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Chou MM, Yuan JC, Lu YA, Chuang SW. Successful treatment of placenta accreta spectrum disorder using management strategy of serial uterine artery embolization combined with standard weekly and a 8-day methotrexate/folinic acid regimens at 7 weeks of gestation. Taiwan J Obstet Gynecol 2021; 59:952-955. [PMID: 33218420 DOI: 10.1016/j.tjog.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We describe our experience with serial uterine artery embolization (UAE) combined with standard weekly methotrexate and a eight-day methotrexate/folinic acid (MTX/FA) treatment regimen in the management of placenta accreta spectrum (PAS) disorder at 7 weeks of gestation. CASE REPORT A 38-year-old woman, gravida 2 para 0, with a history of myomectomy, was referred for ultrasound (US) evaluation due to suspected cervico-isthmic pregnancy. Transvaginal US image showed a viable embryo with a disproportionately bigger placenta encircling the fetus and completely covering the internal os of the cervix at 7 weeks of gestation. Color Doppler imaging revealed diffuse intraplacental and periplacental vascularity. Patient chose to terminate the pregnancy but attempted to preserve the uterus for future fertility following counseling. Serial UAE procedures were performed using Gelfoam and metallic microcoils. Two courses of a standard weekly MTX and a eight-day MTX/FA treatment regimen were administered to accelerate placental regression. The beta-hCG gradually decreased to a normal level, and an ultimate resolution of the PAS disorder was observed at 110 days after treatment. CONCLUSION Early diagnosis of the PAS disorder could result in better obstetric outcome through earlier intervention using serial UAE combined with standard weekly and a eight day MTX//FA regimen in the first trimester of pregnancy.
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Affiliation(s)
- Min-Min Chou
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 40447, Taiwan.
| | - Jia-Chun Yuan
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 40447, Taiwan
| | - Yaw-An Lu
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 40447, Taiwan
| | - Sheng-Wei Chuang
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 40447, Taiwan
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Dong Z, Meng X, Yang W, Zhang J, Sun P, Zhang H, Fang X, Wang DA, Fan C. Progress of gelatin-based microspheres (GMSs) as delivery vehicles of drug and cell. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 122:111949. [PMID: 33641932 DOI: 10.1016/j.msec.2021.111949] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
Gelatin has various attractive features as biomedical materials, for instance, biocompatibility, low immunogenicity, biodegradability, and ease of manipulation. In recent years, various gelatin-based microspheres (GMSs) have been fabricated with innovative technologies to serve as sustained delivery vehicles of drugs and genetic materials as well as beneficial bacteria. Moreover, GMSs have exhibited promising potentials to act as both cell carriers and 3D scaffold components in tissue engineering and regenerative medicine, which not only exhibit excellent injectability but also could be integrated into a macroscale construct with the laden cells. Herein, we aim to thoroughly summarize the recent progress in the preparations and biomedical applications of GMSs and then to point out the research direction in future. First, various methods for the fabrication of GMSs will be described. Second, the recent use of GMSs in tumor embolization and in the delivery of cells, drugs, and genetic material as well as bacteria will be presented. Finally, several key factors that may enhance the improvement of GMSs were suggested as delivery vehicles.
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Affiliation(s)
- Zuoxiang Dong
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China; Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Xinyue Meng
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China
| | - Wei Yang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China
| | - Jinfeng Zhang
- Department of Surgery, Songshan Hospital of Qingdao University, Qingdao 266021, Shandong, China
| | - Peng Sun
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Huawei Zhang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Xing Fang
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Dong-An Wang
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong Special Administrative Region; Shenzhen Research Institute, City University of Hong Kong, Shenzhen Hi-tech Industrial Park, Shenzhen, Guangdong 518057, China; Karolinska Institute Ming Wai Lau Centre for Reparative Medicine, HKSTP, Sha Tin, Hong Kong Special Administrative Region.
| | - Changjiang Fan
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China.
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Rand T, Patel R, Magerle W, Uberoi R. CIRSE standards of practice on gynaecological and obstetric haemorrhage. CVIR Endovasc 2020; 3:85. [PMID: 33245432 PMCID: PMC7695782 DOI: 10.1186/s42155-020-00174-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
This CIRSE Standards of Practice document provides best practices for obstetric haemorrhage embolisation (OHE) in the management of postpartum haemorrhage (PPH). The document is aimed at interventional radiologists involved in treating postpartum haemorrhage, and has been developed by a writing group established by the CIRSE Standards of Practice Committee. CIRSE Standards of Practice documents are not clinical practice guidelines and do not intend to impose a standard of care, rather provide reasonable approaches to and best practices for specific interventional radiology treatments and techniques.
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Affiliation(s)
- Thomas Rand
- Institute for Interventional and Diagnostic Radiology, Klinik Floridsdorf, Brünnerstr.68, 1210, Vienna, Austria. .,Scientific research in diagnostics and interventional radiology, Karl Landsteiner Society, St. Pölten, Austria.
| | - Rafiuddin Patel
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Raman Uberoi
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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Tian H, Li S, Jia W, Yu K, Wu G. Risk factors for poor hemostasis of prophylactic uterine artery embolization before curettage in cesarean scar pregnancy. J Int Med Res 2020; 48:300060520964379. [PMID: 33467974 PMCID: PMC7967858 DOI: 10.1177/0300060520964379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/14/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To observe the hemostatic effect of prophylactic uterine artery embolization (UAE) in patients with cesarean scar pregnancy (CSP) and to examine the risk factors for poor hemostasis. METHODS Clinical data of 841 patients with CSP who underwent prophylactic UAE and curettage were retrospectively analyzed to evaluate the hemorrhage volume during curettage. A hemorrhage volume ≥200 mL was termed as poor hemostasis. The risk factors of poor hemostasis were analyzed and complications within 60 days postoperation were recorded. RESULTS Among the 841 patients, 6.30% (53/841) had poor postoperative hemostasis. The independent risk factors of poor hemostasis were gestational sac size, parity, embolic agent diameter (>1000 μm), multivessel blood supply, and incomplete embolization. The main postoperative complications within 60 days after UAE were abdominal pain, low fever, nausea and vomiting, and buttock pain, with incidence rates of 71.22% (599/841), 47.44% (399/841), 39.12% (329/841), and 36.39% (306/841), respectively. CONCLUSIONS Prophylactic UAE before curettage in patients with CSP is safe and effective in reducing intraoperative hemorrhage. Gestational sac size, parity, embolic agent diameter, multivessel blood supply, and incomplete embolization of all arteries supplying blood to the uterus are risk factors of poor hemostasis.
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Affiliation(s)
- Hongan Tian
- Department of Radiology, Xianning Central Hospital, The First
Affiliated Hospital of Hubei University of Science and Technology, Xianning,
P.R. China
- Department of Radiology, Zhongnan Hospital of Wuhan University,
Wuhan, P.R. China
| | - Shunzhen Li
- Department of Radiology, Xianning Central Hospital, The First
Affiliated Hospital of Hubei University of Science and Technology, Xianning,
P.R. China
| | - Wanwan Jia
- Department of Radiology, Xianning Central Hospital, The First
Affiliated Hospital of Hubei University of Science and Technology, Xianning,
P.R. China
| | - Kaihu Yu
- Department of Radiology, Xianning Central Hospital, The First
Affiliated Hospital of Hubei University of Science and Technology, Xianning,
P.R. China
| | - Guangyao Wu
- Department of Radiology, Zhongnan Hospital of Wuhan University,
Wuhan, P.R. China
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