A 32 weeks twin pregnancy in a non-communicating rudimentary horn: Case report

IntroductionPregnancy in a rudimentary horn represents a serious implication of this rare uterine anomaly. In 90% of cases, rupture of the horn occurred in the second trimester. In this report, we present a rare case of intact twin pregnancy in a non-communicating rudimentary horn that reached 32 weeks of gestation.Case presentationA 25 years old Caucasian woman pregnant for 32 weeks presented with shock, acute lower abdominal pain and considerable vaginal bleeding. The patient was shocked and the uterus was tender and tense. Trans-abdominal ultrasound scan revealed a twin intrauterine pregnancy with no cardiac activity in both fetuses, fetal biometry was equivalent to 32 weeks and there was a huge retroplacental hematoma. Urgent laparotomy was performed and a huge intact right sided rudimentary horn was identified. Vertical incision was done with extraction of the dead twins, and the horn was excised.ConclusionDespite being rare, rudimentary horn pregnancy should be suspected regardless of the gestational age. Placental abruption should also be considered as an unusual presentation of this condition.     

Ultrasonographic soft markers of aneuploidy in second trimester fetuses

ObjectiveTo evaluate ultrasound “soft markers” used in fetal genetic screening.OptionsUltrasound screening at 16–20 weeks is one of the most common genetic screening tests used during pregnancy. The practical concern for ultrasound screening is false-positive and false-negative results. The use and understanding of ultrasound soft markers and their screening relative risks are an important option in the care of pregnant women.IntroductionChromosomal abnormalities occur in 0.1–0.2% of live births, and the most common clinically significant aneuploidy among live-born infants is Down’s syndrome (trisomy 21). Soft markers of aneuploidy are nonspecific, often transient, and can be readily detected during the second and third trimester ultrasound. The most commonly studied soft markers of aneuploidy include a thickened nuchal fold, mild fetal pyelectasis, echogenic bowel, echogenic intracardiac focus and choroid plexus cyst. There is a great deal of interest in the ultrasound detection of aneuploidy, as evidenced by the large number of publications in the literature on this topic.     

Daily self-reports on activities, life events, moods, and somatic changes during the menstrual cycle.

Thirty-three undergraduate students (11 males, 11 females taking oral contraceptives, and 11 females not taking oral contraceptives) filled out daily self-reports on pleasant activities, stressful events, moods, and somatic changes for 35 consecutive days. By randomly assigning each male a "pseudo" cycle, the data were analyzed to compare the three samples across the three phases of the menstrual cycle. The results indicated that males reported somewhat more stable but less positive experiences than females. While males reported a stable, low level of pain and water retention throughout the study, both female samples reported increases during the premenstrual and menstrual phases. Reports of negative affect, impaired concentration, and stressful events did not differ by samples, but significant sample by cycle interactions reflected differential increases in the two female samples during the premenstrual and menstrual phases. Subsequent analyses indicated that the experience of stressful events accounted for more of the variance than did cycle phase for these negative mood factors, but not for pain and water retention.     

The HCG ratio as a predictor of pregnancy outcome in assisted conception cycles

ObjectiveTo determine whether the HCG ratio can be used to predict pregnancy viability in patients undergoing IVF/ICSI treatment.Design and settingsThis was a prospective observational study conducted in a private assisted conception unit.Subjects and methodsThe patients recruited had one either a long luteal agonist protocol, a short agonist protocol, or an antagonist protocol. All patients had a maximum of three embryos transferred per cycle. Pregnancy detection was by routine serum HCG measurement on day 14 after oocyte retrieval (HCG 0) followed by another HCG sample 48h later (HCG 48). Patients with an initial positive HCG had a transvaginal ultrasound 14days later to determine viability.ResultsThree hundred and twenty patients were included in the study. We used receiver operating characteristics (ROC) analysis to predict the ability of HCG measured at 14days (HCG 0), HCG measured at 16days (HCG 48) after oocyte retrieval as well as the HCG ratio (HCG 48/HCG 0) to predict pregnancy viability as well as to predict multiple pregnancy. The HCG ratio with an optimal cut-off of 1.82 had a sensitivity of 97.6%, a specificity of 98.2% and an area under the ROC curve of 98% in the prediction of pregnancy viability. In the prediction of multiple pregnancy the HCG ratio had an optimal cut-off of 2.06 with a sensitivity of 94.5% and a specificity of only 35.6% and an area under of only the ROC curve of 64%. However, the HCG 0 with a cut-off value of 118.56mIU/ml (sensitivity 97%, specificity 96.5%) and the HCG 48 with a cut-off value of 258.16mIU/ml (sensitivity 97.2%, specificity 99.4%) were shown to be accurate in predicting a viable intrauterine multiple pregnancy with an area under the ROC curve of 97% and 99%, respectively.ConclusionThe HCG ratio with a cut-off value of 1.82 can be used to predict pregnancy viability in assisted conception cycles. Also HCG measured 14 and 16days after oocyte retrieval with a cut-off value of 118.56mIU/ml and 258mIU/ml can be used to predict viable multiple pregnancy.     

Efficacy of Bipolar Radiofrequency Endometrial Ablation vs Thermal Balloon Ablation for Management of Menorrhagia: A Population-Based Cohort

Study ObjectiveTo compare the efficacy of bipolar radiofrequency ablation (RFA) and thermal balloon ablation (TBA) using treatment failure and postprocedure amenorrhea as outcome measures.DesignPopulation-based cohort study (Canadian Task Force classification II-2).SettingTwo medical centers in the upper Midwest.PatientsUsing the medical records linkage system of the Rochester Epidemiology Project, we identified 455 residents of Olmsted County, Minnesota, who underwent global endometrial ablation because of menorrhagia from January 1, 1998, through December 31, 2005. Amenorrhea was defined as complete cessation of menstruation that started immediately after ablation and lasted at least 12 months. Treatment failure was defined as necessity of repeat ablation or hysterectomy because of persistent bleeding or pain. Time to treatment failure for each procedure was compared using Kaplan-Meier plots. Relevant clinical data and complications were abstracted from medical records. Risk adjustments were performed using Cox and logistic regression models.InterventionsRadiofrequency ablation (n=255) and thermal balloon ablation (n=200).Measurements and Main ResultsMean (SD) patient age was 43.3 (5.5) years, and median follow-up was 2.2 years. The 3-year cumulative failure rate was 9% (95% confidence interval [CI], 5%–16%) for RFA and 12% (95% CI, 7%–16%) for TBA (p=.26). The difference remained nonsignificant after adjusting for known predictors of treatment failure such as age, parity, pretreatment dysmenorrhea, and tubal ligation (adjusted HR, 0.7; 95% CI, 0.4–1.4; p=.31). However, women had significantly higher rates of amenorrhea after RFA compared with TBA (32% vs 14%; p <.001). This difference remained significant after adjusting for known predictors of amenorrhea such as age, uterine length, and endometrial thickness (adjusted odds ratio, 2.9; 95% CI, 1.7–4.8; p <.001). Complications were infrequent and similar in the 2 groups.ConclusionBoth RFA and TBA were equally effective treatments for menorrhagia in a population-based cohort. However, women who underwent RFA were 3 times more likely to have postprocedure amenorrhea.     

Downmodulation of bFGF-binding protein expression following restoration of p53 function.

Angiogenesis is a requirement for solid tumor growth. Therefore, inhibition of this neovascularization is one mechanism by which restoration of wtp53 function may lead to tumor regression. Here we report that adenoviral vector-mediated wild-type p53 transduction results in growth inhibition of squamous cell carcinoma of the head and neck tumor cells both in vitro and in a xenograft mouse model. This growth inhibition is associated with the down-regulation of the expression of fibroblast growth factor binding protein, a secreted protein required for the activation of angiogenic factor basic FGF. These findings suggest that wtp53-induced tumor regression is due, at least in part, to antiangiogenesis mediated by the downmodulation of fibroblast growth factor binding protein.     

Positional effect of mutations in 5＇UTR of hepatitis C virus 4a on patients＇ response to therapy

AIM： To investigate the effects of mutations in domain Ⅲ of the hepatitis C virus （HCV） internal ribosome entry sequences （IRES） on the response of chronic HCV genotype 4a patients to interferon therapy.
METHODS： HCV RNA was extracted from 19 chronic HCV 4a patients receiving interferon/ribavirin therapy who showed dramatic differences in their response to combination therapy after initial viral clearance. IRES domain Ⅲ was cloned and 15 clones for each patient were sequenced. The obtained sequences were aligned with genotype 4a prototype using the ClustaIW program and mutations scored. Prediction of stem-loop secondary structure and thermodynamic stability of the major quasispecies in each patient was performed using the MFOLD 3.2 program with Turner energies and selected constraints on base pairing.
RESULTS： Analysis of RNA secondary structure revealed that insertions in domain Ⅲ altered WatsonCrick base pairing of stems and reduced molecular stability of RNA, which may ultimately reduce binding affinity to ribosomal proteins. Insertion mutations in domain - were statistically more prevalent in sustained viral response patients （SVR, n = 14） as compared to breakthrough （BT, n = 5） patients.
CONCLUSION： The influence of mutations within domain Ⅲ on the response of HCV patients to combination therapy depends primarily on the position, but not the frequency, of these mutations within IRES domain Ⅲ.     

Ultrasound guidance improves success rate of axillary brachial plexus block

PURPOSE: The purpose of this study is to determine if real time ultrasound guidance improves the success rate of axillary brachial plexus blockade. METHODS: Patients undergoing elective hand surgery were randomly assigned to one of three groups. Axillary blocks were performed using three motor response endpoints in the nerve stimulator (NS) Group, real-time ultrasound guidance in the ultrasound (US) Group and combined ultrasound and nerve stimulation in the USNS Group. Following administration of a standardized solution containing 2% lidocaine with 1:200,000 epinephrine and 0.5% bupivacaine (total 42 mL), sensory and motor functions were assessed by a blinded observer every five minutes for 30 min. A successful block was defined as complete sensory loss in the median, radial and ulnar nerve distribution by 30 min. The need for local and general anesthesia supplementation and post-block adverse events were documented. RESULTS: One hundred and eighty-eight patients completed the study. Block success rate was higher in Groups US and USNS (82.8% and 80.7%) than Group NS (62.9%) (P = 0.01 and 0.03 respectively). Fewer patients in Groups US and USNS required supplemental nerve blocks and/or general anesthesia. Postoperatively, axillary bruising and pain were reported more frequently in Group NS. CONCLUSION: This study demonstrates that ultrasound guidance, with or without concomitant nerve stimulation, significantly improves the success rate of axillary brachial plexus block.