Vaginal Calculus Formation on Exposed Midurethral Sling Mesh

The presence of a vaginal calculus is a rare clinical entity which may develop in the setting of vaginal urinary stagnation. Numerous factors contribute to stone formation, and management can be complicated by variations in size, location of the stone, and location of adjacent structures. Generally, once diagnosed, vaginal calculi should be removed and surrounding anatomy should be evaluated thoroughly for secondary fistula, erosion, or presence of an instituting foreign body. This report presents a case of vaginal calculus formation on exposed midurethral sling mesh in an elderly patient with hemorrhagic cystitis. This report emphasizes contributing pathophysiology, diagnostic factors, and treatment.

Racial differences in hypertensive disorders in pregnancy during the COVID-19 pandemic

OBJECTIVE

To compare rates of pregnancy induced hypertensive disorders during the period of the COVID-19 pandemic to prior, baseline years.

METHODS

We conducted a retrospective study of 17,742 patients on rates for pregnancy induced hypertensive disorders delivering at 2 local hospitals before (Cohort 1; January 2018 to December 2019; n = 8245) and after (Cohort 2; February 2020 to February 2022; n = 9497) the onset of the COVID-19 pandemic. The primary outcomes were rates of gestational hypertension, pre-eclampsia, and chronic hypertension in patients.Wecompared by year (2018-2022), by patient COVID infection status, and by racial demographics.

RESULTS

During the pandemic (Cohort 2), there were lower rates of chronic hypertension (7.4 % vs 6.5 %, p =.02), higher rates of gestational hypertension (26.3 % vs 27.8 %, p =.03), and higher rates of preeclampsia (11.3 % vs 13.1 %, p <.001) compared to years prior to the pandemic (Cohort 1). When evaluating by year, rates of chronic hypertension did not statistically change while rates for preeclampsia increased in the first year of the pandemic and remained high, and rates for gestational hypertension did not increase until the second year of the pandemic. When evaluating by COVID infection status, rates for gestational hypertension were significantly higher for individuals with a positive COVID infection status (COVID negative = 27.4 % vs. COVID positive = 32.8 %; p <.004). Rates of preeclampsia did not differ according to COVID infection status (p = 0.15).

CONCLUSION

In this study, rates of pregnancy induced hypertensive disorders increased during the COVID pandemic regardless of COVID infection status.

Improving Patient Safety Event Reporting Among Residents and Teaching Faculty

BACKGROUND

A June 2012 site visit report from the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review revealed that residents and physicians at TriHealth, Inc., a large, nonprofit independent academic medical center serving the Greater Cincinnati area in Ohio, had an opportunity to improve their awareness and understanding of the hospital's system for reporting patient safety concerns in 3 areas: (1) what constitutes a reportable patient safety event, (2) who is responsible for reporting, and (3) how to use the hospital's current reporting system.

METHODS

To improve the culture of patient safety, we designed a quality improvement project with the goal to increase patient safety event reporting among residents and teaching faculty. An anonymous questionnaire assessed physicians' and residents' attitudes and experience regarding patient safety event reporting. An educational intervention was provided in each graduate medical education program to improve knowledge and skills related to patient safety event reporting, and the anonymous questionnaire was distributed after the intervention. We compared the responses to the preintervention and postintervention questionnaires and tracked monthly patient safety event reports for 1 year postintervention.

RESULTS

The number of patient safety event reports increased following the educational intervention; however, we saw wide variability in reporting per month. On the postintervention questionnaire, participants demonstrated improved knowledge and attitudes toward patient safety event reporting.

CONCLUSION

The goal of this unique project was to increase patient safety event reporting by both residents and teaching faculty in 6 residency programs through education. We achieved this goal through an educational intervention tailored to the institution's new event reporting system delivered to each residency program. We clearly understand that improvements in quality and patient safety require ongoing effort. The keys to ongoing sustainability include (1) developing patient safety faculty and resident experts in each training program to teach patient safety and to be role models, (2) working toward decreasing the barriers to reporting, and (3) providing timely feedback and system changes.

Beta-amyloid precursor protein-like immunoreactivity is upregulated during olfactory nerve regeneration in adult rats

Beta-amyloid precursor protein (APP) is the source of beta-amyloid, which forms the cores of senile plaques in Alzheimer's Disease. However, the function of this precursor protein is currently unknown and an adult animal in which this protein varied substantially would be valuable. We used subcutaneous diethyldithiocarbamate to reversibly lesion the olfactory epithelium in adult rats and found that whole-bulb levels of APP-like immunoreactivity significantly decreased after the lesion, then increased reaching almost five-fold normal levels six weeks after treatment. Growth cone associated protein (GAP43) decreased when the nerve degenerated, then increased, replicating previous studies of olfactory nerve regeneration. Immunocytochemical techniques identified APP immunoreactive perikarya and fibers in and around glomeruli at three days to one week post-lesion and upregulation of APP-like immunoreactivity in mitral cells and dendrites at five weeks. Olfactory nerve regeneration appears to be a useful in vivo model system to understand the regulation of APP-like proteins.

The temporal sequence of G-protein expression in intimal hyperplasia

The universal response of a blood vessel to intimal injury is the development of intimal hyperplasia. The etiology of this lesion is not fully understood but is assumed to involve stimulation of receptors on smooth muscle cells with their subsequent proliferation. Many receptor-mediated processes are coupled to G-proteins but little information exists regarding the expression of G-proteins during the development of intimal hyperplasia. This study examines the kinetics of G-protein expression in experimental vein grafts. Male New Zealand White rabbits had a right carotid interposition bypass graft using the ipsilateral external jugular vein. These were harvested on days 1, 3, 5, 7, 14, and 28 postoperatively for histology (n = 3), for in vitro isometric tension studies of potassium chloride, serotonin, bradykinin, and histamine (n = 3), or for Western blot analysis (n = 3) of the G-protein subunits (alpha(i1), alpha(i2), alpha(i3), alpha(S) and beta). The results show that expression of alpha(i3) developed de novo, was detectable by day 1, and continued to increase through day 7, paralleling the development of intimal hyperplasia. The expression of alpha(S) (52 kDa) increased significantly by day 1 and also continued to increase until day 7. In contrast, expression for alpha(i2), alpha(S) (45 kDa) and beta subunits increased at a much slower rate from 1 to 7 days and remained constant thereafter. No alpha(i1) was detected. The contractile response to potassium chloride was significantly reduced (36% of the response in the jugular vein) over the first 7 days and increased to 196% of the jugular vein response at 14 and 28 days. There was minimal response to serotonin, bradykinin, and histamine over the first 7 days. Contractile responses to serotonin increased while those to bradykinin and histamine decreased from 7 to 28 days. This study demonstrates that there are specific changes in alpha(i) and alpha(S) subunits within 24 hr of grafting and that increases in all G-proteins occur in a time dependent manner up to 7 days postoperatively. Microscopic development of intimal hyperplasia occurs from days 3 to 5 and increases rapidly between 7 and 14 days. Changes in the expression of G-proteins in the vein grafts, particularly the alpha(i3) subunit, parallel this formation of intimal hyperplasia. These alterations in G-protein expression do not appear to correlate with G-protein-mediated, contractile responses in the vein grafts.

Dexamethasone up-regulates A3 adenosine receptors in rat basophilic leukemia (RBL-2H3) cells

The cross-linking of surface IgE receptors by multi-functional Ags promotes the degranulation of mast cells. Previous studies have indicated that the nucleoside adenosine potentiates this response by activating putative A3 adenosine receptors (AR) coupled to phospholipase C in mast cells or their cultured analogues, rat basophilic leukemia (RBL-2H3) cells. Moreover, it has been shown that exposure of RBL-2H3 cells to dexamethasone attenuated antigen-mediated mast cell degranulation, but potentiated the response elicited by adenosine. To determine whether the A3AR is a potential site of action of dexamethasone, we have assessed the status of these receptors in RBL-2H3 cells treated with and without dexamethasone. Treatment with dexamethasone (100 nM) for 24 h resulted in an increase in the number of A3AR to 217 +/- 50% of control. The increased receptor expression was both time- and concentration-dependent, with optimal increases observed following 16 h of treatment and using 100 nM of dexamethasone. No increase in the level of the A2aAR was detectable following dexamethasone treatment. Northern blotting studies indicated a 2.7 +/- 0.3-fold increase in A3AR mRNA in RBL-2H3 cells treated with dexamethasone for 24 h. Dexamethasone also increased the expression of G protein alpha i2, alpha i3, alpha s, and beta subunits by two- to threefold. Activation of the A3AR by aminophenylethyladenosine (APNEA) following dexamethasone treatment enhanced the production of inositol phosphates and the mobilization of intracellular Ca2+. From these data, it is concluded that dexamethasone increases the expression of both A3AR and G proteins in RBL-2H3 cells which contributes to the enhanced response to adenosine.

Dexamethasone up-regulates A3 adenosine receptors in rat basophilic leukemia (RBL-2H3) cells

The cross-linking of surface IgE receptors by multi-functional Ags promotes the degranulation of mast cells. Previous studies have indicated that the nucleoside adenosine potentiates this response by activating putative A3 adenosine receptors (AR) coupled to phospholipase C in mast cells or their cultured analogues, rat basophilic leukemia (RBL-2H3) cells. Moreover, it has been shown that exposure of RBL-2H3 cells to dexamethasone attenuated antigen-mediated mast cell degranulation, but potentiated the response elicited by adenosine. To determine whether the A3AR is a potential site of action of dexamethasone, we have assessed the status of these receptors in RBL-2H3 cells treated with and without dexamethasone. Treatment with dexamethasone (100 nM) for 24 h resulted in an increase in the number of A3AR to 217 +/- 50% of control. The increased receptor expression was both time- and concentration-dependent, with optimal increases observed following 16 h of treatment and using 100 nM of dexamethasone. No increase in the level of the A2aAR was detectable following dexamethasone treatment. Northern blotting studies indicated a 2.7 +/- 0.3-fold increase in A3AR mRNA in RBL-2H3 cells treated with dexamethasone for 24 h. Dexamethasone also increased the expression of G protein alpha i2, alpha i3, alpha s, and beta subunits by two- to threefold. Activation of the A3AR by aminophenylethyladenosine (APNEA) following dexamethasone treatment enhanced the production of inositol phosphates and the mobilization of intracellular Ca2+. From these data, it is concluded that dexamethasone increases the expression of both A3AR and G proteins in RBL-2H3 cells which contributes to the enhanced response to adenosine.

Adenosine acts as an endogenous activator of the cellular antioxidant defense system

Oxygen free radicals have been implicated in the pathogenesis of ischemic cell injuries. These free radicals are normally scavenged by antioxidant enzymes. Adenosine is normally released during ischemia and protects against ischemic injuries by interacting with adenosine receptors (ARs). The mechanism underlying its cytoprotective action is unclear. In this report, we provide evidence that activation of a unique A3AR in rat basophilic leukemia cells (RBL-2H3) leads to a 2 to 3 fold increase in activity of superoxide dismutase, catalase and glutathione peroxidase and also increases in the activity of glutathione reductase. Similar increases in enzyme activity were elicited in bovine and human endothelial cells, rat cardiac myocytes and smooth muscle cells. Increases in enzyme activity were attenuated by theophylline (an antagonist of the A3AR) and by pertussis toxin, implicating a role of A3AR/Gi protein in the activation. Importantly, activation of the A3AR decreased the degree of lipid peroxidation in these cells. These data provide strong evidence that the cytoprotective action of adenosine during ischemic cell injuries is mediated, at least in part, via a novel mechanism-activation of the cellular antioxidant enzymes.