A Rare Complication of a Vaginal Breech Delivery

Rectal lesions without anal sphincter trauma in childbirth are only sporadically described in literature. We describe the case of a 29-year-old primigravida who delivered a child in frank breech presentation. During the second stage of labour a foot presented transanally through a rectal laceration with intact anal sphincters. The laceration was repaired immediately after delivery in theatre. Follow-up visits showed a properly cured laceration and no complaints of incontinence or foul discharge

Differences in renal hemodynamics and renin secretion between patients with unifocal and multifocal fibromuscular dysplasia

Objective: Fibromuscular dysplasia (FMD) can be classified in a multifocal and a unifocal subtype. As unifocal FMD generally leads to more severe hypertension at younger age, we hypothesized that renal hemodynamics are more disturbed in unifocal renal artery FMD as compared with multifocal FMD, leading to increased renin secretion. Methods: We measured renal blood flow ((133)Xenon washout method), renin secretion, and glomerular filtration rate per kidney in 101 patients with FMD (26 unifocal and 75 multifocal), all off medication and prior to balloon angioplasty. Results: We found that renal blood flow and glomerular filtration were substantially lower in kidneys with unifocal FMD as compared with multifocal FMD. In the affected kidney from patients with unilateral FMD for example, mean renal blood flow was 173 +/- 77 in unifocal vs. 244 +/- 79 ml/100 g kidney/min in multifocal FMD (P=0.013). Moreover, lateralization in renin secretion was only observed in a subset of patients with unifocal FMD, but not in any of the patients with multifocal FMD. Conclusion: These findings suggest that the impact of unifocal FMD lesions on the kidney is more severe, resulting in a classical pattern of renovascular hypertension. In multifocal FMD, however, renal blood flow is more preserved, local renin secretion is not increased, and the association between renin levels and blood pressure is inverse. These differences may explain the often more severe clinical presentation and higher success rate of revascularization in unifocal FMD, but also suggest that the pathophysiological mechanisms leading to hypertension may differ between these two disease entities

Coideal Quantum Affine Algebra and Boundary Scattering of the Deformed Hubbard Chain

We consider boundary scattering for a semi-infinite one-dimensional deformed Hubbard chain with boundary conditions of the same type as for the Y=0 giant graviton in the AdS/CFT correspondence. We show that the recently constructed quantum affine algebra of the deformed Hubbard chain has a coideal subalgebra which is consistent with the reflection (boundary Yang-Baxter) equation. We derive the corresponding reflection matrix and furthermore show that the aforementioned algebra in the rational limit specializes to the (generalized) twisted Yangian of the Y=0 giant graviton.Comment: 21 page. v2: minor correction

The applicability of home blood pressure measurement in clinical practice: A review of literature

Willem J Verberk, Abraham A Kroon, Heidi A Jongen-Vancraybex, Peter W de LeeuwUniversity Hospital Maastricht, Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The NetherlandsPurpose: To review the literature on home blood pressure measurement (HBPM), to examine its validity and applicability for clinical practice and to provide recommendations regarding HBPM assessment.Findings: HBPM can eliminate the white coat effect and offers the possibility to obtain multiple measurements under standardized conditions, which increases knowledge of overall blood pressure value. Although it is not entirely capable of replacing ambulatory blood pressure measurement (ABPM), HBPM correlates better with target organ damage and cardiovascular mortality than office blood pressure measurement (OBPM), it enables prediction of sustained hypertension in patients with borderline hypertension, and proves to be an appropriate tool for assessing drug efficacy. Additional advantages of HBPM are that it may increase drug compliance and patient’s awareness of hypertension. Overall, OBPM yield higher blood pressure values than HBPM. Differences between OBPM and HBPM tend to increase with age and are generally higher in patients without antihypertensive treatment than in patients with antihypertensive treatment.Recommendations: Measurements should be performed according to accepted guidelines and recordings should be performed with a memory equipped automatic validated device. From the data reviewed here, we recommend that HBPM be assessed monthly by taking two measurements in the morning within 1 hour after awakening and two in the evening for three consecutive days, the data from the first day should be dismissed. A subject should be labeled hypertensive if his/her HBPM value is equal to or greater than 137 mmHg systolic and/or 84 mmHg diastolic.Keywords: blood pressure, hypertension, self-measurement, home measurement, ambulatory measurement, adherenc

The Quantum Affine Origin of the AdS/CFT Secret Symmetry

We find a new quantum affine symmetry of the S-matrix of the one-dimensional Hubbard chain. We show that this symmetry originates from the quantum affine superalgebra U_q(gl(2|2)), and in the rational limit exactly reproduces the secret symmetry of the AdS/CFT worldsheet S-matrix.Comment: 22 page

Gate-bias assisted charge injection in organic field-effect transistors

The charge injection barriers in organic field-effect transistors (OFETs) seem to be far less critical as compared to organic light-emitting diodes (OLEDs). Counter intuitively; we show that the origin is image-force lowering of the barrier due to the gate bias at the source contact; although the corresponding gate field is perpendicular to the channel current. In coplanar OFETs; injection barriers up to 1 eV can be surmounted by increasing the gate bias; enabling extraction of bulk transport parameters in this regime. For staggered transistors; however; the injection is gate-assisted only until the gate bias is screened by the accumulation channel opposite to the source contact. The gate-assisted injection is supported by two-dimensional numerical charge transport simulations that reproduce the gate-bias dependence of the contact resistance and the typical S-shaped output curves as observed for OFETs with high injection barriers.

Dipolar Interactions and Origin of Spin Ice in Ising Pyrochlore Magnets

Recent experiments suggest that the Ising pyrochlore magnets ${\rm Ho_{2}Ti_{2}O_{7}}$ and ${\rm Dy_{2}Ti_{2}O_{7}}$ display qualitative properties of the spin ice model proposed by Harris {\it et al.} \prl {\bf 79}, 2554 (1997). We discuss the dipolar energy scale present in both these materials and consider how they can display spin ice behavior {\it despite} the presence of long range interactions. Specifically, we present numerical simulations and a mean field analysis of pyrochlore Ising systems in the presence of nearest neighbor exchange and long range dipolar interactions. We find that two possible phases can occur, a long range ordered antiferromagnetic one and the other dominated by spin ice features. Our quantitative theory is in very good agreement with experimental data on both ${\rm Ho_{2}Ti_{2}O_{7}}$ and ${\rm Dy_{2}Ti_{2}O_{7}}$. We suggest that the nearest neighbor exchange in ${\rm Dy_{2}Ti_{2}O_{7}}$ is {\it antiferromagnetic} and that spin ice behavior is induced by long range dipolar interactions.Comment: 4 postscript figures included. Submitted to Physical Review Letters Contact: [email protected]