Case Report: An Undiagnosed Bladder Diverticulum Resulting in Foley Catheter Perforation During Cesarean Section

A bladder diverticulum is diagnosed when herniated bladder mucosa forms an outpouching from the bladder. Bladder diverticula are uncommon and are significantly more common in males. The following case presents a patient with an undiagnosed bladder diverticulum which was incidentally perforated during foley catheter placement for a repeat cesarean section. The diagnosis can be difficult in those who are asymptomatic and lack risk factors, such as the following patient

Case Report: An Undiagnosed Bladder Diverticulum Resulting in Foley Catheter Perforation During Cesarean Section

A bladder diverticulum is diagnosed when herniated bladder mucosa forms an outpouching from the bladder. Bladder diverticula are uncommon and are significantly more common in males. The following case presents a patient with an undiagnosed bladder diverticulum which was incidentally perforated during foley catheter placement for a repeat cesarean section. The diagnosis can be difficult in those who are asymptomatic and lack risk factors, such as the following patient

Stem Cell Transplantation As A Dynamical System: Are Clinical Outcomes Deterministic?

Outcomes in stem cell transplantation (SCT) are modeled using probability theory. However the clinical course following SCT appears to demonstrate many characteristics of dynamical systems, especially when outcomes are considered in the context of immune reconstitution. Dynamical systems tend to evolve over time according to mathematically determined rules. Characteristically, the future states of the system are predicated on the states preceding them, and there is sensitivity to initial conditions. In SCT, the interaction between donor T cells and the recipient may be considered as such a system in which, graft source, conditioning and early immunosuppression profoundly influence immune reconstitution over time. This eventually determines clinical outcomes, either the emergence of tolerance or the development of graft versus host disease. In this paper parallels between SCT and dynamical systems are explored and a conceptual framework for developing mathematical models to understand disparate transplant outcomes is proposed.Comment: 23 pages, 4 figures. Updated version with additional data, 2 new figures and editorial revisions. New authors adde

How much is enough? Minimal responses of water quality and stream biota to partial retrofit stormwater management in a suburban neighborhood

Decentralized stormwater management approaches (e.g., biofiltration swales, pervious pavement, green roofs, rain gardens) that capture, detain, infiltrate, and filter runoff are now commonly used to minimize the impacts of stormwater runoff from impervious surfaces on aquatic ecosystems. However, there is little research on the effectiveness of retrofit, parcel-scale stormwater management practices for improving downstream aquatic ecosystem health. A reverse auction was used to encourage homeowners to mitigate stormwater on their property within the suburban, 1.8 km2 Shepherd Creek catchment in Cincinnati, Ohio (USA). In 2007–2008, 165 rain barrels and 81 rain gardens were installed on 30% of the properties in four experimental (treatment) subcatchments, and two additional subcatchments were maintained as controls. At the base of the subcatchments, we sampled monthly baseflow water quality, and seasonal (5×/year) physical habitat, periphyton assemblages, and macroinvertebrate assemblages in the streams for the three years before and after treatment implementation. Given the minor reductions in directly connected impervious area from the rain barrel installations (11.6% to 10.4% in the most impaired subcatchment) and high total impervious levels (13.1% to 19.9% in experimental subcatchments), we expected minor or no responses of water quality and biota to stormwater management. There were trends of increased conductivity, iron, and sulfate for control sites, but no such contemporaneous trends for experimental sites. The minor effects of treatment on streamflow volume and water quality did not translate into changes in biotic health, and the few periphyton and macroinvertebrate responses could be explained by factors not associated with the treatment (e.g., vegetation clearing, drought conditions). Improvement of overall stream health is unlikely without additional treatment of major impervious surfaces (including roads, apartment buildings, and parking lots). Further research is needed to define the minimum effect threshold and restoration trajectories for retrofitting catchments to improve the health of stream ecosystems

Are Messages of R-parity Violating Supersymmetry Hidden within Top Quark Signals ?

In an R-parity nonconserving supersymmetric theory, the lighter stop can dominantly decay into $b\mu$ and $b\tau$ if R-parity breaking has to explain the neutrino mass and mixing pattern suggested by the data on atmospheric muon neutrinos. This should give rise to $dilepton+dijet$ and $single-lepton+jets$, signals resembling those of the top quark at the Fermilab Tevatron. One can thus constrain the stop parameter space using the current top search data, and similarly look for the first signals of supersymmetry at the upgraded runs of the Tevatron.Comment: 13 pages, RevTeX, 2 PS figures, uses epsfig.sty, few comments and references added, version to appear in Phys. Rev. Let

Cardiovascular outcomes reported in hemodialysis trials

Patients on long-term hemodialysis are at very high risk for cardiovascular disease but are usually excluded from clinical trials conducted in the general population or in at-risk populations. There are no universally agreed cardiovascular outcomes for trials conducted specifically in the hemodialysis population. In this review, we highlight that trials reporting cardiovascular outcomes in hemodialysis patients are usually of short duration (median 3 to 6 months) and are small (59% of trials have \u3c100 participants). Overall, the cardiovascular outcomes are very heterogeneous and may not reflect outcomes that are meaningful to patients and clinicians in supporting decision making, as they are often surrogates of uncertain clinical importance. Composite outcomes used in different trials rarely share the same components. In a field in which a single trial is often insufficiently powered to fully assess the clinical and economic impact of interventions, differences in outcome reporting across trials make the task of meta-analysis and interpretation of all the available evidence challenging. Core outcome sets are now being established across many specialties in health care to prevent these problems. Through the global Standardized Outcomes in Nephrology-Hemodialysis initiative, cardiovascular disease was identified as a critically important core domain to be reported in all trials in hemodialysis. Informed by the current state of reporting of cardiovascular outcomes, a core outcome measure for cardiovascular disease is currently being established with involvement of patients, caregivers, and health professionals. Consistent reporting of cardiovascular outcomes that are critically important to hemodialysis patients and clinicians will strengthen the evidence base to inform care in this very high-risk population

Relationship between latent and rebound viruses in a clinical trial of anti-HIV-1 antibody 3BNC117.

A clinical trial was performed to evaluate 3BNC117, a potent anti-HIV-1 antibody, in infected individuals during suppressive antiretroviral therapy and subsequent analytical treatment interruption (ATI). The circulating reservoir was evaluated by quantitative and qualitative viral outgrowth assay (Q2VOA) at entry and after 6 mo. There were no significant quantitative changes in the size of the reservoir before ATI, and the composition of circulating reservoir clones varied in a manner that did not correlate with 3BNC117 sensitivity. 3BNC117 binding site amino acid variants found in rebound viruses preexisted in the latent reservoir. However, only 3 of 217 rebound viruses were identical to 868 latent viruses isolated by Q2VOA and near full-length sequencing. Instead, 63% of the rebound viruses appeared to be recombinants, even in individuals with 3BNC117-resistant reservoir viruses. In conclusion, viruses emerging during ATI in individuals treated with 3BNC117 are not the dominant species found in the circulating latent reservoir, but frequently appear to represent recombinants of latent viruses

Transcriptional Profiling Suggests Extensive Metabolic Rewiring of Human and Mouse Macrophages during Early Interferon Alpha Responses

Emerging evidence suggests that cellular metabolism plays a critical role in regulating immune activation. Alterations in energy and lipid and amino acid metabolism have been shown to contribute to type I interferon (IFN) responses in macrophages, but the relationship between metabolic reprogramming and the establishment of early antiviral function remains poorly defined. Here, we used transcriptional profiling datasets to develop global metabolic signatures associated with early IFN-α responses in two primary macrophage model systems: mouse bone marrow-derived macrophages (BMM) and human monocyte-derived macrophages (MDM). Short-term stimulation with IFN-α (500 metabolic genes altered in mouse and human macrophage models. Pathway and network analysis identified alterations in genes associated with cellular bioenergetics, cellular oxidant status, cAMP/AMP and cGMP/GMP ratios, branched chain amino acid catabolism, cell membrane composition, fatty acid synthesis, and β-oxidation as key features of early IFN-α responses. These changes may have important impl

Tell me why! Explanations support learning relational and causal structure

Inferring the abstract relational and causal structure of the world is a major challenge for reinforcement-learning (RL) agents. For humans, language--particularly in the form of explanations--plays a considerable role in overcoming this challenge. Here, we show that language can play a similar role for deep RL agents in complex environments. While agents typically struggle to acquire relational and causal knowledge, augmenting their experience by training them to predict language descriptions and explanations can overcome these limitations. We show that language can help agents learn challenging relational tasks, and examine which aspects of language contribute to its benefits. We then show that explanations can help agents to infer not only relational but also causal structure. Language can shape the way that agents to generalize out-of-distribution from ambiguous, causally-confounded training, and explanations even allow agents to learn to perform experimental interventions to identify causal relationships. Our results suggest that language description and explanation may be powerful tools for improving agent learning and generalization.Comment: ICML 2022; 23 page