Urinary bladder melanosis with complete resolution case report

Background Melanosis of the bladder is a rare condition characterized by multifocal, diffuse melanin pigmentation of the urothelial mucosa or lamina propria without any proliferation of melanocytes. Less than 25 cases have been reported so far of which only four patients had concurrent urothelial carcinoma. Case presentation We are reporting a case of melanosis of the bladder in a 58-year-old female associated with pTaG1 transitional urothelial cell carcinoma (TCC) of the bladder who presented with symptoms of recurrent urinary tract infection (UTI). Cystoscopy and biopsy results confirmed benign melanosis. Conclusion Our case is unique because bladder melanosis associated low grade TCC with complete resolution of both conditions within one year

Alternatives for the Optimization of Aggregate and Pavement Properties Related to Friction and Wear Resistance - Executive Summary

DOT-FH-11-8814This report summarizes the major findings of a detailed, comprehensive report which has received only a limited distribution. The full report, FHWA-RD-78-209, is available upon request. An interdisciplinary team of researchers has conducted an in-depth review of the literature, supplemented with expert opinions, research experience, and limited tests, to develop a state-of-the-art on the topics of (a) properties of aggregates, (b) pavement texture and skid resistance, (c) tire-pavement noise, (d) tire wear, (e) light reflection and glare, (f) splash and spray, (g) rolling resistance and fuel consumption, and (h) optimal aggregates and pavement surfacing systems. A cost-benefit analysis is also summarized. The information on aggregates and their contribution to pavement texture, coarse and fine, is being used in on-going FHWA staff and contract research studies to investigate currently and potentially available ceramic and impregnation materials and processes for the manufacture or treatment of aggregates to provide extremely durable and skid-resistant pavement surfaces

The spectrum and clinical impact of epigenetic modifier mutations in myeloma

Epigenetic dysregulation is known to be an important contributor to myeloma pathogenesis but, unlike in other B cell malignancies, the full spectrum of somatic mutations in epigenetic modifiers has not been previously reported. We sought to address this using results from whole-exome sequencing in the context of a large prospective clinical trial of newly diagnosed patients and targeted sequencing in a cohort of previously treated patients for comparison.Whole-exome sequencing analysis of 463 presenting myeloma cases entered in the UK NCRI Myeloma XI study and targeted sequencing analysis of 156 previously treated cases from the University of Arkansas for Medical Sciences. We correlated the presence of mutations with clinical outcome from diagnosis and compared the mutations found at diagnosis with later stages of disease.In diagnostic myeloma patient samples we identify significant mutations in genes encoding the histone 1 linker protein, previously identified in other B-cell malignancies. Our data suggest an adverse prognostic impact from the presence of lesions in genes encoding DNA methylation modifiers and the histone demethylase KDM6A/UTX. The frequency of mutations in epigenetic modifiers appears to increase following treatment most notably in genes encoding histone methyltransferases and DNA methylation modifiers.Numerous mutations identified raise the possibility of targeted treatment strategies for patients either at diagnosis or relapse supporting the use of sequencing-based diagnostics in myeloma to help guide therapy as more epigenetic targeted agents become available

The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs

Laboratory evaluation of pavement surface texture characteristics in relation to skid resistance. Final report.

Mode of access: Internet.Author corporate affiliation: Federal Highway Administration, Office of Research and Development, Washington, D.C.Subject code: BEFSubject code: CDFSubject code: NCYS*CDFSubject code: NCYS*DPCSubject code: WU*CD

[[alternative]]於公路曲線中佈設差異摩擦舖面之效應

[[abstract]]從有彈簧懸吊的車輛動力之觀點，證實公路超高或曲線半徑的設計準則並不能滿 足廣泛的要求。事實上，超高設計原本就有其種種之限制。因此，在本研究中吾人描述一種 差異舖面摩擦之設計以抗衡超高佈設之不足。此種佈置主要係於公路彎道上之各車道之左右 半面提供某一程度的不同舖面摩擦而言。其功能為促使車輛行駛更穩定，乘客更舒適。這種 佈設沒有像佈設超高的缺點以致有其設限:超高在壞天氣時可能會致使車輛產生側滑意外。本 文繪列出不同設計速度及不同曲率半徑下之應有的相對差異摩擦係數值，至於如何在舖面上 實現差異性摩擦則做了一些舖面材料級配方面的選擇介紹分析。最後鄭重地提醒若建造此差 異摩擦路面應注意的相關安全問題。[[abstract]]From the perspective of sprung vehicle dynamics, the design criteria of superelevation or radius is unsatisfactory for broad requirements. Superelevation design has many limitations. Therefore, in this study, we describe a split layout of pavement friction, designed to counterbalance an insufficiency of superelevation. The layout is to provide different friction pavements between the left and the right sides of a lane in curves. Such a layout would cause vehicles to be more stable, in addition to providing passengers with more comfort. There is no deficiency of placing superelevations, of which the inclined cross-sections possibly cause side slipping in bad weather conditions. Also, the ideal values of friction difference for high design speeds versus various radii are illustrated. How to implement a split friction pavement is also introduced accompanied by an analysis of the selection of materials or aggregates. Finally, a special consideration regarding safety for constructing such a pavement is mentioned.[[booktype]]紙