Incarcerated Vaginal Pessary: A Rare Complication

SummaryObjectiveA patient with uterine prolapse (procidentia uteri) received a vaginal pessary, which became incarcerated in the vaginal wall.Case ReportA 70-year-old female patient had been treated for uterine prolapse by insertion of a ring-shaped silicone pessary for about 3 to 4 years. The patient neglected the pessary, which unfortunately became incarcerated in the vaginal wall; it was impossible to remove. Finally, the pessary was displaced after cutting it into two pieces under general anesthesia.ConclusionAfter having inserted a vaginal pessary, patients need to be instructed on its regular removal and cleaning to prevent complications such as infection, ulceration, and incarceration

Silent Uterine Rupture in an Unscarred Uterus

SummaryObjectiveUterine rupture is one of the most serious obstetric complications, with an increased risk of maternal and perinatal morbidity, and even mortality.Case ReportA multiparous woman came to our labor room at 41 weeks of gestation for induction of labor due to being post-term and having a nonreactive nonstress test. She had no history of abdominal or gynecologic surgery. Emergent cesarean section was performed due to prolonged decelerations shown on the fetal monitor. A 12 cm uterine laceration was identified after opening the abdominal cavity. Fortunately, her uterus was preserved and her postoperative condition was stable.ConclusionTo avoid maternal and fetal morbidity, or even mortality, obstetricians should be aware of the possible existence of uterine rupture in an unscarred uterus

Over-expression of the truncated ghrelin receptor polypeptide attenuates the constitutive activation of phosphatidylinositol-specific phospholipase C by ghrelin receptors but has no effect on ghrelin-stimulated extracellular signal-regulated kinase 1/2 activity

In addition to regulating growth hormone release from the pituitary, ghrelin receptors also influence cell proliferation and apoptosis. By studying mitogen-activated protein kinase activity in human embryonic kidney 293 cells over-expressing ghrelin receptors, we aimed to identify the specific cell signalling pathways used by ghrelin receptors, and to determine if the truncated ghrelin receptor polypeptide had any influence on the functional activity of ghrelin receptors. We found that ghrelin activated extracellular signal-regulated kinases 1/2 with an EC50 value of 10 nM, and that this response was inhibited by the ghrelin receptor antagonists d-Lys(3)-GHRP-6 and [d-Arg1,d-Phe5,d-Trp7,9,Leu11 ]-substance P. Ghrelin had little or no effect on the activity of c-Jun N-terminal kinase, p38 kinase or Akt. Ghrelin appeared to activate extracellular signal-regulated kinases 1/2 through a calcium-independent novel protein kinase C isoform which may utilize diacylglycerol derived from hydrolysis of phosphatidylcholine rather than from phosphatidylinositol. Ghrelin-stimulated extracellular signal-regulated kinases 1/2 activity was independent of transactivation of epidermal growth factor receptors, and even when ghrelin receptor internalization was blocked by concanavalin A or a β-arrestin mutant, there was no decrease in phosphorylated extracellular signal-regulated kinases 1/2, suggesting this is a G protein-dependent process. The truncated ghrelin receptor polypeptide had no effect on ghrelin receptor signalling to extracellular signal-regulated kinases 1/2, but decreased the constitutive activation of phosphatidylinositol-specific phospholipase C by ghrelin receptors. In conclusion, our results suggest that any up-regulation of the truncated ghrelin receptor polypeptide might preferentially attenuate functional activity dependent on the constitutive activation of ghrelin receptors, while leaving ghrelin-dependent signalling unaffected. © 2006 Elsevier Ltd. All rights reserved.Link_to_subscribed_fulltex

The truncated ghrelin receptor polypeptide (GHS-R1b) acts as a dominant-negative mutant of the ghrelin receptor

The dimerization properties of the ghrelin receptor (GRLN-R) and its non-signalling, naturally occurring, truncated splice variant (GHS-R1b) have been investigated in human embryonic kidney 293 cells heterologously expressing these proteins. Using the techniques of bioluminescence resonance energy transfer and co-immunoprecipitation, we detected the formation of GRLN-R homodimers and GRLN-R/GHS-R1b heterodimers, but ghrelin-induced conformational changes were only detected in the GRLN-R homodimers. When the expression of GHS-R1b exceeded that of GRLN-R, there was a decrease in the cell surface expression of GRLN-R with a consequent decrease in constitutive activation of phosphatidylinositol-specific phospholipase C (PI-PLC). Furthermore, there was no change in ghrelin affinity, and the efficacy of cell signalling as measured by stimulation of PI-PLC and extracellular signal-regulated kinase 1/2 was unchanged. Cellular localization studies suggest that GRLN-R is normally distributed between the plasma membrane and cytosolic fractions, but in the presence of GHS-R1b, GRLN-R is localized to the nucleus. Therefore, we propose that the decrease in GRLN-R constitutive signalling was due to translocation of GRLN-R to the nucleus due to the formation of GRLN-R/GHS-R1b heterodimers. Therefore, GHS-R1b appears to act as a dominant-negative mutant of the full-length GRLN-R. © 2006 Elsevier Inc. All rights reserved.Link_to_subscribed_fulltex

College students' knowledge and attitudes toward bystander cardiopulmonary resuscitation: A cross-sectional survey ABOUT THE AUTHORS

Abstract: Background: Sudden cardiac arrest attracts global attention because it is a fatal public health concern. Early implementation of high-quality cardiopulmonary resuscitation (CPR) can significantly improve chances of survival. The significance of CPR training is well recognized by the American Heart Association. College students are potential bystanders who could perform CPR in the community. Aim: This study purpose is to explore college students' knowledge and attitudes toward CPR. Methods: A cross-sectional survey with convenience sampling was conducted in a tertiary college. From September to October 2015, 506 hard-copies of a well-validated questionnaire were distributed. Results: Of 351 respondents, 73 (21.8%) were male and 278 (79.2%) were female. The mean knowledge score was 4.97 out of 10 with a standard deviation of 1.61. Over half of the respondents (n = 194, 55.3%) had attended a CPR course before. The mean attitude score was 26.53 out of 30, and the standard deviation was 2.68. Most of the respondents (87.0%) showed a willingness to perform CPR. The reasons for attending CPR training were mainly "interest" (n = 106, 46.5%), followed by "extra-curricular activity" (n = 37, 16.2%), "to help PUBLIC INTEREST STATEMENT Sudden cardiac arrest attracts global attention because it is a fatal public health concern worldwide. Early implementation of cardiopulmonary resuscitation (CPR) is vital to increase the survival chances and improve the neurologic and health outcomes for outof-hospital cardiac arrest victims. This positive association among bystander CPR and beneficial functional outcomes enhances the significance of promoting community CPR programs. Colleges and Universities have been shown to be ideal settings for CPR training, and their students are one of the most suitable potential bystanders trained for CPR in the community. This study explored Hong Kong college students' knowledge, attitudes and related factors affecting bystander CPR, and compared CPR knowledge and attitudes between students who have and have not been trained in CPR. The results provide directions for future planning and training. Incorporation of CPR training into the tertiary education curricula could be a long-term strategy to expand CPR benefits to the wider community. family and friends in need" (n = 37, 16.2%) and "others" (n = 29, 12.7%) such as to fulfill job or academic requirement. The most frequently reported inhibitors of performing bystander CPR were a lack of confidence due to forgetting CPR procedures (28.8%) and lack of confidence due to not having received any CPR training (19.1%). Conclusions: Although students had a positive attitude toward CPR, inadequate knowledge and training were found. Incorporation of CPR training into the college curricula could be a long-term strategy to enhance CPR benefits to the wider community. Maintaining better knowledge and skills retention, regular and refresher training for students are recommended

Expanded Newborn Screening for Inborn Errors of Metabolism in Hong Kong: Results and Outcome of a 7 Year Journey

Newborn screening (NBS) is an important public health program that aims to identify pre-symptomatic healthy babies that will develop significant disease if left undiagnosed and untreated. The number of conditions being screened globally is expanding rapidly in parallel with advances in technology, diagnosis, and treatment availability for these conditions. In Hong Kong, NBS for inborn errors of metabolism (NBSIEM) began as a pilot program in October 2015 and was implemented to all birthing hospitals within the public healthcare system in phases, with completion in October 2020. The number of conditions screened for increased from 21 to 24 in April 2016 and then to 26 in October 2019. The overall recruitment rate of the NBS program was 99.5%. In the period between October 2015 and December 2022, 125,688 newborns were screened and 295 were referred back for abnormal results. The recall rate was reduced from 0.26% to 0.12% after the implementation of second-tier testing. An inherited metabolic disorder (IMD) was eventually confirmed in 47 infants, making the prevalence of IMD in Hong Kong 1 in 2674. At the time of the NBS result, 78.7% of the newborns with IMD were asymptomatic. There were two deaths reported: one newborn with methylmalonic acidemia cobalamin B type (MMACblB) died after the initial crisis and another case of carnitine palmitoyltransferase II deficiency (CPTII) died at 18 months of age after metabolic decompensation. The most common IMD noted were disorders of fatty acid oxidation metabolism (40%, 19 cases), closely followed by disorders of amino acid metabolism (38%, 18 cases), with carnitine uptake defect (19.1%, 9 cases) and citrullinemia type II (17%, 8 cases) being the two most common IMD picked up by the NBSIEM in Hong Kong. Out of the all the IMDs identified, 19.1% belonged to diverse ethnic groups. False negative cases were reported for citrullinemia type II and congenital adrenal hyperplasia during this period