Prevention of Labour-Associated Pelvic Floor Injuries - What is Known for Sure

In order to avoid pelvic floor injuries a caesarean section is on the one hand often requested by the pregnant women and, on the other hand, offered by obstetric staff. For both forms of delivery, comprehensive risk-benefit analyses should be carried out before deciding in favour of the surgical procedure. The present brief review summarizes the current evidence on the avoidance of pelvic floor injuries.

Observation of direct-photon collective flow in Au + Au collisions at √s(NN)] = 200 GeV

The second Fourier component v(2) of the azimuthal anisotropy with respect to the reaction plane is measured for direct photons at midrapidity and transverse momentum (p(T)) of 1-12 GeV/c in Au + Au collisions at √s(NN)] = 200 GeV. Previous measurements of this quantity for hadrons with p(T) < 6 GeV/c indicate that the medium behaves like a nearly perfect fluid, while for p(T) > 6 GeV/c a reduced anisotropy is interpreted in terms of a path-length dependence for parton energy loss. In this measurement with the PHENIX detector at the Relativistic Heavy Ion Collider we find that for p(T) > 4 GeV/c the anisotropy for direct photons is consistent with zero, which is as expected if the dominant source of direct photons is initial hard scattering. However, in the p(T) < 4 GeV/c region dominated by thermal photons, we find a substantial direct-photon v(2) comparable to that of hadrons, whereas model calculations for thermal photons in this kinematic region underpredict the observed v(2).

Hyperfibrinolysis is common in out-of-hospital cardiac arrest: results from a prospective observational thromboelastometry study

BACKGROUND

Cardiocirculatory arrest (CCA) activates procoagulant pathways. It has also been reported to inhibit fibrinolysis, resulting in fibrin deposition and further impairment of blood flow. Until now, no studies have used whole-blood viscoelastic tests to characterize coagulation and the impact of fibrinolysis in out-of-hospital cardiac arrest (OHCA).

METHODS

Patient with established OHCA who underwent cardiopulmonary resuscitation (CPR) were enrolled. Blood samples were obtained immediately after placement of an intravenous line at the scene, for full blood cell count, standard coagulation tests and rotational thromboelastometric (ROTEM(®)) analyses. Patients with return of spontaneous circulation (ROSC) were compared to non-ROSC patients.

RESULTS

Fifty-three patients (median age 67 years, interquartile range: 56-73 years) were included in the study. ROSC was established in 25 patients. Prothrombin time index (PTI) was significantly lower and activated partial thromboplastin time (aPTT) was significantly prolonged in non-ROSC patients compared to ROSC patients. Clotting time (CT) in the extrinsically activated ROTEM test (EXTEM) was significantly longer in non-ROSC versus ROSC patients. For the remaining EXTEM parameters, there were no significant differences between ROSC and non-ROSC patients. Hyperfibrinolysis (maximum lysis>15% according to ROTEM test results) was observed in 19 patients (35.8%). There was no difference between ROSC and non-ROSC patients in the incidence of hyperfibrinolysis.

CONCLUSIONS

PTI, aPTT and EXTEM CT revealed significant differences between ROSC and non-ROSC patients. Hyperfibrinolysis according to ROTEM test results was much more common than previously assumed. Routine use of fibrinolytic therapy in all patients with prolonged CPR cannot therefore be recommended.

Joint kinematics following bi-compartmental knee replacement during daily life motor tasks

In many cases knee osteoarthritis leads to total knee replacement surgery (TKR) even if the lateral compartment is not involved. More recently, a bicompartmental knee replacement system (BKR) (Journey Deuce, Smith & Nephew Inc., Memphis, TN, USA) has been developed that only replaces the medial tibiofemoral and the patellofemoral compartments, thus preserving both cruciate ligaments with its associated benefits. However information on the effect of BKR on in vivo knee joint kinematics is not widely available in the literature. Therefore, this study analyzed full three-dimensional knee joint kinematics in 10 postoperative BKR-subjects for a broad spectrum of relevant daily life activities: walking, walking followed by a cross-over or sidestep turn, step ascent and descent, mild squatting and chair rise. We analyzed to what extent normal knee motion is regained through comparison with their non-involved limb as well as a group of matched controls. Furthermore, coefficients of multiple correlation were calculated to assess the consistency of knee joint kinematics both within and between subject groups. This analysis demonstrated that, despite the presence of differences indicative for retention of pre-operative motion patterns and/or remaining compensations, knee joint kinematics in BKR limbs replicate, for a large range of daily-life motor tasks, the kinematics of the contra-lateral non-affected limbs and healthy controls to a similar extent as they are replicated within both these control groups.

Measurements of higher order flow harmonics in Au+Au collisions at √s(NN)=200 GeV

Flow coefficients ν(n) for n=2, 3, 4, characterizing the anisotropic collective flow in Au+Au collisions at √s(NN)=200 GeV, are measured relative to event planes Ψ(n), determined at large rapidity. We report ν(n) as a function of transverse momentum and collision centrality, and study the correlations among the event planes of different order n. The ν(n) are well described by hydrodynamic models which employ a Glauber Monte Carlo initial state geometry with fluctuations, providing additional constraining power on the interplay between initial conditions and the effects of viscosity as the system evolves. This new constraint can serve to improve the precision of the extracted shear viscosity to entropy density ratio η/s.

Suppression of back-to-back hadron pairs at forward rapidity in d+Au collisions at √s(NN)=200 GeV

Back-to-back hadron pair yields in d+Au and p+p collisions at √s(NN)=200 GeV were measured with the PHENIX detector at the Relativistic Heavy Ion Collider. Rapidity separated hadron pairs were detected with the trigger hadron at pseudorapidity |η|<0.35 and the associated hadron at forward rapidity (deuteron direction, 3.0<η<3.8). Pairs were also detected with both hadrons measured at forward rapidity; in this case, the yield of back-to-back hadron pairs in d+Au collisions with small impact parameters is observed to be suppressed by a factor of 10 relative to p+p collisions. The kinematics of these pairs is expected to probe partons in the Au nucleus with a low fraction x of the nucleon momenta, where the gluon densities rise sharply. The observed suppression as a function of nuclear thickness, p(T), and η points to cold nuclear matter effects arising at high parton densities.

Cold nuclear matter effects on J/ψ yields as a function of rapidity and nuclear geometry in d+A collisions at sqrt[s(NN)]=200 GeV

We present measurements of J/ψ yields in d+Au collisions at sqrt[s(NN)]=200  GeV recorded by the PHENIX experiment and compare them with yields in p+p collisions at the same energy per nucleon-nucleon collision. The measurements cover a large kinematic range in J/ψ rapidity (-2.2<y<2.4) with high statistical precision and are compared with two theoretical models: one with nuclear shadowing combined with final state breakup and one with coherent gluon saturation effects. In order to remove model dependent systematic uncertainties we also compare the data to a simple geometric model. The forward rapidity data are inconsistent with nuclear modifications that are linear or exponential in the density weighted longitudinal thickness, such as those from the final state breakup of the bound state.

Clinically driven design of multi-scale cancer models: the ContraCancrum project paradigm

The challenge of modelling cancer presents a major opportunity to improve our ability to reduce mortality from malignant neoplasms, improve treatments and meet the demands associated with the individualization of care needs. This is the central motivation behind the ContraCancrum project. By developing integrated multi-scale cancer models, ContraCancrum is expected to contribute to the advancement of in silico oncology through the optimization of cancer treatment in the patient-individualized context by simulating the response to various therapeutic regimens. The aim of the present paper is to describe a novel paradigm for designing clinically driven multi-scale cancer modelling by bringing together basic science and information technology modules. In addition, the integration of the multi-scale tumour modelling components has led to novel concepts of personalized clinical decision support in the context of predictive oncology, as is also discussed in the paper. Since clinical adaptation is an inelastic prerequisite, a long-term clinical adaptation procedure of the models has been initiated for two tumour types, namely non-small cell lung cancer and glioblastoma multiforme; its current status is briefly summarized.

A Microstructural Comparison of Cu(In,Ga)Se2 Thin Films Grown from CuxSe and (In,Ga)2Se3 Precursors

We fabricated CulnSe2 and Cu(In,Ga)Se2 thin films by two different pathways using physical vapor deposition. In the first we formed a Cu-Se precursor and then reacted it with a flux of (In,Ga) + Se. These films had large grains but were too rough for optimal device performance. In the other pathway, we first formed a smooth precursor of (In,Ga)2Se3 and then exposed it to a flux of Cu+Se. We overshot the optimal film composition to allow recrystallization of the film by a secondary CuxSe phase. We then consumed the excess CuxSe in a third stage deposition of (In,Ga) + Se. The recrystallization step increased the grain sizes, and the resulting films remained smooth. Photovoltaic solar cells made from these films have produced the highest total-area efficiencies of any non-single-crystal, thin-film solar cell.

Cross section and parity-violating spin asymmetries of W± boson production in polarized p + p collisions at sqrt[s] = 500 GeV

Large parity-violating longitudinal single-spin asymmetries A(L)(e+) = -0.86(-0.14) (+0.30) and A(L)(e-) = 0.88(-0.71) (+0.12) are observed for inclusive high transverse momentum electrons and positrons in polarized p+p collisions at a center-of-mass energy of sqrt[s] = 500 GeV with the PHENIX detector at RHIC. These e± come mainly from the decay of W± and Z0 bosons, and their asymmetries directly demonstrate parity violation in the couplings of the W± to the light quarks. The observed electron and positron yields were used to estimate W± boson production cross sections for the e± channels of σ(pp → W+ X) × BR(W+ → e+ ν(e)) = 144.1 ± 21.2(stat)(-10.3) (+3.4) (syst) ± 21.6(norm)  pb, and σ(pp → W- X) × BR(W- → e- ν[over ¯](e)) = 31.7 ± 12.1(stat)(-8.2) (+10.1) (syst) ± 4.8(norm)  pb.

Azimuthal anisotropy of π⁰ production in Au+Au collisions at sqrt((s)NN)=200 GeV: path-length dependence of jet quenching and the role of initial geometry

We have measured the azimuthal anisotropy of π⁰ production for 1<p(T)<18  GeV/c for Au+Au collisions at sqrt((s)NN)=200  GeV. The observed anisotropy shows a gradual decrease for 3≲p(T)≲7-10  GeV/c, but remains positive beyond 10  GeV/c. The magnitude of this anisotropy is underpredicted, up to at least ∼10  GeV/c, by current perturbative QCD (PQCD) energy-loss model calculations. An estimate of the increase in anisotropy expected from initial-geometry modification due to gluon saturation effects and fluctuations is insufficient to account for this discrepancy. Calculations that implement a path-length dependence steeper than what is implied by current PQCD energy-loss models show reasonable agreement with the data.

Elliptic and hexadecapole flow of charged hadrons in Au+Au collisions at sq.rt(s(NN))=200 GeV

Differential measurements of the elliptic (v(2)) and hexadecapole (v(4)) Fourier flow coefficients are reported for charged hadrons as a function of transverse momentum (p(T)) and collision centrality or number of participant nucleons (N(part)) for Au+Au collisions at sq.rt(s(NN))=200  GeV. The v(2,4) measurements at pseudorapidity |η|≤0.35, obtained with four separate reaction-plane detectors positioned in the range 1.0<|η|<3.9, show good agreement, indicating the absence of significant Δη-dependent nonflow correlations. Sizable values for v(4)(p(T)) are observed with a ratio v(4)(p(T),N(part))/v(2)(2)(p(T),N(part))≈0.8 for 50≲N(part)≲200, which is compatible with the combined effects of a finite viscosity and initial eccentricity fluctuations. For N(part)≳200 this ratio increases up to 1.7 in the most central collisions.

Transition in yield and azimuthal shape modification in dihadron correlations in relativistic heavy ion collisions

Hard-scattered parton probes produced in collisions of large nuclei indicate large partonic energy loss, possibly with collective produced-medium response to the lost energy. We present measurements of π^{0} trigger particles at transverse momenta p{T}{t}=4-12  GeV/c and associated charged hadrons (p{T}{a}=0.5-7  GeV/c) vs relative azimuthal angle Δϕ in Au+Au and p+p collisions at sqrt[s{NN}]=200  GeV. The Au+Au distribution at low p{T}{a}, whose shape has been interpreted as a medium effect, is modified for p{T}{t}<7  GeV/c. At higher p{T}{t}, the data are consistent with unmodified or very weakly modified shapes, even for the lowest measured p{T}{a}, which quantitatively challenges some medium response models. The associated yield of hadrons opposing the trigger particle in Au+Au relative to p+p (I{AA}) is suppressed at high p{T} (I{AA}≈0.35-0.5), but less than for inclusive suppression (R{AA}≈0.2).

Leaching with Penicillium simplicissimum: Influence of Metals and Buffers on Proton Extrusion and Citric Acid Production

In the presence of insoluble metal oxides (industrial filter dust, zinc oxide, synthetic mixture of metal oxides), Penicillium simplicissimum developed the ability to excrete considerable amounts of citric acid (>100 mM). Parallel with the increase of citric acid concentration in the culture broth, zinc was solubilized from zinc oxide. The adsorption of filter dust onto the mycelium (the pellets formed were less than 1 mm in diameter) was required for not only the citric acid excretion but also the leaching of zinc. When the filter dust was replaced with a synthetic mixture of metal oxides or with zinc oxide in combination with trace elements, levels of adsorption and citric acid production were observed to be similar to those in experiments where industrial filter dust was used. The two most important properties of the filter dust were its heavy-metal content and its buffering capacity. These properties were simulated by adding heavy metals in soluble form (as chlorides, sulfates, or nitrates) or soluble buffers to the medium. Both heavy metals and buffers were not able to induce a citric acid efflux. As with citric acid production by Aspergillus niger, the addition of manganese lowered citric acid excretion (by 40% with metal oxide-induced citric acid efflux and by 100% with urea-induced citric acid efflux). Copper antagonized the effect of manganese. The mechanism for the bulk of citric acid excretion by P. simplicissimum, however, seemed to be different from that described for citric acid accumulation by A. niger. Because of the inefficiency of metals in solubilized form and of soluble buffers to induce a strong citric acid efflux, adsorption of an insoluble metal compound (zinc oxide) turned out to be essential. Surface phenomena possibly involving the plasma membrane H-ATPase are thought to participate in the induction of citric acid excretion by P. simplicissimum in the presence of industrial filter dust.