Evaluation of perioperative complications using a newly described staging system for placenta accreta spectrum

Introduction: The antenatal diagnosis of placenta accreta spectrum (PAS) is in large part subjective and based on expert interpretation. The aim of this study was to externally evaluate a recently developed staging system based on specific and defined prenatal ultrasound (US) features in a cohort of women at risk of PAS undergoing specialist prenatal US, in particular relating to surgical morbidity at delivery. Materials and methods: Database study of cases with confirmed placenta previa. In all, the placenta was evaluated in a systematic fashion. PAS was subclassified in PAS0-PAS3 according to the loss of clear zone, placental lacunae, bladder wall interruption, uterovesical hypervascularity and increased vascularity in the parametrial region. Results: 43 cases were included, of whom 33 had major placenta previa. 31 cases were categorized as PAS0; 3, 4 and 5 cases as PAS1, PAS2 and PAS3, respectively. All women underwent caesarean section and hysterectomy was required in 10. The comparison of the perinatal outcomes among the PAS categories yielded greater operative time (50 (35–129) minutes for PAS0 vs 70 (48–120) for PAS1 vs 95 (60–150) for PAS2 vs 100 (87–180) for PAS3, p < 0.001) and estimated blood loss (800 (500–2500) mls for PAS0 vs 3500 (800–7500) for PAS1 vs 2850 (500–7500) for PAS2 vs 6000 (2500–11000) for PAS3, p < 0.001) for the highest PAS categories, which were also associated with a higher rate of hysterectomy (p < 0.001), blood transfusion (p = 0.002) and admission to ITU or HDU (p < 0.001) and longer postoperative admission of 3 (1–9) days for PAS0 vs 3 (2–12) for PAS1 vs 4.5 (3–6) for PAS2 vs 5 (3–22) for PAS3, p = 0.02. Conclusion: Perioperative complications are closely associated with PAS stage. This information is useful for counselling women and may be important in allocating staff and infrastructure resources at the time of delivery

Do pregnant women know how to correct inverted nipples?

Inverted nipples occur in an estimated 9 to 10 percent of women globally, contributing to the number of women who are not exclusively breastfeeding their infants. Women with inverted nipples may want to breastfeed, but infants may be unable to latch to the breast. Inverted nipples can be corrected, but it is unclear if women know about suitable interventions. This study assessed if pregnant women knew about the available techniques to correct inverted nipples. We conducted individual interviews with nine pregnant women with inverted nipples in a tertiary hospital in South Africa. Data were analysed using an inductive content analysis. Most of the women had very limited knowledge of exclusive breastfeeding or inverted nipples and knew very little about correcting devices. These women thought that their infants would be unable to latch and that exclusive breastfeeding would be impossible. Pregnant women with inverted nipples should be educated about methods to correct their nipples.http://www.journals.co.za/content/journal/ajpherd1am2017Nursing Scienc

Implications for the future of obstetrics and gynaecology following the COVID-19 pandemic: a commentary.

In March 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic. At the time of writing, more than 261,184 cases of COVID-19 have been confirmed in the UK resulting in over 36,914 directly attributable deaths.1 The National Health Service (NHS) has been confronted with the unprecedented task of dealing with the enormity of the resultant morbidity and mortality. In addition, the workforce has been depleted as a direct consequence of the disease, in most cases temporarily, but in some tragic cases permanently

Estudo da técnica de denervação da cápsula articular coxofemoral no tratamento da dor em cães com displasia coxofemoral: resultados preliminares

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The urine biomarker PUR-4 is positively associated with the amount of Gleason 4 in human prostate cancers

The Prostate Urine Risk (PUR) biomarker is a four-group classifier for predicting outcome in patients prior to biopsy and for men on active surveillance. The four categories correspond to the probabilities of the presence of normal tissue (PUR-1), D’Amico low-risk (PUR-2), intermediate-risk (PUR-3), and high-risk (PUR-4) prostate cancer. In the current study we investigate how the PUR-4 status is linked to Gleason grade, prostate volume, and tumor volume as assessed from biopsy (n = 215) and prostatectomy (n = 9) samples. For biopsy data PUR-4 status alone was linked to Gleason Grade group (GG) (Spearman’s, ρ = 0.58, p < 0.001 trend). To assess the impact of tumor volume each GG was dichotomized into Small and Large volume cancers relative to median volume. For GG1 (Gleason Pattern 3 + 3) cancers volume had no impact on PUR-4 status. In contrast for GG2 (3 + 4) and GG3 (4 + 3) cancers PUR-4 levels increased in large volume cancers with statistical significance observed for GG2 (p = 0.005; Games-Howell). These data indicated that PUR-4 status is linked to the presence of Gleason Pattern 4. To test this observation tumor burden and Gleason Pattern were assessed in nine surgically removed and sectioned prostates allowing reconstruction of 3D maps. PUR-4 was not correlated with Gleason Pattern 3 amount, total tumor volume or prostate size. A strong correlation was observed between amount of Gleason Pattern 4 tumor and PUR-4 signature (r = 0.71, p = 0.034, Pearson’s). These observations shed light on the biological significance of the PUR biomarker and support its use as a non-invasive means of assessing the presence of clinically significant prostate cancer

Germplasm Acquisition and Distribution by CGIAR Genebanks

The international collections of plant genetic resources for food and agriculture (PGRFA) hosted by 11 CGIAR Centers are important components of the United Nations Food and Agriculture Organization’s global system of conservation and use of PGRFA. They also play an important supportive role in realizing Target 2.5 of the Sustainable Development Goals. This paper analyzes CGIAR genebanks’ trends in acquiring and distributing PGRFA over the last 35 years, with a particular focus on the last decade. The paper highlights a number of factors influencing the Centers’ acquisition of new PGRFA to include in the international collections, including increased capacity to analyze gaps in those collections and precisely target new collecting missions, availability of financial resources, and the state of international and national access and benefit-sharing laws and phytosanitary regulations. Factors contributing to Centers’ distributions of PGRFA included the extent of accession-level information, users’ capacity to identify the materials they want, and policies. The genebanks’ rates of both acquisition and distribution increased over the last decade. The paper ends on a cautionary note concerning the potential of unresolved tensions regarding access and benefit sharing and digital genomic sequence information to undermine international cooperation to conserve and use PGRFA