Aerosol particulate matter in the Baltimore metropolitan area: Temporal variation over a six-year period.

UNLABELLED: This study investigates the sources of fine particulate matter (aerodynamic diameter ≤2.5 µm; PM(2.5)) composition for the Baltimore, Maryland, metropolitan area, covering a 6-year period (2008-2013). Data obtained from the U.S. Environmental Protection Agency (EPA) Air Quality System (AQS) were used for the identification of eight chemical speciation clusters (factors), which, as a percentage of the average concentration, were identified as secondary sulfate (31.9%), secondary nitrate (14.3%), gasoline (17.4%), diesel (10.1%), soil (4.0%), biomass burning (11%), marine aerosol (4.1%), and industrial processing (7.2%). The results show predominant influence from vehicle emissions transiting major highways I-695 and I-95 located in the vicinity of the sampling site. Strong influence on PM2.5 mass from biomass burning was found in the first 2 years (2008-2009) due to particulate matter remnants from forest fire events in North Carolina and a strong contribution in 2013 that was due mainly to wood burning during winter. Sulfate, nitrate, soil, and marine aerosol fractions registered very low variability over the 6-year period analyzed. In addition, this study shows a significant reduction in particulate matter from industrial origins after a major industrial source in Baltimore shut down. The results obtained from Baltimore were compared with those from the Beltsville, Maryland, sampling station located 25 miles south of Baltimore for 2011 and 2012, where good agreement was found for most of the factors. IMPLICATIONS: This paper presents the first long-term aerosol speciation analysis in a Mid-Atlantic United States metropolitan area, which is essential for the air quality management agencies in order to revise regulations and reduce human exposure to adverse air quality conditions. The results suggest that although a declining trend in the overall PM2.5 was observed, no significant tendency was observed in the identified sources besides exceptional events such as the impact of wildfires on local air quality and downward contribution from industrial fraction of PM(2.5) after the Steel Mill at Sparrows Point closure in 2012.

Epidemiological Overview of Overweight and Obesity Related to Eating Habits, Physical Activity and the Concurrent Presence of Depression and Anxiety in Adolescents from High Schools in Mexico City: A Cross-Sectional Study.

Overweight and obesity in adolescents has become a serious public health problem worldwide and Mexico City is no exception. Therefore, the objective of this study was to investigate the epidemiological panorama of overweight and obesity related to eating habits, physical activity and the concurrent presence of depression and anxiety in adolescents from high schools in Mexico City. Anthropometric measurements were taken from 2710 adolescents from 33 participating high schools. Likewise, a previously validated eating habit and physical activity questionnaire was administered, which consisted of four different sections, where each of the sections focused on key aspects of the participants' lifestyle: (1) eating habits, (2) intake of non-recommended foods, (3) food and company environment, and (4) physical activity. Moreover, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression was applied. In this study, a high prevalence of overweight and obesity (26.5% overweight and 20.0% obese) was found in adolescents from high schools in Mexico City. Only 13.14% of participants had adequate eating habits and 18.19% physical activity habits. An association was found between having inadequate eating habits and obesity in adolescent women (OR = 1.95; CI 1.009-3.76). Additionally, associations were observed between depression symptoms and obesity (OR = 5.68, CI 1.36-32.81; p = 0.01), while anxiety was associated with underweight and obesity adjusted by other dietary habits and psychological factors. Therefore, it is important to identify adolescents with overweight or obesity and establish prevention strategies for weight control in this age group, promoting healthy eating, physical activity and education in mental health.

Improving documentation of blood product administration using a standardized electronic health record-based system: a single-institution experience.

OBJECTIVES: To improve documentation of blood product administration by assessing the completion status of blood transfusions. In this way, we can ensure compliance with the Association for the Advancement of Blood & Biotherapies standards and facilitate investigation of potential blood transfusion reactions. METHODS: This before-and-after study includes the implementation of an electronic health record (EHR)-based, standardized protocol for documenting the completion of blood product administration. Twenty-four months of retrospective data (January-December 2021) and prospective data (January-December 2022) were collected. Meetings were held before the intervention. Ongoing daily, weekly, and monthly reports were prepared, and targeted education to deficient areas as well as spot in-person audits by the blood bank residents were conducted. RESULTS: During 2022, 8,342 blood products were transfused, of which 6,358 blood product administrations were documented. The overall percentage of completed transfusion order documentation improved from 35.54% (units/units) in 2021 to 76.22% (units/units) in 2022. CONCLUSIONS: Interdisciplinary collaborative efforts helped produce quality audits to improve the documentation of blood product transfusion through a standardized and customized EHR-based blood product administration module.

VOC and trace gas measurements and ozone chemistry over the Chesapeake Bay during OWLETS-2, 2018.

The Ozone Water-Land Environmental Transition Study, 2018 (OWLETS-2) measured total non-methane hydrocarbons (TNMHC) and EPA PAMS Volatile Organic Compounds (VOCs) on an island site in the northern Chesapeake Bay 2.1 and 3.4 times greater in concentration, respectively, than simultaneous measurements at a land site just 13 km away across the land-water interface. Many PAMS VOCs had larger concentrations at the island site despite lower NEI emissions over the water, but most of the difference comprised species generally consistent with gasoline vapor or exhaust. Sharp chemical differences were observed between the island and mainland and the immediate air ~300 m above the water surface observed by airplane. Ozone formation potential over land was driven by propene and isoprene but toluene and hexane were dominant over the water with little isoprene observed. VOC concentrations over the water were noted to increase diurnally with an inverse pattern to land resulting in increasing NOx sensitivity over the water. Total reactive nitrogen was lower over the water than the nearby land site, but reservoir compounds (NOz) were greater. Ozone production rates were generally slow (~5 ppb hr-1) both at the surface and aloft over the water, even during periods of high ozone (>70 ppbv) at the water surface. However, specific events showed rapid ozone production >40 ppb hr-1 at the water's surface during situations with high VOCs and sufficient NOx. VOC and photochemistry patterns at the island site were driven by marine sources south of the island, implicating marine traffic, and indicate ozone abatement strategies over land may not be similarly applicable to ozone over the water.Implications: Measured chemical properties and patterns driven primarily by marine traffic sources over water during ozone conducive conditions were starkly different to immediately adjacent land sites, implying ozone abatement strategies over land may not be similarly applicable to ozone over the water.

Prognostic Significance of p53 and p63 in Diffuse Large B-Cell Lymphoma: A Single-Institution Experience.

Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma in adults. We evaluated the immunohistochemical (IHC) expression of p63 and p53 in DLBCL and their significance on overall survival (OS) and progression-free survival (PFS). We conducted a retrospective cohort study of 177 patients with DLBCL who presented to Mount Sinai Medical Center of Florida (Miami Beach, Florida) between 2010 and 2020. IHC staining for p63 and p53 protein expression was performed. A significant correlation was found between p63 positivity and p53 expression, p53/p63 co-positivity, Ki-67 proliferation index, MYC expression, and MYC/BCL2 double expression. Regardless of the germinal center B-cell like (GCB) subgrouping, there was a trend among p53+ patients to have MYC/BCL2 double expression, positive MYC expression, and lower OS and PFS. A tendency of poor OS was seen in p53+ patients in the non-GCB, GCB, and double expressors subgroups and poor PFS in p53+ patients regardless of the subgrouping. In conclusion, our results suggest that p63 and p53 may represent potential additional prognostic biomarkers in DLBCL and may be included in the initial diagnostic work up of patients with DLBCL.

Papillary cystadenoma of the epididymis.

Background: Papillary cystadenoma is a rare benign neoplasm of the epididymis. It may occur sporadically or in association with von Hippel-Lindau disease (VHLD). Papillary cystadenoma of the epididymis (PCE) is a benign mimic of metastatic clear cell renal cell carcinoma (CCRCC) given their histologic similarities. Case presentation: Herein, we present the case of a 40-year-old man with a four-year history of microhematuria and a recently detected right paratesticular mass. A testicular sonogram revealed a hypoechoic, hypervascular solid mass in the right epididymal head treated by surgical excision. Histopathological examination demonstrated a 1.1 cm papillary cystadenoma of the epididymis. Genetic testing performed later showed no signs of VHLD. However, heterozygous mutations in three genes - CASR, POT1, and RAD51D - were found which have never been reported in PCE before. Conclusions: Papillary cystadenoma of the epididymis should always be considered in the differential diagnosis of epididymal lesions, especially those that are cystic. The mainstay of treatment remains surgical excision, which provides an excellent prognosis.

Rare thymopharyngeal duct cyst presentation in an adult patient.

Retained thymic tissue may occur anywhere along the path of descent of the thymus. Cervical thymic cysts are a rare cause of benign neck masses. Thymopharyngeal duct cysts are thymic cysts that span the length of the neck and extend towards the mediastinum. These lesions are rare and classically have been described in paediatric patients. Here, we present the case of a 23-year-old woman with a left-sided neck mass, which was found to be a thymopharyngeal duct cyst. Multiple analytic modalities including the clinical presentation, imaging, operative findings and histology were required to confirm the diagnosis and are discussed below.

Primary Histiocytic Sarcoma in Adult Polycystic Kidney Disease: Case Report and Review of Literature.

Genetically driven tissue destruction followed by remodeling in adult polycystic kidney disease (APKD) raises the possibility of malignant transformation. Renal cell carcinoma (RCC) associated with APKD has been frequently reported in the literature; however, only a few cases of nonepithelial neoplasms arising in APKD have been described so far. Histiocytic sarcoma (HS) is a lymphohematopoietic malignant neoplasm that accounts for less than 1% of hematologic malignancies. In this article, we describe a case of primary HS occurring in a 61-year-old man with end-stage renal disease secondary to APKD. This is the first reported case of primary HS in the setting of APKD. The aberrant h-caldesmon expression seen in this case is another novel finding that has previously not been described. This case highlights the importance of morphology in guiding diagnostic workup and reiterates the necessity of maintaining a high index of suspicion for neoplastic entities in APKD.

Intraosseous meningioma mimicking osteosarcoma.

BACKGROUND: Predominantly intraosseous meningiomas are rare entities that include true primary intraosseous meningiomas (PIM), as well as meningiomas that may show extensive bone involvement, such as en plaque meningiomas. Different hypotheses have been proposed to decipher the origin of PIMs, such as ectopic arachnoid cap cell entrapment during birth or after trauma. Surgical resection is the treatment of choice of such lesions. CASE PRESENTATION: We present a case of a 65-year-old man with an enlarging mass in the parieto-occipital region that grew slowly and progressively over 13 years, following head trauma during a motor vehicle accident. One year prior to presentation, he started experiencing daily holocranial headaches and blurry vision. CT and MRI studies revealed a permeative midline calvarial lesion measuring 14 cm in greatest dimension with extensive periosteal reaction, extension into the subcutaneous soft tissues, subjacent dural thickening and intracranial extension with invasion of the superior sagittal sinus. The favored pre-operative clinical diagnosis was osteosarcoma. The abnormal calvarium was excised and histopathological examination confirmed the diagnosis of a predominantly intraosseous calvarial meningioma, WHO grade I. CONCLUSIONS: The present case highlights the importance of histopathologic diagnosis in guiding therapeutic decisions and reiterates the necessity of considering PIM or meningiomas with extensive intraosseous component in the differential diagnosis of calvarial masses, even when imaging suggests a neoplasm with aggressive behavior, such as osteosarcoma.

Repurposing of Anticancer Stem Cell Drugs in Brain Tumors.

Brain tumors in adults may be infrequent when compared with other cancer etiologies, but they remain one of the deadliest with bleak survival rates. Current treatment modalities encompass surgical resection, chemotherapy, and radiotherapy. However, increasing resistance rates are being witnessed, and this has been attributed, in part, to cancer stem cells (CSCs). CSCs are a subpopulation of cancer cells that reside within the tumor bulk and have the capacity for self-renewal and can differentiate and proliferate into multiple cell lineages. Studying those CSCs enables an increasing understanding of carcinogenesis, and targeting CSCs may overcome existing treatment resistance. One approach to weaponize new drugs is to target these CSCs through drug repurposing which entails using drugs, which are Food and Drug Administration-approved and safe for one defined disease, for a new indication. This approach serves to save both time and money that would otherwise be spent in designing a totally new therapy. In this review, we will illustrate drug repurposing strategies that have been used in brain tumors and then further elaborate on how these approaches, specifically those that target the resident CSCs, can help take the field of drug repurposing to a new level.

Comprehensive evaluations of diurnal NO2 measurements during DISCOVER-AQ 2011: effects of resolution-dependent representation of NO x emissions.

Nitrogen oxides (NO x =NO+NO2) play a crucial role in the formation of ozone and secondary inorganic and organic aerosols, thus affecting human health, global radiation budget, and climate. The diurnal and spatial variations in NO2 are functions of emissions, advection, deposition, vertical mixing, and chemistry. Their observations, therefore, provide useful constraints in our understanding of these factors. We employ a Regional chEmical and trAnsport model (REAM) to analyze the observed temporal (diurnal cycles) and spatial distributions of NO2 concentrations and tropospheric vertical column densities (TVCDs) using aircraft in situ measurements and surface EPA Air Quality System (AQS) observations as well as the measurements of TVCDs by satellite instruments (OMI: the Ozone Monitoring Instrument; GOME-2A: Global Ozone Monitoring Experiment - 2A), ground-based Pandora, and the Airborne Compact Atmospheric Mapper (ACAM) instrument in July 2011 during the DISCOVER-AQ campaign over the Baltimore-Washington region. The model simulations at 36 and 4 km resolutions are in reasonably good agreement with the regional mean temporospatial NO2 observations in the daytime. However, we find significant overestimations (underestimations) of model-simulated NO2 (O3) surface concentrations during night-time, which can be mitigated by enhancing nocturnal vertical mixing in the model. Another discrepancy is that Pandora-measured NO2 TVCDs show much less variation in the late afternoon than simulated in the model. The higher-resolution 4 km simulations tend to show larger biases compared to the observations due largely to the larger spatial variations in NO x emissions in the model when the model spatial resolution is increased from 36 to 4 km. OMI, GOME-2A, and the high-resolution aircraft ACAM observations show a more dispersed distribution of NO2 vertical column densities (VCDs) and lower VCDs in urban regions than corresponding 36 and 4 km model simulations, likely reflecting the spatial distribution bias of NO x emissions in the National Emissions Inventory (NEI) 2011.

An automated common algorithm for planetary boundary layer retrievals using aerosol lidars in support of the U.S. EPA Photochemical Assessment Monitoring Stations Program.

A unique automated planetary boundary layer (PBL) retrieval algorithm is proposed as a common cross-platform method for use with commercially available ceilometers for implementation under the redesigned U.S. Environmental Protection Agency Photochemical Assessment Monitoring Stations program. This algorithm addresses instrument signal quality and screens for precipitation and cloud layers before the implementation of the retrieval methodology using the Haar wavelet covariance transform method. Layer attribution for the PBL height is supported with the use of continuation and time-tracking parameters, and uncertainties are calculated for individual PBL height retrievals. Commercial ceilometer retrievals are tested against radiosonde PBL height and cloud-base height during morning and late afternoon transition times, critical to air quality model prediction and when retrieval algorithms struggle to identify PBL heights. A total of 58 radiosonde profiles were used and retrievals for nocturnal stable layers, residual layers and mixing layers were assessed. Overall good agreement was found for all comparisons with one system showing limitations for the cases of nighttime surface stable layers and daytime mixing layer. It is recommended that nighttime shallow stable layer retrievals be performed with a recommended minimum height or with additional verification. Retrievals of residual layer heights and mixing layer comparisons revealed overall good correlations to radiosonde heights (correlation coefficients, r2, ranging from 0.89 - 0.96 and bias ranging from ~ -131 to +63 m, and r2 from 0.88 - 0.97 and bias from -119 to +101 m, respectively).

Prostatic carcinoma with neuroendocrine differentiation harboring the EWSR1-FEV fusion transcript in a man with the WRN G327X germline mutation: A new variant of prostatic carcinoma or a member of the Ewing sarcoma family of tumors?

Since the discovery of the TMPRSS2-ERG fusion transcript in prostatic carcinoma (PCa) more than ten years ago, a long list of recurrent genomic rearrangements involving other transcription factors of the ETS family has been described. Fusions of ETS with the EWSR1 partner gene define many members of the Ewing family of tumors, including primitive neuroectodermal tumor (PNET). Although the expression of EWSR1 appears to be necessary for the oncogenic effects of ETS factors, the EWSR1-ETS rearrangement has never been reported in PCa. Herein, we discuss the pathologic diagnosis of a prostatic tumor in a 44 year-old man, recently treated with finasteride, with the EWSR1-FEV fusion (exon 7: exon 2, join in-frame) discovered by RNA-sequencing and fluorescence in situ hybridization. The tumor was morphologically and immunophenotypically equivocal for a Ewing sarcoma/PNET, and most consistent with a PCa with neuroendocrine differentiation. The patient's family history of PCa led to germline mutation testing by next-generation sequencing showing heterozygosity for the WRNG327X mutation. The WRN protein along with ATM, BRCA1, BRCA2, and RAD51 among others, comprise a DNA repair system by homologous recombination, and its alterations are associated with forms of hereditary PCa. We dispute whether the detection of EWSR1-FEV mandates one to diagnose the patient's tumor as a member of the Ewing sarcoma family.

Cytotoxic Activity of Cu/TiO2 Nanoparticles on Uterine-Cervical Cancer Cells.

Nanoparticles based on metal oxides serve as carrier matrices for molecules of biological interest. In this work, we used different copper complexes that were coupled to TiO2 nanoparticles. Nanoparticles were prepared with the sol-gel method. The Cu/TiO2 nanoparticles were characterized through ultraviolet-visible and Fourier transform infrared spectroscopy, differential scanning calorimetry, thermogravimetric analysis, nitrogen physisorption analysis, and scanning electron microscopy. Their biological activity was determined through DNA degradation and their cytotoxic effect on HeLa cells. The Cu/TiO2 nanoparticles presented a pore size between 2 and 6 nm, the size of nanoparticles agglomerates was between 100 and 500 nm. The nanoparticles of Cu/TiO2 degraded DNA starting at 15 min. The half maximal inhibitory concentration in HeLa cells depends on the used cooper complexes, the kinetics of cell death is of first order. Results revealed that these nanoparticles could be applied in uterine-cervical cancer treatment.

[Intervention for the promotion on the consumption of milk and dairy products as a strategy to reduce overweight in adolescents of México]. / Intervención para el fomento del consumo de leche y productos lácteos como parte de una estrategia para la disminución del exceso de peso en adolescentes de la Ciudad de México.

INTRODUCTION: Introduction: the consumption of milk and dairy products can play an important role in the maintenance of healthy body weight, since, under normal conditions of individuals, a negative association has been observed between daily intake of calcium contained in milk and dairy products and adiposity markers. Objective: to determine if the consumption of milk and dairy products affects the body weight reduction of adolescents in high school in Mexico City. Methods: community trial with 2,368 adolescents in three phases: description of the initial nutritional status, multidisciplinary educational intervention in the intervention group and evaluation of the changes observed. A food frequency and reminder questionnaire of 24 hours was applied to the participants, anthropometric measures were taken and the Who Anthro Plus® program was used to obtain the nutritional diagnosis. Results: it was found, in the intervention group, that adolescents who never consume whole milk, skimmed milk, fresh cow's cheese and natural yogurt have a higher prevalence of obesity (15.8%, 12.5%, 19.0% and 19.0%, respectively), compared to the adolescents who consume them daily (0.0%, 0.0%, 2.3% and 5.6%, respectively), there being a highly significant difference for the consumption of cheese fresh cow's milk and natural yogurt (p ≤ 0.01). It was possible to increase the frequency of dairy consumption and changes in nutritional status were observed in the intervention group, where the prevalence of obesity decreased from 13.8% to 6.1%. Conclusions: adolescents with higher milk consumption and its dairy products had a lower prevalence of obesity.

INTRODUCCIÓN: Introducción: el consumo de leche y productos lácteos puede jugar un papel importante en el mantenimiento del peso corporal saludable, ya que, en condiciones normales de los individuos, se ha observado una asociación negativa entre la ingesta diaria del calcio contenido en la leche y los productos lácteos con el incremento adipositario. Objetivo: determinar si el consumo de leche y productos lácteos repercute en la disminución del peso corporal de los adolescentes de escuelas secundarias de la Ciudad de México. Métodos: ensayo comunitario con 2.368 adolescentes en tres fases: descripción del estado de nutrición inicial, intervención educativa multidisciplinaria en el grupo intervención y evaluación de los cambios observados. Se aplicó a los participantes un cuestionario de frecuencia de consumo de alimentos y recordatorio de 24 horas, se tomaron medidas antropométricas y se utilizó el programa Who Anthro Plus® para obtener el diagnóstico nutricional. Resultados: se encontró, en el grupo de intervención, que los adolescentes que nunca consumen leche entera, leche descremada, queso fresco de vaca y yogur natural presentan mayor prevalencia de obesidad (15,8%, 12,5%, 19,0% y 19,0%, respectivamente), en comparación con los adolescentes que los consumen diariamente (0,0%, 0,0%, 2,3% y 5,6%, respectivamente), con una diferencia altamente significativa para el consumo de queso fresco de vaca y yogurt natural (p ≤ 0,01). Se logró aumentar la frecuencia de consumo de lácteos y se observaron cambios en el estado de nutrición en el grupo de intervención, donde la prevalencia de obesidad disminuyó del 13,8% al 6,1%. Conclusiones: los adolescentes con mayor consumo de leche y productos lácteos presentaron menor prevalencia de obesidad.

Massive Silicone Oil Migration into the Subconjunctival Space: A Leakage Mechanism Dilemma.

PURPOSE: To report a case in which an early, massive silicone oil migration into the subconjunctival space occurred in a patient after sutureless vitrectomy with the presence of a previously implanted pars plana glaucoma drainage device. CASE REPORT: An 80-year-old man presented with neovascular glaucoma secondary to a proliferative diabetic retinopathy in his left eye. After an intracamerular bevacizumab injection and panretinal photocoagulation, a 23-gauge pars plana vitrectomy (PPV) combined with a superotemporal Ahmed pars plana glaucoma valve implantation was performed. Afterwards, the patient underwent a new 23-gauge PPV for a dense vitreous hemorrhage. Intravitreal 1,000 centistokes silicone oil was placed to prevent recurrent intraocular bleeding. No sutures were performed. In the first postoperative month, a massive migration of silicone oil into the 360° subconjunctival space was noted until no intraocular silicone oil was observed. CONCLUSIONS: We discuss the possible leakage mechanisms in this particular case.

Factores asociados a mortalidad en pacientes críticos con COVID-19 en un centro universitario de Paraguay / Factors associated with mortality in critical patients with COVID-19 in an university center in Paraguay

INTRODUCCIÓN: La pandemia por COVID-19 es un problema de salud mundial. Habitualmente cursa con sintomatología leve y 5% de los afectados evoluciona a cuadros graves que requieren de cuidados intensivos. OBJETIVO: Determinar el perfil clínico, la mortalidad y factores asociados a la misma en pacientes con COVID-19 ingresados al Departamento de Cuidados Intensivos de Adultos, del Hospital de Clínicas de la Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Paraguay, entre agosto de 2020 a agosto de 2021. PACIENTES Y MÉTODO: Se realizó un estudio observacional analítico de corte transverso. Los datos se obtuvieron a partir de las historias clínicas de los pacientes. RESULTADOS: Se incluyeron 214 pacientes críticos entre 21 y 85 años de edad (mediana 54 años), 57,9% del sexo masculino, 85% provenientes del Departamento Central y Asunción. La mortalidad global fue de 38,3%. Se asociaron significativamente con la mortalidad una edad ≥ 60 años, las comorbilidades (diabetes mellitus, cardiopatía, enfermedad renal crónica), los índices de gravedad (APACHE II, SOFA, inicial), procalcitonina elevada, utilización de vasopresor, asistencia respiratoria mecánica y utilización del decúbito prono; así como la presencia de SDRA y el requerimiento de depuración extrarenal. En el análisis multivariado (por regresión logística) los factores de riesgo de mortalidad independientes fueron: la edad mayor de 60 años, la utilización de noradrenalina y depuración extra-renal durante la hospitalización. CONCLUSIÓN: Nuestra mortalidad es similar a la reportada internacionalmente. Los factores de riesgo de mortalidad identificados muestran una población con mayores posibilidades de un desenlace desfavorable.

BACKGROUND: The COVID-19 pandemic is a world health issue. Generally, it is with mild and around 5% evolves to a severe disease that requires intensive care. AIM: To determine the clinical profile, mortality and associated factors in COVID-19 patients admitted at the Adult Intensive Care Department at the Hospital de Clinicas, between August 2020 and August 2021. METHODS: Cross-section observational analytic study. Data was obtained from clinical charts. RESULTS: 214 patients were included, with an average age of 54 years, 57.9% male. Overall mortality was 38.3%. Factors associated significantly with mortality were: ≥60 years of age, comorbidity (diabetes mellitus, heart disease, chronic renal disease), severity index (APACHE II, initial SOFA), high procalcitonin, use of vasopressor, mechanical respiratory assistance and prone decubitus; as well as the presence of acute respiratory distress syndrome and hemodialysis. Multi varied analysis identified as mortality risk factors: ≥60 years of age, noradrenaline use and hemodialysis. CONCLUSION: Mortality rate is similar to that reported worldwide. Mortality risk factors identified show a population with higher possibilities for unfavorable outcome.

Papillary cystadenoma of the epididymis

ABSTRACT Background Papillary cystadenoma is a rare benign neoplasm of the epididymis. It may occur sporadically or in association with von Hippel-Lindau disease (VHLD). Papillary cystadenoma of the epididymis (PCE) is a benign mimic of metastatic clear cell renal cell carcinoma (CCRCC) given their histologic similarities. Case presentation Herein, we present the case of a 40-year-old man with a four-year history of microhematuria and a recently detected right paratesticular mass. A testicular sonogram revealed a hypoechoic, hypervascular solid mass in the right epididymal head treated by surgical excision. Histopathological examination demonstrated a 1.1 cm papillary cystadenoma of the epididymis. Genetic testing performed later showed no signs of VHLD. However, heterozygous mutations in three genes - CASR, POT1, and RAD51D - were found which have never been reported in PCE before. Conclusions Papillary cystadenoma of the epididymis should always be considered in the differential diagnosis of epididymal lesions, especially those that are cystic. The mainstay of treatment remains surgical excision, which provides an excellent prognosis.

Assessment of Mixed-Layer Height Estimation from Single-wavelength Ceilometer Profiles.

Differing boundary/mixed-layer height measurement methods were assessed in moderately-polluted and clean environments, with a focus on the Vaisala CL51 ceilometer. This intercomparison was performed as part of ongoing measurements at the Chemistry And Physics of the Atmospheric Boundary Layer Experiment (CAPABLE) site in Hampton, Virginia and during the 2014 Deriving Information on Surface Conditions from Column and Vertically Resolved Observations Relevant to Air Quality (DISCOVER-AQ) field campaign that took place in and around Denver, Colorado. We analyzed CL51 data that were collected via two different methods (BLView software, which applied correction factors, and simple terminal emulation logging) to determine the impact of data collection methodology. Further, we evaluated the STRucture of the ATmosphere (STRAT) algorithm as an open-source alternative to BLView (note that the current work presents an evaluation of the BLView and STRAT algorithms and does not intend to act as a validation of either). Filtering criteria were defined according to the change in mixed-layer height (MLH) distributions for each instrument and algorithm and were applied throughout the analysis to remove high-frequency fluctuations from the MLH retrievals. Of primary interest was determining how the different data-collection methodologies and algorithms compare to each other and to radiosonde-derived boundary-layer heights when deployed as part of a larger instrument network. We determined that data-collection methodology is not as important as the processing algorithm and that much of the algorithm differences might be driven by impacts of local meteorology and precipitation events that pose algorithm difficulties. The results of this study show that a common processing algorithm is necessary for LIght Detection And Ranging (LIDAR)-based MLH intercomparisons, and ceilometer-network operation and that sonde-derived boundary layer heights are higher (10-15% at mid-day) than LIDAR-derived mixed-layer heights. We show that averaging the retrieved MLH to 1-hour resolution (an appropriate time scale for a priori data model initialization) significantly improved correlation between differing instruments and differing algorithms.

Observations and impacts of transported Canadian wildfire smoke on ozone and aerosol air quality in the Maryland region on June 9-12, 2015.

UNLABELLED: Canadian wildfire smoke impacted air quality across the northern Mid-Atlantic (MA) of the United States during June 9-12, 2015. A multiday exceedance of the new 2015 70-ppb National Ambient Air Quality Standard (NAAQS) for ozone (O3) followed, resulting in Maryland being incompliant with the Environmental Protection Agency's (EPA) revised 2015 O3 NAAQS. Surface in situ, balloon-borne, and remote sensing observations monitored the impact of the wildfire smoke at Maryland air quality monitoring sites. At peak smoke concentrations in Maryland, wildfire-attributable volatile organic compounds (VOCs) more than doubled, while non-NOx oxides of nitrogen (NOz) tripled, suggesting long range transport of NOx within the smoke plume. Peak daily average PM2.5 was 32.5 µg m(-3) with large fractions coming from black carbon (BC) and organic carbon (OC), with a synonymous increase in carbon monoxide (CO) concentrations. Measurements indicate that smoke tracers at the surface were spatially and temporally correlated with maximum 8-hr O3 concentrations in the MA, all which peaked on June 11. Despite initial smoke arrival late on June 9, 2015, O3 production was inhibited due to ultraviolet (UV) light attenuation, lower temperatures, and nonoptimal surface layer composition. Comparison of Community Multiscale Air Quality (CMAQ) model surface O3 forecasts to observations suggests 14 ppb additional O3 due to smoke influences in northern Maryland. Despite polluted conditions, observations of a nocturnal low-level jet (NLLJ) and Chesapeake Bay Breeze (BB) were associated with decreases in O3 in this case. While infrequent in the MA, wildfire smoke may be an increasing fractional contribution to high-O3 days, particularly in light of increased wildfire frequency in a changing climate, lower regional emissions, and tighter air quality standards. IMPLICATIONS: The presented event demonstrates how a single wildfire event associated with an ozone exceedance of the NAAQS can prevent the Baltimore region from complying with lower ozone standards. This relatively new problem in Maryland is due to regional reductions in NOx emissions that led to record low numbers of ozone NAAQS violations in the last 3 years. This case demonstrates the need for adequate means to quantify and justify ozone impacts from wildfires, which can only be done through the use of observationally based models. The data presented may also improve future air quality forecast models.