Objective This study aims to compare composite maternal and neonatal morbidities (MM, NM) among pregnant women with diabetes mellitus whose body mass index (BMI) at delivery was < 30 (group 1), 30.0 to 39.9 (group 2), and ≥ 40 kg/m2 (group 3). We hypothesized that increased BMI class at delivery would be associated with worsening maternal and neonatal outcomes. Methods This is a retrospective cohort study. MM was defined as: chorioamnionitis, wound infection, eclampsia, diabetic ketoacidosis, hypoglycemia admission, third/fourth degree laceration, and/or death. NM was defined as umbilical arterial pH < 7.0, 5 minute Apgar < 4, respiratory distress syndrome, mechanical ventilation, neonatal sepsis, stillbirth, and/or death. Odds ratios were adjusted for possible confounders. Results MM was noted in 8, 13, and 24% of groups 1, 2, and 3, respectively, and significantly more common in group 2 versus 1 (adjusted odds ratio [aOR]: 1.66) and group 3 versus 1 (aOR: 3.06). NM was noted in 7, 8, and 15% of each BMI group, respectively, and differed significantly between group 3 vs. 2 (aOR: 1.77). Conclusions The increased rate of morbidities between the BMI groups is useful to inform diabetic women and highlights the need for further investigation of diabetes and obesity as comorbidities in pregnancy.
Introduction Orbital meningoencephalocele formation is primarily a result of congenital defects in the pediatric population and trauma of the anterior cranial fossa in adults. We present a unique case of nontraumatic nasal and orbital meningoencephaloceles presenting as bilateral proptosis with exotropia secondary to chronic hydrocephalus. Clinical presentation A 20-year-old male with a history of tuberous sclerosis, X-linked intellectual disability, and epilepsy presented to the emergency department with two days of nausea, emesis, seizures, and two months of progressive proptosis. Initial radiographs of the skull showed a "copper beaten" appearance, indicating chronically elevated intracranial pressure. Computed tomography imaging of the head demonstrated bilateral defects in the cribriform plate and anterior cranial fossa. Magnetic resonance imaging of the brain revealed triventricular hydrocephalus with meningoencephalocele extension into the nasal cavity and frontal horn herniation into the extraconal space of the orbits. The hydrocephalus was managed with ventriculoperitoneal shunt placement with rapid and complete resolution of the proptosis. Conclusion No reports have described bilateral proptosis as the presenting finding of orbital and nasal meningoencephaloceles in the absence of trauma or congenital defect. This case study demonstrates the management of meningoencephalocele formation secondary to chronic hydrocephalus.
A method to facilitate the characterization of stapled or cyclic peptides is reported via an arginine-selective derivatization strategy coupled with MS/MS analysis. Arginine residues are converted to ornithine residues through a deguanidination reaction that installs a highly selectively cleavable site in peptides. Upon activation by CID or UVPD, the ornithine residue cyclizes to promote cleavage of the adjacent amide bond. This Arg-specific process offers a unique strategy for site-selective ring opening of stapled and cyclic peptides. Upon activation of each derivatized peptide, site-specific backbone cleavage at the ornithine residue results in two complementary products: the lactam ring-containing portion of the peptide and the amine-containing portion. The deguanidination process not only provides a specific marker site that initiates fragmentation of the peptide but also offers a means to unlock the staple and differentiate isobaric stapled peptides.
https://www.videogie.org/cms/asset/5768b3e8-6c6e-4910-a2be-fc50b765f538/mmc1.mp4Loading ...(mp4, 26.38 MB) Download video Cholangioscopy, fluoroscopy, and endoscopy of the percutaneous retrieval of a biliary stent across an iatrogenic common hepatic duct stricture due to surgical staples. A 74-year-old man presented 2 years after a cholecystectomy with abnormal liver function tests (total bilirubin 5.4 mg/dL, alkaline phosphatase 207 units/mL, aspartate aminotransferase 391 units/mL, and alanine aminotransferase 395 units/mL), a high-grade hilar stricture, and a filing defect in the right intrahepatic duct on magnetic resonance imaging. ERCP showed a 1.3-cm stricture in the common hepatic duct (CHD). Cholangioscopy (Spyglass DS II Access & Delivery Catheter, Boston Scientific, Natick, Mass, USA) showed a surgical staple in the mucosa at the distal end of the CHD stricture. A small stone proximal to the stricture could not be accessed even after dilating the stricture with a 6-mm balloon. A 7F, 12-cm plastic stent was placed across the iatrogenic stricture into the right intrahepatic duct. Repeat ERCP was scheduled 10 weeks later to remove the biliary stent and attempt clearance of the duct. While attempting stent retrieval with a snare, the proximal flap of the stent was noted to be embedded in a peripheral right intrahepatic duct and could not be extracted through the high-grade iatrogenic CHD stricture. In this process, the intraduodenal portion of the distal end of the stent sheared off (Fig. 1A and B). Attempts were made to retrieve the stent with a rat-tooth forceps, extraction balloon, and cholangioscopy, without success. A same-session percutaneous cholangioscope-aided stent retrieval was planned with the interventional radiology team. This was performed 10 weeks after the second ERCP. After obtaining percutaneous right-sided biliary access, a guidewire was passed into the distal duodenum. A 12F sheath was advanced percutaneously to the hilum, after dilation of the percutaneous tract. The proximal end of the stent extended above the level at which the sheath encountered the stent (Fig. 1A; Video 1, available online at www.giejournal.org). The novel short cholangioscope (SpyGlass Discover, Boston Scientific) (Fig. 1B) was then advanced by 1 endoscopist (S.T.) into the 12F percutaneous sheath. With respiratory movement of the diaphragm, however, the proximal end of the stent was noted to move proximally into the right intrahepatic duct, precluding attempts at capturing the proximal end for extraction (Video 1). Hence, a second endoscopist (S.G.) applied countertraction on the sheared-off distal end of the stent, which was extending out of the ampulla, with a rat-tooth forceps advanced through the duodenoscope (Fig. 1D and E). The proximal end of the stent was grasped with a retrieval snare (SpyGlass Retrieval Snare, Boston Scientific) and maneuvered into the percutaneous 12F sheath by simultaneously pushing in the percutaneous sheath and pulling on the distal end of the stent, to ensure the stent fit into the percutaneous sheath for retrieval (Fig. 1E and F; Video 1). The distal end of the stent was then released from the grasp of the rat-tooth forceps extending out of the duodenoscope and was smoothly withdrawn through the 12F sheath and out of the patient's body (Video 1). The cholangioscope was reintroduced into the percutaneous sheath, and the hilum and extrahepatic duct were examined. A surgical staple was found in the hilar mucosa (Fig. G; Video 1). The stone seen previously was not seen on cholangioscopy or cholangiogram (Fig. H). The interventional radiology team left an internal-external drain in place to prevent bile leak at the percutaneous puncture site. The next day, the drain had to be upsized because of a pericatheter leak; it was exchanged 2 weeks later because of a recurrent pericatheter leak. Three weeks later, the internal-external drain was exchanged for an external percutaneous drain, after removal of a distal common bile duct filling defect. The external biliary drain was removed 6 weeks after the percutaneous cholangioscopy. The new disposable cholangioscope is primarily intended for laparoscopically assisted cholangioscopy. It has the advantage of increased maneuverability owing to a shorter length (65 cm) and a more flexible tip; hence, it is a useful tool for percutaneous cholangioscopy for indications such as stent retrieval, stone clearance, or evaluation of biliary strictures, when retrograde cholangioscopy through the duodenoscope is unsuccessful or precluded by the patient's anatomy. Percutaneous cholangioscopy requires coordination between the endoscopy and interventional radiology teams. Same-session cholangioscopy via a percutaneous sheath avoids the need for tract maturation, especially for urgent indications—a drawback of classical percutaneous cholangioscopy with reusable large-caliber cholangioscopes.1Monino L. Deprez P.H. Moreels T.G. Percutaneous cholangioscopy with short Spyscope combine with endoscopic retrograde cholangiography in case of difficult intrahepatic bile duct stone.Dig Endosc. 2021; 33: e65-e66Crossref PubMed Scopus (2) Google Scholar,2Ponchon T. Genin G. Mitchell R. et al.Methods, indications, and results of percutaneous choledochoscopy. A series of 161 procedures.Ann Surg. 1996; 223: 26-36Crossref PubMed Scopus (54) Google Scholar The percutaneous tract has to mature before removal of the percutaneous sheath to avoid a bile leak. All authors disclosed no financial relationships. https://www.videogie.org/cms/asset/5768b3e8-6c6e-4910-a2be-fc50b765f538/mmc1.mp4Loading ... Download .mp4 (26.38 MB) Help with .mp4 files Video 1Cholangioscopy, fluoroscopy, and endoscopy of the percutaneous retrieval of a biliary stent across an iatrogenic common hepatic duct stricture due to surgical staples.
This article aims to compare the composite maternal and neonatal morbidities (CMM and CNM, respectively) between macrosomic (≥4,000 g) and nonmacrosomic (<4,000 g) newborns among women with diabetes mellitus (DM). Maternal demographic and peripartum outcome data (N = 1,260) were collected from a retrospective cohort. CMM included chorioamnionitis/endometritis, wound infection, shoulder dystocia, eclampsia, pulmonary edema, admission for hypoglycemia, 3rd/4th degree perineal laceration, and death. CNM included 5-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score of <4, neonatal intensive care unit (NICU) admission, respiratory distress syndrome, mechanical ventilation, intraventricular hemorrhage grade III/IV, necrotizing enterocolitis stage II/III, hypoglycemia, hypocalcemia, bronchopulmonary dysplasia, sepsis, seizures, hyperbilirubinemia, and death. Multivariable Poisson regression models with robust error variance were used to calculate adjusted relative risk (aRR) and 95% confidence interval (CI). The study population consisted of 967 subjects, including 854 (88.3%) nonmacrosomic and 113 (11.7%) macrosomic infants. After adjustment, the risk of CMM was higher among macrosomic deliveries (aRR = 4.08, 95% CI = 2.45-6.80). The risk of CNM was also higher among macrosomic deliveries (aRR = 1.77, 95% CI = 1.39-2.24). Macrosomia was associated with an increased risk in NICU admission, hypoglycemia, and hyperbilirubinemia. Among DM deliveries, macrosomia was associated with a fourfold higher risk of CMM and almost twofold higher risk of CNM.
The sellar, suprasellar, and parasellar space contain a vast array of pathologies, including neoplastic, congenital, vascular, inflammatory, and infectious etiologies. Symptoms, if present, include a combination of headache, eye pain, ophthalmoplegia, visual field deficits, cranial neuropathy, and endocrine manifestations. A special focus is paid to key features on CT and MRI that can help in differentiating different pathologies. While most lesions ultimately require histopathologic evaluation, expert knowledge of skull base anatomy in combination with awareness of key imaging features can be useful in limiting the differential diagnosis and guiding management. Surgical techniques, including endoscopic endonasal and transcranial neurosurgical approaches are described in detail.
Rucaparib camsylate (CO-338; 8-fluoro-2-{4-[(methylamino)methyl]phenyl}-1,3,4,5-tetrahydro-6H-azepino[5,4,3-cd]indol-6-one ((1S,4R)-7,7-dimethyl-2-oxobicyclo[2.2.1]hept-1-yl)methanesulfonic acid salt) is a PARP1, 2 and 3 inhibitor. Phase I studies identified a recommended Phase II dose of 600 mg orally twice daily. ARIEL2 Part 1 established a tumor genomic profiling test for homologous recombination loss of heterozygosity quantification using a next-generation sequencing companion diagnostic (CDx). Rucaparib received US FDA Breakthrough Therapy designation for treatment of platinum-sensitive BRCA-mutated advanced ovarian cancer patients who received greater than two lines of platinum-based therapy. Comparable to rucaparib development, other PARP inhibitors, such as olaparib, niraparib, veliparib and talazoparib, are developing CDx tests for targeted therapy. PARP inhibitor clinical trials and CDx assays are discussed in this review, as are potential PARP inhibitor combination therapies and likely resistance mechanisms.
