Vaginal birth after caesarean section in a woman with twin reversed arterial perfusion sequence

Twin reversed arterial perfusion (TRAP) sequence results from aberrant and asymmetrical twinning. It is a rare but serious complication of monozygotic twin pregnancies. It is characterized by a normally formed fetus that shows features of heart failure, and an acardiac twin. A 26-year-old pregnant woman, gravida 6, para 5, with mono-chorionic di-amniotic twin pregnancy at her 20th week of gestation, was diagnosed with TRAP sequence. Both the pump twin and the acardiac co-twin did not display any cardiac activity. Termination of pregnancy was accomplished by a successful vaginal birth after cesarean section (VBAC) following five prior cesarean sections. Proper and early diagnosis of TRAP sequence can aid in treatment selection and pump twin salvage. Induction of labor by both misoprostol and intracervical balloon catheter showed to be safe and effective in a woman with a uterine scar resulting from five prior cesarean sections

Cigarette smoking increases the development of intimal hyperplasia after vascular injury

Purpose: Our purpose was to determine whether exposure to cigarette smoke increases the development of intimal hyperplasia (IH) after vascular injury.Methods: Sixteen adult male Sprague-Dawley rats underwent standardized balloon catheter injury of the left common carotid artery. For 4 weeks before and 4 weeks after injury, animals in the experimental group (n=8) were exposed to cigarette smoke with an automated vacuum pump device. Animals in the control group (n=8) were restrained in the smoking device for an identical amount of time and underwent arterial injury at 4 weeks but were not exposed to cigarette smoke. Carotid arteries were perfusion-fixed in vivo, prepared as histologic cross sections, and stained for elastin. IH was measured by planimetry and is reported both as the absolute area of IH and as the ratio (IH/IEL) of the absolute area of IH to the normalized area enclosed by the internal elastic lamina (expressed as a percent).Results: The absolute area of IH was 2.09±0.34 for the experimental group compared with 0.94±0.25 for the control group; mean IH/IEL was 43.7%±7.1% for the experimental group versus 17.7%±4.7% for the control group (p<0.05, two-tailed unpaired t test).Conclusions: Inhalation of cigarette smoke increases the development of intimal hyperplasia in a rat model of balloon catheter arterial injury

Seismic damage estimation of in-plane regular steel/concrete composite moment resisting frames

© 2016 Elsevier Ltd. Simple empirical expressions to estimate maximum seismic damage on the basis of four well known damage indices for planar regular steel/concrete composite moment resisting frames having steel I beams and concrete filled steel tube (CFT) columns are presented. These expressions are based on the results of an extensive parametric study concerning the inelastic response of a large number of frames to a large number of ordinary far-field type ground motions. Thousands of nonlinear dynamic analyses are performed by scaling the seismic records to different intensities in order to drive the structures to different levels of inelastic deformation. The statistical analysis of the created response databank indicates that the number of stories, beam strength ratio, material strength and ground motion characteristics strongly influence structural damage. Nonlinear regression analysis is employed in order to derive simple formulae, which reflect the influence of the aforementioned parameters and offer a direct estimation of the damage indices used in this study. More specifically, given the characteristics of the structure and the ground motion, one can calculate the maximum damage observed in column bases and beams. Finally, three examples serve to illustrate the use of the proposed expressions and demonstrate their accuracy and efficiency

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p&lt;0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p&lt;0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

SUMOylation does not affect cardiac troponin I stability but alters indirectly the development of force in response to Ca2+

Post-translational modification of the myofilament protein troponin I by phosphorylation is known to trigger functional changes that support enhanced contraction and relaxation of the heart. We report for the first time that human troponin I can also be modified by SUMOylation at lysine 177. Functionally, TnI SUMOylation is not a factor in the development of passive and maximal force generation in response to calcium, however this modification seems to act indirectly by preventing SUMOylation of other myofilament proteins to alter calcium sensitivity and cooperativity of myofilaments. Utilising a novel, custom SUMO site-specific antibody that recognises only the SUMOylated form of troponin I, we verify that this modification occurs in human heart and that it is upregulated during disease