Antegrade pressure measurement as a diagnostic tool in modern pediatric urology

The antegrade pressure measurement (APM) or perfusion pressure-flow test (Whitaker test) is a method of antegrade measurement of pressure in the upper urinary tract. In this study, we present the long-term follow-up results of APMs performed in our institution in the late 1980s and early 1990s to see whether the diagnostic decisions that were based on the outcomes of the test prove to be correct in the long term. We conducted a retrospective study by searching our hospital's electronic database. We found a total of 16 APMs performed between 1987 and 1995 (10 boys, six girls; mean age 61 months). In nine cases, action was undertaken immediately after the APM had been performed; in seven cases, this was a surgical procedure (re-implantation/re-calibration or pyeloplasty) after obstruction was demonstrated. In two cases (both postoperative after previous pyeloplasty), absence of obstruction was demonstrated and nephrostomy tubes were subsequently closed. In one case, this resulted in hydronephrosis that had to be treated with a new JJ stent. In all the seven cases in which no action was deemed necessary as a result of the outcome of the APM, long-term follow-up showed that intervention had indeed not been necessary. Although not often used anymore, the APM seems to be a safe and valuable diagnostic tool in the work up for possible urinary tract obstruction in children, especially in cases in which there is serious doubt concerning conservative watchful waitin

Value of multiparametric magnetic resonance imaging for local staging of invasive urinary bladder tumours.

Background: Initial tumour staging in bladder cancer mainly relies on the histo-pathological outcome of the transurethral bladder tumour resection (TURBT) and imaging by means of a CT-scan (CT-intravenous urography; CT-IVU). The reported risk of understaging varies from 24-50%. To further improve the the evaluation of depth of invasion of the bladder tumour the application of magnetic resonance imaging (MRI) may be useful. To substantiate the additional value of this imaging modality the present observational study was designed. Study design: This is a prospective observational study to analyse bladder tumour staging with multiparametric magnetic resonance imaging (mpMRI) in patients with a known bladder tumour, who are planned for radical cystectomy. Study population: Patients with an invasive bladder cancer who are planned for radical cystectomy. Intervention: Patients were accrued during their visit to the outpatient department of urology. They underwent routine cystoscopy, laboratory tests (including serum Creatinin) and CT-IVU investigations and subsequently a mpMRI. Main study parameters/endpoints: To demonstrate the value of mpMRI in the initial staging of bladder tumours using radiological bladder tumour stage (T-stage) based on mpMRI and pathological bladder tumour stage based on ‘whole-mount’ histo-pathology after radical cystectomy. Results: Thirty-seven participants with known bladder tumours underwent mpMRI and subsequent cystectomy. After mpMRI 10 participants were diagnosed with non-muscle-invasive bladder cancer (NMIBC) and 27 participants with muscle-invasive bladder cancer (MIBC). In the ‘whole-mount’ pathology results 12 participants had NMIBC and 25 participants had MIBC. We found a sensitivity and specificity of 0.88 en 0.58 respectively, for the evaluation of MIBC. The positive and negative predictive value were 81% and 70% respectively. The diagnostic accuracy of mpMRI to differentiate between NMIBC and MIBC was 78%. Conclusions: We found a sensitivity of 88% and a specificity of 58% for mpMRI to discriminate NMIBC from MIBC

TBX2, a Novel Regulator of Labour

Background and Objectives: Therapeutic interventions targeting molecular factors involved in the transition from uterine quiescence to overt labour are not substantially reducing the rate of spontaneous preterm labour. The identification of novel rational therapeutic targets are essential to prevent the most common cause of neonatal mortality. Based on our previous work showing that Tbx2 (T-Box transcription factor 2) is a putative upstream regulator preceding progesterone withdrawal in mouse myometrium, we now investigate the role of TBX2 in human myometrium. Materials and Methods: RNA microarray analysis of (A) preterm human myometrium samples and (B) myometrial cells overexpressing TBX2 in vitro, combined with subsequent analysis of the two publicly available datasets of (C) Chan et al. and (D) Sharp et al. The effect of TBX2 overexpression on cytokines/chemokines secreted to the myometrium cell culture medium were determined by Luminex assay. Results: Analysis shows that overexpression of TBX2 in myometrial cells results in downregulation of TNFα- and interferon signalling. This downregulation is consistent with the decreased expression of cytokines and chemokines of which a subset has been previously associated with the inflammatory pathways relevant for human labour. In contrast, CXCL5 (C-X-C motif chemokine ligand 5), CCL21 and IL-6 (Interleukin 6), previously reported in relation to parturition, do not seem to be under TBX2 control. The combined bioinformatical analysis of the four mRNA datasets identifies a subset of upstream regulators common to both preterm and term labour under control of TBX2. Surprisingly, TBX2 mRNA levels are increased in preterm contractile myometrium. Conclusions: We identified a subset of upstream regulators common to both preterm and term labour that are activated in labour and repressed by TBX2. The increased TBX2 mRNA expression in myometrium collected during a preterm caesarean section while in spontaneous preterm labour compared to tissue harvested during iatrogenic preterm delivery does not fit the bioinformatical model. We can only explain this by speculating that the in vivo activity of TBX2 in human myometrium depends not only on the TBX2 expression levels but also on levels of the accessory proteins necessary for TBX2 activity

Using Collostructional Analysis to evaluate BERT's representation of linguistic constructions

Collostructional analysis is a technique devised to find correlations between particular words and linguistic constructions in order to analyse meaning associations of these constructions. Contrasting collostructional analysis results with output from BERT might provide insights into the way BERT represents the meaning of linguistic constructions. This study tests to what extent English BERT’s meaning representations correspond to known constructions from the linguistics literature by means of two tasks that we propose. Firstly, by predicting the words that can be used in open slots of constructions, the meaning associations of more lexicalized constructions can be observed. Secondly, by finding similar sequences using BERT’s output embeddings and manually reviewing the resulting sentences, we can observe whether instances of less lexicalized constructions are clustered together in semantic space. These two methods show that BERT represents constructional meaning to a certain extent, but does not separate instances of a construction from a near-synonymous construction that has a different form

Fourier-domain dedispersion

We present and implement the concept of the Fourier-domain dedispersion (FDD) algorithm, a brute-force incoherent dedispersion algorithm. This algorithm corrects the frequency-dependent dispersion delays in the arrival time of radio emission from sources such as radio pulsars and fast radio bursts. Where traditional time-domain dedispersion algorithms correct time delays using time shifts, the FDD algorithm performs these shifts by applying phase rotations to the Fourier-transformed time-series data. Incoherent dedispersion to many trial dispersion measures (DMs) is compute-, memory-bandwidth-, and input-output-intensive, and dedispersion algorithms have been implemented on graphics processing units (GPUs) to achieve high computational performance. However, time-domain dedispersion algorithms have low arithmetic intensity and are therefore often memory-bandwidth-limited. The FDD algorithm avoids this limitation and is compute-limited, providing a path to exploit the potential of current and upcoming generations of GPUs. We implement the FDD algorithm as an extension of the DEDIS

Diagnostic accuracy of multiparametric MRI for local staging of bladder cancer: A systematic review and meta-analysis

To evaluate diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) for local staging of urothelial bladder carcinoma (UBC), a systematic review was performed. Of 2369 records, 20 studies met the inclusion criteria (n=1724). We found a pooled sensitivity and specificity for differentiating between stages ≤T1 and ≥T2 of 0.92 (95% CI 0.88-0.95) and 0.88 (95% CI 0.78-0.94). mpMRI shows high sensitivity and specificity for the differentiation between non-muscle invasive and muscle invasive bladder cancer, but does not appear to be useful for staging per T-stage. It can be used for confirmation when muscle invasive disease is suspected at initial diagnosis

Urinary considerations for adult patients with spinal dysraphism

The incidence of newborns with spinal dysraphism is diminishing worldwide, although survival of individuals with this condition into adulthood continues to improve. The number of adults with spinal dysraphism will, therefore, increase in the coming years, which will pose new challenges in patient management. Urological manifestations of spinal dysraphism can include increased risks of urinary incontinence, urinary tract infection, urinary calculi, sexual dysfunction, end-stage renal disease and iatrogenic metabolic disturbances; however, the severity and incidence of these symptoms varies substantially between patients. Owing to the presence of multiple comorbidities, treatment and follow-up protocols often have to be adapted to best suit the needs of specific patients. Authors describe bladder and kidney function and long-term complications of treatments initiated in childhood, as well as the potential for improvements in quality of life through better follow-up schedules and future development