Umbilical hernia rupture with evisceration of omentum from massive ascites: a case report

<p>Abstract</p> <p>Introduction</p> <p>The incidence of hernias is increased in patients with alcoholic liver disease with ascites. To the best of our knowledge, this is the first report of an acute rise in intra-abdominal pressure from straining for stool as the cause of a ruptured umbilical hernia.</p> <p>Case presentation</p> <p>An 81-year-old Caucasian man with a history of alcoholic liver disease presented to our emergency department with an erythematous umbilical hernia and clear, yellow discharge from the umbilicus. On straining for stool, after initial clinical assessment, our patient noted a gush of fluid and evisceration of omentum from the umbilical hernia. An urgent laparotomy was performed with excision of the umbilicus and devitalized omentum.</p> <p>Conclusion</p> <p>We report the case of a patient with a history of alcoholic liver disease with ascites. Ascites causes a chronic increase in intra-abdominal pressure. A sudden increase in intra-abdominal pressure, such as coughing, vomiting, gastroscopy or, as in this case, straining for stool can cause rupture of an umbilical hernia. The presence of discoloration, ulceration or a rapid increase in size of the umbilical hernia signals impending rupture and should prompt the physician to reduce the intra-abdominal pressure.</p

Identifying frequency decorrelated dust residuals in B-mode maps by exploiting the spectral capability of bolometric interferometry

Astrophysical polarized foregrounds represent the most critical challenge in Cosmic Microwave Background (CMB) B-mode experiments. Multi-frequency observations can be used to constrain astrophysical foregrounds to isolate the CMB contribution. However, recent observations indicate that foreground emission may be more complex than anticipated. We investigate how the increased spectral resolution provided by band splitting in Bolometric Interferometry (BI) through a technique called spectral imaging can help control the foreground contamination in the case of unaccounted Galactic dust frequency decorrelation along the line-of-sight. We focus on the next generation ground-based CMB experiment CMB-S4, and compare its anticipated sensitivities, frequency and sky coverage with a hypothetical version of the same experiment based on BI. We perform a Monte-Carlo analysis based on parametric component separation methods (FGBuster and Commander) and compute the likelihood on the recovered tensor-to-scalar ratio. The main result of this analysis is that spectral imaging allows us to detect systematic uncertainties on r from frequency decorrelation when this effect is not accounted for in component separation. Conversely, an imager would detect a biased value of r and would be unable to spot the presence of a systematic effect. We find a similar result in the reconstruction of the dust spectral index, where we show that with BI we can measure more precisely the dust spectral index also when frequency decorrelation is present. The in-band frequency resolution provided by BI allows us to identify dust LOS frequency decorrelation residuals where an imager of similar performance would fail. This opens the prospect to exploit this potential in the context of future CMB polarization experiments that will be challenged by complex foregrounds in their quest for B-modes detection.Comment: 13 Pages, 15 figures, 4 tables. Submitted to A&

A potent betulinic acid analogue ascertains an antagonistic mechanism between autophagy and proteasomal degradation pathway in HT-29 cells

Betulinic acid (BA), a member of pentacyclic triterpenes has shown important biological activities like anti-bacterial, anti-malarial, anti-inflammatory and most interestingly anticancer property. To overcome its poor aqueous solubility and low bioavailability, structural modifications of its functional groups are made to generate novel lead(s) having better efficacy and less toxicity than the parent compound. BA analogue, 2c was found most potent inhibitor of colon cancer cell line, HT-29 cells with IC50 value 14.9 μM which is significantly lower than standard drug 5-fluorouracil as well as parent compound, Betulinic acid. We have studied another mode of PCD, autophagy which is one of the important constituent of cellular catabolic system as well as we also studied proteasomal degradation pathway to investigate whole catabolic pathway after exploration of 2c on HT-29 cells. Mechanism of autophagic cell death was studied using fluorescent dye like acridine orange (AO) and monodansylcadaverin (MDC) staining by using fluorescence microscopy. Various autophagic protein expression levels were determined by Western Blotting, qRT-PCR and Immunostaining. Confocal Laser Scanning Microscopy (CLSM) was used to study the colocalization of various autophagic proteins. These were accompanied by formation of autophagic vacuoles as revealed by FACS and transmission electron microscopy (TEM). Proteasomal degradation pathway was studied by proteasome-Glo™ assay systems using luminometer.The formation of autophagic vacuoles in HT-29 cells after 2c treatment was determined by fluorescence staining – confirming the occurrence of autophagy. In addition, 2c was found to alter expression levels of different autophagic proteins like Beclin-1, Atg 5, Atg 7, Atg 5-Atg 12, LC3B and autophagic adapter protein, p62. Furthermore we found the formation of autophagolysosome by colocalization of LAMP-1 with LC3B, LC3B with Lysosome, p62 with lysosome. Finally, as proteasomal degradation pathway downregulated after 2c treatment colocalization of ubiquitin with lysosome and LC3B with p62 was studied to confirm that protein degradation in autophagy induced HT-29 cells follows autolysosomal pathway. In summary, betulinic acid analogue, 2c was able to induce autophagy in HT-29 cells and as proteasomal degradation pathway downregulated after 2c treatment so protein degradation in autophagy induced HT-29 cell

Status of QUBIC, the Q&U Bolometer for Cosmology

The Q&U Bolometric Interferometer for Cosmology (QUBIC) is a novel kind of polarimeter optimized for the measurement of the B-mode polarization of the Cosmic Microwave Back-ground (CMB), which is one of the major challenges of observational cosmology. The signal is expected to be of the order of a few tens of nK, prone to instrumental systematic effects and polluted by various astrophysical foregrounds which can only be controlled through multichroic observations. QUBIC is designed to address these observational issues with a novel approach that combines the advantages of interferometry in terms of control of instrumental systematics with those of bolometric detectors in terms of wide-band, background-limited sensitivity.Comment: Contribution to the 2022 Cosmology session of the 33rd Rencontres de Blois. arXiv admin note: substantial text overlap with arXiv:2203.0894

Risk Factors Associated with Adverse Fetal Outcomes in Pregnancies Affected by Coronavirus Disease 2019 (COVID-19): A Secondary Analysis of the WAPM study on COVID-19

To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Mean gestational age at diagnosis was 30.6\ub19.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible

A PROSPECTIVE RANDOMIZED STUDY COMPARING LAPAROSCOPIC BURCH VERSUS TVT. SHORT AND LONG TERM FOLLOW-UP

Objective: To report short and long-terms results of a prospective randomized laparoscopic Burch vs TVT for the treatment of stress incontinence (GSI). Methods: Since January 1999 to January 2003 we performed 66 LB and 67 TVT. In the LB group the mean age was 51years ( range 38–65), mean body weight 73 Kg.(range 48–88), mean parity 2,5 (range 1–5), menopause 38 (57,5%), while in the TVT group the mean age was 53years (range 37–72), mean body weight 70Kg. (range 46–84), mean parity 2,3 (range 1–4), menopause 19 (28,3%). All pts. preoperativelly underwent a complete urogynaecological work-up . All the pts. showed S.U.I. mean grade II (according to Ingelman Sundeberg) and urethra hypermobile. The surgical precedure was carried out under epidural anaesthesia for TVT and general for LB. Post menopausal pts were taking systemic or local estrogen therapy. We introduced in the study patients that never underwent a previous surgery for GSI. The choice of the patients to treat with Burch or TVT was casual. In the study we excluded pts. that needed an additional surgical procedure to repair coexisting pelvic floor defects. Results: There were clinical differences between the two methods: procedure time was 1–1,5 h for LB and<30 min for TVT, hospitalization was 2 days and 1 day respectively, anaesthesia was general for LB and local for TVT, invasiveness mini for LB and micro for TVT, learning curve: 6 months training for LB and 15 days for TVT. Complications: 2 (3,3%) cases of hematoma Retzius in LB and 3 (4,4%) bladder perforations in TVT. Blood loss was absent in both methods. The Foley catheter was removed 3–4 h after procedures in both groups while in the patients with bladder injuries we put on indwelling catheter for 2 days. At 3 months follow-up all patients were completely dry. At 6–36 months followup in the TVT group 63 (94%) were continent, 3 pts. (4%) were significantly improvement, only 1 (1,5%) failed. In the LB group 60 (91%) were continent, 2 (3,1%) was significantly improvement, 5 pts. (7,5%) failed. In the TVT group we found 3 pts (4,5%) with de novo instability and in the LB group, we found 2 pts (3%) with de novo instability at the post-operative follow-up. Conclusions: The mean hospital cost of TVT is lower than the one of LB. The learning curve for the surgeons is longer for the LB. There is a different cost-effectiveness between the two form of management: TVT has to be considered more cost-effectiveness than LB. Anyway the immediate results for both procedures at long follow-up are encouragin