Management of a Case of Colovesical Fistula with Fecaluria as First Sign

Introduction. Fecaluria and pneumaturia are the patognomonic signs of an abnormal communication between the bladder and the intestinal tract. Therefore, when a history of digestive signs, symptoms or digestive diseases is missing, this borderline pathology leads the patients in the care of urologists. From diagnosis to treatment the management of these cases can be difficult and challenging. Materials and Methods. A 48 year old patient, without any significant medical history, presented to the emergency room for fecaluria, pneumaturia and an episode of haematuria. He had no prior digestive symptoms. The contrast enhanced abdominal and pelvic CT scan revealed a pelvic mass involving the sigmoid colon and the dome and the posterior wall of the bladder. The cystoscopy objectifies a tumor mass involving the right postero-lateral bladder wall, with extravasation of faeces. A biopsy was taken and the frozen section found mainly uncertain inflammatory type tissue. A colonoscopy couldn’t be done because of an impassable obstacle at 15 cm from the anus. Together with general surgeons we decided for en bloc resection of the tumor with partial cystectomy, right ureterocystoneostomy and rectosigmoid resection with mechanic end to end anastomosis. Results. The postoperative period was uneventful. The histopathological examination revealed an abscessed sigmoid diverticulum with vesico-sigmoid fistula and perilesional inflammatory tissue. Two years after the surgery the patient is asymptomatic with a normal function of the right kidney and restored bladder capacity. Conclusions. Being a borderline pathology, patients with fecaluria and pneumaturia and lack of digestive symptoms are referred and managed by the urologists. Despite extensive investigations, even when preoperative biopsies reveal inflammatory tissue the patients should be treated as oncologic cases. A close cooperation with general surgeons for en bloc multiorgan resection within oncologic safety margins is mandatory

Graviton Mass or Cosmological Constant?

To describe a massive graviton in 4D Minkowski space-time one introduces a quadratic term in the Lagrangian. This term, however, can lead to a readjustment or instability of the background instead of describing a massive graviton on flat space. We show that for all local Lorentz-invariant mass terms Minkowski space is unstable. We start with the Pauli-Fierz (PF) term that is the only local mass term with no ghosts in the linearized approximation. We show that nonlinear completions of the PF Lagrangian give rise to instability of Minkowski space. We continue with the mass terms that are not of a PF type. Although these models are known to have ghosts in the linearized approximations, nonlinear interactions can lead to background change due to which the ghosts are eliminated. In the latter case, however, the graviton perturbations on the new background are not massive. We argue that a consistent theory of a massive graviton on flat space can be formulated in theories with extra dimensions. They require an infinite number of fields or non-local description from a 4D point of view.Comment: 16 pages; references and comments adde

Understanding mechanisms of genetic risk for adolescent internalizing and externalizing problems: The mediating role of parenting and personality

Genetic predispositions play an important role in the development of internalizing and externalizing behaviors. Understanding the mechanisms through which genetic risk unfolds to influence these developmental outcomes is critical for developing prevention and intervention efforts, capturing key elements of Irv's research agenda and scientific legacy. In this study, we examined the role of parenting and personality in mediating the effect of genetic risk on adolescents' major depressive disorder and conduct disorder symptoms. Longitudinal data were drawn from a sample of 709 European American adolescents and their mothers from the Collaborative Studies on Genetics of Alcoholism. Results from multivariate path analysis indicated that adolescents' depressive symptoms genome-wide polygenic scores (DS_GPS) predicted lower parental knowledge, which in turn was associated with more subsequent major depressive disorder and conduct disorder symptoms. Adolescents' DS_GPS also had indirect effects on these outcomes via personality, with a mediating effect via agreeableness but not via other dimensions of personality. Findings revealed that the pattern of associations was similar across adolescent gender. Our findings emphasize the important role of evocative gene-environment correlation processes and intermediate phenotypes in the pathways of risk from genetic predispositions to complex adolescent outcomes

Gravity induced over a smooth soliton

I consider gravity induced over a smooth (finite thickness) soliton. Graviton kinetic term is coupled to bulk scalar that develops solitonic vacuum expectation value. Couplings of Kaluza-Klein modes to soliton-localized matter are suppressed, giving rise to crossover distance $r_c=M_{P}^2/M_{*}^3$ between 4D and 5D behavior. This system can be viewed as a finite thickness brane regularization of the model of Dvali, Gabadadze and Porrati.Comment: 12 pages, 2 figure

String Branchings on Complex Tori and Algebraic Representations of Generalized Krichever-Novikov Algebras

The propagation differential for bosonic strings on a complex torus with three symmetric punctures is investigated. We study deformation aspects between two point and three point differentials as well as the behaviour of the corresponding Krichever-Novikov algebras. The structure constants are calculated and from this we derive a central extension of the Krichever-Novikov algebras by means of b-c systems. The defining cocycle for this central extension deforms to the well known Virasoro cocycle for certain kinds of degenerations of the torus. AMS subject classification (1991): 17B66, 17B90, 14H52, 30F30, 81T40Comment: 11 pages, amste

TRIF adaptor signaling is important in abdominal aortic aneurysm formation

Objective: Abdominal aortic aneurysm (AAA) is characterized by inflammation, loss of smooth muscle cells (SMCs), and degradation of the extracellular matrix in the vessel wall. Innate immune receptors such as Toll-like receptors (TLRs) were recently shown to regulate immunological processes leading to the formation and progression of atherosclerotic plaques as well as to other cardiovascular pathologies. Our aim was to investigate whether blockage of TLR signaling, under the control of TIR domain-containing adaptor protein including IFN-beta (TRIF), could inhibit the inflammatory response and AAA development in mice. Results: In human AAA, an increased TLR3 and TLR4 expression in association with macrophages and T lymphocytes was demonstrated with immunohistochemical analysis. Angiotensin (Ang) II-induced aneurysm formation was significantly reduced by 30% in ApoE(-/-)Trif(-/-) mice compared to ApoE(-/-) mice. Morphologically, AngII-infused ApoE(-/-)Trif(-/-) mice had a more intact cellular and extracellular matrix while ApoE(-/-) mice infused with AngII displayed an increased medial thickness associated with aortic dissection, thrombus formation, and a more disorganized vessel wall. Gene expression analysis of the abdominal aorta revealed a profound decrease of the inflammatory genes CD68 (P <0.05), CD11b (P <0.05), and TNF-alpha (P <0.05) and the protease gene MMP-12 (P <0.01) in ApoE(-/-)Trif(-/-) mice compared to ApoE(-/-) mice infused with AngII. Conclusion: Our results suggest that signaling through TRIF is important for the inflammatory response of AngII-induced AAA and that blockage of the TRIF pathway reduces vascular inflammation and protects against AAA formation. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.Peer reviewe

Testing whether muon neutrino flavor mixing is maximal

The small difference between the survival probabilities of muon neutrino and antineutrino beams, traveling through earth matter in a long baseline experiment such as MINOS, is shown to be an important measure of any possible deviation from maximality in the flavor mixing of those states.Comment: Some revision has been made in the experimental discussions with two new figures replacing the old ones and a clarification of the accuracy of the perturbative result has been included. This version will be published in Physical Review Letters. Title changed as asked by the editors of Physical Review Letter

Predictors of subgroups based on maximum drinks per occasion over six years for 833 adolescents and young adults in COGA.

ObjectiveA person's pattern of heavier drinking often changes over time, especially during the early drinking years, and reflects complex relationships among a wide range of characteristics. Optimal understanding of the predictors of drinking during times of change might come from studies of trajectories of alcohol intake rather than cross-sectional evaluations.MethodThe patterns of maximum drinks per occasion were evaluated every 2 years between the average ages of 18 and 24 years for 833 subjects from the Collaborative Study on the Genetics of Alcoholism. Latent class growth analysis identified latent classes for the trajectories of maximum drinks, and then logistic regression analyses highlighted variables that best predicted class membership.ResultsFour latent classes were found, including Class 1 (69%), with about 5 maximum drinks per occasion across time; Class 2 (15%), with about 9 drinks at baseline that increased to 18 across time; Class 3 (10%), who began with a maximum of 18 drinks per occasion but decreased to 9 over time; and Class 4 (6%), with a maximum of about 22 drinks across time. The most consistent predictors of higher drinking classes were female sex, a low baseline level of response to alcohol, externalizing characteristics, prior alcohol and tobacco use, and heavier drinking peers.ConclusionsFour trajectory classes were observed and were best predicted by a combination of items that reflected demography, substance use, level of response and externalizing phenotypes, and baseline environment and attitudes

Hyper-Ramsey Spectroscopy of Optical Clock Transitions

We present non-standard optical Ramsey schemes that use pulses individually tailored in duration, phase, and frequency to cancel spurious frequency shifts related to the excitation itself. In particular, the field shifts and their uncertainties of Ramsey fringes can be radically suppressed (by 2-4 orders of magnitude) in comparison with the usual Ramsey method (using two equal pulses) as well as with single-pulse Rabi spectroscopy. Atom interferometers and optical clocks based on two-photon transitions, heavily forbidden transitions, or magnetically induced spectroscopy could significantly benefit from this method. In the latter case these frequency shifts can be suppressed considerably below a fractional level of 10^{-17}. Moreover, our approach opens the door for the high-precision optical clocks based on direct frequency comb spectroscopy.Comment: 5 pages, 4 figure

Microbial communities of the Lemon Creek Glacier show subtle structural variation yet stable phylogenetic composition over space and time

Glaciers are geologically important yet transient ecosystems that support diverse, biogeochemically significant microbial communities. During the melt season glaciers undergo dramatic physical, geochemical and biological changes that exert great influence on downstream biogeochemical cycles. Thus, we sought to understand the temporal melt-season dynamics of microbial communities and associated geochemistry at the terminus of Lemon Creek Glacier (LCG) in coastal southern Alaska. Due to late season snowfall, sampling of LCG occurred in three interconnected areas: proglacial Lake Thomas, the lower glacial outflow stream and the glacier’s terminus. LCG associated microbial communities were phylogenetically diverse and varied by sampling location. However, Betaproteobacteria, Alphaproteobacteria and Bacteroidetes dominated communities at all sampling locations. Strict anaerobic groups such as methanogens, SR1, and OP11 were also recovered from glacier outflows, indicating anoxic conditions in at least some portions of the LCG subglacial environment. Microbial community structure was significantly correlated with sampling location and sodium concentrations. Microbial communities sampled from terminus outflow waters exhibited day-to-day fluctuation in taxonomy and phylogenetic similarity. However, these communities were not significantly different from randomly constructed communities from all three sites. These results indicate that glacial outflows share a large proportion of phylogenetic overlap with downstream environments and that the observed significant shifts in community structure are driven by changes in relative abundance of different taxa, and not complete restructuring of communities. We conclude that LCG glacial discharge hosts a diverse and relatively stable microbiome that shifts at fine taxonomic scales in response to geochemistry and likely water residence time