Secondary Postpartum Hemorrhage due to Spontaneous Uterine Artery Rupture after Normal Vaginal Delivery Managed by Selective Arterial Embolization

Secondary postpartum hemorrhage due to an intraperitoneal bleed following a vaginal delivery is extremely rare. We present a case of spontaneous rupture of the uterine artery following a normal vaginal delivery with a delayed presentation, which resulted in significant morbidity. This case discusses the presentation and management of this rare obstetrical emergency. The report also discusses the role of selective arterial embolization in management of secondary postpartum hemorrhage

Tetralogy of Fallot: Imaging of common and uncommon associations by multidetector CT

AbstractPurposeTo demonstrate the superior role of multidetector computed tomography (MDCT) in delineation of the extracardiac vascular abnormalities including the pulmonary arterial tree, major aortopulmonary collateral arteries (MAPCAs), patent ductus arteriosus (PDA), and also the detection of the common and uncommon findings in Fallot Tetralogy cases for proper pre-surgical evaluation.Material and methodsA retrospective study of all multidetector CT images acquired to evaluate suspected cases of Tetralogy of Fallot sent by their respective referring physicians between April 2009 and August 2010. A total of 23 cases were included in this study. MDCT protocol, image analysis and calculations used in the diagnosis are explained in detail.ResultsDetailed explanation of the MDCT imaging findings in the 23 cases with Tetralogy of Fallot, as well as the common and uncommon associations of the disease, namely pulmonary atresia, MAPCAs, PDAs, atrial septal defects (ASDs), right sided aortic arch, and a few less common associations.ConclusionA customized approach to MDCT imaging improves the diagnostic accuracy and reduces unneeded prolongation of the study and sedation times. A careful preoperative perceptive of the complex cardiovascular anatomy in patients with Tetralogy of Fallot aids in exposing the patient to a directed and prepared surgical approach

Z-permutable subgroups of finite groups

Let ℨ be a complete set of Sylow subgroups of a finite group G, that is, a set composed of a Sylow p-subgroup of G for each p dividing the order of G. A subgroup H of G is called ℨ-permutable if H permutes with all members of ℨ. The main goal of this paper is to study the embedding of the ℨ-permutable subgroups and the influence of ℨ-permutability on the group structure

Racemisation in chemistry and biology

The two enantiomers of a compound often have profoundly different biological properties and so their liability to racemisation in aqueous solutions is an important piece of information. We have reviewed the available data concerning the process of racemisation in vivo, in the presence biological molecules (e.g. racemase enzymes, serum albumin, cofactors and derivatives) and under purely chemical but aqueous conditions (acid, base and other aqueous systems). Mechanistic studies are described critically in light of reported kinetic data. The types of experimental measurement that can be used to effectively determine rate constants of racemisation in various conditions are discussed and the data they provide is summarised. The proposed origins of enzymatic racemisation are presented and suggest ways to promote the process that are different from processes taking place in bulk water. Experimental and computational studies that provide understanding and quantitative predictions of racemisation risk are also presented

Official American thoracic society clinical practice guidelines: Diagnostic evaluation of infants with recurrent or persistent wheezing

Background: Infantile wheezing is a common problem, but there are no guidelines for the evaluation of infants with recurrent or persistent wheezing that is not relieved or prevented by standard therapies. Methods: An American Thoracic Society-sanctioned guideline development committee selected clinical questions related to uncertainties or controversies in the diagnostic evaluation of wheezing infants. Members of the committee conducted pragmatic evidence syntheses, which followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The evidence syntheses were used to inform the formulation and grading of recommendations. Results: The pragmatic evidence syntheses identified few studies that addressed the clinical questions. The studies that were identified constituted very low-quality evidence, consisting almost exclusively of case series with risk of selection bias, indirect patient populations, and imprecise estimates. The committee made conditional recommendations to perform bronchoscopic airway survey, bronchoalveolarlavage,esophagealpHmonitoring,andaswallowing study.Italsomadeconditionalrecommendationsagainstempiricfood avoidance, upper gastrointestinal radiography, and gastrointestinal scintigraphy. Finally, the committee recommended additional research about the roles ofinfantpulmonaryfunction testingand food avoidance or dietary changes, based on allergy testing. Conclusions: Although infantile wheezing is common, there is a paucity of evidence to guide clinicians in selecting diagnostic tests for recurrent or persistent wheezing. Our committee made several conditional recommendations to guide clinicians; however, additional research that measures clinical outcomes is needed to improve our confidence in the effects of various diagnostic interventions and to allow advice to be provided with greater confidence

Chronic airflow obstruction and ambient particulate air pollution

Smoking is the most well-established cause of chronic airflow obstruction (CAO) but particulate air pollution and poverty have also been implicated. We regressed sex-specific prevalence of CAO from 41 Burden of Obstructive Lung Disease study sites against smoking prevalence from the same study, the gross national income per capita and the local annual mean level of ambient particulate matter (PM2.5) using negative binomial regression. The prevalence of CAO was not independently associated with PM2.5 but was strongly associated with smoking and was also associated with poverty. Strengthening tobacco control and improved understanding of the link between CAO and poverty should be prioritised

Coherence and recurrency: maintenance, control and integration in working memory

Working memory (WM), including a ‘central executive’, is used to guide behavior by internal goals or intentions. We suggest that WM is best described as a set of three interdependent functions which are implemented in the prefrontal cortex (PFC). These functions are maintenance, control of attention and integration. A model for the maintenance function is presented, and we will argue that this model can be extended to incorporate the other functions as well. Maintenance is the capacity to briefly maintain information in the absence of corresponding input, and even in the face of distracting information. We will argue that maintenance is based on recurrent loops between PFC and posterior parts of the brain, and probably within PFC as well. In these loops information can be held temporarily in an active form. We show that a model based on these structural ideas is capable of maintaining a limited number of neural patterns. Not the size, but the coherence of patterns (i.e., a chunking principle based on synchronous firing of interconnected cell assemblies) determines the maintenance capacity. A mechanism that optimizes coherent pattern segregation, also poses a limit to the number of assemblies (about four) that can concurrently reverberate. Top-down attentional control (in perception, action and memory retrieval) can be modelled by the modulation and re-entry of top-down information to posterior parts of the brain. Hierarchically organized modules in PFC create the possibility for information integration. We argue that large-scale multimodal integration of information creates an ‘episodic buffer’, and may even suffice for implementing a central executive

The Edinburgh Social Cognition Test (ESCoT):Examining the effects of age on a new measure of theory of mind and social norm understanding

<div><p>Current measures of social cognition have shown inconsistent findings regarding the effects of healthy aging. Moreover, no tests are currently available that allow clinicians and researchers to examine cognitive and affective theory of mind (ToM) and understanding of social norms within the same test. To address these limitations, we present the Edinburgh Social Cognition Test (ESCoT) which assesses cognitive and affective ToM and inter- and intrapersonal understanding of social norms. We examined the effects of age, measures of intelligence and the Broader Autism Phenotype (BAP) on the ESCoT and established tests of social cognition. Additionally, we investigated the convergent validity of the ESCoT based on traditional social cognition measures. The ESCoT was administered alongside Reading the Mind in Films (RMF), Reading the Mind in Eyes (RME), Judgement of Preference and Social Norm Questionnaire to 91 participants (30 aged 18–35 years, 30 aged 45–60 years and 31 aged 65–85 years). Poorer performance on the cognitive and affective ToM ESCoT subtests were predicted by increasing age. The affective ToM ESCoT subtest and RMF were predicted by gender, where being female predicted better performance. Unlike the ESCoT, better performance on the RMF was predicted by higher verbal comprehension and perceptual reasoning abilities, while better performance on the RME was predicted by higher verbal comprehension scores. Lower scores on inter-and intrapersonal understanding of social norms were both predicted by the presence of more autism-like traits while poorer interpersonal understanding of social norms performance was predicted by increasing age. These findings show that the ESCoT is a useful measure of social cognition and, unlike established tests of social cognition, performance is not predicted by measures of verbal comprehension and perceptual reasoning. This is particularly valuable to obtain an accurate assessment of the influence of age on our social cognitive abilities.</p></div

Generalized Bose-Einstein Condensation

Generalized Bose-Einstein condensation (GBEC) involves condensates appearing simultaneously in multiple states. We review examples of the three types in an ideal Bose gas with different geometries. In Type I there is a discrete number of quantum states each having macroscopic occupation; Type II has condensation into a continuous band of states, with each state having macroscopic occupation; in Type III each state is microscopically occupied while the entire condensate band is macroscopically occupied. We begin by discussing Type I or "normal" BEC into a single state for an isotropic harmonic oscillator potential. Other geometries and external potentials are then considered: the {}"channel" potential (harmonic in one dimension and hard-wall in the other), which displays Type II, the {}"cigar trap" (anisotropic harmonic potential), and the "Casimir prism" (an elongated box), the latter two having Type III condensations. General box geometries are considered in an appendix. We particularly focus on the cigar trap, which Van Druten and Ketterle first showed had a two-step condensation: a GBEC into a band of states at a temperature $T_{c}$ and another "one-dimensional" transition at a lower temperature $T_{1}$ into the ground state. In a thermodynamic limit in which the ratio of the dimensions of the anisotropic harmonic trap is kept fixed, $T_{1}$ merges with the upper transition, which then becomes a normal BEC. However, in the thermodynamic limit of Beau and Zagrebnov, in which the ratio of the boundary lengths increases exponentially, $T_{1}$ becomes fixed at the temperature of a true Type I phase transition. The effects of interactions on GBEC are discussed and we show that there is evidence that Type III condensation may have been observed in the cigar trap.Comment: 17 pages; 6 figures. Intended for American Journal of Physic