was no distant metastasis . histopathologic findings of the biopsy showed round / polygonal tumor cells in a solid or diffuse pattern with moderate amounts of eosinophilic cytoplasm and rhabdoid characteristics ( fig . a blood examination also revealed an elevated carbohydrate antigen 125 value ( 62 u / ml ) . in october 2011 , a wide resection by a combined iliac resection procedure was performed , and the resection margin was negative . the postoperative course was favorable , and approximately 2 weeks postoperatively , the patient began partial weight - bearing on the affected limb . in october 2012 , ct revealed multiple nodules , some accompanied by cavitation , in both lung fields , and a diagnosis of bilateral multiple lung metastases was made ( fig . a ct examination approximately 2.5 months after the start of pazopanib treatment showed a clear reduction in the size of the pulmonary metastases ( fig . 3b ) , and to date , 30 months after the start of pazopanib treatment , most of the metastases have disappeared and shrunken , and no development of new lesions has been seen ( fig . side effects , including diarrhea , general fatigue , and stomatitis , have been observed , but they have all been grade 1 or less . epithelioid sarcoma was first reported by enzinger in 1970 as a rare mesenchymal cell sarcoma that had a predilection for the extremities and showed a tendency toward epithelial differentiation . later , in 1997 , a more malignant subtype that developed at proximal sites , such as the trunk , was reported by guillou et al . , and since then that type has been classified as proximal - type epithelioid sarcoma , and the former type as distal ( conventional or classic)-type epithelioid sarcoma . the incidence of proximal - type epithelioid sarcomas is said to be approximately half of the distal type , making them very rare , and they are more common in males and tend to occur between 20 and 65 years of age , i.e. an older age bracket than the distal type [ 5 , 6 ] . as the distal type , the proximal type is also said to be resistant to chemotherapy , but it has an even poorer prognosis than the distal type [ 5 , 6 ] . hasegawa et al . reviewed 20 cases of proximal - type epithelioid sarcoma and reported that there had been postoperative recurrence in 65% and distant metastasis in 75% , and that 65% experienced a tumor death . the multikinase inhibitor pazopanib is the first molecularly targeted drug to be approved for the treatment of soft tissue sarcoma . although a significant prolongation of overall survival time was not detected in a previously performed international collaborative phase iii trial whose subjects were 369 patients with advanced soft tissue sarcoma ( palette study ) , a significant prolongation of progression - free survival of approximately 13 weeks was reported , and it has attracted attention as a new treatment method for advanced soft tissue sarcoma . at present , effective chemotherapy for soft tissue sarcomas is limited , and the advent of pazopanib has made it possible to provide a new treatment option . the therapeutic efficacy of pazopanib according to the histological type of soft tissue sarcomas is unknown at this stage , and further investigation will be necessary in the future . lung metastasis developed postoperatively in our own case , which was a case of proximal - type epithelioid sarcoma . a reduction in size or disappearance of the pulmonary metastases was observed after pazopanib administration . it appeared that pazopanib was capable of serving as one of the choices of therapeutic agents that should be taken into consideration for the treatment of epithelioid sarcoma . informed consent was obtained from the patient for publication of this case report and any accompanying images . sanae irimura , kazumasa nishimoto , kazutaka kikuta , robert nakayama , michiro susa , keisuke horiuchi , masaya nakamura , and morio matsumoto have no conflict of interest directly relevant to the content of this article .

– Former Afghan President Hamid Karzai is mincing no words in assessing the United States' bombing of an ISIS stronghold with its second-largest non-nuclear device, reports the New York Times: "Shame, shame," he says of current President Ashraf Ghani's admission that his government coordinated the bombing with the Trump administration. "No Afghan with self-respect would do that. He is a traitor, a traitor." Karzai further said he will work toward "ousting the US," and the Times notes that he has grown more vocal in his anti-American sentiment since leaving office—despite having largely come to power on the back of the American military. Karzai is denouncing the bomb to anyone who will listen, telling al Jazeera that "This was an inhuman act, a brutal act against an innocent country, against innocent people, against our land, against our sovereignty, against our soil and against our future." Ghani's office wouldn't respond directly, but said only in a statement that "Every Afghan has the right to speak their mind. This is a country of free speech." The Times finds dissent on the bombing within Afghanistan, with one conservative Islamist party rep dismissing the use of the so-called "Mother of all Bombs" as nothing more than a show of American power for the benefit of the likes of North Korea. A powerful governor, meanwhile, said he was in favor of the MOAB, as well as any "crackdown on insurgents and fundamentalists." But most Afghans will consider the messenger in evaluating Karzai's anti-American comments, a journalist tells al Jazeera: "At least for a decade, he was using US bodyguards to protect himself. Now he is talking about pushing the US to leave Afghanistan. This is something people will not believe."

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Kabul, Afghanistan - An attack that saw the United States drop the largest non-nuclear bomb on Afghanistan was a "brutal act" against Afghan people, the environment and the country's sovereignty, Hamid Karzai, former president, has told Al Jazeera. The 9,797kg GBU-43 Massive Ordnance Air Blast (MOAB) was unleashed in combat for the first time on Thursday, targeting a complex of caves and tunnels used by ISIL fighters in Nangarhar province, according to the US army. Dubbed the "Mother of All Bombs", the device can devastate the area around its landing of a radius of more than 1.6km. "This was an inhuman act, a brutal act against an innocent country, against innocent people, against our land, against our sovereignty, against our soil and against our future," Karzai said in Kabul. "A bomb of that magnitude has consequences for the environment, for our lives, for our plants, for our water, for our soil - this is poison." WATCH: What impact will MOAB have in the fight against ISIL? At least 90 ISIL fighters were killed in the attack, according to the US and Afghan armies. For the most part, Afghan officials welcomed the bombing, saying it was a step towards security. They have also said that there were no civilian casualties. But Karzai, who was president from 2004 until 2014, said the US should stop using Afghanistan as a "testing ground" and re-engage with Afghans towards a peaceful solution. If these conditions are met, he said, "they [US] can stay on - if the Afghan people agree to it. If they continue this militant approach, this heavy-handed military approach in Afghanistan, then, of course, I want them out of the country." READ MORE: Condemnation, praise over massive bombing The massive bomb was dropped after fighting intensified over the past week and US-backed ground forces struggled to advance in the area. A US soldier was killed on April 8 in Nangarhar while conducting operations against ISIL, which stands for Islamic State of Iraq and the Levant, and is also known as ISIS. Karzai said he was speaking up because many Afghan officials - some of whom were part of his own cabinet - had endorsed the bombing. "I considered it a treason and I stood up against them, and I will continue," he said. "This poison will be there for years and years to come. How can we allow our country to be used this way And why? How many [ISIL fighters] have they killed, 100, 200, 300? "Why should Afghanistan suffer in such a massive way with a bomb so big, so dangerous that they themselves call it the 'mother of all bombs'. Karzai's time in office was at times plagued by accusations from the US of corruption and incompetence. Fahim Dashty, a journalist, politician and political analyst, said that Karzai's comments were unlikely to be welcomed by the majority of Afghans, dismissing the former president's rhetoric as an attempt at "heroism". "There were lots of problems while he was president of Afghanistan," Dashty told Al Jazeera from Kabul. OPINION: Bombs away! Wag that dog! "At least for a decade, he was using US bodyguards to protect himself. Now he is talking about pushing the US to leave Afghanistan. This is something people will not believe." On the bombing, Dashty said Afghans had little reason not to welcome the attack on ISIL targets. "There weren't any reports of civilian casualties in the last attack," he said. "It was said that it was targeting ISIL leaders. As much as it targets terrorist groups, I think people will welcome it." ||||| Amin Karim, the spokesman for the main faction of Hezb-e-Islami, a conservative Islamist party with links to the insurgency, said members of his party disagreed with the strike because they believed it was carried out for American domestic political reasons and as a way to send a message to other countries at odds with the United States, rather than strictly to fight terrorism in Afghanistan. “The goal of this attack was for beyond Afghanistan — it was for showing American power to North Korea, Syria and some other countries; it was for scaring these countries,” Mr. Amin said. At a news conference organized by the Nangarhar governor’s office on Friday, a group of elders from the Achin district, where the bomb was dropped, expressed support for the use of such overwhelming force to eliminate the Islamic State fighters. Atta Muhammad Noor, the powerful governor of the northern Balkh Province and a leader of the Jamiat-e-Islami, one of the largest Islamist parties, said he supported the use of the bomb as well as any “crackdown on insurgents and fundamentalists.” Mr. Karzai said the people of eastern Afghanistan had expressed concern about Islamic State fighters crossing the border with Pakistan when the threat emerged more than two years ago, but little action was taken then. “They allowed Daesh to come and come, and empty villages of their residents and entrench themselves,” he said, using the Arabic acronym for the Islamic State. “Why did they wait for two years? Why didn’t they stop them then? All the entry points were known.” He added: “The conclusion is that Daesh was a U.S. contractor, like DynCorp, like other U.S. companies, that they used to empty an area of its population and create a cause, create an environment, a psychological environment in which the U.S. can then test its weapon.” Mr. Karzai, who has grown more anti-American in recent years despite having come to power with the help of the United States military, had been seen as a quiet opposition figure, albeit one intent on derailing Mr. Ghani’s government.

vulval involvement in crohn s disease ( cd ) is rare , particularly in children . the clinical features include erythema , edema , ulceration , and labial skin tags . the authors present two cases of children with vulval cd . in both cases , marked labial edema was the presenting feature . in one patient the immunomodulator tacrolimus ointment 0.03% was used with success . in the second patient control was achieved with intralesional triamcinolone in combination with systemic metronidazole .

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cutaneous manifestations of crohn s disease ( cd ) typically present as lesions that are contiguous with the gastrointestinal tract , such as peri - oral and peri - anal lesions [ 1 , 2 ] . vulval involvement , mostly due to distant spread of granulomata ( metastatic cd ) , is rare , especially in children [ 2 , 3 ] . here , a 10-year - old girl presented to the dermatology department at york hospital with a 12-month history of asymptomatic erythema and swelling of the vulva . the patient was a healthy - looking girl with normal height and weight for her age . peau dorange appearance , with a large skin tag in the anterior peri - anal area ( fig . 1 ) . examination of the oral mucosa , rectum , and the rest of the skin was unremarkable . the patient was treated with tacrolimus ointment 0.03% which resulted in good control of the disease . a year after the initial presentation 1vulval swelling noted in patient 1 vulval swelling noted in patient 1 a 13-year - old girl presented with a 9-month history of asymptomatic vulval swelling . the patient was diagnosed with cd at the age of 5 years and had been well - controlled on methotrexate . examination of the peri - anal skin showed fissures and skin tags ( fig . 2 ) . examination of the rest of the skin , oral mucosa , and other systems was unremarkable . biopsy of the affected vulval area showed typical features of non - caseating granulomata with negative stains and culture for organisms . the patient was treated with intralesional triamcinolone and oral metronidazole , which resulted in a clear improvement in terms of swelling after 3 months.fig . 2unilateral vulval swelling with erythema noted in patient 2 unilateral vulval swelling with erythema noted in patient 2 a 10-year - old girl presented to the dermatology department at york hospital with a 12-month history of asymptomatic erythema and swelling of the vulva . the patient was a healthy - looking girl with normal height and weight for her age . peau dorange appearance , with a large skin tag in the anterior peri - anal area ( fig . 1 ) . examination of the oral mucosa , rectum , and the rest of the skin was unremarkable . the patient was treated with tacrolimus ointment 0.03% which resulted in good control of the disease . a year after the initial presentation a 13-year - old girl presented with a 9-month history of asymptomatic vulval swelling . the patient was diagnosed with cd at the age of 5 years and had been well - controlled on methotrexate . examination of the peri - anal skin showed fissures and skin tags ( fig . 2 ) . examination of the rest of the skin , oral mucosa , and other systems was unremarkable . biopsy of the affected vulval area showed typical features of non - caseating granulomata with negative stains and culture for organisms . the patient was treated with intralesional triamcinolone and oral metronidazole , which resulted in a clear improvement in terms of swelling after 3 months.fig . 2unilateral vulval swelling with erythema noted in patient 2 unilateral vulval swelling with erythema noted in patient 2 metastatic cd in children is rare , and most present prior to the diagnosis of cd [ 1 , 2 ] . parks et al . there have only been 16 cases of vulval metastatic cd in children reported in the literature . vulval cd may present as the first and only manifestation of cd , as seen in patient 1 , or after development of the disease , even if well - controlled otherwise , as in patient 2 . the clinical presentation of vulval cd is variable and may simply manifest as diffuse edema with infiltration or ulceration . the absence of gastrointestinal symptoms often makes diagnosis difficult in children ; however , the presence of peri - anal fissures and skin tags should raise suspicion for vulval cd . the differential diagnoses for vulval swelling should include sarcoidosis , infections ( e.g. tuberculosis , cellulitis , lymphogranuloma venereum , actinomycosis , pyogenic infections , hidradenitis suppurativa , intertrigo , syphilitic lesions ) , foreign body reactions , contact dermatitis , acquired lymphangiectasia , vascular malformations , and sexual abuse [ 46 ] . biopsy of the lesion is often necessary to reach a definitive diagnosis , revealing the typical appearance of a non - caseating granulomatous inflammation as seen in cd . as there is little correlation between the activity and/or severity of skin lesions and bowel disease , treatment of the underlying cd may not be effective against cutaneous cd , as was seen in patient 2 . currently , metronidazole alone and/or topical / oral steroids seem to be the most effective treatment for metastatic cd . other beneficial therapies include dapsone , tetracycline , azathioprine , 6-mercaptopurine , sulphasalazine , and oral zinc supplementation . surgical procedures , such as vulvectomy , simple excision , curettage , and debridement , are reserved for resistant cases . tacrolimus ointment is currently licensed for use as a second - line agent in the management of atopic eczema . in children , the licensed strength is 0.03% ; however , it is increasingly used in other inflammatory conditions , including a pediatric vulval case of pemphigoid . in conclusion , vulval swelling can be the first or subsequent manifestation of cd and dermatologists should have a high index of suspicion to facilitate early diagnosis and control of the disease .

– Fox has announced the 10 candidates who have qualified for Thursday's prime-time debate, and it's bad new for Rick Perry and some other familiar names, reports the Los Angeles Times. Fox averaged five recent polls, and Perry finished eight-tenths of a point behind No. 10 John Kasich, notes Politico. Those in: Donald Trump, Jeb Bush, Scott Walker, Mike Huckabee, Ben Carson, Ted Cruz, Marco Rubio, Rand Paul, Chris Christie, and John Kasich. Those out: Rick Perry, Rick Santorum, Bobby Jindal, Carly Fiorina, Lindsey Graham, Jim Gilmore, and George Pataki.

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Chris Christie and John Kasich are in. Rick Perry is out. And Donald Trump will be center stage. The jockeying to win a ticket to the first Republican presidential debate in Cleveland ended Tuesday afternoon, when Fox News announced the roster of 10 candidates who will be on the stage Thursday evening. Story Continued Below The candidates, drawn from an average of the five most recent national polls, ranked from first to 10th: Trump, former Florida Gov. Jeb Bush, Wisconsin Gov. Scott Walker, former Arkansas Gov. Mike Huckabee, neurosurgeon Ben Carson, Texas Sen. Ted Cruz, Florida Sen. Marco Rubio, Kentucky Sen. Rand Paul, Christie and Kasich. Perry, the former governor of Texas whose performance in the debates four years ago helped doom his campaign, finished in 11th place, eight-tenths of a point behind Kasich. Former Pennsylvania Sen. Rick Santorum, Louisiana Gov. Bobby Jindal, former Hewlett-Packard CEO Carly Fiorina, South Carolina Sen. Lindsey Graham, former Virginia Gov. Jim Gilmore and former New York Gov. George Pataki are farther behind. The top 10 candidates will debate in a two-hour event at 9 p.m. Eastern time on Thursday. The also-rans will be invited to appear at a separate, one-hour debate, which airs at 5 p.m. Eastern. Much about the debate criteria remained unclear right up until the 5 p.m. deadline Fox News set back in May. The network hadn’t revealed precisely which polls would be used to calculate its average. And when the network unveiled its criteria, it also raised the possibility of expanding beyond 10 participants in the event of a tie. Ultimately, the most controversial decision Fox News made in choosing the polls that would be used was dismissing an NBC News/Wall Street Journal poll conducted from July 26-30 and using a Quinnipiac University survey conducted July 23-28. The change would not have altered the composition of the top 10, however. Fox said it dismissed the NBC News/Wall Street Journal poll “because it did not meet our criterion that the poll read the names of each Republican candidate in the vote question.” Interviewers instead read the name of each candidate and asked respondents if they had a positive or negative opinion of that candidate. Following that battery of questions, respondents were asked which candidate they would favor, given a choice of 10 candidates (the 10 who made the final cut, except substituting Perry for Kasich), “or would you vote for one of the other candidates that were mentioned in the previous question?” Fox News’ decision to limit the field has shaped much of the race on the Republican side in recent weeks. Super PACs and other groups supporting Rubio, New Jersey Gov. Christie and Perry spent more than $4 million combined on national cable television advertising in an effort to boost the candidates’ name recognition. The candidates themselves eschewed trips to Iowa and New Hampshire for appearances on Fox News and other television networks. Some candidates sought other ways to earn free media coverage, either with funny, viral Internet videos or by attacking Trump, who has dominated headlines since declaring his candidacy in June. Kasich timed the declaration of his candidacy almost perfectly, using a post-announcement bounce to vault into the top 10. The Ohio governor staged his announcement rally on July 21, two days before the first of the decisive polls entered the field — the Quinnipiac survey, which showed Kasich at 5 percent, his high-water mark. By qualifying for the debate, Kasich avoids the embarrassment of being sidelined in his home state. But the 5 p.m. forum will also have a number of accomplished candidates: the former governors of three big states (Texas, Virginia and New York), a sitting senator, a former senator and a former Fortune 500 CEO who is also the field’s only female candidate. Some of the also-rans accepted the assignment in stride. Santorum was alone in taking aim at Fox News — and the Republican National Committee — for relegating him to the earlier debate. “The senator will be taking part in the earlier debate; however, the process employed by both Fox News and the RNC is incredibly flawed,” said Santorum spokesman Matthew Beynon. “The idea that they have left out the runner-up for the 2012 nomination, the former … governor of Texas, the governor of Louisiana, the first female Fortune [500] CEO, and the three-term senator from South Carolina due to polling seven months before a single vote is cast is preposterous. While Fox is taking a lot of heat, the RNC deserves as much blame for sanctioning this process. They should not be picking winners and losers. That’s the job of the voters, particularly those in Iowa and New Hampshire who have the role of voting first.” Jindal will also attend the earlier debate, but his campaign made clear that it is focused on Iowa. “The crowds are growing and the governor is rising in the Iowa polls,” said Jindal spokeswoman Shannon Dirmann. “That’s where our time will be spent.” Dylan Byers and Katie Glueck contributed to this report. ||||| That's according to a new study out with some interesting findings: Trump dominates the conversation in social media and traditional news sources. He's done little to leverage that into support. "Trump is making a lot of noise, but he's not necessarily doing the work" that would be needed "to turn that share of voice into actual votes," said Lara Brown, associate professor at George Washington University's Graduate School of Political Management, a co-author of the study. Hillary Rodham Clinton is a pro on social media, using it to bring in supporters. And perhaps most surprising at all, at least for those of us inside newsrooms: The public is even more focused than the media are on Trump. Details on the study from The Times' David Lauter:

Amends the Alaska Native Claims Settlement Act (ANCSA) to make certain Native Alaskans who are Vietnam veterans eligible, for up to one year after the enactment of this Act, for up to 160 acres apiece of nonmineral Alaskan land. Withdraws certain Alaska lands from disposition under the public land laws, entry or appropriation under the mining laws, and the operation of U.S. mineral leasing, subject to valid existing rights, for a one-year period, for selection by the Elim Native Corporation. Authorizes: (1) such Corporation to select 50,000 acres of such lands to satisfy its land entitlements under ANCSA; (2) the Secretary of the Interior to receive, adjudicate, and convey such lands to the Corporation, subject to valid existing rights and an easement reserved to the United States for the benefit of the public; and (3) the Secretary to withdraw, and the Corporation to select, certain additional adjacent lands withdrawn to fulfill the Corporation's land entitlements equal to the total acreage of the Norton Bay Reservation as withdrawn by executive order. Constitutes the Corporation's selection of such lands as full satisfaction of all Corporation claims under ANCSA and the extinguishment of the Norton Bay Reservation.

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SECTION 1. VIETNAM VETERANS ALLOTMENT. The Alaskan Native Claims Settlement Act (43 U.S.C. 1600, et seq.) is amended by adding at the end the following: ``open season for certain native alaskan veterans for allotments ``Sec. 41. (a) In General.--(1) During the one-year period beginning on the date of enactment of this section, an individual described in subsection (b) is eligible for an allotment of not more than 160 acres of land under the Act of May 17, 1906 (chapter 2469; 34 Stat. 197), as such Act was in effect before December 18, 1971. ``(2) Allotments selected under this section shall not be from existing native or non-native campsites. ``(3) The Secretary shall prescribe such rules as may be necessary to carry out this section. ``(b) Eligible Individuals.--(1) An individual is eligible under subsection (a) if the individual would have been eligible under the Act of May 17, 1906 (chapter 2469; 34 Stat. 197), as such Act was in effect before December 18, 1971, and the individual is a veteran of the Vietnam era. ``(2) For purposes of this section, in the case of an individual described in paragraph (1) who is deceased, the heirs of the individual shall be treated as the individual described in paragraph (1). ``(c) Conveyance Deadline.--The Secretary of the Interior shall complete land conveyances pursuant to this section not later than one year after the end of the period referred to in subsection (a). ``(d) Definitions.--For the purposes of this section, the terms `veteran' and `Vietnam era' have the meaning given such terms by paragraphs (2) and (29), respectively, of section 101 of title 38, United States Code.''.SEC. 2. ELIM NATIVE CORPORATION LAND RESTORATION. The Alaskan Native Claims Settlement Act (43 U.S.C. 1600, et seq.), as amended by section 1 of this Act, is further amended by adding at the end the following: ``elim native corporation land restoration ``Sec. 42. (a) Withdrawal and Availability for Selection.--The lands described in subsection (b) are withdrawn from disposition under the public land laws, entry or appropriation under the mining laws of the United States, and the operation of the mineral leasing laws of the United States, subject to valid existing rights, for a period of one year from the date of enactment of this section, for selection by the Elim Native Corporation under this section. ``(b) Lands Described.--The lands described in this section are within the boundary of the parcel of land in the vicinity of Elim, Alaska, at approximately latitude 64 50 N. longitude 162 00 W, more particularly described as follows: ``Beginning at the point of intersection of line 3-4, U.S. Survey No. 2548 with the protracted West Boundary of T8S, R18W KRM, Alaska; ``Thence North, along the west boundary of the aforementioned township, approximately 4\1/2\ miles to the protracted position for the corner of sections 1, 6, 7, and 12; ``Thence Northeasterly, parallel with line 4-3 of U.S. Survey No. 2548, approximately 20\1/2\ miles, to a point; ``Thence East approximately 6 miles to corner No. 3 U.S. Survey No. 2548; ``Thence Southwesterly along lines 3-4, U.S. Survey 2548 approximately 27\1/2\ miles to the point of beginning. ``(c) Authorization To Select Lands; Reservation of Easement.--The Elim Native Corporation is authorized to select 50,000 acres of lands within the boundary of the lands described in subsection (b) to satisfy its land entitlements under section 19(b). The Secretary is authorized to receive, adjudicate, and convey the lands to the Elim Native Corporation subject to-- ``(1) valid existing rights; and ``(2) an easement reserved to the United States for the benefit of the public. An easement in the lands shall be reserved to the Iditarod National Historic Trail. ``(d) Withdrawal and Selection of Additional Lands.--The Secretary is authorized to withdraw, and Elim Native Corporation is authorized to select, not later than 18 months after the date of the enactment of this section additional lands adjacent to the lands withdrawn by subsection (a) to fulfill Elim Native Corporation's land entitlements equal to the total acreage of the Norton Bay Reservation as withdrawn by Executive Order No. 2508, dated January 3, 1917. ``(e) Finality of Selections.--Selection by the Elm Native Corporation of lands under subsection (c) or (d) shall constitute full satisfaction of any claim or entitlement of the Elim Native Corporation-- ``(1) with respect to subsection (c), to its land entitlements under section 19(b), and ``(2) with respect to subsection (d), to the extinguishment of the Norton Bay Reservation (as withdrawn by Executive Order No. 2508, dated January 3, 1917).''.

– Boston hasn't clinched a World Series at home in nearly a century, and that's translating into a big payday for those willing to sell tickets to tonight's Game Six. Consider that someone paid $24,000 on StubHub for two front-row tickets near home plate, reports ESPN. But even the cheap seats aren't so cheap, with the average ticket price now north of $2,000 and climbing. One thing that helps is old-fashioned supply and demand, notes the Christian Science Monitor: Fenway holds a relatively small capacity of about 37,000.

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Tickets for Game 6 of the World Series between the Boston Red Sox and St. Louis Cardinals are setting price records for both baseball and Boston-area sporting events. What's driving the Game 6 price surge? If the Boston Red Sox lock up a World Series win in tonight’s Game 6 against the St. Louis Cardinals in Fenway Park, it will be the first time the franchise has clinched a Series win at home since 1918. And if you’d like to bear witness to that historic event, you’ll be paying dearly for it. Ticket prices for tonight’s game are shattering price records, for both Major League Baseball and Boston sporting events in general. On the secondary ticket marketplace Stub Hub, standing room tickets are listed just south of $1,000 apiece. TiqIQ, a ticket price aggregator for sporting events, lists the average price tag for a Game 6 seat (or non-seat) at $2,296. And those are for the nosebleeds; a more choice seat could easily set you back over $10,000. Darren Rovell at ESPN reported that one StubHub user shelled out $24,000 for a pair of tickets between home plate and one of the on-deck circles. SI.com found one field box seat listed at Stub Hub for $42,000 on Wednesday morning. Money-wise, Game 6 is making a run at some of the most expensive events in any sport. Tickets for Super Bowl XLVII between the Baltimore Ravens and the San Francisco 49ers in New Orleans this past February averaged a comparatively paltry $1,210, according to NOLA.com (though that figure was for face value, and third-party tickets sold for as much as $316,000). For this past summer’s Stanley Cup Finals between the Chicago Blackhawks and another Boston franchise, the Bruins, average ticket prices reached $1,380 – a huge figure in hockey terms but nowhere near tonight's game. A few key factors are driving the World Series price surge (inflation aside). For one, the site, Fenway Park, is the fourth-smallest Major League stadium, with a capacity of only 37,402. Second, though Boston has enjoyed two World Series titles in the past decade, neither the 2004 series against the Cardinals nor the 2007 series against the Colorado Rockies were clinched in Boston. Die-hard fans had been waiting nearly a century for the Sox to end their World Series drought when they did it in ’04, but many of those same fans didn’t get to see it live and would relish the opportunity to finally do so. Third, championship series in the Major Leagues, NBA, and NHL aren’t destination events like the Super Bowl and college football national title games, which are held in neutral site cities (this year’s BCS title game, for instance, will be held in Pasadena, Calif). That means many World Series attendees don’t have to shell out big buck for airfare and hotels, leaving them more money to spend on tickets. "People want to see them win it here," Jim Holzman of Ace Tickets, a vendor in Boston, told ESPN. "That's what has made this the biggest ticket we've ever seen. It's the Super Bowl except people don't have to pay $1,000 for a hotel and $2,000 for airfare." The kicker? If the Cardinals win tonight and force a Game 7, those ticket prices will be even more eye-popping than Game 6. ||||| The opportunity to see the Boston Red Sox win a World Series at home for the first time in a lifetime has turned Game 6 at Fenway Park into the most expensive local ticket in the city's history. The Red Sox have not won a World Series-clinching game at historic Fenway Park since 1918. Jamie Squire/Getty Images As of Wednesday morning, the average list price on the resale market for a ticket to Wednesday night's game was $2,056, according to TiqIQ, a ticket tracking company. That's an 11.48 percent increase from Tuesday morning's prices. The average purchase price of a ticket? That's at $1,047, up 19.25 percent from Tuesday. According to SeatGeek, another ticket market tracking company, ticket prices are now equivalent to last year's Super Bowl, which had an average resale price of $2,199 and a "get-in" price of $1,062. Bleacher seats to Wednesday's Red Sox-St. Louis Cardinals game, which could have been had for $300 last week, were selling for $1,100 on Tuesday. On Monday night, someone who wanted two of the best seats in the house paid $24,000 on StubHub for a pair in the first row in a dugout box between home plate and one of the on-deck circles. "There was this type of excitement in 2004 for the Red Sox home games because people thought it would never come again," said Jim Holzman of Ace Ticket, a Boston-based brokerage that has been in business for 33 years. The Red Sox went on to win the World Series in 2004 and again in 2007, ending it on the road both times. The last time the Red Sox won it all in Boston was with a victory over the Chicago Cubs on Sept. 11, 1918 -- the ticket price for that game was $1.65. "People want to see them win it here," Holzman said. "That's what has made this the biggest ticket we've ever seen. It's the Super Bowl except people don't have to pay $1,000 for a hotel and $2,000 for airfare." Holzman said fans began buying tickets in earnest Monday night after the Red Sox scored in the top of the first inning during their 3-1 Game 5 victory. "Prices were going up $50 an inning," Holzman said. Bleacher seats that were $625 when the game started were at $900 by game's end. Field boxes to Game 6 that were selling for $1,400 were $1,900 by the time Red Sox pitcher Jon Lester walked off the mound in the eighth inning.

– The last guest on Sacha Baron Cohen's last show of the season for Who Is America? is a doozy: OJ Simpson. In the interview, the comedian poses as an Italian TV host named Gio Monaldo who keeps making references to the murder of Nicole Brown Simpson, notes Entertainment Weekly. But instead of a confession, Cohen gets repeated denials—and a high-five. At one point, "Monaldo's" girlfriend leaves the room and Cohen says, “She’s gorgeous, but sometimes I want to kill her.” Simpson looks uncomfortable as Cohen then talks about taking the woman for a helicopter ride over the Grand Canyon and dropping her out. He leans over for a high-five and Simpson complies while shaking his head and laughingly saying, “Stop, stop." See the exchange here. At another point, Cohen's character tells Simpson he has a wealthy friend who'd love to hear the truth about Simpson's wife. "Well, first of all, she wasn’t my wife," says Simpson. "We had been divorced. And second of all, I didn’t do it. … I didn’t ‘get away’ with nothing." And when Cohen refers to both of them as "ladykillers," Simpson responds, "No, I didn't kill nobody." The interview wraps up a controversial first season, though the Daily Beast notes that Cohen's sit-down with one big name never aired. Sarah Palin had been the first to come forward saying she had been duped by Cohen, but the resulting interview has not seen the light of day. Whether that's because of legal threats or simply because it wasn't up to snuff is not clear, writes Matt Wilstein. (This guy should be so lucky.)

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Sacha Baron Cohen saved one of his most controversial guests on Who Is America? for last. On Sunday night’s possible last episode of the Showtime comedy, Cohen, disguised as one of his characters, interviewed none of other than former football star, former actor, and former murder suspect O.J. Simpson. Simpson, who — like all guests on Who Is America? — was unaware he was being interviewed by the comedian, sat down with a man he believed to be Gio Monaldo, an Italian billionaire playboy, fashion photographer, and television host whom Cohen has inhabited throughout the first season. Describing Simpson as “an American hero and women’s rights activist,” Monaldo spoke with The Juice in Las Vegas. A woman playing Monaldo’s girlfriend, Christina, pretended not to recognize Simpson as Cohen explained he was a “Buffalo Bill” and starred in the Naked Gun films. It’s only when Monaldo made a stabbing motion that Christina recalled Simpson’s face. “She knows that, oh Jesus,” Simpson said with a laugh. After Christina left the room, Simpson told Monaldo that she was “gorgeous.” Monaldo agreed, but said, “Sometimes I want to kill her,” adding that he wanted “to send her on a private helicopter and throw her over the Grand Canyon.” He then high-fived Simpson, who continued to laugh and playfully told Monaldo to “stop.” When Monaldo said that he wants to meet Johnnie Cochran, Simpson’s lawyer from the Nicole Brown and Ron Goldman murder trials, Simpson explained that Cochran is dead. “What, you didn’t kill him too, did you?” Monaldo asked. “Stop,” Simpson teased again, still laughing. “Me and you, we got something in common,” Cohen said later. “We both, how you say, ‘ladykillers.'” Simpson waved his hands “no” while laughing, and said, “No, I didn’t kill nobody.” “Ah, I didn’t either,” Monaldo chuckled. You can see a portion of the interview teased at the end of the clip below: ||||| Tweet with a location You can add location information to your Tweets, such as your city or precise location, from the web and via third-party applications. You always have the option to delete your Tweet location history. Learn more ||||| It was less than two months ago that Sarah Palin emerged as the first major public figure to admit she had been “duped” by Sacha Baron Cohen for a mysterious new Showtime series called Who Is America? A lot has happened since then. Over the past seven weeks, the British comedian most famous for playing characters like Ali G and Borat has convinced sitting Republican congressmen to endorse arming toddlers and forced a George state senator out of office for screaming the “N-word,” among other sometimes hilarious, always provocative stunts. Despite Showtime’s attempts to tamp down expectations, it seemed inevitable that Baron Cohen would save Palin’s sit-down interview with Dr. Billy Wayne Ruddick, PhD for the seventh and final episode this Sunday. But it was nowhere to be found, perhaps for legal reasons or simply because the comedian just didn’t think it was good enough. Given how many prominent people had followed her lead in exposing themselves as targets before their appearances aired, a lot of viewers were left wondering if there were any genuine surprises still up the comedian’s sleeve. The answer to that question came Sunday night in the form of none other than the recently freed O.J. Simpson, who had made no attempts to get ahead of his talk with Baron Cohen’s Italian socialite character Gio Monaldo . The O.J. bit came as a post-credits sequence after Dr. Ruddick sat down with an increasingly frustrated Barney Frank and Col. Errad Morad embarked on a particularly surreal journey with an older man who ended up posing as a “radical lesbian” who loved the HBO show Girls at the Women’s March in San Francisco. “To good friends,” Baron Cohen’s Gio said, clinking champagne glasses with Simpson in what looked to be a dark Las Vegas suite. Within seconds, Baron Cohen was making overt references to the murder of Nicole Brown Simpson and Ron Goldman in front of the former NFL star. After the character’s girlfriend left the room, Baron Cohen confessed to Simpson, “She’s gorgeous, but sometimes I want to kill her.” Simpson seemed uncomfortable with all of the allusions to murder, but that didn’t stop him from high-fiving the host when he said he wanted to take her in a helicopter and drop her over the Grand Canyon. “Stop, stop,” Simpson said, simultaneously laughing and shaking his head. When Baron Cohen suggested that his guest would have to introduce him to Johnnie Cochran, Simpson reminded him that his famous lawyer is no longer living. “What, you didn’t kill him too, did you?” Baron Cohen asked with another laugh. From there, Baron Cohen did his best to get Simpson, who may or may not have realized he was being filmed based on the camera placement, to tell him what really happened to his wife that night in 1994. “Well, first of all, she wasn’t my wife,” Simpson said, seemingly focused on the wrong part of the question. “We had been divorced and separated.” Asked how he “got away with it,” Simpson insisted, “Hey, hey, I didn’t get away with nothing.” “Me and you, we’ve got something in common,” Baron Cohen told Simpson. “We’re both, how you say, ladykillers.” “No, I didn’t kill nobody,” Simpsons replied, laughing hysterically. As much as many viewers would have loved to see what Baron Cohen got Sarah Palin to say on camera, it was hard to imagine a more fitting capper to an insane season of television that came out of nowhere this summer. And in the end, Palin got credit for her “inadvertent” work as a “Special Publicity Consultant.”

dyschromatosis universalis hereditaria ( duh ) is a rare genodermatosis reported initially and mainly in japan . however , subsequent cases have been reported from other countries . we report a case of duh in a south indian woman with a positive family history with cosmetic disfigurement and severe psychological impairment .

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dyschromatoses are a group of disorders characterized by the presence of small irregular hyper- and hypopigmented macules . it is a spectrum of diseases which includes dyschromatosis universalis hereditaria ( duh ) , dyschromatosis symmetrica hereditaria ( dsh ) , or acropigmentation of dohi and a segmental form called unilateral dermatomal pigmentary dermatosis ( udpd ) . it is characterized by a symmetrical distribution of hyper- and hypopigmented macules on the extremities , especially over dorsa of the hands and feet . in 1933 ichikawa and higara described duh which was essentially the same disorder , but occurring in a generalized as opposed to acral distribution . a 28-year - old unmarried woman from rural south india presented to us with chief complaints of multiple hyper- and hypopigmented lesions over arms , legs , trunk , and buttocks since she was 3-years - old , she was apparently normal prior to that age . the lesions had started over both the legs and gradually spread upwards towards the thighs . few lesions had appeared during this time over the hands subsequently spreading upwards to the elbows . there was no history of handling any chemical directly or any significant history of drug intake . physical examination revealed numerous asymptomatic , generalized , 0.5 - 1 cm hyperpigmented macules interspersed with spotty hypopigmented macules . there was no apparent atrophy , erythema , or telangiectasia [ figures 1 and 2 ] . she reported that her father and sister had similar lesions , but in a milder form . she was depressed since she was not married due to the cosmetic disfigurement and felt worthless , we counseled the patient and also referred her for psychiatric consultation . the lesions were dense on the limbs and trunk with sparing of the palms and soles multiple dense hyper - and hypopigmented lesions over arms a skin biopsy was taken from both the hyper- and hypopigmented lesions . basal layers showed mild vacuolar change , papillary dermis with melanin incontinence , and dilated dermal vessels . hyperpigmented lesions showed increase in pigment extending into the stratum spinosum ; whereas , in the hypopigmented lesions it showed decrease in pigment . dermis in both the biopsies showed mild perivascular and periadnexeal lymphomononuclear infitrate [ figures 3 and 4 ] . basal layers showed mild vacuolar change , papillary dermis with melanin incontinence , and dilated dermal vessels ( hematoxylin and eosin ( h and e , 10 ) histopathology of the skin lesion : in high power , section shows increase in pigment extending into the stratum spinosum . dermis showed mild perivascular and periadnexeal lymphomononuclear infitrate ( h and e , 10 ) the patient is currently being treated with narrowband ultraviolet b ( nbuvb ) therapy , has completed 20 sessions and feels her lesions have improved . also , was put on escitalopram 10 mg in the morning and clonazepam 0.5 mg at night for depression . patient feels after the counseling and with treatment , is happier with the cosmetic appearance of the lesions and has started working too . although majority of cases show autosomal dominant pattern of inheritance , a few have inherited it in an autosomal recessive fashion . a variable autosomal mode of inheritance of duh has also been described . in our case , two major types have been described , based on distribution of lesions as follows : duh , first reported in 1933 by ichikawa and higara , in which mixtures of hyper- and hypopigmented macules occur all over the body ; and dsh , also known as acropigmentation of dohi , described in 1929 by toyama , which is a localized form involving only the acral areas . however , a few cases of duh were described among europeans , south americans , indians , and saudi arabians and in tunisia . in duh , facial lesions were seen in almost 50% of affected individuals , but involvement of palms and soles is unusual . the histopathology typically shows a focal increase or decrease in melanin content of the basal layer ( depending on the type of the lesion biopsied ) and occasionally pigmentary incontinence . in a recent ultrastructural skin investigation , nuber et al . indicated that duh is a disorder of melanosome synthesis rate or in melanocyte activity and not a disorder of melanocyte number . of the 37 previously reported cases from japan , 15 were men and 22 were women . eighty - two percent of patients had clinical symptoms before the age of 6 years . our patient gave a history that her lesions presented at the age of 3 years . duh may be associated with abnormalities of dermal connective tissue , nerve tissue , or be associated with other systemic complications . lesions of dsh have to be differentiated from xeroderma pigmentosum , since in both the disorders patients clinically show lesions in the photoexposed areas . . the lesions also run a benign course . generally , duh does not progress or worsen with age . in all reports other differential diagnosis of duh to be considered are dsh , dyskeratosis congenital , generalized dowlinge - degos disease , incontinentia pigmenti ( bloch - sulzberger ) , naegelie - franceschetti - jadassohn syndrome , chronic arsenic toxicity , and chronic radiodermatitis . once thought to be a disease confined to japanese , duh is being reported with increasing frequency in other races as well . from india these patients often suffer from depression because of cosmetic disfigurement so simultaneous counseling and psychiatric consultation can help them lead more fulfilling and productive lives . role of nbuvb as a treatment modality should be evaluated and tried for better cosmetic appearance .

Guam and the Northern Marianas Commemorative Coin Act - Directs the Secretary of the Treasury to issue one-dollar coins emblematic of the American forces that liberated Guam and the Northern Mariana Islands in World War II. Requires payment of surcharges received from the coin sales to the Secretary of the Interior to construct a visitors center and museum at: (1) the War in the Pacific National Historical Park on Guam; and (2) the American Memorial Park on Saipan.

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SECTION 1. SHORT TITLE. This Act may be cited as the ``Guam and the Northern Marianas Commemorative Coin Act''.SEC. 2. COIN SPECIFICATIONS. (a) Issuance.--The Secretary of the Treasury (hereafter in this Act referred to as the ``Secretary'') shall issue not more than 1,500,000 one dollar coins which shall-- (1) weigh 26.73 grams; (2) have a diameter of 1.500 inches; and (3) contain 90 percent silver and 10 percent copper. (b) Design.--The design of the coins authorized under subsection (a) shall be emblematic of the heroism of the American forces that liberated Guam and the Northern Mariana Islands in World War II. On each such coin there shall be a designation of the value of the coin, an inscription of the years ``1944-1994'', and inscriptions of the words ``Mariana Islands'', ``Liberty'', ``In God We Trust'', ``United States of America'', and ``E Pluribus Unum''. (c) Legal Tender.--The coins issued under this Act shall be legal tender as provided in section 5103 of title 31, United States Code. (d) Numismatic Items.--The coins issued under this Act shall be considered numismatic items for purposes of section 5134 of title 31, United States Code.SEC. 3. SOURCES OF BULLION. The Secretary shall obtain silver for the coins minted under this title from stockpiles established under the Strategic and Critical Minerals Stock Piling Act.SEC. 4. SELECTION OF DESIGN. The design for each coin authorized under this Act shall be selected by the Secretary after consultation with the Delegate from Guam to Congress and the Resident Representative of the Commonwealth of the Northern Mariana Islands.SEC. 5. SALE OF COINS. (a) Sale Price.--The coins issued under this Act shall be sold by the Secretary at a price equal to the face value, plus the cost of designing and issuing such coins (including labor, materials, dies, use of machinery, overhead expenses, marketing and shipping), and the surcharge provided for in subsection (d). (b) Bulk Sales.--The Secretary shall make bulk sales at a reasonable account. (c) Prepaid Orders.--The Secretary shall accept prepaid orders for the coins issued under this Act prior to the issuance of such coins. Sales under this subsection shall be at a reasonable discount. (d) Surcharge Required.--All sales of coins issued under this Act shall include a surcharge of $10 per coin.SEC. 6. USE OF SURCHARGES. The surcharges received by the Secretary from the sale of the coins issued under this Act shall be made available or paid to the Secretary of the Interior for the following purposes: (1) Amounts to be made available for the construction of a visitors center and museum on guam.--The Secretary of the Treasury shall make available to the Secretary of the Interior all funds from such surcharges as may be necessary to construct a visitors center and museum at the War in the Pacific National Historical Park on Guam. (2) Amounts to be made available for the construction of a visitors center and museum on saipan.--The Secretary of the Treasury shall make available to the Secretary of the Interior all funds from such surcharges as may be necessary to construct a visitors center and museum at the American Memorial Park on Saipan.SEC. 7. ISSUANCE OF THE COINS. (a) Period for Issuance.--The Secretary shall make every effort to issue the coins under this Act by July 21, 1994. The coins shall be made available for issue during the 1-year period beginning on the date the coins are first issued. (b) Proof and Uncirculated Coins.--The coins authorized under this Act shall be issued in uncirculated and proof qualities.SEC. 8. GENERAL WAIVER OF PROCUREMENT REGULATIONS. (a) In General.--Except as provided in subsection (b), no provision of law governing procurement or public contracts shall be applicable to the procurement of goods or services required to carry out this Act. (b) Equal Employment Opportunity.--Subsection (a) shall not relieve any person entering into a contract under the authority of this Act from complying with any law relating to equal employment opportunity.SEC. 9. FINANCIAL ASSURANCE. (a) No Net Cost to the Government.--The Secretary shall take such actions as may be necessary to ensure that the minting and issuance of the coins referred to in section 2 shall not result in any net cost to the Federal Government. (b) Payment for Coins.--No coin shall be issued under this Act unless the Secretary has received-- (1) full payment for such coin; (2) security satisfactory to the Secretary to indemnify the United States for full payment; or (3) a guarantee of full payment satisfactory to the Secretary from a depository institution whose deposits are insured by the Federal Government.

– Last year, while being profiled as a finalist for Time's Person of the Year issue, Paul Ryan posed for some "beefcake" pictures for the magazine in which he flexed his muscles while lifting weights, while wearing a backwards baseball cap and making doofy faces. Time coyly chose to publish them today, as Ryan's debate with Joe Biden looms. Some of the reaction: Writes Dan Amira on Daily Intel: "In December of last year, a time when Paul Ryan must have known that he would be on any candidate's VP short list, Time approached the Wisconsin congressman about posing for a series of intimate weightlifting photos, and he was like, 'Yeah, sure, I can't see why not.' … It's like the mimbo from Seinfeld is running for vice president." The Daily Beast wonders if he's running to be "the future vice bro of the United States?" and notes, "Forget Big Bird, check out those big guns." The Atlantic Wire's headline: "Paul Ryan Beefcake Photos Released: Abs Remain Elusive." Elspeth Reeve notes that in the photos, Ryan is doing "what high school gym coaches nationwide call 'curls for girls,' bicep curls that make your arms beefy for the ladies but don't really make you stronger or better at sports." Mashable rounds up some of the memes that have popped up, including some pretty hilarious altered photos and tweets from "Paul Ryan's Bicep." Check out the photos for yourself here.

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In December of last year, a time when Paul Ryan must have known that he would be on any candidate's V.P. short list, Time approached the Wisconsin congressman about posing for a series of intimate weightlifting photos, and he was like, "Yeah, sure, I can't see why not." Somehow, Time managed to hold off releasing them until now, in its latest issue, which probably took a lot of willpower because, well, look at this photo. Is this any less silly than Dukakis in the tank or Kerry in the Woody Allen sperm suit? It's like the mimbo from Seinfeld is running for vice-president. ("Hey, Biden, you better step off.") And what's happening in this one here? Ryan looks like he's in a low-budget boy-band video. ||||| The Prohibition era in America, which lasted for well over a decade and—inconceivable as it might be today—effectively banned the sale and production of booze in the United States, ended with the ratification of the 21st Amendment on Dec. 5, 1933. ||||| Paul Ryan P90x Meme Talk about the right to bear arms. Paul Ryan, the Republican nominee for vice president, was nominated for Time Magazine's Person of the Year in 2012. He didn't win the honor, but he did pose for a photo shoot about his P90x workout routine. The photos, which were never published before now, are being featured in a profile of the candidate in this week's issue. The photos appeared online for the first time today, and netizens have reacted both accordingly and predictably. Political Twitter parody accounts are all the rage right now, which makes the nearly immediate creation of the twitter account @PaulRyansBicep an obvious choice. The account has been tweeting gems such as this one for the past hour: Has a VP candidate ever worn a sleeveless tee to a debate? — Paul Ryan's Bicep (@PaulRyansBicep) October 11, 2012 Other people have just taken to playfully poking fun at the photos on Twitter, creating memes and compiling image mashups. We've included some of our favorite tweets below, and images in the gallery above. Maybe Biden will run on stage shouting "I got your P90X beat, Ryan!" and frantically pumping a Shake Weight. ti.me/RhUIcU — John Hayward (@Doc_0) October 11, 2012 What if Paul Ryan and Joe Biden come on stage tonight wearing the same physique? — Josh Greenman (@joshgreenman) October 11, 2012 ||||| Paul Ryan has posed for beefcake photos in which he flexes his biceps while doing reps of what high school gym coaches nationwide call "curls for girls," bicep curls that make your arms beefy for the ladies but don't really make you stronger or better at sports. You can mark this as one more data point in the critical debate over Ryan's workout routine, his unbelievable 6 percent body fat, and whether it's better to be jacked or ripped. Unfortunately, the Time photos do not display Ryan's wildly famous but as-yet-unseen killer abs. The photos were taken in December last year, when Ryan was a finalist for the magazine's Person of the Year, and when documenting his elusive abs was not such a pressing election issue. Gazing at Ryan's admirable muscle mass, you can't help but think of Sarah Palin's modeling of tights and shortish shorts for Runner's World. Both are a slightly awkward, somewhat self-conscious attempt to bring some youth and sexiness to a Republican brand. But Palin, at least, waited until June 2009 -- when it was safe to fan speculation about her own presidential candidacy long after John McCain lost the 2008 race. The day of the vice-presidential debate, Ryan might not want to encourage that comparison. Want to add to this story? Let us know in comments or send an email to the author at ereeve at theatlantic dot com. You can share ideas for stories on the Open Wire. Elspeth Reeve ||||| Top Definition mimbo Made famous from an episode of Seinfeld reffering to a masculine version of a bimbo by Anonymous June 18, 2003 Add your own Random Word 2 mimbo a male bimbo. He's a male bimbo. He's a mimbo. Dan Cortese. by Dangly Parts February 24, 2004 3 mimbo A mimbo is a very good looking male who either is or acts like he is extremely stupid. The female counterpart of the mimbo is the bimbo. Derek Zoolander from the movie Zoolander makes fun of an stereotypical mimbo - renowned for being "ridiculously good looking" yet having the brain cells of a gnat. by Wen-Wen Lam May 17, 2007 4 Mimbo A man who is rather ditzy. The equivilent of a female bimbo or bambi . Not to be confused with mambo Maggie: OMG. Mitchell is such a mimbo! Mary: I know! I can't believe he twirls his hair! Liz: Remember when he ran into the door? Noemi: And when he molested the Dough Boy? *group laughs* by Mary-chan October 25, 2005 5 mimbo Male bimbo Monty is such a mimbo! He always forgets how to do his job! by ayemm January 21, 2009 ||||| The future vice bro of the United States? Paul Ryan’s dedication to the intense fitness regime P90X is by this point legendary. But when the vice-presidential candidate was profiled by Time magazine for its Person of the Year issue last December, it was barely on the national radar. So 10 months later, with Ryan in his final preparations for Thursday night’s debate against Joe Biden, Time is releasing a series of outtakes from that profile’s photo shoot—and they’re nothing short of spectacular. Sporting a backwards red baseball cap, Ryan mugs and flexes for the camera as he lifts dumbbells, putting his toned biceps—and goofy grin—on full display. Forget Big Bird, check out those big guns.

ovarian cancer is the seventh most common cancer in the world and the fifth most common cause of death from cancer ; it is responsible for over half of all deaths related to gynecological cancers . the presence of lymphatic metastasis is an important prognostic factor in ovarian cancer . nodal metastases to the pelvic and the para - aortic lymph nodes are common , particularly in an advanced of the disease ( stages iii - iv ) . the finding of distant nodal metastasis , especially subclavian lymph node metastasis , from ovarian carcinoma is very uncommon . 18f - fluorodeoxyglucose - positron emission tomography ( fdg - pet ) or fdg - pet / computed tomography ( ct ) provides an improved imaging for detecting metastatic lymph nodes in patients with ovarian cancer . immunohistochemically , ovarian carcinoma cells are positive for estrogen receptor , progesterone receptor , cancer antigen 125 , wilms ' tumor 1 protein , and p53 ; they are negative for thyroid transcription factor ( ttf-1 ) and caudal - related homeobox 2 ( cdx-2 ) . this report describes a korean woman diagnosed with ovarian cancer with subclavian lymph node metastasis revealed by fdg pet / ct and verified by an immunohistochemical staining . differentiating between the primary ovarian lesion and the metastatic lesion will allow the initiation of an appropriate treatment and help predict the prognosis .

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ovarian cancer is the fifth most common cause of death from cancer and represents over half of all deaths related to gynecological cancers.1,2 epithelial ovarian cancer classically spreads by exfoliation of cancerous cells into the intra - abdominal cavity , movement of the cells through lymphatic channels , and hematogenous dissemination . lymph nodes are involved in about 50 - 70% of cases of advanced ovarian cancer.3,4 the presence of lymphatic metastasis is an important prognostic factor in ovarian cancer.3,5,6,7 nodal metastases to the pelvic and para - aortic lymph nodes are common , particularly in advanced disease ( stages iii - iv).8 the finding of distant nodal metastasis is very uncommon . moreover , subclavian lymph node metastases secondary to ovarian carcinoma are extremely rare and they are considered a poor prognostic sign . positron emission tomography ( pet ) or pet / computed tomography ( pet / ct ) using 18f - fluorodeoxyglucose ( fdg ) performs superior imaging in the detection of lymph node metastasis in patients with ovarian cancer.9,10,11,12,13 immunohistochemically , ovarian carcinoma cells are positive for estrogen receptor ( er ) , progesterone receptor ( pr ) , cancer antigen 125 ( ca-125 ) , wilms ' tumor 1 protein ( wt1 ) , and p53 . they are negative for thyroid transcription factor ( ttf-1 ) and caudal - related homeobox 2 ( cdx-2 ) . this report describes a korean woman diagnosed with ovarian cancer in whom subclavian lymph node metastasis was revealed by fdg pet / ct and verified by immunohistochemical staining . abdominal and pelvic computed tomography showed an ovarian tumor that was 15 cm in diameter . her level of serum ca-125 was 971.3 u / ml ( the normal range is 0 to 35 u / ml ) . unexpectedly , the fdg - pet / ct scan showed hypermetabolic activity in the left subclavian lymph nodes ( standardized uptake value [ suvmax ] = 15.8 ) ( fig . ultrasonography of the neck was performed , which showed multiple variably sized lymph nodes in the left subclavian fossa . ultrasonography - guided biopsy was performed , and the pathology revealed metastatic carcinoma ( fig . immunohistochemical staining was positive for er , pr , p53 , p16 , and wt1 . the patient underwent a hysterectomy , bilateral salpingo - oophorectomy , total omentectomy , pelvic lymphadenectomy , and para - aortic lymphadenectomy . during the surgery , a 10 cm cystic mass of the right ovary and a 4 cm sized solid mass of the left ovary were found infiltrating the posterior cul - de - sac . furthermore , several masses with maximum diameters of 6 cm and 4 cm were found in the right and left para - aortic lymph nodes , respectively . the pathology was positive for cancer in the pelvic and para - aortic lymph nodes ( 25/51 ) . subsequently , our patient underwent six cycles of paclitaxel ( 175 mg / m ) plus carboplatin at an area under the curve ( auc ) of 5 mg given on day one of a 21-day cycle . the follow - up fdg - pet / ct at the end of chemotherapy showed no evidence of recurrence of residual lesions in the neck , pelvis , or elsewhere ( fig . however , serum concentrations of ca-125 ( 36.57 u / ml ) failed to decrease below the normal limit after six cycles ; thus , the physician decided to administer an additional three cycles of paclitaxel plus carboplatin . after a total of nine cycles , the serum ca-125 levels decreased and entered the normal range ( 23.51 u / ml ) , and the follow - up fdg - pet / ct still showed no evidence of recurrence . the most common routes for spread of ovarian cancer are lymphatic dissemination through the nearby internal organs . the most frequent sites of lymph node involvement are the abdominal ( 47% ) , para - aortic ( 38% ) , mediastinal ( 29% ) , and pelvic ( 17% ) regions.14 extra - abdominal metastasis is considered to be infrequent . several studies have shown that distant lymph node metastases in ovarian cancer can be detected by fdg - pet / ct and it was shown that preoperative fdg pet / ct can be a useful tool . but pathological confirmation of the pet / ct - positive lymph nodes was not performed.9,11,12 although the histologic diagnosis of metastatic lesions can be difficult , immunohistochemistry has made the diagnosis of these lesions more accurate . the markers that helped to confirm the diagnosis were er , pr , ca-125 , st1 , and p53 . furthermore , the negative ttf-1 and cdx2 staining indicated that the carcinoma was not pulmonary or colorectal carcinoma . ttf-1 is a selective marker of adenocarcinoma of pulmonary origin in cytologic preparations.15 in our case , a perimenopausal woman was found to have subclavian lymph node metastases during the initial preoperative work - up for fdg - pet / ct . subsequently , we concluded through immunohistochemical analysis that the metastases originated from the ovary . about 25% of gynecological cancers including ovarian cancer will occur in premenopausal and perimenopausal women , and approximately 30% of ovarian neoplasms in postmenopausal women are malignant.16,17 in the advanced stage of epithelial ovarian cancer , preoperative fdg pet / ct and immunohistochemical analysis to confirm the presence of distant metastasis in lymph nodes are warranted in order to evaluate whether the lymph nodes should be taken into consideration when deciding on the extent of the treatment or when assessing the prognosis . differentiating between the primary ovarian lesion and the metastatic lesion allowed for the initiation of the appropriate treatment and helped determine the prognosis .

treatment options of ruptured vertebrobasilar fusiform aneurysms ( vfa ) are limited and often carry significant mortality and morbidity . we report the use of pipeline embolization device ( ped ) to successfully treat a patient with a ruptured vertebrobasilar fusiform aneurysm ( vfa ) who presented with subarachnoid hemorrhage ( sah ) . a 73 year - old man with a history of cardiac stent placement seven days earlier presented with hunt - hess ii sah . he was taking aspirin and clopidogrel . computed tomography angiogram revealed a large vertebrobasilar fusiform aneurysm . microsurgical treatment options are technically challenging and carry high risk . he underwent endovascular treatment of the ruptured vfa using overlapping peds . five peds were placed in a telescoping fashion to reconstruct the affected portions of the left vertebral and basilar arteries . an additional 2-mm blister aneurysm in the right vertebral artery was also discovered during the conventional cerebral angiography and was treated with one additional ped . the patient remained neurologically intact after the procedure . he was continued on aspirin and clopidogrel . follow - up magnetic resonance imaging at three months demonstrated patency of the stents without any evidence of ischemic change . follow - up conventional cerebral angiogram at six months demonstrated thrombosis of the vfa and reconstruction of the vertebrobasilar system . the patient remained clinically well . an endovascular approach using peds can be a safe and effective treatment option for ruptured vfa in selected cases .

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vertebrobasilar fusiform aneurysm ( vfa ) , also known as vertebrobasilar dolichoectasia , is a vasculopathy characterized by pathologically elongated and dilated vertebral and basilar arteries with estimated incidence of 0.06 - 5.8%.10 ) it can be diagnosed radiographically using smoker 's criteria.8 ) clinical manifestations of vfa may include ischemic stroke , cranial nerve palsies , brainstem compression , hydrocephalus and intracranial hemorrhage.6)10 ) subarachnoid hemorrhage ( sah ) is an uncommon presentation of vfa with a crude incidence rate of 2.2 per 1000-person years.6 ) traditional treatment options for ruptured vfas have been limited and often carry significant mortality and morbidity . the pipeline embolization device ( ped ) ( covidien , ca ) is a braided , self - expandable , platinum and nickel - cobalt chromium alloy wire mesh initially approved by food & drug administration ( fda ) for treatment of aneurysms in the internal carotid artery from the petrous to the superior hypophyseal segments . , ped has gained much popularity in an attempt to reconstruct vessels with abnormal morphology . several centers have reported using ped for treating complex posterior circulation aneurysms with mixed results.1)5)7)9 ) in this report , we describe the use of peds to successfully treat a ruptured vfa . he was on aspirin 325 mg and clopidogrel 75 mg daily for his coronary artery stent placed seven days earlier . computed tomography ( ct ) angiography of the brain showed severely ectatic left vertebral and basilar arteries consistent with vfa . a complete 6-vessel cerebral angiogram demonstrated severe dolichoectasia involving the left vertebral and the basilar arteries . it also revealed a 2-mm blister in the right vertebral artery proximal to right pica take off that was not apparent on pre - operative ct angiogram . since either the left dolichoectatic vertebrobasilar artery or the right vertebral artery blister aneurysm could be the source of sah , the decision was made to treat both . through a 6 french sheath , a 6f neuron guide catheter ( penumbra , ca ) was used to catheterize the left vertebral artery . the patient was given 3,000 units of heparin intravenous injection with an activated clotting time of 214 . his aspirin reaction units was 407 ; clopidogrel activity test showed 73% platelet inhibition with p2y12 reactivity unit of 98 . a marksman catheter ( covidien , ca ) along with a synchro 2 ( stryker , mi ) standard microwire was navigated through the left dolichoectatic vertebral artery into the basilar artery . next , five peds ( four 4.5 20 mm , one 4.5 18 mm ) were deployed in a telescoping fashion starting from proximal part of the basilar artery down to the left vertebral artery , essentially reconstructing the entire length of the affected vertebrobasilar system . each ped was placed within the previous one with 50% overlap . a cerebral angiogram after the ped placement demonstrated good patency of the target vessels and there was stasis in the irregularity outside the ped . next , the right vertebral artery was selectively catheterized and one additional ped ( 3.0 16 mm ) was placed across the blister in the right vertebral artery . the final angiogram from the left vertebral artery demonstrated patency of both vertebral arteries ( fig . 3 ) . mri at three months after the procedure showed no ischemic changes suggesting patency of perforators in the vertebrobasilar system . conventional cerebral angiogram at six months demonstrated successful reconstruction of the vertebrobasilar system and thrombosis of the vfa ( fig . sah is an uncommon presentation of vfa and only accounts for about 3.85% of the cases overall.6 ) however , the risk for re - hemorrhage in these patients is high.4 ) open surgical treatment in the setting of sah in this elderly patient on aspirin and clopidogrel carries high risk . the optimal strategy and treatment goal in this setting would be strengthen and reconstruct the vfa to prevent recurrent hemorrhage and further comprise in vessel wall integrity . it provides a metal scaffold for endothelial cells to promote neointimal growth,1 - 3 ) which eventually forms an entirely new endothelial - lined lumen with metal reinforced vessel wall . in theory , this would decrease the chance for recurrent hemorrhage and may even deter or halt the disease progression . we recommend not overlapping ped 's more than 50% of their length in the posterior circulation to avoid mechanical obstruction of perforators . ideally , a longer length ped would have been our first choice to allow single device coverage of this aneurysm , but unfortunately , this device is not currently available in the united states . the drawback of using a stent in the case of acute sah is that the patient was continued on dual antiplatelet therapy , which might have complicated the hospital course if the patient would have needed external ventricular drainage or a shunting procedure . in addition , the use of ped in the acute phase of sah is controversial due to the fact that ped might not immediately occlude the area that bled . other endovascular options would have been sacrifice of the dominant vertebral artery with the hopes that the non - dominant vertebral artery would have sufficient perfusion . however , in this case the non - dominant vertebral artery was diseased as well . the use of regular self - expanding stents would have been an option , but would not have significant flow diversion . endovascular approach using peds could be a safe and effective treatment option for selected cases of ruptured vfas . it may not only decrease the chance for recurrent hemorrhage , but also may halt the disease progression by addressing its underlying pathology .

– The death toll in yesterday's riot inside a Mexican prison has now climbed to 44, officials say. No guards were among the dead, but MSNBC reports that corrupt ones may have helped enable the brawl. All the Apodaca prison's guards are reportedly being held for questioning. The clash was initially blamed on an effort to transfer some of the prisoners, but rival drug gangs also likely contributed to the fighting, the Los Angeles Times reports; most of the inmates involved were imprisoned on drug-related charges. A state spokesperson says all the victims were killed with knives, clubs, or stones. As Mexico's drug war overcrowds prisons with inmates, violence between rival gangs in prisons is worsening; such violence has claimed more than 100 lives in the past two years and has also contributed to mass escapes. The Apodaca prison had a population of 3,000 despite the fact that it was built to hold just 1,500. Last week, more than 350 were killed in a fire at an overcrowded Honduras prison.

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Dozens of inmates were killed Sunday in a fierce brawl inside a Mexican prison, authorities said, the latest lethal incident in Latin America's overcrowded, poorly maintained jails.Officials said at least 44 inmates died at the prison outside the northern industrial city of Monterrey.Initial reports blamed the violence on efforts to transfer some inmates to another jailhouse elsewhere in the country. But it was also likely that the fighting involved rival drug gangs that increasingly dominate Mexican prisons. One guard was reported having been taken hostage, but none was reported killed.Public security authorities in Nuevo Leon state, where Monterrey is, said inmates began fighting in one cellblock about 2 a.m. and the violence spread to a second block.Relatives of inmates gathered before dawn for Sunday visiting hours and realized that something was badly amiss inside. They shoved against security gates to demand information; some told reporters they had heard explosions and seen smoke coming from the prison.But Jorge Domene, the state's public security spokesman, said all of the dead were killed by knives, other sharp instruments, clubs or stones.He said authorities regained control of the institution about four hours after the clashes started. Most of the prisoners were incarcerated on drug-trafficking charges and related crimes, Domene said.Last week, more than 350 people were killed when fire spread through an overcrowded prison in Comayagua, Honduras, underscoring the deteriorating conditions in prisons throughout Latin America. Mexico 'sraging drug war is helping to fill prisons in many cities at more than twice the capacity.In Sunday's incident, the prison in a town called Apodaca, about 20 miles from Monterrey, was reportedly built to hold 1,500 inmates but had a population of 3,000.Violence in Mexican prisons, mostly between rival gangs, has killed more than 100 inmates in the last two years. Mass escapes are routine.Sunday's "tragedy is not an isolated incident, but rather one that is part of a continuous and perverse process of dehumanization in the penitentiary centers," the Monterrey-based Citizens in Support of Human Rights said in a statement. Authorities "have failed to take basic measures to secure the lives and integrity of inmates, as well as of the people who work in these centers." ||||| Daniel Becerril / Reuters Inmates' relatives wait for news outside Apodaca prison in Monterrey, Mexico, which is about 140 miles from the border with Texas. MEXICO CITY -- Around 44 prisoners died in battles between rival drug cartels in a prison in northern Mexico on Sunday, with victims being beaten, stabbed and stoned to death, according to officials. "We can't rule out the possibility that some prisoners escaped, which also could be a motive if the fight started as a distraction," Reuters quoted Jorge Domene, security spokesman for the Nuevo Leon state government, as saying. Inmates at the prison in Monterrey, about 140 miles from the border with Texas, include members of Mexico's Gulf cartel as well as the feared Zetas cartel. The outburst in Apodaca prison would be the second-largest "mass homicide" in the state of Nuevo Leon's history, after an attack on a casino left 52 dead in August, according to Mexican magazine Proceso (Link in Spanish). In May, 14 inmates were killed and burned in Apodaca's psychiatric area, according to the magazine. Authorities said clashes erupted at around 2 a.m. local time (3 a.m. ET), after which a fire broke out. Unidentified sources told Proceso that gunfire was also heard. However, Domene told Milenion magazine that no firearms were used during the violence (Link in Spanish). Officials had regained control of Apodaca by 9 a.m. (10 a.m. ET) Mexico's 'super labs' send meth pouring across border Corrupt prison guards may have been involved in facilitating the disturbance at the prison and authorities were holding all the prison officials for questioning, Domene said late Sunday. In recent years there have been a number of prison breaks in Mexico, sometimes with the aid of complicit guards. Sunday's violence was the second deadly incident at a Latin American prison within a week. Desperate overcrowding in Honduras' prisons last week led to a massive fire in a run-down jail that killed more than 350 inmates. NBC's Kerry Sanders reports that more than 350 people are dead after an enraged inmate set the Comayagua prison in Honduras on fire. Doctors say the survivors suffered burns over 65 percent of their body. The prison in Monterrey is, like many in Mexico, overcrowded as a result of the five-year-old drug war President Felipe Calderon has been waging against cartels. The prison held about 80 percent more prisoners than it was designed for, Domene said, adding many of the inmates were charged with federal crimes related to drug trafficking. In Mexico, where prisoners held on federal drug charges are mixed with common criminals, the system is troubled by violence tied to the powerful drug cartels battling for control of smuggling routes along the U.S.-Mexican border. Officials: Honduras prison fire kills hundreds Collusion between guards and prisoners is also a long-standing problem. In the most notorious example, collusion led to the escape of Mexico's most wanted man, Joaquin "Shorty" Guzman, from jail in a laundry basket in 2001. In 2010, more than 140 inmates escaped through the front gate of a prison in Tamaulipas state, helped by prison officials. About 50,000 people have been killed in Mexico in the past five years since Calderon launched an army-backed offensive against drug gangs shortly after taking office. Mexico leader's message to US: 'No more weapons!' Drug violence hit Monterrey, the wealthy capital of Nuevo Leon state, when the Zetas split off from their former employers the Gulf cartel and began fighting for control of drug trafficking routes and other criminal rackets in the city. More from msnbc.com and NBC News: Msnbc.com staff and Reuters contributed to this report.

cholinergic urticaria with acquired generalized hypohidrosis , and its pathophysiology is not well known . autoimmunity to sweat glands or to acetylcholine receptors on sweat glands has been mentioned as one of the possible etiologies . systemic steroid therapy , antihistamines , anticholinergics , and avoidance of the stimulatory situations are recommended for treatment . we experienced a case of cholinergic urticaria with acquired generalized hypohidrosis in a patient who had no other associated disease , and the symptoms eased after repeated bilateral stellate ganglion block . stellate ganglion block normalized the elevated sympathetic tone and may relieve symptoms in patients with this condition .

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a 24-year - old male was admitted to the hospital due to systemic erythema and wheals with an itchy sensation , which he had had for 9 years . a stinging pain , rated 7 cm on a visual analogue scale ( vas : from 0 to 10 cm ) , was one of the dermatological symptoms and was predominant when the patient ate hot or spicy foods , engaged in a vigorous workout , took a hot bath , or experienced situational nervousness or stress . the symptoms disappeared within 30 - 90 minutes of rest or symptomatic relief . when the patient was exposed to heat , the symptoms worsened , with an excessive hot flush sensation ; the symptoms were relieved when he rested in cool conditions . there were no signs of autonomic dysfunction such as orthostatic hypotension , impotence , and photophobia . the results of the blood laboratory test , liver function test , urinalysis , rheumatoid factor , coagulation test , erythrocyte sedimentation rate ( esr ) , c - reactive protein ( crp ) , and chest x - ray were either within the normal range or negative . glycopyrrolate 2 mg / day was administered orally for 1 week for diagnostic purposes , and a symptomatic change was observed . after the reduction in diaphoresis from the administration of glycopyrrolate , the hot flush became severe and the patient still complained of pain with a vas rating of 7 cm . the medication was ceased under the impression of possible cholinergic urticaria with generalized hypohidrosis , and a right and left stellate ganglion block was carried out by administering mepivacaine 10 cc with a 20-minute interval . in the 1-week follow - up , the frequency of symptoms was similar , but there was a reduction in the degree of excessive hot flushes , and the systemic pain had a vas rating of 4 cm . an extra stellate ganglion block was since carried out , and the vas rating was reduced to 2 cm . cholinergic urticaria is characterized by systemic erythema and wheals with an itchy sensation and is brought by an increase in body temperature after an exercise or hot bath . the diagnosis is generally made from the patient history , and differential diagnosis should be made with respect to exercise - induced urticaria or anaphylactic reaction to foods through a provocation test . the pathology of cholinergic urticaria is not clearly identified but can be divided into 4 large categories according to the cause : poral occlusion , acquired generalized hypohidrosis , sweat allergy , and idiopathic . from these 4 categories , cholinergic urticaria with generalized hypohidrosis is defined by urticaria with reduced sweat secretion even with sufficient stimulation . the etiological factors are occlusion of the sweat glands due to keratinization , autoimmune disease or disappearance of the sweat glands as a congenital defect , and a malfunction of the autonomic nervous system . stimulation of the sympathetic nervous system causes the secretion of acetylcholine , and sweat secretion occurs as feedback of the reaction of acetylcholine receptors in the sweat glands . reported through skin tissue biopsies that patients with cholinergic urticaria with generalized hypohidrosis have reduced cholinergic receptor muscarinic 3 ( chrm 3 ) . they hypothesized that the reduction of chrm 3 in sweat glands leads to insufficient sweat secretion and an increase in acetylcholine secretion through a feedback mechanism , and the increased serum acetylcholine induces the surrounding master cells to secrete histamine or stimulate sensory nerve terminals , which in turn causes cholinergic urticaria and pain . the authors used anticholinergic drugs to differentiate sweat allergy from a hypersensitivity reaction after sweat secretion and cholinergic urticaria with generalized hypohidrosis , and a worsening of the patient 's symptoms was observed soon after administration of the medication and the reduction in sweat secretion . therefore , the reduction of sweat is thought to be the etiological factor in this patient . in this case , the patient did not have any significant medical history such as specific physical appearances or intellectual abnormalities to suggest the possibility of congenital diseases . moreover , the patient did not present any abnormalities in the autonomic nervous system except for hypohidrosis . diagnosis is thus possible , as the sweat glands disappeared due to autoimmune disease or were occluded by keratinization rather than congenital defects . antihistamines and anticholinergic drugs are the standard treatments for cholinergic urticaria . however , most patients experience moderate relief from an antihistamine and minor relief from anticholinergic drugs . systemic steroids can be administered when the cause of hypohidrosis is destruction or occlusion of sweat glands due to autoimmune disease . keratolysis can be chosen as a treatment for the blockade of the opening of sweat glands due to keratinization . the stellate ganglion block is effective at stabilizing the hypertonic sympathetic nerve system in the head , neck , and arms . it is known to temporarily block the sympathetic nervous system , and it also disconnects the pain circle and recovers the balance of the somatic nervous system and sympathetic nervous system within the area where pain occurs . cholinergic urticaria with generalized hypohidrosis is a symptom that arises when the sympathetic nerve system is activated due to excessive exercise or bathing and sufficient sweat secretion does not occur . this increases the serum acetylcholine level and activation of the sympathetic nervous system through a feedback system , and the stellate ganglion block can facilitate improvement of symptoms . however , persistent nerve therapy and follow - up observations are needed for an accurate determination of efficacy , consideringthat stellate ganglion block also causes hypohidrosis and the low frequency of the stellate ganglion block procedure .

granular cell tumor , an uncommon neoplasm , can occur at any site in the body , but they are more commonly observed in the head and neck region , especially the oral cavity . a lesion of controversial origin , this entity has to be considered in the differential diagnosis of swellings of the tongue . immunohistochemical findings obtained in the present case also render support for the neural histogenetic origin for this tumor . though commonly observed in the fourth to sixth decades of life , we present this case in a 9-year - old female patient .

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granular cell tumor also known as abrikossoff 's tumor or granular cell myoblastoma was variably considered as being a true neoplasm , degenerative metabolic process or trauma - induced lesion . a 9-year - old female patient presented to the dental clinic with a chief complaint of a swelling on the left side of her tongue since 6 months . there was a solitary well - defined , non - tender and non - fluctuant swelling with smooth borders , on the left side of the dorsal surface of the tongue , measuring approximately 1.5 1 cm . her hematogram findings were within normal limits . with a clinical diagnosis of a benign mesenchymal lesion , the hematoxylin and eosin - stained sections [ figure 1 ] revealed a well - defined lesion surrounded by stratified squamous epithelium with the underlying connective tissue comprising of bundles of collagen and abundant muscle fibers . the deeper aspect of the connective tissue showed cellular proliferation of polygonal cells with abundant granular cytoplasm . a panel of markers , namely , s-100 , vimentin , cluster of differentiation ( cd ) 68 , cd34 , smooth muscle actin ( sma ) and inhibin were used . positivity was observed with vimentin , s-100 , cd68 and inhibin [ figures 2 , 3 and 4 ] confirming the diagnosis of granular cell tumor . photomicrograph showing granular cells with indistinct cell borders interspersed with muscle fibers ( h&e stain , 100 ) photomicrograph showing strong positivity of granules for the s-100 protein ( ihc stain , 100 ) photomicrograph showing strong positivity of granules for inhibin ( ihc stain , 100 ) photomicrograph showing granular cells staining positive for cd68 ( ihc stain , 100 ) the granular cell tumor is also known as abrikossoff 's tumor , abrikossoff 's myoblastoma , granular cell neurofibroma or granular cell schwannoma . first described in 1926 by russian pathologist alexei ivanovich abrikossoff , it is an uncommon neoplasm . it was earlier also known as granular cell myoblastoma implying its origin from the striated muscles . a tumor of uncertain histogenesis , abrikossoff 's tumor was considered to be a true neoplasm , degenerative metabolic process or a proliferative lesion induced by trauma . earlier literature also suggested the other possibilities of muscular , histiocytic , fibroblastic or pericytic origin . with the advent of immunohistochemistry and the application of various markers , the common location in the head and neck region is the tongue as was observed in the present case , followed by cheek mucosa palate , lip , gingiva , uvula and parotid gland . other body sites being the skin , soft tissues , breast , lungs , nervous system , gastrointestinal tract , urinary bladder , female reproductive tract and bronchus . typically appearing as a single ( cases of multiple lesions have been reported ) and sessile asymptomatic nodule , these lesions follow a benign course and the surface is smooth or pseudoulcerated . there are reports of painful symptoms during tooth brushing , consumption of spicy foods and bite trauma . normally the size of the lesion is usually less than 3 cm , commonly affecting females in the fourth to sixth decades of life and is rare in children . histopathologically these lesions present with round or polygonal cells with abundant granular cytoplasm and small nucleus that is eccentrically placed . the cells are arranged in the form of unencapsulated sheets , cords or nests with a syncitial appearance . over 50% of cases , especially the lesions on the tongue the granularity of the cells has been attributed to various factors neoplasia , degenerative or reactive processes like anoxia , metabolic disorders and lysosomic effects . the differential diagnosis for this lesion includes other benign connective tissue tumors , traumatic fibromas , lipomas , neuromas , neurofibromas or schwannomas , with its malignant variants and even oral carcinoma , minor salivary gland tumors , dermoid cysts and vascular lesions . granular cells can be found in lesions other than granular cell tumor , these include ameloblastoma , ameloblastic fibroma , odontogenic fibroma , odontogenic cysts , congenital epulis of the newborn and oral lichen planus . additionally , it is clearly known that when there is damage to the myelin sheath , the myelin enters into a process of disintegration and is phagocytosed initially by schwann cells and later by macrophages . electronic microscopy has shown a continuous basal layer around the tumoral cells with certain resemblance to the perineurium and the presence of structures compatible with myelin inside the liposomes . vimentin is a primordial member of the intermediate filament family and is expressed in mesenchymal tissue . s-100 immunoreactivity of granular cell tumors is the most widely used marker for identification of the granular cells , which constantly shows a strong and diffuse staining . it is a protein that belongs to a family of small acidic ef - hand ( helix - loop - helix type conformation ) calcium - binding proteins initially discovered in brain extracts . cd68 is a heavily glycosylated membrane protein , closely related to the family of lysosomal - associated mucin - like membrane proteins . inhibin- is a glycoprotein hormone that participates in the regulation of the pituitary - gonadal feedback system . it is a specific marker for sex cord - stromal tumors of ovary and is also expressed in adrenal cortical neoplasms . this lesion though uncommon should be considered in the differential diagnosis of swellings of the oral cavity and an updated knowledge of immunohistochemistry aids in the differential diagnosis of other lesions . considering the aggressiveness of the granular cell lesions , a regular follow up of the patients is of pivotal importance .

– Bill Hillmann had one job at Pamplona, and it’s a job that in theory he should’ve nailed. The Chicago resident, 32, was seriously injured this morning at Spain’s weeklong “running of the bulls” after he tripped and was gored in the right thigh by one of the enormous black beasts, reports Reuters. Which wouldn’t be that unusual, since hundreds of people are injured at the festival every year—except for the fact that Hillmann co-wrote the 2014 e-book How to Survive the Bulls of Pamplona. It offers tips on everything from the best footwear to which parts of the course are better for beginners, notes the Chicago Tribune. Hillmann, who remains in serious condition at a Spanish hospital after his encounter with the 1,300-pound bull, reveals to the Tribune that he was inspired to start participating in the annual event three years ago after reading Ernest Hemingway’s The Sun Also Rises. He also said that doctors told him the bull’s horn had been just 1 centimeter away from piercing his femoral artery, which would have almost certainly resulted in death. Despite his close call, Hillmann tells the Tribune he’ll run again, crediting the dangerous dash with helping him get sober and finish his latest novel. And he’s not holding it against the bull, either: “I don’t hold a grudge," he says. The Spanish fighting bull is "the most wonderful animal in the world, and I’m proud to have been gored by one.”

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A Chicago author who wrote a chapter of the book “How to Survive the Bulls of Pamplona” was gored Wednesday during the Spanish bull running festival. “When I fell, the bull fell with me and gored me in one motion,” said Bill Hillmann, who spoke by phone from his hospital room in Spain. “The horn went in one side of my thigh and exited the other side and he pulled it through.”Hillmann said he plans to run again next year.A former Chicago boxing champion, Hillmann is a veteran of the running of the bulls. His chapter in the 2014 e-book about the event offers frank advice to would-be bull runners that ranges from shoe selection to which parts of the course are appropriate for beginners."You cannot run a very long distance with the bulls,” Hillmann wrote. “They have four legs. They’re faster than you.”Hillmann, 32, said he approached a massive black bull Wednesday that had become distanced from the pack.“I always run with lone bulls when the bulls get separated,” he said after undergoing surgery in a Pamplona hospital. “I always try to run them up the street. This was a normal morning for me.”But he recalls being pushed and then tripping. Hillmann said he and the bull fell simultaneously. Though he said doctors expect him to make a full recovery, they told him the prognosis could have been much worse.“They said it was a centimeter away from my femoral artery and if it had hit that artery I would have died,” said Hillmann, who grew up in Chicago’s Edgewater neighborhood and today lives in Little Village.Though he apparently hadn’t been seriously injured before, this wasn’t Hillmann’s first time on the wrong side of a bull’s horns. In 2011, he told the Tribune about another close call in Pamplona.“One time I tried to challenge a bull, cut in front of him,” he said then. “He picked me up — I thought I was gored, but he just hooked my shirt — and he slammed me to the street.”The animal that gored him Wednesday was the heaviest of the morning's six bulls, weighing around 1,300 pounds. Hillmann said there were no hard feelings between him and the beast.“I don’t hold a grudge,” he said. “That animal, it was a beautiful bull. And if I wouldn’t have been pushed and tripped up and fallen down with him, I would have a great run with that bull.”A Spanish man was also gored Wednesday in the "encierro," when runners in red scarves and white outfits dash through the Spanish town's streets pursued by the huge animals.Wednesday's run was the third in the weeklong San Fermin festival, depicted in Ernest Hemingway's 1926 novel "The Sun Also Rises." A Hemingway enthusiast, Hillmann told the Tribune three years ago that the book led him to the running of the bulls.Hillmann, a bull running veteran of about 10 years, credited the event with helping him become sober and finish his Chicago-based novel “The Old Neighborhood.” He spoke at this year’s Printers Row Lit Fest.Hillmann said Wednesday’s wound — which he estimated to be between the size of a golf ball and baseball — hasn’t affected his passion for the event.“I love the Spanish fighting bulls,” he said. “It’s the most wonderful animal in the world and I’m proud to have been gored by one. It’s an honor and it only makes me love this tradition even more.”Reuters and Tribune reporter Meredith Rodriguez contributed. ||||| A runner gored in the leg by a Victoriano del Río fighting bull, falls at the entrance to the bullring during the third running of the bulls of the San Fermin festival in Pamplona July 9, 2014. Three runners were hospitalized following a run that lasted three minutes and... PAMPLONA Spain An American who co-wrote a book called "Fiesta: How To Survive The Bulls Of Pamplona" was badly gored on Wednesday in the morning bull run at Pamplona's San Fermin festival. A Spanish man was also gored in the "encierro", when runners in red scarves and white outfits dash through the Spanish town's streets pursued by the huge animals. Chicago resident Bill Hillmann, 32, tripped and fell when a bull gored him in his right thigh, according to festival website sanfermin.com. The Spaniard, a 35-year-old man from Valencia, was gored in the chest and taken to hospital in a semi-conscious state, officials said. The two men are in a serious condition, the regional government said. A further three, all Spanish, were taken to hospital with lesser injuries from the chaotic stampede through the narrow streets of Pamplona's old town, authorities said. All the injured were men. Few women take part in the run. Authorities did not give the names of the injured men. Wednesday's run was the third in the week-long San Fermin festival, depicted in Ernest Hemingway's 1926 novel "The Sun Also Rises". The daily bull run starts at 8 a.m. (0600 GMT) and usually lasts around 3 to 5 minutes. It ends at the bull-ring, where the bulls are corralled before reappearing in the evening bullfight, when they are killed. San Fermin has become a global tourist attraction, with tens of thousands of Spaniards and foreigners pouring into the Navarran capital. Many participants drink and dance all night. Hemingway aficionado Hillmann travels to Pamplona every year to take part in the festival. The black bull that gored him was the heaviest of the morning's six bulls from the Victoriano del Rio ranch, weighing around 600 kilos. A 27-year-old man from Madrid was the last person to be killed during the bull run after being gored in the neck in 2009. There have been 14 fatalities over the past century at the fiesta, which dates to the 13th century. (This story corrects title of book in first paragraph) (Reporting By Vincent West, Writing by Sonya Dowsett, Editing by Gareth Jones)

– Buckingham Palace has a strong suggestion for reporters who will be covering Prince William and wife Kate's visit to America next month: Don't dress like slobs. Or in the more formal language of the palace: "Smart attire for men includes the wearing of a jacket and tie, and for women a trouser or skirt suit." And, please, no jeans or sneakers. The rules apply to journalists and their "technicians," and slovenly offenders risk being turned away from events. At the Daily Beast, Tom Sykes explains that back home, UK reporters "can get a serious telling-off from the press minders and even be excluded from future events" if they disregard the royal dress code and other forms of etiquette. He quips, however, that top hats "seem to be entirely optional." In its coverage of the rules, the Daily News points out that America has some, too. For example, male reporters who want to rub shoulders with members of the House in the "Speaker's Lobby" need a jacket and tie, with none other than John Boehner himself known to dispense suggestions to get a haircut. (Click to read about what kind of a king Charles might be.)

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WASHINGTON — We threw off British rule in 1776 — but American reporters still face a royal dressing-down if they don’t bow to sartorial standards when William and Kate come to town. U.S. reporters applying to cover a visit by the Duke and Duchess of Cambridge to New York and Washington next month have been reminded of Buckingham Palace’s posted policy on proper dress for covering the royal family. The edict warned: “Journalists wishing to cover royal engagements, whether in the United Kingdom or abroad, should comply with the dress code on formal occasions out of respect for the guests of the queen, or any other member of the royal family.” Kate Middleton's royal maternity style The warning told reporters to show some respect. “Smart attire for men includes the wearing of a jacket and tie, and for women a trouser or skirt suit.” The guidelines warn that slobs are so not welcome to cover the always elegant prince and his wife. “Those wearing jeans or trainers will not be admitted and casually dressed members of the media will be turned away. This also applies to technicians,” the rules state. U.S. reporters applying to cover a visit by Prince William (pictured) and his wife Kate Middleton will have to agree to come dressed for the part. (Chris Jackson/Getty Images) D.C. reporters may be left Googling to find out what “trainers” are (British English for sneakers), but at least many of them have run into dress codes before while covering Congress, where requirements for attire often depend on location. In the House, men need a jacket and tie to mingle with members in the “Speaker’s Lobby” next to the chamber. The speaker himself, Rep. John Boehner (R-Ohio), regularly admonishes scruffy scribes and sometimes suggests they shave or visit a barber. Sign up for BREAKING NEWS Emails privacy policy Thanks for subscribing! ||||| Dress Smart, Think Smart Why journalists covering William and Kate's US trip should dress smart Journalists are an ill-dressed lot, by and large. From Bernstein and Woodward in All The President’s Men to Lester Bangs in Almost Famous, the global army of ink-stained wretches may have a certain effortless style, but they are not often held up as paradigms of formal dressing (JJ Hunsecker is the exception that proves the rule). Indeed, the overarching meme when it comes to the journalistic dress code is a rumpled and slept-in look - after all who has time to change their shirt or shave when they’re chasing down stories through the mean streets of A.N Other City? The shabby dress code by which most journalists operate is obviously something of a concern to the press office at Buckingham Palace, which has guidelines on its website which will be relevant to journalists covering Prince William and Kate Middleton’s 48 hour love-bombing of New York City and Washington DC, which will take place from the 7 - 8 December, recommending that the fourth estate look out some smart duds if they want to get in sniffing distance of the royals. The website says, “Journalists wishing to cover Royal engagements, whether in the United Kingdom or abroad, should comply with the dress code on formal occasions out of respect for the guests of The Queen, or any other member of the Royal Family. “Smart attire for men includes the wearing of a jacket and tie, and for women a trouser or skirt suit. Those wearing jeans or trainers will not be admitted and casually dressed members of the media will be turned away. This also applies to technicians." Top hats, however, seem to be entirely optional. The Buckingham Palace press office has always been somewhat celebrated for the rules it seeks to impose on press photographers, rules which have become steadily less relevant since the sale of the first camera-equipped phone. The palace website, for example, cautions photographers that they “should not photograph” royals “while they have food or a glass in their hand or during a meal,” although, the website allows, “it is quite in order for a photograph to be taken during a Loyal Toast, or immediately before food is served.” Bizarrely, in royal press protocol, journalists are only allowed to take photos during speeches , “for the first minute after they start talking”. You are also not allowed to film or photograph a royal ‘at prayer’. In the UK you can get a serious telling-off from the press minders and even be excluded from future events if you disobey these rules. Press are also discouraged from asking and shouting out questions at the Royals during press calls. It should also be noted that the ancient paparazzi tradition of yelling , “Oi! Kate! Over here love!” to get the Duchess to turn your way is not on at all, although lately some photographers have taken to gently calling out, “Sir, Sir, Ma’am, over here please!” Get The Beast In Your Inbox! Daily Digest Start and finish your day with the top stories from The Daily Beast. Cheat Sheet A speedy, smart summary of all the news you need to know (and nothing you don't). By clicking "Subscribe," you agree to have read the Terms of Use and Privacy Policy Subscribe Thank You! You are now subscribed to the Daily Digest and Cheat Sheet. We will not share your email with anyone for any reason The ultimate sin, though, is to obstruct the Royal view. As the press office says, “It is particularly unfortunate if photographers are allowed to insert themselves between the Royal visitors and whomever or whatever it is they are meeting or watching.” “Particularly unfortunate” is, of course, code for, “You’ll never work this beat again, pal.” Friends, you have been warned.

– Eleven years ago, Pam Beesly felt God in a Chili's. But apparently it's been hell getting back into one. On Monday, actress Jenna Fischer tweeted a photo of herself standing in front of a Chili's, asking if she should "try to go in." Mashable reports Fischer's character on The Office, Pam Beesly, was permanently banned from all Chili's restaurants after getting drunk and falling out of her chair in a 2005 episode. It was a cute tweet. Then things took a turn for the surreal. Apparently having seen the tweet, Chili's parent company, Brinker International, issued a press release, the Huffington Post reports. "Effective immediately, Chili’s Grill & Bar has removed the longstanding ban on a Scranton, Pennsylvania, woman who allegedly caused a disturbance during a company awards party held at a Chili’s," the company states. The president of Chili's goes on to call Pam an "inspiration to many" and says they "welcome her with open arms." Fischer, apparently excited by the prospect of more Chili's margaritas, responded: "OMG! Second drink!!!"

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Chili's Lifts Permanent Ban on Pam Beesly Halpert Effective immediately, Chili’s® Grill & Bar has removed the longstanding ban on a Scranton, Pennsylvania woman who allegedly caused a disturbance during a company awards party held at a Chili’s near the Pennsylvania town of Scranton. The woman, Pam Beesly Halpert, received a prestigious award for having the whitest sneakers in the company. After thanking her shoes and coworkers, the woman declared, “I feel God in this Chili’s tonight.” "After reviewing the good conduct of Pam, I have decided to lift the now 11-year ban," said Kelli Valade, President of Chili's. "Pam is an inspiration to many and we welcome her with open arms." ||||| Forgiveness is a cherished virtue. It's also something that Pam Beesly, former receptionist at Dunder Mifflin from our favorite show The Office, experienced today when restaurant chain Chili's officially forgave her for her uncouth behavior 11 years ago. It all started when Jenna Fischer, the actress who played Pam, tweeted out this photo. Should I try to go in? pic.twitter.com/HDpPqzA0by — Jenna Fischer (@jennafischer) February 6, 2017 Fischer is alluding to a scene from Season 2 of The Office, when Pam becomes so drunk at Chili's that she falls out of a chair and is subsequently kicked out of the restaurant. Not only that, but the owner of the restaurant proclaims, "She is not welcome at this restaurant chain ever again." Well, Fischer's tweet showing her potential reunion with Chili's went around the internet a number of times. When Chili's heard about it, they decided that it was time to give Pam another chance. BREAKING: Chili’s lifts permanent ban on Pam (@JennaFischer), welcomes her back to any #Chilis restaurant: https://t.co/jw76381O8K — Chili's Grill & Bar (@Chilis) February 7, 2017 The link in the tweet takes you to an actual press release, which states the following: Effective immediately, Chili’s® Grill & Bar has removed the longstanding ban on a Scranton, Pennsylvania woman who allegedly caused a disturbance during a company awards party held at a Chili’s near the Pennsylvania town of Scranton. The woman, Pam Beesly Halpert, received a prestigious award for having the whitest sneakers in the company. After thanking her shoes and coworkers, the woman declared, “I feel God in this Chili’s tonight.” "After reviewing the good conduct of Pam, I have decided to lift the now 11-year ban," said Kelli Valade, President of Chili's. "Pam is an inspiration to many and we welcome her with open arms." Classy move, Chili's. We're sure that Pam Beesly Halpert-Jenna Fischer will seize this opportunity to never misbehave in a Chili's again. Uh oh. ||||| These crawls are part of an effort to archive pages as they are created and archive the pages that they refer to. That way, as the pages that are referenced are changed or taken from the web, a link to the version that was live when the page was written will be preserved.Then the Internet Archive hopes that references to these archived pages will be put in place of a link that would be otherwise be broken, or a companion link to allow people to see what was originally intended by a page's authors.The goal is to fix all broken links on the web . Crawls of supported "No More 404" sites. ||||| Back in 2005 on the beloved TV comedy “The Office,” Pam Halpert née Beesly was permanently banned from Chili’s after getting too drunk during The Dundies award show. Now it seems Pam has returned to the restaurant chain 11 years later in an apparent attempt to bury the hatchet, and Chili’s was ready to work things out. Jenna Fischer, the actress who played the soft-spoken but charming secretary, tweeted on Monday a selfie as she stood in front of a Chili’s restaurant with a concerned look on her face. She asked her fans, “Should I try to go in?” Should I try to go in? pic.twitter.com/HDpPqzA0by — Jenna Fischer (@jennafischer) February 6, 2017 Fans replied to Fischer’s tweet with nostalgia for the retired show, many of them sharing their favorite Dunder Mifflin moments with a gif. Lots of people were also quick to remind the actress she was eighty-sixed from the establishment for life. @jennafischer Be careful. If I remember correctly, they xeroxed your driver's license and you weren't welcome at that chain ever again — Mark Ludwiczak (@MarkLud12) February 6, 2017 Even Chili’s official Twitter account decided to get involved by taking a jab at Pam’s drunken night. @jennafischer we hope you felt God tonight. — Chili's Grill & Bar (@Chilis) February 7, 2017 The Office Then something incredible happened. Brinker International, the company that owns Chili’s, published an official press release Tuesday afternoon officially lifting its “longstanding ban” on “Pam Beesley Halpert.” “After reviewing the good conduct of Pam, I have decided to lift the now 11-year ban,” Chili’s President Kelli Valade said in an official statement. “Pam is an inspiration to many and we welcome her with open arms.” BREAKING: Chili’s lifts permanent ban on Pam (@JennaFischer), welcomes her back to any #Chilis restaurant: https://t.co/jw76381O8K — Chili's Grill & Bar (@Chilis) February 7, 2017 Brinker International Unsurprisingly, die-hard fans of “The Office” went crazy over the unexpected news. @Chilis @BeccaCanote @jennafischer Finally, we can close this ugly chapter on our history. (I'm going to take whatever victories I can). — Jonathan Strickland (@JonStrickland) February 7, 2017 But based on Fischer’s latest tweets, we’re starting to think Pam hasn’t really learned her lesson. @johnkrasinski I promise not to fall off the stool next time. — Jenna Fischer (@jennafischer) February 8, 2017

– A Swedish girl has been freed from the clutches of the Islamic State in Iraq. Kurdish special forces rescued the 16-year-old Wednesday during a raid near Mosul, report Reuters and the AP. The teen—whom BuzzFeed identifies as Marlin Stivani Nivarlain—was "misled" by an ISIS member in Sweden and first traveled to Syria from the Swedish town of Boras, the Kurdish government says, adding Swedish authorities and family asked for help in rescuing her. Officials say she'll be "transferred to Swedish authorities to return home once necessary arrangements" are made.

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Kurdistan Region Security Council ID: 8058413 A 16-year-old Swedish teen has been rescued from ISIS by Iraqi/Kurdish troops in Iraq, the Kurdistan Regional Government (KRG) said Tuesday. The girl, identified as Marlin Stivani Nivarlain, was rescued by counterterrorism forces near the ISIS-controlled city of Mosul. Nivarlain, from the city of Borås in southern Sweden, traveled to Syria after being “misled” by an ISIS member, the statement said. Counter-Terrorism Forces (CTD) rescued a young Swedish National, Ms Marlin Stivani Nivarlain, from #ISIL near Mosul. — KR Security Council (@KRSCPress) ID: 8058335 The KRG said she was rescued on Feb. 17 after “we were called upon by Swedish authorities and her family to help rescue her.” “She’s currently in the Kurdistan region. We are working with Swedish authorities to allow her to return home as quickly as possible,” the statement said. In an interview with Kurdistan 24, Nivarlain said she traveled to Syria with a boyfriend but said she didn’t know who ISIS was before she arrived. “First we were good but then he started to look at ISIS videos and speak about them and stuff like that. Then he said he wanted to go to ISIS and I said, ‘OK, no problem,’ because I didn’t know what ISIS means, what Islam is — nothing.” The couple travelled from from Sweden in late May 2015 and made their way across Europe by bus and train until reaching the Turkish border province of Gaziantep. They later crossed into Syria. Kurdistan 24 / Via kurdistan24.net ID: 8067191 Once they arrived in Syria, ISIS militants moved them by bus with other men and women to the city of Mosul in neighboring Iraq. Here they lived in a house with no electricity or running water. “I didn’t have any money either — it was a really hard life,” she said. “When I had a phone I started to contact my mom and I said, ‘I want to go home.’ “In Sweden we have everything, and when I was there, we didn’t have anything.” ||||| IRBIL, Iraq (AP) — Iraqi Kurdish troops have rescued a Swedish teenager from the Islamic State group near the extremist-controlled city of Mosul, the Kurdish government said Tuesday. A statement from the regional government said the rescue operation by the Kurdish anti-terrorist forces took place on Feb. 17 near Mosul, 360 kilometers (225 miles) northwest of the Iraqi capital, Baghdad. The statement identified the young woman by name, saying she is a 16-year-old from the Swedish town of Boras who "was misled" by an IS member in Sweden to travel to Syria and later to Mosul. It also said the Swedish authorities and the teenager's family had contacted the Iraqi Kurdish government and asked for help in locating and rescuing the girl from the IS. The young woman is currently in Iraqi Kurdish territory and is being "provided the care afforded to her under international law," the statement said, adding that she will be "transferred to Swedish authorities to return home once necessary arrangements" are made. The statement provided no details on the rescue operation and did not say whether the teen was mistreated while with the Islamic State group. The Associated Press does not identify minors who may have been victims of abuse or may be accused of crimes. Iraqi Kurdish officials contacted by the AP in Irbil, the capital of the Kurdish semi-autonomous region in northern Iraq, declined to provide more details on the case. Iraq's second-largest city of Mosul was the first major city to fall into the hands of Islamic State militants during their blitz in June 2014, when the group swept across vast areas in the country's north and west. To this day, Mosul remains under control of IS as Iraqi forces, aided by airstrikes that are being carried out by the U.S.-led international coalition, are battling along as well as Shiite militiamen and Sunni pro-government fighters, are battling to reclaim ground lost to the militants. Iraqi Kurdish peshmerga forces are fighting IS militants to the north and east of the city. ___ Associated Press Writer Sinan Salaheddin in Baghdad contributed to this report. ||||| ERBIL, Iraq (Reuters) - A teenage Swedish girl being held by Islamic State militants in Iraq was rescued in a raid by Kurdish special forces last week, the autonomous region’s security council said in a statement on Tuesday. A teenage Swedish girl who was rescued after being held by Islamic State militants in Iraq is seen in this undated handout photo. Social Media The 16-year-old traveled from Sweden to Syria last year and later crossed into Iraq, where she was rescued near the Islamic State stronghold of Mosul on Feb. 17 by forces from the Kurdish counter terrorism department, the statement said. The Kurdish security council identified the rescued teenager as coming from the Swedish town of Boras and said she had been “misled” into making the journey to Syria by an Islamic State member in Sweden. “The Kurdistan Region Security Council was called upon by Swedish authorities and members of her family to assist in locating and rescuing her from ISIL,” the statement read. The teenager is currently in the Kurdistan region and will be handed over to Swedish authorities so she can return home once necessary arrangements are made, it added. Security services estimate that hundreds of Western men and women have left home to join Islamic State since they overran large parts of Iraq and Syria in June 2014. Earlier this month, a mother who took her 14-month-old son to Syria to join Islamic State fighters was jailed for six years by a British court.

– Black smoke was filling a burning shed in Charleston, SC, last June when firefighter William Lindler spotted a badly burned puppy within. Less than a year later, that puppy is now an honorary firefighter and the official mascot of the Hanahan Fire Department. After the 3-week-old pit bull, Jake, was given "mouth-to-snout breaths," the vet said he had burns over 75% of his body and needed laser skin therapy, antibiotics, and morphine, which his family couldn't afford, per ABC News and Inside Edition. So Lindler adopted him. Jake now has a full life ahead of him: Lindler hopes to train Jake as an arson detection dog to prevent tragedies like the one he survived.

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A pit bull named Jake, who was badly burned in a fire as a puppy, is now an honorary firefighter and mascot at the fire department that saved him. Firefighter William Lindler of the Hanahan Fire Department in South Carolina told ABC News he rescued Jake from a "badly burning shed" outside a family's house in Charleston last April. Jake was only three weeks old at the time, he said. "I literally found Jake in the last place you could see before the smoke became pitch black and was too dark to navigate through," Lindler said. "He wasn't doing too good, and I gave him mouth-to-snout breaths until we could get an oxygen mask for him." Jake was taken to a local emergency veterinarian's office, where a vet warned Lindler that there was a chance that the pup might not survive, Lindler said. abc But little Jake "was a fighter," Lindler added. William Lindler The firefighter soon found out from the vet that Jake's original family couldn't afford the medical bills and that "they had abandoned him," he said. "So I adopted him!" William Lindler The pup was treated with antibiotics and morphine for over a month, Lindler said. He explained that the vet staff would "have to scrub dead skin off him everyday" and that Jake had to undergo laser skin therapy. William Lindler "All in all, it was about four months of recovery," he said. "Of course, even when he came home, we still had to continue putting special antibiotics and ointments, and his scars will always remain. We actually have to put sunscreen on him when we take him to the beach." William Lindler Once Jake was fully recovered, Lindler said he allowed the pup to accompany him to the station this past September. William Lindler "All the guys fell in love with him, and the ladies at town hall always have treats for him," he said. Lindler added that this past December, Hanahan's fire chief and mayor actually proclaimed Jake an honorary firefighter and swore him in as the official mascot for the fire department. William Lindler Lindler said he hopes to soon be able to train Jake to become an arson detection dog. "He loves sniffing and snooping around when I play with him and hide his toys," he said. "So I figured, hey, he might be a good fit for being a detection dog." William Lindler The firefighter said he now hopes that Jake's story will also "change people's perception of pit bulls." He said that Jake "is actually a very loving and gentle dog who's never met anyone he didn't like." William Lindler The pup will soon be celebrating his first birthday. "Oh yeah, we'll have a puppy birthday party complete with a puppy birthday cake for sure," Lindler said. ||||| This South Carolina fire department recently made a one-year-old pup into an honorary firefighter after they rescued him from a devastating fire months before. Bill Lindler told InsideEdition.com that on the day of his neighbor's fire, he knew there was a 3-week-old pitbull still in the garage. Read: Meet Mahe, The Service Dog That Soothed Boy with Autism During Hospital Visit "I felt helpless," Lindler said to InsideEdition.com. Lindler is a firefighter himself, and while the entire family had escaped unharmed, he knew there was nothing he could do for the puppy until the fire department arrived. Ten minutes later, the fire department finally arrived to the scene. Lindler said he found little Jake in a corner after having crawled out from under the collapsed ceiling. The pup needed mouth-to-mouth for the smoke inhalation. He also had burns over 75 percent of his body, including his paws, and was given morphine for the first 6 weeks following the fire. "Most humans would have died in those conditions," Lindler said. Read: Principal is Living in a Motel After Students Allegedly Burned Down His Family Home Jake was brought to the vet, but his neighbors were not able to afford Jake's medical bills. The vet then deemed him abandonned, which is when Lindler decided he would step in. Lindler adopted the little pup, and began to nurse him back to health. Once Jake was off medication, Lindler began bringing him to the fire station during his shifts. "Everyone there fell in love with him," Lindler said to IE.com. After Jake's spontaneous visits to the fire department became more regular, the Chief of Halahan Fire Department decided it would be appropriate to officially welcome Jake as a member of the team. Jake was soon sworn in as an honorary member of the fire department, and a mascot of the team. He is also the first dog in the department to hold the title. Jake's body is still scarred from the fire, but Lindler said that it was indication that he would be a perfect fit: “Before they even made him a firefighter, that was his firefighter badge.” Read: Meet Jedi, the Dog That Saves Type-1 Diabetic Child Every Night When The Family Sleeps Firefighters at the department now bring their four-legged team member on fire prevention presentations at local schools. "He was burned and survived," Lindler said. "I think it gets them to understand the importance of fire safety better." In the future, the Halahan Fire Department plans to train Jake to be an accelerant detection dog, where he will learn to recognize certain scents that indicate whether an arson has occurred. Watch: Cops Say Teens Arrested For Shooting Puppy 18 Times With BB Gun, Charged With Animal Cruelty

apoptosis is of pivotal importance in the pathogenesis of sepsis . depending on the cell type involved and the time point of the disease process , apoptosis may be linked to either a good or a bad outcome . work presented in this issue by giamarellos - bourboulis and coworkers suggests that an early increase in the apoptosis of blood monocytes is associated with improved survival in patients with varying degrees of sepsis . although the mechanism by which monocyte apoptosis influences the outcome of sepsis can not be determined by this study , these observations represent an important advance in our understanding of this complicated disease process .

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apoptosis is a tightly regulated process by which cells orchestrate their own dismantling and disposal in an orderly and noninflammatory manner . apoptosis is critical for homeostasis , development and as highlighted by recent work from giamarellos - bourboulis and colleagues ( presented in this issue ) for regulation of inflammation and immune cell function . since its first description in 1972 there has been an explosion of literature on this topic . a pubmed search for ' apoptosis ' yields over 100,000 citations . a question when faced with such a number is coincidentally the same as that raised by giamarellos - bourboulis and colleagues ; when is enough apoptosis , enough ? sepsis and septic shock represent an over - exuberant host response to an infectious insult . neutrophils , monocytes and tissue macrophages play key roles in the initial reaction and release a variety of cytokines to marshal the immune response . once the threat is contained and/or the adaptive immune response is awakened , the innate immune cells are downregulated and must be disposed of in a timely and noninjurious manner because some of them are proverbial ' ticking time bombs ' . it has been suggested that dysregulated apoptosis may play a role in increasing the duration and/or severity of the systemic response to sepsis . clearly , monocytes and macrophages can contribute to inflammation simply by ' hanging around ' longer with the opportunity to release their cytotoxic products that damage host cells . additionally , there is evidence that phagocytosis of apoptotic cells leads to active elaboration of anti - inflammatory signals . thus , reduced apoptosis may contribute to inflammation in a number of ways , with the end result being that the host immune response contributes more to damaging the host than to protecting it . it is important to note that apoptosis of structural cells such as endothelium or epithelium in systemic inflammatory response syndrome is associated with disrupted organ function . furthermore , lymphocyte apoptosis is associated with a poor outcome in septic shock , presumably because these cells are important regulators of the immune response and coordinate the body 's response to infection . giamarellos - bourboulis and coworkers add to this literature and present evidence that early monocyte apoptosis confers a survival advantage in sepsis related to ventilator - associated pneumonia . their study group of patients was divided into those with low ( < 50% ) and high ( > 50% ) rates of monocyte apoptosis when tested on day 1 . forty - nine per cent ( 28 out of 57 ) of those with low apoptosis died versus only 15% ( 5 out of 33 ) of those with high degrees of monocyte apoptosis . this is a remarkable finding , and theirs is one of the first studies to correlate monocyte apoptosis with survival in sepsis . however , some questions arise from these observations . first , is monocyte apoptosis in the study simply a marker for another more proximate factor that is causally associated with mortality ? the authors note that there is a difference in the incidence of bacteraemia between the low and high apoptosis groups but they do not discuss any other parameters . although this group of 90 patients is as homogenous as one can except in a study of sepsis , there are differences between patients that could contribute to mortality . thus , demographic factors ( age , sex ) , illness severity ( acute physiology and chronic health evaluation ii score , sequential organ failure assessment score ) and other comorbid conditions ( trauma , diabetes , medications , etc . ) may be confounding variables if differences exist between the low and high apoptosis groups . second , percentage apoptosis changed over the 7 days during which blood was collected , and so those patients assigned to the low group may at times have had more than 50% apoptosis and vice versa . timing of apoptosis is sure to be important ( theoretically , too much too early may be associated with a poor outcome , as would too little too late ) . duration of illness before enrolment in this study may introduce enough variability to make timing difficult to determine . one possibility , mentioned by the authors , is a decreased release of proinflammatory cytokines by monocytes undergoing apoptosis . however , of the serum cytokines measured ( intereukin-6 , interleukin-8 and tumour necrosis factor- ) no correlation with survival was noted . this is a critical issue if we hope to modulate this process to the advantage of patients . finally , there are a variety of technical considerations in measuring apoptosis in peripheral blood monoctyes that introduce uncertainty into the measurement . the recovery of apoptotic monocytes may not be complete in a ficoll density gradient because cell density is altered by apoptosis . also , healthy monocytes may ingest apoptotic cells and through membrane transfer subsequently stain falsely positive for annexin v. ultimately , it may be the responses of monocytes that have already extravasated from the blood into the tissues that is most relevant to the outcome of sepsis , and this was not measured in the study . given these points , it is too soon to say with certainty that increased early monocyte apoptosis confers a survival advantage in the context of sepsis . however , the study by giamarellos - bourboulis and coworkers is an important first step in trying to make sense of a complicated and fundamentally important process . at the very least , this assay of monocyte apoptosis may conceivably be used as a prognostic tool , especially if it is combined with other factors in a multivariate model .

vitamin d deficiency is highly prevalent among critically ill patients and may be associated with adverse outcomes . failure of conventional vitamin d supplementation in correcting deficiency has called for studies to evaluate the efficacy and safety of a high - dose regime in critically ill patients . high - dose vitamin d supplementation that corrects a deficient state effectively and safely allows for intervention studies to be undertaken to determine the impact of vitamin d on morbidity and mortality in critically ill patients .

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vitamin d research has entered a renaissance in the past decade , with growing awareness of its pleiotropic actions beyond musculoskeletal health . vitamin d deficiency is now implicated in the pathogenesis of a wide range of conditions , including infection , vasculopathy , metabolic disorders and cancer , and the therapeutic potential of vitamin d is a topic of intense interest . in the current issue of critical care , amrein and colleagues report the efficacy and safety of a single dose of 540,000 units cholecalciferol ( vitamin d3 ) , given orally / enterally , to critically ill patients . vitamin d research in acute critical care is in its infancy , due to the traditional bias of vitamin d deficiency being a chronic condition . this belief has been over - turned by recent studies associating vitamin d deficiency with acute life - threatening hypocalcaemia , cardiac failure and increased mortality in critically ill patients . whether vitamin d replacement improves outcomes in critically ill patients is unknown . oral and enteral formulations may be ineffective due to malabsorptive processes arising from gastrointestinal oedema and inflammation . the intramuscular route is relatively contraindicated in patients with coagulopathy or in patients receiving anticoagulants . intravenous supplementation up to 500 units daily in parenteral feed , more than doubling the conventional regime , failed to correct deficiency . the failure to achieve vitamin d sufficiency in early studies has indicated the need for an alternative regime , but the efficacy of high - dose vitamin d supplementation in critically ill patients has only been reported recently . the definition of vitamin d sufficiency in the general population is a subject of ongoing debate . the proposed optimal vitamin d level ranges from 20 to > 32 ng / ml . while the optimal level in critical illness is yet to be defined , applying these cut - off points means a single dose of 540,000 units cholecalciferol , used in the current study , is capable of restoring vitamin d sufficiency in critically ill patients as early as within 24 hours of administration ( mean 25-hydroxyvitamin d ( 25(oh)d ) > 20 ng / ml ) and certainly by 1 week ( mean 25(oh)d > 38 these findings are similar to those reported by another recent study demonstrating efficacy of 120,000 units in divided doses . the increment of 25(oh)d in the current study ( ~22 ng / ml by day 3 ) stands in contrast to that reported in the general population . the mean rise in 25(oh)d 3 days after a similar single dose ( 300,000 to 600,000 units ) of cholecalciferol was two or three times higher ( 40 to 60 ng / ml ) in community - dwelling individuals . while baseline vitamin d status and obesity may determine response to vitamin d supplements , baseline 25(oh)d concentrations were not markedly different ( 13 to 15 ng / ml ) and the reported mean body mass index was < 30 kg / min these studies . these intriguing differences have shed light on the pathogenesis of vitamin d deficiency in critical illness . lesser increments in 25(oh)d concentration in critically ill patients , as observed in the current study , may relate to impairment in absorption , hydroxylation or vitamin d transport . another hypothesis is an increase in tissue vitamin d requirement during critical illness , resulting in heightened conversion of 25(oh)d to active this is supported by the more severe degree of secondary hyperparathyroidism at baseline and the surge in 1,25-di - hydroxyvitamin d concentration shortly after vitamin d replacement in the critically ill population . collectively these results suggest a higher replacement dosage may be required in critically ill patients compared to the general population , implying critically ill patients may be more deficient than the measured serum 25(oh)d concentrations indicate . future studies should evaluate changes in vitamin d metabolites , their binding proteins and the parathyroid axis following different dosing regimes , to determine how vitamin d metabolism , tissue requirement and renal handling of metabolites are affected during critical illness . if critically ill patients are profoundly deficient in vitamin d due to increased tissue requirement for this pleiotropic hormone for immune defence and metabolic regulation , does vitamin d treatment improve outcome ? this is reminiscent of the growth hormone story , with similar enthusiasm over the potential benefits of growth hormone in critical illness a decade ago , which ended in disappointment when studies showed that high - dose growth hormone treatment increased mortality . the current study revealed no occurrence of hypercalcaemia in any patients , as supported by similar safety data in the general population . a recent randomised controlled trial surprisingly revealed an increased risk of falls and fractures in community - dwelling women treated with a single dose of 500,000 units oral cholecalciferol , thus raising safety concerns surrounding high - dose supplementation , independent of hypercalcaemia . causes of this unexpected harm are unclear but could be related to stunning from the ultra high dose and protective upregulation of the enzyme 25-hydroxyvitamin d-24-hydroxylase , which catabolises 1,25-dihydroxyvitamin d , thus paradoxically reducing its tissue level . a more physiologic regime consisting of more frequent dosing of lesser amounts of vitamin d may be similarly effective and should be tested in critically ill patients . there is currently tantalising circumstantial evidence supporting a therapeutic role for vitamin d in critical illness . an effective vitamin d dosing regime will set the stage for undertaking intervention studies to investigate the impact of vitamin d supplementation on outcomes in critical illness . we wait eagerly for vitamin d to declare its true identity : is it a novel pleiotropic saviour , or another bystander in critical illness ?

– Kim Jong Un made his first public appearance today since the death of his father, paying his respects at the Pyongyang mausoleum where Kim Jong Il lies in state in a glass coffin, reports the New York Times. The younger Kim was accompanied by senior party and military officials, while mourners in the street praised him and the official state media touted his legitimacy—indicating that North Korea's transition of power so far appears to be on track. The United States appears divided over how much to push Pyongyang for reform at this delicate time, reports the Wall Street Journal. Some advocate pressuring the young leader now, as he is still consolidating power, while others believe foreign countries should back off and let North Korea stabilize, as a new generation of leaders might be more open to change. Kim Jong Il's official funeral will be held Dec. 28, but foreign delegations will not be invited. “There will be new leaders in North Korea. They will be younger,” said one intelligence expert. “US officials will need to consider what signals to send to North Korea and when and how best to do this, to maximize the chances for positive change in North Korea.”

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SEOUL, South Korea — Kim Jong-un , catapulted into prominence after Kim Jong-il ’s sudden death, paid respects at his father’s glass coffin on Tuesday, as the regime stepped up a campaign to portray the impoverished country as standing behind its young new leader. Kim Jong-un’s visit to the Kumsusan mausoleum, where the body was lying in state, was his first public appearance since his father’s death on Saturday pushed him to the forefront of the North Korean leadership, whose inner workings and power struggles remain a mystery to the outside world. Televised images and photographs from North Korea showing streams of weeping soldiers and citizens who filled plazas in Pyongyang to mourn the death of Kim Jong-il. Combined with an outpouring of effusive praise for the son, the official coverage of the mourning seemed to reflect a calculated propaganda message meant to depict a smooth transition. The son was inheriting not only the mantle of power but also a cult of personality from his father: the media began calling him “another leader sent from the heaven,” a description until now reserved for his father. The North announced the death on Monday. The outside world, caught off guard, scrambled to figure out where a regime with a food crisis and nuclear weapons would be headed under a young and inexperienced leader, whose command of loyalty among hard-line generals and Workers’ Party officials — all veterans of bloody power games — remains untested. “Comrade Kim paid his respect with a grief-stricken heart,” the North’s official news agency, K.C.N.A., said in a brief dispatch. The North’s state television showed Kim Jong-il’s body covered with a red blanket and his head on a white pillow. The coffin was surrounded by white chrysanthemums and Kimjongilia, a flower named after the deceased leader. Kim Jong-un was accompanied by a group of senior party and military officials, giving the outside world a hint of whom Mr. Kim was relying on during a critical transition. But the list included no new or unusual names. Paying a tribute and swearing to uphold the wishes of a dead ancestor is a crucially important political gesture for the son. The Kim family, starting with Mr. Kim’s grandfather, Kim Il-sung, the North’s founding president, has ruled the country for more than six decades. In a lengthy editorial, North Korea’s main party daily, Rodong Sinmun, legitimized the third-generation dynastic succession by calling Korea “the Kim Il-sung nation” and “the Kim Jong-il Korea.” It called Kim Jong-un “the spiritual pillar and the lighthouse of hope” for the military and the people. State radio said: “The respected comrade Kim Jong-un’s ideology equals General Kim Jong-il’s ideology and will.” Crowds of people, some wailing and some grim-faced, placed flowers at monuments around the Pyongyang, the North Korean capital, The Associated Press reported. Flags flew at half-staff and shops were closed. China and Russia, North Korea’s Cold War-era allies, quickly moved to indicate support for the new leadership of the government in Pyongyang. The United States and South Korea remained cautious but called for a peaceful and stable transition in North Korea. President Hu Jintao of China visited the North Korean Embassy in Beijing to express condolences. President Dmitri A. Medvedev of Russia sent a message of condolence to Kim Jong-un. “We offer our condolences to the North Korean people,” the South Korean government said in a statement. “We hope that North Korea will recover stability soon and South and North Korea can work together for peace and prosperity on the Korean peninsula.” Unification Minister Yu Woo-ik said that South Korea would not send a delegation to Mr. Kim’s funeral on Dec. 28. But he said the government would allow visits to the North by the families of the late President Kim Dae-jung, who held a landmark summit with Mr. Kim in 2000, and the former chairman of Hyundai, Chung Mong Hun, who had business ties with North Korea. Kim Jong-il died of a heart attack brought about by overwork and stress, according to the North’s media. Because of the age and inexperience of his son, who is believed to be in his late 20s, the world is watching how the transition will proceed. For policy makers in the region, the worst case scenario would be an unruly power struggle accompanied by a breakdown of command and control over the country’s nuclear weapons. But the transition also offers opportunities for Washington and the government in Seoul, said David Straub, deputy director of the Shorenstein Asia-Pacific Research Center at Stanford University. Kim Jong-un is the first North Korean leader who was educated at least partly in the West. He studied in Switzerland as a teenager. “There will be new leaders in North Korea. They will be younger,” he said. “U.S. officials will need to consider what signals to send to North Korea and when and how best to do this to maximize the chances for positive change in North Korea.” ||||| Dow Jones Reprints: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues, clients or customers, use the Order Reprints tool at the bottom of any article or visit www.djreprints.com U.S. officials aggressively lobbied China, Russia and Japan and suspended a food-aid plan for North Korea following the death of the country's leader, aiming to gain a diplomatic foothold as control over the authoritarian, nuclear-armed country appeared to pass to Kim Jong Il's untested young son. North Korea officially returned to its customary silence on Monday after announcing the death of its supreme leader early in the day, underscoring the world's anxiety over its trajectory under Kim Jong Eun, the former ruler's youngest son, whom state media says will now lead the isolated country. The U.S. doesn't have a clear ...

facial defects resulting from neoplasms , congenital malformations , or trauma can be restorated with facial prostheses using different materials and retention methods to achieve a lifelike look and function . for the successful result , a lot of factors as harmony , texture , color matching , and blending of tissue interface of prosthesis is important . this clinical report describes treatment using a silicone prosthesis with a mechanical - retentined design for a patient who received a partial rhinectomy . defects resulting from diseases as squamous cell carcinoma can be managed with the prosthetic rehabilitation so that the patient more comfortably and confidently resumed regular daily activity . mechanical retention alone was sufficient to retain the prosthesis ; thus , prosthetic adhesives were not necessary .

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squamous cell carcinoma ( scc ) is an aggressive malignant neoplasm.1 malignancies of the nasal septum are considered rare , and squamous cell carcinoma ( scc ) comprises about 66% of such lesions.2 the treatment of choice for scc depends on the location , size , and depth of penetration of the tumor . curettement and electrodesiccation are effective for small lesions that are not deeply invasive . for large neoplasms , the most commonly used treatment modalities are primary resection , radiation therapy , and mohs micrographic surgery.3 the prognosis for patients with this pathology depends on the size , infiltration and location of the lesion , presence or absence of metastatic spread , perineural invasion , rapid growth , history of previous treatment , to a certain degree the differentiation of the tumor , and etiologic factors such as burn scars , radiation , and chronic ulceration.2,4,5 facial defects secondary to the treatment of neoplasms , congenital malformations , and trauma result in multiple functional and psychosocial difficulties.6 surgical reconstruction techniques , prosthetic rehabilitation or a combination of both the methods to restore these facial disfigurements may improve the level of function and self - confidence for patients.6,7 the site , size , and etiology of the defect , patient s age , general medical condition and desire are used to determine the methods of reconstruction . prosthetic rehabilitation can be preferred due to probability of recurrence , complexity of the surgical reconstruction procedure , radiation therapy , and esthetic importance.8,9 biomaterials such as polymethyl methacrylate and silicone have been used for prosthetic rehabilitation for facial defects . important factors to consider when choosing silicone are biocompatibility , flexibility , translucency , color stability , and durability.10 advantages of silicones include a simplified fabrication process , optimal esthetics , light weight , and the ability to use soft flexible projections that can gently engage minor tissue undercuts to enhance retention and stability.11 retention of prosthesis in the midface region has been accomplished with anatomic undercuts , adhesives , eyeglasses and attachment to maxillary obturators,7 prosthetic connections to endosseous implants.10 when suitable conditions are provided , mechanical retention obtained by anatomic undercuts is the most advantageous . the advantages of this prosthesis are that the techniques is noninvasive , tissue tolerant , aesthetic , comfortable to use , and easy to fabricate and clean . additionally , these prosthesis are often preferred by the patients because the weight and the cost of such a prosthesis are low . the presence of moisture , mobile soft tissues , or lack of stable tissue support are affect the retention , these are disadvantages of anatomic retention.10,12 this clinical report describes the prosthetic rehabilitation of a patient with scc after a partial rhinectomy . a 77-year - old woman with a partial rhinectomy ( figure 1 ) had diagnosed with scc and undergone surgery due to the disease recurred two times . surgical reconstruction had not recommended at the time due to the need for continued observation and patient had not worn any prosthesis after the previous surgical resections . it was noted that the right and left side of the nose and part of the nasal septum were removed . the fabrication of a silicone nasal prosthesis was planned , and the expectation of this treatment was explained to the patient . the patient was draped in the usual manner and petrolatum jelly was applied to the patient s eyebrows and eyelashes . after moist gauze was packed to prevent the flow of material into the undesired areas of the defect , an impression was taken from the defect together with the adjacent tissue , using an irreversible hydrocolloid impression material ( kromopan , lascod spa , firenze , italy ) . the impression was removed and poured in type iii dental stone ( giladur , bk giulini gmbh , ludwigshafen , rh . ) . the prosthesis was sculpted with type i plate wax over the model , taking into account the patient s general appearance and previous photographs ( figure 2 ) . the flask was kept in boiling water for 5 minutes so that the wax was eliminated . prior to the patient s dismissal , the intrinsic coloration technique , which produces the most lifelike appearance of the prosthesis , was used to apply the various colors ( i-1998 extrinsic coloring kit , factor ii , inc . , lakeside , az , usa ) in multiple layers onto the textured surface of the mold.13 the platinum silicone elastomer ( a - rtv-30 v50011 a&b kit , factor ii , inc . ) mixed with intrinsic colors ( iintrinsic ii , factor ii inc . ) on a ceramic slab compared to the patient s skin color tone . the prosthesis was removed from the mold and rinsed with water to eliminate the residues ( figure 3 ) . finally , the prosthesis was evaluated on the patient and some extrinsic water - resistant coloration was applied ( kt-199 - extrinsic coloration system , factor ii , inc . ) nasal prosthesis must gain adhesive retention from a wide extension of the prosthesis beyond the defect , which may negatively influence the cosmetic result . mechanical retention by extension into the defect or through contact with eyeglass may augment adhesive retention.14 in this case , the retention was highest without eyeglass , but the esthetic appearance of the prosthesis was enhanced by using an eyeglass , the skin adhesive was not used ( figure 5 ) . the patient was scheduled for the first post - insertion adjustment one day after the insertion to ensure health of the tissues , to relieve the prosthesis for pressure areas on the tissues . follow - up evaluation was carried out once in 3 months recall for evaluation and observation of any recurrence .

we report the case of 3 brothers aged 34 , 24 , and 22 years , unmarried , who presented to our endocrinology clinic with absence of secondary sexual characters . there was no such history in other siblings , but their maternal uncle had similar complaints . on examination , all 3 had pre - pubertal appearance , voice , and genitalia along with anosmia and bimanual synkinesia . cryptorchidism was noticed in 2 while third person had small hypoplastic testes . it was also noted that all 3 patients had icthyosis mainly involving trunk , back , and limbs . the hormonal assays were consistent with isolated hypogonadotrophic hypogonadism . iq testing revealed mental retardation in the 2 patients . ultrasound showed ectopic right kidney in one patient , atrophic right kidney in the second patient while the third patient had normal kidneys . mri brain of all the patients showed poorly visualized olfactory tract and bulb . kallmann syndrome ( ks ) was diagnosed based on hormonal evaluation and mri results . of the four types of ks : synkinesia , renal anomaly , and x - linked pedigree pattern in our patients pointed towards x - linked type 1 ks as the possible cause . but , icthyosis and mental retardation are not usual presentation of type 1 ks . they are usually seen as a result of contiguous gene deletion of kal1 , steroid sulfatase ( sts ) , and mental retardation ( mrx ) gene on x chromosome . hence , the possible gene defect in our cases is inherited defect in contiguous gene deletion . the contiguous gene deletion as the cause of ks in 3 patients of same family is very rare and worth reporting . also , the significance of phenotype - genotypic association in kallmann syndrome is discussed

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the finding of hypoplasia or aplasia of olfactory bulbs demonstrated by mri also aid in diagnosing kallmann syndrome . a 34-year - old male unmarried male a presented to our endocrinology clinic with complaints of absence of secondary sexual characters . on probing , he also gave history of similar symptoms in 2 of his brothers having similar complaints . two of them ( b and c ) gave history of absent testes in scrotum while the third had small testes . they had 5 more brothers and 6 sisters , neither of whom had any such complaints . in b , c there was history of poor performance in school and delayed developmental milestones . there was history of similar complaints in maternal uncle who had died due to some unknown cause . on examination , all 3 had pre - pubertal appearance , voice , and genitalia along with anosmia and synkinesia of upper limb . testes were small and hypoplastic in a , while in b and c , they were not palpable in the scrotum or inguinal canal . it was also noted that all 3 patients had icthyosis mainly involving trunk , back , and limbs . hormonal assays revealed isolated hypogonadotrophic hypogonadism with normal thyroid function tests and basal cortisol level . growth hormone provocation test did not reveal any growth hormone deficiency . in b and c it also revealed atrophic right kidney in a , ectopic right kidney in c while c had normal kidneys . patient b had a 4 2 cm cyst in cerebellopontine angle , arachnoid cyst . all 3 were diagnosed as a case of kallmann syndrome and treated with testosterone injection to induce secondary sexual characters . kallmann syndrome is the most common cause of isolated hypogonadotrophic hypogonadism ( ihh ) accounting for 60% cases of ihh . kallmann syndrome has a prevalence of 1 in 7500 males and 1 in 50000 females . most cases are sporadic , but it can also be inherited as x - linked recessive , autosomal - dominant , or autosomal - recessive . the basic defect is in the hypothalamus due to defect in migration of gnrh secreting neurons from neuroepithelium of nasal placode . since olfactory neurons also arise from nasal placode , these patients have associated anosmia / hyposmia . few of them are identified , and defect in them are found to cause kallmann syndrome . five causal genes have been identified to date , namely , kal1 , fgfr1 ( fibroblast growth factor receptor-1 gene ) , prokr2 ( prokineticin receptor-2 gene ) , prok2 ( prokineticin-2 gene ) , and fgf8 ( fibroblast growth factor-8 gene ) . each genetic form shows clinical heterogenicity within families , indicating role of other factors than gene defect in expression . among them , the most common gene defect is kal1 gene present on x chromosome coding for anosmin-1 ( type 1 kallmann ) , which plays role in cell surface signaling and migration . this is usually the most severe form with the least variability in the same family . synkinesia is a unique feature present in up to 80% of x - linked cases , being almost exclusive to this type . unilateral renal aplasia or dysplasia is another feature present in around 30% patients . in our cases , all 3 had bimanual synkinesia , one patient ( a ) had renal aplasia while the other patient ( b ) had an ectopic right kidney . fgfr1/fgf8 gene defect is responsible for mostly sporadic autosomal - dominant type 2 kallmann syndrome , which has variable penetrance . both of these are usually autosomal - recessive but are known to present in homozygous , heterozygous , or heterohomozygous fashion . the chd7 ( chromodomain helicase dna binding protein 7 ) and nelf ( nasal embryonic lhrh factor ) genes are the other rare genes involved in kallmann syndrome . but , only 30 - 40% cases ( 10 - 20% kal1 , 10% fgfr1 , 5% prokr2 , 5% prok2 ) of kallmann syndrome can be explained by these known gene defects . all of our patients were male with , synkinesia , family history in maternal uncle and unilateral renal abnormality in 2 of our patients points towards x - linked - recessive inheritance . these patients had height <3 percentile in contrast to normal or tall stature seen in kallmann syndrome . apart from these , icthyosis was seen in all 3 patients and mental retardation in 2 patients ( iq 74 and 47 ) . combination of kallmann syndrome , icthyosis , and mental retardation are reported due to contiguous gene deletion of kal1 and steroid sulfatase ( sts ) gene and mental retardation ( mrx ) gene in x chromosome . the kal1 , sts , and mrx genes are situated on x chromosome in that order . hence , the presence of icthyosis and mental retardation in our cases points towards the contiguous gene deletions . there are few case reports of arachnoid cysts in kallmann syndrome , the importance of which is not yet clear . on treatment with testosterone depot preparation , all 3 of our patients we do not yet have any data on the fertility status , as all 3 are unmarried . these may guide us in pinpointing the possible genotype and search for other associated anomalies . also , contiguous gene deletion as the possible cause of kallmann syndrome in 3 members of a family is very rare and not reported in existing literature . although the clinical suspicion is strong , the confirmation of the genotype and gene deletion is possible only after gene analysis , which was not available to us .

– Looks like Aaron Hernandez's home surveillance system may have backfired on him. Photos have emerged showing the former football star carrying a gun shortly after the shooting of Odin Lloyd, prosecutors say. "Interior surveillance footage shows Aaron Hernandez pass through the living room area of the residence while holding an item, identified by investigators being consistent with a firearm," says an affidavit, per ABC News. The images exist despite Hernandez tampering with the 14-camera surveillance system, prosecutors say. Meanwhile, a clearer story of the night is emerging: Hernandez sent a text to Lloyd hours before he was killed that read: "I'm coming to grab that tonight. U gon b around I need dat and we could step for a little again." A gas station security camera shows Hernandez filling a silver sedan; that sedan was later caught pulling into the industrial park where the murder happened, an affidavit says. "This vehicle entered the crime scene at 3:23am on Monday, June 17, 2013." The timing "is consistent with the reports of employees at an adjacent business who heard gunshots." The home surveillance footage is from 10 minutes later, according to police. Police found a Hungarian rifle and 33-round magazine at Hernandez's home; the AK-47-like gun carried Hernandez's palm print, the Boston Herald reports. Lloyd was found with the keys to a vehicle Hernandez had rented. When police went to Hernandez's home to question him, he initially slammed the door; then he agreed to an interview at the police station.

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Surveillance images in newly released documents allege to show disgraced tight end Aaron Hernandez with a gun in his hand. Those surveillance images came from one of the 14 cameras at the former tight end's home, police say. A Hungarian rifle with a 33-round magazine was also seized from the North Attleboro home of the ex-Patriot by police who went back to his sprawling house searching for more clues in the murder case against the former NFL rising star, documents reveal. Part of the 104 pages of affidavits point to state troopers eyeing the .39 caliber rifle -- similar to an AK-47 semi-automatic assault rifle -- that had Hernandez's palm print still on it, police state. More pages relating to the weapon are redacted. Hernandez, 23, is accused of murdering his friend Odin L. Lloyd of Dorchester in the early morning hours of June 17. Autopsy results also contained in today's release state Lloyd, 27, was shot five times, including once in the back and twice in the chest. One of the shots to the chest, possibly the one that killed him, went through his heart, liver, lung and out his back, records state. Police also report going to a neighbor to ask if they knew where the ex-Patriot player was later on June 17 -- only to be told by the man answering the door that he was a Patriot coach and did not know where Hernandez was. Police state they went hunting for the disgraced tight end hours after Lloyd's body was found in an industrial park less than a mile from the former NFL player's North Attleboro mini-mansion. The newly released court documents state the coach said he had not seen Hernandez since June 13, and only at practice. Lloyd had a set of car keys in his pocket, police state, when his body was found. Those keys, records state, were for a black 2013 Chevy Suburban with Rhode Island plates that was listed as rented by Hernandez. Police said they found the Suburban at Lloyd's home in Dorchester. The affidavits also state Hernandez slammed the door on police later that same night, only to open the door up and said he'd talk, but down at the police station. His fiancee drove him down to the station as their child slept in the back of the car, records state. Hernandez is also being probed in connection with a double slaying in Boston's South End last July, Boston police have said. Developing ... ||||| Accused killer Aaron Hernandez was captured on his own home surveillance cameras holding a large caliber firearm in the minutes after his friend was shot dead, according to court documents released today. Prosecutors added that they found a spent .45 caliber shell casing in a car rented by the former New England Patriots star that matched the five bullets found in the body of murder victim Odin Lloyd. The documents were released by Massachusetts investigators today. "Interior surveillance footage shows Aaron Hernandez pass through the living room area of the residence while holding an item, identified by investigators being consistent with a firearm," according to a search warrant affidavit released by the Attleboro District Court today. "Aaron Hernandez is observed on the surveillance video moving the item believed to be a firearm between his hands as he passes through the living room,'' the affidavit stated. The photographs were taken inside his home and recovered from the 14 surveillance cameras Hernandez had throughout his $1.2 million mansion in North Attleboro, Mass. Hernandez, prosecutors said, had tampered with the cameras but investigators were able to retrieve photographs. The pictures helped police build a timeline allegedly leading to the murder of Lloyd, 27, a semi-pro football player whose body was found less than a mile from Hernandez's home. He was shot five times with a .45 caliber handgun. Hours before the June 16 slaying, Hernandez sent a text message to Lloyd that read: "I'm coming to grab that tonight. U gon b around I need dat and we could step for a little again." Hernandez's surveillance cameras showed him leaving his home at 1:12 a.m. with two other men, who police and prosecutors identified as Ernest Wallace, 41, and Carlos Ortiz, 27. Wallace has been charged in connection with Lloyd's murder and Ortiz was arrested on firearms charges. Hernandez and Wallace have denied the charges. It's not clear if Ortiz has entered a plea. At 2:09 a.m., a security camera at a Blue Hill Avenue gas station in Boston showed Hernandez purchasing a cigar and Bubble Yum Cotton Candy flavored gum after filling the tank of a silver sedan, according to court documents. Roughly 20 minutes later the men pick up Lloyd at his home, according to video recovered from Boston Police cameras. At 3:20 a.m., the silver sedan was captured driving into an industrial park, near the Hernandez home, where Lloyd was killed, according to a search warrant affidavit. "This vehicle entered the crime scene at 3:23 a.m. on Monday June 17, 2013," the affidavit states. "The time of this activity is consistent with the reports of employees at an adjacent business who heard gunshots." The surveillance photos of Hernandez back in his home and holding what appears to be a pistol were taken at 3:33 a.m., the police document states. Hernandez was arrested on murder and weapons charges June 26 and has been held in a solitary confinement cell at Bristol County Correctional Center in Dartmouth since. He was in court for a probable cause hearing Wednesday, but the hearing was delayed until Aug. 22. After that court appearance Hernandez's cousin, Tanya Singleton, was served with search warrants for her Bristol, Conn., home and her cell phone was seized, ABC News reported.

crohn 's disease ( cd ) can occur anywhere in the gastrointestinal tract from the mouth to the anus and sometimes it presents in a nonspecific manner . herein we describe a case of local peritonitis as the first manifestation of cd in an 11-year - old girl , and the subsequent method of treatment .

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crohn 's disease ( cd ) is a chronic condition characterized by an inflammatory process that extends across all tissue layers of the small intestine , and may appear in any section of the gastrointestinal tract . free or sealed perforation with local peritonitis is a rare complication of cd . the incidence of free perforation in cd has been reported to be 1 - 2% in western countries , manifesting either initially or eventually in the disease course . herein we describe a case of suspected acute appendicitis but with the operative finding of local peritonitis as the first manifestation of cd , and the subsequent method of treatment . an 11-year - old girl presented to our hospital with abdominal pain and vomiting lasting 3 days . she had a white cell count of 15,000 k / ml ( neutrophils , 86.2% ; lymphocytes , 5.9% ) and an erythrocyte sedimentation rate of 25 mm ; all other hematological findings were within normal limits . an abdominal ultrasound investigation of the patient revealed the presence of free fluid in the right iliac fossa and an inflamed appendix . the preoperative diagnosis was acute appendicitis , and the child was immediately prepared for surgery . at the operation , pus was found in the right abdominal cavity and the appendix appeared to be swollen , thickened , and covered by inflamed omentum . an appendicectomy was performed and a drain was placed in the douglas space following irrigation of the abdominal cavity . on the 7 postoperative day , the patient developed fever ( 39c ) and wound infection despite administration of antibiotics . nevertheless , on the 11 postoperative day the patient again developed pyrexia ( 40c ) and enteric discharge from the wound . computed tomography ( ct ) of the abdomen revealed a pericecal collection , two enterocutaneous fistulae , and two strictures in the ileum , suggesting cd [ figure 1a and b ] . a colonoscopy was also performed along with biopsy of the terminal ileum [ figure 2 ] . the patient was managed with total parenteral nutrition , antibiotics , and corticosteroids . despite this conservative treatment , a mass measuring 5 4 cm containing the cecum , terminal ileum , and part of the omentum were noted ; probably resulting from postinfectional adhesions . a right limited hemicolectomy including the fistulae and strictures was performed using a stapler , with anastomosis of the macroscopically appearing healthy bowel of the ascending colon and ileum . histological investigation of the resected specimen confirmed the presence of cd in the terminal ileum . the child was followed - up for 1 year and remained asymptomatic thereafter , receiving long - term azathioprine to keep the disease inactive . computed tomography ( ct ) scan of the abdomen showing with white arrows the two enterocutaneous fistulae ( a ) and stricture in the ileum ( b ) colonoscopy showing edematous , reddish ileocecal valve with erosions the associated inflammatory process in the intestine is a full - thickness injury that can lead to significant complications such as fistulae , abscesses , and phlegmons from microperforation of the intestine . free perforation is unusual in cd , except in areas of longstanding active cd with obstruction , where increased luminal pressure resulting from the obstruction readily leads to perforation . cd diagnosis is based on a combination of clinical manifestations and radiological findings and can be confirmed only after histopathology . uncommon initial presentations of cd may be revealed by a single symptom or sign such as mouth ulcers , eating disorders , pathological fractures , gastropathy , and perianal disease . although the intraoperative findings in our patient with ileocecal cd suggested inflammation of the appendix with local peritonitis , the histological investigation confirmed only periappendicular inflammation without involvement of the appendix . the periappendicular inflammation and the pus were probably due to extension of the inflammatory process from the microperforation of the terminal ileum . an english - language review revealed only two clinical reports of spontaneous free perforation of the small intestine in cd . those reports did not make clear whether the perforation was the initial symptom of cd in the patients . the surgical management of cd has changed considerably during the past decade as a result of developments in medical therapy . surgical interventions are employed in children only after acute complications such as strictures , perforations , abscesses , fistulae , or severe perianal disease . medical intervention and surgery have traditionally been regarded as complementary treatments for cd , because despite improvements in medical treatments most patients ( 70 - 90% ) with cd will eventually require surgical intervention . however , there are some unfavorable factors that preclude fistula closure , including poor nutritional status , presence of sepsis , and active cd . a patient should be prepared for surgery when a fistula does not close within the expected time frame ( i.e. , within 4 - 5 weeks ) . long - term studies have demonstrated that there is a 50% chance that the patient will never require further related surgery following resection of the ileocecal segment . periodic surveillance visits with radiological and endoscopic examination of the small intestine and colon for a period of at least 3 years is recommended by most authors to allow prompt detection of any recurrence . free or sealed perforation of the bowel is an uncommon event in the natural history of cd in children , and occurs mainly in the course of the disease ; it is only rarely an initial presentation . although it is an uncommon occurrence , perforation of the bowel with local peritonitis should be included in the differential diagnosis of cd , even in young patients .

– A climber who abandoned a Polish team following a dispute with fellow mountaineers to attempt a solo ascent of K2, the world's second-highest peak, returned to base camp on Monday because of bad weather, reports the AP. The news dispelled concerns expressed by the other climbers after Denis Urubko walked away from the team on Sunday to attempt a summit on his own—something that Pakistani climber Mirza Ali Baig tells the BBC is "completely suicidal." Urubko, a Russian-Polish national, had reportedly argued with team members. He left base camp on Sunday without informing the expedition management, and an expedition spokesman later tweeted they had no radio communication with him. Asghar Ali Porik, chief of Jasmine Tours, which organized logistics for the Polish K2 expedition, said Urubko returned to base camp 2, located at an altitude of 21,982 feet. "He is known as the 'Himalayan expert' among the mountaineering community ... but his decision is not correct and does not suit someone of his stature," mountaineering pal Karim Shah says. Urubko was part of last month's mission, along with Adam Bielecki, that rescued French mountain climber Elisabeth Revol from Nanga Parbat, another Himalayan peak in Pakistan. Her climbing partner was injured and is presumed to have died during that summit. Ashraf Aman, the first Pakistani who climbed K2 in 1977, spoke highly of Urubko's skills and rescue of Revol. "He is the star of this era of mountaineering ... he has done the Broad Peak (another Himalayan summit) as a solo climber in 36 hours and just recently rescued (Revol) by climbing without a rope in the night," Aman said. Per Porik, Urubko will wait at base camp for the weather to improve and ascend the summit with the other team members.

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ISLAMABAD (AP) — A climber who abandoned a Polish team following a dispute with fellow mountaineers to attempt a solo ascent of K2, the world's second-highest peak, returned to base camp because of bad weather, a tour operator said Monday. The news dispelled concerns expressed by the other climbers after Denis Urubko walked away from the team on Sunday to attempt a summit on his own — something that Karrar Haidri of the Alpine Club of Pakistan said was a highly risky feat in winter weather. Urubko, a Russian-Polish national, had reportedly argued with team members. He left base camp on Sunday without informing the expedition management and expedition spokesman Michal Leksinski later tweeted they had no radio communication with him. Asghar Ali Porik, chief of Jasmine tours which organized logistics for the Polish K2 expedition, said Urubko returned to base camp 2, located at an altitude of 6,700 meters (21,982 feet). High wind and extremely rough weather, combined with an icy track forced Urubko to descend to base camp and rejoin the other expedition members, said Porik. Urubko was part of last month's mission, along with Adam Bielecki, that rescued French mountain climber Elisabeth Revol from Nanga Parbat, another Himalayan peak in Pakistan. Her Polish climbing partner, Tomasz "Tomek" Mackiewicz, was injured and is presumed to have died during that summit. According to Porik, the tour operator, Urubko will now wait at the base camp for the weather to improve and will ascend the summit with the other team members. Ashraf Aman, the first Pakistani who climbed K2 in 1977, spoke highly of Urubko's skills and rescue of Revol. "He is the star of this era of mountaineering ... he has done the 'broad peak' (another Himalayan summit) as a solo climber in 36 hours and just recently rescued (Revol) by climbing without a rope in the night," Aman said. ||||| Image copyright AFP/ALPINE CLUB OF PAKISTAN Image caption Fellow climbers branded Denis Urubko's decision "completely suicidal" Mountaineer Denis Urubko has quit a dangerous bid to make the first solo winter ascent of K2, the world's second-highest mountain, a spokesman for his Polish expedition says. Mr Urubko decided on Sunday to set out alone after a row with the expedition. He is said to have wanted to make the ascent before the arrival of better weather conditions in March. Amid concern over his safety, the expedition spokesman said Mr Urubko was now heading down the peak to a base. Michal Leksinski told the BBC that he expected Mr Urubko to reach base camp by Tuesday morning at the latest. The Russian-Polish mountaineer is likely to have spent a night at 7,200m (23,600ft) and decided to turn back after experiencing the severe weather conditions, Mr Leksinski added. He said other climbers on the mountain had seen Mr Urubko descending and reported it to base camp. It is thought he wanted to reach the top of the mountain this month so his effort would definitely count as a winter climb. Why did they fall out? Mr Urubko reportedly left for the summit without a radio, after refusing to discuss his plans. "He was trying to persuade the team to push for the summit in February," a porter with the group told AFP news agency. "He has had a heated debate with the team leader and left for the summit without saying a word." How dangerous would a solo bid be? Professional mountaineers expressed dismay at the climber's decision. "A solo attempt of K2 in winter is completely suicidal," said Pakistani climber Mirza Ali Baig. Image copyright Getty Images Image caption K2's nickname is The Savage Mountain because it is so difficult to climb Alan Arnette, a US climber who did make it to the summit of K2, told the BBC: "It's a huge risk. You have to cross a traverse underneath a 30-storey ice serac, a hanging serac of a wall of ice that let loose in 2008 and killed 11 climbers that year." Karim Shah, a mountaineering friend of Mr Urubko, agreed the move was "very risky". "He is known as the 'Himalayan expert' among the mountaineering community. But his decision is not correct and does not suit someone of his stature," he said. How good is Denis Urubko? He is said to be a highly capable mountaineer who has conquered all of the world's 14 peaks over 8,000m. Media playback is unsupported on your device Media caption Elisabeth Revol describes her rescue from Nanga Parbat Mr Urubko made headlines just last month by saving a stricken French climber, Elisabeth Revol. He and three other team members were flown by helicopter from K2 to the 8,126m Nanga Parbat in Pakistan - nicknamed Killer Mountain - where they performed an audacious night-time rescue. K2 stands at 8,611m and is the only peak above 8,000m never climbed in winter. Image copyright Reuters Image caption A spokesman for the expedition said its members would continue to support Mr Urubko It has a higher fatality-to-summit rate than Everest, and is known as the Savage Mountain due to its fiendish conditions. Avalanches are an ever-present risk, and in winter temperatures can fall to -50C (-58F), accompanied by winds of up to 200km/h (124mph). On 1 August 2008, 11 climbers from international expeditions were killed or simply vanished on K2 - in what was one of the deadliest days in mountaineering history. You might also be interested in Why China is censoring Winnie the Pooh again The snooker queen on top of the world Lift peeing video ignites fury in China

objective to determine , in an adult population with type 1 diabetes , barriers to regular physical activity using a diabetes - specific barriers measure ( the barriers to physical activity in diabetes [ type 1 ] [ bapad1 ] scale ) and factors associated with these barriers.research design and methods one hundred adults with type 1 diabetes answered a questionnaire assessing perceived barriers to physical activity and related factors . a1c was obtained from the medical chart of each individual.resultsfear of hypoglycemia was identified as being the strongest barrier to physical activity . greater knowledge about insulin pharmacokinetics and using appropriate approaches to minimize exercise - induced hypoglycemia were factors associated with fewer perceived barriers . greater barriers were positively correlated with a1c levels ( r = 0.203 ; p = 0.042 ) and negatively with well - being ( r = 0.45 ; p < 0.001).conclusions fear of hypoglycemia is the strongest barrier to regular physical activity in adults with type 1 diabetes , who should therefore be informed and supported in hypoglycemia management .

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a 44-item questionnaire was answered by 103 type 1 diabetic patients when attending their regular appointment at the university of montreal hospital center or the montreal institute of clinical research outpatient clinics . for the bapad1 scale , participants rated 12 barriers to physical activity on a scale from 1 to 7 ( whether the item would keep them from engaging in regular physical activity over the next 6 months : 1 , extremely unlikely , and 7 , extremely likely ) . in addition , social support for physical activity was assessed by three questions adapted from the questionnaire by sallis et al . ( 7 ) ; participants indicated on a scale from 1 ( never ) to 5 ( very often ) how often family or friends encouraged them to do physical activity , proposed to do physical activity with them , or did physical activity with them . patients were asked to report the number of hypoglycemic episodes in the previous 2 weeks and the number of severe hypoglycemic episodes in the last year . for management of exercise - induced hypoglycemia , patients were asked what actions they took to prevent such episodes ( insulin dose reduction and/or snacks for exercise or at bedtime ) . knowledge of insulin pharmacokinetics was assessed by asking patients to state the time of onset and peak action of their insulin prescription ( correct / incorrect ) . the world health organization-5 well - being index , a validated scale of five questions developed to assess quality of life , was included in the questionnaire ( 8) . the most recent value ( within 3 months ) of a1c pearson 's correlations and student 's t tests for independent sample were performed to determine the relation between various factors and perceived barriers . internal consistency reliability ( cronbach 's -coefficient ) for the bapad1 scale , social support measure , and the world health the final sample consisted of 100 adults with type 1 diabetes ( 50% women ) . mean sd age was 43.5 11.6 years , duration of diabetes 23.3 13.2 years , and bmi 25.9 4.9 kg / m . glucose control was suboptimal with a mean a1c of 7.7 1.1% and a mean number of hypoglycemic episodes in the previous 2 weeks of 7.47 7.25 ; 25% of the participants experienced severe hypoglycemia in the previous year . one - third of the cohort had a low income ( 20,000 usd per year ) and/or a low level of education ( secondary education or less ) , while one - fifth reported active smoking . the highest barrier scores were fear of hypoglycemia ( 3.58 2.02 ) , work schedule ( 3.05 1.98 ) , loss of control over diabetes ( 2.83 1.80 ) , and low levels of fitness ( 2.83 1.95 ) . perceived well - being , knowledge of insulin pharmacokinetics , implementation of strategies to reduce the probability of exercise - induced hypoglycemia , and greater social support were associated with fewer barriers . moreover , having someone with whom to perform physical activity was also associated with fewer barriers ( r = 0.36 ; p < 0.001 ) . glycemic control , as assessed by a1c , was positively correlated with bapad1 total score . the frequency of mild or severe hypoglycemia was not associated with the level of perceived barriers . as fear of hypoglycemia was the strongest barrier , we investigated factors associated with this specific item of the bapad1 scale . the number of severe hypoglycemic episodes in the previous year was significantly associated ( r = 0.26 ; p = 0.009 ) with fear of hypoglycemia . the number of strategies used to prevent hypoglycemic episodes related to physical activity was not associated with perceived fear of hypoglycemia , but some subitems , such as eating an evening snack after physical activity to prevent nocturnal hypoglycemia , were associated with less fear of hypoglycemia ( t = 3.00 ; p = 0.007 ) . knowledge of insulin pharmacokinetics , demonstrated by only 52% of participants , was also associated with less fear of hypoglycemia ( t = 2.34 ; p = 0.021 ) . the four main barriers to physical activity identified among type 1 diabetic patients attending university hospital outpatient clinics were fear of hypoglycemia , work schedule , loss of control over diabetes , and low fitness level . factors associated with barriers to physical activity included basic knowledge about insulin pharmacokinetics and implementation of strategies to prevent hypoglycemia . half of the participants were not knowledgeable about these fundamental elements , suggesting that there is a major gap in information and support required by individuals with type 1 diabetes in this field . thus , programs intended to increase physical activity in adults with type 1 diabetes should incorporate diabetes - specific actions to prevent hypoglycemia . furthermore , the striking inverse relationship between social support , a powerful motivator to help initiate and then maintain a physically active lifestyle ( 9 ) , and perceived barriers suggests that this factor should also be considered in programs to enhance physical activity participation . finally , we found that individuals with greater perceived barriers to physical activity had poorer glycemic control as measured by a1c . the association between a1c and barriers suggests that the bapad1 scale probably captures general aspects related to type 1 diabetes care . it is possible that patients able to manage barriers for physical exercise are also the ones able to cope with other problems . with regard to limitations , our study design does not allow us to establish the causal direction of the associations found ; further research is needed using a prospective controlled design .

– The "stolen babies" mystery uncovered by the touching reunion of Zella Jackson Price and her long-lost daughter keeps getting murkier. Price says she was told by a nurse at Homer G. Phillips Hospital in St. Louis that her daughter died soon after birth in 1965, but adoption records cited in a letter obtained by the AP contradict key parts of her account, stating that the baby girl was born at a different hospital—and Price abandoned her. Her lawyer, Albert Watkins, says the "glaring inconsistencies" in the record suggest that there has been a cover-up and add evidence to the theory that the hospital stole and sold Price's baby. He tells the St. Louis Post-Dispatch that the letter lists City Hospital No. 1, which mainly dealt with white patients, and Price has told him that she wouldn't even drive into that part of town during the segregated mid-1960s. Price says the letter contains many other mistakes, including her age and information about what it calls the "putative biological father." As for the claim she abandoned the girl: "That's the biggest lie ever told," Price tells the AP. "I have five other children. They're all spoiled like they were only children. Why would I give up this one?" Watkins, who suspects the records may have been falsified as part of a scheme to steal Price's baby and possibly many more, is trying to obtain more records, although state privacy laws about adoptions are proving to be an obstacle, the Post-Dispatch reports. And he's not the only one seeking information: A city health department spokesman tells the AP that 282 women have requested medical records since St. Louis police began their investigation. (More on the case here.)

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Some mothers whose babies were born at Homer G. Phillips Hospital in the mid-20th century undoubtedly were disappointed with the answer they got on Friday about what happened to their children. U.S. Attorney Richard Callahan released medical records ending the hopes of those mothers that they may have living children who were taken from them at birth in an alleged baby-theft ring and declared dead by the hospital. ||||| FILE - In this April 29, 2015 file photo, Zella Jackson Price poses for a photo at her attorney’s office in Clayton, Mo. Price claims that her baby was stolen at Homer G. Phillips Hospital in 1965 after... (Associated Press) FILE - In this April 29, 2015 file photo, Zella Jackson Price poses for a photo at her attorney’s office in Clayton, Mo. Price claims that her baby was stolen at Homer G. Phillips Hospital in 1965 after... (Associated Press) ST. LOUIS (AP) — Missouri adoption records contradict a St. Louis woman's claim that her baby was stolen at Homer G. Phillips Hospital in 1965 after she was told the newborn had died. The Associated Press obtained a letter dated May 21 from the juvenile division of family court in St. Louis, citing records stating that the biological mother abandoned the baby. The letter does not mention the biological mother's name, but Zella Jackson Price and her attorney say DNA tests confirmed she is the birth mother. Among other discrepancies, it said the child was born at a different St. Louis hospital, not Homer G. Phillips. Price on Wednesday said the letter is rife with inaccuracies, including her age, details about the biological father, the hospital where she gave birth and the notion that she abandoned the child. The letter states that the court "is unable to ensure the validity of the information contained in your file," but did not elaborate. "That's the biggest lie ever told," Price, 76, said of the claim that she abandoned the baby. "I have five other children. They're all spoiled like they were only children. Why would I give up this one?" Price's attorney, Albert Watkins, said information in the adoption file may have been falsified as part of a cover-up. He believes that Price's daughter, and perhaps other supposedly dead babies at Homer G. Phillips Hospital, were stolen and sold for illegal adoptions. Asked for proof, Watkins said Price's story has remained consistent, that relatives have corroborated Price's story that she gave birth at Homer G. Phillips in 1965 but never brought home a baby, and that Price did not abandon or give up her other children. "This is a woman who culturally and in terms of her own family would never give up a child," Watkins said. Price gave birth to a premature girl on Nov. 25, 1965. She said a nurse told her hours later that her daughter had died, but she was not allowed to see the deceased infant and never received a death certificate, although she said she made requests to both the city and the state. Price said the St. Louis vital statistics office told her they couldn't find a death certificate; the state health department never responded, she said. Earlier this year, Price received a Facebook message from Mehiska Jackson, the daughter of Diane Gilmore of Springfield, Oregon. Gilmore's children were searching for her birth mother. Price agreed to DNA testing that proved with near 100-percent certainty that Gilmore was her daughter. The two reunited in April. The reunion drew international media attention. Scores of other women came forward to question whether their own infants, born from the 1940s through the 1970s, had really died soon after birth at Homer G. Phillips, a hospital that served predominantly black patients until it closed in 1979. St. Louis police launched an investigation and the city health department set up a number for women seeking medical records. Health Department spokesman Harold Bailey said the office has received 282 inquiries. To find out what happened to her as a child, Gilmore requested her adoption records. Adoption specialist Jesse Cannon responded with the May 21 letter, which contradicts key elements of Price's story. Cannon declined an interview request with the AP, citing privacy laws concerning adoption records. The letter says the child was born at City Hospital No. 1, then later abandoned and put up for adoption. City Hospital No. 1 has since closed. Gilmore's adoption birth certificate does not list the hospital of her birth. The letter said Gilmore's case came to the court's attention on April 6, 1966, when a petition was filed alleging "the mother left this infant at City Hospital #1 and failed to ever return for it." Custody was granted to Children's Services of St. Louis on June 6, 1966, Cannon wrote. Gilmore, who is deaf, was raised by adoptive parents but not formally adopted until Dec. 16, 1983. The letter offers no explanation as to why it took so long to finalize. The court did not release the entire adoption file, citing the need for permission from the biological father. The letter said the father was reportedly a 29-year-old unemployed truck driver, whom Price said fits the description of her ex-husband, Theon Jackson, who had a child born at City Hospital No. 1 with another woman the same year Gilmore was born. Price said Jackson is not Gilmore's father and that Gilmore was conceived with the man she married after Jackson. That man has since died. Theon Jackson has since signed a consent form for Gilmore's adoption records to be released, Watkins said. Price also has requested medical records she says could prove she gave birth at Homer G. Phillips but has yet to receive them. ___ Mohr reported from Jackson, Mississippi.

spontaneous umbilical endometriosis is a rare extrapelvic manifestation of endometriosis . very few such cases have been previously reported , almost always associated with a variety of symptoms , usually during menstruation . we present a case of asymptomatic umbilical endometriosis treated with skin - sparing excision . differential diagnoses relevant to the clinician , as well as treatment options , are also presented . surgeons should always consider umbilical endometriosis in their diagnostic approach when confronted with atypical umbilical nodules , regardless of whether they are symptomatic or not .

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umbilical endometriosis , or villar 's nodule , is a rare , extrapelvic manifestation of endometriosis [ 1 , 2 ] . existing literature on this disorder reports a wide variety of symptoms associated with the umbilical lesions , ranging from mild to severe , usually cyclically synchronized with menstruation [ 17 ] . we present a case of completely asymptomatic umbilical endometriosis , adjacent to a previous peri - umbilical piercing site , which was treated by skin - sparing excision with a good postoperative result a 39-year - old female patient ( para 1 ) was referred to the plastic surgery service from the department of dermatology with a nodular lesion arising from her umbilicus ( fig . 1 ) . the lesion had been present for 18 months and had remained static in size for 1 year prior to presentation . it had remained asymptomatic throughout , with no episodes of bleeding , discharge or cyclical changes during menstruation . there was no history of previous trauma to the umbilicus with the exception of a long - standing peri - umbilical piercing . the patient had previously had excision of a benign ovarian cyst during caesarean section 10 years prior to presentation , but no other abdominal surgeries , in particular , no laparoscopic procedures with umbilical cannulation . clinical examination revealed a firm polypoid lesion arising from the central umbilicus with a normal skin envelope . the lesion was in close proximity to the previous piercing but appeared to arise separately from it . ultrasound scan of the lesion revealed a superficial soft tissue nodule , measuring 15 12 12 mm , with an identifiable posterior wall and no evidence of deep connections . the resultant central umbilical soft tissue defect was reconstructed with a local flap fashioned from the skin - sparing excision . a good postoperative cosmetic outcome was achieved with no evidence of clinical recurrence 2 months after surgery ( fig . 2 ) . histology of the lesion revealed the presence of ectopic endometrial glands and stroma ; hence , a diagnosis of umbilical endometriosis was made . she has since been referred to the department of obstetrics and gynaecology for further assessment . endometriosis is a common disorder , defined as the extrauterine presence of endometrial glands and stroma . it is a common , oestrogen - dependent condition , affecting 510% of women in the reproductive age . endometriosis is associated with a wide range of symptoms , most commonly pelvic pain , dysmenorrhoea , dyspareunia and subfertility / infertility [ 5 , 8 ] . multiple hypotheses have been proposed for its aetiology , but its pathogenesis still remains unclear . implantation of endometrial cells through retrograde menstruation , haematogenous or lymphatic dissemination of endometrial cells and the ectopic differentiation of pluripotent peritoneal progenitor cells to endometrial tissue ( coelomic metaplasia ) are amongst the most dominant theories of the pathogenesis of primary endometriosis [ 6 , 8 ] . secondary endometriosis as a result of the iatrogenic implantation of endometrial cells during surgery , especially cell seeding during laparoscopic port cannulation , has also been hypothesized [ 1 , 7 ] . endometriosis most commonly affects the pelvic cavity , but extrapelvic endometrial deposits affecting distant sites have also been widely reported . umbilical endometriosis , also known as villar 's nodule , is a rare extrapelvic manifestation of endometriosis , representing 0.51% of ectopic endometrial deposits [ 4 , 7 ] . few cases have been reported in literature , all associated with varying symptoms , most commonly size fluctuations during the menstrual cycle and discharge from the lesions . the presence of concurrent abdominal masses or previous history of endometriosis was also common in most cases , with imaging of the lesions , in almost all reported cases , showing intraperitoneal extension [ 14 , 6 , 7 ] . extremely rare conditions such as recurrent catamenial pneumothorax have also been described . in our case , the patient was a fit and healthy woman in her reproductive age with no previous symptoms or cyclical pain during menstruation . the presence of a previous peri - umbilical piercing further confounded the differential diagnosis , by adding keloid scarring or dermatofibroma to the list of possible pathologies . ultrasound scan excluded intra - abdominal extension , though ct or mri scanning would arguably have been more sensitive alternatives . other disorders that need to be considered in the differential diagnosis of an umbilical nodule include malignancies ( melanoma , sarcoma , adenocarcinoma , metastatic visceral carcinoma sister mary joseph nodule ) , inflammatory processes ( abscess , omphalitis , folliculitis ) , other benign lesions ( urachal anomalies , pyogenic granuloma , lipoma , haemangioma , inclusion cyst ) and umbilical hernia [ 6 , 7 ] . in terms of possible explanations of the pathogenesis of this extrapelvic deposit , the haematogenous or lymphatic dissemination of endometrial cells appears more likely than retrograde menstruation or coelomic metaplasia in this case . skin - sparing excision with local flap closure gave the patient a good postoperative outcome ; however , in the event of recurrence , other surgical and/or medical modalities might need to be considered , such as complete resection of the umbilical stalk with or without surgical management of any pelvic / intra - abdominal disease and adjuvant hormonal therapies . surgeons should include endometriosis in their differential diagnosis in cases of atypical umbilical lesions and should bear in mind that cyclical symptoms are common but not always present . simple skin - sparing excision and local flap reconstruction , when planned carefully , can give an aesthetically pleasing outcome , but contingency plans need to be in place in the event of recurrence .

cardiac hemangioma is a rare tumor with a reported incidence of 1 - 2% . we describe the case of a neonate with a right atrial mass that was diagnosed prenatally . the fetus developed a supraventricular tachycardia and was delivered by cesarean section in the 35th week of gestation . the infant underwent surgery after 24 hours to remove the mass which was diagnosed as a cardiac capillary - cavernous hemangioma .

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the prevalence of cardiac tumors has been reported to be 0.05% in an autopsy study of infants only.1 cardiac hemangioma in infancy is extremely rare and resection of these tumors after prenatal diagnosis has been rarely reported.2 there have been approximately 40 reported cases of primary cardiac hemangiomas in current cardiac literature.3 mcallister reviewed 533 primary tumors and cysts of the heart and pericardium of which 15 ( 2.8% ) were hemangiomas.4 we report the case of a 1-day - old infant who had a right atrial tumor diagnosed on prenatal ultrasound , that was excised on the second day of life . recently a pericardial effusion had been detected on screening prenatal ultrasound and this had led to a fetal echo , which showed a large right atrial mass and moderate sized pericardial effusion . the tumor was based predominantly on the free wall of the right atrium and showed dramatic growth between the 29 and 31 week of gestation , with an increase in size from 12 by 13 mm to 19.5 by 18.8 mm ( fig . this rapid phase of growth then plateaued with the tumor reaching 23.5 mm by 24.9 mm in diameter by the 34 week ( fig . 1b ) . the echocardiographic appearance of the tumor was complex with multiple cystic spaces and initially was thought to be a teratoma . ( a ) prenatal echocardiogram at 31 week showing a right atrial non - homogenous non - mobile mass approximately 19.5x18.8 mm . ( b ) prenatal echocardiogram at 34 week showing the right atrial mass approximately 23.5x24.9 mm and moderate sized pericardial effusion . ( la= left atrium , lv= left ventricle , pe= pericardial effusion , rv = right ventricle ) . during the 35 week of gestation , the fetus developed a supraventricular tachycardia with a heart rate of approximately 188 beats per minute in association with mild tricuspid regurgitation and an increase in the size of the pericardial effusion . due to concern over possible cardiac tamponade from the effusion the mother underwent a cesarean section . echocardiography confirmed the presence of a large right atrial tumor and a nonrestrictive patent foramen ovale . the patient was maintained on a prostaglandin infusion post - natally to ensure ductal patency as there was exclusive right to left shunting across the patent foramen ovale and moderate tricuspid regurgitation . at 24 hours of life cardiopulmonary bypass was instituted with bicaval cannulation and the aortic cross clamp was applied with cold antegrade cardioplegia being delivered via the aortic root . a right atriotomy was made and the tumor was noted to be densely adherent to the free wall of the right atrium ( fig . 2a & 2b ) extending down toward the ivc and then curving back upwards onto the underside of the av groove . there was a small secondary tumor mass just superior and medial to the orifice of the coronary sinus , close to where the av node would be anticipated and this area was not excised completely , as resection would likely have injured the av node . a second site of tumor was left at the junction of the right atrium and ventricle where it was very close to the overlying right coronary artery . an intra - operative transesophageal echocardiogram revealed reasonable ventricular function with no evidence of shunts at either the atrial or ventricular levels and without evidence of injury to the tricuspid valve . operative view ( a ) tumor ( t ) adherent to free wall of right atrium . the infant returned to the pediatric intensive care unit and did well , being discharged at 2 weeks after surgery . histopathological exam revealed a vascular lesion , composed of a mixture of small , slit like vessels and solid areas ( fig . 3b ) . there was no evidence of significant atypia and mitotic activity was moderate . ( a ) h&e stain showing vascular channels with myxoid stroma in between ( original magnification 100 ) ( b ) ulex stains the blood vessels demonstrating the vascular nature of the lesion ( original magnification 100 ) a diagnosis of cardiac capillary - cavernous hemangioma was made . the child is now 24 months of age and an echocardiogram in june 2005 showed residual 6 by 7 mm oval tumor near the area of the coronary sinus that has remained unchanged from previous post operative echocardiograms . a holter monitor showed sinus rhythm with a single premature ventricular contraction over 24 hours . cardiac hemangiomas consist of closely packed capillary structures ( capillary type ) or widely dilated vascular channels ( cavernous type ) with focal connective tissue in the walls . though most cardiac hemangiomas are discovered incidentally , they may cause dyspnea , palpitation , atypical chest pain and arrhythmia . some of these tumors may also cause a pericardial effusion . ct and mr have been used in preoperative diagnosis and to evaluate extra cardiac extension and myocardial involvement.5 there has been a reported case of spontaneous resolution of a cardiac hemangioma,6 but this is more typical of cardiac rhabdomyomas where upto 70% of tumors can regress spontaneously.7 the natural history of cardiac hemangiomas is variable and is the reason why all resectable lesions must be surgically removed . the long - term prognosis is favorable after adequate surgical resection.8 unresectable tumors have a poor prognosis and may lead to sudden death due to arrhythmias . non - surgical management of complicated hemangiomas has been described.9 the present case illustrates the multidisciplinary management of this rare cardiac tumor in a fetus . prenatal diagnosis , early cesarean section and then early surgery was achieved by involvement of maternal fetal medicine , pediatric cardiology and pediatric cardiac surgical services in regular fetal assessment meetings .

– Two days after being indicted Rick Perry is still calling the findings of the Texas grand jury little more than a political witch hunt, reports Politico. "I stood up for the rule of law in the state of Texas," he told Fox News Sunday. "And if I had to do it again, I would make exactly the same decision." The indictment, he said, as per the AP, is "not the way we settle political differences in this country. You don't do it with indictments. We settle our political differences at the ballot box." Perry claims he's not the only one skeptical of the case, pointing to longtime Obama operative David Axelrod, who tweeted that it was "sketchy." He's gotten support from high-profile Republicans—including those he could potentially face off against in the 2016 presidential race, Bobby Jindal, Ted Cruz, and Jeb Bush—and today got some more from Ohio Republican Michael Turner. "This is the criminalization of just the legislative function and when you do that you weaken democracy," Turner told Meet the Press. "This is certainly a political attack, and this is very bad precedent." Wendy Davis, a Democrat running for Perry's job, was more measured, calling the charges, "very, very serious."

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Texas Gov. Rick Perry said on Sunday he would “make exactly the same decision” that resulted in a grand jury indicting him. Perry, who was indicted by a Travis County grand jury in Texas on Friday alleging he abused the powers of his office, told “Fox News Sunday” that the indictment was “not the way we settle political differences in this country.” The felony counts against the Republican governor stem from his attempt to pressure a Democratic district attorney in Travis County to step down by threatening to veto state funding for her office following her drunken driving arrest and conviction. “I very clearly, I very publicly, said as long as that individual was running that agency, I had lost confidence in her, the public had lost confidence in her,” the Republican governor said. (WATCH: The Sunday shows in 90 seconds) “I stood up for the rule of law in the state of Texas," he said. "And if I had to do it again, I would make exactly the same decision.” Perry said “across the board you’re seeing people weigh in and reflecting that this is way outside of the norm,” pointing out a tweet from one of President Barack Obama's former top aides, David Axelrod, who wrote that the indictment “seems pretty sketchy.” Perry has vowed to fight his indictment, calling it a "farce" during a news conference on Saturday. Read more about: Rick Perry, Texas, Indictments ||||| WASHINGTON (AP) — Texas Gov. Rick Perry on Sunday defended the veto that led a grand jury to indict him on two felony counts of abuse of power, noting that even some Democrats have questioned the move by prosecutors. FILE - In this Friday, Aug. 8, 2014, file photo, Texas Gov. Rick Perry delivers a speech to nearly 300 in attendance at the 2014 RedState Gathering, in Fort Worth, Texas. Perry was indicted on Friday,... (Associated Press) FILE - This Aug. 8, 2014, file photo shows Governor Rick Perry as he speaks at the 2014 Red State Gathering, in Fort Worth, Texas. Perry has been indicted for abuse of power after carrying out a threat... (Associated Press) "I stood up for the rule of law in the state of Texas, and if I had to do it again I would make exactly the same decision," Perry, a potential candidate for the 2016 Republican presidential nomination, said. Already the longest-serving governor in state history, Perry has made it clear that he plans to complete his third and final term in January as planned. In an interview with "Fox News Sunday," the governor noted that David Axelrod, a former adviser to President Barack Obama, had called the indictment "sketchy" while Harvard Law professor Alan Dershowitz had questioned the move. "Across the board you're seeing people weigh in and reflecting that this is way outside of the norm. This is not the way that we settle differences, political differences in this country," Perry said. "You don't do it with indictments. We settle our political differences at the ballot box." A Travis County grand jury on Friday indicted Perry for carrying out a threat to veto state funds to the local district attorney, an elected Democrat, unless she resigned following her arrest and conviction for drunken driving. That 2013 veto prompted a criminal investigation. Perry said he had lost confidence in the prosecutor and had been clear about his intentions to veto the funding. The governor said Sunday that the indictment reflected a larger problem of government agencies not following the rule of law, pointing to the Internal Revenue Service scandal in Washington and concerns about National Security Agency surveillance. Several Republicans have come to Perry's defense and the governor has received words of support from Louisiana Gov. Bobby Jindal, Texas Sen. Ted Cruz and former Florida Gov. Jeb Bush. "This is the criminalization of just the legislative function and when you do that you weaken democracy. This is certainly a political attack, and this is very bad precedent," said Rep. Michael Turner, R-Ohio, who appeared on NBC's "Meet the Press." Perry is the first Texas governor since 1917 to be indicted. The charges came as he has sought to reintroduce himself to Republican leaders and rank-and-file party members eager to win back the White House. Several stumbles during his presidential bid in 2012 led to his early departure from the race. Perry's veto cut $7.5 million in funding to the state's ethics watchdog housed in the county district attorney's office. A state judge assigned a special prosecutor to investigate the veto following a complaint filed by a left-leaning watchdog group, which accused Perry of trying to leverage his power to force the resignation of District Attorney Rosemary Lehmberg. That unit of public corruption investigators is based in Austin, a liberal haven in the mostly conservative state. Voters in the county reliably elect a Democrat to serve as district attorney. Perry said Saturday he was confident that he would prevail and said those responsible for this "farce of a prosecution" would be held accountable. Many Democrats criticized Perry's aggressive reaction to the indictment and accused him of trying to shift the blame. Yet state Sen. Wendy Davis, the face of the party in Texas who's running a high-profile campaign for governor, took a more cautious tone Saturday. "The charges that were brought down by the grand jury are very, very serious," Davis said, adding that she trusted the justice system to do its job. Tensions between Republicans and the public integrity unit have simmered for years. Conservatives have long grumbled that the unit operates through a partisan lens and targets Republicans. ___ Associated Press writer Douglass K. Daniel contributed to this report. ___ Follow Ken Thomas on Twitter: https://twitter.com/AP_Ken_Thomas

– Here's an extracurricular activity that won't look so great on your kid's college applications: visiting a strip club with his chemistry teacher. Travis Lechien, 31, was fired from Indiana's Hanover Central High School on Tuesday for allegedly taking teens to a strip club to celebrate a student's birthday, NBC Chicago reports. The ex-teacher also faces jail time; he's been charged with contributing to the delinquency of a minor, the Northwest Indiana Times reports. Additional choice detail No. 1: The affidavit explains that Lechien was pulled over for speeding, with the teens in his car, post-strip club. And No. 2: The students, some younger than 18, also say they "hung out" at Lechien's house frequently, drinking alcohol and smoking from Lechien's hookah. And that's not even this week's only inappropriate teacher story: A University of Iowa teaching assistant accidentally sent nude pictures to students in her math class, the Press-Citizen reports. TotalFratMove.com has a screenshot of the email, which reads, "Hi Class, I attach the solutions for number 76 and 78 in this email." It reports the TA gamely made it to class yesterday morning, "clearly very rattled," which makes sense considering how many people had been discussing the incident on Twitter. University officials are asking students to delete the message and say they are investigating the incident.

Make an abstract according to the given text content, only output the abstract content and nothing else.

Close Get email notifications on Carmen McCollum daily! Your notification has been saved. There was a problem saving your notification. Whenever Carmen McCollum posts new content, you'll get an email delivered to your inbox with a link. Email notifications are only sent once a day, and only if there are new matching items. ||||| Hanover Central teacher Travis Lechien was fired, after allegations arose that he gave students alcohol at his home, and took some of them to a strip club. He now faces misdemeanor charges. Kim Vatis reports. (Published Thursday, Oct. 24, 2013) A northwest Indiana teacher who allegedly took some students to a strip club and gave them alcoholic beverages at his home was terminated Tuesday night, district officials said. "We take this seriously," Supt. Tom Taylor said of the investigation surrounding Travis Lechien. Lechien, of Crown Point, faces up to one year in prison on three Class A misdemeanor charges of contributing to the delinquency of a minor. The charges were filed Oct. 7, records show. The 31-year-old had been suspended without pay from his job as a chemistry teacher at Hanover Central High School since Sept. 10. He was a teacher at the school for 10 years, the Times of Northwest Indiana reported. Defendant Doesn't Take Stand in Bat Beating Trial Heriberto Veramontes' lawyers tried to prove their client didn't beat and rob Natasha McShane and Stacy Jurich in April 2010. (Published Thursday, Oct. 24, 2013) Court documents said Lechien allowed the students to drink beer and other alcoholic beverages at his home and took some of them to a strip club in Hammond to celebrate a student's birthday. An affidavit states Lechien and the students were pulled over on their way home from the strip club after Lechien, who was driving at the time, was speeding, according to public information officer Patti Van Til with the Lake County Sheriff's Department. The affidavit also states several students, some 18 and others younger, said they often "hung out" at Lechien's house and sometimes drank beer and hard liquor as well as used flavored tobacco from a hookah the students said belonged to the teacher. Defense attorney Richard Wolter said he hadn't reviewed the case enough to comment but that Lechien intended to plead not guilty. Taylor said the incident "puts a stain" on all teachers. ||||| Emailer’s remorse is a very real thing. It can be described as that gut-wrenching feeling one experiences after clicking “send” on an email they’d like to have back. You can’t have it back, though, thus the unease. Once it’s out, it’s permanent. This feeling is commonly the result of writing something regretful to a friend during a harshly-worded exchange amid heightened emotions, or accidentally CC-ing the wrong person in an email about personal business. Rarely does it hit after attaching sexually explicit nudies of yourself to email that was blasted out to an entire class, the very class that you help lead. Per multiple sources, and currently breaking over Twitter, a teacher assistant at the University of Iowa sent out an email to students of a math class that was intended to assign a homework assignment. The attachment was not a set of math problems, however, but was actually a series of nude photos featuring the female T.A. and a male counterpart — possibly screenshots from a sex video. breaking news: an Iowa TA accidentally emailed naked pictures of herself to 80+ students instead of sending the study guide #uhoh — Olivia Middleton (@livinthemiddle) October 23, 2013 University of Iowa is the #1 party school and #1 Teacher sextape school #hilarious — Wiley (@Jackwarning) October 23, 2013 Class with the most famous TA in University of Iowa history starts in an hour and a half. Wish me luck! Should I ask for an autograph? — Andrew Merschman (@merschman) October 23, 2013 Andrew Merschman is excited, as I assume many others are around campus. I predict a high attendance rate in this class for the rest of the week. You gotta feel for this poor girl, though. It may be a rough semester for her. Details are minimal at this point, but we will update this story as they come in. 9:50am CST Update: We obtained a copy of the email. View it below. 10:03am CST Update: We also obtained the nude images. I cannot post them here for obvious reasons. However, I’ll try to describe them for you. The images are from a video chat that is quite sexual in nature. It appears that two people are “cyber-sexing” from different locations using video equipment. Both are nude and, well, “engaging” themselves in a sexual manner. They appear to be having a grand time. Furthermore, some of the images are in .gif form (short, animated clips). 12:01pm CST Update: The T.A. was back in class this morning trying to play it off like nothing ever happened. Per tipster: The TA was teaching her 7:30 discussion session this morning trying to act like nothing happened but clearly very rattled. No one said anything about it but it was just extremely awkward. Thursday Update: The T.A. is no longer with the class. In a move that really just had to be made, the teacher assistant has been removed from her position. From KCRG in Iowa: A University of Iowa teaching assistant who accidentally emailed nude pictures of herself to math students is no longer assigned to their class. University spokesman Tom Moore confirmed the assignment change for the graduate student late Wednesday, but didn’t immediately elaborate. ___ Listen to Roger Dorn discuss this story on Kansas City’s 96.5 The Buzz: Image via Iowa Now ***

kikuchi disease ( kd ) is a rare form of necrotizing lymphadenitis . kd usually presents with cervical lymphadenopathy and fever in young women . it tends to run a benign course and resolve spontaneously within months . the aetiology of the disease is still unclear although a variety of infectious agents have been postulated . there is also a documented but rare association with systemic lupus erythematosus ( sle ) . we present the case of a young woman with biopsy - proven kd who subsequently developed sle with biopsy - proven lupus nephritis . nephrologists should be aware of kd as it may precede the development of sle and lupus nephritis .

Make an abstract according to the given text content, only output the abstract content and nothing else.

it usually involves the cervical nodes although it may also present with generalized lymphadenopathy . the aetiology of the disease is unknown but there are several associations , notably with systemic lupus erythematosus ( sle ) . we present the case of a young female patient in whom kd preceded the development of sle with renal involvement and membranous lupus nephritis . a 24-year - old asian woman first presented with a 6-week history of being generally unwell with a flu - like illness , low - grade continuous fever , anorexia and enlarged cervical lymph nodes . she had also lost weight , but there was no history of arthralgia or night sweats . she was fit and a non - smoker , with no significant past medical or family history . examination revealed a mobile , non - tender group of lymph nodes measuring 2 2 cm in the sub - mental region of the cervical group . laboratory tests revealed haemoglobin of 9.5 10/l , erythrocyte sedimentation rate ( esr ) 116 mm / h with a normal white cell count and peripheral blood film . immunology was all normal , including assays for rheumatoid factor , immunofluorescence ( if ) for anti - neutrophil cytoplasmic antibodies ( anca ) , anti - nuclear antibodies ( ana ) and enzyme - linked immunosorbent assay ( elisa ) for anti - double - stranded dna antibodies ( anti - ds dna ) . complement c3 and c4 were also normal . ultrasound of the abdomen and chest x - ray were normal . in view of her ethnic background , the patient was commenced on a trial of prednisolone with good response and the steroids were tapered after 3 months . the fever disappeared , as did the lymph node swelling and the patient made an uneventful recovery . two years later , she presented again , this time with raynaud 's syndrome of both hands . examination was unremarkable except for bluish discoloration of the fingers of both hands and fingertip ulceration . urine analysis revealed 4 + protein and 2 + blood with a proteinuria of 7 g / day . anti - ds dna elisa was positive at 84 u / ml . assays for anti - rnp , anti - sm , anti - ro and anti - la were all positive . a diagnosis of probable sle was made , and she was started on prednisolone 60 mg / day whilst awaiting a kidney biopsy . the kidney biopsy showed membranous glomerulonephritis in keeping with type v lupus nephritis ( figures 13 ) . her most recent urine protein creatinine ratio is 230 g / mol with normal renal function while on mmf and prednisolone . there were no extra - renal symptoms of sle and her raynaud 's had improved as well , without recent digital infarcts . glomeruli show very mild segmental areas of mesangial cell hyper - cellularity with some mesangial matrix increase , but without necrosis or crescents . silver methenamine stain confirming diffuse thickening of the glomerular basement membrane , in keeping with membranous glomerulonephritis . immunohistochemistry showing granular staining of the basement membrane for immunoglobulin g. ( a ) low power field ; ( b ) high power field . igm , iga , c3 and c1q were also all positive and electron microscopy showed subepithelial deposits ( not shown ) . kd is a rare but recognized cause of pyrexia and lymphadenopathy of an unknown origin . the initial two cases were described in japan and the disease is felt to be more common in asia . for example , in a korean study of 147 patients who underwent a biopsy for lymphadenitis , kd was the leading diagnosis in 34.7% of cases . kd is less common elsewhere although it has now been described throughout the world and in all ethnic groups . in this regard , a study in the united states described the ethnic origin of 75% of cases as caucasian . symptoms of the disease include headache , anorexia , nausea , vomiting , skin lesions and hepato - splenomegaly . in a large series of 244 patients fever ( 35% ) , lymphadenopathy ( 100% ) and high esr ( 40% ) the main pathological feature is the presence of necrosis in cortical and para - cortical regions of affected lymph nodes . there is no established treatment , although corticosteroids and a variety of immunosuppressant drugs have been used in severe cases . suffice to say that epstein - barr virus , toxoplasma , cytomegalovirus , yersinia enterocolitica , the human immunodeficiency virus , varicella - zoster virus and human herpesvirus-6 have all been implicated . an autoimmune aetiology has also been suggested , chiefly because of the association of kd with lupus . the association remains rare in that in dorfman 's seminal report , only 2 out of 108 patients with kd subsequently developed sle . the differentiation between kd and sle is often difficult not least as lymphadenopathy is seen in more than half the patients with sle . histological examination of lymph nodes in sle also shows areas of necrosis , but the presence of haematoxylin bodies , abundant plasma cells and granulocytes points towards a diagnosis of sle . these features were all absent in our case and the lupus serology was normal ; hence , our initial diagnosis was kd . in some cases , however , the histology may be indistinguishable . skin involvement similar to sle is occasionally seen in patients with kd ( 530% ) . steroid monotherapy may be indicated in refractory cases of kd , whereas more intense immunosuppression is usually indicated in sle .

– A rehab facility in Florida allegedly performed $58 million in false tests and treatments on opioid addicts it lured with strip club visits, the AP reports. Meanwhile, authorities say a doctor in Houston sold opioid prescriptions for cash, according to NBC News. And six doctors in Michigan conspired to prescribe unneeded opioids. All were part of the more than 400 people charged this week by the Justice Department in connection with medical fraud and the opioid epidemic. Politico reports that, all told, 412 people—56 of them physicians—were charged with defrauding the government of $1.3 billion via illegal billing of Medicare and Medicaid. Jeff Sessions calls it “the largest health care fraud takedown operation in American history.” As a result of the investigation, nearly 300 providers will be prohibited from participating in Medicaid, Medicare, and similar programs. Andrew McCabe says prescribing unnecessary opioids to addicts is "a death sentence, plain and simple." “Some doctors wrote out more prescriptions for controlled substances in one month than entire hospitals were writing,” the acting FBI director says. According to the CDC, enough opioids were prescribed in 2015 to keep every American medicated 24 hours a day for three weeks.

Make an abstract according to the given text content, only output the abstract content and nothing else.

poster="http://v.politico.com/images/1155968404/201707/2887/1155968404_5506383434001_5506319897001-vs.jpg?pubId=1155968404" true Justice Department crackdown targets fraudulent opioid treatments The Justice Department on Thursday launched a crackdown that in large part focuses on fraudulent opioid prescribing. Attorney General Jeff Sessions at a press conference described the effort as the largest of its kind in U.S. history, charging 412 people, including 56 physicians, with defrauding the federal government of $1.3 billion. Story Continued Below Sessions said 120 people have been charged with opioid-related crimes. Nearly 300 providers are in the process of being barred from participating in federal health care programs, including Medicare and Medicaid. “We will use every tool we have to stop criminals from exploiting vulnerable people and stealing our hard-earned tax dollars,” Sessions said. The Justice Department’s action came on the heels of an announcement that Mallinckrodt Pharmaceuticals has agreed to pay $35 million to settle charges that it failed to notify the Drug Enforcement Agency of suspicious drug orders from 2008 to 2011. The settlement was the first that the government has secured with an opioid manufacturer. Playbook PM Sign up for our must-read newsletter on what's driving the afternoon in Washington. Email Sign Up By signing up you agree to receive email newsletters or alerts from POLITICO. You can unsubscribe at any time. Sessions was joined by top Trump administration officials, including HHS Secretary Tom Price and acting FBI Director Andrew McCabe. Officials said the takedown involved more than 1,000 federal, state and local law enforcement personnel. According to CDC data, opioid prescriptions are on the decline but opioid-involved overdose death rates continue to increase. Agency officials earlier this month said the amount of opioids prescribed in the country in 2015 was enough for every American to be medicated around the clock for three weeks. ||||| From left, Health and Human Services Secretary Tom Price, Attorney General Jeff Sessions, and Acting FBI Director Andrew McCabe, leave a news conference about opioid addiction, Thursday, July 13, 2017,... (Associated Press) WASHINGTON (AP) — More than 400 people have been charged with taking part in health care fraud and opioid scams that totaled $1.3 billion in false billing, Attorney General Jeff Sessions announced Thursday. Sessions called the collective action the "largest health care fraud takedown operation in American history" and said it indicates that some doctors, nurses and pharmacists "have chosen to violate their oaths and put greed ahead of their patients." Among those charged are six Michigan doctors accused of a scheme to prescribe unnecessary opioids. A Florida rehab facility is alleged to have recruited addicts with gift cards and visits to strip clubs, leading to $58 million in false treatments and tests. Officials said those charged in the schemes include more than 120 people involved in illegally prescribing and distributing narcotic painkillers. Such prescription opioids are behind the deadliest drug overdose epidemic in U.S. history. More than 52,000 Americans died of overdoses in 2015 — a record — and experts believe the numbers have continued to rise. "In some cases, we had addicts packed into standing-room-only waiting rooms waiting for these prescriptions," acting FBI director Andrew McCabe said. "They are a death sentence, plain and simple." Nearly 300 health care providers are being suspended or banned from participating in federal health care programs, Sessions said. "They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves, often at the expense of taxpayers, but also feed addictions and cause addictions to start," Sessions said. Health care fraud sweeps like Thursday's happen each year across the country, but law enforcement officials continue to grapple over the best way to fight the problem. The people charged were illegally billing Medicare, Medicaid and the health insurance program that serves members of the armed forces, retired service members and their families, the Justice Department said. The allegations include claims that those charged billed the programs for unnecessary drugs that were never purchased or given to the patients. ||||| Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. WASHINGTON — The Department of Justice on Thursday announced charges against more than 400 people in connection with a major crackdown on medical fraud aimed at combating the nation’s opioid epidemic. The investigation focused on doctors who authorities say were prescribing unnecessary opioids and medical facilities that preyed on addicts to shell out cash for unnecessary treatments that only worsened their condition. Related: Lots of Americans Prescribed Opioids, Insurance Survey Shows “Some doctors wrote out more prescriptions for controlled substances in one month than entire hospitals were writing,” Acting FBI Director Andrew McCabe told reporters. “To opioid addicts, these prescriptions escalate their dependence on drugs. They are a death sentence, plain and simple.” The scams resulted in more than $1 billion in false billing uncovered in what Attorney General Jeff Sessions called “the largest health care fraud takedown operation in American history.” Much of that came out of the government's pocket by illegally billing Medicare and Medicaid. Among those charged were a fake Florida rehab facility that is alleged to have used gift cards and strip club visits to recruit addicts, and a Houston doctor who sold thousands of opioid prescriptions for cash. “We want to send a message to those that are violating the law that we are coming after you,” Sessions said. The attorney general said the crackdown is part of President Donald Trump’s goal to curb the nation’s drug epidemic. The Centers for Disease Control and Prevention said earlier this month that prescriptions for painkillers have tripled since 1999. “The United States is by far the highest prescribing opioid nation in the world, no nation is close to it,” Sessions said. “And I think that is a cause of addiction.”

this paper presents a method developed for finding sinusoidal components within a nonlinear non - stationary time - series data using genetic algorithm ( ga ) ( a global optimization technique ) . it is called search - enhanced instantaneous frequency detection ( seifd ) algorithm . the ga adaptively define the configuration of the components by simulating the solution finding process as a series of genetic evolutions . the start - time , end - time , frequency , and phase of each of these components are identified once convergence in the implementation is achieved . adaptive data analysis ; instantaneous frequency ; global optimizations ; genetic algorithms .

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the search - enhanced instantaneous frequency detection ( seifd ) algorithm uses genetic algorithm ( ga ) @xcite to identify the characteristics of sinusoidal components ( see fig .[ fig : sinudoidal - component ] ) within a nonlinear non - stationary time series data .the time - series data is modeled as a superposition of these components , each exist within a unique time range .it is represented as below .@xmath0 where , @xmath1 is the index of each sinusoidal component ; @xmath2 is its amplitude ; @xmath3 , is its frequency ; and @xmath4 is its phase .the parameters which define each of the components are encoded as a solution string consisting binary values . during implementation ,the ga attempts to find their value by simulating it as a solution improvement process modeled as a series of genetic evolutions . because the problem is non - stationary , each of the sinusoidal components possesses unique start and end time ( denoted respectively as @xmath5 and @xmath6 ) .they are as well encoded in the solution string . in this way , the solver attempts to decompose the time - series data into its consituting sinusoidal components in order to reveal the instantaneous frequencies of the time - series data .the sinusoidal parameters are encoded as a string of binary values .the length of the binary string is determined based on the sum of the bit counts carried by each of the parameters computed with their respective lower and upper bound , as well as the step size of increment .the bit count for each of the parameters is computed as below .@xmath7 + 1\ ] ] where , bit(@xmath8 ) is the bit count of parameter @xmath8 ; @xmath9 and @xmath10 respectively are the upper bound and lower bound of parameter @xmath8 ; and @xmath11 is the step size of each increment of parameter @xmath8 in the solution .the solution string is organized as shown in fig .[ fig : sample - solution - string ] .the real value of each of the parameters can be decoded from the solution string using the following equation .@xmath12\ ] ] where , @xmath13 is the length of bits in the solution string representing the value of @xmath8 .the solution string is regarded as a chromosome ( fig .[ fig : chromosome ] ) in the simulated genetic evolution process . in the initial stage , ga generates a group ( a population ) of random chromosomes of varying quality computed with the following fitness function .@xmath14\ ] ] where the @xmath15 is the raw time - series data .the fitness function describes the environment ( the solution space ) in which the chromosomes evolve .the implementation should achive continuous improvement ( lower fitness function in every subsequent generation ) until the fitness score converged at a targeted fitness score. the targeted fitness score of @xmath16 is 0 .then , ga selects some chromosomes possessing good fitness score for creating new offsprings in the subsequent repetitions . in the process ,the algorithm identify and retain good alleles that lead to the yielding of better fitness scores .meanwhile , it modifies the inferior allele values using simulated biological crossover and mutation processes .the operation is repeated until the termination criterion is finally met .compare to fourier transforms , the method adaptively identifies the start and end of such sinusoidal components ( within the time horizon of the data ) , as well as their exact instantaneous attributes . among others , its performance is not constrained by : i. ) the need to ensure the completion of at least one oscillation cycle in all of the sinusoidal components ; and ii . )the existence of discontinuity within the data .the result fulfills the following generalized fourier representation @xcite : @xmath17 the identification of the quantity of sinusoidal components at every time step , @xmath18 can be solved as a combinatorial optimization ( co ) problem ( the ga is a well - known approach for solving co problems ( i.e. , @xcite ) ) . to do so, the method could be implemented as below : 1 .establish a list of repeatable combination , @xmath19 of length @xmath20 , which consist of a list of integer , @xmath21 ; where @xmath20 is the length of the data , @xmath22 is an integer representing the maximum quantity of sinusoidal components in the data .2 . implement ga to determine the value of components in @xmath19 , @xmath23 .3 . determine the @xmath24 and @xmath25 for each of the sinusoidal component based on @xmath19 , and identify their configurations .improve @xmath19 until convergence is achieved .the method is tested on a time series data shown in fig . [fig : sample - data ] .the algorithm is codified using the python programming language .the iteration - best value of @xmath2 , @xmath3 , and @xmath4 found by the ga is shown in fig . [fig : convergence ] .the changes in the parameter values which leads to the convergence of @xmath16 is clearly seen in the figure .the final results obtained in the implementation is shown in fig .[ fig : result ] .a. l. corcoran and r. l. wainwright , `` using libga to develop genetic algorithms for solving combinatorial optimization problems , '' in _ the application handbook of genetic algorithms_,1995 , pp . 143172 . n. e. huang , z. shen , s. r. long , m. c. wu , h. h. shih , q. zheng , n. yen , c. c. tung , and h. h. liu , `` the empirical mode decomposition and the hilbert spectrum for nonlinear and non - stationary time series analysis , '' _ proceedings : mathematical , physical and engineering sciences _ , vol .1971 , pp .903995 , 1998 .

introduction : the cyst of anterior cruciate ligament ( acl ) is a known clinical entity , but its association with knee synovitis and melon or rice bodies is not documented.case report : we report a rare case of ganglionic cyst of of the knee in association with diffuse synovitis and multiple melon or rice bodies in a 36 year old male . the case was treated arthroscopically with removal ofthe cyst of acl and multiple melon seed bodies.conclusion:information regarding incidence , treatment , and outcomes for patients with synovial cysts and melon seed bodies is lacking . arthroscopic examination of joint gives the opportunity to diagnose such rare entity of the joint and also provide minimally invasive effective treatment of such pathology .

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the cyst of anterior cruciate ligament ( acl ) is a known clinical entity , but its association with knee synovitis and melon or rice bodies is not documented . we report a rare case of ganglionic cyst of of the knee in association with diffuse synovitis and multiple melon or rice bodies in a 36 year old male . the case was treated arthroscopically with removal ofthe cyst of acl and multiple melon seed bodies . information regarding incidence , treatment , and outcomes for patients with synovial cysts and melon seed bodies is lacking . arthroscopic examination of joint gives the opportunity to diagnose such rare entity of the joint and also provide minimally invasive effective treatment of such pathology . the cysts of acl are known and described in the literature , but their association with diffuse synovitis and multiple melon or rice seed bodies has not been well documented . we report a rare case of a 36 year old gentleman who underwent arthroscopy of knee for swelling and locking , was found to have synovial cyst and melon seed bodies which were removed . the outcomes of such patients and recurrences have not been well described in the literature . a 36 year old gentleman presented with complaints of dull aching pain in the right knee for 6 months which was aggravated on walking and relieved on rest . patient did not give any history of fever , weight loss or instability while walking . there was no history of any other joint symptoms , comorbidities or long term drug intake . the clinical examination revealed parapatellar fullness over right knee without any local rise of temperature or tenderness . plain x ray revealed mild joint space reduction medially ( fig . 1 ) and mri revealed posterior horn degeneration of medial meniscus with mild effusion in the knee joint and a cyst behind the acl . 2 ) showed diffuse synovitis with well - defined cyst posterior to the acl ( fig . about 50 - 60 ml of synovial fluid mixed with multiple loose bodies ( fig 4 ) was removed . the histopathological examination revealed synovial chondromatosis and no evidence of tuberculosis or rheumatoid arthritis . at 3 month follow - up , there was complete resolution of swelling and pain with full range of motion of the knee . intraopertive picture showing diffuse synovitis and melon bbodies arthroscopic picture showing acl cyst & removal of melon bodies synovial fluid with melon seed bodies cysts associated with the anterior cruciate ligament ( acl ) are rare with an incidence of less than 1% . prevalence rates for cysts in two large mri series was 0.25% and 0.44% and in an arthroscopic series of 8,000 cases , only 49 ( 0.6% ) cystic masses were found to originate from the acl . a cyst in the mid - portion of the acl was first described by caan in 1924 , in the cadaver of an elderly man with no documented antemortem symptoms referable to the knee . the etiology of these lesions remains obscure , and a history of significant trauma is obtained in only a minority of cases . theories include post - traumatic mucinous degeneration of connective tissue mediated by local release of hyaluronic acid , herniation of the synovium into a defect in surrounding tissue , and even displacement of synovial tissue during embryogenesis . symptoms comprise anteromedial knee pain aggravated by changing direction while running , on squatting or with extreme flexion and extension , and may resemble those of internal derangement . a ganglion can arise as a cystic lesion from a tendon sheath or a joint capsule and contain a glassy , clear , and jelly - like fluid . a review of the literature reveals a controversial discussion about the clinical significance as well as the etiology of ganglion cysts arising from the cruciate ligaments . these case reports show that an intra - articular ganglion cyst of the cruciate ligaments is difficult to diagnose . a cyst does not necessarily have to be associated with specific clinical symptoms or a previous trauma . due to its multiplanar capability , mri is the imaging modality of choice for diagnosis of these lesions , and demonstrates fusiform swelling of the acl . the cysts return homogenously low signal intensity on t 1-weighted images and high signal intensity on t 2-weighted images which are articularly good at contrasting the cysts against an intact acl . arthroscopic evaluation and removal of synovial cysts and loose bodies although it was observed that most synovial cysts were asymptomatic and did not need any sort of treatment and were found incidentally . most patients have good or excellent results after arthroscopic excision of acl cysts ; postsurgical recurrence has not been reported . melon or rice bodies are free corpuscles of synovial origin with a cartilage - like appearance that may reach hundreds in number in the intra - articular space . rheumatologic or infectious pathologies that may produce synovial hypertrophy play a major role in the etiology . magnetic resonance imaging ( mri ) is the most useful diagnostic modality for detecting acl cysts and the treatment of choice in symptomatic cases is by arthroscopic surgery . information regarding incidence , treatment , and outcomes for patients with synovial cysts and melon seed bodies is lacking . arthroscopic examination of joint gives the opportunity to diagnose such rare entity of the joint and also provide minimally invasive effective treatment of such pathology . awareness about the association of an acl cyst with diffuse knee synovitis and melon bodies is crucial to reach an early diagnosis . arthroscopic surgery provides an accurate diagnosis and means to remove the melon bodies while carrying simultaneous synovectomy .

the observable consequences of a nova outburst depend sensitively on the details of the thermonuclear runaway which initiates the outburst . one of the more important sources of uncertainty is the nuclear reaction data used as input for the evolutionary calculations . a recent paper by starrfield , truran , wiescher , & sparks @xcite has demonstrated that changes in the reaction rate library used within a nova simulation have significant effects , not just on the production of individual isotopes ( which can change by an order of magnitude ) , but on global observables such as the peak luminosity and the amount of mass ejected . we will present preliminary results of systematic analyses of the impact of reaction rate uncertainties on nova nucleosynthesis . # 1#1 @xmath0

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observations of nova outbursts have revealed an elemental composition that differs markedly from solar .theoretical studies indicate that these differences are caused by the combination of convection with explosive hydrogen burning which results in a unique nucleosynthesis that is rich in odd - numbered nuclei such as @xmath1 , @xmath2 and @xmath3 .these nuclei are difficult to form in other astrophysical events .many of the proton - rich nuclei produced in nova outbursts are radioactive , offering the possibility of direct observation with @xmath4-ray instruments .potentially important @xmath4-ray producers include @xmath5 , @xmath6 , @xmath7 and @xmath8 .the observable consequences of a nova outburst depend sensitively on the details of the thermonuclear runaway which initiates the outburst .one of the more important sources of uncertainty is the nuclear reaction data used as input for the evolutionary calculations @xcite .a number of features conspire to magnify the effects of nuclear uncertainties on nova nucleosynthesis .many reactions of relevance to novae involve unstable proton - rich nuclei , making experimental rate determinations difficult . for hydrodynamic conditions typical of novae , many rates depend critically on the properties of a few individual resonances , resulting in wide variation between different rate determinations . statistical model( hauser - feshbach ) calculations , which are employed with great success for a large number of reactions @xcite , are unreliable for rates dominated by individual resonances .the similarity of the nuclear burning and convective timescales results in nuclear burning in novae which is far from the steady state which typifies quiescent burning .though analysis of the impact of variations in the rates of a few individual reactions has recently been performed using one - dimension hydrodynamic models @xcite , analysis of the impact of the complete set of possible reaction rate variations in such hydrodynamic models remains computationally prohibitive .we therefore begin by examining in detail the nucleosynthesis of individual zones , using hydrodynamic trajectories ( temperature and density as a function of time ) drawn from nova outburst models .such one zone , post - processing nucleosynthesis simulations are a common means of estimating nova nucleosynthesis ( see e.g. , @xcite ) . for this presentationwe are using a hydrodynamic trajectory for an inner zone of a @xmath9 onemg wd which is similar to that described in @xcite .these calculations were performed using a nuclear network with 87 species , composed of elements from n and h to s , including all isotopes between the proton drip line and the most massive stable isotope .figure [ fig : mcabund ] shows the abundances of each species at the end of the simulation , @xmath10 after peak temperature . because of the long time which has elapsed , the unstable proton - rich nuclei have decayed , reducing their abundances to less than @xmath11 .to investigate the extent to which nuclear reaction uncertainties translate into abundance differences , we use a monte carlo technique which assigns to each reaction rate in the nuclear network a random enhancement factor .the error bars displayed in fig .[ fig : mcabund ] are the 90% confidence intervals which result from 992 monte carlo iterations .monte carlo methods have been employed with great success in the analysis of big bang nucleosynthesis @xcite , but have not previously been applied to other thermonuclear burning environments .the reaction rate enhancement factors are distributed according to the log - normal distribution , which is the correct uncertainty distribution for quantities like reaction rates which are manifestly positive @xcite , @xmath12 where @xmath13 and @xmath14 are the ( logarithmic ) mean and standard deviation . for small uncertainties@xmath15 , the difference between the log - normal distribution and the normal ( gaussian ) distribution is small .however , for uncertainties of larger sizes such as those encountered in this problem , the difference is important . for this preliminary analysis ,we have chosen to assign uncertainties of @xmath16 both to rates calculated by hauser - feshbach methods and also to rates whose measurement require radioactive ion beams . for all other rates we assign @xmath17 .figure [ fig : hist ] plots the resulting abundance distributions for two representative nuclei .[ fig : hist ] also demonstrates the differences between normal and log - normal distributions for widths of these sizes .these are very conservative uncertainties ; relatively few reactions , especially among unstable nuclei , have measurement uncertainties this small .as evidenced by the error bars in fig . [ fig : mcabund ] , the impact of even our conservatively chosen variations in reaction rates on the nucleosynthesis is large .while broader conclusions will require analysis of additional hydrodynamic trajectories , a number of interesting points can be made from the analysis of this single trajectory .the impact on the rate of energy production is small . at the 90% confidence level ,variations in the amount of hydrogen consumed represent @xmath18 variation in the thermonuclear energy released . for the most abundant metals ( those which represent more than 1% of the mass ) , 2@xmath19 variations by factors of 1.1 to 1.4 are common , with some of these nuclei showing 2@xmath19 variations as large as a factor of 2 , for example , @xmath20 ( @xmath21 ) and @xmath22 ( @xmath23 ) . for the @xmath4-ray source nuclei @xmath6 and @xmath5 , the 90% confidence interval includes variations of nearly a factor of 2 , representing almost a factor of 4 difference in the distancefrom which novae may be observed by @xmath4-ray telescopes . for @xmath7 ,the 90% confidence interval spans more than 2 orders of magnitude . such large uncertainties in the nucleosynthesis , resulting from poorly known nuclear reaction rates ,constrain our ability to make detailed comparisons between theoretical models for the nova outburst and astrophysical observations to a degree which is often ignored .improved knowledge of these uncertain rates , both experimental and theoretical , is necessary to provide tight constraints on the nova outburst from its nucleosynthetic products .

objective : meningiomas in children is a rare occurrence . primary intraventricular meningiomas ( ivms ) are even rarer with reported incidence of 0.5%5% of all meningiomas . the aim of the study was to describe the demographic profile , location , surgical approach , complications , and histopathology of six pediatric patients with ivm.materials and methods : we retrospectively analyzed all intraventricular tumors operated at our institute from january 2010 till july 2015 . patients ' clinical details and follow - up were obtained from hospital records and scans were obtained from picture archiving and communication system.results:we found 6 pediatric patients ( age 18 years ) with histopathologically proven ivm . the mean age in this series was 14.6 years . tumor was most commonly approached through the superior parietal lobule in this series . gross total excision was achieved in all patients . the blood loss in the series was in the range of 6002000 ml with a mean of 1100 ml . all were grade 1 meningioma on histopathological examination . transitional meningioma was the most common histological subtype . none of the patients had a recurrence at last follow-up.conclusions:pediatric ivms are rare tumors . they tend to have a male preponderance in contrast to adults which have a preference for females . parietooccipital transcortical , transcallosal approach , middle / inferior temporal gyrus approach are the described techniques to tackle such tumors depending on the location of such tumors . surgeons should watch out for massive blood loss during surgery , especially via the parietooccipital transcortical approach .

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they comprise approximately 3% of all pediatric brain tumors . primary intraventricular meningiomas ( ivms ) are even rarer with reported incidence of 0.5%5% of all meningiomas . most commonly they are located in the lateral ventricle , followed by third ventricle and rarely in the fourth ventricle . lateral ventricle meningioma usually presents with symptoms of raised intracranial pressure and can attain significant size before being detected . we describe a series of 6 pediatric patients with ivm managed surgically in our institute . we retrospectively analyzed all intraventricular tumors operated at our institute from january 2010 to july 2015 . patients ' clinical details and follow - up were obtained from hospital records and scans were obtained from picture archiving and communication system . the presentation , radiology , surgical approach , intraoperative events , histopathology and follow - up of all the patients was analyzed . case details of all patients are summarized in table 1 . the mean age in this series was 14.6 years with minimum age being 8 years and two patients of age 18 years . three patients were operated via the superior parietal lobule , one patient via transcallosal approach , one patient via middle temporal gyrus . the patient underwent bifrontal craniotomy , evacuation of edh , and tumor excision via transcortical approach . the blood loss in the series was in the range of 6002000 ml with a mean of 1100 ml . figures 13 reveal the preoperative images , immediate postoperative scan after 4 h and follow - up scan at 6 months respectively of an 8-year - old male child with left lateral ventricle meningioma . the symptoms , surgical approach , complications , and follow - up of all six cases in the series ( a ) noncontrast computed tomography head axial sections showing well defined hyperdense lesion in left lateral ventricle with perilesional edema ( b ) contrast enhanced ct head ( axial sections ) of the above patient showing enhancement of the intraventricular lesion with mass effect and midline shift postoperative noncontrast computed tomography head axial sections showing postoperative changes with pneumoventricle and no residual tumor contrast enhanced magnetic resonance imaging brain axial section at 6 month follow - up showing postoperative changes with no evidence of residual tumor the third ventricle meningiomas arise from tela of velum interpositum whereas the fourth ventricle from the choroids or inner tela choroidea . this is in concordance with the existing literature which favors a slight male preponderance for pediatric intracranial meningiomas . five out of six patients had solitary ivm whereas one patient had multiple meningiomas with bilateral acoustic schwannoma as a manifestation of neurofibromatosis-2 . cushing and eisenhardt defined five clinical features of trigonal meningiomas ( 1 ) pressure symptoms ( often unilateral headache ) , ( 2 ) contralateral homonymous hemianopia ( frequently macula splitting ) , ( 3 ) contralateral sensorimotor deficit ( sensory involvement greater than motor involvement and sometimes trigeminal involvement ) , ( 4 ) cerebellar affection ( > 50% ) , and ( 5 ) dysphasic and paralexic disturbance in left - sided tumors . symptoms may be ascribed to raise intracranial pressure as a result of tumor , ventricular dilatation , surrounding edema , and compression of adjacent normal brain parenchyma . ivm appear hyperdense on computed tomography with or without areas of calcification , isointense to hypointense on t1-weighted images , intense enhancement on postgadolinium scans . the vascular supply of ivm comes from anterior , and lateral posterior choroidal arteries and both are not suitable for embolization . incidental ivm without perilesional edema , temporal horn dilatation can be followed up with serial imaging . meningioma being a benign tumor with excellent outcomes following surgical excision is best managed through surgical excision . radiosurgery is a viable option in patients who are not fit for general anesthesia or who refuse consent for surgery . this approach has the shortest trajectory , granting an early control of the feeding vessels . other approaches described are via the inferior temporal gyrus , collateral sulcus , and the occipitotemporal gyrus . tumors in three patients were approached via the superior parietal lobule which is well described and commonly used . the superior parietal lobule approach although seem to have a longer trajectory ; the distance becomes actually shorter when tumor grows superiorly and enlarges the atrium . the superior parietal lobule approach prevents damage to the optic radiations which occur in a middle temporal gyrus approach . in the superior parietal lobule approach , one of the patients had intraoperative hypotension during surgery as a result of massive blood loss . fornari et al . have suggested a sagittal paramedian incision of the parietal cortex at a distance of 4 cm from the midline that starts 1 cm behind the postcentral fissure and is continued for 45 cm as far as the parietooccipital fissure . this approach is supposed to be less harmful with regards to damage to the optic radiation . a significant limitation of our study is the lack of visual perimetry both in the pre- and post - operative period . no fresh neurological deficits were observed in the postoperative period in any of our patients . anterior transcallosal approach was used in one of our patient in which tumor was localized to the third ventricle and frontal horn of lateral ventricle . they tend to have a male preponderance in contrast to adults which have a preference for females . parietooccipital transcortical , transcallosal approach , middle / inferior temporal gyrus approach are the described techniques to tackle such tumors depending on the location of such tumors . surgeons should watch out for massive blood loss during surgery , especially via the parietooccipital transcortical approach .

– Yes, OJ Simpson knows about the knife allegedly found on the grounds of his former home, but no, he's not worried about it ... much, Simpson's former manager Norman Pardo tells People. He's just "a little worried because if it's one of his pocket [knives] and if it's got his blood on it, that could make him look bad when he's up for parole," Pardo admits. (Simpson is currently serving time on a robbery conviction and could be paroled in November 2017.) "That's really his only fear," Pardo continues. "Personally, I think it belonged to a construction worker [who was working at Simpson's house] and fell out of his pocket. Honestly, I don't think it pertains to anything." He says, for the most part, Simpson is "shrugging it off," other than to "shake his head" in wonderment that people are still so interested in his decades-old murder trial. So, is Simpson's small amount of fear justified? As Yahoo News explains, though the Constitution guarantees Simpson won't be tried again for the murders of Nicole Brown and Ronald Goldman, there's no such guarantee that hypothetical new evidence won't affect the Nevada Parole Board's decision. The board "may consider and give relevant weight to any evidence that bears on whether the release of the petitioning inmate could constitute a danger to the public," says a government spokesperson. (The man who razed OJ's home thinks the knife is a "joke.")

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At Wednesday’s Democratic debate, presidential candidates Bernie Sanders and Hillary Clinton exchanged jabs over Cuba but agreed on deportation issues. Photo: Getty Two gunmen ambush a backyard party near Pittsburgh, killing at least five people and injuring several, media and police say. Rough Cut (no reporter narration). At least five killed in shooting near Pittsburgh Democratic presidential hopefuls Hillary Clinton and Bernie Sanders tangled repeatedly in their eighth presidential debate over who's a true advocate for Latinos and who has a track record of letting Hispanics down. (March 10) Syrian children lead a protest against a government blockade they say is preventing the delivery of food, medicine and clean water. Natasha Howitt reports. The videotape of Dassey telling Manitowoc County police he helped his uncle rape and kill Teresa Halbach was the centerpiece of evidence prosecutors used at his murder trial. In the wake of several murders over the past few days in the capital city -- Mayor Tony Yarber created a criminal justice task force. Six years after a local man was murdered in Homewood, his loved ones are still waiting for justice and still trying to cope with the loss; KDKA's Ralph Iannotti reports. Police have arrested a man in connection with a triple stabbing that left one person dead and two others injured in West Philadelphia. A defense attorney said he was attacked at the Central Justice Center in Santa Ana by an investigator for the Orange County District Attorney's Office on Wednesday. On March 4, 2016, O.J. Simpson's fmr. attorney, Yale Galanter, joined Yahoo News and Finance Anchor Bianna Golodryga to discuss the significance of the knife reportedly found on former O.J. Simpson property. O.J. Simpson's fmr. attorney weighs in on knife reportedly found on former Simpson property O.J. Simpson's fmr. attorney weighs in on knife reportedly found on former Simpson property O.J. Simpson's fmr. attorney weighs in on knife reportedly found on former Simpson property Even if O.J. Simpson used the knife now being tested in the 1994 brutal slayings of Nicole Brown Simpson and Ronald Goldman, the Fifth Amendment of the Constitution guarantees that he will not face a second prosecution for the infamous murders. But it doesn’t preclude the Nevada Department of Corrections — where Simpson is doing time for an unrelated armed robbery and kidnapping — from taking notice. View gallery . O.J. Simpson, 68, is serving nine to 33 years for armed robbery and kidnapping. (Nevada Dept. of Corrections) The 68-year-old is eligible for parole next year, but a knife tying Simpson to the unsolved murders could block his release. “The Nevada Parole Board may consider and give relevant weight to any evidence that bears on whether the release of the petitioning inmate could constitute a danger to the public,” a spokeswoman from attorney general Adam Paul Laxalt’s office said in an email to Yahoo News. Nevada law permits the parole board to take into account: (a) Whether there is a reasonable probability that the prisoner will live and remain at liberty without violating the laws; (b) Whether the release is incompatible with the welfare of society; (c) The seriousness of the offense and the history of criminal conduct of the prisoner. News of the knife is the latest twist in a saga that’s captured the world's attention for more than two decades. Simpson’s ex-wife Nicole and Goldman, her friend, were stabbed to death June 12, 1994, in Los Angeles’s upscale Brentwood neighborhood. View gallery . Simpson is eligible for parole again in 2017. (Nevada Dept. of Corrections) The unearthed knife, now undergoing forensic testing, was allegedly found by workers who were razing the Simpson estate in 1998 after the property was sold. But Trent Copeland, an attorney for retired Los Angeles Police Department patrolman George Maycott, told the Los Angeles Times his client didn’t receive the knife until 2003. That’s when Maycott, while working security on a Brentwood movie, said a construction worker handed him the knife. “‘Hey look, I found this knife on what I think is O.J. Simpson’s property,’” Copeland said of his client’s recollection of the encounter. “‘It is dirty, muddy and rusted out, but do you guys want it?’” View gallery . Workers razed the former Los Angeles home of O.J. Simpson in July 1998. Detectives are investigating a knife purportedly … “O.J. Simpson has been acquitted and there is double jeopardy ... there is nothing we can do,” Copeland said Maycott was told. Last Friday, Capt. Andy Neiman emphasized that detectives were still trying to determine the authenticity of the knife story and whether “this whole story is possibly bogus from the get-go.” “It’s unusual how this all of a sudden becomes a huge story during this time,” Neiman said. The original saga is currently receiving renewed attention because of the FX series “The People v. O.J. Simpson: American Crime Story.” In June, ESPN plans to air a five-part miniseries on the rise and fall of Simpson called “O.J.: Made in America.” The owner of the construction crew who leveled Simpson’s former home is among those casting doubt about the knife’s connection to the case. “I think it’s a joke,” Mike Weber, owner of Weber-Madgwick Inc., told the Los Angeles Times. “It’s just filler. … No one on my crew found anything. I had instructed my people, ‘If you find anything, don’t keep it. Tell me, we’ll take the appropriate action.’” Jason Sickles is a national reporter for Yahoo News. Follow him on Twitter (@jasonsickles). ||||| Starting in 1996, Alexa Internet has been donating their crawl data to the Internet Archive. Flowing in every day, these data are added to the Wayback Machine after an embargo period.

– They're not quite at the point where they can implant a human brain into a robot—but scientists have taken a step closer. They've simulated the simple and well-studied nervous system of the Caenorhabditis elegans roundworm and stuck it in a robot, the Smithsonian reports. First, they mapped the creature's nervous system; then, they re-created it in software form. Finally, that software went to work in a robot made of Legos. Instead of a nose, the Smithsonian notes, the robot has a sonar sensor; the program controls motors on the robot's sides instead of muscles, I Programmer reports. No instructions were programmed into the device, but it reportedly acted a lot like C. elegans does. If researchers stimulated its nose, it stopped moving; touching a food sensor drove it forward. "What we found is that rather than just random, crazy movements by the robot, it actually responded to its environment in the same manner as the biological worm," researcher Timothy Busbice tells Gizmodo. (The experiment might lend some support to the theory that robots will be smarter than we are by 2029.)

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Take the connectome of a worm and transplant it as software in a Lego Mindstorms EV3 robot - what happens next? It is a deep and long standing philosophical question. Are we just the sum of our neural networks. Of course, if you work in AI you take the answer mostly for granted, but until someone builds a human brain and switches it on we really don't have a concrete example of the principle in action. KDS444, modified by Nnemo The nematode worm Caenorhabditis elegans (C. elegans) is tiny and only has 302 neurons. These have been completely mapped and the OpenWorm project is working to build a complete simulation of the worm in software. One of the founders of the OpenWorm project, Timothy Busbice, has taken the connectome and implemented an object oriented neuron program. The model is accurate in its connections and makes use of UDP packets to fire neurons. If two neurons have three synaptic connections then when the first neuron fires a UDP packet is sent to the second neuron with the payload "3". The neurons are addressed by IP and port number. The system uses an integrate and fire algorithm. Each neuron sums the weights and fires if it exceeds a threshold. The accumulator is zeroed if no message arrives in a 200ms window or if the neuron fires. This is similar to what happens in the real neural network, but not exact. The software works with sensors and effectors provided by a simple LEGO robot. The sensors are sampled every 100ms. For example, the sonar sensor on the robot is wired as the worm's nose. If anything comes within 20cm of the "nose" then UDP packets are sent to the sensory neurons in the network. The same idea is applied to the 95 motor neurons but these are mapped from the two rows of muscles on the left and right to the left and right motors on the robot. The motor signals are accumulated and applied to control the speed of each motor. The motor neurons can be excitatory or inhibitory and positive and negative weights are used. And the result? It is claimed that the robot behaved in ways that are similar to observed C. elegans. Stimulation of the nose stopped forward motion. Touching the anterior and posterior touch sensors made the robot move forward and back accordingly. Stimulating the food sensor made the robot move forward. Watch the video to see it in action. The key point is that there was no programming or learning involved to create the behaviors. The connectome of the worm was mapped and implemented as a software system and the behaviors emerge. The conectome may only consist of 302 neurons but it is self-stimulating and it is difficult to understand how it works - but it does. Currently the connectome model is being transferred to a Raspberry Pi and a self-contained Pi robot is being constructed. It is suggested that it might have practical application as some sort of mobile sensor - exploring its environment and reporting back results. Given its limited range of behaviors, it seems unlikely to be of practical value, but given more neurons this might change. Is the robot a C. elegans in a different body or is it something quite new? Is it alive? These are questions for philosophers, but it does suggest that the ghost in the machine is just the machine. For us AI researchers, we still need to know if the principle of implementing a connectome scales. Comments Make a Comment or View Existing Comments Using Disqus or email your comment to: [email protected] ||||| GIF Artificial intelligence researchers have started looking to some of the simplest creatures for inspiration. Cyborgs who think like humans are still just a sci-fi dream, but scientists have had success recreating a less complicated brain. They've already created LEGO robot with the artificial mind of a worm. The OpenWorm project (which kind of sounds like somewhat like a band of mischievous 10-year-olds with a pocketknife would call themselves, but OK) has mapped the brain of the tiny nematode worm Caenorhabditis elegans (C. elegans), known both for being squirmy and only having 302 neurons. Advertisement One of OpenWorm's founders, Timothy Busbice, applied the brain mapping to create software that mimics the way the natural neural network works. Then he put it in a LEGO Mindstorms EV3 robot. And then it started its mechanic wriggle. "My research takes the way the worm's brain is wired and extends it to a robot for sensory input and motor output," Buspice told me. "What we found is that rather than just random, crazy movements by the robot, it actually responded to it's environment in the same manner as the biological worm." Advertisement Since C.elegans can smell, taste, and sense light and temperature, the robot has sensory neurons, too. This is what a robot looks like when it thinks its a teeny roundworm: Busbice essentially reverse-engineered a worm nervous system onto a robot using sensors and software. The robotics expert is now using a Raspberry Pi and a GoPiGo (a robot built to interact with Raspberry Pi) to test his worm-brain software again. So far, he hasn't been happy with the results, but he's still working on the experiment and making adjustments. "My goal is to create a autonomous, "living" robot that could be used for multiple purposes," Buspice said. "In my original work, we sometimes let the robot wander the house and it's like having a pet wandering around - pretty cool and fun." We'll see if this FrankenRobotWorm can rise twice. [iProgrammer]

– The high-profile arrest of Dominique Strauss-Kahn apparently wasn't enough to convince one exec that he should keep his hands off New York City's maids. Prominent Egyptian banker Mahmoud Abdel Salam Omar was arrested yesterday and charged with sexually abusing a maid at a Manhattan hotel, barely 2 weeks after the former IMF chief was arrested on similar charges, AP reports. Police say the maid was called to the 74-year-old executive's room at the Pierre to drop off tissues, but once she was inside the room, he refused to let her leave and groped her. "When she came to his room, he got carried away. He started grabbing at her. He wouldn't let her go," a hotel bellman tells the New York Daily News. "It's a total copycat of what happened with the French guy." Omar, the former chairman of one of Egypt's biggest banks, is being held on charges of sexual abuse, unlawful imprisonment, forcible touching, and harassment.

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Egyptian businessman Mahmoud Abdel-Salam Omar accused of sexually abusing hotel maid at The Pierre Vic Nicastro for News Egyptian businessman Mahmoud Abdel-Salam Omar, accused of groping maid at The Pierre hotel, is led by NYPD detectives from the 19th Precinct early Tuesday. The hotel maid allegedly groped by an Egyptian businessman, immediately reported it to a supervisor but was told to wait a day to speak to security, sources said Tuesday. The supervisor's decision explains why Sunday night's alleged assault was not reported to police until Monday morning. Mahmoud Abdel-Salam Omar, 74, the former head of the Bank of Alexandria and now chairman of a leading Middle Eastern salt company, is accused of locking the 44-year-old maid inside his $900-a-night room at The Pierre on Sunday. Channeling his inner Dominique Strauss-Kahn, Omar called for room service requesting tissues and answered the door in his pajamas, police sources said. When the maid - whom he had not specifically asked for - arrived at his 10th-floor room, he asked her to put the box of tissues on a table, sources said. As she moved toward the table, he locked the door. "He locked her in the room and had her trapped," a police source said. "He grabbed her breasts, groped her. He was grinding against her." Omar then asked the maid for her phone number, a police source said. After she gave him a made-up number he let go, and she fled the room. The incident happened about 6 p.m. on Sunday but was not reported to police until Monday morning. In a statement Monday night, hotel management said they made the safety "of our guests and staff," a priority. "We take all complaints very seriously and investigate thoroughly. This incident has been formally reported to the New York Police Department and is under investigation. We will fully comply with the investigation as requested," the statement read. Despite the delay, investigators believe the woman's story. "Experienced NYPD detectives found the complainant to be credible," said Paul Browne, the NYPD's top spokesman. Omar was arrested at the hotel Monday afternoon and charged with sexual abuse, unlawful imprisonment, forcible touching and harassment, officials said. The financier paused briefly as he was led out of the 19th Precinct stationhouse early Tuesday and stared mutely at reporters with a stunned expression. "He's an old man," said a friend who tried to visit Omar in the police station but was turned away. "He's a good man and also a grandfather." At the posh hotel, news of the alleged attack spread quickly. "When I came in they were all talking about it," said a bellman, who declined to give his name. "When she came to his room, he got carried away. He started grabbing at her. He wouldn't let her go." The maid has worked at the hotel for about a year, co-workers said. She did not return to her job Monday. "I don't want to say it, but he tried to rape her," the bellman added. "It's a total copycat of what happened with the French guy." Strauss-Kahn, the former head of the International Monetary Fund and a leading French presidential candidate, was arrested May 14 for allegedly forcing himself on a maid at the Sofitel in Manhattan. He remains under house arrest in a posh Tribeca townhouse. Omar was head of the Bank of Alexandria in Egypt before becoming chairman of the Egyptian salt company El-Mex Salines Co. "They were saying the guest was a very nice guy, and then this," said a shocked housekeeper at the hotel. "Human beings are strange." With Kerry Wills [email protected] ||||| A former chairman of one of Egypt's major banks was arrested Monday on charges of sexually abusing a maid at a Manhattan hotel, just weeks after the arrest of former International Monetary Fund chief Dominique Strauss-Kahn on similar allegations, police said. Mahmoud Abdel Salam Omar is accused of sexually abusing the maid at The Pierre, a luxury hotel near Central Park and Fifth Avenue on the Upper East Side, police said. The maid was called to Omar's room Sunday night to drop off tissues, police said. But once inside the 74-year-old's room, police said Omar would not let her leave and touched her inappropriately. The encounter was not reported until Monday, police said. Paul Browne, a spokesman for the New York City Police Department, said detectives found the complainant to be credible. There was no immediate information on whether Omar had an attorney. He was being held Monday night at a police precinct. Police said further details will be released at the suspect's arraignment, expected to take place Tuesday. Omar is the former chairman of Egypt's Bank of Alexandria, but is currently an executive with El-Mex Salines Co., according to the salt production company's website. The Pierre said it will "fully comply with the investigation," according to a statement read over the phone by a hotel manager. "The Pierre's priority is the safety of our guests and staff," the statement also said. The Pierre is owned by Taj Hotels Resorts and Palaces of India. The hotel attack comes about two weeks after Strauss-Kahn quit as managing director of the IMF, on May 18, after he was charged with sexually assaulting a maid at a different city hotel, the Sofitel, near Times Square. He has denied the allegations, but is under house arrest as he awaits trial.

– The Trump administration's Russia problem just got a lot worse, according to the New York Times' sources: Four officials say intelligence agencies have uncovered phone records and other evidence that members of Trump's campaign team and other aides were in contact with senior Russian officials during the campaign. The sources say that after routine NSA surveillance revealed the Trump associates' contact with Russian officials, the FBI made monitoring those officials a priority. CNN's sources say the Trump associates, including business contacts as well as high-level campaign aides, were in "constant communication" with the Russians, "raising a red flag" for intelligence agencies and law enforcement. The Times' sources say former Trump campaign Chairman Paul Manafort is among those being investigated, though he strongly denies having improper contacts. "I have never been involved with anything to do with the Russian government or the Putin administration or any other issues under investigation today," he says, adding: "It's not like these people wear badges that say, 'I'm a Russian intelligence officer.'" Kremlin spokesman Dmitry Peskov denied the report Tuesday, saying it's "not based on any facts," the AP reports. The Guardian notes that the new report of Russian links is trouble for Trump for several reasons, including the fact that it shows intelligence officials are still willing to leak material damaging to his administration.

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The officials said the intercepted communications were not limited to Trump campaign officials, and included other associates of Mr. Trump. On the Russian side, the contacts also included members of the government outside of the intelligence services, they said. All of the current and former officials spoke on the condition of anonymity because the continuing investigation is classified. The officials said that one of the advisers picked up on the calls was Paul Manafort, who was Mr. Trump’s campaign chairman for several months last year and had worked as a political consultant in Ukraine. The officials declined to identify the other Trump associates on the calls. The call logs and intercepted communications are part of a larger trove of information that the F.B.I. is sifting through as it investigates the links between Mr. Trump’s associates and the Russian government, as well as the hacking of the D.N.C., according to federal law enforcement officials. As part of its inquiry, the F.B.I. has obtained banking and travel records and conducted interviews, the officials said. Mr. Manafort, who has not been charged with any crimes, dismissed the officials’ accounts in a telephone interview on Tuesday. “This is absurd,” he said. “I have no idea what this is referring to. I have never knowingly spoken to Russian intelligence officers, and I have never been involved with anything to do with the Russian government or the Putin administration or any other issues under investigation today.” He added, “It’s not like these people wear badges that say, ‘I’m a Russian intelligence officer.’” Several of Mr. Trump’s associates, like Mr. Manafort, have done business in Russia. And it is not unusual for American businessmen to come in contact with foreign intelligence officials, sometimes unwittingly, in countries like Russia and Ukraine, where the spy services are deeply embedded in society. Law enforcement officials did not say to what extent the contacts might have been about business. ||||| (CNN) High-level advisers close to then-presidential nominee Donald Trump were in constant communication during the campaign with Russians known to US intelligence, multiple current and former intelligence, law enforcement and administration officials tell CNN. President-elect Trump and then-President Barack Obama were both briefed on details of the extensive communications between suspected Russian operatives and people associated with the Trump campaign and the Trump business, according to US officials familiar with the matter. Both the frequency of the communications during early summer and the proximity to Trump of those involved "raised a red flag" with US intelligence and law enforcement, according to these officials. The communications were intercepted during routine intelligence collection targeting Russian officials and other Russian nationals known to US intelligence. Among several senior Trump advisers regularly communicating with Russian nationals were then-campaign chairman Paul Manafort and then-adviser Michael Flynn. Officials emphasized that communications between campaign staff and representatives of foreign governments are not unusual. However, these communications stood out to investigators due to the frequency and the level of the Trump advisers involved. Investigators have not reached a judgment on the intent of those conversations. Adding to US investigators' concerns were intercepted communications between Russian officials before and after the election discussing their belief that they had special access to Trump, two law enforcement officials tell CNN. These officials cautioned the Russians could have been exaggerating their access. Trump dismissed the claims that his advisers had close ties to Russia in a tweet Wednesday. "This Russian connection non-sense is merely an attempt to cover-up the many mistakes made in Hillary Clinton's losing campaign," Trump tweeted. CNN has reached out to Flynn for comment. In an interview, Manafort emphatically denied that he was in contact with Russians known to US intelligence. "That is 100% not true, at least as far as me," he said. "I cannot believe that they are including me in anything like that. I have not been involved in any of these activities." Manafort said he did not know where US officials got the idea that he was in contact with suspected Russian operatives during the campaign but said he never spoke with any Russian officials during that time. "I don't remember talking to any Russian officials, ever. Certainly during the time we're talking about," he said, calling the allegations "boggling." "I have knowingly never talked to any intelligence official or anyone in Russia regarding anything of what's under investigation," he said. "I have never had any connection to (Russian President Vladimir) Putin or the Russian government before, during or after the campaign." Manafort said the FBI has not contacted him about the allegations and said he was not aware of any other Trump campaign officials or people close to Trump being in touch with Russians known to US intelligence. Manafort, who has held business ties with Russian and Ukrainian individuals, also emphasized that his work for the Yanukovich government in Ukraine should not be interpreted as closeness to the Russians. He said he worked for Yanukovich during a time when Ukraine was "moving into the European orbit." The extensive contacts drew concerns of US intelligence and law enforcement officials in part because it came at a time of Russian cyberactivities targeting mostly Democratic Party political organizations Post-election intelligence briefings on Russian meddling in the US elections included details of those communications, which included people involved in Trump's businesses. The communications were gathered as part of routine US intelligence collection and not because people close to Trump were being targeted. The FBI and US intelligence agencies continue to try to determine what the motive for the communications were. One concern was whether Trump associates were coordinating with Russian intelligence operatives over the release of damaging information about the Hillary Clinton campaign. "If that were the case, then that would escalate things," one official briefed on the investigation said.

a debate is currently ongoing about whether a large gastrointestinal stromal tumor ( gist ) should be treated by the laparoscopic approach because of the increased risk of tumor rupture during manipulation of the tumor with laparoscopic instruments and the resultant peritoneal tumor dissemination . herein , we report a case of a large gist of the stomach which was successfully treated by the laparoscopic approach . a 57 year old female patient visited our institution complaining of postprandial epigastric discomfort . an esophagogastroduodenoscopy and an abdominal computed tomography scan revealed a 108 cm sized submucosal tumor at the greater curvature side of the gastric antrum . the patient underwent laparoscopic distal gastrectomy with intracorporeal billroth - ii reconstruction without any breakage of the tumor . her postoperative course was uneventful and she was discharged on the 7th postoperative day . even a large gist of the stomach can safely be treated by the laparoscopic approach when it is performed with proper techniques by an experienced surgeon .

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gastrointestinal stromal tumor ( gist ) is the most common mesenchymal tumor of the gastrointestinal tract and it is most frequently found in the stomach . fifty to sixty percent of gists are found as a localized disease at presentation , and 95% can be completely resected . surgical resection with a 1~2 cm negative resection margin is the standard treatment for a non - metastatic gist . the most important oncologic principle while resectioning is to avoid rupturing the tumor during manipulation in order to circumvent peritoneal dissemination of the tumor which can result in poor prognosis of the patient , because the characteristic of the mass is soft and fragile . the tumor commonly metastasizes to the liver or the peritoneum but it rarely metastasizes to the lymph nodes . ( 1 - 4 ) while minimally invasive surgery has recently been gaining popularity in the resection of gists , it lacks evidence - based recommendation , especially in the resection of a gist larger than 5 cm . herein , we report a case of a large gist of the stomach which was successfully treated by the laparoscopic approach in order to investigate the technical feasibility and the oncologic safety of laparoscopic resection for large gists . an esophagogastroduodenoscopy ( egd ) and abdominal computed tomography ( ct ) scan were performed . on egd finding , a submucosal tumor was found at the posterior wall of the gastric antrum ( fig . 1 ) , and it was revealed by ct scan to be a 10 8 cm sized heterogeneously enhanced , well circumscribed solid mass arising from the posterior wall of the gastric antrum ( fig . the operator was positioned on the right side , and the first assistant was positioned on the left side of the patient . a 5 mm trocar and a 12 mm trocar on the right upper abdomen were used as working channels for the operator . another 5 mm trocar and a 12 mm trocar on left upper abdomen were used for the first assistant . 3 ) . the right gastroepiploic vessels were identified and doubly ligated with clips and the duodenum was resected with a laparoscopic linear stapler . the right gastric vessels and descending branches of the left gastric artery were identified and doubly ligated . the stomach was transected at 4 cm proximal from the upper border of the mass with a laparoscopic linear stapler . the specimen was placed into a plastic bag and retrieved through the umbilical port site which was extended to a 4 cm length ( fig . as the consistency of the mass was soft , even a 10 cm sized mass could be extracted through a 4 cm length incision without any breakage ( fig . oral feeding was started from the second postoperative day and the patient was discharged on the 7th postoperative day without any complication . the pathologic result was cd 117 and cd 34 positive gastrointestinal stromal tumor with 1 mitosis per 50 high power field ( intermediate risk ) . gastric wedge resection with a proper safety margin is the preferred type of surgery in treating gastric gist . however , the type of surgery can differ according to the size and location of the tumor . in some cases in which the tumor is located at the prepyloric area or around the esophagogastric junction , more extended surgery such as a partial gastrectomy or even a total gastrectomy can be necessary.(4 - 6 ) as the laparoscopic approach is gaining popularity in the treatment of gastric gist , many debates on its oncologic safety and relevance have arisen . the reported early postoperative outcomes of laparoscpic approaches have been comparable to or even better than those of the conventional open approach.(7 ) several reports have been presented about the comparable longterm oncologic outcomes of the laparoscopic approach for gist . however , most of these reports focus on the oncologic outcomes of small or medium sized ( less than 5 cm ) gists.(8 ) according to the national cancer care network guideline which was revised in 2010 , gastric gists 5 cm or smaller may be removed through laparoscopic wedge resection and the tumor should be removed in a protective plastic bag . however , in the case of a gist of more than 5 cm in size , the laparoscopic or hand - assisted approach was recommended because of the benefit of tactile feedback.(9 ) the reason for this recommendation is that if the size of the tumor is larger , the risk of rupture of the pseudocapsule by laparoscopic manipulation would be greater.(2 ) recently , an increasing number of reports have been presented for safe laparoscopic resection for larger gists due to the advancement of the laparoscpic technique . however , many reports still recommend open conventional resection for tumors which are more than 7~10 cm in size.(2,5 ) in our case , the authors successfully resected a large gastric gist of 10 cm in size without any breakage of the tumor using a meticulous laparoscopic surgical technique . to avoid tumor rupture , an attached fibrosis band was left on the tumor when resecting around the tumor , and if traction was needed , the fibrous tissue or normal gastric wall around the mass was used . as a result , there was no direct manipulation of the tumor during the operation . moreover , the size of the minilaparotomy incision could be minimized to 4 cm in extracting the 10 cm sized mass . the laparoscopic approach is feasible for a large gist of the stomach when proper laparoscopic techniques are used by an experienced surgeon . however , further study will be needed on the limitation of the size of the tumor in laparoscopic resection of gist .

abstractto clarify the effect of surgery on the prevention cerebral hemorrhage in adult moyamoya disease , we compared postoperative courses between superficial temporal artery - middle cerebral artery ( sta - mca ) anastomosis and conservative therapy . the study subjects were 30 adults with moyamoya disease . unilateral sta - mca anastomosis was conducted in 7 of these 30 cases , and bilateral sta - mca anastomosis was conducted in 8 of these 30 cases . therefore , anastomosis was performed in a total of 23 sides . the postoperative clinical course was observed for more than 5 years after the sta - mca anastomosis . cerebral hemorrhage occurred after operation in 2 sides ( 8.7% ) among the 23 sides that received sta - mca anastomosis . on the contrary , hemorrhage occurred during conservative therapy in 5 sides ( 13.5% ) among 37 non - operation sides ( no significance in 2 test ) . cerebral infarction occurred in 3 sides ( 13% ) among 23 sides treated with sta - mca anastomosis . however , the infarction occurred in 2 sides ( 5.4% ) among the 37 non - operation sides ( no significance in 2 test).cerebral hemorrhage tended to occur less frequently after sta - mca anastomosis , and bypass surgery was suggested to have some beneficial effect in preventing cerebral hemorrhage in adult moyamoya disease . however , it was revealed that sta - mca anastomosis exacerbated the brain ischemia . therefore , strict management is mandatory in the perioperative period .

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superficial temporal artery - middle cerebral artery ( sta - mca ) anastomosis has been attempted for the prevention of cerebral hemorrhage ; however , its effectiveness is unclear . to clarify the effect of operation on the prevention of cerebral hemorrhage in adult moyamoya disease , we compared postoperative courses between sta - mca anastomosis and conservative therapy . the onset was tia in 6 cases , cerebral infarction in 5 cases , cerebral hemorrhage in 8 cases , intraventricular hemorrhage in 4 cases , convulsion in 3 cases , depression in 1 case , and other symptoms in 3 cases . bilateral sta - mca anastomosis was conducted for 8 cases , and therefore , anastomosis was performed on a total of 23 sides . the postoperative clinical course was observed for more than 5 years after sta - mca anastomosis . cerebral hemorrhage occurred after the operation in 2 sides ( 8.7% ) among 23 sides treated with sta - mca anastomosis . ( table 1 ) these 2 patients had shown cerebral hemorrhage ( 1 case ) and intraventricular hemorrhage ( 1 case ) at the onset . on the contrary , hemorrhage occurred during conservative therapy in 5 sides ( 13.5% ) among 37 non - operation sides ( no significance in 2 test ) . these 5 patients had shown cerebral hemorrhage ( 2 cases ) , intraventricular hemorrhage ( 2 cases ) and transient ischemic attack ( tia ) ( 1 case ) at the onset . cerebral infarction occurred in 3 sides ( 13% ) among 23 sides treated with sta - mca anastomosis . ( table 2 ) these 3 patients had shown cerebral infarction ( 1 case ) , cerebral hemorrhage ( 1 case ) and convulsion ( 1 case ) at the onset . on the contrary , infarction occurred in 2 sides ( 5.4% ) among 37 non - operation sides ( no statistical significance in 2 test ) . these 2 patients had shown tia ( 1 case ) and convulsion ( 1 case ) at the onset . the sta - mca anastomosis operation was performed for 3 out of 6 patients with tia . for one among the 3 patients operated on cerebral hemorrhage in the side of sta - mca anastomosis and the non - operation side . cerebral hemorrhage happened after operation in 2 sides ( 8.7% ) among 23 sides of sta - mca anastomosis . on the contrary , hemorrhage occurred during conservative therapy in 5 sides ( 13.5% ) among 37 non - operation sides ( no significance in 2 test ) . cerebral infarction in the side of sta - mca anastomosis and the non - operation side . cerebral infarction occurred in 3 sides ( 13% ) among 23 sides of sta - mca anastomosis . on the contrary , infarction developed in 2 sides ( 5.4% ) among 37 non - operation sides ( no significance in 2 test ) . the patient was a 42-year - old female , who suffered from left hemiparesis and became comatose when she was 17 years old . an sta - mca anastomosis operation was performed on both sides 6 months after the first attack , and she had been in an independent condition thereafter . she presented with nausea , dizziness and right hemiparesis , and suffered from incomplete right hemiparesis and conjugate deviation to the left side upon admission . 1 ) cerebral angiography revealed that the collateral flow via sta - mca anastomosis and middle meningial artery was poor on the left side , compared with the right side . 2 ) the moyamoya vessels developed more prominently on the left side than the right side . she was treated conservatively and eventually walked independently , but marked aphasia remained . this case seems to show that poor revascularization and remaining moyamoya vessel are related with cerebral hemorrhage . it is suggested that decreasing the moyamoya vessels by adequate revascularization will be effective for preventing cerebral hemorrhage in the future . cerebral angiography 5 days after second attack . left cerebral angiography ( a , lateral view ) and right cerebral angiography ( b , lateral view ) . they revealed that collateral flow via sta - mca anastomosis ( arrow ) and middle meningial artery ( double arrow ) was poor on the left side , compared with the right side . the moyamoya vessels ( arrowhead ) developed more prominently on left side than right side . in bypass surgery for moyamoya disease , rebleeding was less likely to occur in patients who had undergone bypass or some other revascularization surgery . the rebleeding rate was 19.1% in the bypass surgery group in contrast to 28.3% in the conservative treatment group ( no significance ) . rebleeding was observed in 12.5% of patients who underwent bypass surgery and in 38.5% of patients who did not ( no significance ) . in the current series , cerebral hemorrhage occurred in 8.7% of sta - mca anastomosis sides in contrast to 13.5% of non - operation sides . cerebral hemorrhage tended to occur less frequently after sta - mca anastomosis and bypass surgery was suggested to have some beneficial effect in preventing cerebral hemorrhage in adult moyamoya disease . however , it was revealed that sta - mca anastomosis caused poor results for those with brain ischemia . cerebral infarction occurred in 3 sides ( 13% ) among 23 sides treated with sta - mca anastomosis . on the contrary , infarction occurred in 2 sides ( 5.4% ) among 37 non - operation sides . another report mentioned that 20% of patients presented with an ischemic event during the follow - up period after encephalo - duro - arterio - synangiosis .

– In one of the stranger events of a strange campaign season, Ben Carson and Ted Cruz ended up in a convention center storage closet for more than 20 minutes after looking for "neutral ground" to resolve some differences, the Daily Beast reports. The pair spent around 25 minutes in the closet after Cruz called the meeting before Thursday's night Conservative Review convention in South Carolina to discuss his campaign's "dirty tricks" during the Iowa caucuses. It's not clear whether the closet had chairs or lights, CBS notes. Despite the length of the meeting—which ended only when it began to run into Carson's convention speaking time—the campaigns do not seem to have resolved their differences. Carson communications strategist Jason Osborne tells the Beast that the meeting did not go well and Carson said afterwards that they "disagree on accountability and culpability." Osborne says they hadn't planned to tell the press about the meeting, "but it seems pretty clear that the other party involved had a different agenda." (Donald Trump accused Cruz of "illegally stealing" Iowa by claiming Carson had quit the race.)

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Ted Cruz asked Ben Carson on Thursday night to meet with him privately, the Carson campaign confirmed to CBS News. The meeting was called to discuss the Cruz campaign's tactics during the Iowa caucuses in which it spread a false rumor to voters about Carson dropping out of the race at that point. In a statement provided to CBS, the Carson campaign said, "Clearly they (the Cruz campaign) thought the meeting would produce something for them politically" and that "it appears that Cruz still resists accepting any responsibility." The meeting, which was first reported by The Daily Beast, happened in a storage closet just before the Conservative Review convention, according to the report. There may not have been chairs or lights in the closet, the report said. A GOP operative who witnessed the meeting told The Daily Beast that the two candidates were in the closet for about 20 to 25 minutes as Carson's Secret Service detail waited outside. Carson wanted the meeting to remain off the record, and suggested that the Cruz campaign leaked it to the press. The retired neurosurgeon said earlier this month that Cruz had asked for a one-on-one meeting to discuss what happened on the night of the Iowa caucuses on Feb. 1. Jason Osborne, senior communications strategist, for Carson's campaign told The Daily Beast that the candidate was informed about the meeting late and didn't have time to prepare and as a result it "did not go well." Their secret meeting comes before South Carolina's GOP primary on Saturday. CBS News' Erica Brown contributed to this story. ||||| Two grown men running for president met in a storage closet last night. The meeting, called by Ted Cruz in an attempt to mend fences with Ben Carson ahead of the South Carolina primary, was held on Thursday night before the Conservative Review convention. The two huddled in the unusual venue for nearly 20 to 25 minutes, as Carson’s Secret Service detail stood outside, according to a Republican operative who witnessed the strange scene. Carson, whose campaign has spent the weeks after Iowa blasting Cruz for lying to voters in the Hawkeye State, agreed to meet him for five minutes, according to a source close to Carson’s campaign, to try to put to bed the issue of his dirty campaign tricks in Iowa, during which Cruz’s campaign told caucus-goers that Carson had dropped out of the race. Carson’s campaign confirmed the meeting—which was was supposed to be short and off-the-record—and blamed the Cruz campaign for leaking the fact that it occurred in an attempt to rectify his public image. Given previous opportunities to accept responsibility for his actions, Cruz blamed a report from CNN, alleging that it misled his campaign into thinking that the former neurosurgeon was no longer in the presidential contest. In the weeks after the Iowa caucus, the 2016 Committee, a PAC affiliated with Carson, has spent a great deal of time fundraising off of Cruz’s lie. Cruz has been under fire since Iowa from Donald Trump, Carson, and now Marco Rubio for what they call dirty campaign tricks. Most recently the Rubio campaign slammed Cruz for a ridiculous photoshopped image that depicted Marco Rubio shaking (left) hands with President Obama. “We weren’t going to comment to the press on it, but it seems pretty clear that the other party involved had a different agenda,” Jason Osborne, senior communications strategist for Carson’s campaign, told The Daily Beast. “How else could we perceive that to be?” He said that he was informed late about the meeting and didn’t have time to prepare Carson at all. It “did not go well.” The meeting, which took place in a storage closet across from a bathroom at the convention center on Thursday, ended with Carson saying “we agree to disagree.” “We disagree on accountability and culpability,” is how Carson put it, according to Osborne. A Republican operative told The Daily Beast that the Cruz campaign wanted to have the conversation on “neutral ground,” so they would not allow for it to take place in Carson’s green room, which was right next to Cruz’s. Reporters were allegedly already calling the Carson campaign as the meeting was going on, with the two full-grown men in a closet that allegedly had no chairs, which indicates that someone leaked details in advance of The Daily Beast being informed about the meeting. Get The Beast In Your Inbox! Daily Digest Start and finish your day with the top stories from The Daily Beast. Cheat Sheet A speedy, smart summary of all the news you need to know (and nothing you don't). By clicking “Subscribe,” you agree to have read the Terms of Use and Privacy Policy Subscribe Thank You! You are now subscribed to the Daily Digest and Cheat Sheet. We will not share your email with anyone for any reason. Secret Service members were guarding the door and simply said to a Republican operative in the hallway: “Yeah, they’re in that closet.” It is unclear if there were lights inside of it. The conversation lasted so long that it bled into Carson’s speaking time at the convention, leaving members of his campaign having to knock on the door to get him ready. After Carson spoke at the convention, and saw Cruz in the hallway again, Cruz didn’t even look at Carson, according to the latter’s campaign. “There was a political play there and it didn’t work for them,” a Republican operative close to the campaign told The Daily Beast. “The meeting didn’t go as well as Cruz wanted it to go. Carson had a smile on his face and was looking right at him.” When reached for comment, Rick Tyler, a spokesman for Cruz’s campaign, said, “Yes, they had a good visit.”

here , we report metagenome from the tuwa hot spring , india using shotgun sequencing approach . metagenome consisted of 541,379 sequences with 98.7 mbps size with 46% g + c content . metagenomic sequence reads were deposited into the embl database under accession number erp009321 . community analysis presented 99.1% sequences belong to bacteria , 0.3% of eukaryotic origin , 0.2% virus derived and 0.05% from archea . unclassified and unidentified sequences were 0.4% and 0.07% respectively . a total of 22 bacterial phyla include 90 families and 201 species were observed in the hot spring metagenome . firmicutes ( 97.0% ) , proteobacteria ( 1.3% ) and actinobacteria ( 0.4% ) were reported as dominant bacterial phyla . in functional analysis using cluster of orthologous group ( cog ) , 21.5% drops in the poorly characterized group . using subsystem based annotation , 4.0% genes were assigned for stress responses and 3% genes were fit into the metabolism of aromatic compounds . the hot spring metagenome is very rich with novel sequences affiliated to unclassified and unidentified lineages , suggesting the potential source for novel microbial species and their products .

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http://www.ebi.ac.uk/ena/data/view/erp009321 culturability of microorganisms in extreme habitats is usually very poor , which creates the need to explore the culture - independent techniques to evaluate the taxonomic and functional status of the microbes . currently , either 16s rrnas amplicon based metagenome sequencing or shotgun metagenome sequencing is largely used for the assessment of the microbial diversity , . such culture - independent techniques have been successfully used for comprehensive analysis of microbial populations in hot spring . metagenomic study of hot springs produced huge information , providing holistic images of the microbial communities present in hot springs . therefore , hot spring microbial communities largely encompass the thermophilic , hyperthermophilic and polyextremophilic microbes . india is endowed with 340 thermal hot water springs , presenting an opportunity to study their microbial ecology to trap the novel species and genes . hot spring of indian subcontinent offers an attractive and challenging platform for researchers due to the existence of unknown and untapped microbial communities . many hidden microbial species and genes have been revealed in culture - independent microbial diversity assessment of tulsi shyam and lasundra hot spring , india , . tuwa hot spring ( 2247'58"n and 7327'37"e ) is one of the unexplored hot water springs situated in panchmahal district , gujarat state , india . the temperature of tuwa hot spring is usually recorded between 54 to 65 c and water is alkaline with high salt and minerals content . the bottom of the reservoir has hard rocks and photosynthetic microbes thrive in the water column . to the best of our knowledge , the microbial diversity and biogeological study of tuwa hot water springs has not yet been investigated . the present research is the first investigation to describe the microbial diversity by metagenomics approach . the water sample was collected in thermos bottle and transported to the laboratory for the physicochemical analysis . the microbial community dna from the hot spring water was isolated and purified by silica spin columns using hipurawater dna isolation kit ( mb547 ; hi - media , mumbai , india ) . isolated metagenomic dna was subjected to the sequencing after the testing of quality and purity using agarose gel electrophoresis and spectrophotometer . shotgun metagenomic sequencing was performed with an ion torrent pgm platform using ion express template 300 chemistry on a 318 chip as per the manufacturer 's instructions . analysis and annotation of output data were carried out by mg - rast , an online server using default parameter . during the sampling of water from tuwa hot springs , ph was reported ranging from 8.2 to 9.0 and conductivity was 19 s / cm . the elemental composition of hot spring water ( mg / l ) showed the sodium19.93 , potassium 14.5 , calcium 0.5 , chloride 15.8 and sulphate 1.83 , carbonate 2.4 and bicarbonate 0.4 . the output data encompassed a total of 541,379 sequences comprised of 98,773,736 bps with 46% g + c content . the microbial community analysis revealed predominance of domain bacteria ( 99.1% ) , followed by unclassified sequences ( 0.4% ) eukaryota ( 0.3% ) , viruses ( 0.2% ) , unidentified sequences ( 0.07% ) , and archaea ( 0.05% ) . at phyla level , a total of 22 diverse microbial phyla together with unclassified category were depicted in the metagenome . most abundant sequences affiliated to bacterial phyla were firmicutes ( 97.0% ) followed by proteobacteria ( 1.3% ) and actinobacteria ( 0.4% ) . whereas ascomycota ( 0.08% ) and chordata ( 0.08% ) were abundant eukaryotic phyla and prominent archaeal phylum was euryarchaeota ( 0.05% ) . metagenomes comprised a total of 90 families with the abundant existence of bacillaceae ( 94.6% ) followed by paenibacillaceae ( 0.4% ) and clostridiaceae ( 0.4% ) . at the species level , the most common bacterial species reported were bacillus licheniformis ( 40% ) and bacillus subtilis ( 26% ) ( fig . 1 ) . thermophilic alkaline serine protease producing b. licheniformis was reported from the same territory at unnai hot spring , india . functional analysis was also performed using mg - rast server . out of the 350,069 sequences that exceeded quality control , of these 170,681 predicted protein features , 127,064 ( 74.4% ) of features have been assigned an annotation using at least one of the protein databases ( m5nr ) and rest of 25.6% of features have no significant similarities to the protein database . in the functional annotation , a total of 218,926 features were assigned to functional categories with cog approach and 47,049 sequences ( 21.5% ) falls in the poorly characterized group . out of them , likewise , the annotation with non - supervised orthologous groups ( nog ) approach , 16,754 predicted functions assigned and interestingly 13,619 sequences ( 81.3% ) falls in the poorly characterized group and out of them 93% were an unknown function . based annotation approach , 4% genes belonged to stress responses for the oxidative stress , osmotic stress , heat shock , acid shock , periplasmic stress , detoxification , desiccation stress and cold shock . likewise , 3% genes were assigned for the metabolism of aromatic compounds ( fig . 2 ) . furthermore , many key biotechnological process and product encoding genes were detected in the hot spring metagenome . the result indicates the shared activities of thermophilic microbes useful to access the metagenome as a resource of novel molecular sequence space . the study presented a considerable microbial diversity and offers insights into microbial community composition , distribution and abundance . a number of dna sequences remained taxonomically and functionally unanswered representing potentially novel microorganisms and genes in the hot spring .

abstractmoyamoya disease is an extremely rare cerebrovascular condition that predisposes affected patients to stroke in association with progressive stenosis of the intracranial internal carotid arteries and their proximal branches . to our knowledge , this is the first report of a lethal complication due to moyamoya disease after septorhinoplasty . a 25-year - old female caucasian patient presented to our outpatient clinic with impaired nasal breathing for septorhinoplasty . regrettably the patient died 6 days postoperatively due to progressive infarct series affecting all major cerebral vessels . despite a thorough knowledge of possible local complications after septorhinoplasty , it is of utmost importance to consider rare general complications like moyamoya disease . although cerebral infarctions are very rare in young people , it is crucial to identify and correctly interpret underlying typical symptoms .

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first described in 1957 , moyamoya disease is an extremely rare cerebrovascular condition that predisposes affected patients to stroke in association with progressive stenosis of the intracranial internal carotid arteries and their proximal branches . further , reduced blood flow in the major vessels of the circulation of the anterior brain leads to compensatory development of collateral vasculature that can lead to haemorrhage . on angiography , the formation of these fragile vessels appears as a puff of cigarette smoke , named moyamoya in japanese . besides the aforementioned typical radiographic findings and the prevalence to asian origin , moyamoya can also be associated with conditions such as radiotherapy of the head and neck , dwarfism and others . here , we report a young female caucasian patient , who underwent functional septorhinoplasty and afterwards suffered from a series of cerebral infarctions due to an occult underlying moyamoya disease . a 25-year - old female caucasian patient presented to our outpatient clinic with impaired nasal breathing due to nasal deviation caused by a deviated septum ( figures 1 and 2 ) . the patient s medical history was significant for left - sided otosclerosis , arterial hypertension , dwarfism , thoracic kyphoscoliosis , several allergies , for example , nickel and synthetic flavours , and headache 1 week prior to surgery . besides lercanidipine 5 mg / day for 1 week prior to hospital admission , no further medication was recorded . about 6 hours after functional septorhinoplasty under uneventful general anaesthesia , the patient complained of dysphonia and nausea . for symptomatic treatment of the nausea , granisetron 3 mg diluted in 100 ml sodium chloride solution were administered , and the patient was presented to the otolaryngologist to exclude laryngeal violation during tracheal intubation in general anaesthesia as cause for dysphonia . one hour later the patient additionally suffered from left haemiplegia and a fixed right - view . computed tomography of the brain revealed a large subacute right middle cerebral artery infarct and a small subacute infarct in the left posterior cerebral artery . cerebral angiography and magnetic resonance angiography revealed bilateral stenosis of the internal carotid and middle cerebral arteries with a puffy collateral vascular network typical for moyamoya disease ( figure 3 ) . the patient was transferred to the stroke unit and further on underwent parietal craniotomy of the right side for intracranial pressure release . trans - oesophageal echocardiography revealed no persistent ovale foramen or other cardiac anomalies ; further investigation also showed no further risk factors for cerebral infarctions , besides the mentioned moyamoya disease . regrettably the patient died 6 days postoperatively due to progressive infarct series affecting all major cerebral vessels . frontal view of the patient with nasal breathing impairment due to nasal deviation caused by a deviated septum . computed tomography image of the septum deviation causing nasal breathing impairment . cerebral angiography showing the internal carotid ( a ) and middle cerebral arteries ( b ) with a puffy collateral vascular network ( arrows ) typical for moyamoya disease . cerebral infarctions in young adults are extremely rare with an incidence rate at 11.3 cases per 100,000 people per year in the white population . of them , approximately 10 14% occur in young adults aged between 18 and 45 years and their incidence , risk factors and aetiology differ notably from those in older patients . among others , congenital or acquired heart disease , haematological and metabolic disorders , substance abuse and vasculopathies have been identified as prothrombotic conditions . among vasculopathies , moyamoya is a very rare entity , which majorly affects asians but rarely caucasians . besides the other already - mentioned associated conditions , it is reported that patients with moyamoya disease can also suffer from headache , arterial hypertension and dwarfism afflictions that we also saw in our patient . one day prior to septorhinoplasty the patient s blood pressure was 150/90 mmhg , the anaesthesiology protocol revealed a minimum blood pressure of 115/60 mmhg during general anaesthesia . one week prior to surgery the patient suffered from headaches and arterial hypertension , for which she received lercanidipine 5 mg / day from her general practitioner . previous studies have shown that patients with moyamoya disease have very limited haemodynamic reserves and that just a moderate decrease in cerebral blood perfusion , as seen during antihypertensive therapy or during general anaesthesia , may predispose and lead to cerebral infarctions . in our case the initial symptoms of a cerebral stroke such as dysphonia and nausea have been misinterpreted as results of the tracheal intubation and general anaesthesia , which led to a delay in the correct diagnosis . in case of a devastating complication such as cerebral infarction after an elective procedure in a young patient , quick diagnosis , decision taking and an interdisciplinary approach may be crucial for patient s survival and an adequate management of the particular complication . although complications after septorhinoplasty are reported , they mostly affect the surgical site . to our knowledge , this is the first report of a lethal complication due to moyamoya disease after septorhinoplasty . we feel obliged to report this dreadful complication , so that our fellow surgeons may have the opportunity to correctly identify evidence as well as symptoms of underlying moyamoya disease and thus enable them avoid such disastrous complications in the future . we conclude that despite a thorough knowledge of possible local complications after septorhinoplasty , it is of utmost importance to consider rare general complications like moyamoya disease , even more whenever a patient suffers from associated afflictions such as headaches , arterial hypertension and dwarfism . although cerebral infarctions are very rare in young people , it is crucial to identify and correctly interpret underlying typical symptoms .

verrucous epidermal nevi are congenital , noninflammatory cutaneous hamartomas composed of keratinocytes . they follow the lines of blaschko and show hyperkeratosis without cellular atypia . the routine histology shows variable amount of hyperkeratosis , acanthosis and papillomatosis and rarely epidermolytic hyperkeratosis . we saw a 3-year - old boy with bilaterally symmetrical , systematized verrucous plaques along the lines of blaschko extensively involving the trunk and extremities but sparing the face and palmoplantar skin . histopathology showed features of epidermal nevi with prominent epidermolytic hyperkeratosis . we report here the case for the rarity of this entity .

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epidermal nevi are hamartomatous proliferations of the epithelium , including keratinocytes , sebocytes , pilosebaceous units , eccrine glands , or apocrine glands . verrucous epidermal nevi ( ven ) are non - inflammatory keratinocytic hamartomas composed of keratinocytes . vens are characterized by linearly arranged , closely set , gray - brown to black verrucous papules . the term systematized denotes many linear lesions limited to one side of the body or having a bilateral symmetrical distribution . the histological changes of ven are variable hyperkeratosis , acanthosis and papillomatosis . apart from this usual picture there are some rarer histological patterns including epidermolytic hyperkeratosis . epidermal nevi of the epidermolytic type are rare and represent mosaic expression of epidermolytic hyperkeratosis also known as linear or nevoid bullous ichthyosiform erythroderma ( bie ) . we hereby report a case of extensive bilaterally symmetrical systematized epidermal nevus occurring along the lines of blaschko and showing epidermolytic hyperkeratosis on histology in a 3-year - old boy for the rarity of the entity . a 3-year - old boy , the only child of a non - consanguineous parentage , presented with widespread warty eruption all over the body including the genitalia but sparing the scalp , face and palms and soles . the eruption began when the child was 3 weeks of age with lesions appearing first symmetrically over anterior thigh , and then over the axillae , and within a period of about 6 months progressed to attain the present distribution . examination showed multiple , bilaterally symmetrical , verrucous plaques along the lines of blaschko extensively involving the trunk and extremities [ figure 1 ] . the linear plaques ran transversely over the trunk and longitudinally over the limbs [ figures 2 and 3 ] . focal epidermolytic hyperkeratosis was evident in the form of perinuclear vacuolization of keratinocytes of the upper epidermis with coarse keratohyaline granules [ figure 4 ] . based on the characteristic clinical and histopathological features , a diagnosis of bilateral , systematized epidermolytic verrucous epidermal nevus was made . bilaterally symmetrical verrucous plaques along the lines of blaschko symmetrical , linear verrucous plaques along the lines of blaschko over the buttock and back of thighs transversely arranged , bilaterally symmetrical linear verrucous plaques over the back histopathology showing massive hyperkeratosis and focal granular degeneration of the epidermis . epidermal nevi of all types are considered an expression of genetic mosaicism arising from somatic mutation in the affected skin but sparing the unaffected skin . the most common pattern of keratinizing epidermal nevi is verrucous epidermal nevus presenting as verrucous , serpiginous plaque following the lines of blaschko . bilaterally symmetrical involvement is also called ichthyosis hystrix . while there are many histologic variants of the epidermal nevus , most cases demonstrate variable degrees of hyperkeratosis , acanthosis , and papillomatosis . rare histological variants include epidermolytic hyperkeratosis and variants resembling acrokeratosis verruciformis , verruca vulgaris , darier disease , porokeratosis , seborrheic keratosis or psoriasis . identical histology of epidermolytic ven and bie results from a clone of cells expressing a mutation in one of the bie genes krt 1 and krt 10 in the former . bie , a rare autosomal dominant disorder , presenting as severe blisters and erythroderma at birth which usually subsides as the child grows and is replaced by appearance of thick , dark , hyperkeratotic skin especially on joints , apposed skin , scalp and neck for the rest of life . by analogy with bie , patients of epidermolytic ven are expected to be blistered at birth but they do not show such tendency , which was also evident in our case . epidermolytic ven occurs sporadically and is not heritable , but a parent with such nevus may have gonadal mutation as well and can produce offspring with classical bie . although ven may be associated with cerebral and other internal manifestations in the form of epidermal nevus syndrome , epidermolytic variety is not associated with extracutaneous abnormalities as in our case as keratin genes are expressed only in the epithelia . the clinical differentials of systematized epidermolytic ven include non - epidermolytic ven , verrucous stage of incontinentia pigmenti , ichthyosis bullosa of siemens , and ichthyosis hystrix of curth and macklin . incontinentia pigmenti produces systematized lesions along the lines of blaschko and characteristically evolves through four clinical stages ( bullous , verrucous , hyperpigmentation , and hypopigmentation ) and exhibits eosinophilic spongiosis on histology . ichthyosis bullosa of siemens is caused by mutation of keratin 2 gene and may show mild phenotype of bie . ichthyosis hystrix of curth macklin may show systematized rigid spiky hyperkeratosis and its histopathology exhibits non - specific features of hyperkeratosis , acanthosis , and papillomatosis without epidermolysis . epidermolytic hyperkeratosis ( ehk ) refers to the combination of compact hyperkeratosis , perinuclear vacuolization of keratinocytes of the upper layers of epidermis , and coarse keratohyalin granules . these changes may occur incidentally in a large number of acquired benign and malignant conditions . however , only two congenital conditions besides bie may show these changes : ichthyosis bullosa of siemens and epidermolytic palmoplantar keratoderma of vorner . associated bacterial overgrowth can be treated with antibacterial soaps and when necessary , oral antibiotics . topical agents have a limited role and various agents had been used to decrease the hyperkeratosis . these include preparations containing salicylic acid , lactic acid , retinoic acid , 5-fluorouracil , calcipotriol and calcitriol . oral and topical retinoids have also been shown to improve patients with ehk although retinoids may promote desquamation and exacerbate blistering . continuous - wave carbon dioxide laser vaporization has been used with benefit for extensive ven . we reported a case of extensive , bilaterally symmetrical , systematized verrucous epidermal nevus of epidermolytic variety .