Peri-Operative Urodynamic Assessment has Poor Predictive Value for Developing Post-Operative Urinary Retention

Introduction: Post-operative urinary retention (POUR) following primary total joint arthroplasty (TJA) has a reported prevalence up to 35%. Risk factors for developing POUR have traditionally included surrogate markers such as the presence or absence of urologic disease. However, dynamic measurement of the renal system with post-void residual volumes (PVR) has not been investigated as a tool for assessing POUR risk. Methods: All male TJA patients underwent an pre-operative screen for POUR, including PVR measurements, patient-derived subjective urinary retention scores, and assessment of urologic disease. This was combined with a post-operative monitoring and catheterization protocol developed in partnership with a Urologist. Patient records were retrospectively reviewed and assessed whether pre-operative PVR cutoffs or urinary retention scores were associated with developing POUR. Proportions were evaluated with the chi square test, while continuous variables were evaluated by logistic regression analysis. Receiver-operator characteristic (ROC) curves were utilized to determine the efficacy of using urodynamic variables as a predictor of developing POUR. Results: Two hundred and fifty-two (252) male patients were reviewed who had a mean age of 64.9 years and mean BMI 30.8 kg/m2. The overall rate of POUR was 5.2%; the rate of protocol-driven catheterization was higher (19.8%). Patient urinary retentions scores were not associated with the risk of POUR. Elevated pre-operative PVR (\u3e10 cc) alone and in combination with a history of urologic disease was significantly associated with POUR (p \u3c 0.001 and p = 0.001, respectively). However, both had low positive-predictive values (10.5 and 18.2%, respectively), despite high negative predictive values (99.2 and 97.9%, respectively). Utilization of PVR resulted in moderate sensitivity (91.6%) and low specificity (72.1%) with an AUC of 0.694. Discussion: Urodynamic measurements and patient urinary retention scores, as part of institutional pre-operative screening, have limited value in determining risk of POUR. False-positive rates of up to ~90% were observed with correspondingly low specificity. The authors call into question the utility of obtaining these measurements pre-operatively, particularly as they have no modifiable impact on institutional post-operative catheterization protocol

Phomopsis bougainvilleicola prepatellar bursitis in a renal transplant recipient

Prepatellar bursitis is typically a monomicrobial bacterial infection. A fungal cause is rarely identified. We describe a 61-year-old man who had received a renal transplant 21 months prior to presentation whose synovial fluid and surgical specimens grew Phomopsis bougainvilleicola, a pycnidial coelomycete

A Determination of the Centre-of-Mass Energy at LEP2 using Radiative 2-fermion Events

Using e+e- -> mu+mu-(gamma) and e+e- -> qqbar(gamma) events radiative to the Z pole, DELPHI has determined the centre-of-mass energy, sqrt{s}, using energy and momentum constraint methods. The results are expressed as deviations from the nominal LEP centre-of-mass energy, measured using other techniques. The results are found to be compatible with the LEP Energy Working Group estimates for a combination of the 1997 to 2000 data sets.Comment: 20 pages, 6 figures, Accepted by Eur. Phys. J.

Discovery of a Modified Tetrapolar Sexual Cycle in Cryptococcus amylolentus and the Evolution of MAT in the Cryptococcus Species Complex

Sexual reproduction in fungi is governed by a specialized genomic region called the mating-type locus (MAT). The human fungal pathogenic and basidiomycetous yeast Cryptococcus neoformans has evolved a bipolar mating system (a, α) in which the MAT locus is unusually large (>100 kb) and encodes >20 genes including homeodomain (HD) and pheromone/receptor (P/R) genes. To understand how this unique bipolar mating system evolved, we investigated MAT in the closely related species Tsuchiyaea wingfieldii and Cryptococcus amylolentus and discovered two physically unlinked loci encoding the HD and P/R genes. Interestingly, the HD (B) locus sex-specific region is restricted (∼2 kb) and encodes two linked and divergently oriented homeodomain genes in contrast to the solo HD genes (SXI1α, SXI2a) of C. neoformans and Cryptococcus gattii. The P/R (A) locus contains the pheromone and pheromone receptor genes but has expanded considerably compared to other outgroup species (Cryptococcus heveanensis) and is linked to many of the genes also found in the MAT locus of the pathogenic Cryptococcus species. Our discovery of a heterothallic sexual cycle for C. amylolentus allowed us to establish the biological roles of the sex-determining regions. Matings between two strains of opposite mating-types (A1B1×A2B2) produced dikaryotic hyphae with fused clamp connections, basidia, and basidiospores. Genotyping progeny using markers linked and unlinked to MAT revealed that meiosis and uniparental mitochondrial inheritance occur during the sexual cycle of C. amylolentus. The sexual cycle is tetrapolar and produces fertile progeny of four mating-types (A1B1, A1B2, A2B1, and A2B2), but a high proportion of progeny are infertile, and fertility is biased towards one parental mating-type (A1B1). Our studies reveal insights into the plasticity and transitions in both mechanisms of sex determination (bipolar versus tetrapolar) and sexual reproduction (outcrossing versus inbreeding) with implications for similar evolutionary transitions and processes in fungi, plants, and animals

Allelic Exchange of Pheromones and Their Receptors Reprograms Sexual Identity in Cryptococcus neoformans

Cell type specification is a fundamental process that all cells must carry out to ensure appropriate behaviors in response to environmental stimuli. In fungi, cell identity is critical for defining “sexes” known as mating types and is controlled by components of mating type (MAT) loci. MAT–encoded genes function to define sexes via two distinct paradigms: 1) by controlling transcription of components common to both sexes, or 2) by expressing specially encoded factors (pheromones and their receptors) that differ between mating types. The human fungal pathogen Cryptococcus neoformans has two mating types (a and α) that are specified by an extremely unusual MAT locus. The complex architecture of this locus makes it impossible to predict which paradigm governs mating type. To identify the mechanism by which the C. neoformans sexes are determined, we created strains in which the pheromone and pheromone receptor from one mating type (a) replaced the pheromone and pheromone receptor of the other (α). We discovered that these “αa” cells effectively adopt a new mating type (that of a cells); they sense and respond to α factor, they elicit a mating response from α cells, and they fuse with α cells. In addition, αa cells lose the α cell type-specific response to pheromone and do not form germ tubes, instead remaining spherical like a cells. Finally, we discovered that exogenous expression of the diploid/dikaryon-specific transcription factor Sxi2a could then promote complete sexual development in crosses between α and αa strains. These data reveal that cell identity in C. neoformans is controlled fully by three kinds of MAT–encoded proteins: pheromones, pheromone receptors, and homeodomain proteins. Our findings establish the mechanisms for maintenance of distinct cell types and subsequent developmental behaviors in this unusual human fungal pathogen

Dirty and 40 days in the wilderness: Eliciting childbirth and postnatal cultural practices and beliefs in Nepal.

Background: Pregnancy and childbirth are socio-cultural events that carry varying meanings across different societies and cultures. These are often translated into social expectations of what a particular society expects women to do (or not to do) during pregnancy, birth and/or the postnatal period. This paper reports a study exploring beliefs around childbirth in Nepal, a low-income country with a largely Hindu population. The paper then sets these findings in the context of the wider global literature around issues such as periods where women are viewed as polluted (or dirty even) after childbirth. Methods: A qualitative study comprising five in-depth face-to-face interviews and 14 focus group discussions with mainly women, but also men and health service providers. The qualitative findings in Nepal were compared and contrasted with the literature on practices and cultural beliefs related to the pregnancy and childbirth period across the globe and at different times in history. Results: The themes that emerged from the analysis included: (a) cord cutting & placenta rituals; (b) rest & seclusion; (c) purification, naming & weaning ceremonies and (d) nutrition and breastfeeding. Physiological changes in mother and baby may underpin the various beliefs, ritual and practices in the postnatal period. These practices often mean women do not access postnatal health services. Conclusions: The cultural practices, taboos and beliefs during pregnancy and around childbirth found in Nepal largely resonate with those reported across the globe. This paper stresses that local people’s beliefs and practices offer both opportunities and barriers to health service providers. Maternity care providers need to be aware of local values, beliefs and traditions to anticipate and meet the needs of women, gain their trust and work with them

Measurement of flavor asymmetry of light-quark sea in the proton with Drell-Yan dimuon production in p+pp+p and p+dp+d collisions at 120 GeV

Evidence for a flavor asymmetry between the $\bar u$ and $\bar d$ quark distributions in the proton has been found in deep-inelastic scattering and Drell-Yan experiments. The pronounced dependence of this flavor asymmetry on $x$ (fraction of nucleon momentum carried by partons) observed in the Fermilab E866 Drell-Yan experiment suggested a drop of the $\bar d\left(x\right) / \bar u\left(x\right)$ ratio in the $x > 0.15$ region. We report results from the SeaQuest Fermilab E906 experiment with improved statistical precision for $\bar d\left(x\right) / \bar u\left(x\right)$ in the large $x$ region up to $x=0.45$ using the 120 GeV proton beam. Two different methods for extracting the Drell-Yan cross section ratios, $\sigma^{pd} /2 \sigma^{pp}$, from the SeaQuest data give consistent results. The $\bar{d}\left(x\right) / \bar{u}\left(x\right)$ ratios and the $\bar d\left(x\right) - \bar u\left(x\right)$ differences are deduced from these cross section ratios for $0.13 < x < 0.45$. The SeaQuest and E866/NuSea $\bar{d}\left(x\right) / \bar{u}\left(x\right)$ ratios are in good agreement for the $x\lesssim 0.25$ region. The new SeaQuest data, however, show that $\bar d\left(x\right)$ continues to be greater than $\bar u\left(x\right)$ up to the highest $x$ value ($x = 0.45$). The new results on $\bar{d}\left(x\right) / \bar{u}\left(x\right)$ and $\bar{d}\left(x\right) - \bar{u}\left(x\right)$ are compared with various parton distribution functions and theoretical calculations