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Aim: To develop evidence‐based clinical algorithms for the assessment and management of spontaneous, uncomplicated labour and vaginal birth. Population: Pregnant women at any stage of labour, with singleton, term pregnancies considered to be at low risk of developing complications. Setting: Health facilities in low‐ and middle‐income countries. Search Strategy: We searched for relevant published algorithms, guidelines, systematic reviews and primary research studies on Cochrane Library, PubMed, and Google on terms related to spontaneous, uncomplicated labour and childbirth up to 01 June 2023. Case scenarios: Three case scenarios were developed to cover assessments and management for spontaneous, uncomplicated first, second and third stage of labour. The algorithms provide pathways for definition, assessments, diagnosis, and links to other algorithms in this series for management of complications. Conclusions: We have developed three clinical algorithms to support evidence‐based decision making during spontaneous, uncomplicated labour and vaginal birth. These algorithms may help guide health care staff to institute respectful care, appropriate interventions where needed, and potentially reduce the unnecessary use of interventions during labour and childbirth. Evidence‐based clinical algorithms may help support respectful, high quality intrapartum care. [Correction added on 23 August 2024, after first online publication: The Abstract has been updated to structure layout in this version.] [ABSTRACT FROM AUTHOR]

Key Clinical Message: Spontaneous spinal epidural hematoma (SSEH) rarely occurs. Without early diagnosis, SSEH can lead to the acute onset of neurologic deficits. We report the case of a 65‐year‐old male with diabetes mellitus who was admitted to our emergency department with a chief complaint of sharp and severe pain in the left scapula and behind the sternum. He was misdiagnosed with cardiovascular disease until the onset of progressive bilateral paraplegia and lower limb numbness. Magnetic resonance imaging revealed a ventral thoracic SSEH. Surgical treatment to remove epidural hematoma and laminectomy for decompression were performed. Except for urine retention, bilateral lower limb paraplegia and numbness were alleviated postoperatively. Due to the high risk of poor neurological outcomes without treatment or with delayed intervention, timely surgical evacuation of the hematoma and hemostasis are recommended to ensure favorable neurological outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To identify and internally validate metabolites predictive of spontaneous preterm birth (sPTB) using multiple machine learning methods and sequential maternal serum samples, and to predict spontaneous early term birth (sETB) using these metabolites. Design: Case–cohort design within a prospective cohort study. Setting: Cambridge, UK. Population or sample: A total of 399 Pregnancy Outcome Prediction study participants, including 98 cases of sPTB. Methods: An untargeted metabolomic analysis of maternal serum samples at 12, 20, 28 and 36 weeks of gestation was performed. We applied six supervised machine learning methods and a weighted Cox model to measurements at 28 weeks of gestation and sPTB, followed by feature selection. We used logistic regression with elastic net penalty, followed by best subset selection, to reduce the number of predictive metabolites further. We applied coefficients from the chosen models to measurements from different gestational ages to predict sPTB and sETB. Main outcome measures: sPTB and sETB. Results: We identified 47 metabolites, mostly lipids, as important predictors of sPTB by two or more methods and 22 were identified by three or more methods. The best 4‐predictor model had an optimism‐corrected area under the receiver operating characteristics curve (AUC) of 0.703 at 28 weeks of gestation. The model also predicted sPTB in 12‐week samples (0.606, 95% CI 0.544–0.667) and 20‐week samples (0.657, 95% CI 0.597–0.717) and it predicted sETB in 36‐week samples (0.727, 95% CI 0.606–0.849). A lysolipid, 1‐palmitoleoyl‐GPE (16:1)*, was the strongest predictor of sPTB at 12 weeks of gestation (0.609, 95% CI 0.548–0.670), 20 weeks (0.630, 95% CI 0.569–0.690) and 28 weeks (0.660, 95% CI 0.599–0.722), and of sETB at 36 weeks (0.739, 95% CI 0.618–0.860). Conclusions: We identified and internally validated maternal serum metabolites predictive of sPTB. A lysolipid, 1‐palmitoleoyl‐GPE (16:1)*, is a novel predictor of sPTB and sETB. Further validation in external populations is required. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Sewing needle ingestion is a rare but potentially dangerous event that can affect people of all ages and backgrounds like this patient.Conservative management with serial abdominal examination and x‐rays can be a reasonable option for patients who do not show signs of perforation or sepsis, as most foreign bodies will pass spontaneously without complications such as this case. Though rare, swallowing a sewing needle is a peculiar and potentially dangerous health risk. People of all ages and backgrounds can accidentally ingest sewing needles, with cases documented in both children and adults. Our case focuses on a 17‐year‐old Ethiopian girl who accidentally gulped down a needle while stitching her clothing. Subsequently, she had an episode of vomiting that was tinged with blood along with ingested matter. Remarkably, the patient underwent conservative management using repeated abdominal checkups and x‐rays, successfully passing the broken needle without any surgical intervention. It is important to remember that while uncommon, ingesting sewing needles might lead to significant complications, necessitating immediate and appropriate care. [ABSTRACT FROM AUTHOR]

Background: Aspiration pneumonitis (AP) secondary to cerebrospinal fluid (CSF) leak is underestimated and rarely discussed. This study aimed to evaluate the association between AP and CSF leaks. Methods: Clinical and surgical characteristics of CSF leak patients with and without AP between January 2010 and December 2022 were included and compared. Results: This study included 159 patients, 16 with CSF otorrhea and 143 with CSF rhinorrhea. Among them, 40 (25.2%) had AP. Bilateral pneumonitis was identified in 32 cases, of which 11 showed severe pneumonitis in the right upper lung lobe. Twenty-one (52.5%) asymptomatic and 19 (47.5%) symptomatic cases were documented. The major clinical manifestations included cough (n = 19, 47.5%) and expectoration (n = 9, 22.5%). The prevalence of pneumonitis was significantly higher in the spontaneous group than in the traumatic group. High-flow CSF leak was associated with AP (42.5% vs. 16.8%, p = 0.001). No significant differences were identified in defect locations between patients with and without AP. Patients with pneumonitis had a higher prevalence of meningitis (32.5% vs. 12.6%, p = 0.003). Multiple logistic regression results revealed that meningitis, spontaneous and high-flowCSF leaks are independent factors forAP occurrence. Both the CSF leak and pulmonary complications resolved following successful surgical repair. Conclusions: AP secondary to CSF leaks is frequently underdiagnosed, with a higher incidence identified in spontaneous cases. The occurrence of AP was associated with high-flow CSF leak. [ABSTRACT FROM AUTHOR]

Objective: We undertook a systematic review of the literature with meta‐analysis to identify the role of obesity (BMI ≥30) in the patient characteristics presenting with spontaneous cerebrospinal fluid (sCSF) leaks of the lateral skull base and the outcomes of their repair. Data Sources: A Systematic Review of English Articles using MEDLINE, EMBASE, and Cochrane Library. Review Methods: The research algorithm included the following keywords: "spontaneous CSF leak," "lateral skull base," "temporal bone," "meningocele," "encephalocele," and "otorrhea." We also manually searched the references of included studies, to identify possible studies missed during our literature search. Results: More than two‐thirds of the patients were female (69.2%) and often were obese (mean BMI 36.5 kg/m2) with a mean age of 57. Most common presenting symptoms were otorrhea and hearing loss. Most authors did not report a routine use of a post‐operative lumbar drain. Most patients had a single skull base defect and encephaloceles prolapsing through, across obese and non‐obese groups. Median length of stay in hospital was 3.2 days, and the majority of patients did not have any recurrence during their follow‐up (89.6%), which was not affected by obesity. Conclusion: Obesity does not affect length of hospital stay or recurrence rate following surgical repair of lateral skull base sCSF leaks. Surgical repair is a safe and viable approach in the management of obese patients with sCSF leaks in the temporal bone. Level of Evidence: NA Laryngoscope, 134:2012–2018, 2024 [ABSTRACT FROM AUTHOR]

Introduction: Preterm birth (PTB) is the leading cause of infant mortality and morbidity worldwide. Rates of PTB in the Netherlands are declining, possibly due to the implementation of preventive strategies. In this study we assessed the overall trend in PTB rates in the Netherlands in recent years, and in more detail in specific subgroups to investigate potential groups that require scrutiny in the near future. Material and methods: Based on the national perinatal registry, we included all pregnancies without severe congenital abnormalities resulting in a birth from 24 to 42 completed weeks of gestation between 2011 and 2019 in the Netherlands. We assessed PTB rates in two different clinical subtypes (spontaneous vs. iatrogenic) and in five gestational age subgroups: 24–27+6 weeks (extreme), 28–31+6 weeks (very), 32–33+6 weeks (moderate, 34–36+6 weeks [late] and, in general, 24–36+6 weeks [overall PTB]). Trend analysis was performed using the Cochran Armitage test. We also compared PTB rates in different subgroups in the first 2 years compared to the last 2 years. Singleton and multiple gestations were analyzed separately. Results: We included 1 447 689 singleton and 23 250 multiple pregnancies in our study. In singletons, we observed a significant decline in PTB from 5.5% to 5.0% (p < 0.0001), mainly due to a decrease in iatrogenic PTBs. When focusing on different gestational age subgroups, there was a decrease in all iatrogenic PTB and in moderate to late spontaneous PTB. However, in spontaneous extreme and very PTB there was an significant increase. When assessing overall PTB risk in different subgroups, the decline was only visible in women with age ≥25 years, nulliparous and primiparous women, women with a medium or high socioeconomic status and hypertensive women. In multiples, the rate of PTB remained fairly stable, from 52.3% in 2011 to 54.1% in 2019 (p = 0.57). Conclusions: In the Netherlands, between 2011 and 2019, PTB decreased, mainly due to a reduction in late PTB, and more in iatrogenic than in spontaneous PTB. Focus for the near future should be on specific subgroups in which the decline was not visible, such as women with a low socioeconomic status or a young age. [ABSTRACT FROM AUTHOR]

In the resting state, cortical neurons can fire action potentials spontaneously but synchronously (Up state), followed by a quiescent period (Down state) before the cycle repeats. Extracellular recordings in the infragranular layer of cortex with a micro‐electrode display a negative deflection (depth‐negative) during Up states and a positive deflection (depth‐positive) during Down states. The resulting slow wave oscillation (SWO) has been studied extensively during sleep and under anaesthesia. However, recent research on the balanced nature of synaptic excitation and inhibition has highlighted our limited understanding of its genesis. Specifically, are excitation and inhibition balanced during SWOs? We analyse spontaneous local field potentials (LFPs) during SWOs recorded from anaesthetised rats via a multi‐channel laminar micro‐electrode and show that the Down state consists of two distinct synaptic states: a Dynamic Down state associated with depth‐positive LFPs and a prominent dipole in the extracellular field, and a Static Down state with negligible (≈0mV$ \approx 0{\mathrm{\;mV}}$) LFPs and a lack of dipoles extracellularly. We demonstrate that depth‐negative and ‐positive LFPs are generated by a shift in the balance of synaptic excitation and inhibition from excitation dominance (depth‐negative) to inhibition dominance (depth‐positive) in the infragranular layer neurons. Thus, although excitation and inhibition co‐tune overall, differences in their timing lead to an alternation of dominance, manifesting as SWOs. We further show that Up state initiation is significantly faster if the preceding Down state is dynamic rather than static. Our findings provide a coherent picture of the dependence of SWOs on synaptic activity. Key points: Cortical neurons can exhibit repeated cycles of spontaneous activity interleaved with periods of relative silence, a phenomenon known as 'slow wave oscillation' (SWO).During SWOs, recordings of local field potentials (LFPs) in the neocortex show depth‐negative deflection during the active period (Up state) and depth‐positive deflection during the silent period (Down state).Here we further classified the Down state into a dynamic phase and a static phase based on a novel method of classification and revealed non‐random, stereotypical sequences of the three states occurring with significantly different transitional kinetics.Our results suggest that the positive and negative deflections in the LFP reflect the shift of the instantaneous balance between excitatory and inhibitory synaptic activity of the local cortical neurons.The differences in transitional kinetics may imply distinct synaptic mechanisms for Up state initiation.The study may provide a new approach for investigating spontaneous brain rhythms. [ABSTRACT FROM AUTHOR]

Synthesis of maleic anhydride (MA) and styrene (St) copolymers possessing ultra‐high molecular weight, strictly alternating regularity and high glass transition temperature simultaneously is still an issure with great challenge. Herein, the spontaneous alternating copolymerization of MA and St derivatives were investigated by using various Lewis acids. In the presence of alkyl aluminum or butyl magnesium, the MA−St alternating copolymers with ultra‐high molecular weight (Mn≤166.5×104) and high glass transition temperature (211 °C≤Tg≤216 °C) were produced and the microstructure of MA−St copolymers were analyzed by 1H and 13C NMR spectra. The copolymerizations of MA with St derivatives, including divinylbenzene, p‐butenyl styrene, p‐methoxystyrene, trans‐anethole, p‐fluorostyrene and p‐chlorostyrene, also were explored by using AlOctyl3 as an activator in toluene at 50 °C. [ABSTRACT FROM AUTHOR]

Background: Patients awaiting liver transplant are usually assessed for presence of dental foci to prevent bacterial infection post‐transplant, but evidence to support dental examination and treatment is limited. We investigated if treatment of dental foci decreased bacterial infections before and after transplant. Methods: Patients transplanted at the university hospital of Bonn were retrospectively assessed for occurrence of bacterial infections before and after transplant according to presence and treatment of dental foci. Results: 35/110 patients showed good oral health, 39/110 patients received dental care and 36/110 patients did not receive dental care despite poor oral health. Patients with alcohol‐associated liver disease presented with the highest rate of dental foci. Bleeding complications due to oral care occurred in five patients with poor coagulation. After transplant, the number of infections per patient was higher in patients with poor oral health (2.9) compared to patients after dental care (1.9) or with good oral health (1.8) (p =.02), with streptococcal infections being more frequent in patients with poor oral health. Before transplant, bacterial infections, in particular bacteraemia and spontaneous bacterial peritonitis, were also more common in patients with untreated dental foci. Streptococci and Staphylococci were more often detected in patients with dental foci. Dental treatment was associated with a reduction in bacterial infections. Conclusion: Presence of dental foci is associated with an increased risk for bacterial infections not only after but also before liver transplant. Dental treatment might be a safe and effective procedure to mitigate this risk. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Isolated spontaneous superior mesenteric artery (SMA) dissection is relatively rare. Often found incidentally on cross‐sectional imaging, often managed non‐operatively. We present a patient who presented with chest pain and was found to have a SMA dissection. [ABSTRACT FROM AUTHOR]

Objective: To describe the rates of and risk factors associated with iatrogenic and spontaneous preterm birth and the variation in rates between hospitals. Design: Cohort study using electronic health records. Setting: English National Health Service. Population: Singleton births between 1 April 2015 and 31 March 2017. Methods: Multivariable Poisson regression models were used to estimate adjusted risk ratios (adjRR) to measure association with maternal demographic and clinical risk factors. Main outcome measures: Preterm births (<37 weeks of gestation) were defined as iatrogenic or spontaneous according to mode of onset of labour. Results: Of the births, 6.1% were preterm and of these, 52.8% were iatrogenic. The proportion of preterm births that were iatrogenic increased after 32 weeks. Both sub‐groups were associated with previous preterm birth, extremes of maternal age, socio‐economic deprivation and smoking. Iatrogenic preterm birth was associated with higher body mass index (BMI) (BMI >40 kg/m2 adjRR 1.59, 95% CI 1.50–1.69) and previous caesarean (adjRR 1.88, 95% CI 1.83–1.95). Spontaneous preterm birth was less common in women with a higher BMI (BMI >40 kg/m2 adjRR 0.77, 95% CI 0.70–0.84) and in women with a previous caesarean (adjRR 0.87, 95% CI 0.83–0.90). More variation between NHS hospital trusts was observed in rates of iatrogenic, compared with spontaneous, preterm births. Conclusions: Just over half of all preterm births resulted from iatrogenic intervention. Iatrogenic births have overlapping but different patterns of maternal demographic and clinical risk factors to spontaneous preterm births. Iatrogenic and spontaneous sub‐groups should therefore be measured and monitored separately, as well as in aggregate, to facilitate different prevention strategies. This is feasible using routinely acquired hospital data. This article includes Author Insights, a video abstract available at: https://vimeo.com/745289966. [ABSTRACT FROM AUTHOR]

Self‐affirmations—responding to self‐threatening information by reflecting on positive values or strengths—help to realign working self‐concept and may support adaptive coping and wellbeing. Little research has been undertaken on spontaneous self‐affirmations in response to everyday threats, and less has been undertaken on the relationships between spontaneous self‐affirmations, coping, and wellbeing. This study aimed to test both within‐ and between‐person relationships between spontaneous self‐affirmations, coping, and wellbeing, controlling for threat intensity and other outcomes. A repeated survey assessment design was adopted to achieve these aims. Outcome measures included approach coping, avoidance coping, positive affect, negative affect, and eudaimonic wellbeing. It was found that spontaneous self‐affirmations positively predicted approach coping and positive affect at both within‐ and between‐person levels, and eudaimonic wellbeing at the between‐person level. Overall, spontaneous self‐affirmations were positively associated with approach coping and aspects of wellbeing. [ABSTRACT FROM AUTHOR]

Uterine rupture mostly occurs in the third trimester. However, it may occur at an earlier time with the same catastrophic consequences. The authors present a case report of uterine rupture occurring in the second trimester at 18 weeks gestation. [ABSTRACT FROM AUTHOR]

A promoter‐free chalcogenophosphorylation reaction between diverse P(O)−H reagents and chalcogenosulfonates has been developed. In the absence of metal or any other additives, these transformations proceed through a spontaneous process at room temperature, which provide a convenient and compatible approach to a broad range of selenophosphates and thiophosphates. [ABSTRACT FROM AUTHOR]

Preterm birth contributes significantly to neonatal mortality and morbidity. Despite its global significance, there has only been limited progress in preventing preterm birth. Spontaneous preterm birth (sPTB) results from a wide variety of pathological processes. Although many non‐genetic risk factors influence the timing of gestation and labor, compelling evidence supports the role of substantial genetic and epigenetic influences and their interactions with the environment contributing to sPTB. To investigate a common and complex disease such as sPTB, various approaches such as genome‐wide association studies, whole‐exome sequencing, transcriptomics, and integrative approaches combining these with other 'omics studies have been used. However, many of these studies were typically small or focused on a single ethnicity or geographic region with limited data, particularly in populations at high risk for sPTB, or lacked a robust replication. These studies found many genes involved in the inflammation and immunity‐related pathways that may affect sPTB. Recent studies also suggest the role of epigenetic modifications of gene expression by the environmental signals as a potential contributor to the risk of sPTB. Future genetic studies of sPTB should continue to consider the contributions of both maternal and fetal genomes as well as their interaction with the environment. [ABSTRACT FROM AUTHOR]

Objective: Evidence for the association between subclinical thyroid dysfunction before conception and its pregnancy outcomes is inconsistent. Thus, we evaluated the relationship between preconception thyroid‐stimulating hormone (TSH) levels and adverse pregnancy outcomes. Design: Retrospective cohort study. Methods: A total of 50,217 women without prior thyroid disease who became pregnant within 1 year after undertaking a routine TSH test in the Chongqing Municipality of China (2010–2016) were studied. Restricted cubic spline regression and logistic regression were used to estimate the association between preconception TSH levels and pregnancy outcomes. The main outcomes were individual and composite adverse pregnancy outcomes (CAPOs) comprising pregnancy loss, small for gestational age, large for gestational age, and preterm birth. Results: Incidence of CAPO was 24.19%. Increased preconception TSH level was positively associated with CAPO (odds ratio [OR]/SD: 1.04, 95% confidence interval [CI]: 1.01–1.07) when TSH was ≥2.1 mIU/L, positively associated with pregnancy loss (OR/SD: 1.06, 95% CI: 1.01–1.12) when TSH was <2.1 mIU/L, negatively and positively associated with preterm delivery when TSH levels were <1.3 mIU/L (OR/SD: 0.90, 95% CI: 0.83–0.97) and >3.0 mIU/L (OR/SD: 1.08, 95% CI: 1.00–1.17), respectively. Women with subclinical hypothyroidism before conception were at a higher risk for CAPO (adjusted odds ratio [aOR]: 1.12, 95% CI: 1.04–1.22), while those with subclinical hyperthyroidism had a higher risk of preterm delivery (aOR: 1.31, 95% CI: 1.01–1.70). Conclusions: Nonlinear associations were indicated between preconception TSH levels and pregnancy outcomes. Subclinical thyroid dysfunction before conception was associated with an increased risk of adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Synopsis: This study describes a rare case of a prenatal spontaneous abdominal wall hematoma that occurred in a pregnant woman with severe pre‐eclampsia and upper respiratory tract infection. [ABSTRACT FROM AUTHOR]

The role of IL‐5 in chronic spontaneous urticarial (CSU) is unclear. It may be that benralizumab is an important bidirectional modifier of CSU; that is, blocking IL‐5 may improve CSU in some patients, but it is possible that it may worsen CSU in others. The anti‐interleukin‐5 monoclonal IL‐5‐ (IL‐5) receptor‐α antibody benralizumab is currently proposed as one of the drugs for the treatment of patients with severe chronic spontaneous urticaria (CSU). However, it is possible that benralizumab, as a bidirectional modifier of CSU, may lead to exacerbation of CSU in some patients. [ABSTRACT FROM AUTHOR]

Spontaneous regression (SR) of thymoma is rare. A 44‐year‐old man with right chest pain underwent computed tomography (CT), which showed an 11.0 cm mass in the anterior mediastinum and right pleural effusion. He refused surgery and was sent home without medication and additional treatment. One year later, the mass had regressed to 5.5 cm, and the right pleural effusion had disappeared. He was then lost to follow‐up. Four years after the initial visit, he presented with diplopia and fatigue. A significant increase in his anti‐acetylcholine receptor antibody levels led to myasthenia gravis (MG) diagnosis. CT revealed a regressed mediastinal mass (3.0 cm). After extended thymectomy, histologic analysis confirmed a thymoma type B2, Masaoka stage IIa. The SR was due to intratumoral infarction. This report is the first to describe MG developing during SR. Anterior mediastinal tumors undergoing SR should be differentiated from thymomas and MG perioperative development should be considered. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association between Hox transcript antisenses RNA (HOTAIR) polymorphisms, rs12826786 C/T, rs920778 T/C, rs4759314 A/G, and rs1899663 G/T, with recurrent spontaneous abortion (RSA) susceptibility in the Iranian women. Methods: We enrolled 161 patients diagnosed with RSA and 177 healthy women with at least one live birth without a history of abortion. Genotyping of HOTAIR polymorphisms was carried out using both restriction fragment length polymorphism‐polymerase chain reaction and amplification refractory mutation system‐polymerase chain reaction methods. Odds ratios (ORs) with 95% confidence intervals (CIs) were assessed to estimate the strength of association. Results: Different inheritance models of rs12826786 C/T, rs920778 T/C, and rs1899663 G/T polymorphisms significantly enhanced the risk of RSA (p < 0.05), whereas the rs4759314 A/G polymorphism was correlated with diminished risk of developing RSA under recessive AA versus GA + GG (OR 0.42 [95% CI = 0.19–0.91]), log‐additive GG versus GA vs. GG (OR 0.67 [95% CI = 0.48–0.93]), and allelic A versus G (OR 0.65 [95% CI = 0.47–0.92]) models. Moreover, the TGTC, TTCT, TTTC, CGTC, CGTT, CTCC, CTCT, CTTC, and CTTT haplotypes of rs920778/rs1899663/rs12826786/ significantly increased the risk of RSA. The studied variants were not in strong linkage disequilibrium. Conclusions: Our results indicated that variations in the HOTAIR gene might serve as beneficial biomarkers for determining susceptibility to RSA. To confirm these findings, replication studies with a larger population and different races are needed. [ABSTRACT FROM AUTHOR]

Background: Second‐trimester and early third‐trimester uterine rupture in a nonlaboring woman is a very rare and life‐threatening condition for both mothers and newborns. We aimed to present clinical characteristics, prenatal findings, and maternal and neonatal outcomes following second‐trimester and early third‐trimester spontaneous antepartum uterine rupture in our institute. Method: The medical records of all women with full‐thickness second‐trimester and early third‐trimester uterine rupture treated in our department from 1988 to 2019 were retrieved from the institutional database and reviewed. Small uterine defects, incomplete ruptures, and silent uterine incision dehiscence were excluded. Results: From 1988 to 2019, 213 665 deliveries were recorded in our institute. Of these, 12 patients experienced second‐trimester or early third‐trimester spontaneous uterine rupture. Obstetric history revealed that 50% of the women in each period had undergone previous classical uterine incisions and 50% had a short interpregnancy (IP) interval. The mean age at diagnosis of uterine rupture was 26.3 ± 5.1 weeks. The ruptures were associated with abnormal placentation in 10 cases (83.3%): placenta previa (n = 7); and placenta previa and percreta (n = 3). No maternal mortality occurred. Seven of the 10 (70%) viable newborns survived. Conclusions: The increasing rates of cesarean births (CB) may lead to iatrogenic complications including midgestational prelabor spontaneous uterine rupture, an obstetric emergency, which is hard to diagnose. Maternal and neonatal outcomes can be optimized by a greater awareness of the risk factors, recognition of clinical signs and symptoms, and the availability of ultrasound to assist in establishing a diagnosis to enable prompt surgical intervention. [ABSTRACT FROM AUTHOR]

Objectives: To assess the diagnostic value and impact on management of visualizing on ultrasound an amniotic sac without a live embryo (amniotic sac sign). We also examined the potential effect on the number of follow-up visits in early pregnancy units of incorporating this sign into current diagnostic algorithms.Methods: This was a prospective cohort study of all pregnant women who attended a single specialist early pregnancy unit from July 2017 to November 2018 with symptoms of pain and/or bleeding, or with a history of ectopic pregnancy or miscarriage, at < 14 weeks' gestation. Detailed initial ultrasound findings were documented, including whether an amniotic sac was present in a normally sited intrauterine pregnancy with absence of a live embryo. Women were followed up until a conclusive diagnosis was made.Results: The study included 6012 women who attended our unit with early pregnancy complications during the study period. A conclusive diagnosis was reached on the initial scan in 4221 (70.2%), whilst 1135 (18.9%) women had a pregnancy of uncertain viability and 656 (10.9%) had a pregnancy of unknown location (PUL). All women with a pregnancy of uncertain viability required follow-up ultrasound scans to differentiate between a live pregnancy and early embryonic demise. An amniotic sac in the absence of a live embryo was found in 174/1135 (15.3%) women with a pregnancy of uncertain viability at the initial ultrasound scan. The diagnosis of early embryonic demise was confirmed in all 134 of these women who attended their follow-up scans. The presence of an amniotic sac without a live embryo at the initial visit had a specificity of 100% (95% CI, 98.53-100.00%) and positive predictive value of 100% (95% CI, 97.2-100.0%) for the diagnosis of early pregnancy failure. A total of 1403/6012 (23.3%) women were asked to attend for a follow-up ultrasound scan to resolve diagnostic uncertainties, including 268/656 (40.9%) women with a PUL. The majority of follow-up scans needed to reach a conclusive diagnosis were in women with a pregnancy of uncertain viability (1135/1403 (80.9%)). By using the presence of the amniotic sac sign to diagnose early pregnancy failure at the first visit, the number of follow-up scans for pregnancies of uncertain viability would be reduced by 14.4%, which accounted for 11% of all follow-up scans during the study period.Conclusions: The finding on ultrasound of an amniotic sac without a live embryo (amniotic sac sign) is a reliable marker of early pregnancy failure and could reduce the number of follow-up scans by 11% in cases of diagnostic uncertainty. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Presently, the literature describing the influence of diurnal variation on dynamic cerebral autoregulation (dCA) metrics is sparse. Additionally, there is little data with respect to dCA comparisons between anterior/posterior circulation beds and biological sexes using squat‐stand maneuvers. Eight male and eight female participants (n = 16) performed 5 min of spontaneous upright rest and squat‐stand maneuvers at 0.05 and 0.10 Hz across seven time points throughout the day. All testing sessions commenced at 8:00 a.m. each day and dCA parameters were quantified across the cardiac cycle (diastole, mean, and systole) using transcranial Doppler ultrasound to insonate cerebral blood velocity within the middle and posterior cerebral arteries (MCA, PCA). No cardiac cycle alternations were seen spontaneous (all p >.207) while a trend was noted in some driven (all p >.051) dCA metrics. Driven dCA produced much lower coefficient of variances (all <21%) compared with spontaneous (all <58%). Moreover, no sex differences were found within driven metrics (all p >.096). Between vessels, PCA absolute gain was reduced within all spontaneous and driven measures (all p <.014) whereas coherence, phase, and normalized gain were unchanged (all p >.099). There appears to be little influence of diurnal variation on dCA measures across the day (8:00 a.m. to 6:00 p.m.). Absolute gain was blunted in the PCA relative to the MCA and consistent with previous literature, driven methods demonstrated vastly improved reproducibility metrics compared to spontaneous methods. Finally, no dCA differences were found between biological sexes, demonstrating that males and females regulate in a harmonious manner, when females are tested within the early follicular phase of the menstrual cycle. [ABSTRACT FROM AUTHOR]

Diabetes mellitus may present for the first time with necrotizing fasciitis. Early treatment of septic shock and immediate surgical debridement reduces mortality. A diverting loop colostomy prevents soiling of extensive postdebridement wound. Local wound care together with good glycemic and infection control leads to spontaneous wound closure. [ABSTRACT FROM AUTHOR]

Hydrochar obtained after hydrothermal carbonization (HTC) of Lepironia articulata (LA) was modified into biochar by reacting with a specific amount of KOH in a tubular reactor under slow pyrolysis. The physical and chemical properties of the hydrochar and modified biochar were characterized. The performance of modified biochar (LABC) was investigated through batch sorption experiments. Removal (%) and the maximum adsorption capacity (qmax) of Cr(VI) onto LABC increased up to 98.9% and 28.75 mg/g relative to 63.44% and 21.90 mg/g in unmodified hydrochar (LAHC) at pH 2.0, 313 K, and 200 mg/L, respectively. The sorption kinetics uptake data were best interpreted with pseudo‐second‐order model, and sorption isotherm was simulated with the Langmuir adsorption model. The thermodynamic parameters confirm the adsorption process to be an endothermic, spontaneous, and increased disorder. The overall results revealed that LABC can be utilized as an environmentally friendly, inexpensive, and effective adsorbent in Cr(VI) removal. Practitioner points: Hydrochar and modified biochar prepared from a tropical biomass (Lepironia articulata) were successfully used for the removal of Cr(VI) from aqueous solution.Increased specific surface was obtained by applying chemical modification with alkali treatment, contributing to effectiveness as adsorbent.Dimensionless Kc was estimated from the Langmuir fits and then used to estimate thermodynamics of adsorption.The signs of ∆H°, ∆G°, and ∆S° indicate that the adsorption of Cr(VI) onto LABC was an endothermic, spontaneous, and increased disorder. [ABSTRACT FROM AUTHOR]

Objectives: To describe the occurrence of both peripheral and central auditory system dysfunction in sickle cell anaemia (SCA) patients and discuss the different mechanisms hypothesised to be responsible for these alterations.Methods: An electronic search was conducted using PubMed Central® (MEDLINE), LILACS® and Scopus® databases. This systematic review was performed in accordance with the PRISMA statement. Original observational studies that utilised audiological tests for auditory system evaluations in SCA were included.Results: A total of 183 records were found in the databases searched. Twenty-one of these studies met the inclusion criteria. Pooled prevalence of sensorineural hearing loss (SNHL) was 20.5% (CI: 10.3-33%). Retrocochlear involvement was detected with the auditory brainstem response, which assesses integrity of the cochlea, 8th cranial nerve and brainstem structures. In addition, the increase in otoacoustic emission amplitudes in SCA patients indicates changes in cochlear micromechanics and precedes the expression of a detectable cochlear pathology.Conclusion: The prevalence of the SNHL is higher than in the general population. Dysfunction of the auditory system may be present in SCA patients, with the most probable mechanism being the presence of circulatory disturbances resulting from the chronic inflammatory state of the disease. [ABSTRACT FROM AUTHOR]

Isolation of viable circulating tumor cells (CTC) holds the promise for improving screening, early diagnosis, and personalized treatment of lymphoma. In this study, we isolated and characterized spontaneously immortalized B‐lymphocyte (SIBC) lines from HIV‐infected patients with and without Non‐Hodgkin's Lymphoma (AIDS‐NHL). A total of 22 SIBC lines was isolated from peripheral blood mononuclear cells (PBMC) of HIV‐infected patients with (n = 40) and without (n = 77) clinically detectable NHL, but not from healthy individuals (n = 34). Of these, 8 SIBC lines named HIV‐SIBC were generated from HIV‐infected patients without AIDS‐NHL (10%, 8/77), while 14 SIBCs named AIDS‐NHL‐SIBC were from 13 of the AIDS‐NHL patients (32.5%, 13/40). Among the 14 AIDS‐NHL‐SIBCs, 12 were derived from AIDS‐NHL patients with poor prognoses (survival time less than 1 year). SIBCs displayed markers typical of memory B cells (CD3‐CD20+CD27+) with EBV infection. Moreover, AIDS‐NHL‐SIBCs were representative of CTC as evidenced by monoclonal Ig gene rearrangement, abnormal chromosomal karyotype, and the formation of xenograft tumors, while HIV‐SIBCs generated harbored some features of tumor cells, none had the capacity of xenograft tumor formation, suggesting HIV‐SIBC present the precursor of CTC. These results indicate that SIBCs is associated with poor prognosis in AIDS‐NHL patients and can be isolated from HIV‐infected patients with NHL and without NHL. This findings point to the need for further molecular characterization and functional studies of SIBCs, which may prove the value of SIBCs in the diagnosis, prognoses, and screening for NHL among HIV‐infected patients. [ABSTRACT FROM AUTHOR]

Small cell lung cancer (SCLC) is a unique tumor that has a distinct clinical behavior and dismal prognosis. If untreated, it can become aggressively malignant, and life expectancy could be limited to weeks. Spontaneous regression of lung cancer has rarely been reported, and among them SCLC is even rarer. The underlying mechanisms of spontaneous regression are poorly understood. Here, we report a case of complete spontaneous SCLC remission in an elderly patient. [ABSTRACT FROM AUTHOR]

Background: Miscarriage can result in significant psychological morbidity. Research suggests health professionals play a role in shaping women's experience of miscarriage. Aims: This study explored the views and practices of Australian health professionals in caring for women experiencing miscarriage. Materials and Methods: Twelve health professionals from disciplines including medicine, midwifery and sonography were purposively sampled. Semi‐structured interviews were recorded, transcribed and subjected to thematic analysis. Results: Participants acknowledged miscarriage is often a distressing event associated with feelings of grief and failure. They believed women who conceived through in vitro fertilisation, had experienced multiple miscarriages, or had a pre‐existing mental illness were likely to experience more distress than others. Despite limited training, participants generally felt competent in their abilities to provide emotional support. They viewed their role largely as guilt‐mitigation, which they achieved by stressing the frequency of miscarriage and emphasising that women were not at fault. Follow‐up practices varied, and where they did occur, focused on physical recovery. Generally, participants relied on women to express the need for further support. Participants reported that time and resource issues, compassion fatigue and a need for self‐protection restricted their abilities to provide better support care. Conclusions: There are discrepancies between the emotional support health professionals think women want and are able to provide, and the support women would like. This exploratory study suggests the need for further investigation into provision of improved health professional support for women. [ABSTRACT FROM AUTHOR]

The interventricular septal dissection is an uncommon, and is occasionally associated with sinus of Valsalva aneurysm. A spontaneous dissection with a normal sinus of Valsalva is extremely rare and is mostly a result of a congenital defect. We report the case of a 23‐year‐old male admitted for complete heart block and presenting as an incidental finding during the TTE multiple and huge cystic‐like mass in the interventricular septum (IVS) which is the TTE characteristic of IVS dissection. Most patients remain asymptomatic until the anatomical and hemodynamic changes lead to complications like: severe aortic regurgitation with heart failure and conduction abnormalities. Although transthoracic echocardiogram (TTE) has been the first‐line imaging modality for such findings, cardiac computed tomography (CT) and magnetic resonance imaging have been increasingly used as supplemental or confirmatory tests. The imaging modalities showed a perforation of right sinus of Valsalva causing the expansion of the dissection to the apex. The patient underwent surgical repair with satisfying results. In conclusion, we report an extremely rare clinical case of spontaneous dissection of the interventricular septum using multiple imaging techniques and with a successful surgery. [ABSTRACT FROM AUTHOR]

Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse drug effect consisting of bone destruction of the maxilla and/or mandible. The most common precipitating event described in the literature is the extraction of a tooth followed by "spontaneous" occurrence with no clear predisposing event. Current studies are investigating methods of managing dental extractions in patients at risk of MRONJ; however, no studies to date examine the aetiology and management of "spontaneous" MRONJ. This paper describes two cases of "spontaneous" MRONJ seen at the Dental Unit in the Alfred Hospital and systematically reviews the current literature. No significant interactions (P > 0.05) were detected between variables: age, sex, bone disease, antiresorptive, antiresorptive duration, jaw, location and stage. "Spontaneous" cases were commonly associated with the mylohyoid ridge, palatal tori and other anatomical sites, and tended to occur in those generally considered at low risk of developing MRONJ. The review suggests that perhaps the term "spontaneous" is a misnomer and thorough history taking is critical in establishing a precipitating event. [ABSTRACT FROM AUTHOR]

Superficial arteriovenous fistulae in the absence of other complicating features can be easily treatable with simple surgical excision. In this case, the patient's troublesome symptoms were completely cured with a straightforward procedure. [ABSTRACT FROM AUTHOR]

In this case report, we describe a patient with a chronological relationship between exacerbations of chronic spontaneous urticaria and remissions of concomitant generalized plaque psoriasis. [ABSTRACT FROM AUTHOR]

Somatic mutations accumulate in the human genome and are correlated with increased cancer incidence as humans age. The standard model for studying the carcinogenic effects of exposures for human risk assessment is the rodent 2‐year carcinogenicity assay. However, there is little information regarding the effect of age on cancer‐driver gene mutations in these models. The mutant fraction (MF) of Kras codon 12 GGT to GAT and GGT to GTT mutations, oncogenic mutations orthologous between humans and rodents, was quantified over the lifespan of B6C3F1 mice. MFs were measured in lung and liver tissue, organs that frequently develop tumors following carcinogenic exposures. The MFs were evaluated at 4, 6, 8, 12, 21, and 85 weeks, with the 12‐week and 21‐week time points being coincident with the conclusion of 28‐day and 90‐day exposure durations used in short‐term toxicity testing. The highly sensitive and quantitative Allele‐specific Competitive Blocker PCR (ACB‐PCR) assay was used to quantify the number of mutant Kras codon 12 alleles. The mouse lung showed a slight, but significant trend increase in the Kras codon 12 GAT mutation over the 85‐week period. The trend with age can be equally well‐fit by several non‐linear functions, but not by a linear function. In contrast, the liver GAT mutation did not increase, and the GTT mutation did not increase for either organ. Even with the slight increase in the lung GAT MFs, our results indicate that the future use of Kras mutation as a biomarker of carcinogenic effect will not be confounded by animal age. Environ. Mol. Mutagen. 59:715–721, 2018. Published 2018. This article is a U.S. Government work and is in the public domain in the USA. [ABSTRACT FROM AUTHOR]

Background: First trimester miscarriage affects 20% of pregnancies. Medical management has a high degree of patient acceptance and does not increase the risk of infection. Mifepristone is an anti‐progesterone shown to improve outcomes when used in conjunction with misoprostol for first trimester abortion. However, there have been conflicting results when it has been added to treatment regimens for miscarriage. Methods: We performed a retrospective cohort analysis of women presenting to the Acute Gynaecology Service of our tertiary referral centre for miscarriage management from December 2010 until December 2013. Patients given misoprostol alone were compared to those who received combination treatment with mifepristone and misoprostol. Primary outcome was failure of treatment determined by the need for repeat medical management or surgical curettage. Secondary outcome was need for hospital admission. Results: A total of 281 women were treated from December 2010 to December 2013: 179 received combined mifepristone and misoprostol and 102 received misoprostol only. The primary outcome was significantly different between the two groups; 73% of women in the mifepristone and misoprostol group required no further treatment compared to only 56% of women in the misoprostol only group (P = 0.012). There were fewer hospital admissions, with 24% in the combined therapy group being admitted compared to 42% in the misoprostol only group (P < 0.001). Conclusion: The addition of mifepristone to medical treatment regimens for first trimester miscarriage significantly decreased the need for repeat medical dosing and surgical curettage. Hospital admissions were also significantly decreased. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to compare pregnancy outcomes in twin pregnancies after assisted conception and spontaneous conception, according to chorionicity.Material and Methods: Retrospective cohort study of 1305 twin pregnancies between 1995 and 2015. All spontaneous (n = 731) and assisted conception conceived (n = 574) twin pregnancies with antenatal care and delivery in University Medical Center Utrecht, the Netherlands, a tertiary obstetric care center were studied according to chorionicity.Results: Maternal age and incidence of nulliparity were higher among the assisted conception twins. Hypertensive disorders also appeared to be more frequent in assisted conception pregnancies, which could largely be explained by the higher proportion of elderly nulliparous women in this group. Spontaneously conceived twins were born earlier than twins after assisted conception, with subsequent lower birthweights and more admissions to a neonatal intensive care unit with increased neonatal morbidity. Monochorionic twins had worse pregnancy outcomes compared with dichorionic twins, irrespective of mode of conception; monochorionic twins conceived by assisted reproduction had more neonatal morbidity (mainly respiratory distress syndrome and necrotizing enterocolitis) and late neonatal deaths compared with spontaneously conceived monochorionic twins.Conclusions: Spontaneously conceived twins have worse pregnancy outcome compared with twins after assisted conception, probably due to a lower incidence of monochorionicity in the assisted conception group. The already increased perinatal risks in monochorionic twins are even higher in monochorionic twins conceived after infertility treatments compared with spontaneously conceived monochorionic twins, which warrants extra attention to these high-risk pregnancies. [ABSTRACT FROM AUTHOR]

Background: Karyotype determination has a central role in the genetic workup of pregnancy loss, as aneuploidy (trisomy and monosomy) and polyploidy (triploidy and tetraploidy) are the cause in at least 50% of first trimester, 25% of second trimester, and 11% of third trimester miscarriages. There are several limitations with the current approaches of obtaining a karyotype using traditional cytogenetics, fluorescence in situ hybridization with a limited number of probes, and chromosomal microarray. These include culture failure, incomplete results, lower sensitivity, and longer reporting time. Methods: To overcome current limitations, a novel molecular assay is developed with a Standard Resolution Interphase Chromosome Profiling probe set which is a variation of the recently developed High Resolution probe set. It generates a molecular karyotype that can detect all major changes commonly associated with pregnancy loss. Initial familiarization of signal patterns from the probe set was used, followed by validation of the method using 83 samples from miscarriages in a blind study from three different laboratories. Finally, the clinical utility of the method was tested on 291 clinical samples in two commercial reference laboratory settings on two different continents. Results: The new molecular approach not only identified all the chromosome changes observed by current methods, but also significantly improved abnormality detection by characterizing derivative chromosomes and finding subtle subtelomeric rearrangements, balanced and unbalanced. All Robertsonian translocations were also detected. The abnormality rate was 54% on clinical samples from commercial laboratory 1 and 63% from laboratory 2. Conclusion: The attributes of this method make it an ideal choice for the genetic workup of miscarriages, namely (1) near 100% successful results, (2) greater sensitivity than conventional chromosome analysis or FISH panels, (3) rapid reporting time, and (4) favorable comparisons with chromosomal microarray. [ABSTRACT FROM AUTHOR]

It has been the matter of much debate whether perceivers are able to distinguish spontaneous vocal expressions of emotion from posed vocal expressions (e.g., emotion portrayals). In this experiment, we show that such discrimination can be manifested in the autonomic arousal of listeners during implicit processing of vocal emotions. Participants (N = 21, age: 20–55 years) listened to two consecutive blocks of brief voice clips and judged the gender of the speaker in each clip, while we recorded three measures of sympathetic arousal of the autonomic nervous system (skin conductance level, mean arterial blood pressure, pulse rate). Unbeknownst to the listeners, the blocks consisted of two types of emotional speech: spontaneous and posed clips. As predicted, spontaneous clips yielded higher arousal levels than posed clips, suggesting that listeners implicitly distinguished between the two kinds of expression, even in the absence of any requirement to retrieve emotional information from the voice. We discuss the results with regard to theories of emotional contagion and the use of posed stimuli in studies of emotions. [ABSTRACT FROM AUTHOR]

Abstract: Background: Simultaneous bilateral spontaneous pneumothorax (SBSP) is an uncommon condition with limited data on its incidence in the literature. In this study, we aimed to describe the bilaterality in both primary and secondary spontaneous pneumothorax cases, and the clinical approach in simultaneous disease and prognosis of these patients. Methods: A total of 16 patients who were followed with the diagnosis of bilateral spontaneous pneumothorax between January 2005 and January 2017 were retrospectively analyzed. The patients were divided into two groups: secondary spontaneous pneumothorax (SSP; Group 1, n = 11) and primary spontaneous pneumothorax (PSP; Group 2, n = 5). Demographic data, underlying lung pathologies, treatments applied, clinical findings and survival data were recorded. Results: Of the patients in Group 1, four (36.3%) had chronic obstructive pulmonary disease (COPD), three (27.3%) had granulomatous lung disease, two (18.2%) had idiopathic pulmonary fibrosis, one (9.1%) had bronchiectasis and one (9.1%) had hypersensitivity reaction. Of these patients, four had bilateral tube thoracostomy, four had unilateral tube thoracostomy and the remaining three received medical treatment under follow‐up. Of the Group 1 patients, six (54.6%) died during the 72‐month follow‐up period, while only one of these patients had COPD. All patients in Group 2 were treated using bilateral video‐assisted thoracoscopic surgery either in the first or the second episode. Conclusions: These results suggest that simultaneous and bilateral occurrence of SPP is an indicator of an advanced lung pathology with a poor prognosis. [ABSTRACT FROM AUTHOR]

Objectives To review the safety and efficacy of surgical management for spontaneous cerebrospinal fluid (CSF) leaks of the anterior and lateral skull base. Data Sources A systematic review of English articles using MEDLINE. Review Methods Search terms included spontaneous, CSF, cerebrospinal fluid, endoscopic, middle fossa, transmastoid, leak, rhinorrhea. Independent extraction of articles by 3 authors. Results Patients with spontaneous CSF leaks are often obese (average BMI of 38 kg/m2) and female (72%). Many patients also have obstructive sleep apnea (∼45%) and many have elevated intracranial pressure when measured by lumbar puncture. In addition to thinning of the skull base, radiographic studies also demonstrate cortical bone thinning. Endoscopic surgical repair of anterior skull base leaks and middle cranial fossa (MCF) approach for repair of lateral skull base leaks are safe and effective with an average short-term failure rate of 9% and 6.5%, respectively. Long-term failure rates are low. One randomized trial failed to show improved success of anterior leak repairs with the use of a lumbar drain (LD) (95% with vs. 92% without; P = 0.2). In a large retrospective cohort of MCF lateral skull base repairs, perioperative LD use was not necessary in >94% of patients. Conclusions Spontaneous CSF leaks are associated with female gender, obesity, increased intracranial hypertension, and obstructive sleep apnea. Endoscopic repair of anterior skull base leaks and MCF or transmastoid approaches for lateral skull base leaks have a high success rate of repair. In most cases, intraoperative placement of lumbar drain did not appear to result in improved success rates for either anterior or lateral skull base leaks. Level of Evidence 2a, Systematic Review. [ABSTRACT FROM AUTHOR]

Key Clinical Message Spontaneous quadriceps tendon rupture is a rare occurrence in patients with primary hyperparathyroidism ( PHPT), which is less common in adolescents. We first reported a spontaneous unilateral rupture in a young patient with PHPT. [ABSTRACT FROM AUTHOR]

Background: Classifying preterm birth as spontaneous or indicated is critical both for clinical care and research, yet the accuracy of classification based on different data sources is unclear. We examined the accuracy of preterm birth classification as spontaneous or indicated based on birth certificate data.Methods: This is a retrospective cohort study of 123 birth certificates from preterm births in Missouri. Correct classification of spontaneous or indicated preterm birth subtype was based on multi-provider (RN, MFM Fellow, MFM attending) consensus after full medical record review. A categorisation algorithm based on clinical data available in the birth certificate was designed a priori and classification was performed by a single investigator according to the algorithm. Accuracy of birth certificate classification as spontaneous or indicated was compared to the consensus classification. Errors in misclassification were explored.Results: Classification based on birth certificates was correct for 66% of preterm births. Most errors in classification by birth certificate occurred in classifying a birth as spontaneous when it was in fact indicated. The vast majority of errors occurred when preterm rupture of membranes (≥12 h) was checked on the birth certificate causing classification as spontaneous when there was a maternal or fetal indication for delivery.Conclusions: Birth certificate classification overestimated spontaneous preterm birth and underestimated indicated preterm birth compared to classification performed from medical record review. Revisions to birth certificate clinical data would allow more accurate population level surveillance of preterm birth subtypes. [ABSTRACT FROM AUTHOR]

Objectives: (1) Correlate skull base thickness with perioperative outcomes for spontaneous cerebrospinal fluid (CSF) otorrhea. (2) Augment perioperative counseling of patients with abnormally thin skull bases.Study Design: Case series with chart review.Setting: Tertiary center. Patients with spontaneous CSF otorrhea have thin skull bases. This is associated with obesity and/or idiopathic intracranial hypertension. The influence of skull base thinning on perioperative outcomes is unknown.Subjects and Methods: A retrospective review was conducted from 2004 to 2014. Forty-eight cases of spontaneous CSF otorrhea met the inclusion criteria of primary surgery by the senior authors: preoperative dedicated temporal bone computed tomography, absence of other leak etiologies, and follow-up >6 months. Patients were stratified into thin (<0.9 mm) and thick (>0.9 mm) groups based on computed tomography measures of their tegmen. Primary outcomes measures were as follows: postoperative meningitis, recurrent leak, second site leak (contralateral ear/anterior fossa), and permanent shunt placement. Hearing outcomes were not assessed in this study.Results: Thirty and 15 patients composed the thin and thick groups, respectively. Both the incidence (P < .0001) and the rate (P = .005) of adverse outcomes were significantly higher in the thin group. Only 2 patients in the thick group experienced an adverse outcome. Eleven patients underwent multiple procedures for spontaneous leaks. The recurrence rate was 14.5%. All but 1 recurrence occurred in the thin group.Conclusions: An abnormally thin tegmen was significantly associated with adverse perioperative outcomes in cases of spontaneous CSF otorrhea. A thick skull base and the presence of an encephalocele may be protective against recurrence. The effect of untreated intracranial hypertension on the results is unknown. [ABSTRACT FROM AUTHOR]

Background Pathological fractures are a significant and often devastating event in the progression of metastatic bone disease. They are frequently a marker of end-stage cancer and the end of functional independence. Although several studies look into prognosis following the development of metastatic lesions, few look into the prognosis after the fracture itself. This study investigates the variables affecting prognosis in patients suffering pathological fractures. Method Retrospective clinical audit of 72 patients from the Orthopaedic Unit at Fremantle Hospital in Western Australia. The variables of interest include primary cancer, fracture site, method of fixation, use of cement augmentation, appendicular metastatic load, spinal metastatic load, presence of visceral metastases, patient co-morbidities and functional scoring before and after the fracture has occurred. Results The median time between diagnosis of cancer to pathological fracture was 8.3 months, while the median survival post-fracture was 3.3 months. There is a statistically significant correlation between patient survival and primary cancer type, spinal metastatic burden and functional performance score. Conclusion Overall, the prognosis following pathological fracture is extremely poor. We propose that these variables are scrutinized by the treating orthopaedic team preoperatively to help guide management and provide patients and their families with a realistic expectation of functional outcome and survival time. [ABSTRACT FROM AUTHOR]

Background We report the causes of mortality for 4350 captive baboons that died or were euthanized due to natural causes during a 23 year period at the Southwest National Primate Research Center. Methods Necropsy records were retrieved and reviewed to determine a primary cause of death or indication for euthanasia. Data was evaluated for morphological diagnosis, organ system, and etiology. Results The 20 most common morphologic diagnoses accounted for 76% of the cases, including stillborn (10.8%); colitis (8.6%); hemorrhage (8.4%); ulcer (5.2%); seizures (4.7%); pneumonia (4.2%); inanition (4.1%); dermatitis (3.8%); spondylosis (3.3%); and amyloidosis (3.0%). The digestive system was most frequently involved (21.3%), followed by the urogenital (20.3%), cardiovascular (12.2%), and multisystem disease (10.3%). An etiology was not identified in approximately one-third of cases. The most common etiologies were trauma (14.8%), degenerative (9.5%), viral (8.7%), and neoplastic/proliferative (7.0%). Conclusion This information should be useful for individuals working with baboons. [ABSTRACT FROM AUTHOR]

Background Spontaneous cerebrospinal fluid (CSF) leaks/encephaloceles are proven to be associated with intracranial hypertension by objective measurements of CSF pressure during or following endoscopic repair. A common area of involvement is a pneumatized lateral recess of the sphenoid (LRS) sinus, where prolonged intracranial pressures lead to arachnoid pits and subsequent development of skull-base defects. Even though the LRS is never present at birth, a 'congenital' cause of these leaks due to a persistent Sternberg's (lateral craniopharyngeal) canal continues to be erroneously perpetuated in the literature. The objective of this study was to eliminate the myths defining these leaks as congenital in nature. Methods Evaluation of LRS CSF leaks present within a multiinstitutional case series was performed. Data regarding demographics, body mass index (BMI), radiologic evaluation of intracranial hypertension, and direct intracranial pressure measurements (when available) were collected. Results Data evaluation identified 77 LRS CSF leaks in 59 patients (mean age 52 years). Obesity was present in 83% of individuals (mean BMI 36) and 81% were females. Radiologic evidence of intracranial hypertension (eg, empty sella, dilated optic nerve sheaths, and scalloped/attenuated bone) was present on 96% of preoperative computed tomography (CT) and/or magnetic resonance imaging (MRI) scans. Opening or postsurgical lumbar drain or ventriculostomy pressure measurements were elevated in 95% of patients (mean 27.7; range, 9-50 cmH2O). Conclusion This study provides objective evidence that LRS CSF leaks are secondary to erosions from intracranial hypertension and refutes the myth regarding a congenital origin from Sternberg's canal. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Mounting evidence indicates the majority of spontaneous cerebrospinal fluid (CSF) leaks are associated with intracranial hypertension. The objectives of the current study were to assess outcomes regarding spontaneous CSF leaks focusing on premorbid factors, surgical technique, and management of intracranial pressure. Study Design Prospective cohort. Methods Prospective evaluation of patients with spontaneous CSF leaks was performed. Data regarding demographics, nature of presentation, body mass index (BMI), location and size of defect, intracranial pressure, clinical follow-up, and complications were collected. Results Over 5 years, 46 patients (average age, 51 years) with 56 spontaneous CSF leaks were treated by a single otolaryngologist. Twenty-one subjects presented with recurrence of their CSF leak following previous endoscopic and/or open approaches by other physicians. Obesity was present in 78% of individuals (average BMI, 35.6). Fifty-two CSF leaks (93%) were successfully repaired at first attempt. With secondary repair, all CSF leaks were closed at last clinical follow-up (average, 93 weeks). Three patients developed late failures (>2 months), with one recurrence at a distinct location from the primary site at 8 months postprocedure (associated with ventriculoperitoneal shunt failure). Opening pressures via lumbar puncture averaged 24.3 ± 8.3 cm H20, which increased significantly to 32.3 ± 9.0 cm H20 ( P < .0001) following closure of the skull base defect(s). Management of intracranial hypertension included acetazolamide (n = 23) or permanent CSF diversion (n = 19, including five revisions of failed preexisting shunts). Conclusions Although spontaneous CSF leaks have the highest recurrence rate of any etiology, prospective evaluation demonstrates high success rates with control of intracranial hypertension. Level of Evidence 4. Laryngoscope, 124:70-75, 2014 [ABSTRACT FROM AUTHOR]