Successful management of cesarean scar pregnancy complicated by an arteriovenous malformation

Background: Cesarean scar ectopic pregnancies are rare, with an incidence of approximately 1 in 2,000 pregnancies. The trauma of a cesarean section and a subsequent cesarean scar pregnancy can lead to the formation of an arteriovenous malformation (AVM). The resulting intractable bleeding is difficult to manage and can result in an emergent surgical intervention that could jeopardize a female's ability to become pregnant in the future

5-HT obesity medication efficacy via POMC activation is maintained during aging

Peer reviewedPublisher PD

Combined flow-focus and self-assembly routes for the formation of lipid stabilized oil-shelled microbubbles

Lipid and polymer stabilized microbubbles are used in medicine as contrast agents for ultrasound imaging and are being developed for the delivery of water soluble drugs to diseased areas of the body. However, many new therapeutics exhibit poor water solubility or stability, which has led to the requirement for the development of effective hydrophobic drug delivery systems. This study presents a new method to produce microbubbles coated with an oil layer capable of encapsulating hydrophobic drugs and suitable for targeted, triggered drug release. This new method utilizes highly controllable flow-focusing microfluidics with lipid oil nanodroplets self-assembling and spreading at gas–aqueous interfaces. Oil layer inside microbubbles were produced with diameters of 2.4±0.3 μm (s.d., 1.6 μm) and at concentrations up to 106 bubbles per milliliter. The mechanism of oil layer inside microbubble assembly and stability were characterized using methods including contact angle measurements, quartz crystal microbalance with dissipation monitoring and fluorescence resonance energy transfer imaging

Analytic morphomics identifies predictors of new‐onset diabetes after liver transplantation

Among liver transplant recipients, development of post‐transplant complications such as new‐onset diabetes after transplantation (NODAT) is common and highly morbid. Current methods of predicting patient risk are inaccurate in the pre‐transplant period, making implementation of targeted therapies difficult. We sought to determine whether analytic morphomics (using computed tomography scans) could be used to predict the incidence of NODAT. We analyzed peri‐transplant scans from 216 patients with varying indications for liver transplantation, among whom 61 (28%) developed NODAT. Combinations of visceral fat, subcutaneous fat, and psoas area were considered in addition to traditional risk factors. On multivariate analysis adjusting for usual risk factors such as type of immunosuppression, subcutaneous fat thickness remained significantly associated with NODAT (OR = 1.43, 95% CI 1.00–1.88, p = 0.047). Subgroup analysis showed that patients with later‐onset of NODAT had higher visceral fat, whereas subcutaneous fat thickness was more correlated with earlier‐onset of NODAT (using 10 months post‐transplant as the cut‐off).ConclusionAnalytic morphomics may be used to help assess NODAT risk in patients undergoing liver transplantation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111210/1/ctr12537.pd

Dealing with missing standard deviation and mean values in meta-analysis of continuous outcomes: a systematic review

Background: Rigorous, informative meta-analyses rely on availability of appropriate summary statistics or individual participant data. For continuous outcomes, especially those with naturally skewed distributions, summary information on the mean or variability often goes unreported. While full reporting of original trial data is the ideal, we sought to identify methods for handling unreported mean or variability summary statistics in meta-analysis. Methods: We undertook two systematic literature reviews to identify methodological approaches used to deal with missing mean or variability summary statistics. Five electronic databases were searched, in addition to the Cochrane Colloquium abstract books and the Cochrane Statistics Methods Group mailing list archive. We also conducted cited reference searching and emailed topic experts to identify recent methodological developments. Details recorded included the description of the method, the information required to implement the method, any underlying assumptions and whether the method could be readily applied in standard statistical software. We provided a summary description of the methods identified, illustrating selected methods in example meta-analysis scenarios. Results: For missing standard deviations (SDs), following screening of 503 articles, fifteen methods were identified in addition to those reported in a previous review. These included Bayesian hierarchical modelling at the meta-analysis level; summary statistic level imputation based on observed SD values from other trials in the meta-analysis; a practical approximation based on the range; and algebraic estimation of the SD based on other summary statistics. Following screening of 1124 articles for methods estimating the mean, one approximate Bayesian computation approach and three papers based on alternative summary statistics were identified. Illustrative meta-analyses showed that when replacing a missing SD the approximation using the range minimised loss of precision and generally performed better than omitting trials. When estimating missing means, a formula using the median, lower quartile and upper quartile performed best in preserving the precision of the meta-analysis findings, although in some scenarios, omitting trials gave superior results. Conclusions: Methods based on summary statistics (minimum, maximum, lower quartile, upper quartile, median) reported in the literature facilitate more comprehensive inclusion of randomised controlled trials with missing mean or variability summary statistics within meta-analyses

General anaesthesia versus local anaesthesia for carotidsurgery (GALA): a multicentre, randomised controlled trial.

Background The eff ect of carotid endarterectomy in lowering the risk of stroke ipsilateral to severe atherosclerotic carotid-artery stenosis is off set by complications during or soon after surgery. We compared surgery under general anaesthesia with that under local anaesthesia because prediction and avoidance of perioperative strokes might be easier under local anaesthesia than under general anaesthesia. Methods We undertook a parallel group, multicentre, randomised controlled trial of 3526 patients with symptomatic or asymptomatic carotid stenosis from 95 centres in 24 countries. Participants were randomly assigned to surgery under general (n=1753) or local (n=1773) anaesthesia between June, 1999 and October, 2007. The primary outcome was the proportion of patients with stroke (including retinal infarction), myocardial infarction, or death between randomisation and 30 days after surgery. Analysis was by intention to treat. The trial is registered with Current Control Trials number ISRCTN00525237. Findings A primary outcome occurred in 84 (4·8%) patients assigned to surgery under general anaesthesia and 80 (4·5%) of those assigned to surgery under local anaesthesia; three events per 1000 treated were prevented with local anaesthesia (95% CI –11 to 17; risk ratio [RR] 0·94 [95% CI 0·70 to 1·27]). The two groups did not signifi cantly diff er for quality of life, length of hospital stay, or the primary outcome in the prespecifi ed subgroups of age, contralateral carotid occlusion, and baseline surgical risk. Interpretation We have not shown a defi nite diff erence in outcomes between general and local anaesthesia for carotid surgery. The anaesthetist and surgeon, in consultation with the patient, should decide which anaesthetic technique to use on an individual basis

Evaluating Biophysical Attributes of Environmentally Degraded Landscapes in Northern Ethiopia using LANDSAT ETM data and GIS

Biophysical attributes of environmentally degraded landscapes in Adwa district, northern Ethiopia, were evaluated using LANDSAT ETM data and GIS. Satellite remote sensing (RS) has captured the spatial distribution and variability of Adwa land covers (75% classification accuracy, 73% Kappa statistic). GIS-based analysis of degraded land’s biophysical attributes has revealed associations between land-cover types, landform elements and major soils groups in the district. Agricultural farms were located closer to human settlements, while woodlands furthest away from settlements. Moreover, wooded croplands were found between arable and woodlands, indicating encroaching human activities through agricultural expansion. Forests and woodlands were dominant on high mountains, steep slopes and depressions, while degraded shrublands and scrublands were prominent on Leptosols and on dissected uplands and hills. On the other hand, agriculture was prominent on rolling hills and uplands, concave-shaped foot-slopes, and on the soils of the district characterized as Fluvisols and Vertisols. This study provides base-line information and add to land cover knowledge for this and similar regions. Additionally, it has identified associations among biophysical attributes in degraded Ethiopian highlands have important management implications for both under-developed and over-utilized areas.Keywords: Land cover, land degradation, soil erosion, land rehabilitation, deforestation, Ethiopian highland