The impact of a nationwide hands-on workshop on the diagnostic rates and management of obstetrical anal sphincter Injuries in Israel.

AIM: The aim was to evaluate the influence of a half day, hands-on, workshop on the detection and repair of obstetric anal sphincter injuries (OASIs). METHOD: Starting in February 2011, hands-on workshops for the diagnosis and repair of OASIs were delivered by trained urogynaecologists in departments of tertiary medical centres in Israel. The structure of the hands-on workshop resembles the workshop organized at the International Urogynecological Association annual conferences. Participants included medical staff, midwives and surgical residents from each medical centre. We collected data regarding the rate of OASIs, 1 year before and 1 year following the workshop, in 11 medical centres. The study population was composed of parturients with the following inclusion criteria: singleton pregnancy, vertex presentation and vaginal delivery. Pre-viable preterm gestations (< 24 weeks), birth weight < 500 g, stillborn, and those with major congenital anomalies, multifoetal pregnancies, breech presentations and caesarean deliveries were excluded from the analysis. RESULTS: In the reviewed centres, 70 663 (49.3%) women delivered prior to the workshop (pre-workshop group) and 72 616 (50.7%) women delivered following the workshop (post-workshop group). Third- or fourth-degree perineal tears occurred in 248 women (0.35%) before the workshop, and in 328 (0.45%) following the workshop, a significant increase of 28.7% (P = 0.002). The increase in diagnosis was significant also in women with third-degree tears alone, 226 women (0.32%) before the workshop and 298 (0.41%) following the workshop, an increase of 28.3% (P = 0.005). CONCLUSION: The detection rate of OASIs has significantly increased following the hands-on workshop. The implementation of such programmes is crucial for increasing awareness and detection rates of OASI following vaginal deliveries.

Quantum Interference between Photons from an Atomic Ensemble and a Remote Atomic Ion.

Many remote-entanglement protocols rely on the generation and interference of photons produced by nodes within a quantum network. Quantum networks based on heterogeneous nodes provide a versatile platform by utilizing the complementary strengths of the differing systems. Implementation of such networks is challenging, due to the disparate spectral and temporal characteristics of the photons generated by the different quantum systems. Here, we report on the observation of quantum interference between photons generated from a single ion and an atomic ensemble. The photons are produced on demand by each source located in separate buildings, in a manner suitable for quantum networking. Given these results, we analyze the feasibility of hybrid ion-ensemble remote entanglement generation.

Electromagnetically induced transparency in inhomogeneously broadened solid media.

We study, theoretically and experimentally, electromagnetically induced transparency (EIT) in two different solid-state systems. Unlike many implementations in homogeneously broadened media, these systems exhibit inhomogeneous broadening of their optical and spin transitions typical of solid-state materials. We observe EIT lineshapes typical of atomic gases, including a crossover into the regime of Autler-Townes splitting, but with the substitution of the inhomogeneous widths for the homogeneous values. We obtain quantitative agreement between experiment and theory for the width of the transparency feature over a range of optical powers and inhomogeneous linewidths. We discuss regimes over which analytical and numerical treatments capture the behavior. As solid-state systems become increasingly important for scalable and integratable quantum optical and photonic devices, it is vital to understand the effects of the inhomogeneous broadening that is ubiquitous in these systems. The treatment presented here can be applied to a variety of systems, as exemplified by the common scaling of experimental results from two different systems.

Retinal vascular diameters in relation to physical activity in Danish children - The CHAMPS Eye Study.

Our objective was to determine associations between retinal vascular caliber and physical activity (PA) in a school-based child cohort. In a prospective study, we created a childhood cumulative average PA-index using objectively measured PA (accelerometry) assessed at four periods between 2009 and 2015. Cumulative exposure to PA intensities was estimated. Cross-sectional examinations on biomarkers, anthropometry, and ophthalmological data including retinal fundus photographs were performed in 2015. Semi-automated measurements of retinal vascular diameters were performed and summarized into central retinal arteriolar and venular equivalents (CRAE, CRVE). We included 307 participants. Mean age in 2015 was 15.4 years (0.7). The mean CRAE and CRVE were 156.5 µm (2.8) and 217.6 µm (7.7), respectively. After adjusting for age, gender, and axial length, more time in PA was independently related to thinner retinal venules (ß-coefficient = -1.25 µm/%, 95% confidence interval = -2.20, -0.30, P < .01). Sedentary time was associated with wider venules (P < .01). Furthermore, birthweight (ß-coefficient = 0.56 µm/%, 95% confidence interval = 0.18, 0.95, P < .01) was associated with CRVE. Blood pressure was associated with thinner retinal arterioles (ß-coefficient = -0.19 µm/mmHg, 95% confidence interval = -0.36, -0.01, P = .04). We concluded that children with higher PA in childhood had thinner retinal venular caliber. Our results suggest that PA during childhood positively impacts the retinal microcirculation and that retinal vascular analysis may be a possible assessment to detect microvascular impairments in children with an increased risk of future cardiovascular disease.

Anomalous Broadening in Driven Dissipative Rydberg Systems.

We observe interaction-induced broadening of the two-photon 5s-18s transition in ^{87}Rb atoms trapped in a 3D optical lattice. The measured linewidth increases by nearly 2 orders of magnitude with increasing atomic density and excitation strength, with corresponding suppression of resonant scattering and enhancement of off-resonant scattering. We attribute the increased linewidth to resonant dipole-dipole interactions of 18s atoms with blackbody induced population in nearby np states. Over a range of initial atomic densities and excitation strengths, the transition width is described by a single function of the steady-state density of Rydberg atoms, and the observed resonant excitation rate corresponds to that of a two-level system with the measured, rather than natural, linewidth. The broadening mechanism observed here is likely to have negative implications for many proposals with coherently interacting Rydberg atoms.

Quiste epidermoide del ventrículo lateral / Epidermoid cyst of the lateral ventricle

Los quistes epidermoides del ventrículo lateral son lesiones extremadamente infrecuentes originadas por la inclusión de elementos epiteliales al momento del cierre del tubo neural. Son tumores de lento crecimiento y se presentan clínicamente con síntomas inespecíficos. La Resonancia Magnética de encéfalo permite realizar un diagnóstico presuntivo, que se confirma por hallazgos característicos durante la cirugía. El diagnóstico de certeza es por la anatomía patológica en donde se observa un epitelio escamoso estratificado. Se presenta un caso de una mujer de 39 años operada por vía microquirúrgica con asistencia endoscópica.

Epidermoid cysts occurring within the lateral ventricles are uncommon lesions. These tumors are of developmental etiology, due to migration of epiblast inclusion at the time of neural tube occlussion of the neural tube. They are slow growing tumors and clinical presentation is nonspecific. Magnetic Resonance is suggestive of a cystic lesion, and is confirmed to be a epidermoid cyst at operation. Histopathology reveals typical stratified squamous epithelium. A case of a woman of 39 years old woman operated on with microsurgery and endoscopic assistance is presented..

Quantum simulation. Two-dimensional superexchange-mediated magnetization dynamics in an optical lattice.

The interplay of magnetic exchange interactions and tunneling underlies many complex quantum phenomena observed in real materials. We study nonequilibrium magnetization dynamics in an extended two-dimensional (2D) system by loading effective spin-1/2 bosons into a spin-dependent optical lattice and use the lattice to separately control the resonance conditions for tunneling and superexchange. After preparing a nonequilibrium antiferromagnetically ordered state, we observe relaxation dynamics governed by two well-separated rates, which scale with the parameters associated with superexchange and tunneling. With tunneling off-resonantly suppressed, we observe superexchange-dominated dynamics over two orders of magnitude in magnetic coupling strength. Our experiment will serve as a benchmark for future theoretical work as the detailed dynamics of this 2D, strongly correlated, and far-from-equilibrium quantum system remain out of reach of current computational techniques.

Genetic and environmental effects on myopia development and progression.

This review aims at elucidating the interaction between genetic and environmental factors in the aetiology of primarily low myopia. Genetics greatly influence the growth of the eye, but the fine correlation between the components of refraction for the eye to become emmetrope is affected by environmental factors such as education, metabolism, physical activity, and outdoor activity.

Storage and retrieval of collective excitations on a long-lived spin transition in a rare-earth ion-doped crystal.

Robust, long-lived optical quantum memories are important components of many quantum information and communication protocols. We demonstrate coherent generation, storage, and retrieval of excitations on a long-lived spin transition via spontaneous Raman scattering in a rare-earth ion-doped crystal. We further study the time dynamics of the optical correlations in this system. This is the first demonstration of its kind in a solid and an enabling step toward realizing a solid-state quantum repeater.

Sellar hemangioblastoma mimicking a macroadenoma.

PURPOSE: Hemangioblastomas (HGB) are slow growing benign vascular tumors that arise almost always from the cerebellum and the spinal cord. Supratentorial location is extremely rare with approximately 130 cases published to date. We present a case of a sellar hemangioblastoma. CASE REPORT: An eleven year-old girl presented with a sellar and suprasellar tumor that seemed to be a macroadenoma. A transsphenoidal approach was attempted but excessive intraoperative bleeding made the resection not feasible. A second transcranial approach was successful in partially removing the lesion and decompressing the optic chiasm and the pituitary stalk. Pathological review revealed a seller hemangioblastoma. screening for Von Hippel Lindeau Syndrome was negative. CONCLUSION: The preoperative diagnosis of HGB is extremely difficult in this case but would have been essential in order to choose the right surgical approach.

Feasibility of cetuximab given with a simplified schedule every 2 weeks in advanced colorectal cancer: a multicenter, retrospective analysis.

Cetuximab was approved using a weekly schedule, alone or in combination with chemotherapy (CT). However, many CT regimens in metastatic colorectal cancer (CRC) are delivered every 2 weeks (q2wks). Preliminary data suggested that a simplified schedule using cetuximab q2wks, 500 mg/m² would be equivalent to the standard weekly administration. Medical data of all patients with advanced CRC who received cetuximab q2wks were retrospectively collected and checked for consistency by an independent monitor in 4 European centers. Ninety-one patients were treated between 2005 and 2007 when the K-RAS mutational status of tumors was not determined routinely. They received a median of 4 (0-5) previous drugs, including previous weekly cetuximab in 38.5% of patients. Cetuximab q2wks was associated with an irinotecan-based regimen in 85.7% of patients. The median number of cetuximab administrations was 6 (1-23). Skin toxicity was observed in 68.2% of evaluable patients (grade 3 in 15%). Only one grade 1 allergy was reported. In the 84 patients beyond first-line therapy, response rate was 29.3%. The median progression-free survival was 3.0 months (range 2.2-3.8), and median overall survival was 9.0 months (range 6.2-11.8). Cetuximab q2wks appears safe and effective in heavily pretreated patients and convenient in combination with q2wks CT schedules.

Enhancing image contrast using coherent states and photon number resolving detectors.

We experimentally map the transverse profile of diffractionlimited beams using photon-number-resolving detectors.We observe strong compression of diffracted beam profiles for high detected photon number. This effect leads to higher contrast than a conventional irradiance profile between two Airy disk-beams separated by the Rayleigh criterion.

Treatment with rituximab, dexamethasone, high-dose cytarabine, and oxaliplatin (R-DHAOx) produces a strong long-term antitumor effect in previously treated patients with follicular non-Hodgkin's lymphoma.

BACKGROUND: We explored the addition of rituximab to high-dose cytarabine (ara-C), oxaliplatin (L-OHP), and dexamethasone [R-DHAOx], in resistant and relapsed patients with CD20-positive follicular non-Hodgkin's lymphoma. METHODS: Twenty-two patients were included; they were treated previously with one to five chemotherapy regimens, including 13 patients who had also received rituximab. R-DHAOx consisted of rituximab, 375mg/m(2), day 1; dexamethasone, 40mg/d, days one to four; L-OHP, 130mg/m(2), day 1; and ara-C, 2000mg/m(2) every 12 h, day 2. Courses were repeated every 21 days for eight courses. RESULTS: Twenty-one patients (95%) achieved a complete response and one had a partial response. Responses were obtained in patients with and without resistance to prior treatment, either alone or combined with rituximab. The median follow-up time was 58.3 months (range, 8.7-92.6 months). Progression-free survival reached a plateau at 84% at 38.2 months. Only two of the 21 complete responders have relapsed. Tumor molecular markers disappeared in all 10 complete responders whose markers were found before treatment. Peripheral neuropathy related to the cumulative dose of L-OHP, and myelosuppression were the most prominent toxic effects. CONCLUSIONS: R-DHAOx is highly active for salvage treatment of patients with follicular non-Hodgkin's lymphoma, and it produces long-term antitumor efficacy.

Increased growth of young citrus trees under reduced radiation load in a semi-arid climate.

This study investigated the effects of radiation heat-load reduction by shading on the growth and development of citrus trees in a warm subtropical region. The experiment was conducted from mid-June until late October when daily maximal air temperature averaged 29.3 degrees C. Two-year-old de-fruited Murcott tangor (Citrus reticulata BlancoxCitrus sinensis (L.) Osb.) trees were grown under 30% or 60% shade tunnels, or 60% flat shade (providing midday shade only), using highly reflective aluminized nets. Non-shaded trees were used as the control. Shading reduced direct more than diffuse radiation. Daily radiation was reduced by 35% for the 30% Tunnel and 60% Flat treatments, and by 55% for the 60% Tunnel. Two days of intensive measurement showed that shading increased average sunlit leaf conductance by 44% and photosynthesis by 29%. Shading did not significantly influence root and stem dry weight growth, but it increased the increment in leaf dry weight during the three month period by an average of 28% relative to the control, while final tree height in the 30% Tunnel treatment exceeded the control by 35%. Shoot to root and shoot mass ratios increased and root mass ratio decreased due to shading because of the increase in leaf dry weight. Shading increased starch concentration in leaves while the shadiest treatment, 60% Tunnel, decreased starch concentration in the roots. Carbon isotope ratio (delta(13)C) of exposed leaves that developed under shading was significantly reduced by 1.9 per thousand in the 60% Tunnel, indicating that shading increased CO(2) concentrations at the chloroplasts (C(c)), as would be expected from increased conductance. Substomatal CO(2) concentrations, C(i), computed from leaf net CO(2) assimilation rate and conductance values, also indicate that shading increases internal CO(2) concentrations. Based on tree dry mass, tree height, and total carbohydrates fractions, the 30% Tunnel and the 60% Flat were the optimal shade treatments.

Induction of Resistance to Penicillium digitatum in Grapefruit by the Yeast Biocontrol Agent Candida oleophila.

ABSTRACT The yeast Candida oleophila, the base of the commercial product Aspire, is recommended for the control of postharvest decay in citrus and pome fruit. Its modes of action include nutrient competition, site exclusion, and direct mycoparasitism. In the present study, we showed that application of Candida oleophila to surface wounds or to intact 'Marsh Seedless' grapefruit elicited systemic resistance against Penicillium digitatum, the main postharvest pathogen of citrus fruit. The induction of pathogen resistance in fruit was already pronounced 24 h after elicitation; it was distance, concentration, and time dependent and restricted to the peel tissue closely surrounding the yeast application site. The induction of pathogen resistance required viable yeast cells at concentrations of 10(8) to 10(9) cells ml(-1). Nonviable autoclaved or boiled yeast cells or lower yeast concentrations were ineffective in enhancing fruit disease resistance. Application of Candida oleophila cell suspensions to grapefruit peel tissue increased ethylene biosynthesis, phenylalanine ammonia lyase activity, and phytoalexin accumulation, and increased chitinase and beta-1,3-endoglucanase protein levels, indicated by western immunoblotting analysis. Scanning electron microscope observations revealed that spore germination and germ tube growth of Penicillium digitatum were markedly inhibited in wounds made near the yeast-treated sites. Overall, this study provides evidence that induced resistance against postharvest decay of citrus fruit should be considered an important component of the multiple modes of action of the yeast Candida oleophila.

The development of myopia in Hong Kong children.

PURPOSE: The purpose of this two and one-half year follow-up study is to evaluate the relationship between early academic activities and the development of myopia. METHODS: 128 children randomly selected from 51 pre-schools completed an education and vision assessment study. At the end of the period, the children were 8.5 years old. Data were collected on developmental performance in the areas of cognition, language, social, academic and motor skills. The prevalence of myopia, mean refraction and change of refraction over this period were described in terms of the gender, geographical areas, type of pre-schools and type of primary schools. RESULTS: The prevalence of myopia shifted towards a higher proportion of myopia in all the above categories. The mean refraction at the initial visit was 0.5 D and became about -0.50 D at the follow-up visit. There was no difference in the changes of refraction in relation to the type of pre-school or primary school. The change of refraction was also not related to the educational scores. However, there was a statistically significant difference in the academic scores, in particular the reading scores, between the activity and conventional primary schools. There was also gender difference in language scores between the girls and the boys of the activity schools. There was no difference in all scores between the myopes and non-myopes. CONCLUSION: The present study did not demonstrate a relationship between early academic activities and development of myopia. However, the higher reading scores and the slightly faster progression rate in the conventional schools may indicate an influence of the curriculum on the refractive development. A longer follow-up study may elucidate a clearer trend.

Cytotoxic synergism of methioninase in combination with 5-fluorouracil and folinic acid.

Potentiation of the cytotoxic activity of 5-fluorouracil (FUra) by folinic acid (5-HCO-H4folate) is due to elevation of the methylene tetrahydrofolate (CH2-H4folate) level, which increases the stability of the ternary complex of thymidylate synthase (TS), fluorodeoxyuridine monophosphate, and CH2-H4folate that inactivates the TS. Methionine deprivation results in the production of tetrahydrofolate (H4folate) and, subsequently, CH2-H4folate from methyl tetrahydrofolate, as a consequence of the induction of methionine synthesis. We hypothesized that the efficacy of FUra could be augmented by the combination of high-concentration 5-HCO-H4folate and recombinant methioninase (rMETase), a methionine-cleaving enzyme. Studies in vitro were performed with the cell line CCRF-CEM. Cytotoxic synergism of FUra + rMETase and FUra + 5-HCO-H4folate + rMETase was demonstrated with the combination index throughout a broad concentration range of FUra and rMETase. A subcytotoxic concentration of rMETase reduced the IC50 of FUra by a factor of 3.6, and by a factor of 7.5, in the absence and in the presence of 5-HCO-H4folate, respectively. 5-HCO-H4folate increased the intracellular concentrations of CH2-H4folate and H4folate from their baseline levels. Concentrations of folates were not changed by exposure to rMETase. Levels of free TS in cells treated with FUra + 5-HCO-H4folate and with FUra + rMETase were lower than those in cells exposed to FUra alone. The decrease of TS was still more pronounced in cells treated with FUra + 5-HCO-H4folate + rMETase. The synergism described in this study will be a basis for further exploration of combinations of fluoropyrimidines, folates, and rMETase.

Dexamethasone, high-dose cytarabine, and oxaliplatin (DHAOx) as salvage treatment for patients with initially refractory or relapsed non-Hodgkin's lymphoma.

BACKGROUND: Dexamethasone. cytarabine (ara-C), and cisplatin (DHAP) can be used effectively to treat patients with non-Hodgkin's lymphoma (NHL). We hypothesized that substitution of cisplatin by oxaliplatin (L-OHP) could result in less toxicity and greater efficacy. L-OHP is active in patients with lymphoma. It produces mild myelosuppression and is devoid of renal toxicity. We report on a phase II study of dexamethasone, high-dose ara-C, and L-OHP (DHAOx) used to treat patients with NHL who were previously treated with chemotherapy. PATIENTS AND METHODS: Fifteen patients were given DHAOx. They had failed to achieve a CR with initial chemotherapy or had recurrent disease. DHAOx consisted of dexamethasone, 40 mg/day (days 1 to 4): L-OHP, 130 mg/m2 (day 1); and ara-C, 2,000 mg/m2 every 12 h (day 2). Treatment was repeated every 21 days. RESULTS: Patients received a median of four courses of DHAOx. Myelosuppression and transient sensory peripheral neuropathy were the most prominent toxic effects. Serum creatinine levels did not increase in patients with normal renal function, nor in patients who had renal impairment before DHAOx. The median follow-up time from the start of DHAOx treatment was 17 months. Eight patients (53%) achieved a CR, and three patients (20%) had a PR. Responses were achieved by patients with lymphomas of various histologies that included mainly the follicular subtype, and by patients with and without resistance to prior chemotherapy. None of the eight responders have relapsed from CR at 4+. 6+, 14+, 15+, 19+, 20+, 24+, and 24+ months. They had various types of therapy after DHAOx. Disappearance of molecular markers was observed in all four patients who achieved a CR and whose tumor cells carried molecular abnormalities. CONCLUSION: DHAOx possesses characteristics of toxicity which compare favorably to those reported with DHAP, and it is useful as a salvage treatment for patients with NHL. Larger studies are required to establish the therapeutic potential of the regimen.