Most individuals with interstitial cystitis (IC) have both pelvic pain and urinary urgency/frequency, and many have dyspareunia. Existing questionnaires designed to assess bladder-origin pelvic pain ...(IC) give little attention to pelvic pain or dyspareunia, however. On the basis of our clinical experience with more than 5000 patients with IC, we have designed a pelvic pain and urgency/frequency (PUF) symptom scale that gives balanced attention to urinary urgency/frequency, pelvic pain, and symptoms associated with sexual intercourse.
We used the intravesical potassium sensitivity test (PST) to validate the PUF scale in urologic patients suspected of having IC, gynecologic patients with pelvic pain, controls, and women attending lectures given by one of us (C.L.P.). Positive potassium sensitivity is known to be associated with a bladder epithelial dysfunction present in most individuals with IC.
The PST was positive in 74% of patients with a PUF score of 10 to 14, 76% of those scoring 15 to 19, and 91% of those scoring 20 or higher. All controls’ PUF scores were less than 3, and the rate of positive PST in controls was 0%. The PUF scores in women screened at lectures suggested that 1 in 4.5 women have IC.
High PUF scores appear to correlate directly with a higher likelihood of positive PST in both urologic patients suspected of having IC and gynecologic patients with pelvic pain. The PUF appears to be a valid tool for detecting IC in these two populations, as well as in the general population. Use of the PUF alone may prove to be an accurate method for detecting IC. The IC prevalence may be as high as 1 in 4.5 women.
Primary testicular diffuse large B-cell lymphoma (PT-DLBCL) is a unique subtype of DLBCL. The impact of rituximab on survival and patterns of treatment failure in PT-DLBCL patient remain ...controversial. We analyzed the clinical and biological feature of 280 PT-DLBCL cases, 64% of which were treated with rituximab-containing regimens. Although most (95%) patients achieved complete remission, a continuous risk of relapse was observed. Rituximab significantly reduced the cumulative risk of relapse (P=0.022) and improved both progression-free survival (PFS, P=0.012) and overall survival (OS, P=0.027) of PT-DLBCL patients (5-year PFS, 56% vs 36%; 5-year OS, 68% vs 48%). Central nervous system and contralateral testis were the most common sites of relapse, but other extranodal and nodal sites of relapse were also observed. Most cases of PT-DLBCL had a non-germinal center B-cell like (84%) immunophenotype and an activated B-cell like (86%) gene expression profile (GEP) subtype. The distinctive GEP signature of primary testicular lymphoma was relevant to tumor cell proliferation, dysregulated expression of adhesion molecules and immune response, likely accounting for the poor outcome. Accordingly, forkhead box P1 transcription factor (FOXP1) and T-cell leukemia/lymphoma 1 (TCL1) oncogenic activation were confirmed and predicted a significant trend of poor survival. This study provides valuable observations for better understanding of both clinical and biological features in PT-DLBCL patients.
Abstract
We present a spectroscopic survey of 248 white dwarf candidates within 40 pc of the Sun; of these 244 are in the Southern hemisphere. Observations were performed mostly with the Very Large ...Telescope (X-Shooter) and Southern Astrophysical Research Telescope. Almost all candidates were selected from Gaia Data Release 3 (DR3). We find a total of 246 confirmed white dwarfs, 209 of which had no previously published spectra, and two main-sequence star contaminants. Of these, 100 white dwarfs display hydrogen Balmer lines, 69 have featureless spectra, and two show only neutral helium lines. Additionally, 14 white dwarfs display traces of carbon, while 37 have traces of other elements that are heavier than helium. We observe 35 magnetic white dwarfs through the detection of Zeeman splitting of their hydrogen Balmer or metal spectral lines. High spectroscopic completeness (> 97 per cent) has now been reached, such that we have 1058 confirmed Gaia DR3 white dwarfs out of 1083 candidates within 40 pc of the Sun at all declinations.
To perform an economic evaluation on the cost associated with an outbreak of carbapenemase-producing Enterobacteriaceae (CPE).
We performed an observational economic evaluation of an outbreak of CPE ...(NDM-producing Klebsiella pneumoniae) affecting 40 patients in a group of five hospitals across three sites in West London. Costs were split into actual expenditure (including anti-infective costs, enhanced CPE screening, contact precautions, temporary ward-based monitors of hand and environmental practice, and environmental decontamination), and ‘opportunity cost’ (staff time, bed closures and elective surgical missed revenue). Costs are estimated from the hospital perspective over the 10-month duration of the outbreak.
The outbreak cost €1.1m over 10 months (range €0.9–1.4m), comprising €312 000 actual expenditure, and €822 000 (range €631 000–€1.1m) in opportunity cost. An additional €153 000 was spent on Estates renovations prompted by the outbreak. Actual expenditure comprised: €54 000 on anti-infectives for 18 patients treated, €94 000 on laboratory costs for screening, €73 000 on contact precautions for 1831 contact precautions patient-days, €42 000 for hydrogen peroxide vapour decontamination of 24 single rooms, €43 000 on 2592 hours of ward-based monitors, and €6000 of expenditure related to ward and bay closures. Opportunity costs comprised: €244 000 related to 1206 lost bed-days (range 366–2562 bed-days, €77 000–€512 000), €349 000 in missed revenue from 72 elective surgical procedures, and €228 000 in staff time (range €205 000–€251 000). Reduced capacity to perform elective surgical procedures related to bed closures (€349 000) represented the greatest cost.
The cost estimates that we present suggest that CPE outbreaks are highly costly.
ABSTRACT Radio emission has been detected from tens of white dwarfs, in particular in accreting systems. Additionally, radio emission has been predicted as a possible outcome of a planetary system ...around a white dwarf. We searched for 3 GHz radio continuum emission in 846 000 candidate white dwarfs previously identified in Gaia using the Very Large Array Sky Survey (VLASS) Epoch 1 Quick Look Catalogue. We identified 13 candidate white dwarfs with a counterpart in VLASS within 2 arcsec. Five of those were found not to be white dwarfs in follow-up or archival spectroscopy, whereas seven others were found to be chance alignments with a background source in higher resolution optical or radio images. The remaining source, WDJ204259.71+152108.06, is found to be a white dwarf and M-dwarf binary with an orbital period of 4.1 d and long-term stochastic optical variability, as well as luminous radio and X-ray emission. For this binary, we find no direct evidence of a background contaminant, and a chance alignment probability of only ≈2 per cent. However, other evidence points to the possibility of an unfortunate chance alignment with a background radio and X-ray emitting quasar, including an unusually poor Gaia DR3 astrometric solution for this source. With at most one possible radio emitting white dwarf found, we conclude that strong (≳1–3 mJy) radio emission from white dwarfs in the 3 GHz band is virtually non-existent outside of interacting binaries.
Abstract
Marine microplastics (MPs) accumulate in sediments but impacts on ecosystem functions are poorly understood. MPs interactions with stabilizing benthic flora/fauna or biostabilization ...processes, have not been fully investigated, yet this is critical for unraveling MPs effects on ecosystem-scale processes and functions. This is also vital for understanding feedback processes that may moderate the stock and flow of MPs as they are transported through estuaries. The relationships between sedimentary MPs, biota, environmental properties and sediment stability from field sediments, were examined using variance partitioning (VP) and correlation analyses. VP was used to identify common and unique contributions of different groups of variables (environmental, fauna and microplastic variables) to sediment stability. The influence of microplastic presence (fragment/fiber abundances and microplastic diversity) on sediment stability (defined using erosion thresholds and erosion rates) was demonstrated. Furthermore, MPs appeared to mediate the biostabilizing effects of environmental properties (including microorganisms) and fauna. Environmental properties and sediment stability could also explain the variation in MPs across sites suggesting biostabilizing properties may mediate the abundance, type and diversity of MPs that accumulate in the bed. The potential for MPs to influence biota and biostabilization processes and mediate microplastic resuspension dynamics within estuaries is discussed.
We analyse the Catalina Real-time Transient Survey light curves of 835 spectroscopically confirmed white dwarf plus main-sequence binaries from the Sloan Digital Sky Survey (SDSS) with g < 19, in ...search of new eclipsing systems. We identify 29 eclipsing systems, 12 of which were previously unknown. This brings the total number of eclipsing white dwarf plus main-sequence binaries to 49. Our set of new eclipsing systems contains two with periods of 1.9 and 2.3 d, making them the longest period eclipsing white dwarf binaries known. We also identify one system which shows very large ellipsoidal modulation (almost 0.3 mag), implying that the system is both very close to Roche lobe overflow and at high inclination. However, our follow-up photometry failed to firmly detect an eclipse, meaning that either this system contains a cool white dwarf and hence the eclipse is very shallow and undetectable in our red-sensitive photometry or that it is non-eclipsing. Radial velocity measurements for the main-sequence stars in three of our newly identified eclipsing systems imply that their white dwarf masses are lower than those inferred from modelling their SDSS spectra. 13 non-eclipsing post-common envelope binaries were also identified, from either reflection or ellipsoidal modulation effects. The white dwarfs in our newly discovered eclipsing systems span a wide range of parameters, including low-mass (∼0.3 M), very hot (80 000 K) and a DC white dwarf. The spectral types of the main-sequence stars range from M2 to M6. This makes our sample ideal for testing white dwarf and low-mass star mass-radius relationships as well as close binary evolution.
Abstract
Background
Exposure-based therapy is an effective first-line treatment for anxiety-, obsessive–compulsive, and trauma- and stressor-related disorders; however, many patients do not improve, ...resulting in prolonged suffering and poorly used resources. Basic research on fear extinction may inform the development of a biomarker for the selection of exposure-based therapy. Growing evidence links orexin system activity to deficits in fear extinction and we have demonstrated that reactivity to an inhaled carbon dioxide (CO
2
) challenge—a safe, affordable, and easy-to-implement procedure—can serve as a proxy for orexin system activity and predicts fear extinction deficits in rodents. Building upon this basic research, the goal for the proposed study is to validate CO
2
reactivity as a biomarker of exposure-based therapy non-response.
Methods
We will assess CO
2
reactivity in 600 adults meeting criteria for one or more fear- or anxiety-related disorders prior to providing open exposure-based therapy. By incorporating CO
2
reactivity into a multivariate model predicting treatment non-response that also includes reactivity to hyperventilation as well as a number of related predictor variables, we will establish the mechanistic specificity and the additive predictive utility of the potential CO
2
reactivity biomarker. By developing models independently within two study sites (University of Texas at Austin and Boston University) and predicting the other site’s data, we will validate that the results are likely to generalize to future clinical samples.
Discussion
Representing a necessary stage in translating basic research, this investigation addresses an important public health issue by testing an accessible clinical assessment strategy that may lead to a more effective treatment selection (personalized medicine) for patients with anxiety- and fear-related disorders, and enhanced understanding of the mechanisms governing exposure-based therapy.
Trial registration
ClinicalTrials.gov Identifier: NCT05467683 (20/07/2022).
PDF
