Successful conservative management of a colorenal fistula complicating percutaneous cryoablation of renal tumors: a case report.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.INTRODUCTION: Colorenal fistula is a rare phenomenon and may complicate percutaneous cryoablation of renal cell carcinoma. Treatment remains controversial. CASE PRESENTATION: A 62-year-old Caucasian man presented with pneumaturia and left flank pain six weeks following ultrasound-guided percutaneous cryoablation of two recurrent lesions in the left kidney 14 years after partial left nephrectomy for a left renal cell carcinoma. A computed tomography scan eight weeks after cryoablation revealed a cryoablated mass with adjacent stranding and adherent descending colon as well as bubbles of gas in the area of stranding, the left collecting system, and the bladder. These features were consistent with a colorenal fistula at the site of previous ablation. Successful resolution of the fistula, both clinical and radiological, was achieved following a complete conservative non-interventional out-patient approach. No ureteric stent or surgical intervention was employed. CONCLUSIONS: In the absence of severe symptoms or sepsis, complete conservative management of a colorenal fistula complicating percutaneous cryoablation of renal tumors should be considered prior to interventional stenting or resectional surgery

Cost and time damping: evidence from aggregate rail direct demand models

There is a significant body of evidence from both disaggregate choice modelling literature and practical travel demand forecasting that the responsiveness to cost and possibly to time diminishes with journey length. This has, in Britain at least, been termed ‘Cost Damping’, and is recognised in guidance issued by the UK Department for Transport. However, the consistency of the effect across modes and data types has not been established. Cost damping, if it exists, affects both the forecasting of demand and our understanding of behaviour. This paper aims to investigate the evidence for cost and time damping in rail demand using aggregate rail ticket sales data. The rail ticket sales data in Britain has, for many years, formed the basis of analysis of a wide range of impacts of rail demand. It records the number of tickets sold between station pairs, and it is generally felt to provide a reasonably accurate reflection of travel demand. However, the consistency of these direct demand models with choice modelling and highway demand model structures has not been investigated. Rail direct demand models estimated by ticket sales data indicate only slight variation in the fare elasticity with distance, as is evidenced in the largest meta-analysis of price elasticities conducted to date (Wardman, 2014). This study of UK elasticities shows strong variation between urban and inter-urban trips, presumably a segmentation at least in part by purpose, but less remaining variation by trip length. A lack of variation by length supports the hypothesis of cost damping, because constant cost sensitivity would imply that fare elasticity would increase strongly with distance, because of the increasing impact of higher fares at longer distances. In this paper we indicate that rail direct demand models have some consistency of behavioural paradigm with utility based choice models used in highway planning. We go on to use rail demand data to estimate time and fare elasticities in the context of various cost damping functions. Our empirical contribution is to estimate time elasticities on a basis directly comparable with cost elasticities and to show that the phenomenon of cost damping is strongly present in ticket sales data. This finding implies that cost damping should be included in models intended for multimodal analysis, which may otherwise give incorrect predictions

QoEMultiSDN: Management of Multimedia Services using MPTCP/SR in Softwarized and Virtualized Networks

5G networks are set to empower new user experiences for multimedia streaming services by offering high data rates and low latency. The rapid growth of multimedia services, such as video streaming services over future softwarized 5G networks, poses great challenges for both service providers and network operators regarding service provisioning with high Quality of Experience (QoE). Network evolution towards Software Defined Networking (SDN) and Network Function Virtualization (NFV) provides new opportunities to develop innovative ways to address the challenges. In this paper, we present a novel QoE-aware management scheme based on SDN/NFV by utilizing Multi-Path-TCP/Segment-Routing (MPTCP/SR) techniques and exploring information from both the network and client. The new scheme, entitled QoEMultiSDN, provides an optimized end-to-end QoE for multimedia service delivery. QoEMultiSDN employs two novel strategies to achieve this: (a) QoE-based multisource routing and QoE optimization, and (b) multipath protection and dynamic link-failure-free mechanisms. We implemented the proposed scheme over SDN through Dynamic Adaptive Streaming over HTTP (DASH) experiments using Mininet, POX and OpenDaylight controllers, and compared its performance with MPTCP and regular TCP. Experimental results indicate that the QoEMultiSDN outperforms others in terms of system throughput, failure recovery time and the QoE of the end-user.Science Foundation IrelandInsight Research Centre2021-02-24 JG: broken PDF replacedUpdate citation details during checkdate report - A

Understanding pregnancy planning in a low-income country setting: validation of the London measure of unplanned pregnancy in Malawi

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: The London Measure of Unplanned Pregnancy (LMUP) is a new and psychometrically valid measure of pregnancy intention that was developed in the United Kingdom. An improved understanding of pregnancy intention in low-income countries, where unintended pregnancies are common and maternal and neonatal deaths are high, is necessary to inform policies to address the unmet need for family planning. To this end this research aimed to validate the LMUP for use in the Chichewa language in Malawi.Methods: Three Chichewa speakers translated the LMUP and one translation was agreed which was back-translated and pre-tested on five pregnant women using cognitive interviews. The measure was field tested with pregnant women who were recruited at antenatal clinics and data were analysed using classical test theory and hypothesis testing.Results: 125 women aged 15-43 (median 23), with parities of 1-8 (median 2) completed the Chichewa LMUP. There were no missing data. The full range of LMUP scores was captured. In terms of reliability, the scale was internally consistent (Cronbach's alpha = 0.78) and test-retest data from 70 women showed good stability (weighted Kappa 0.80). In terms of validity, hypothesis testing confirmed that unmarried women (p = 0.003), women who had four or more children alive (p = 0.0051) and women who were below 20 or over 29 (p = 0.0115) were all more likely to have unintended pregnancies. Principal component analysis showed that five of the six items loaded onto one factor, with a further item borderline. A sensitivity analysis to assess the effect of the removal of the weakest item of the scale showed slightly improved performance but as the LMUP was not significantly adversely affected by its inclusion we recommend retaining the six-item score.Conclusion: The Chichewa LMUP is a valid and reliable measure of pregnancy intention in Malawi and can now be used in research and/or surveillance. This is the first validation of this tool in a low-income country, helping to demonstrate that the concept of pregnancy planning is applicable in such a setting. Use of the Chichewa LMUP can enhance our understanding of pregnancy intention in Malawi, giving insight into the family planning services that are required to better meet women's needs and save lives. © 2013 Hall et al.; licensee BioMed Central Ltd.Dr Hall’s Wellcome Trust Research Training Fellowship, grant number 097268/Z/11/Z

The effect of distance on reaction time in aiming movements

Target distance affects movement duration in aiming tasks but its effect on reaction time (RT) is poorly documented. RT is a function of both preparation and initiation. Experiment 1 pre-cued movement (allowing advanced preparation) and found no influence of distance on RT. Thus, target distance does not affect initiation time. Experiment 2 removed pre-cue information and found that preparing a movement of increased distance lengthens RT. Experiment 3 explored movements to targets of cued size at non-cued distances and found size altered peak speed and movement duration but RT was influenced by distance alone. Thus, amplitude influences preparation time (for reasons other than altered duration) but not initiation time. We hypothesise that the RT distance effect might be due to the increased number of possible trajectories associated with further targets: a hypothesis that can be tested in future experiments

Liposomal Co-Entrapment of CD40mAb Induces Enhanced IgG Responses against Bacterial Polysaccharide and Protein

Background Antibody against CD40 is effective in enhancing immune responses to vaccines when chemically conjugated to the vaccine antigen. Unfortunately the requirement for chemical conjugation presents some difficulties in vaccine production and quality control which are compounded when multivalent vaccines are required. We explore here an alternative to chemical conjugation, involving the co-encapsulation of CD40 antibody and antigens in liposomal vehicles. Methodology/Principal Findings Anti-mouse CD40 mAb or isotype control mAb were co-entrapped individually in cationic liposomal vehicles with pneumococcal polysaccharides or diphtheria and tetanus toxoids. Retention of CD40 binding activity upon liposomal entrapment was assessed by ELISA and flow cytometry. After subcutaneous immunization of BALB/c female mice, anti-polysaccharide and DT/TT responses were measured by ELISA. Simple co-encapsulation of CD40 antibody allowed for the retention of CD40 binding on the liposome surface, and also produced vaccines with enhanced imunogenicity. Antibody responses against both co-entrapped protein in the form of tetanus toxoid, and Streptococcus pneumoniae capsular polysaccharide, were enhanced by co-encapsulation with CD40 antibody. Surprisingly, liposomal encapsulation also appeared to decrease the toxicity of high doses of CD40 antibody as assessed by the degree of splenomegaly induced. Conclusions/Significance Liposomal co-encapsulation with CD40 antibody may represent a practical means of producing more immunogenic multivalent vaccines and inducing IgG responses against polysaccharides without the need for conjugation

Spectral Line-by-Line Pulse Shaping of an On-Chip Microresonator Frequency Comb

We report, for the first time to the best of our knowledge, spectral phase characterization and line-by-line pulse shaping of an optical frequency comb generated by nonlinear wave mixing in a microring resonator. Through programmable pulse shaping the comb is compressed into a train of near-transform-limited pulses of \approx 300 fs duration (intensity full width half maximum) at 595 GHz repetition rate. An additional, simple example of optical arbitrary waveform generation is presented. The ability to characterize and then stably compress the frequency comb provides new data on the stability of the spectral phase and suggests that random relative frequency shifts due to uncorrelated variations of frequency dependent phase are at or below the 100 microHertz level.Comment: 18 pages, 4 figure

The ansamycin antibiotic, rifamycin SV, inhibits BCL6 transcriptional repression and forms a complex with the BCL6-BTB/POZ domain

BCL6 is a transcriptional repressor that is over-expressed due to chromosomal translocations, or other abnormalities, in ~40% of diffuse large B-cell lymphoma. BCL6 interacts with co-repressor, SMRT, and this is essential for its role in lymphomas. Peptide or small molecule inhibitors, which prevent the association of SMRT with BCL6, inhibit transcriptional repression and cause apoptosis of lymphoma cells in vitro and in vivo. In order to discover compounds, which have the potential to be developed into BCL6 inhibitors, we screened a natural product library. The ansamycin antibiotic, rifamycin SV, inhibited BCL6 transcriptional repression and NMR spectroscopy confirmed a direct interaction between rifamycin SV and BCL6. To further determine the characteristics of compounds binding to BCL6-POZ we analyzed four other members of this family and showed that rifabutin, bound most strongly. An X-ray crystal structure of the rifabutin-BCL6 complex revealed that rifabutin occupies a partly non-polar pocket making interactions with tyrosine58, asparagine21 and arginine24 of the BCL6-POZ domain. Importantly these residues are also important for the interaction of BLC6 with SMRT. This work demonstrates a unique approach to developing a structure activity relationship for a compound that will form the basis of a therapeutically useful BCL6 inhibitor

Non-local effects in the mean-field disc dynamo. II. Numerical and asymptotic solutions

The thin-disc global asymptotics are discussed for axisymmetric mean-field dynamos with vacuum boundary conditions allowing for non-local terms arising from a finite radial component of the mean magnetic field at the disc surface. This leads to an integro-differential operator in the equation for the radial distribution of the mean magnetic field strength, $Q(r)$ in the disc plane at a distance $r$ from its centre; an asymptotic form of its solution at large distances from the dynamo active region is obtained. Numerical solutions of the integro-differential equation confirm that the non-local effects act similarly to an enhanced magnetic diffusion. This leads to a wider radial distribution of the eigensolution and faster propagation of magnetic fronts, compared to solutions with the radial surface field neglected. Another result of non-local effects is a slowly decaying algebraic tail of the eigenfunctions outside the dynamo active region, $Q(r)\sim r^{-4}$, which is shown to persist in nonlinear solutions where $\alpha$-quenching is included. The non-local nature of the solutions can affect the radial profile of the regular magnetic field in spiral galaxies and accretion discs at large distances from the centre.Comment: Revised version, as accepted; Geophys. Astrophys. Fluid Dyna

Neural processing of criticism and positive comments from relatives in individuals with schizotypal personality traits

Objectives. High negative expressed emotion by family members towards schizophrenia patients increases the risk of subsequent relapse. The study aimed to determine whether individuals with high schizotypy (HS) and low schizotypy (LS) would differ in activation of brain areas involved in cognitive control when listening to relative criticism