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Vaginal Birth after Cesarean after Zavanelli Maneuver: A Woman’s Right to Choose

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Open Journal of Obstetrics and Gynecology 2024年第7期14卷 1091-1095页

作者： Nicole Jenkins gregory Vurture Jonathan d. Baum department of Obstetrics and Gynecology Jersey Shore University Medical Center Neptune NJ USA

Introduction: Vaginal birth after cesarean (VBAC) plays an essential role in lowering cesarean rates. despite endorsement, trial of labor after cesarean (TOLAC) attempt rates remain low, in part due to fear of lawsuits. Zavanelli maneuver is a last resort procedure in the management of shoulder dystocia. We discuss a case of a woman determined to have a vaginal birth after her prior birth was complicated by shoulder dystocia requiring a Zavanelli maneuver. Her physicians were reluctant to allow her a TOLAC given her prior obstetric history. Case: A 34-year-old para 1 with prior cesarean delivery due to shoulder dystocia that required Zavanelli maneuver presents determined to pursue VBAC in her current pregnancy. She considered her delivery route options and addressed her modifiable risk factors. She consulted with multiple perinatologists who agreed that a TOLAC was reasonable, however she had to travel more than 70 miles (from Pennsylvania to New Jersey) to find an obstetrical practice and hospital willing to consider VBAC. She transferred care and the remainder of her prenatal course was uncomplicated. She went into labor at 41 weeks and had a successful VBAC without complication. In a thank you letter to her obstetrician, she described her birth experience as euphoric. Conclusion: This case illustrates how a woman’s choice of delivery route may be impacted by fear of litigation. Local providers focused on her prior delivery instead of her overall improved risk profile. delivery route decisions should be based on a thorough evaluation of all risk factors and individualized to meet the reproductive goals of each woman. .

关键词： Vaginal Birth after Cesarean Zavanelli Autonomy Case Report

PETG:Applications in Modern Medicine

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Engineered Regeneration 2024年第1期5卷 45-55页

作者： Catherine Yan Corinne Kleiner Aaron Tabigue Veer Shah gregory Sacks darshi Shah Vincent deStefano Renaissance School of Medicine at Stony Brook University Stony BrookNYUSA department of Biology Niagara UniversityLewistonNYUSA Stony Brook University Stony BrookNYUSA department of Mechanical and Industrial Engineering Northeastern UniversityBostonMAUSA

Polyethylene terephthalate glycol,PETG,is a miscible,transparent thermoplastic known to have strong tensile properties,high ductility,as well as resistance to heat and chemical *** may be manufactured in several ways,most notably 3d printing *** such,PETG has emerged as a viable biomaterial for a variety of medical applications such as tissue engineering,dentistry,optometry,vascular health,cardiology,orthopedics,neurology,gynecology,and *** also serves a valuable role in biomedical research and engineering by offering improvements in cell studies,drug carriers,and anti-bacterial *** medical research and innovation utilizing PETG will better characterize its value as an inexpensive and versatile biomaterial.

关键词： Polyethylene terephthalate glycol Tissue Engineering 3d Printing Clinical Applications Biomedical Research

Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting

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Open Journal of Orthopedics 2024年第4期14卷 173-186页

作者： Loïc Fonkoue Gaspary Fodjeu kennedy Olivier Muluem Olivier Ngongang Theophile Nana Marie Ange Ngo Yamben désiréAkaba Urich Tambekou daniel Eone Handy department of Orthopaedics and Trauma Yaound&#233 General Hospital Yaound&#233 Cameroon. department of Surgery and Specialities University of Yaound&#233 1 Yaound&#233 Cameroon department of Orthopaedics and Trauma Yaound&#233 Emergency Center Yaound&#233 Cameroon department of Orthopaedics and Trauma Yaound&#233 Central Hospital Yaound&#233 Cameroon

Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using dynamic hip screw (dHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and dHS from January 2016 to december 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAd), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAd was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAd (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using dHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas o

关键词： Proximal Femoral Fracture Watson-Jones Approach dynamic Hip Screw Low Resource Setting

Intestinal inflammation and the diet:Is food friend or foe?

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World Journal of Gastrointestinal Surgery 2016年第2期8卷 115-123页

作者： Bryant W Megna Patrick R Carney gregory d kennedy department of Surgery University of Wisconsin School of Medicine and Public Health

Inflammatory bowel disease(IBd) is a chronic intestinal illness of autoimmune origin affecting millions across the globe. The most common subtypes include ulcerative colitis(UC) and Crohn's disease. While many medical treatments for IBd exist,none come without the risk of significant immunosuppression and in general do not have benign side effect profiles. Surgical intervention exists only as radical resection for medically refractory UC. There exists a dire need for novel treatments that target the inherent pathophysiologic disturbances of IBd,rather than global immune suppression. One avenue of investigation that could provide such an agent is the interaction between certain dietary elements and the aryl hydrocarbon receptor(AHR). The AHR is a cytosolic transcription factor with a rich history in environmental toxicant handling,however,recently a role has emerged for the AHR as a modulator of the gastrointestinal immune system. Studies have come to elucidate these effects to include the enhancement of Th cell subset differentiation,interactions between enteric flora and the luminal wall,and modulation of inflammatory interleukin and cytokine signaling. This review highlights advancements in our understanding of AHR activity in the digestive tract and how this stimulation may be wrought by certain dietary "micronutriceuticals",namely indole-3-carbinol(I3C) and its derivatives. Greater clarity surrounding these dynamics could lead to a novel diet-derived agonist of the AHR which is not only non-toxic,but also efficacious in the amelioration of clinical IBd.

关键词： Inflammatory bowel diseases Aryl hydrocarbon receptor Mucosal immunity dietary phytochemicals Autoimmune diseases

Regression of recurrent granulosa cell tumor liver metastases following selective internal radiation therapy

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Hepatobiliary & Pancreatic diseases International 2023年第4期22卷 406-408页

作者： Omar A Mownah John d Leahy Jeffrey Summers Stephen M gregory Nigel d Heaton Institute of Liver Studies King’s Healthcare PartnersKing’s College Hospital NHS Foundation TrustDenmark HillLondon SE59RSUK department of Oncology Maidstone and Tunbridge Wells NHS TrustMaidstone ME169QQUK

Granulosa cell tumor(GCT)is the most common sex cordstromal tumor,comprising 5%of all ovarian malignancies[1].The disease course is indolent,and the majority of cases present at stage ***,metastases may develop with potential sites being peritoneum,lung,brain,liver and bone[2].due to the rarity of the disease,published evidence for management of granulosa cell tumor liver metastases(GCTLM)is *** resection is the optimal treatment in instances where there is a high chance of achieving complete resection[3].With regards to unresectable GCTLM there is a paucity of evidence to guide treatment strategy.

关键词： metastases liver lung

The Soft X-ray Imager(SXI)on the SMILE Mission

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Earth and Planetary Physics 2024年第1期8卷 5-14页

作者： S.Sembay A.L.Alme d.Agnolon T.Arnold A.Beardmore A.Belén Balado Margeli C.Bicknell C.Bouldin G.Branduardi-Raymont T.Crawford J.P.Breuer T.Buggey G.Butcher R.Canchal J.A.Carter A.Cheney Y.Collado-Vega H.Connor T.Crawford N.Eaton C.Feldman C.Forsyth T.Frantzen G.Galgóczi J.Garcia G.Y.Genov C.Gordillo H-P.Gröbelbauer M.Guedel Y.Guo M.Hailey d.Hall R.Hampson J.Hasiba O.Hetherington A.Holland S-Y.Hsieh M.W.J.Hubbard H.Jeszenszky M.Jones T.kennedy K.Koch-Mehrin S.Kögl S.Krucker K.d.Kuntz C.Lakin G.Laky O.Lylund A.Martindale J.Miguel Mas Hesse R.Nakamura K.Oksavik N.Østgaard H.Ottacher R.Ottensamer C.Pagani S.Parsons P.Patel J.Pearson G.Peikert F.S.Porter T.Pouliantis B.H.Qureshi W.Raab G.Randal A.M.Read N.M.M.Roque M.E.Rostad C.Runciman S.Sachdev A.Samsonov M.Soman d.Sibeck S.Smit J.Søndergaard R.Speight S.Stavland M.Steller TianRan Sun J.Thornhill W.Thomas K.Ullaland B.Walsh d.Walton C.Wang S.Yang School of Physics and Astronomy University of LeicesterLeicesterLE17RHUK Space Park Leicester University of LeicesterLeicesterLE17RHUK Mullard Space Science Laboratory University College LondonDorkingRH56NTUK Centre for Electronic Imaging Open UniversityMilton KeynesMK76 AAUK Birkeland Centre for Space Science Department of Physics and TechnologyUniv.of BergenN-5007 BergenNorway University of Vienna A-1010 ViennaAustria Space Research Institute Austrian Academy of SciencesA-8042 GrazAustria National Institute of Aerospace Technology MadridSpain ESTEC European Space Agency2201 AZ NoordwijkNetherlands State Key Laboratory of Space Weather National Space Science CentreBeijing 100190China University of Applied Sciences and Arts Northwestern Switzerland CH-5210 WindischSwitzerland Koegl Space GmbH CH-8157 DielsdorfSwitzerland Space Acoustics GmbH CH-8157 DielsdorfSwitzerland Zurich University of Applied Sciences 8400 WinterhurSwitzerland Genov Solutions N-5172 LoddefjordNorway STM Engineering N-5165 LaksevagNorway John Hopkins University Applied Physics Laboratory MD 20723USA NASA/Goddard Space Flight Centre MD 20771USA Center for Space Physics Boston UniversityBostonMA 02215USA department of Theoretical Physics and Astrophysics Masaryk University60177 BrnoCzech Republic Institute of Physics E¨otvo¨s Lor´and University1053 BudapestHungary Aerospace Information Research Institute Chinese Academy of SciencesBeijing 100045China Centro de Astrobiologia(CAB) CSIC-INTAMadridSpain

The Soft X-ray Imager(SXI)is part of the scientific payload of the Solar wind Magnetosphere Ionosphere Link Explorer(SMILE)*** is a joint science mission between the European Space Agency(ESA)and the Chinese Academy of Sciences(CAS)and is due for launch in *** is a compact X-ray telescope with a wide field-of-view(FOV)capable of encompassing large portions of Earth’s magnetosphere from the vantage point of the SMILE *** is sensitive to the soft X-rays produced by the Solar Wind Charge eXchange(SWCX)process produced when heavy ions of solar wind origin interact with neutral particles in Earth’s *** provides a mechanism for boundary detection within the magnetosphere,such as the position of Earth’s magnetopause,because the solar wind heavy ions have a very low density in regions of closed magnetic field *** sensitivity of the SXI is such that it can potentially track movements of the magnetopause on timescales of a few minutes and the orbit of SMILE will enable such movements to be tracked for segments lasting many *** is led by the University of Leicester in the United Kingdom(UK)with collaborating organisations on hardware,software and science support within the UK,Europe,China and the United States.

关键词： Soft X-ray Imaging micropore optics large area CCd

Introducing RiverProfileApp,a web application for near-global,exploratory,longitudinal river profile analysis

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International Journal of digital Earth 2022年第1期15卷 679-689页

作者： gregory A.Ruetenik Czech Academy of Sciences Institute of GeophysicsPragueCzech Republic

River profile analysis has been used extensively in the earth sciences. Commonly,exploration of river profiles requires downloading and processing digital Elevation Models (dEMs) for specific areas,which limits the scope of exploratory analysis. Presented here is a web application designed to analyze river profiles at 90m resolution at a near-global scale. The app allows users to quickly query downstream or upstream from selected points anywhere within ±60 degrees latitude,in order to interactively analyze corresponding river profiles. River profile analysis can be performed in both distance and χ space,where χ is a metric that is proportional to the presumed steady-state shape of the river profile. River locations are based on the HydroSHEdS 90m drainage direction grid,as well as custom computed d8 drainage direction and void-filled SRTM dEMs. RiverProfileApp is open source,and although currently it is designed as an exploratory tool,more functions can be easily added via community contributions and/or from existing toolsets. It is available from ***.

关键词： River profile analysis geomorphology big data science communication

Quantifying relations between altered hydrology and fish community responses for streams in Minnesota

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Ecological Processes 2022年第1期11卷 536-560页

作者： Jeffrey R.Ziegeweid gregory d.Johnson Aliesha L.Krall Kara Fitzpatrick Sara B.Levin U.S.Geological Survey California Water Science Center6000 J StPlacer HallSacramentoCA 85819USA U.S.Geological Survey Upper Midwest Water Science Center2280 Woodale DrMounds ViewMN 55112USA Minnesota Pollution Control Agency 520 Lafayette RdSt.PaulMN 55155USA Minnesota Pollution Control Agency 7678 College RoadSuite 105BaxterMN 56425USA

Background:Altered hydrology is a stressor on aquatic life,but quantitative relations between specific aspects of streamflow alteration and biological responses have not been developed on a statewide scale in *** sub-sets regression analysis was used to develop linear regression models that quantify relations among five categories of hydrologic metrics(i.e.,duration,frequency,magnitude,rate-of-change,and timing)computed from streamgage records and six categories of biological metrics(i.e.,composition,habitat,life history,reproductive,tolerance,trophic)computed from fish-community samples,as well as fish-based indices of biotic integrity(FIBI)scores and FIBI scores normalized to an impairment threshold of the corresponding stream class(FIBI_BCG4).Relations between hydrology and fish community responses were examined using three hydrologic datasets that represented periods of record,long-term changes,and short-term changes to flow regimes in streams of ***:Regression models demonstrated significant relations between hydrologic explanatory metrics and fish-based biological response metrics,and the five regression models with the strongest linear relations explained over 70%of the variability in the biological metric using three hydrologic metrics as explanatory ***-based biological metrics demonstrated the strongest linear relations to hydrologic *** most commonly used hydrologic metrics were related to bankfull flows and aspects of flow ***:Final regression models represent paired streamgage records and biological samples throughout the State of Minnesota and encompass differences in stream orders,hydrologic landscape units,and watershed *** methods can support evaluations of stream fish communities and facilitate targeted efforts to improve the health of fish *** also can be applied to locations outside of Minnesota with continuous streamgage data and fish-community sampl

关键词： EflowStats Best subset regression Altered hydrology Fish community Indices of biotic integrity Ecological flows

Ultra-transparent nanostructured coatings via flow-induced one-step coassembly

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Nano Materials Science 2022年第2期4卷 97-103页

作者： Jingjing Liu Sonia E.Chavez Hao ding Maria M.Farooqui Zaili Hou Sharon Lin Thomas d.d'Auria Julia M.kennedy Anna Marie LaChance Luyi Sun Polymer Program Institute of Materials ScienceUniversity of ConnecticutStorrsConnecticut06269United States department of Chemical&Biomolecular Engineering University of ConnecticutStorrsConnecticut06269United States department of Biomedical Engineering University of ConnecticutStorrsConnecticut06269United States

Polyvinyl alcohol(PVA)/laponite(LP)nanocomposite coatings were fabricated via a facile one-step coassembly *** formed nanocoatings contain a high concentration of LP nanosheets,which can be well aligned along the substrate surface during the coassembly *** to the highly orientated structure,the flexible nanocoatings exhibit ultra-high transparency and superior mechanical properties,and can also act as excellent gas *** nanocoatings can be exceptional candidates for a variety of applications,such as food packaging.

关键词： Nanocoating Coassembly Polyvinyl alcohol Laponite