Referral Center Experience With Nonpalpable Contraceptive Implant Removals.

ObjectiveTo describe our experience with office removal of nonpalpable contraceptive implants at our referral center.MethodsWe performed a retrospective cohort study by reviewing the charts of patients referred to our family planning specialty center for nonpalpable or complex contraceptive implant removal from January 2015 through December 2018. We localized nonpalpable implants using high-frequency ultrasonography and skin mapping in radiology, followed by attempted removal in the office using local anesthesia and a modified vasectomy clamp. We abstracted information on demographics, implant location, and outcomes.ResultsOf 61 referrals, 55 patients attended their scheduled appointments. Seven patients had palpable implants; six elected removal. The other 48 patients had ultrasound localization, which identified 47 (98%) of the implants; the remaining patient had successful localization with computed tomography imaging. Nonpalpable implants were suprafascial (n=22), subfascial (n=25) and intrafascial (n=1); four of these patients opted to delay removal. Of 50 attempted office removals, all palpable (n=6), all nonpalpable suprafascial (n=21 [100%, 95% CI 83-100%]), and 19 out of 23 (83%, 95% CI 67-98%) subfascial implants were successful. Three of the four patients with failed subfascial implant office removal had successful operating room removal with a collaborative orthopedic surgeon; the other patient sought removal elsewhere. Transient postprocedure neuropathic complaints were noted in 7 out of 23 (30%, 95% CI 12-49%) subfascial and 1 out of 21 (5%, 95% CI 0-13%) suprafascial removals (P=.048). Nonpalpable implants were more likely to be subfascial in nonobese patients (24/34, 71%) as compared with obese (1/13, 8%) patients (P<.001). Seven (28%) of the 25 subfascially located implants had been inserted during a removal-reinsertion procedure through the same incision.ConclusionMost nonpalpable contraceptive implants can be removed in the office by an experienced subspecialty health care provider after ultrasound localization. Some patients may experience transient postprocedure neuropathic pain. Nonpalpable implants in thinner women are more likely to be in a subfascial location

Differentiating criminal networks in the illegal wildlife trade: organized, corporate and disorganized crime

Historically, the poaching of wildlife was portrayed as a small-scale local activity in which only small numbers of wildlife would be smuggled illegally by collectors or opportunists. Nowadays, this image has changed: criminal networks are believed to be highly involved in wildlife trafficking, which has become a significant area of illicit activity. Even though wildlife trafficking has become accepted as a major area of crime and an important topic and criminologists have examined a variety of illegal wildlife markets, research that specifically focusses on the involvement of different criminal networks and their specific nature is lacking. The concept of a ‘criminal network’ or ‘serious organized crime’ is amorphous – getting used interchangeably and describes all crime that is structured rather than solely reflecting crime that fits within normative definitions of ‘organized’ crime. In reality, criminal networks are diverse. As such, we propose categories of criminal networks that are evidenced in the literature and within our own fieldwork: (1) organized crime groups (2) corporate crime groups and (3) disorganized criminal networks. Whereas there are instances when these groups act alone, this article will (also) discuss the overlap and interaction that occurs between our proposed categories and discuss the complicated nature of the involved criminal networks as well as predictions as to the future of these networks

A Reverse Shock and Unusual Radio Properties in GRB 160625B

We present multi-wavelength observations and modeling of the exceptionally bright long γ-ray burst GRB 160625B. The optical and X-ray data are well fit by synchrotron emission from a collimated blastwave with an opening angle of {\theta }_{j}\approx 3\buildrel{\circ}\over{.} 6 and kinetic energy of ${E}_{K}\approx 2\times {10}^{51}$ erg, propagating into a low-density ($n\approx 5\times {10}^{-5}$ cm−3) medium with a uniform profile. The forward shock is sub-dominant in the radio band; instead, the radio emission is dominated by two additional components. The first component is consistent with emission from a reverse shock, indicating an initial Lorentz factor of ${{\rm{\Gamma }}}_{0}\gtrsim 100$ and an ejecta magnetization of {R}_{B}\approx 1\mbox{--}100. The second component exhibits peculiar spectral and temporal evolution and is most likely the result of scattering of the radio emission by the turbulent Milky Way interstellar medium (ISM). Such scattering is expected in any sufficiently compact extragalactic source and has been seen in GRBs before, but the large amplitude and long duration of the variability seen here are qualitatively more similar to extreme scattering events previously observed in quasars, rather than normal interstellar scintillation effects. High-cadence, broadband radio observations of future GRBs are needed to fully characterize such effects, which can sensitively probe the properties of the ISM and must be taken into account before variability intrinsic to the GRB can be interpreted correctly

Differential expression and localization of TIMP-1 and TIMP-4 in human gliomas

Studies have suggested that an imbalance of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) may contribute to the malignant phenotype of gliomas. In this study, we have undertaken a detailed analysis of expression of the TIMP family in normal human brain and malignant gliomas at both the mRNA and protein level. Reverse transcription-PCR (RT-PCR) analyses of total RNA from surgical tumour specimens revealed unique expression patterns for the 4 members of the TIMP family, with TIMP-1 and -4 showing positive and negative correlations, respectively, with glioma malignancy. By RT-PCR, TIMP-2 and TIMP-3 expression did not change with tumour grade. In situ hybridization localized TIMP-1 to glial tumour cells and also to the surrounding tumour vasculature. TIMP-4 transcripts were predominantly localized to tumour cells, though minor expression was found in vessels. Recombinant TIMP-4 reduced invasion of U251 glioma cells through Matrigel, and U87 clones overexpressing TIMP-4 showed reduced invasive capacity in vitro. TIMP-4, but not TIMP-1, blocked Membrane Type-1-MMP-mediated progelatinase-A (MMP-2) activation in human umbilical vein endothelial cells. The differential expression and localization of individual TIMPs may contribute to the pathophysiology of human malignant gliomas, particularly with regard to tumour vascularization. © 2001 Cancer Research Campaign http://www.bjcancer.co

Methods and results of an automatic analysis of a complete sample of Swift-XRT observations of GRBs

We present a homogeneous X-ray analysis of all 318 Gamma Ray Bursts detected by the X-ray Telescope on the Swift satellite up to 2008 July 23; this represents the largest sample of X-ray GRB data published to date. In Sections 2--3 we detail the methods which the Swift-XRT team has developed to produce the enhanced positions, light curves, hardness ratios and spectra presented in this paper. Software using these methods continues to create such products for all new GRBs observed by the Swift-XRT. We also detail web-based tools allowing users to create these products for any object observed by the XRT, not just GRBs. In Sections 4--6 we present the results of our analysis of GRBs, including probability distribution functions of the temporal and spectral properties of the sample. We demonstrate evidence for a consistent underlying behaviour which can produce a range of light curve morphologies, and attempt to interpret this behaviour in the framework of external forward shock emission. We find several difficulties, in particular that reconciliation of our data with the forward shock model requires energy injection to continue for days to weeks.Comment: Spectral tables (8-10) have been replaced with corrected versions, following the discovery and correction of a glitch in the pile-up correction algorithm for the spectra which significantly affected ~10% of objects. Note that the overall PDFs and sample statsistics were not affected by this glitc

Limits on optical polarization during the prompt phase of GRB 140430A

Gamma-ray burst GRB 140430A was detected by the Swift satellite and observed promptly with the imaging polarimeter RINGO3 mounted on the Liverpool Telescope, with observations beginning while the prompt $\gamma$-ray emission was still ongoing. In this paper, we present densely sampled (10-second temporal resolution) early optical light curves in 3 optical bands and limits to the degree of optical polarization. We compare optical, X-ray and gamma-ray properties and present an analysis of the optical emission during a period of high-energy flaring. The complex optical light curve cannot be explained merely with a combination of forward and reverse shock emission from a standard external shock, implying additional contribution of emission from internal shock dissipation. We estimate an upper limit for time averaged optical polarization during the prompt phase to be as low as P < 12% (1$\sigma$). This suggests that the optical flares and early afterglow emission in this GRB are not highly polarized. Alternatively, time averaging could mask the presence of otherwise polarized components of distinct origin at different polarization position angles

Successful reduced-intensity SCT from unrelated cord blood in three patients with X-linked SCID

We describe three males with X-linked SCID (X-SCID) who were successfully treated by reduced-intensity SCT from unrelated cord blood (CB). Mean age at transplant was 5.7 months (range, 3–9 months). Pre-transplant conditioning for all patients consisted of fludarabine (FLU) (30 mg/m2 per day) from day −7 to day −2 (total dose 180 mg/m2) and BU 4 mg/kg per day from day −3 to day −2 (total dose 8 mg/kg). All CB units were serologically matched at HLA-A, B and DR loci. Although two patients had suffered from fungal or bacterial pneumonia before transplantation, there were no other infectious complications during transplantation. All patients engrafted and achieved 100% donor chimerism. We also confirmed full donor chimerism of both T and B cells. Only one patient developed acute GVHD grade III, which was resolved by increasing the dose of oral corticosteroid. None of the patients has developed chronic GVHD during follow up for 21–77 months. None of the patient received i.v. Ig replacement post transplant, or showed delay in psychomotor development. Reduced-intensity conditioning consisting of FLU and BU and transplantation from unrelated CB was an effective and safe treatment for these patients with X-SCID

Alterations in integrin expression modulates invasion of pancreatic cancer cells

Background Factors mediating the invasion of pancreatic cancer cells through the extracellular matrix (ECM) are not fully understood. Methods In this study, sub-populations of the human pancreatic cancer cell line, MiaPaCa-2 were established which displayed differences in invasion, adhesion, anoikis, anchorage-independent growth and integrin expression. Results Clone #3 displayed higher invasion with less adhesion, while Clone #8 was less invasive with increased adhesion to ECM proteins compared to MiaPaCa-2. Clone #8 was more sensitive to anoikis than Clone #3 and MiaPaCa-2, and displayed low colony-forming efficiency in an anchorage-independent growth assay. Integrins beta 1, alpha 5 and alpha 6 were over-expressed in Clone #8. Using small interfering RNA (siRNA), integrin β1 knockdown in Clone #8 cells increased invasion through matrigel and fibronectin, increased motility, decreased adhesion and anoikis. Integrin alpha 5 and alpha 6 knockdown also resulted in increased motility, invasion through matrigel and decreased adhesion. Conclusion Our results suggest that altered expression of integrins interacting with different extracellular matrixes may play a significant role in suppressing the aggressive invasive phenotype. Analysis of these clonal populations of MiaPaCa-2 provides a model for investigations into the invasive properties of pancreatic carcinoma