Ruptured rudimentary horn of the unicornuate uterus at 16 weeks of pregnancy: a case report

Pregnancy in the rudimentary horn of the uterus is a rare form of ectopic pregnancy; most of the cases were being diagnosed at laparotomy for haemorrhagic shock due to rupture when the patient presents in the second trimester. Pre-rupture diagnosis is possible in the early pregnancy in suspicious cases. Pregnancy in the rudimentary horn has a poor maternal and foetal outcome and 90% of them present with intraperitoneal haemorrhage in the second trimester due to rupture of the horn. We report a case of ruptured rudimentary horn pregnancy at 16weeks, in shock with severe anaemia. Excision of the rudimentary horn with right salpingectomy was done

Gestational carriers: A viable alternative for women with medical contraindications to pregnancy*

Objective: Compare the efficacy of surrogate or gestational carrier (GC) cycles to that of autologous in vitro fertilization (IVF)/intracytoplasmic sperm injections (ICSI) in patients with gynecologic or medical co-morbidities contraindicative to pregnancy. Design: Retrospective cohort study. Setting: Infertility patients from a single university hospital-based program from 1998-2009. Intervention(s) 128 GC cycles from 80 intended parents were identified and compared with 15,311 IVF or ICSI cycles. Main Outcome Measure(s) The peak estradiol (E2), number of oocytes retrieved, cycle cancellation, ongoing pregnancy, and live-birth were compared between GCs and autologous IVF carriers. Indications for GC use were also identified. Multiple cycles contributed by the same patient were accounted for using multivariable generalized estimating equations and two-sided Wald p-values. Results: Uterine factors (67%) was the most common indication for using a GC, followed by non-gynecologic medical conditions including coagulopathies (13%), end stage renal disease (10%), cardiovascular disease (5%) and cancer (5%). Adjusting for age, ovulation induction in GC cycles had similar peak E2 levels and number of oocytes retrieved relative to IVF cycles (p = 0.23 and 0.43, respectively). Clinical pregnancy (49% vs. 42%, p = 0.28) and live-birth rates (31% vs. 32%, p = 0.74) were also comparable. A sub-analysis of GC cycles in those women with uterine factor indications, demonstrated significantly higher clinical pregnancy rates (OR = 2.0; CI = 1.2 - 3.5) with 60% greater odds of live-birth relative to IVF/ICSI cycles, however this odds was not statistically significant for differences in live-birth (CI = 0.9 - 2.9). Conclusions: GCs are a viable alternative to start families for patients with medical co-morbidities precluding pregnancy

Aerosols in the central Arctic cryosphere: satellite and model integrated insights during Arctic spring and summer

The central Arctic cryosphere is influenced by the Arctic amplification (AA) and is warming faster than the lower latitudes. AA affects the formation, loss, and transport of aerosols. Efforts to assess the underlying processes determining aerosol variability are currently limited due to the lack of ground-based and space-borne aerosol observations with high spatial coverage in this region. This study addresses the observational gap by making use of total aerosol optical depth (AOD) datasets retrieved by the AEROSNOW algorithm over the vast cryospheric region of the central Arctic during Arctic spring and summer. GEOS-Chem (GC) simulations combined with AEROSNOW-retrieved data are used to investigate the processes controlling aerosol loading and distribution at different temporal and spatial scales. For the first time, an integrated study of AOD over the Arctic cryosphere during sunlight conditions was possible with the AEROSNOW retrieval and GC simulations. The results show that the spatial patterns observed by AEROSNOW differ from those simulated by GC. During spring, which is characterized by long-range transport of anthropogenic aerosols in the Arctic, GC underestimates the AOD in the vicinity of Alaska in comparison with AEROSNOW retrieval. At the same time, it overestimates the AOD along the Bering Strait, northern Europe, and the Siberian central Arctic sea-ice regions, with differences of −12.3 % and 21.7 %, respectively. By contrast, GC consistently underestimates AOD compared with AEROSNOW in summer, when transport from lower latitudes is insignificant and local natural processes are the dominant source of aerosol, especially north of 70° N. This underestimation is particularly pronounced over the central Arctic sea-ice region, where it is −10.6 %. Conversely, GC tends to overestimate AOD along the Siberian and Greenland marginal sea-ice zones by 19.5 % but underestimates AOD along the Canadian Archipelago by −9.3 %. The differences in summer AOD between AEROSNOW data products and GC-simulated AOD highlight the need to integrate improved knowledge of the summer aerosol process into existing models in order to constrain its effects on cloud condensation nuclei, on ice nucleating particles, and on the radiation budget over the central Arctic sea ice during the developing AA period.</p

Efficient Small Extracellular Vesicles (EV) Isolation Method and Evaluation of EV-Associated DNA Role in Cell-Cell Communication in Cancer

SIMPLE SUMMARY: Small extracellular vesicles (sEVs) released by all cell types function as a mediator in intercellular communication that can promote cell division and survival to remodel the tumor microenvironment to develop tumor invasion and metastasis. Even though dsDNA baggage is associated with all small EV populations, the functional role of EV-DNA in cancer remains poorly understood. This is due to a lack of methods allowing the efficient separation of small EVs (sEVs) from other non-sEV components. The main aim of our study was to develop an efficient sEV isolation method along with EV-associated DNA (EV-DNA) monitoring tool to evaluate the role of EV-DNA as a mediator of cell–cell communication in cancer. Our detailed small EV-DNA characterization confirmed that isolated sEVs using the TSU method (Tangential flow filtration + Size exclusion chromatography + Ultrafiltration) are free from contaminants such as cell-free and apoptotic bodies DNA, making TSU ideal for performing EV-DNA functional studies. Next, we revealed the exact EV-DNA distribution in the recipient cells using 3D image analysis and the association of EV-DNA with key cellular proteins, which may have an essential role in cancer. In the leukemia model, EV-DNA isolated from leukemia cell lines associated with mesenchymal stromal cells (MSCs), a crucial factor in the bone marrow (BM) microenvironment. ABSTRACT: Small extracellular vesicles (sEVs) play essential roles in intercellular signaling both in normal and pathophysiological conditions. Comprehensive studies of dsDNA associated with sEVs are hampered by a lack of methods, allowing efficient separation of sEVs from free-circulating DNA and apoptotic bodies. In this work, using controlled culture conditions, we enriched the reproducible separation of sEVs from free-circulated components by combining tangential flow filtration, size-exclusion chromatography, and ultrafiltration (TSU). EV-enriched fractions (F2 and F3) obtained using TSU also contained more dsDNA derived from the host genome and mitochondria, predominantly localized inside the vesicles. Three-dimensional reconstruction of high-resolution imaging showed that the recipient cell membrane barrier restricts a portion of EV-DNA. Simultaneously, the remaining EV-DNA overcomes it and enters the cytoplasm and nucleus. In the cytoplasm, EV-DNA associates with dsDNA-inflammatory sensors (cGAS/STING) and endosomal proteins (Rab5/Rab7). Relevant to cancer, we found that EV-DNA isolated from leukemia cell lines communicates with mesenchymal stromal cells (MSCs), a critical component in the BM microenvironment. Furthermore, we illustrated the arrangement of sEVs and EV-DNA at a single vesicle level using super-resolution microscopy. Altogether, employing TSU isolation, we demonstrated EV-DNA distribution and a tool to evaluate the exact EV-DNA role of cell–cell communication in cancer

Black women are more likely than white women to schedule a uterine-sparing treatment for leiomyomas

Background: To evaluate differences in the proportion of uterine fibroid (UF) treatments that are uterine-sparing between Black women and White women and identify factors that could explain disparities. Methods: Women at age 18-54 years who were enrolled from 10 clinical sites in the United States into the Comparing Options for Management: Patient-Centered Results for UFs (COMPARE-UF) treatment registry completed questionnaires before their UF procedure. UF symptoms and quality of life were assessed by questionnaires. Details on UF imaging and treatment (hysterectomy, myomectomy, or uterine artery embolization [UAE]) were collected from each patient's medical record. Random-effects logistic regression was used to assess the association between race and the odds of having a uterine-sparing procedure versus hysterectomy. Subgroup analyses compared each uterine-sparing procedure with hysterectomy. Results: In this cohort of 1141 White women and 1196 Black women, Black women tended to be younger (median 41.0 vs. 42.0 years) and report worse symptoms, pain, and function on every scale compared with White women. Black women were more likely to have had a prior UF treatment compared with White women (22.8% vs. 14.6%). White women had more hysterectomies (43.6% vs. 32.2%) and myomectomies (50.9% vs. 50.2%) versus Black women. Black women had more UAEs (15.1% vs. 4.7%) than White women. After adjusting for clinical site and other variables, Black women had greater odds than White women of having a myomectomy (odds ratio [OR] = 2.41, 95% confidence interval [CI] = 1.63-3.56) or a UAE versus hysterectomy (OR = 4.24, 95% CI = 2.41-7.46). Conclusion: In these participants, Black women were more likely to schedule a uterine-sparing UF treatment and a nonsurgical UF treatment than their White counterparts; this may not be true for all women. Longer comparative effectiveness studies are needed to inform women about the durability of UF treatments. Greater understanding of factors influencing treatment selection is needed as are studies that include women without access to tertiary care centers. Clinical Trial Registration: Clinicaltrials.gov, NCT02260752 (enrollment start: November 2015)

Genome-Wide Analysis of Müller Glial Differentiation Reveals a Requirement for Notch Signaling in Postmitotic Cells to Maintain the Glial Fate

Previous studies have shown that Müller glia are closely related to retinal progenitors; these two cell types express many of the same genes and after damage to the retina, Müller glia can serve as a source for new neurons, particularly in non-mammalian vertebrates. We investigated the period of postnatal retinal development when progenitors are differentiating into Müller glia to better understand this transition. FACS purified retinal progenitors and Müller glia from various ages of Hes5-GFP mice were analyzed by Affymetrix cDNA microarrays. We found that genes known to be enriched/expressed by Müller glia steadily increase over the first three postnatal weeks, while genes associated with the mitotic cell cycle are rapidly downregulated from P0 to P7. Interestingly, progenitor genes not directly associated with the mitotic cell cycle, like the proneural genes Ascl1 and Neurog2, decline more slowly over the first 10–14 days of postnatal development, and there is a peak in Notch signaling several days after the presumptive Müller glia have been generated. To confirm that Notch signaling continues in the postmitotic Müller glia, we performed in situ hybridization, immunolocalization for the active form of Notch, and immunofluorescence for BrdU. Using genetic and pharmacological approaches, we found that sustained Notch signaling in the postmitotic Müller glia is necessary for their maturation and the stabilization of the glial identity for almost a week after the cells have exited the mitotic cell cycle

Management of Thyroglossal Duct Remnants: Our Experience

Background: Thyroglossal duct remnants are more common in paediatric population. Complete excision of the tract is necessary to prevent recurrence. Sistrunk's surgery is done for thyroglossal duct remnants. This surgery has considerable failure rate. Aims and Objectives: This study was done to present our clinical experience regarding the successful management of thyroglossal cyst and fistula to know the role of imaging in prevention of recurrence after Sisktrunk's surgery. Material and Methods: This is an observational study of 15 cases of thyroglossal cyst and fistula. The data was collected retrospectively from the medical records of SDM College of Medical Sciences and Hospital. Results: No recurrence was seen in this series with a follow up period of 1 year. Conclusion: CT fistulography for thyroglossal fistula and USG neck for thyroglossal cyst is the imaging modality of choice. Nevertheless, it is pivotal to excise a wider core of tissue in revision cases to ensure complete cure to prevent possible recurrence