The CDC has admitted that between 1955–1963 over 98 million Americans received one or more doses of a polio shot which was contaminated with a cancer-causing virus called Simian vacuolating virus 40 (SV40). The CDC quickly took down the page, along with Google, but the site was luckily cached and saved to symbolize this grand admission.
A 63-year-old man was admitted because of current chest pain with perspiration for 6 hours. Electrocardiography showed complete right bundle-branch block and ST-segment elevation on leads II, III, aVF, and V2 through V6 (Figure 1); we therefore suspected an anterior and inferior wall acute myocardial infarction. Coronary angiography revealed total occlusion of the proximal left anterior descending artery (Figure 2 and Movie I in the online-only Data Supplement); the left circumflex and right coronary arteries showed no abnormalities. The left anterior descending artery was recanalized by percutaneous catheter intervention. The patient complained of chest pain the next afternoon after percutaneous catheter intervention, and the ECG was not changed. A transthoracic echocardiogram was performed, which demonstrated that the apical segments of the left ventricular walls were akinetic with normal thickness in the 4-chamber view (Movie II in the online-only Data Supplement), but the apex myocardium was dyskinetic with a perforation (2 mm in diameter) connected to a small apical aneurysm (10×5 mm) covered by intact epicardium that communicated with the left ventricular cavity as demonstrated by color Doppler (Figure 3A and 3B and Movie III in the online-only Data Supplement) from the apical 2-chamber view. This was consistent with a subepicardial aneurysm (SEA). On the follow-up echocardiography performed 8 days after infarction, there was a small thrombus at the apex, and the false aneurysm could not be seen (Figure 3C and Movie IV in the online-only Data Supplement).
Electrocardiography showed complete right bundle-branch block and ST-segment elevation on leads II, III, aVF, and V2 through V6.
Coronary angiography revealed total occlusion (arrow) of the proximal left anterior descending artery.
Apical 2-chamber view showed an apical myocardial perforation (2 mm in diameter) connected to a small apical aneurysm (10×5 mm) covered by intact epicardium (A), which communicated with the left ventricular cavity as demonstrated by color Doppler (B). Follow-up echocardiography performed 8 days after infarction showed a small thrombus at the apex, and the false aneurysm could not be seen (C).
To confirm the diagnosis, cardiac magnetic resonance imaging (MRI) was performed. Axial (Figure 4A) and short-axis (Figure 4B) first-pass perfusion steady-state free-precession MRIs demonstrated an area of microvascular obstruction in the apical wall (solid arrows) with an small aneurysm (open arrow) compatible with a left ventricular rupture. The magnified view (Figure 4C) of the steady-state free-precession MRI confirmed an apical thrombus (arrow) at the area of the ruptured orifice (open arrow) covered by intact epicardium. The 2-chamber-view (Figure 4D) delayed-enhancement inversion-recovery MRI (steady-state free-precession–gradient recalled echocardiography) after intravenous gadolinium injection showed apical acute myocardial infarction with a persistent area of microvascular obstruction (arrowheads), small apical thrombus, and a small aneurysm with clot covered by epicardium (arrow).
A, Cine (steady-state free-precession) cardiac magnetic resonance imaging of the 2-chamber view in the diastolic phase clearly showing a diverticulum-like cavity (arrowhead) with thrombus (white arrow) inside. B, In cine imaging of the 2-chamber view in the systolic phase, the diverticulum-like cavity disappeared, which indicated the formation of an aneurysm. The intact epicardium could be seen in this phase (white solid arrow), which was consistent with a subepicardial aneurysm. The thrombus (black arrow) still could be seen in the left ventricular apex. C, Late gadolinium enhancement (LGE) imaging of the short axis. The scar (arrowheads) was demonstrated by enhanced myocardium, whereas significant microvascular obstruction was detected as the hypoenhancement (white arrow) within the necrotic area. D, LGE imaging of the 2-chamber view. Enhanced myocardium was detached in the apex, and thromboses (open arrow) can be seen in the left ventricle and inside the diverticulum.
To prevent epicardial rupture or sudden death, an aneurysmectomy was performed 28 days after infarction. During surgery, a small ruptured orifice filled with thrombus in the left ventricular apex was evident. A ventricular aneurysm resection and coronary artery bypass saphenous vein to left anterior descending artery side anastomosis operation were performed.
Pathological examination showed that the endocardial layer and muscle layer structure ruptured, but the epicardial layer was intact with fibrous tissue and a small number of myocardial cells (Figure 5). The patient was discharged from hospital 10 days after surgery in good condition.
Gross pathological examination showed that the epicardial layer of the apical surface was intact (1*), but the endocardial layer and muscle layer structure ruptured (2, arrow), covered by thrombus (3 and 4). Histological examination showed that the epicardial layer was integrity (arrow) with fibrous tissue and a small number of myocardial cells (5).
There are several potentially life-threatening complications: arrhythmias, cardiogenic shock, and ventricular wall rupture with the formation of aneurysm. In left ventricular complete free wall ruptures account for almost 4% of patient deaths after acute myocardial infarction (33% occur within the first 24 hours, 85% within the first week),1 complete septal ruptures (accounting for 1%–5% of all infarct-related deaths),2 and the formation of false aneurysms. Although true aneurysms typically do not require emergency treatment, false aneurysms, or pseudoaneurysms, are the result of a complete rupture of the ventricular wall with containment of the resulting hematoma by adherent pericardium and thus have a high mortality rate. SEA is rare; of 1814 hearts examined after postmortem arteriography from autopsy subjects at the Johns Hopkins Hospital, 704 had 1140 infarcts, and only 3 SEAs were found (0.2% of infarcts).3 Because SEAs are precursors to pseudoaneurysms with a high propensity to rupture, immediate treatment is often lifesaving. Although conservative management has been reported to be successful in asymptomatic chronic SEAs,4 surgical treatment is still considered the standard of care, especially for symptomatic acute SEAs, as in our case. The options include aneurysmectomy (resection) or aneurysmorrhaphy (patch repair). In addition to an elevated risk of death, patients with SEAs are initially difficult to diagnose owing to a lack of specific symptoms. Although the transthoracic echocardiography demonstrated the abnormality, sometimes the features are not distinct enough to differentiate aneurysm subtypes, and MRI or computed tomography may be helpful for accurate diagnosis. Because SEAs have a high risk of rupture, if patients have a history of acute myocardial infarction or signs of coronary artery disease, the cardiac surgery therapy should be performed as soon as the diagnosis confirmed.
In a patient with continued chest pain after acute myocardial infarction, subendocardial left ventricular aneurysm/impending rupture should be considered as an uncommon life-threatening differential diagnosis. In our case, the SEA was found by transthoracic echocardiography and was confirmed on a dedicated cardiac MRI. Emergency surgery guided by these imaging findings most likely saved the patient’s life.
People with sleep apnea need not suffer anymore. Long gone are the days of only one or two mask options and loud, noisy and bulky CPAP machines. You can find relief if you have been diagnosed with sleep apnea — or think you may have sleep apnea — but do not want to be strapped to a mask that reminds you of Darth Vader.
Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly and you feel tired even after a full night’s sleep.
“I have been helping patients with sleep apnea for 20 years and have seen many changes in continuous positive airway pressure (CPAP) machines that deliver air pressure through a mask placed over your nose while you sleep,” says Kara Grottke, Mayo Clinic Health Systemrespiratory therapist. “The air pressure is somewhat greater than that of the surrounding air and is just enough to keep your upper airway passages open, preventing apnea and snoring.”
Older devices would take up most of your nightstand, and the machine would keep both you and your significant other awake at night. Or, if you were able to adjust to the noise coming from the machine, you were waking up every hour to readjust your mask because the fit just wasn’t made for the curves and uniqueness of your face.
The machines now are small enough they can be held in one hand and, when coupled with a good mask seal, are whisper-quiet when in use. Manufacturers have heard the consumer and agree that one or two sizes do not fit all. There also are many mask options, sizes and styles from which to choose:
“I understand that the thought of going to bed with something attached to your face and blowing air may seem undesirable,” adds Grottke. “However, I continually hear from patients that they didn’t realize how much they were missing out on before they used a CPAP machine. They knew they were tired, and that untreated sleep apnea had many health consequences, but they didn’t know how good they could feel.”
Using a CPAP machine can be frustrating at first, but it is important to stick with it. With time and patience, CPAP can positively affect your quality of life and health.
A CONTROVERSIAL BILL WOULD GIVE COMPANIES THE RIGHT TO OWN NATURAL RESOURCES IN SPACE, AND IT MAY PASS IN THE SENATE BY THE END OF SEPTEMBER
If mankind is ever to become an interplanetary species, our outward expansion across the solar system probably can’t be fueled by NASA funding alone. Why did the first humans venture out of Africa? What made the Europeans sail into the unknown? What drove Americans to expand across the continent? Curiosity and an adventurous spirit, yes, but more importantly: resources–be they riches, food, or fertile farmland.
Similarly, resources may be the only thing that can lure us from the comforts of Earth. Mining for lunar water could make it up to 90 percent cheaper to colonize the moon. And extracting platinum and other minerals from asteroids could propel mankind to travel beyond low Earth orbit.
At least two companies—Planetary Resources and Deep Space Industries—are openly planning to mine asteroids. The former has already launched a simple test vehicle into low Earth orbit, with more planned.
Planetary Resource’s Arkyd-6 test vehicle is expected to launch in 2015 or 2016
It’s younger sibling, Arkyd-3, launched from the International Space Station in July 2015, to test out some asteroid mining hardware.
Both companies have a long way to go before their technologies will be able to visit an asteroid, assess what valuable resources it contains, and then extract those resources and deliver them back to Earth. First the companies need to clear a major legal obstacle.
The Outer Space Treaty, which the U.S., Russia, and a number of other countries have signed, specifically states that nations can’t own territory in space. “Outer space shall be free for exploration and use by all States,” the treaty says. “Outer space is not subject to national appropriation by claim of sovereignty, by means of use or occupation, or by any other means.”
But what does that mean for a private company?
“There is no clear-cut answer as to whether [private mining in space] is legal or not,” says Frans von der Dunk, a space law professor at the University of Nebraska. “It depends on your interpretation of certain rather broad statements in the Outer Space Treaty, and it depends on your particular interests.”
In May, the House of Representatives passed a bill that would give asteroid mining companies property rights to the minerals they extract from space. Called the Space Act of 2015, the bill now awaits the Senate’s decision.
If the decision isn’t made by the end of September or shortly thereafter, an expiring moratorium will give the Federal Aviation Administration permission to begin regulating commercial spaceflight—something conservatives have wanted to postpone so that the fledgling industry could have some time to grow.
Von der Dunk predicts the Senate will pass the bill by the end of October. After that, President Obama will have the opportunity to sign it into law or veto it.
Harvesting materials from an asteroid
The bill (which is similar to last year’s stalled ASTEROIDS Act) says that resources extracted from asteroids and other objects in space belong to the person or company who extracts them. It also would require space mining companies to “avoid causing harmful interference in outer space,” and allows a company to sue others who cause “harmful interference” to space mining ventures.
“It’s a very succinct act,” says Von der Dunk. “That is one reason why I don’t foresee many complications.”
Nonetheless, it’s causing a bit of an uproar in the international community, says Michael Listner, lawyer and founder of the consulting firm Space Law and Policy Solutions.
Planetary Resources is pleased with the bill. “The SPACE Act of 2015 is a very good foundation for future asteroid resource activities,” a spokesperson toldPopular Science. “If the bill passed tomorrow it would explicitly state a government position that has been implied for decades. The law would provide clarity and move this entire industry ahead very quickly.”
But not everyone is enthusiastic about it. In an article in the journal Space Policy, Fabio Tronchetti, a lawyer at the Harbin Institute of Technology in China, argues that the Space Act of 2015 would violate the Outer Space Treaty. He writes:
States are forbidden from extending their territorial sovereignty over outer space or any parts of it. Despite arguments claiming otherwise this prohibition also extends to private entities.
In essence, Tronchetti argues that if the U.S. passes this bill, it will confer rights to space companies that the U.S. doesn’t have the power to give.
Tronchetti also points out that the bill’s concept of ‘harmful interference’ isn’t defined, and could potentially be used to create exclusion zones around mining operations. That would go against the nature of the treaty, whose goal was to make sure space remains the “province of all mankind,” open for exploration by everyone.
Although von der Dunk says that even though he doesn’t see anything in the current version that clearly violates international law, it could still cause concerns overseas.
“Russia and China might consider using this as another example of the economic aggression of the U.S. and going ahead of the international law,” he says.
The space mining debate probably should have started with international discussions, Tronchetti and von der Dunk agree, before going to the House and Senate.
But international consensus has been hard to come by in the past. The 1979Moon Agreement, for example, would have limited mining in space to international governing bodies. Over the years, 16 nations have signed on to the treaty, but none of the major space-faring nations have agreed to it.
Von der Dunk says it’s too late for those discussions now. “It would take years and lead to a watered-down version. We’re probably going to go ahead with this.”
Scientists and businesses are exploring a variety of methods to extract minerals from asteroids. Here’s one way.
Michael Listner has some major qualms with the bill in its current form. It requires the President to assess the international impacts of space mining and set up a regulatory structure for it within 180 days of signing the bill into law, but has no vision beyond those 180 days. “It’s a short-term bill,” says Listner. “I don’t think it goes far enough.”
For example, what is the licensing process for a company that wants to mine asteroids? Although issues such as this could be addressed in the President’s 180-day report, that report, Tronchetti writes, “might not be a sufficient step to fill in the gap resulting from a near-absolute absence of a national regulatory framework governing private mining activities on asteroids.” He goes on:
rather than rushing the adoption of controversial legislation dealing with extraterrestrial property rights, [the United States] should gradually develop a national regulatory framework to manage (non-governmental) activities on celestial bodies, including the establishment of technical and safety standards as well as of licensing procedures.
“There are just too many questions,” says Listner. “It conjures rights out of thin air, and has no supporting infrastructure.”
Moon Colony
Mining lunar water could pave the way to human colonies on the moon and Mars. But is the Space Act of 2015 up to the task?
If the bill does get through the Senate, there’s no guarantee that President Obama will sign it into law. Although he’s supported SpaceX’s commercial spaceflight ventures, the international ramifications plus Democrats’ calls to discuss the implications of space mining in a committee could lead the President to veto this part of the bill. If that happens, Congress would need to drum up a two-thirds majority to override the veto.
Tronchetti notes that the bill has proceeded “in a rather sudden and unexpected fashion.” Despite strong opposition from Democrats, the Republican-led House pushed it through without any hearings or expert testimony.
But the bill may be more about gauging the reaction from the legal community than anything else, Listner says. “They could just be throwing mud at walls to see if anything sticks.”
Flu viruses come in many strains, and some are better equipped than others to spread from person to person. Scientists have now discovered that the soft palate — the soft tissue at the back of the roof of the mouth — plays a key role in viruses’ ability to travel through the air from one person to another.
The findings, described in the Sept. 23 online edition of Nature, should help scientists better understand how the flu virus evolves airborne transmissibility and assist them in monitoring the emergence of strains with potential to cause global outbreaks.
Researchers from MIT and the National Institute of Allergy and Infectious Diseases (NIAID) made the surprising finding while examining the H1N1 flu strain, which caused a 2009 pandemic that killed more than 250,000 people.
MIT biological engineer Ram Sasisekharan, one of the study’s senior authors, has previously shown that airborne transmissibility depends on whether a virus’ hemagglutinin (HA) protein can bind to a specific type of receptor on the surface of human respiratory cells. Some flu viruses bind better to alpha 2-6 glycan receptors, which are found primarily in humans and other mammals, while other viruses are better adapted to alpha 2-3 glycan receptors, found predominantly in birds.
The 2009 strain was very good at binding to human alpha 2-6 receptors. In the new study, the researchers made four mutations in the HA molecule of this virus, which made it better suited to bind alpha 2-3 receptors instead of alpha 2-6. They then used it to infect ferrets, which are often used to model human influenza infection.
The researchers believed the mutated virus would not spread, but to their surprise, it traveled through the air just as well as the original version of the virus. After sequencing the virus’ genetic material, they found that it had undergone a genetic reversion that allowed its HA protein to bind to alpha 2-6 glycan receptors as well as alpha 2-3 glycan receptors.
“This is an experimental validation that gain of binding to the 2-6 glycan receptor is critical for aerosol transmission,” says Sasisekharan, the Alfred H. Caspary Professor of Biological Engineering and Health Sciences and Technology at MIT and a member of the Koch Institute for Integrative Cancer Research.
Airborne evolution
The researchers then examined tissue from different parts of the respiratory tract and found that viruses with the genetic reversion were most abundant in the soft palate. By three days after the initial infection, 90 percent of the viruses in this region had the reverted form of the virus. Other sites in the respiratory tract had a mix of the two types of virus.
The researchers are now trying to figure out how this reversion occurs, and why it happens in the soft palate. They hypothesize that flu viruses with superior ability to transmit through the air outcompete other viruses in the soft palate, from which they can spread by packaging themselves into mucus droplets produced by cells in the soft palate known as goblet cells.
Now that the researchers have confirmed that viruses with the ability to bind to both alpha 2-6 and alpha 2-3 glycan receptors can spread effectively among mammals, they can use that information to help identify viruses that may cause pandemics, Sasisekharan says.
“It really provides us with a handle to very systematically look at any evolving pandemic viruses from the point of view of their ability to gain airborne transmissibility through binding to these 2-6 glycan receptors,” he says.
Kanta Subbarao of NIAID is the paper’s other senior author, and the lead author is Seema Lakdawala, also of NIAID.
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