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Purpose: Takayasu arteritis is a large-vessel vasculitis in women of childbearing age that affects large vessels including the aorta and its main branches. Inflammation of arteries can produce lesions that lead to occlusion, stenosis, or aneurysms which can lead to complications. If signs of organ dysfunction are present, vascular intervention may be necessary. Case Report: In this article, we present a case of Takayasu arteritis with high-grade stenosis of all the great vessels of the thoracic aorta treated with drug-coated balloon (DCB) angioplasty and stenting requiring multiple follow-up interventions over a 1-year follow-up. Conclusion: The DCB angioplasty is a potential endovascular treatment for thoracic great artery stenosis in Takayasu arteritis that could be further explored.

Click here for the corresponding questions to this CME article.

Click here for the corresponding questions to this CME article.

Northeastern Queensland is a far-field site from ice caps formed during the Last Glacial. However, the region has experienced glacio-hydroisostatically driven coastal elevation change during the Holocene that generated a distinctive relative sea-level record. We tested whether this subtle vertical movement of the coast is recorded in the morphology and stratigraphy of the beach-ridge strandplain at Cowley Beach, which comprises a series of 36 prominent and several subdued or truncated beach ridges. Previous studies have shown that the strandplain records the long-term progradation of the coast, with the ridges comprising coarse-medium sand that was deposited during both fairweather (foreshore and berm facies) and tropical cyclone events (erosional unconformities; storm-surge deposits) over the past approximately 7 ka. We utilised a fine-scale digital elevation model of the strandplain to examine beach ridge morphology and to compare the elevation pattern with published Holocene sea-level data for the region. The overall elevation pattern of the strandplain surface is consistent with the regional sea-level history, that includes a highstand at around 6 ka BP generated by isostatic uplift, and the elevation of the berm facies matches well robust coral sea-level indicator data. We also modelled the strandplain topographic patterns that would result under stable and continually rising Holocene sea-levels. The frequencies of elevation classes across the strandplain are normally distributed when the strandplain is deposited during a period of stable sea level, and negatively skewed with a continually rising sea level, consistent with the expected patterns. The results indicate the sensitivity of the elevation of the top of the berm facies preserved in beach ridges to subtle changes in sea level (tens of cm over a thousand years). Our results further underline the utility of beach-ridge strandplains, a globally distributed coastal landform, for building relatively detailed regional records of sea level during the Holocene at sites currently lacking this information.

The extent to which scleractinian coral inhabited southern Australia during the warm intervals of the Quaternary is poorly understood because identifiable corals from interglacial sedimentary recor...

Acetaminophen-induced hepatotoxicity is the most common cause of acute liver failure in adults and a major cause of acute liver failure in children. Prompt treatment with N-acetylcysteine can mitigate hepatotoxicity and progression to liver failure. This article describes a 16-year-old girl who ingested a large dose of extra-strength acetaminophen, and how the 150 rule was used in her management.

Storm surges generated by tropical cyclones have been considered a primary process for building coarse-sand beach ridges along the north-eastern Queensland coast, Australia. This interpretation has led to the development of palaeotempestology based on the beach ridges. To better identify the sedimentary processes responsible for these ridges, a high-resolution chronostratigraphic analysis of a series of ridges was carried out at Cowley Beach, Queensland, a meso-tidal beach system with a >3 m tide range. Optically-stimulated luminescence ages indicate that 10 ridges accreted seaward over the last 2500 to 2700 years. The ridge crests sit +3.5 to 5.1 m above Australian Height Datum (ca Mean Sea Level). A ground-penetrating radar profile shows two distinct radar facies, both of which are dissected by truncation surfaces. Hummocky structures in the upper facies indicate that the nucleus of the beach ridge forms as a berm at +2.5 m Australian Height Datum, equivalent to the fair weather swash limit during high tide. The lower facies comprises a sequence of seaward-dipping reflections. Beach progradation thus occurs via fair weather-wave accretion of sand, with erosion by storm waves resulting in a sporadic sedimentary record. The ridge deposits above the fair weather swash limit are primarily composed of coarse and medium sands with pumice gravels and are largely emplaced during surge events. Inundation of the ridges is more likely to occur in relation to a cyclone passing during high tide. The ridges may also include an aeolian component as cyclonic winds can transport beach sand inland, especially during low tide, and some layers above +2.5 m Australian Height Datum are finer than aeolian ripples found on the backshore. Coarse-sand ridges at Cowley Beach are thus products of fair weather swash and cyclone inundation modulated by tides. Knowledge of this composite depositional process can better inform the development of robust palaeoenvironmental reconstructions from the ridges. This article is protected by copyright. All rights reserved.

Spatial information on the distribution of seabed substrate types in high use coastal areas is essential to support their effective management and environmental monitoring. For Darwin Harbour, a rapidly developing port in northern Australia, the distribution of hard substrate is poorly documented but known to influence the location and composition of important benthic biological communities (corals, sponges). In this study, we use angular backscatter response curves to model the distribution of hard seabed in the subtidal areas of Darwin Harbour. The angular backscatter response curve data were extracted from multibeam sonar data and analysed against backscatter intensity for sites observed from seabed video to be representative of “hard” seabed. Data from these sites were consolidated into an “average curve”, which became a reference curve that was in turn compared to all other angular backscatter response curves using the Kolmogorov–Smirnov goodness-of-fit. The output was used to generate interpolated spatial predictions of the probability of hard seabed (p-hard) and derived hard seabed parameters for the mapped area of Darwin Harbour. The results agree well with the ground truth data with an overall classification accuracy of 75% and an area under curve measure of 0.79, and with modelled bed shear stress for the Harbour. Limitations of this technique are discussed with attention to discrepancies between the video and acoustic results, such as in areas where sediment forms a veneer over hard substrate.

In contrast to the detection and resolution of Late Pleistocene interstadials (Marine Isotope Stages; MIS 5c, 5a and 3) in marine and ice core-based oxygen isotope records, accurately defining palaeosea-levels for these events from sea level indicators remains a challenge. Commonly, such investigations have been undertaken in tectonically active, subduction-related settings, on emergent marginal marine-coastal successions above present sea level, given that the higher ice volumes during these Marine Isotope Stages resulted in ice-equivalent sea levels significantly below present, particularly in far-field settings. Delineation of palaeosea-levels for this period, has accordingly involved an assumption about the long-term rate of coastal uplift. Core SV#23 collected from the tectonically highly stable, remote far-field setting of southern Gulf St Vincent, southern Australia, in a present water depth of 40 m obtained a 3.89 m undisturbed sedimentary record of Late Pleistocene to Holocene age. The basal 2.39 m of the sediment record is of Late Pleistocene interstadial age, as it overlies the Last Interglacial Glanville Formation (128–118 ka; MIS 5e) and occurs beneath the Holocene St Kilda Formation. The extent of aspartic acid and glutamic acid racemization in the benthic foraminifer Elphidium macelliforme sampled at 2 cm intervals continuously from the interstadial succession in Core SV#23, confirms the relative age interpreted from lithostratigraphy. A mean amino acid racemization (AAR) age of 75 ± 13 ka indicates a correlation with MIS 5a, and highlights the utility of E. macelliforme as a species for AAR geochronology. As the foraminifers more closely define the timing of sedimentation, the interstadial succession is regarded as beyond the range of radiocarbon dating (>50 kyr), as revealed in a comparison of radiocarbon ages of fossil molluscs with AAR ages for E. macelliforme from the same depth intervals within the interstadial succession. All of the radiocarbon ages for fossil marine molluscs from the interstadial succession represent minimum ages, resulting from contamination by trace levels of modern radiocarbon. The foraminiferal faunal assemblages within the interstadial succession reveal changes of water depth at the time of deposition, pointing to millennial-scale sea level variability. In particular, the ratio of Elphidium crispum to E. macelliforme indicates several oscillations in relative sea level within a bandwidth of 26 to 24 ± 4.6 m below present sea level (BPSL). Notwithstanding the large uncertainty associated with palaeosea-level estimation based on the Elphidium ratio, the inferred relative sea level record is in accord with the sea level records of Barbados and the Red Sea, and points to Sub-Milankovitch interstadial sea level variability as noted in Greenland and Antarctic ice cores. Refereed/Peer-reviewed

The last interglacial maximum (Marine Isotope Substage 5e [MIS 5e], 128–116 ka) is a distinctive event in recent Earth history. Shoreline successions of this age are important for calibrating climate models and defining the overall behaviour of the crust–mantle system to fluctuating ice and ocean-water volumes. In a global context, the recently intensified interest in last interglacial shoreline successions has revealed considerable variability in the magnitude of sea-level rise during this time interval and highlighted the need to examine paleosea-level evidence from tectonically stable, far-field settings. Situated in the far-field of continental ice sheets and on the tectonically stable Gawler Craton, the 300 km coastal sector of western Eyre Peninsula between Fowlers Bay and Lake Newland in southern Australia represents an important region for defining the glacio-eustatic (ice-equivalent) sea-level attained during the last interglacial maximum based on the relative sea-level observations from ...

The continental shelf of the microtidal Black Sea, with its 4125 km-long coastline, has an average width of c. 40 km and may be subdivided into seven regions, the largest of these being the NW Shelf and the SW Shelf. Palimpsest shelf environments and terrestrially derived siliciclastic sedimentation are dominant. The Marmara Gateway, bisecting the southwestern shelf, controls the influx of Mediterranean-sourced water into the semi-enclosed Black Sea, and has been episodically open during the Quaternary. The best evidence for the most recent marine transgression of the pre-existing and isolated lake is found on the mid- and outer NW Shelf. Radiocarbon dating of marine and non-marine bivalve molluscs and peat indicates the most recent re-connection of the Black Sea with the oceanic reservoir occurred between 8200 and 8600 14 C years BP. Water levels during the transgression in the enclosed lake rose from a level 107 m or more below present values, to above the Bosphorus Sill (−35 m) in about 400 14 C years. However, the transition from low-salinity (0–5‰) lacustrine conditions to near-modern values (18‰) took ≥1000 years, indicated by the progression from freshwater to brackish molluscs and gastropods, dominated by Dreissena , to Mediterranean-derived estuarine taxa (e.g. Mytilus ), suited to nutrient-rich conditions.

The extent to which fluids may leak from sedimentary basins to the seabed is a critical issue for assessing the potential of a basin for carbon capture and storage. The Petrel Sub-basin, located beneath central and eastern Joseph Bonaparte Gulf in tropical northern Australia, was identified as potentially suitable for the geological storage of CO2 because of its geological characteristics and proximity to offshore gas and petroleum resources. In May 2012, a multidisciplinary marine survey (SOL5463) was undertaken to collect data in two targeted areas of the Petrel Sub-basin to facilitate an assessment of its CO2 storage potential. This paper focuses on Area 1 of that survey, a 471 km2 area of sediment-starved shelf (water depths of 78 to 102 m), characterised by low-gradient plains, low-lying ridges, palaeo-channels and shallow pockmarks. Three pockmark types are recognised: small shallow unit pockmarks 10–20 m in diameter (generally

Malignant prolactinoma is an exceedingly rare endocrine tumor and cannot be diagnosed on histological grounds alone. Similarly to other neuroendocrine tumors such as pheochromocytoma, the mitoses index, Ki-67, p53, and others are utilized in helping understand whether a tumor is benign or malignant or to better predict tumor behavior. We here present the unusual case of an unfortunate young man with an aggressive prolactinoma, the complications of which led to his premature death.A 25-year-old white man developed severe headaches, low energy, and decreased libido. A brain magnetic resonance imaging (MRI) showed a 4 x 3 x 2 cm pituitary tumor invading the left cavernous sinus. Laboratory findings revealed elevated prolactin (470 ng/mL) and adrenocorticotropic hormone (ACTH, 82 pg/ml) and decreased total testosterone (176 ng/dl). Visual fields showed superior quadrantanopia in the left eye. Transsphenoidal pituitary resection was undertaken. Pathology revealed a prolactinoma with atypical cells, diffuse p53 nuclear labeling, and a Ki-67 index of 23% (high). Postoperatively, prolactin remained elevated (725-891 ng/ml) and cabergoline was increased to 1 mg three times weekly, with serum prolactin further increasing to 3507 ng/ml five months postoperatively. Repeat MRI revealed extension of the tumor with optic chiasm compression and left orbit invasion. Because of acute left vision loss with ophthalmoplegia, an urgent left frontotemporal craniotomy and tumor resection were conducted. The Ki-67 index of the tumor was 24.8%, the mitotic figure immunostain phosphohistone-H3 positive. Sixty percent (60%) of tumor cells were positive for p53. Cabergoline was increased to 1 mg daily but prolactin remained elevated (770 ng/ml). The patient then underwent proton beam radiation to the area of concern involving the sella. Prolactin thereafter improved to 44 ng/ml. He then developed acute vision loss of the right eye with an MRI showing tumor in the right cavernous sinus. A 15 mm dural-based right temporal mass believed to be a metastasis was also noted. Following this scan, he was considered too high risk for debulking surgery and instead underwent gamma knife irradiation to the sella area. This shrank the right cavernous sinus tumor mass, while the right temporal mass increased in size. The patient developed blindness and left-sided weakness and required enteral feeding and tracheostomy after prolonged intubation. A trial of chemotherapy with temozolomide (350 mg daily for 5 days) near the end of his life was unsuccessful. He died on home hospice 31 months after his first surgery.Headaches, vision changes, and symptoms of androgen deficiency syndrome can be manifestations of an aggressive prolactinoma that might require surgery and additional medical therapy including cabergoline and temozolomide with an unpredictable time of survival.

The restricted environment of the Black Sea is particularly sensitive to climatic and oceanographic fluctuations, owing to its connection with the Mediterranean Sea via the narrow Bosphorus Strait. The exact mechanism and timing of the most recent connection between these water bodies is controversial with debate on the post-glacial history of the Black Sea being dependent on radiocarbon dating for numerical ages. Here we present new 23 accelerator mass spectrometer (AMS) radiocarbon ages on peat and bivalve molluscs, supported by the first amino acid racemization (AAR) dating of bivalve molluscs (n = 66) in the Black Sea. These data indicate infilling of the Black Sea during the early Holocene from an initial depth 107 m below sea-level, and 72 m below that of the Bosphorus Sill. These data combined with a review of previous radiocarbon ages has enabled a unique perspective on the post-glacial Black Sea. A sea-level curve based on conventional and AMS radiocarbon ages on peat and AMS-based ages on Dreissena sp. shells indicate the water-level in the earlier lake phase continued, until the early Holocene, to be lower than the Bosphorus Sill after the Younger Dryas ended. However, the absence of AMS-dated mollusc ages from the shelves of this basin older than the Younger Dryas is suggestive of sub-aerial exposure of the shelves, and comparatively lower water-levels when the Younger Dryas began. Thus post-glacial outflow from the Black Sea occurred through a lowered or open Bosphorus seaway. Basin-wide radiocarbon ages on peat indicate a prompt increase in water-level from that of the pre-existing and unconnected palaeo-lake during the earliest Holocene (9600–9200 cal a BP). Mass colonisation of the Black Sea by Mediterranean taxa did not occur until salinity had risen sufficiently, a process which took 1000 a or more from the initial transgressive event. This gradual change in salinity contrasts with the prompt transgression which would have taken ∼400 a to occur.

Vitamin D deficiency is widely prevalent across all ages, races, geographical regions, and socioeconomic strata. In addition to its important role in skeletal development and calcium homeostasis, several recent studies suggest its association with diabetes, hypertension, cardiovascular disease, certain types of malignancy, and immunologic dysfunction. Here, we review the current evidence regarding an association between vitamin D deficiency and hypertension in clinical and epidemiological studies. We also look into plausible biological explanations for such an association with the renin-angiotensin-aldosterone system and insulin resistance playing potential roles. Taken together, it appears that more studies in more homogeneous study populations are needed before a firm conclusion can be reached as to whether vitamin D deficiency causes or aggravates hypertension and whether vitamin D supplementation is safe and exerts cardioprotective effects. The potential problems with bias and confounding factors present in previous epidemiological studies may be overcome or minimized by well designed randomized controlled trials in the future.

Patient perception of the radiology experience will impact a hospital's HCAHPS results, and radiologic technology has a critical role to play in making those experiences as positive as they can be. Recent advances in DR acquisition and workstation technology make the modality an ideal fit for healthcare organizations focused on improving patient safety and satisfaction. This article will look at how DR and workstation technology can improve technologist responsiveness to patients, radiology report generation, recognition of patient acuity, cleanliness and quietness of facilities, patient transport and positioning, and dose management.

The imaging of a case of intrarenal aneurysm with associated “Ask-Upmark kidney” is presented. Pitfalls and limitations encountered with imaging in this case are discussed. Magnetic resonance imaging (MRI) proved to be the best imaging modality for visualization and characterization of the mass lesions present.

Diabetic patients are traditionally taught to discard plastic syringe/needle units after a single use and to employ aseptic technique for administering insulin injections. We surveyed 87 diabetic outpatients for compliance with aseptic recommendations. We then studied prospectively the effects of reusing disposable syringes in 56 diabetic patients who reused syringes a mean of 6.6 times for 8.3 months and an aggregate of 23,664 injections. Almost half (49%) of diabetic patients in a combined university clinic and private practice reused supposedly disposable insulin syringes a mean of 3.9 times. Compliance with standard aseptic precautions was poor, with only 29% of patients following recommended practices. No adverse effect of syringe reuse was identified. The authors conclude that diabetic patients frequently reuse disposable syringes, without apparent harmful effect.

A method has been developed for increasing dissolved oxygen concentrations in the turbine releases from hydroelectric power plants. A systematic procedure was used for evaluating promising solutions to low DO concentrations. The method selected for development at Fort Patrick Henry Dam was oxygen injection by use of small pore diffusers located upstream from the turbine intakes. Laboratory tests were conducted on commercially available, fine-pore diffusers to select those diffusers worthy of field testing. Laboratory tests included determination of bubble sizes and oxygen transfer efficiency. Field tests for oxygen transfer efficiency were performed for two different diffusers. Additional tests were performed to assess the effect of spacing between diffusers on oxygen transfer efficiency.

The effect of temperature on oxygen transfer by diffused-air aeration is presented. The study was made in a full scale aeration tank using both saran tubes and spargers as the diffusion media at aeration rates from 7 to 32 ft 3 /min per foot of tank length. The oxygen transfer was measured in water through a temperature range 10–30°C in 2.5°C increments. The results are analyzed statistically and are summarized in the form of a mathematical expression.

The Mamainse Point Formation formed on the margin of the Late Proterozoic Keweenawan Rift. It consists of olivine- and feldspar-phyric flood basalts with felsites and conglomeratic sediments, and spans the palaeomagnetic reversal normally regarded as the boundary between Lower and Middle Keweenawan. The basalts are classified as olivine and quartz tholeiites, although the dykes show some alkalic tendencies in trace-element characteristics and are better termed transitional basalts. Formation of the lava pile was accompanied by low-grade burial metamorphism in the zeolite and prehnite-pumpellyite facies. Secondary minerals developed both within the rock and in veins and vesicles. A crude mineral zonation developed from epidote at the base to stilbite at the top of the exposed section. Heterogeneity, with the development of epidote-, chlorite- and albite-rich metadomains, is restricted to feldspar-phyric melaphyres in lower parts of the section. Calcite-laumontite veins are ubiquitous and even cross-cut the higher grade epidote-bearing rocks, suggesting that metamorphism took place in two stages, the second at a lower temperature. Geochemical evidence also suggests that fluid compositions changed. The initial hydration event established mineral zonation and resulted in addition of H₂O+ and alkalis (K, Rb, Li, Na, Ba) to the rocks. Cu was leached from some rocks and added to others. Latter fluids were more CO₂-rich depositing calcite and laumontite, with the resulting addition of CO₂ and mobilization of Ca and Sr. Al, ΣFe, Mg, Ti, P, Y, Zr, Nb, Ni, Cr, Co, REE's, Th, Ta, Hf and U appear to be immobile or only moderately affected by the alteration. The stratigraphic variation of these elements allows the subdivision of the sequence into fiva series. The immobile trace-elements confirm the tholeiitic nature of the lavas and suggest an ocean floor to within-plate character. Incompatible element patterns suggest a similarity to E-type MORB. Shallow-level fractionation of olivine-chromite-plagioclase can account for most of the geochemical variation in the five series, although in differing proportions. Clinopyroxene and Fe-Ti oxides crystallized after extrusion of the lavas. Variations in REE-patterns and incompatible element ratios cannot be explained by fractionation, however, and appear to have resulted during genesis of the primary magmas. Modelling of REE patterns requires varying degrees of melting of a garnet-lherzolite mantle. However, two source compositions are indicated by initial REE concentrations, one with a relatively flat chondritic pattern and the other with a LREE-depleted pattern. Other incompatible element variations appear to be consistent with this, although Th and U abundances may point to further heterogeneities. The need for a different mantle source for virtually every series can be reconciled, however, by appealing to a dynamic partial melting model, in which variable batch and incremental melting take place within ascending mantle diapirs, each labelled with slightly different Th/U. Petrographic and geochemical evidence suggest that some basalts have been contaminated by ?felsic crustal material, although this is restricted to series III flows and the dykes. Doctor of Philosophy (PhD)