28 injured at Calif. fireworks when platform tips

SIMI VALLEY, Calif. (AP) ? More than two dozen people were injured when a wood platform holding live fireworks tipped over, sending the pyrotechnics into a crowd at a Fourth of July show northwest of Los Angeles, authorities said Friday.

Between 8,000 and 10,000 revelers were settling into their seats for the fireworks extravaganza at a Simi Valley park Thursday night when the spectacle of lights that were supposed to be launched in the sky never took off. Instead, a bright plume of red and white bursts spread across the ground, injuring 28 people and sending others fleeing for safety.

Police were still investigating what led to the explosion, but they said early indications show a platform designed and built to hold the fireworks gave way.

"For some unknown reasons the structure that holds these ordinances collapsed and caused them to be firing into the crowd," Simi Valley police Cmdr. Stephanie Shannon.

Four people were listed in serious condition, but their injuries were not considered life-threatening. Sixteen more were taken to hospitals with minor to moderate injuries. The remainder were treated at the park where emergency crews, already on hand as a safety precaution, set up a triage area.

Meanwhile, a worker at a fireworks show in North Myrtle Beach, S.C., was injured Thursday evening when a shell exploded prematurely. The explosion at the Cherry Grove Pier caused the show to end early, after just six minutes, and left a hole in the pier.

In California, a video clip aired on KCAL-TV shows a pair of firework blasts at or near the ground. Another clip, posted on YouTube and shot from a distance, shows three ground-level bursts. The fireworks continue for almost another minute before stopping.

"There was a big boom, everybody started running down the street, people were screaming," Justice Allen, 17, of Simi Valley told the Los Angeles Times. "Everybody was just terrified. People hid in bushes."

Authorities estimate people were 900 feet away from where the fireworks were being launched. One police officer who ran into the crowd when the blasts occurred had shrapnel tear through his leather belt and his clothing, Shannon said. He had minor injuries to his back.

Shannon said most people responded admirably and left in an orderly fashion. A bomb squad was at the park to deactivate the remainder of the fireworks.

Shannon said the fireworks primarily shot in one direction.

"They are going to travel the same distance across the park as they would in the air," she said. "The ones that had actually ignited that had to run their fuse were going directly into the crowd."

The annual July Fourth celebration has been sponsored by the city and the local Rotary Club for the past 43 years. Shannon said she had no information about the company hired for the fireworks show.

Simi Valley, home to the Ronald Reagan Presidential Library, is about 40 miles northwest of Los Angeles.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/386c25518f464186bf7a2ac026580ce7/Article_2013-07-05-Fireworks%20Show-Blast/id-2b2ea2b51b0e49418f79dfa4d8c7f883

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Link between fear and sound perception discovered

June 30, 2013 ? Anyone who's ever heard a Beethoven sonata or a Beatles song knows how powerfully sound can affect our emotions. But it can work the other way as well -- our emotions can actually affect how we hear and process sound. When certain types of sounds become associated in our brains with strong emotions, hearing similar sounds can evoke those same feelings, even far removed from their original context. It's a phenomenon commonly seen in combat veterans suffering from post-traumatic stress disorder (PTSD), in whom harrowing memories of the battlefield can be triggered by something as common as the sound of thunder. But the brain mechanisms responsible for creating those troubling associations remain unknown. Now, a pair of researchers from the Perelman School of Medicine at the University of Pennsylvania has discovered how fear can actually increase or decrease the ability to discriminate among sounds depending on context, providing new insight into the distorted perceptions of victims of PTSD.

Their study is published in Nature Neuroscience.

"Emotions are closely linked to perception and very often our emotional response really helps us deal with reality," says senior study author Maria N. Geffen, PhD, assistant professor of Otorhinolaryngology: Head and Neck Surgery and Neuroscience at Penn. "For example, a fear response helps you escape potentially dangerous situations and react quickly. But there are also situations where things can go wrong in the way the fear response develops. That's what happens in anxiety and also in PTSD -- the emotional response to the events is generalized to the point where the fear response starts getting developed to a very broad range of stimuli."

Geffen and the first author of the study, Mark Aizenberg, PhD, a postdoctoral researcher in her laboratory, used emotional conditioning in mice to investigate how hearing acuity (the ability to distinguish between tones of different frequencies) can change following a traumatic event, known as emotional learning. In these experiments, which are based on classical (Pavlovian) conditioning, animals learn to distinguish between potentially dangerous and safe sounds -- called "emotional discrimination learning." This type of conditioning tends to result in relatively poor learning, but Aizenberg and Geffen designed a series of learning tasks intended to create progressively greater emotional discrimination in the mice, varying the difficulty of the task. What really interested them was how different levels of emotional discrimination would affect hearing acuity -- in other words, how emotional responses affect perception and discrimination of sounds. This study established the link between emotions and perception of the world -- something that has not been understood before.

The researchers found that, as expected, fine emotional learning tasks produced greater learning specificity than tests in which the tones were farther apart in frequency. As Geffen explains, "The animals presented with sounds that were very far apart generalize the fear that they developed to the danger tone over a whole range of frequencies, whereas the animals presented with the two sounds that were very similar exhibited specialization of their emotional response. Following the fine conditioning task, they figured out that it's a very narrow range of pitches that are potentially dangerous."

When pitch discrimination abilities were measured in the animals, the mice with more specific responses displayed much finer auditory acuity than the mice who were frightened by a broader range of frequencies. "There was a relationship between how much their emotional response generalized and how well they could tell different tones apart," says Geffen. "In the animals that specialized their emotional response, pitch discrimination actually became sharper. They could discriminate two tones that they previously could not tell apart."

Another interesting finding of this study is that the effects of emotional learning on hearing perception were mediated by a specific brain region, the auditory cortex. The auditory cortex has been known as an important area responsible for auditory plasticity. Surprisingly, Aizenberg and Geffen found that the auditory cortex did not play a role in emotional learning. Likely, the specificity of emotional learning is controlled by the amygdala and sub-cortical auditory areas. "We know the auditory cortex is involved, we know that the emotional response is important so the amygdala is involved, but how do the amygdala and cortex interact together?" says Geffen. "Our hypothesis is that the amygdala and cortex are modifying subcortical auditory processing areas. The sensory cortex is responsible for the changes in frequency discrimination, but it's not necessary for developing specialized or generalized emotional responses. So it's kind of a puzzle."

Solving that puzzle promises new insight into the causes and possible treatment of PTSD, and the question of why some individuals develop it and others subjected to the same events do not. "We think there's a strong link between mechanisms that control emotional learning, including fear generalization, and the brain mechanisms responsible for PTSD, where generalization of fear is abnormal," Geffen notes. Future research will focus on defining and studying that link.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/most_popular/~3/Wq0G_0EHIi4/130630145002.htm

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Cloud behavior expands habitable zone of alien planets

July 1, 2013 ? A new study that calculates the influence of cloud behavior on climate doubles the number of potentially habitable planets orbiting red dwarfs, the most common type of stars in the universe. This finding means that in the Milky Way galaxy alone, 60 billion planets may be orbiting red dwarf stars in the habitable zone.

Researchers at the University of Chicago and Northwestern University based their study, which appears in Astrophysical Journal Letters, on rigorous computer simulations of cloud behavior on alien planets. This cloud behavior dramatically expanded the habitable zone of red dwarfs, which are much smaller and fainter than stars like the sun.

Current data from NASA's Kepler Mission, a space observatory searching for Earth-like planets orbiting other stars, suggest there is approximately one Earth-size planet in the habitable zone of each red dwarf. The UChicago-Northwestern study now doubles that number.

"Most of the planets in the Milky Way orbit red dwarfs," said Nicolas Cowan, a postdoctoral fellow at Northwestern's Center for Interdisciplinary Exploration and Research in Astrophysics. "A thermostat that makes such planets more clement means we don't have to look as far to find a habitable planet."

Cowan is one of three co-authors of the study, as are UChicago's Dorian Abbot and Jun Yang. The trio also provide astronomers with a means of verifying their conclusions with the James Webb Space Telescope, scheduled for launch in 2018.

The formula for calculating the habitable zone of alien planets -- where they can orbit their star while still maintaining liquid water at their surface -- has remained much the same for decades. But the formula largely neglects clouds, which exert a major climatic influence.

"Clouds cause warming, and they cause cooling on Earth," said Abbot, an assistant professor in geophysical sciences at UChicago. "They reflect sunlight to cool things off, and they absorb infrared radiation from the surface to make a greenhouse effect. That's part of what keeps the planet warm enough to sustain life."

A planet orbiting a star like the sun would have to complete an orbit approximately once a year to be far enough away to maintain water on its surface. "If you're orbiting around a low mass or dwarf star, you have to orbit about once a month, once every two months to receive the same amount of sunlight that we receive from the sun," Cowan said.

Tightly orbiting planets

Planets in such a tight orbit would eventually become tidally locked with their sun. They would always keep the same side facing the sun, like the moon does toward Earth. Calculations of the UChicago-Northwestern team indicate that the star-facing side of the planet would experience vigorous convection and highly reflective clouds at a point that astronomers call the sub-stellar region. At that location the sun always sits directly overhead, at high noon.

The team's three-dimensional global calculations determined for the first time the effect of water clouds on the inner edge of the habitable zone. The simulations are similar to the global climate simulations that scientists use to predict Earth climate. These required several months of processing, running mostly on a cluster of 216 networked computers at UChicago. Previous attempts to simulate the inner edge of exoplanet habitable zones were one-dimensional. They mostly neglected clouds, focusing instead on charting how temperature decreases with altitude.

"There's no way you can do clouds properly in one-dimension," Cowan said. "But in a three-dimensional model, you're actually simulating the way air moves and the way moisture moves through the entire atmosphere of the planet."

These new simulations show that if there is any surface water on the planet, water clouds result. The simulations further show that cloud behavior has a significant cooling effect on the inner portion of the habitable zone, enabling planets to sustain water on their surfaces much closer to their sun.

Astronomers observing with the James Webb Telescope will be able to test the validity of these findings by measuring the temperature of the planet at different points in its orbit. If a tidally locked exoplanet lacks significant cloud cover, astronomers will measure the highest temperatures when the dayside of the exoplanet is facing the telescope, which occurs when the planet is on the far side of its star. Once the planet comes back around to show its dark side to the telescope, temperatures would reach their lowest point.

But if highly reflective clouds dominate the dayside of the exoplanet, they will block a lot of infrared radiation from the surface, said Yang, a postdoctoral scientist in geophysical sciences at UChicago. In that situation "you would measure the coldest temperatures when the planet is on the opposite side, and you would measure the warmest temperatures when you are looking at the night side, because there you are actually looking at the surface rather than these high clouds," Yang said.

Earth-observing satellites have documented this effect. "If you look at Brazil or Indonesia with an infrared telescope from space, it can look cold, and that's because you're seeing the cloud deck," Cowan said. "The cloud deck is at high altitude, and it's extremely cold up there."

If the James Webb Telescope detects this signal from an exoplanet, Abbot noted, "it's almost definitely from clouds, and it's a confirmation that you do have surface liquid water."

Source: http://feeds.sciencedaily.com/~r/sciencedaily/space_time/nasa/~3/g9tQ0dZnz1k/130701135131.htm

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Researchers find 2 new methods to determine ALK status

Public release date: 1-Jul-2013
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Contact: Kristal Griffith
Kristal.Griffith@iaslc.org
720-325-2952
International Association for the Study of Lung Cancer

Tests continue trend in personalized medicine for lung cancer patients

DENVER The implementation of personalized health care in cancer relies on the identification and characterization of cancer biomarkers and the availability of accurate detection systems and therapies for those biomarkers. Anaplastic lymphoma kinase (ALK), a tyrosine kinase, is a more recently characterized cancer biomarker in nonsmall-cell lung cancer (NSCLC). To identify NSCLC patients with ALK gene rearrangement in clinical trials, researchers have used the methods known as fluorescence in situ hybridization (FISH) or immunohistochemistry (IHC). While IHC is a less complex and less costly technology than FISH, both methods present challenges.

Now research published in the August issue of the Journal of Thoracic Oncology (JTO), describes the development and evaluation of two new methodologies.

To improve IHC assay sensitivity, the researchers incorporated the novel, nonendogenous hapten 3-hydroxy-2-quinoxaline and tyramide amplification into a diaminobenzidine and horseradish peroxidasebased assay. The new detection system proved to be very useful for detecting low levels of ALK protein expression in NSCLC.

They also developed a brightfield IHCin situ hybridization combination assay (geneprotein assay) for the concurrent visualization of ALK protein and ALK gene arrangement. This allows the concurrent visualization of ALK gene and ALK protein status in single cells, allowing more accurate ALK status determination even in heterogeneous specimens.

The authors say, "this tool for simultaneously assessing both ALK protein expression (IHC) and ALK gene rearrangement (ISH) in NSCLC will be valuable for research on the mechanisms driving ALK-dependent malignancies and as a model of new diagnostic approach for identifying patients who might benefit from ALK-targeted therapies. More generally, it also provides proof of concept for the development of new methodologies for the simultaneous assessment of gene structure and protein-expression status in a single cell.

###

The lead author of the study is Dr. Hiroaki Nitta. Dr. Koji Tsuta is an IASLC co-author.

About the IASLC:

The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated to the study of lung cancer. Founded in 1974, the association's membership includes more than 3,500 lung cancer specialists in 80 countries. To learn more about IASLC please visit http://www.iaslc.org.

---

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?

AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Public release date: 1-Jul-2013
[ | E-mail | Share ]

Contact: Kristal Griffith
Kristal.Griffith@iaslc.org
720-325-2952
International Association for the Study of Lung Cancer

Tests continue trend in personalized medicine for lung cancer patients

DENVER The implementation of personalized health care in cancer relies on the identification and characterization of cancer biomarkers and the availability of accurate detection systems and therapies for those biomarkers. Anaplastic lymphoma kinase (ALK), a tyrosine kinase, is a more recently characterized cancer biomarker in nonsmall-cell lung cancer (NSCLC). To identify NSCLC patients with ALK gene rearrangement in clinical trials, researchers have used the methods known as fluorescence in situ hybridization (FISH) or immunohistochemistry (IHC). While IHC is a less complex and less costly technology than FISH, both methods present challenges.

Now research published in the August issue of the Journal of Thoracic Oncology (JTO), describes the development and evaluation of two new methodologies.

To improve IHC assay sensitivity, the researchers incorporated the novel, nonendogenous hapten 3-hydroxy-2-quinoxaline and tyramide amplification into a diaminobenzidine and horseradish peroxidasebased assay. The new detection system proved to be very useful for detecting low levels of ALK protein expression in NSCLC.

They also developed a brightfield IHCin situ hybridization combination assay (geneprotein assay) for the concurrent visualization of ALK protein and ALK gene arrangement. This allows the concurrent visualization of ALK gene and ALK protein status in single cells, allowing more accurate ALK status determination even in heterogeneous specimens.

The authors say, "this tool for simultaneously assessing both ALK protein expression (IHC) and ALK gene rearrangement (ISH) in NSCLC will be valuable for research on the mechanisms driving ALK-dependent malignancies and as a model of new diagnostic approach for identifying patients who might benefit from ALK-targeted therapies. More generally, it also provides proof of concept for the development of new methodologies for the simultaneous assessment of gene structure and protein-expression status in a single cell.

###

The lead author of the study is Dr. Hiroaki Nitta. Dr. Koji Tsuta is an IASLC co-author.

About the IASLC:

The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated to the study of lung cancer. Founded in 1974, the association's membership includes more than 3,500 lung cancer specialists in 80 countries. To learn more about IASLC please visit http://www.iaslc.org.

---

[ | E-mail | Share ]

?

AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Source: http://www.eurekalert.org/pub_releases/2013-07/iaft-rft070113.php

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Ouya Game Console Hopes to Disrupt Market at $99 - WTVY

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The Ouya, a $99 video game console powered by the Android operating system. (Courtesy: The Associated Press)

Ouya, a bite-sized game console running on Google's Android operating system, wants to take a bite out of the video game system market long ruled by Microsoft, Sony and Nintendo.

The console, which went on sale Tuesday for $100, lets players try games for free before buying them, a selling point that Ouya CEO Julie Uhrman likes to bring up since new games for the big three consoles often cost as much as $60 and that's before trying.

"We are definitely disrupting the console market," Uhrman said. "We offer something different."

There are more than 170 games available for Ouya, ranging from the likes of "Crazy Cat Lady" to the more established "Final Fantasy III" from Square Enix, with more to come.

Non-gaming apps include TuneIn Radio. Pricing is up to the game developers and generally in the single-digits. "Final Fantasy" is an exception at $16. While you won't find "Grand Theft Auto IV" or the latest "Call of Duty" among the available titles, there are plenty of others from independent developers who wouldn't necessarily make it on to the dominant consoles.

Ouya is unlikely to make a dent in the demand for high-end video game consoles coming out from Sony and Microsoft later this year, lacking high-end graphics and computing power, not to mention blockbuster games such as the latest "Call of Duty."

But at a fraction of the price (it costs $500 for the Xbox One and $400 for the PlayStation 4), it could appeal to budget-conscious gamers, gadget geeks and those looking for a second or third console.

"We sought to build a $99 game console where all the games are free to try, where any developer whether established or newcomer can bring the games to television," siad Uhrman.

The project to build the console launched on Kickstarter last July. "We brought it to Kickstarter because we wanted to know if anybody really wanted this," Uhrman said.

On Aug. 9, 2012, Ouya's funding period ended with $8.6 million pledged, more than nine times the original $950,000 goal its creators had set out to reach.

More than 63,000 people donated, with 12 pledging $10,000 or more. This May, Ouya received another $15 million, this time in venture capital funding from Kleiner Perkins Caufield & Byers and other VC firms, along with chip maker Nvidia.

Source: http://www.wtvy.com/news/4theconsumer/headlines/Ouya-Game-Console-Hopes-to-Disrupt-Market-at-99-213095951.html

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7 Billion People And Trillions Of Creatures To Be Photographed Together On July 19

It's going to be a very small picture, but we're all going to be in it. All trillions of us on Earth.

It's not our first group portrait, but Carolyn Porco, the woman in charge, says it's going to be gasp-worthy. She should know. She helped shoot some of the early ones.

What am I talking about?

Well, going back a bit, here's the first one, the granddaddy of Earth pictures. It's often called the "Blue Marble" shot, and it was our first look at our whole planet suspended in space, taken in 1972 as the Apollo 17 crew headed toward the moon. It makes us look dazzlingly blue ? and quite alone.

The next one on my list is trickier. For one thing, the camera was much farther from Earth ? about 3.7 billion miles away. It was on a space probe called Voyager sent by NASA to explore the outer solar system. In 1990, after traveling for 12 years, just as it was about to leave the solar system, astronomer Carl Sagan asked that it be turned around and given one last photographic instruction. Carolyn Porco was on the team that did this. Sagan wanted to make pictures of the various planets so we could see what we looked like from far, far away. Earth makes a teeny appearance here.

You can find us at the midpoint of this image, inside the band of scattered sun rays at the far right, peeping through. That little dot is Earth, our planet.

Looking at this, Carl Sagan thought, first, how small we look, how small we are ? which inspired him to write his eloquent Pale Blue Dot meditation, which, if you haven't read it lately, take a minute and a half to look at this short version gorgeously animated by Joel Somerfield at Order, a British design studio. Carl Sagan himself is narrating.

Our smallness, our alone-ness impressed Sagan, but so did our noisy colorfulness. We emit radio waves and TV signals. We have technology. We are blue in our watery parts, reddish on our land parts (because the chlorophyll in our plants absorbs red and blue light waves, reflecting green back into space). Which gave Sagan an idea.

Imagine you are sweeping through a solar system, looking for a place, any place that might harbor some sign of life, and there, in the blackness, you see a dot of light, a little pinprick shining back at you. Could you, from a distance, learn if there is life there? Are there telltale signs?

Check Out This Place Called 'Earth'

Sagan imagined four traits that he thought would be strong indicators of life: the persistent presence of methane, an unusual proportion of oxygen in the atmosphere (both often produced by life), a reddish coloring on land, (because of the chlorophyll) and radio waves. If the planet is broadcasting, somebody down there must be talking (and tinkering).

Then he proposed an experiment ? the first ever life-sensing test. He knew, back in 1990, that another NASA spacecraft, Galileo, was zipping past Earth on its way to Jupiter, so he asked NASA to turn to the probe to earth to see if it could pick up the four traits. Yup, yup, yup and yup. Methane, oxygen, reddish tones and radio waves, all of them, of course, were there.

Then, because he wanted this to be the world's first-ever controlled experiment in astrobiological sensing, he asked that the probe be turned to the moon.

Check Out This Place Called 'The Moon'

We all know there's life on Earth, (i.e., you reading this, me writing this) and we are pretty sure that there's none on the moon. It's cold. It's barren. It's always been so. So would Galileo pick up any life traces when looking moonward? No, no, no and no. Galileo sniffed and found "Nothing," says David Noever, a NASA astrobiologist.

"There was no evidence for life. No chlorophyll, no oxygen-methane atmosphere, no artificial radio transmissions. It was just as we would have expected, and consistent with the Sagan criteria."

Ever since, we have been looking, using Sagan's criteria and a few more, to hunt for signs of like on distant dots of light. We like signs of water. There are several watery orbs in our solar system. It's why we like the color blue. It's our color, and so it's a hue that teases us, that makes us wonder, "You too?"

The last photo on my list was taken in 2006 by the Cassini probe, 930 million miles from Earth, near Saturn. You can see some of Saturn's rings on the right. Earth, once again, is a little dot in the background, but in this image, we've enlarged ourselves, so you can see us better.

Carolyn Porco, now a team leader on the Cassini project, says what we see here, hanging in dark space, is a "pale blue orb, and a faint suggestion of the moon." The moon is a "dim protrusion to the upper left of Earth" and from this angle, if we could zoom in (we can't), we'd be looking down on the Atlantic Ocean and the west coast of North Africa.

In 2006, this was the best Cassini could do. But Carolyn says they're going to try again, On July 19, in just a few weeks, Cassini's cameras will take advantage of Saturn eclipsing the sun, and snap a new photo. It will be, says Carolyn "an image of the highest resolution we are capable of taking."

That doesn't mean we'll see cities glowing at night, or continents. What we will see, she thinks, is a telltale difference. The part of the image that is the moon, she says, will be "a colorless, star-like point of light." That's our lifeless moon. The other part, the bigger part, will have traces of color, hints of red, and the distinct blush of blue.

That little beacon of life-light, of course, is our home, our pale blue dot.

Source: http://www.npr.org/blogs/krulwich/2013/06/27/196226342/7-billion-people-and-trillions-of-creatures-to-be-photographed-together-on-july-?ft=1&f=1007

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Unraveling the largest outbreak of fungal infections associated with contaminated steroid injections

Public release date: 26-Jun-2013
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Contact: Eileen Leahy
ajpmedia@elsevier.com
732-238-3628
Elsevier Health Sciences

Findings suggest black mold targeting the base of the brain, reports The American Journal of Pathology

Philadelphia, PA, June 26, 2013 Investigators from the Centers for Disease Control and Prevention (CDC) describe pathologic findings from 40 case reports of fungal infection in patients who had been given contaminated epidural, paraspinal, or intra-articular (into joints) steroid injections and correlate these findings with clinical and laboratory data. The report, published in the September issue of The American Journal of Pathology, alerts clinicians and the general public to the catastrophic dangers of contaminated epidural injections.

In September 2012, CDC began hearing multiple reports of fungal meningitis in patients following epidural steroid injections. By June 2013, 745 people had confirmed infections and 58 had died, making this the largest reported outbreak of infections associated with epidural and intra-articular injections.

After intensive investigation, the contamination was traced to more than 17,000 vials from three contaminated lots of preservative-free methylprednisolone acetate (MPA) originating from a single compounding pharmacy. More than 13,000 people were injected with the potentially contaminated drug. Most cases were attributable to Exserohilum rostratum, a dark-colored environmental mold that rarely infects humans.

Researchers, including the CDC's Exserohilum Infections Working Group, report that of 40 cases reviewed, 16 were fatal, and all except two fatal cases had a clinical diagnosis of meningitis. Autopsy examination showed extensive hemorrhage and necrosis (tissue decay) around the base of the brain and thrombi (clots) involving the basilar arterial circulation.

Tissue specimens from infected individuals showed inflammation of the leptomeninges (thin membranes lining the brain) and blood vessel walls within the brain. Distinctive abnormalities were observed around blood vessels, and fungus was found around and within arterial walls. Interestingly, fungus deep within the brain tissue itself was found in only one case.

Similar pathologic findings were seen at the epidural injection site. Fungus was not found in tissue samples taken from the heart, lung, liver, or kidney.

Investigators wondered why fungus injected in the spinal region should target the base of the brain. "The observation of abundant fungi in the perivascular tissues, but relatively low numbers of fungi inside blood vessels, suggests migration of fungus into, rather than out of, vessels at this location. This supports the hypothesis that Exserohilum migrates from the lumbar spine to the brain through the cerebrospinal fluid with subsequent vascular invasion, rather than migration through the vasculature," suggests Jana M. Ritter, DVM, a veterinary pathologist at the CDC's Infectious Diseases Pathology Branch.

In addition to characterizing the histopathology seen in this outbreak, the authors also provide practical information for pathologists, including an evaluation of various diagnostic methods to detect the fungal infection in tissues. Polyfungal immunohistochemistry (IHC) in formalin-fixed paraffin-embedded tissues (FFPE) was found to be the most sensitive method. IHC identified fungus in 100% of cases, compared with 43% by standard hematoxylin-eosin (H&E) and 95% with Grocott's methenamine silver (GMS) stains. Factors that may affect cellular inflammatory patterns and fungal concentration are discussed, and the authors note that their findings may reflect the simultaneous introduction of the fungus along with the steroid.

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Contributors to the investigation also included researchers from the Office of the Chief Medical Examiner, Louisville, KY and the Department of Pathology, University of Michigan, Ann Arbor, MI.

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Public release date: 26-Jun-2013
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Contact: Eileen Leahy
ajpmedia@elsevier.com
732-238-3628
Elsevier Health Sciences

Findings suggest black mold targeting the base of the brain, reports The American Journal of Pathology

Philadelphia, PA, June 26, 2013 Investigators from the Centers for Disease Control and Prevention (CDC) describe pathologic findings from 40 case reports of fungal infection in patients who had been given contaminated epidural, paraspinal, or intra-articular (into joints) steroid injections and correlate these findings with clinical and laboratory data. The report, published in the September issue of The American Journal of Pathology, alerts clinicians and the general public to the catastrophic dangers of contaminated epidural injections.

In September 2012, CDC began hearing multiple reports of fungal meningitis in patients following epidural steroid injections. By June 2013, 745 people had confirmed infections and 58 had died, making this the largest reported outbreak of infections associated with epidural and intra-articular injections.

After intensive investigation, the contamination was traced to more than 17,000 vials from three contaminated lots of preservative-free methylprednisolone acetate (MPA) originating from a single compounding pharmacy. More than 13,000 people were injected with the potentially contaminated drug. Most cases were attributable to Exserohilum rostratum, a dark-colored environmental mold that rarely infects humans.

Researchers, including the CDC's Exserohilum Infections Working Group, report that of 40 cases reviewed, 16 were fatal, and all except two fatal cases had a clinical diagnosis of meningitis. Autopsy examination showed extensive hemorrhage and necrosis (tissue decay) around the base of the brain and thrombi (clots) involving the basilar arterial circulation.

Tissue specimens from infected individuals showed inflammation of the leptomeninges (thin membranes lining the brain) and blood vessel walls within the brain. Distinctive abnormalities were observed around blood vessels, and fungus was found around and within arterial walls. Interestingly, fungus deep within the brain tissue itself was found in only one case.

Similar pathologic findings were seen at the epidural injection site. Fungus was not found in tissue samples taken from the heart, lung, liver, or kidney.

Investigators wondered why fungus injected in the spinal region should target the base of the brain. "The observation of abundant fungi in the perivascular tissues, but relatively low numbers of fungi inside blood vessels, suggests migration of fungus into, rather than out of, vessels at this location. This supports the hypothesis that Exserohilum migrates from the lumbar spine to the brain through the cerebrospinal fluid with subsequent vascular invasion, rather than migration through the vasculature," suggests Jana M. Ritter, DVM, a veterinary pathologist at the CDC's Infectious Diseases Pathology Branch.

In addition to characterizing the histopathology seen in this outbreak, the authors also provide practical information for pathologists, including an evaluation of various diagnostic methods to detect the fungal infection in tissues. Polyfungal immunohistochemistry (IHC) in formalin-fixed paraffin-embedded tissues (FFPE) was found to be the most sensitive method. IHC identified fungus in 100% of cases, compared with 43% by standard hematoxylin-eosin (H&E) and 95% with Grocott's methenamine silver (GMS) stains. Factors that may affect cellular inflammatory patterns and fungal concentration are discussed, and the authors note that their findings may reflect the simultaneous introduction of the fungus along with the steroid.

###

Contributors to the investigation also included researchers from the Office of the Chief Medical Examiner, Louisville, KY and the Department of Pathology, University of Michigan, Ann Arbor, MI.

---

[ | E-mail | Share ]

?

AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Source: http://www.eurekalert.org/pub_releases/2013-06/ehs-utl062013.php

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