613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

Background Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. Methods Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. Results We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. Conclusions Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture

Photovoltaic Plant Output Power Forecast by Means of Hybrid Artificial Neural Networks

The main goal of this chapter is to show the set up a well-defined method to identify and properly train the hybrid artificial neural network both in terms of number of neurons, hidden layers and training set size in order to perform the day-ahead power production forecast applicable to any photovoltaic (PV) plant, accurately. Therefore, this chapter has been addressed to describe the adopted hybrid method (PHANN—Physic Hybrid Artificial Neural Network) combining both the deterministic clear sky solar radiation algorithm (CSRM) and the stochastic artificial neural network (ANN) method in order to enhance the day-ahead power forecast. In the previous works, this hybrid method had been tested on different PV plants by assessing the role of different training sets varying in the amount of data and number of trials, which should be included in the “ensemble forecast.” In this chapter, the main results obtained by applying the above-mentioned procedure specifically referred to the available data of the PV power production of a single PV module are presented

A post-contact Aboriginal mortuary tree from southwestern Victoria, Australia

Here we document the investigation of the first Australian Aboriginal mortuary tree found since the early 20th century and the first studied by archaeologists and Aboriginal traditional owners. In 2001, a landowner discovered Aboriginal skeletal remains inside a fallen, dead tree while evaluating the tree’s potential as firewood, leading to the investigation of the site. The tree was located near Moyston, in southwestern Victoria, in traditional Djab Wurrung country and held the partial skeletons of three Aboriginal individuals—two adults and a child. Clay pipe-stem wear on several teeth belonging to the two adults indicates that these remains were broadly contemporaneous secondary placements from the early post-contact period (ca. A.D. 1835–1845). Along with five additional mortuary trees within 30 km of the Moyston tree, this practice constitutes a previously unknown traditional mortuary pattern and contributes to our understanding of the complex mortuary behavior of the Aboriginal people of southwestern Victoria

Key issues in the conservation of the Australian coastal archaeological record: natural and human impacts

Australia has an extensive coastline extending over 60,000 km through diverse tropical and temperate environments. Indigenous archaeological sites are found along this coastline from the time of earliest settlement at least 50,000 years ago. However, Pleistocene sites are rare owing largely to the destructive impacts of sea-level change associated with the end of the last ice age around 10,000 years ago. After this sites are more numerous but there is variability around the coastline due to the impact of a range of both natural and human factors. Here we focus on six key issues impacting on the development and conservation of coastal archaeological deposits: sea-levels, climate change, cyclones, storms, tsunamis and contemporary human impacts. A number of examples of these impacts are discussed from across Australia. Managing and monitoring of sites has been limited in Australia and geoindicators are discussed as a means of developing a long-term measurement of continuing impacts

Immunotoxins for targeted cancer therapy

Immunotoxins are proteins that contain a toxin along with an antibody or growth factor that binds specifically to target cells. Nearly all protein toxins work by enzymatically inhibiting protein synthesis. For the immunotoxin to work, it must bind to and be internalized by the target cells, and the enzymatic fragment of the toxin must translocate to the cytosol. Once in the cytosol, 1 molecule is capable of killing a cell, making immunotoxins some of the most potent killing agents. Various plant and bacterial toxins have been genetically fused or chemically conjugated to ligands that bind to cancer cells. Among the most active clinically are those that bind to hematologic tumors. At present, only 1 agent, which contains human interleukin-2 and truncated diphtheria toxin, is approved for use in cutaneous T-cell lymphoma. Another, containing an anti-CD22 Fv and truncatedPseudomonas exotoxin, has induced complete remissions in a high proportion of cases of hairy-cell leukemia. Refinement of existing immunotoxins and development of new immunotoxins are underway to improve the treatment of cancer