Cesarean scar defect- obstetric consequences

Scope. This review aims to achieve a parallelism between literature studies on imaging diagnosis, the characteristics of cesarean scar defect and its evolution during pregnancy, and the obstetric consequences that can lead to increased maternal morbidity. Materials and Methods. There have been many literature studies published in recent years aimed to identify the methods of diagnosis for cesarean scar defect, the characteristics and the main changes of it during pregnancy, and the risks undertaken by pregnant women undergoing labor for vaginal delivery after a previous cesarean surgery. Results and Discussions. The most commonly used method for visualizing and evaluating uterine scar is transvaginal ultrasound in the first trimester of pregnancy, and abdominal ultrasonography in the II and III trimesters. The two areas characteristic of uterine scarring: "niche" and "thickness of the residual myometrium" undergo changes during the three trimesters of pregnancy. Some studies in the literature reported a higher incidence of uterine rupture, especially when the lower uterine segment fell below 2.3 mm, and a mean thickness of 3.2 mm, higher among multiparous women. A question that still does not have a generally valid answer refers to the hysterorrhaphy technique. There are different opinions among the authors, but most of them consider that after a double layer suture the thickness of the residual myometrium is higher. However, data from the literature show that the incidence of complications such as uterine rupture, dehiscence of the uterine trance are similar, regardless of the type of suture used. Another complication that occurs due to uterine scar is the pregnancy inserted at this level, which in the case of expectancy, leads to an increase in maternal and fetal morbidity. 50% of them evolve to spontaneous abortion in the first trimester, and almost all full-term pregnancies result in hysterectomy of necessity. Conclusions. Due to the many obstetrical and gynecological complications that occur on a uterine scar, an evaluation in dynamics is essential. There are no standardized protocols yet, but the identification and measurement of the uterine scar area in the third trimester may predict the chance of success of the labor test for vaginal delivery after cesarean surgery

Prognostic prediction of the immunohistochemical expression of p16 and p53 in cutaneous melanoma: a comparison of two populations from different geographical regions

p16INK4a and p53 are tumor-suppressor genes frequently altered in various malignancies, including cutaneous melanoma. The purpose of the study was to establish the prognostic value of immunohistochemical expression of p16INK4a and p53 in sporadic cutaneous melanoma (CM) in two regions with a high-risk for melanoma in Italy and Ecuador. Immunohistochemical staining of p16 and p53 was performed in samples of primary CM from 82 patients with Stage I and II melanoma according to the American Joint Committee on Cancer (AJCC) staging system. Survival differences between categories of p16 or p53 expression were analyzed using the product-limit procedure (Kaplan-Meier method, log-rank test). Clinical variables (gender, age, tumor location, Clark’s level, thickness) were correlated with survival and p16 or p53 expression. p16 nuclear immunoreactivity was observed in 85% of Italian patients compared to 48.7% of Ecuadorians; a small number of cases showed p53 immunoreactivity in both populations. Only nuclear p16 expression exhibited a significant correlation with survival (Italians p=0.001, Ecuadorians p=0.017) but did not appear to correlate with any clinicopathological parameter. No significant difference was observed in survival with regard to p53 expression or cytoplasmic p16. Our results demonstrate that nuclear expression of p16 can be considered a molecular prognostic factor in patients with sporadic CM and indicate its importance as a clinical marker

Public Opinion on Migration and the Role of the Media in the Context of the “European Refugee Crisis”

This book presents an overview of European migration policy and the various institutional arrangements within and between various actors, such as local councils, local media, local economies, and local civil society initiatives. Both the role of local authorities in this policy field and their cooperation with civil society initiatives or networks are under-explored topics for research. In response, this book provides a range of detailed case studies focusing on the six main groups of national and administrative traditions in Europe: Germanic, Scandinavian, Napoleonic, Southeastern European, Central-Eastern European and Anglo-Saxon.Peer reviewe

Calpain 3 is important for muscle regeneration: Evidence from patients with limb girdle muscular dystrophies

<p>Abstract</p> <p>Background</p> <p>Limb girdle muscular dystrophy (LGMD) type 2A is caused by mutations in the CAPN3 gene and complete lack of functional calpain 3 leads to the most severe muscle wasting. Calpain 3 is suggested to be involved in maturation of contractile elements after muscle degeneration. The aim of this study was to investigate how mutations in the four functional domains of calpain 3 affect muscle regeneration.</p> <p>Methods</p> <p>We studied muscle regeneration in 22 patients with LGMD2A with calpain 3 deficiency, in five patients with LGMD2I, with a secondary reduction in calpain 3, and in five patients with Becker muscular dystrophy (BMD) with normal calpain 3 levels. Regeneration was assessed by using the developmental markers neonatal myosin heavy chain (nMHC), vimentin, MyoD and myogenin and counting internally nucleated fibers.</p> <p>Results</p> <p>We found that the recent regeneration as determined by the number of nMHC/vimentin-positive fibers was greatly diminished in severely affected LGMD2A patients compared to similarly affected patients with LGMD2I and BMD. Whorled fibers, a sign of aberrant regeneration, was highly elevated in patients with a complete lack of calpain 3 compared to patients with residual calpain 3. Regeneration is not affected by location of the mutation in the <it>CAPN3 </it>gene.</p> <p>Conclusions</p> <p>Our findings suggest that calpain 3 is needed for the regenerative process probably during sarcomere remodeling as the complete lack of functional calpain 3 leads to the most severe phenotypes.</p

Street-level methane emissions of Bucharest, Romania and the dominance of urban wastewater

Atmospheric methane (CH4) continues to increase, but there are multiple anthropogenic source categories that can be targeted for cost-effective emissions reduction. Cities emit CH4 to the atmosphere from a mixture of anthropogenic CH4 sources, which include, but are not limited to, fugitive emissions from natural gas distribution systems, wastewater treatment facilities, waste-and rainwater networks, and landfills. Therefore, to target mitigation measures, it is important to locate and quantify local urban emissions to prioritize mitigation opportunities in large cities. Using mobile measurement techniques, we located street-level CH4 leak indications, measured flux rates, and determined potential source origins (using carbon and hydrogen stable isotopic composition along with ethane: CH4 ratios) of CH4 in Bucharest, Romania. We found 969 confirmed CH4 leak indication locations, where the maximum mole fraction elevation (above background) was 38.3 ppm (mean = 0.9 ppm ± 0.1 ppm s.e.; n = 2482). Individual leak indicator fluxes, derived using a previously established empirical relation, ranged up to around 15 metric tons CH4 yr-1 (mean = 0.8 metric tons yr-1 ± 0.05, s.e.; n = 969). The total estimated city emission rate is 1832 tons CH4 yr-1 (min = 1577 t yr-1 and max = 2113 t yr-1). More than half (58%–63%) of the CH4 elevations were attributed to biogenic wastewater, mostly from venting storm grates and manholes connecting to sewer pipelines. Hydrogen isotopic composition of CH4 and ethane:methane ratios were the most useful tracers of CH4 sources, due to similarities in carbon isotope ratios between wastewater gas and natural gas. The annual city-wide CH4 emission estimate of Bucharest exceeded emissions of Hamburg, Germany by 76% and Paris, France by 90%