Maternal serum markers in predicting successful outcome in expectant management of missed miscarriage

The aim of this study was to evaluate the use of biological serum markers, available routinely in most hospital clinical laboratories, in predicting successful outcomes of expectant management in women presenting with a missed miscarriage. This is a single centre observational prospective study over a 16-month period. Among the 490 women who consented to the study protocol, 83 presented with missed miscarriage during the first trimester of pregnancy and opted for expectant management. The mean gestation sac diameter and volume of the gestation sac were recorded during ultrasound examination. Maternal serum samples were obtained in each case and assayed for human chorionic gonadotrophin, progesterone, pregnancy associated plasma protein A (PAPP-A) and high-sensitivity C-reactive protein using commercial assays. When examined individually, maternal age (P = 0.01), progesterone (P = 0.03) and PAPP-A (P = 0.02) were all significantly associated with successful expectant management. Increased maternal age was associated with an increased chance of success with the odds of success increased by around 75% for a 5-year increase in age. Higher values of progesterone and PAPP-A were associated with a reduced chance of successful management. Low maternal serum progesterone concentration was the strongest parameter associated with a successful spontaneous completion of miscarriage

First observations of W Virginis stars with K2: detection of period doubling

We present the first analysis of W Vir stars observed by the Kepler space telescope in the K2 mission. Clear cycle-to-cycle variation were detected in the light curves of KT Sco and the globular cluster member M80-V1. While the variations in the former star seems to be irregular on the short time scale of the K2 data, the latter appears to experience period doubling in its pulsation. Ground-based colour data confirmed that both stars are W Vir-type pulsators, while a comparison with historical photometric time-series data revealed drastic period changes in both stars. For comparison we reexamine ground-based observations of W Vir, the prototype of the class, and conclude that it shows period doubling instead of mode beating. These results support the notion that nonlinear dynamics plays an important role in the pulsation of W Virginis-type stars.Comment: 8 pages, 7 figures, accepted for publication in MNRA

Has increased clinical experience with methotrexate reduced the direct costs of medical management of ectopic pregnancy compared to surgery?

<p>Abstract</p> <p>Background</p> <p>There is a debate about the cost-efficiency of methotrexate for the management of ectopic pregnancy (EP), especially for patients presenting with serum human chorionic gonadotrophin levels of >1500 IU/L. We hypothesised that further experience with methotrexate, and increased use of guideline-based protocols, has reduced the direct costs of management with methotrexate.</p> <p>Methods</p> <p>We conducted a retrospective cost analysis on women treated for EP in a large UK teaching hospital to (1) investigate whether the cost of medical management is less expensive than surgical management for those patients eligible for both treatments and (2) to compare the cost of medical management for women with hCG concentrations 1500–3000 IU/L against those with similar hCG concentrations that elected for surgery. Three distinct treatment groups were identified: (1) those who had initial medical management with methotrexate, (2) those who were eligible for initial medical management but chose surgery (‘elected’ surgery) and (3) those who initially ‘required’ surgery and did not meet the eligibility criteria for methotrexate. We calculated the costs from the point of view of the National Health Service (NHS) in the UK. We summarised the cost per study group using the mean, standard deviation, median and range and, to account for the skewed nature of the data, we calculated 95% confidence intervals for differential costs using the nonparametric bootstrap method.</p> <p>Results</p> <p>Methotrexate was £1179 (CI 819–1550) per patient cheaper than surgery but there were no significant savings with methotrexate in women with hCG >1500 IU/L due to treatment failures.</p> <p>Conclusions</p> <p>Our data support an ongoing unmet economic need for better medical treatments for EP with hCG >1500 IU/L.</p

Single dose systemic methotrexate versus expectant management for treatment of tubal ectopic pregnancy: A placebo-controlled randomised trial

OBJECTIVE: Methotrexate is routinely used worldwide for medical treatment of clinically stable women with tubal ectopic pregnancies. This is despite the lack of robust evidence to show its superior effectiveness over expectant management. The aim of our multicentre randomised trial study was to compare the success rates of methotrexate with placebo for the conservative treatment of tubal ectopic pregnancies. METHODS: The study was multicentre; it took place in three UK early pregnancy units between January 2006 and June 2014. Inclusion criteria were clinically stable women with a conclusive ultrasound diagnosis of a tubal ectopic pregnancy presenting with low serum β-hCG <1500IU/l. Women were randomly assigned to single systemic injection of methotrexate 50mg/m(2) or placebo. The primary outcome of the study was a binary indicator for success of conservative management, defined as resolution of clinical symptoms and decline of serum β-hCG to <20IU/l or negative urine pregnancy test without the need for any additional medical intervention. An intention to treat analysis was followed. RESULTS: We recruited a total of 80 women: 42 to methotrexate and 38 to placebo. The two arms of the study were balanced in terms of age, ethnicity, obstetric histories, pregnancy characteristics and serum β-hCG and progesterone. The proportions of successes were similar: 83% with methotrexate and 76% with placebo. On univariate analysis, this difference was not statistically significant (χ2(1df) = 0.53; P = 0.23). On multivariate logistic regression, β-hCG was the only covariate which was significantly associated with outcome. The odds of failure increased by 0.15% for each unit increase in β-hCG (OR=1.0015; 95% CI 1.0002 to 1.003; P = 0.02). In 14 women presenting with serum hCG 1000-1500IU/l the success of expectant management was 33% compared to 62% in the methotrexate arm. Although this result was not statistically significant a larger sample size would give us greater power to detect a difference in this subgroup of women, In women with successful conservative management there was no significant difference in median resolution times between methotrexate and placebo arms [17.5 days (IQR 14 - 28.0) (n = 30)] vs [14 days (IQR 7 - 29.5) (n = 25)] (P = 0.73) CONCLUSION: The results of our study do not support routine use of methotrexate for the treatment of clinically stable women diagnosed with tubal ectopic pregnancies presenting with low serum hCG <1500IU/l. Further work is required to identify a subgroup of women with tubal ectopic pregnancies and hCG≥1500IU/l in whom methotrexate may offer a safe and cost-effective alternative to surgery

Deep sub-threshold Ξ−\Xi^- production in Ar+KCl reactions at 1.76A GeV

We report first results on a deep sub-threshold production of the doubly strange hyperon $\Xi^-$ in a heavy-ion reaction. At a beam energy of 1.76A GeV the reaction Ar+KCl was studied with the High Acceptance Di-Electron Spectrometer (HADES) at SIS18/GSI. A high-statistics and high-purity $\Lambda$ sample was collected, allowing for the investigation of the decay channel $\Xi^- \to \Lambda \pi^-$. The deduced $\Xi^-/(\Lambda+\Sigma^0)$ production ratio of $(5.6 \pm 1.2 ^{+1.8}_{-1.7})\cdot 10^{-3}$ is significantly larger than available model predictions.Comment: 4 pages, including 4 figure

An upper limit on hypertriton production in collisions of Ar(1.76 AGeV)+KCl

A high-statistic data sample of Ar(1.76 AGeV)+KCl events recorded with HADES is used to search for a hypertriton signal. An upper production limit per centrality-triggered event of $1.04$ x $10^{-3}$ on the $3\sigma$ level is derived. Comparing this value with the number of successfully reconstructed $\Lambda$ hyperons allows to determine an upper limit on the ratio $N_{_{\Lambda}^3H}/N_{\Lambda}$, which is confronted with statistical and coalescence-type model calculations

In-Medium Effects on K0 Mesons in Relativistic Heavy-Ion Collisions

We present the transverse momentum spectra and rapidity distributions of $\pi^{-}$ and K$^0_S$ in Ar+KCl reactions at a beam kinetic energy of 1.756 A GeV measured with the spectrometer HADES. The reconstructed K$^0_S$ sample is characterized by good event statistics for a wide range in momentum and rapidity. We compare the experimental $\pi^{-}$ and K$^0_S$ distributions to predictions by the IQMD model. The model calculations show that K$^0_S$ at low tranverse momenta constitute a particularly well suited tool to investigate the kaon in-medium potential. Our K$^0_S$ data suggest a strong repulsive in-medium K$^0$ potential of about 40 MeV strength.Comment: 10 pages, 10 figures, accepted by Phys. Rev.

Baryonic resonances close to the Kbar-N threshold: the case of Sigma(1385)^+ in pp collisions

We present results of an exclusive measurement of the first excited state of the Sigma hyperon, Sigma(1385)^+, produced in p+p -> Sigma^+ + K^+ + n at 3.5 GeV beam energy. The extracted data allow to study in detail the invariant mass distribution of the Sigma(1385)^+. The mass distribution is well described by a relativistic Breit-Wigner function with a maximum at m_0 = 1383.2 +- 0.9 MeV/c^2 and a width of 40.2 +- 2.1 MeV/c^2. The exclusive production cross-section comes out to be 22.27 +- 0.89 +- 1.56 +3.07 -2.10 mu b. Angular distributions of the Sigma(1385)^+ in different reference frames are found to be compatible with the hypothesis that 33 % of Sigma(1385)^+ result from the decay of an intermediate Delta^{++} resonance.Comment: 12 pages; 12 figures; submitted to PR

Subthreshold Xi- Production in Collisions of p(3.5 GeV)+Nb

Results on the production of the double-strange cascade hyperon $\mathrm{\Xi^-}$ are reported for collisions of p\,(3.5~GeV)\,+\,Nb, studied with the High Acceptance Di-Electron Spectrometer (HADES) at SIS18 at GSI Helmholtzzentrum for Heavy-Ion Research, Darmstadt. For the first time, subthreshold $\mathrm{\Xi^-}$ production is observed in proton-nucleus interactions. Assuming a $\mathrm{\Xi^-}$ phase-space distribution similar to that of $\mathrm{\Lambda}$ hyperons, the production probability amounts to $P_{\mathrm{\Xi^-}}=(2.0\,\pm0.4\,\mathrm{(stat)}\,\pm 0.3\,\mathrm{(norm)}\,\pm 0.6\,\mathrm{(syst)})\times10^{-4}$ resulting in a $\mathrm{\Xi^-/(\Lambda+\Sigma^0)}$ ratio of $P_{\mathrm{\Xi^-}}/\ P_{\mathrm{\Lambda+\Sigma^0}}=(1.2\pm 0.3\,\mathrm{(stat)}\pm0.4\,\mathrm{(syst)})\times10^{-2}$. Available model predictions are significantly lower than the estimated$\mathrm{\Xi^-}$ yield.Comment: 6 pages, 3 figure