A rare case of triplet pregnancy with three different fates of each conceptus

Rate and number of multifetal gestations have increased dramatically largely due to infertility therapy. A number of pregnancies are multifetal to start with followed by spontaneous reduction of one or more embryos. The final outcomes of such pregnancies vary in relation to zygosity, chorionicity and gestational age. In this case report we present a triplet pregnancy resulting from controlled ovarian hyperstimulation followed by intrauterine-insemination in a primarily infertile patient and how it ended up into a singleton pregnancy with no conscious attempts at selective reduction or selective termination. While fighting with problem of multiple pregnancies which comes along with the widespread infertility treatment nature has its own miraculous way to get rid of such. Little patience and watchful expectancy from the part of obstetrician can achieve a healthy live baby without inadvertent complication.

New treatments for hepatitis C virus (HCV): scope for preventing liver disease and HCV transmission in England

New direct-acting antivirals have the potential to transform the hepatitis C (HCV) treatment landscape, with rates of sustained viral response in excess of 90%. As these new agents are expensive, an important question is whether to focus on minimizing the consequences of severe liver disease, or reducing transmission via 'treatment as prevention'. A back-calculation model was used to estimate the impact of treatment of mild, moderate and compensated cirrhosis on incident cases of HCV-related end-stage liver disease/hepatocellular carcinoma (ESLD/HCC). In addition, a dynamic model was used to determine the impact on incidence and prevalence of chronic infection in people who inject drugs (PWID), the main risk group in England. Treating 3500 cirrhotics per year was predicted to reduce ESLD/HCC incidence from 1100 (95% CrI 970-1240) cases per year in 2015 to 630 (95% CrI 530-770) in 2020, around half that currently expected, although treating moderate-stage disease will also be needed to sustain this reduction. Treating mild-stage PWID was required to make a substantial impact on transmission: with 2500 treated per year, chronic prevalence/annual incidence in PWID was reduced from 34%/4.8% in 2015 to 11%/1.4% in 2030. There was little overlap between the two goals: treating mild stage had virtually no impact on ESLD/HCC within 15 years, but the long timescale of liver disease means relatively few PWID reach cirrhosis before cessation of injecting. Strategies focussing on treating advanced disease have the potential for dramatic reductions in severe morbidity, but virtually no preventative impact.

Comparative study of linear and curvilinear ultrasound probes to assess quadriceps rectus femoris muscle mass in healthy subjects and in patients with chronic respiratory disease

Introduction

Ultrasound measurements of rectus femoris cross-sectional area (RF_CSA) are clinically useful measurements in chronic obstructive pulmonary disease (COPD) and critically ill patients. Technical considerations as to the type of probe used, which affects image resolution, have limited widespread clinical application. We hypothesised that measurement of RF_CSA would be similar with linear and curvilinear probes.

Methods

Four studies were performed to compare the use of the curvilinear probe in measuring RF_CSA. Study 1 investigated agreement of RF_CSA measurements using linear and curvilinear probes in healthy subjects, and in patients with chronic respiratory disease. Study 2 investigated the intra-rater and inter-rater agreement using the curvilinear probe. Study 3 investigated the agreement of RF_CSA measured from whole and spliced images using the linear probe. Study 4 investigated the applicability of ultrasound in measuring RF_CSA during the acute and recovery phases of an exacerbation of COPD.

Results

Study 1 showed demonstrated no difference in the measurement of RF_CSA using the curvilinear and linear probes (308±104 mm² vs 320±117 mm², p=0.80; intraclass correlation coefficient (ICC)>0.97). Study 2 demonstrated high intra-rater and inter-rater reliability of RF_CSA measurement with ICC>0.95 for both. Study 3 showed that the spliced image from the linear probe was similar to the whole image RF_CSA (308±103.5 vs 263±147 mm², p=0.34; ICC>0.98). Study 4 confirmed the clinical acceptability of using the curvilinear probe during an exacerbation of COPD. There were relationships observed between admission RF_CSA and body mass index (r=+0.65, p=0.018), and between RF_CSA at admission and physical activity levels at 4 weeks post-hospital discharge (r=+0.75, p=0.006).

Conclusions

These studies have demonstrated that clinicians can employ whole and spliced images from the linear probe or use images from the curvilinear probe, to measure RF_CSA. This will extend the clinical applicability of ultrasound in the measurement of muscle mass in all patient groups.

Multiscale edge detection and parametric shape modeling for boundary delineation in optoacoustic images

In this article, we present a novel scheme for segmenting the image boundary (with the background) in optoacoustic small animal in vivo imaging systems. The method utilizes a multiscale edge detection algorithm to generate a binary edge map. A scale dependent morphological operation is employed to clean spurious edges. Thereafter, an ellipse is fitted to the edge map through constrained parametric transformations and iterative goodness of fit calculations. The method delimits the tissue edges through the curve fitting model, which has shown high levels of accuracy. Thus, this method enables segmentation of optoacoutic images with minimal human intervention, by eliminating need of scale selection for multiscale processing and seed point determination for contour mapping.

Monsoon variability, crop water requirement, and crop planning for kharif rice in Sagar Island, India

In the Sagar Island of Bay of Bengal, rainfed lowland rice is the major crop, grown solely depending on erratic distribution of southwest monsoon (SM) rainfall. Lack of information on SM rainfall variability and absence of crop scheduling accordingly results in frequent occurrence of intermittent water stress and occasional crop failure. In the present study, we analyzed long period (1982-2010) SM rainfall behavior (onset, withdrawal, rainfall and wetness indices, dry and wet spells), crop water requirement (CWR, by Food and Agriculture Organization (FAO) 56), and probability of weekly rainfall occurrence (by two-parameter gamma distribution) to assess the variability and impact on water availability, CWR, and rice productivity. Finally, crop planning was suggested to overcome monsoon uncertainties on water availability and rice productivity. Study revealed that the normal onset and withdrawal weeks for SM rainfall were 22nd ± 1 and 43rd ± 2 meteorological weeks (MW), respectively. However, effective monsoon rainfall started at 24th MW (rainfall 92.7 mm, p > 56.7 % for 50 mm rainfall) and was terminated by the end of 40th MW (rainfall 90.7 mm, p < 59.6 % for 50 mm rainfall). During crop growth periods (seed to seed, 21st to 45th MW), the island received an average weekly rainfall of 65.1 ± 25.9 mm, while the corresponding weekly CWR was 47.8 ± 5.4 mm. Despite net water surplus of 353.9 mm during crop growth periods, there was a deficit of 159.5 mm water during MW of 18-23 (seedling raising) and MW of 41-45 (flowering to maturity stages). Water stress was observed in early lag vegetative stage of crop growth (32nd MW). The total dry spell frequency during panicle initiation and heading stage was computed as 40 of which 6 dry spells were >7 days in duration and reflected a significant (p < 0.05) increasing trend (at 0.22 days year(-1)) over the years (1982-2010). The present study highlights the adaptive capacity of crop planning including abiotic stress-tolerant cultivars to monsoon rainfall variability for sustaining rainfed rice production vis-à-vis food and livelihood security in vulnerable islands of coastal ecosystem.

Perfluoroalkyl substances measured in breast milk and child neuropsychological development in a Norwegian birth cohort study

Perfluoroalkyl substances (PFASs) are chemicals with potential neurotoxic effects although the current evidence is still limited. This study investigated the association between perinatal exposure to perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) and neuropsychological development assessed at 6, 12 and 24 months. We measured PFOS and PFOA in breast milk samples collected one month after delivery by mothers of children participating in the HUMIS study (Norway). Cognitive and psychomotor development was measured at 6 and at 24 months using the Ages and Stages Questionnaire (ASQ-II). Behavioral development was assessed using the infant-toddler symptom checklist (ITSC) at 12 and at 24 months. Weighted logistic regression and weighted negative binomial regression models were applied to analyze the associations between PFASs and ASQ-II and ITSC, respectively. The median concentration of PFOS was 110 ng/L, while the median for PFOA was 40 ng/L. We did not detect an increased risk of having an abnormal score in ASQ-II at 6 months or 24 months. Moreover, no consistent increase in behavioral problems assessed at 12 and 24 months by ITSC questionnaire was detected. We observed no association between perinatal PFOS and PFOA exposure and early neuropsychological development. Further longitudinal studies are needed to confirm the effects of these compounds on neuropsychological development in older children.

Large and prolonged food-borne multistate hepatitis A outbreak in Europe associated with consumption of frozen berries, 2013 to 2014

In May 2013, Italy declared a national outbreak of hepatitis A, which also affected several foreign tourists who had recently visited the country. Molecular investigations identified some cases as infected with an identical strain of hepatitis A virus subgenotype IA. After additional European Union/European Economic Area (EU/EEA) countries reported locally acquired and travel-related cases associated with the same outbreak, an international outbreak investigation team was convened, a European outbreak case definition was issued and harmonisation of the national epidemiological and microbiological investigations was encouraged. From January 2013 to August 2014, 1,589 hepatitis A cases were reported associated with the multistate outbreak; 1,102 (70%) of the cases were hospitalised for a median time of six days; two related deaths were reported. Epidemiological and microbiological investigations implicated mixed frozen berries as the vehicle of infection of the outbreak. In order to control the spread of the outbreak, suspected or contaminated food batches were recalled, the public was recommended to heat-treat berries, and post-exposure prophylaxis of contacts was performed. The outbreak highlighted how large food-borne hepatitis A outbreaks may affect the increasingly susceptible EU/EEA general population and how, with the growing international food trade, frozen berries are a potential high-risk food.

Heteronuclear J-coupling measurements in grossly inhomogeneous magnetic fields

It is difficult to measure chemical shifts in the small and inhomogeneous magnetic fields found in ex situ and single-sided NMR systems, such as those used for well-logging. However, it is still possible to obtain chemical information from J-coupling constants, which are independent of static field strength and temperature. We describe and analyze (1)H-(13)C double-resonance pulse sequences that are suitable for measuring heteronuclear J-coupling in grossly inhomogeneous fields. We also present preliminary experimental results from a low-frequency fringe-field system.

Medium-term cost-effectiveness of an automated non-invasive ventilation outpatient set-up versus a standard fixed level non-invasive ventilation inpatient set-up in obese patients with chronic respiratory failure: a protocol description

INTRODUCTION

Obesity is an escalating issue, with an accompanying increase in referrals of patients with obesity-related respiratory failure. Currently, these patients are electively admitted to hospital for initiation of non-invasive ventilation (NIV), but it is unknown whether outpatient initiation is as effective as inpatient set-up. We hypothesise that outpatient set-up using an autotitrating NIV device will be more cost-effective than a nurse-led inpatient titration and set-up.

METHODS AND ANALYSIS

We will undertake a multinational, multicentre randomised controlled trial. Participants will be randomised to receive the usual inpatient set-up, which will include nurse-led initiation of NIV or outpatient set-up with an automated NIV device. They will be stratified according to the trial site, gender and previous use of NIV or continuous positive airway pressure. Assuming a 10% dropout rate, a total sample of 82 patients will be required. Cost-effectiveness will be evaluated using standard treatment costs and health service utilisation as well as health-related quality of life measures (severe respiratory insufficiency (SRI) and EuroQol-5 dimensions (EQ-5D)). A change in the SRI questionnaire will be based on the analysis of covariance adjusting for the baseline measurements between the two arms of patients.

ETHICS AND DISSEMINATION

This study has been approved by the Westminster National Research Ethics Committee (11/LO/0414) and is the trial registered on the UKCRN portfolio. The trial is planned to start in January 2015 with publication of the trial results in 2017.

TRIAL REGISTRATION NUMBER

ISRCTN 51420481.

Characterization of biochar obtained from weeds and its effect on soil properties of North Eastern Region of India

In the global climate change scenario, application of biochar in soil has become one of the important management practices for carbon sequestration, soil health improvement and climate change mitigation. In this study, an attempt was made to see the effect of biochar prepared from weed biomass on soil properties in subtropical northeast India. Biochar were prepared from seven locally available weed biomass viz. Ageratum conyzoides, Lantana camera, Gynura sp., Setaria sp., Avena fatua, Maize stalk, Pine needles and were characterised. Apot experiment was conducted with maize, where biochar was applied alone and in combination with fertilizers. Results revealed that biochar had significant impact on soil pH, SOC, and available nutrients like N, P and K. It also had significant impact on maize biomass yield. All biochar contained more than 50% stable carbon. Increase in soil pH was in the range of 0.26 to 0.3 and that of SOC from 1.62% in control to 1.74% in biochar added treatments. Biochars alone improved the available nitrogen ranging from 4.5 to 21.3 mg kg(-1), available P from 3.32 to 3.68 mg kg(-1) and increased K content by 20% above control. Weed biomass can be potential alternative to enhance soil and crop productivity through conversion into biochar.

The potential role of behavioral therapies in the management of centrally mediated abdominal pain

BACKGROUND

Chronic abdominal pain carries a substantial health care burden but little is known about best practices for it management across ambulatory, hospital, and emergency room settings. This is especially true when abdominal pain presents in the absence of peripheral triggers like tissue injury (e.g. appendicitis) or altered bowel movements (e.g. IBS). Unfortunately, once central sensitization has occurred, pain can present without any stimulation or with minimal peripheral stimulation (feeling of clothing on the area) to the abdominal region. Several studies have proven the superior efficacy of behavioral interventions on many centrally mediated pain conditions including headaches and musculoskeletal problems. However, behavioral treatment of centrally mediated abdominal pain is less investigated due to the complexity of the patients involved and the poor understanding of the factors which either initiate or maintain persistent GI pain.

PURPOSE

We examine the evidence for a range of psychological and behavioral interventions in the context of centrally mediated abdominal pain. In addition to a strong rationale for a behavioral approach tied to the fear avoidance model of pain, we describe the structure, therapeutic targets, current evidence and relevance for each class of behavioral interventions.

Rhodium catalysed conversion of carbenes into ketenes and ketene imines using PNN pincer complexes

PNN pincer-type rhodium complexes catalyze ketene and ketene imine synthesis, using CO or an isocyanide and a carbene precursor.