Atraumatic splenic rupture secondary to Epstein-Barr virus infection.

We present a case report of atraumatic splenic rupture secondary to Epstein-Barr virus (EBV) infection. A woman aged 36 years presented to a London teaching hospital's Accident and Emergency department with severe abdominal pain following a 6-day history of diarrhoea and vomiting, which had been under review by her GP. A CT scan demonstrated free intraperitoneal fluid and abnormal appearance of her spleen. Blood tests demonstrated EBV infection with positive serology and leucocytosis. She underwent a laparoscopic washout, which confirmed a subcapsular splenic haematoma that was initially managed conservatively. However, she subsequently re-presented with increasing pain and required an elective splenectomy. This case demonstrates the risk of splenic rupture following EBV infection, even in the absence of trauma, and highlights the importance of prompt diagnosis and appropriate counselling in patients with infectious mononucleosis.

Scenarios for Low Carbon and Low Water Electric Power Plant Operations: Implications for Upstream Water Use.

Electric sector water use, in particular for thermoelectric operations, is a critical component of the water-energy nexus. On a life cycle basis per unit of electricity generated, operational (e.g., cooling system) water use is substantially higher than water demands for the fuel cycle (e.g., natural gas and coal) and power plant manufacturing (e.g., equipment and construction). However, could shifting toward low carbon and low water electric power operations create trade-offs across the electricity life cycle? We compare business-as-usual with scenarios of carbon reductions and water constraints using the MARKet ALlocation (MARKAL) energy system model. Our scenarios show that, for water withdrawals, the trade-offs are minimal: operational water use accounts for over 95% of life cycle withdrawals. For water consumption, however, this analysis identifies potential trade-offs under some scenarios. Nationally, water use for the fuel cycle and power plant manufacturing can reach up to 26% of the total life cycle consumption. In the western United States, nonoperational consumption can even exceed operational demands. In particular, water use for biomass feedstock irrigation and manufacturing/construction of solar power facilities could increase with high deployment. As the United States moves toward lower carbon electric power operations, consideration of shifting water demands can help avoid unintended consequences.

Evidence of an environmental effect on survival in ALS.

Amyotrophic lateral sclerosis (ALS, motor neuron disease) is a neurodegenerative disorder of motor neurons leading to paralysis and eventual death by respiratory failure. Median survival is 2-3 years. Susceptibility genes, environmental triggers and disease related prognostic factors have been established, but environmental effects on survival are yet to be investigated. We analysed survival in the South-East England ALS register (SEALS register). Kaplan-Meier and Cox regression analyses were used to investigate survival in London, coastal and rural areas according to postcode at diagnosis. Results showed that there were 933 cases of ALS identified in the catchment area during the study period (1994-January 2012). Cox regression demonstrated a highly significant model for survival with significant protective variables: coastal residency, riluzole use and younger age at onset. Significantly worse survival was associated with London residency, older age as well as definite and probable El Escorial classifications. In conclusion, these findings suggest the possibility of an environmental effect on survival in ALS.

Young-onset amyotrophic lateral sclerosis: historical and other observations.

There is a wide range of age at initial symptom onset in amyotrophic lateral sclerosis despite a mean age of 65 years in population-based studies. 'Young-onset' amyotrophic lateral sclerosis typically refers to patients younger than ∼45 years and accounts for about 10% of cases in contemporary series. A review of published cases of amyotrophic lateral sclerosis from 1850 to 1950 revealed a far higher proportion of cases with young onset (>50%), with a steady decline to the contemporary figure. It is possible that this is not solely explained by increases in life expectancy. While there is still a rich variation in phenotypes among cases of young-onset amyotrophic lateral sclerosis, bulbar onset was found to be significantly under-represented in analysis of a large patient database, with implications for age-related vulnerabilities pertaining to focality of symptom onset. The timing of initiating pathological processes in relation to the emergence of symptoms is discussed, including the potential role of very early development and the interaction of epigenetic and environmental factors.