A Clot (Possibly); Due to Loss of TNF-α Supression.

INTRODUCTION: Inflammation and venous thrombosis enjoy a close Relationship. We present a patient who had multiple DVTs following the discontinuation of anti- TNF-α therapy. CASE: A 34 year old African American female with a history of multiple DVT's, miscarriages, and reported Crohn's disease presented with shortness of breath. In the Emergency Department, CTA showed bilateral pulmonary emboli. The patient had been off adalimumab for one year and reported abdominal pain with 6-7 non-bloody bowel movements daily. She had been prescribed lovenox for her unprovoked DVTs yet reported missing several doses prior to admission. Following admission, she developed severe abdominal pain prompting an emergent CT angiogram and she then developed a pulseless painful left lower extremity. CT revealed a partially occlusive thrombus in the infra-renal abdominal aorta, proximal left common iliac artery, and right renal artery with subsequent right renal infarction. Following emergent vascular surgery to restore blood flow to the left lower extremity, the patient received four days of plasma exchange and high dose steroids for potential catastrophic antiphospholipid syndrome. Serology for APLA was negative. The patient was discharged with lifelong anticoagulation. DISCUSSION: The endothelial surface is a complex organ that works in concert with the surrounding environment. Inflammation and thrombus formation is closely associated. TNF-α can increase the expression of adhesion molecules, specifically, tissue factor, on the surface endothelial cells and promote thrombosis. Suppression of TNF-α expression by low molecular weight heparin has been shown to inhibit the inflammatory cascade and reduce thrombus formation in animal models. Clinical data is less clear. Interruption of TNF blockers has been shown to increase the risk of DVT in patients with rheumatoid arthritis undergoing orthopedic surgery. For patients with Bechet's syndrome, anti-TNF agents appear help treat patients with pulmonary artery thrombosis. Further review of anti-TNF-α therapy in our general medicine patient population may disclose additional risks associated with discontinuation of these medications.

Efficiency of insect exclusion screens for preventing whitefly transmission of tomato yellow leaf curl virus of tomatoes in Israel.

Tomato yellow leaf curl virus (TYLCV) is the most frequently occurring virus in tomatoes in the Middle East, and the most harmful one. It is transmitted solely by the whitefly Bemisia tabaci (Gennadius). Within 4-6h of inoculative feeding, a whitefly can transmit TYLCV to a healthy plant with 80% probability. The symptoms are apparent after two to three weeks whereupon fruit-set is effectively terminated. The only means of controlling TYLCV is by controlling the whitefly. Until 1990 this was exclusively by insecticides. Starting in 1990, growers of greenhouse tomatoes in Israel began adopting insect exclusion screens to prevent inoculation of TYLCV. This article reports on the methods used in the search for efficient screening materials and presents data on their relative efficiencies in excluding B. tabaci and several other greenhouse pests. Ten materials were tested, of which five were found to be effective in excluding B. tabaci under laboratory conditions. This number was reduced to three following field trials and trials in commercial tomato greenhouses. These materials are now in widespread use in Israel: by 2000 practically all table tomatoes in Israel were grown under exclusion screens. The use of exclusion screens has been shown to be an economically viable pest management method.

Significance of forebrain structures in acoustically guided behavior in anurans.

In order to test the hypothesis that the forebrain is involved in controlling acoustically guided behaviour, we carried out behavioural studies in combination with brain lesions, neuroanatomical and electrophysiological experiments in males and females of different species of frogs. Whereas the dorsomedial pallium plays no or only a minor role, the striatum, the septum, and the preoptic area potentially influence the behaviour because they send parallel descending projections to different premotor and motor networks in the brainstem. These parallel projections may be the basis for the variability seen in the behaviour.