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Uterine rupture during labor is a serious complication resulting in maternal and neonatal morbidity and mortality. We present the extremely rare case of a 38-year-old gravid woman admitted with labor pain at term, about to experience a uterine rupture during labor. She had previously twice delivered vaginally, and during her third pregnancy had a low transverse Cesarean section. Prior to arriving at the hospital with labor pains, she had routine prenatal care with normal prenatal laboratory tests. One day the woman reported to having sudden epigastric pain, and 40 minutes after her admission a pelvic exam was completed. The unborn baby had a persistent revealed, and a live neonate was promptly delivered with an Apgar score of 1 at one minute and 5 at five minutes. On the fifth postoperative day the woman and her baby were discharged home with no maternal and neonatal complications.

Musashi RNA-binding protein 2 (MSI2) has important roles in human cancer. However, the regulatory mechanisms by which MSI2 alters breast cancer pathophysiology have not been clearly identified. Here we demonstrate that MSI2 directly regulates estrogen receptor 1 (ESR1), which is a well-known therapeutic target and has been shown to reflect clinical outcomes in breast cancer. Based on gene expression data analysis, we found that MSI2 expression was highly enriched in estrogen receptor (ER)-positive breast cancer and that MSI2 expression was significantly correlated with ESR1 expression, including expression of ESR1 downstream target genes. In addition, MSI2 levels were associated with clinical outcomes. MSI2 influenced breast cancer cell growth by altering ESR1 function. MSI2 alters ESR1 by binding specific sites in ESR1 RNA and by increasing ESR1 protein stability. Taken together, our findings identified a novel regulatory mechanism of MSI2 as an upstream regulator of ESR1 and revealed the clinical relevance of the RNA-binding protein MSI2 in breast cancer.

Background: Extranodal natural killer/T-cell lymphoma (NKTCL) is a clinically heterogeneous disease with a poor prognosis, requiring risk-stratified management in affected patients. Recently, tumor microenvironment including regulatory T cells (Tregs) has been implicated as a prognostic marker in certain types of lymphoma. Patients and methods: We collected 64 NKTCL cases and numerically quantified the amount of tumor-infiltrating FOXP3-positive Tregs by automated slide scanning and image analysis program after immunohistochemical staining using anti-FOXP3 antibody. Results: Patients were able to be classified into two end groups by their level of Tregs. Twenty-eight (44%) patients had Tregs

To evaluate the prognostic significance of positron emission tomography/computed tomography (PET/CT) in patients diagnosed with cervical cancer.Patients with cervical cancer in FIGO Stages IB1 to IVB were imaged with PET/CT prior to treatment during one of the staging work-ups. The patients were observed for a median of 31.4 months (range, six to 89 months) after the initial treatment. The standardized uptake value (SUV) max of the primary cervical tumor mass was compared with the prognostic factors. RESULTs: A total of 81 patients who were primarily treated with radical hysterectomy (RH, n = 45) or concurrent chemoradiation (CCRT, n = 36) were analyzed. Multivariate analysis indicated that larger tumor size (4 cm, OR 8.694, 95% CI, 1.638-46.146), deep stromal invasion (≥ 1 cm, OR 7.249, 95% CI, 1.141-46.039) by the primary tumor, and pathologically confirmed pelvic lymph node involvement (positive, OR 14.586, 95% CI, 2.072-102.674) were significantly associated with recurrence after treatment. However, pretreatment SUVmax was not a significant independent predictor of disease recurrence (OR 1.058, 95% CI, 0.255-4.398).[18F]Fluorodeoxyglucose (FDG) uptake by the primary tumor showed a significant association with several risk factors that have been identified as treatment predictors. However, a high pretreatment SUVmax was not predictive of recurrence in uter- ine cervical cancer patients.

To present the authors' experience with laparoendoscopic single-site surgery (LESS) surgery for large benign adnexal tumors and to compare the removal time of resected specimen with that of conventional laparoscopy.Ten consecutive patients underwent LESS for huge adnexal tumors at Myongjil Hospital, Korea between March 2011 and July 2012. A modified open Hasson technique was used to gain access to the abdominal cavity. The single-port device was inserted trans-umbilically into the wound opening. After suction of large amount of fluid content, LESS salpingo-oophorectomy was performed. The resected adnexal specimen was placed into a LapBag for removal out of the abdominal cavity. The authors compared the removal time of resected specimen between LESS and previously performed conventional laparoscopy for large benign adnexal tumors.The adnexal tumors in this study were all very large cystic tumors reaching near or over the umbilicus. It took less than ten minutes for the removal of the resected adnexal tumors in all LESS cases (three to ten minutes), much less time than that of the conventional laparoscopy (usually ten to 17 minutes).LESS for large benign adnexal tumors is feasible and removal of resected adnexal tumor is easier than conventional laparoscopic surgery.

Excessive acetabular cover secondary to a retroverted acetabulum causes pincer impingement, which may cause early osteoarthritis of the hip. Our aim was to determine if there was a relationship between acetabular version and osteoarthritis of the hip. Using image processing and analysis software we studied 117 CT images of the hip in patients aged less than 65 years who had undergone a CT virtual colonoscopy. The mean CT joint space of the 18 hips with acetabular retroversion was narrower compared with the 99 hips with normal acetabular alignment (p < 0.0001). A correlation of r = 0.46 (p < 0.01) was found between right hip acetabular version and the mean right hip joint space and of r = 0.31 (p = 0.02) between left hip acetabular version and the mean left hip joint space. Acetabular retroversion is associated with radiological evidence of osteoarthritis of the hip. An understanding of the mechanical basis of osteoarthritis of the hip allows early treatment of the underlying structural abnormality and prevents progression of the degenerative condition.

The ABG I uncemented hip prosthesis has demonstrated an unacceptably high failure rate and poor functional outcome in our patients. A prospective review was performed of 38 implanted hips with a mean follow-up of 11 years. Sixteen hips have been revised or are candidates for revision hip surgery, due principally to polyethylene wear and pelvic osteolysis. Contributing factors were likely to be the poor wear characteristics of the polyethylene liners—which were gamma irradiated in air—and the thinness of these liners. Of further concern were the poor pain and function scores in the remaining hips [mean Harris Hip Scores (HHS) of 70 (SD 22) at 11-year follow-up]. The influence of the surgical learning curve on clinical results may have been an important factor. Undersized femoral components were associated with poor pain and functional scores in five patients with HHS < 60. All ABG I hip implants must remain under careful, long-term review.

Wider application of CT angiography (CTA) improves the diagnosis of acute pulmonary embolism (PE). It also permits the visualisation of saddle embolism (SE), namely thrombi, which are located at the bifurcation of the main pulmonary artery. The aim of this study was to assess the prevalence of SE and whether SE predicts a complicated clinical course in patients with non-high-risk PE.In total, 297 consecutive patients with non-high-risk PE confirmed using CTA in the emergency department were studied. The presence of SE and its ability to predict the occurrence of major adverse events (MAEs) within 1 month were determined.Of the 297 patients, 27 (9.1%) had an SE. The overall mortality at 1 month was 12.5%; no significant difference was observed between the SE and non-SE groups (18.5% vs 11.9%, p=0.32). However, patients with SE were more likely to receive thrombolytic therapy (29.6% vs 8.1%, p0.01) and had significantly more MAEs (59.3% vs 25.6%, p0.01).At the time of diagnosis, SE, as determined using CTA, is associated with the development of MAE within 1 month. It may be a simple method for risk stratification of patients with non-high-risk PE.The prognosis of patients with SE, especially those who are haemodynamically stable, is unclear. This study shows that patients with SE, determined with CTA, is associated with the development of MAE.

Mutations in the gene for desmoplakin (DSP) may cause arrhythmogenic right ventricular cardiomyopathy (ARVC) and Carvajal syndrome (CS). Desmoplakin is part of all desmosomes, which are abundantly expressed in both myocardial and epidermal tissue and serve as intercellular mechanical junctions. This study aimed to investigate protein expression in myocardial and epidermal tissue of ARVC and CS patients carrying DSP mutations in order to elucidate potential molecular disease mechanisms. Genetic investigations identified three ARVC patients carrying different heterozygous DSP mutations in addition to a homozygous DSP mutation in a CS patient. The protein expression of DSP in mutation carriers was evaluated in biopsies from myocardial and epidermal tissue by immunohistochemistry. Keratinocyte cultures were established from skin biopsies of mutation carriers and characterized by reverse transcriptase polymerase chain reaction, western blotting, and protein mass spectrometry. The results showed that the mutation carriers had abnormal DSP expression in both myocardial and epidermal tissue. The investigations revealed that the disease mechanisms varied accordingly to the specific types of DSP mutation identified and included haploinsufficiency, dominant-negative effects, or a combination hereof. Furthermore, the results suggest that the keratinocytes cultured from patients are a valuable and easily accessible resource to elucidate the effects of desmosomal gene mutations in humans.

This study sought to study the effect of high intensity aerobic interval endurance training on peak stroke volume and maximal strength training on mechanical efficiency in coronary artery disease (CAD) patients. 8 CAD patients (age 61.4 ± 3.7 years) trained 30 interval training sessions with 4 × 4 min intervals at 85-95% of peak heart rate while 10 CAD patients (age 66.5 ± 5.5 years) trained 24 sessions of maximal horizontal leg press. In the interval training group peak stroke volume increased significantly by 23% from 94.1 ± 23.0 mL · beat (-1) to 115.8 ± 22.4 mL · beat (-1) (p

The purpose of this study was to determine if HPV DNA testing improves the accuracy of detecting possible high-grade cervical lesions in women with atypical squamous cells of undetermined significance (ASC-US).Cervical cytology and Hybrid Capture II (HCII) assay for HPV DNA detection was performed in 10,526 women from July 2005 to July 2007. Two hundred and sixty women with ASC-US underwent colposcopy-directed biopsy to determine the final histologic diagnosis. They were divided into two groups according to the positivity of the HPV DNA test, and the respective biopsy results were compared.Positive HCII was significantly more associated with CIN 2, CIN 3, and invasive cancer than negative HCII (p0.001). The odds ratio of positive HPV DNA testing in detecting high-grade lesions was 7.0 (95% CI; 2.8-17.7).The HPV DNA test is useful for predicting the severity of lesions of the uterine cervix and formulating decisions with regard to treatment plans.

Our aim was to know preoperative magnetic resonance imaging (MRI) can accurately predict lymph node metastasis (LNM) and deep myometrial invasion (DMI,or = 50%) in patients with uterine cancer.From January 1997 to December 2006, 99 patients who were diagnosed with uterine cancer and surgically staged at our institution were retrospectively analyzed. Preoperative clinicopathologic characteristics and MRI findings were reviewed and compared with LNM status and DMI observed in the final pathology.The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) for MRI in determination of pelvic LNM were 77.7%, 85.6%, 35.0%, and 94.7%, respectively. MRI failed to detect the presence of paraaortic LNM in all of the three patients with positive paraaortic lymph nodes. The sensitivity, specificity, PPV, and NPV for MRI in determining DMI were 46.6%, 84.5%, 35%, and 89.8%, respectively.Preoperative evaluation of uterine cancer by MRI does not accurately predict the LNM and DMI.

Congenital dislocation of the patella may be a phenotype, which has several genotypes, i.e. it may be congenital or acquired. This hypothesis is suggested with three illustrative case studies. Risk factors predictive of the development of irreducible dislocation of the patella in infancy are suggested. As there is a spectrum of possible aetiologies, 'late' diagnosis and a number of 'risk' factors but a common pathology, the word 'congenital' is not always appropriate. We suggest 'Developmental dysplasia and dislocation of the patella (DDDP)' is a more appropriate term for this rare condition.

Current 2D black blood coronary vessel wall imaging suffers from a relatively limited coverage of the coronary artery tree. Hence, a 3D approach facilitating more extensive coverage would be desirable. The straightforward combination of a 3D-acquisition technique together with a dual inversion prepulse can decrease the effectiveness of the black blood preparation. To minimize artifacts from insufficiently suppressed blood signal of the nearby blood pools, and to reduce residual respiratory motion artifacts from the chest wall, a novel local inversion technique was implemented. The combination of a nonselective inversion prepulse with a 2D selective local inversion prepulse allowed for suppression of unwanted signal outside a user-defined region of interest. Among 10 subjects evaluated using a 3D-spiral readout, the local inversion pulse effectively suppressed signal from ventricular blood, myocardium, and chest wall tissue in all cases. The coronary vessel wall could be visualized within the entire imaging volume.

We used tissue velocity imaging (TVI) and three-dimensional echocardiography to evaluate the effect of acute biventricular pacing on left ventricular (LV) performance and volumes in patients with severe heart failure and bundle branch block.Biventricular pacing causes acute hemodynamic improvement in patients with severe heart failure, and QRS duration has been used as a predictor of improved resynchronization. Tissue velocity has the potential of demonstrating the degree of LV resynchronization and three-dimensional echocardiography enables accurate quantitation of LV volumes and function.TVI and three-dimensional echocardiography were performed during sinus rhythm and biventricular pacing in 25 consecutive patients with severe heart failure.Biventricular pacing significantly improved the extent of contracting myocardium in synchrony by 15.4% and the duration of contraction synchrony by 17% (p0.05 for both). Furthermore, end-diastolic and end-systolic volumes decreased by 7 +/- 4.5% and 13 +/- 6% (p0.01) and ejection fraction increased by 22.8 +/- 9% (p0.01). Baseline duration of QRS and the preejection period as well as the extent of myocardium with asynchronous contraction measured by TVI predicted pacing efficacy. In multivariate analysis, only the extent of myocardium with asynchronous contraction at the LV base predicted biventricular pacing efficacy.Biventricular pacing improves LV systolic performance and reduces LV volumes during short-term treatment. TVI provides important pathophysiological information on the degree of LV resynchronization and may contribute to improved patient selection.

A case report of lidocaine intoxication in a newborn following local anesthesia for maternal episiotomy is presented. A molded head in the occiput posterior position may predispose to inadvertent, direct injection of the fetal scalp.

Pneumonia is the primary source of sepsis and is significantly associated with mortality. However, only a few studies focus on its clinical characteristics and outcomes.We evaluated 500 intensive care unit patients who met severe sepsis or septic shock criteria, dividing them into two distinct groups (43%, sepsis with pneumonia; 41%, sepsis with an infection other than pneumonia).Moderate differences between the groups were observed. The group of sepsis with pneumonia had a higher 28-day in-hospital mortality (41% vs. 30%; P=0.02). Multivariate analysis revealed that the presence of pneumonia associated significantly with mortality (OR 1.76, 95% CI 1.11-2.78) along with cardiopulmonary resuscitation (OR 4.20, 95% CI 1.50-11.74), serum lactate ≥ 3.5 mmol/L (OR 1.92, 95% CI 1.20-3.08), and SOFA score ≥ 12 (OR 2.41, 95% CI 1.52-3.82). Survival analysis revealed for both groups that the patients with PaO2/FiO2 (PF) ratio170 and lactate ≥ 3.5 mmol/L had a worse prognosis than the patients with PF ratio ≥ 170 and lactate ≥ 3.5 mmol/L or PF ratio170 and lactate3.5 mmol/L.In patients admitted with sepsis, the pneumonia infection independently predicts 28-day in-hospital mortality. Combining the levels of serum lactate and PF ratio could be a useful approach in predicting mortality of these patients.