Medical versus surgical termination of the first trimester missed miscarriage

Using dilatation and curettage (D&C) without prior cervical ripening in the termination of the first trimester missed miscarriage may often cause a concern because of the associated complications. Our aim of this study was to compare the frequency of complications of dilatation and curettage with medical method. A prospective comparison study was carried out in Al-Thawra General Hospital Sana’a over a year (from Dec. 1st 2010 to Nov. 31st 2011). Eligible women were randomized into surgical group (n= 55) and medical group (n= 52). Misoprostol 400 lg was given for the medical group intravaginally as initial dose followed by 200 lg every 4 h vaginally. Dilatation and curettage was performed for the surgical group. All participants were invited to attend a follow-up visit one week later. The complications were recorded during the procedure, before discharge and at follow-up. The success rate of medical group was 80.7% (95%, CI: 69.97–91.43) and 100% for the surgical group. Infection had occurred in 3.8% of the medical vs. 1.8% of the surgical group (p=0.967), hemorrhage was recorded in 7.7% vs. 5.4% of the medical and surgical group respectively (p=0.928). Only one patient of the medical group required readmission for blood transfusion. The mean induction abortion time was 20.4 ± 8.3 h. No other major complication was observed in both groups. We concluded that dilatation and curettage is safe and acceptable in terms of more rapid evacuation and lower complication rates compared to medical methodKeywords: Medical termination of first trimester; Misoprostol; Miscarriag

Misregulation of Scm3p/HJURP Causes Chromosome Instability in Saccharomyces cerevisiae and Human Cells

The kinetochore (centromeric DNA and associated proteins) is a key determinant for high fidelity chromosome transmission. Evolutionarily conserved Scm3p is an essential component of centromeric chromatin and is required for assembly and function of kinetochores in humans, fission yeast, and budding yeast. Overexpression of HJURP, the mammalian homolog of budding yeast Scm3p, has been observed in lung and breast cancers and is associated with poor prognosis; however, the physiological relevance of these observations is not well understood. We overexpressed SCM3 and HJURP in Saccharomyces cerevisiae and HJURP in human cells and defined domains within Scm3p that mediate its chromosome loss phenotype. Our results showed that the overexpression of SCM3 (GALSCM3) or HJURP (GALHJURP) caused chromosome loss in a wild-type yeast strain, and overexpression of HJURP led to mitotic defects in human cells. GALSCM3 resulted in reduced viability in kinetochore mutants, premature separation of sister chromatids, and reduction in Cse4p and histone H4 at centromeres. Overexpression of CSE4 or histone H4 suppressed chromosome loss and restored levels of Cse4p at centromeres in GALSCM3 strains. Using mutant alleles of scm3, we identified a domain in the N-terminus of Scm3p that mediates its interaction with CEN DNA and determined that the chromosome loss phenotype of GALSCM3 is due to centromeric association of Scm3p devoid of Cse4p/H4. Furthermore, we determined that similar to other systems the centromeric association of Scm3p is cell cycle regulated. Our results show that altered stoichiometry of Scm3p/HJURP, Cse4p, and histone H4 lead to defects in chromosome segregation. We conclude that stringent regulation of HJURP and SCM3 expression are critical for genome stability