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Objective: To review management options for nontubal ectopic pregnancies.Design: Retrospective cohort study.Setting: Tertiary hospital in Melbourne, Australia.Population: A total of 100 nontubal pregnancies: 1 abdominal, 32 caesarean scar, 14 cervical, 41 cornual-interstitial, 12 ovarian.Methods: Cases were classified according to ectopic site. Management categories were medical, surgical, combination or expectant. Use of minimally invasive approaches (ultrasound-guided intra-sac injections or selective surgical techniques) was identified. Primary management was considered to be successful if no further unplanned interventions were required.Main Outcome Measures: Success of primary management and frequency of unplanned interventions.Results: A high rate of success (82%) was demonstrated for all management regimens, with minimal morbidity and no deaths occurring. A high success rate was shown when the primary management regimen was systemic methotrexate or ultrasound-guided intra-sac injection (88%). The success rate for primary surgical management was 57%. High success rates were reported for both primary management with ultrasound-guided injections or in combination with systemic methotrexate (94%) and for primary management with systemic methotrexate alone (81%). Seventy-five per cent of women managed with minimally invasive surgical approaches avoided the need for more extensive surgery, but required longer follow up and additional interventions.Conclusion: Minimally invasive approaches were found to be safe and effective treatment for women desiring to conserve fertility. Ultrasound-guided intra-sac injection and laparoscopic ectopic removal procedures aimed at preserving reproductive organs should be included as minimally invasive primary management tools in addition to the well-recognised option of systemic methotrexate.Tweetable Abstract: Nontubal ectopics: minimally invasive procedures a safe alternative to surgery in selected cases. [ABSTRACT FROM AUTHOR]

Fifteen multiparous Friesian cows with live body weight (LBW) of 510-532 kg and 2-4 parities were used at 45 days prepartum and continues until 120 days post-partum and divided into three similar groups (5 in each group) for study the effect of Spirulina additive on their productive and reproductive performance. Group 1 was unsupplemented which was served as control (G1), or supplemented with Spirulina and their media at the levels of 1 ml (low level) or 2 ml (high level) / kg LBW in drinking water for tested treatments G2 and G3, respectively. Spirulina was grown in a modified Zarrouk,s medium for 21 days. Results showed that digestibility of all nutrients and feeding values of G3 were significant higher (P<0.05) than those of either of G1 or G2, and also all values of these items were significant higher than those of G1. Total DMI was insignificant increased with G2 and significant increased with G3 compared with that of G1. Ruminal pH values did not significant affected by treatments, while TVFA's was increased significantly with increasing Spirulina supplement in dietary treatments and NH3-N values had an inverse trend among treatments. Most blood biochemical and haematological parameters were markedly increased with increasing the algae level in drinking water of cows. Live body weight and body condition score decreased gradually until reach 90, 75 and 60 days and increased thereafter for G1, G2 and G3, respectively. Group 3 recorded significantly (P<0.05) the highest daily yield of actual milk and 4%- FCM, colostrum and milk composition, feed and economic efficiencies and the lowest electrical conductivity in milk. Concerning reproductive traits, cows in G3 recorded significantly (P<0.05) the short periods from parturition until the first estrus and insemination, as well as days open, the highest conception rate and the lowest number of service per conception. In conclusion, cows supplemented with Spirulina and their media at the level of 2 ml/kg LBW in drinking water showed the best results concerning productive performance and body condition score as well as post-partum reproductive traits. [ABSTRACT FROM AUTHOR]

Forty New Zealand White (NZW) rabbit males aged 12 weeks and weighing 1540.80±22.16 g were equally and randomly divided into four groups (10 in each). All groups were fed a commercial pelleted diet and the first group was served as a control, while diet of the second group was supplemented with 5 g pumpkin seed oil/kg diet (PSO), the third group received 5 g black seed oil/kg diet (BSO), however the fourth group received 5 g from both PSO and BSO/kg diet (PSO+BSO). Results showed that male rabbits in PSO+BSO group showed the heaviest (P<0.05) live body weight (LBW), total weight gain (TWG), average daily gain (ADG), feed conversion ratio and performance index, followed by those in PSO or BSO groups, while males in control group had the light values. Male rabbits received diet supplemented with PSO+BSO combination reached puberty significantly (P<0.05) faster compared with control group, while PSO or BSO groups were intermediate with insignificant differences. Moreover, buck rabbits in PSO+BSO group showed the highest (P<0.05) scrotal circumference, testicular index, weights of testes, epididymis and sexual accessory glands (included seminal vesicles, prostate and the paired bulbourethral (Cowper's gland), plasma testosterone concentration at puberty and the short reaction time and latency period, followed by those in either PSO or BSO groups, however bucks in control group had the lowest values. Semen volume and gel, pH value and semen color score were significantly (P<0.05) higher in PSO+BSO group than that in control group, PSO or BSO groups had intermediate values with insignificant differences. Semen color tended to be milky in PSO+BSO and BSO groups and heavy watery in PSO and control groups. All semen characteristics differ significantly (P<0.05) among the different collection weeks with a tendency to improve with advancing age. The PSO+BSO group showed highly (P<0.001) significant of percentages of sperm motility, livability, sperm cell concentration and the lowest sperm abnormality percentage, followed by PSO or BSO groups, however the control group had the lowest values. All sperm characteristics were significantly (P<0.05) differ among the different collection weeks and improved with age progress. Bucks in PSO+BSO group recorded the highly (P<0.001) significant of total count, total motile, total live and total normal per ejaculate, followed by those in PSO or BSO groups, however, the lowest in control group. Also, all counts of spermatozoa were significantly (P<0.05) differ among the different collection weeks and tended to increase with age. [ABSTRACT FROM AUTHOR]

ims/hypothesis: The pathogenic role of excessive vascular endothelial growth factor (VEGF)-A in diabetic nephropathy has not been defined. We sought to test whether increased podocyte VEGF-A signalling determines the severity of diabetic glomerulopathy. Methods: Podocyte-specific, doxycycline-inducible Vegf (the most abundant Vegfa isoform) overexpressing adult transgenic mice were made diabetic with low doses of streptozotocin and examined 12 weeks after onset of diabetes. We studied diabetic and non-diabetic transgenic mice fed a standard or doxycycline-containing diet. VEGF-A and albuminuria were measured by ELISA, creatinine was measured by HPLC, renal morphology was examined by light and electron microscopy, and gene expression was assessed by quantitative PCR, immunoblotting and immunohistochemistry. Results: Podocyte Vegf overexpression in our mouse model of diabetes resulted in advanced diabetic glomerulopathy, characterised by Kimmelstiel-Wilson-like nodular glomerulosclerosis, microaneurysms, mesangiolysis, glomerular basement membrane thickening, podocyte effacement and massive proteinuria associated with hyperfiltration. It also led to increased VEGF receptor 2 and semaphorin3a levels, as well as nephrin and matrix metalloproteinase-2 downregulation, whereas circulating VEGF-A levels were similar to those in control diabetic mice. Conclusions/interpretation: Collectively, these data demonstrate that increased podocyte Vegf signalling dramatically worsens diabetic nephropathy in a streptozotocin-induced mouse model of diabetes, resulting in nodular glomerulosclerosis and massive proteinuria. This suggests that local rather than systemic VEGF-A levels determine the severity of diabetic nephropathy and that semaphorin3a signalling and matrix metalloproteinase-2 dysregulation are mechanistically involved in severe diabetic glomerulopathy. [ABSTRACT FROM AUTHOR]

To examine the association between isolated single umbilical artery (SUA) and congenital heart disease/adverse perinatal outcome in an Australian tertiary centre. The study population was comprised of fetuses diagnosed with SUA at the mid-trimester scan between May 2003 and March 2009 during detailed ultrasound examination at The Royal Women's Hospital Melbourne, Australia. Colour Doppler was used to visualise the umbilical arteries adjacent to the fetal bladder and in a section of a free loop of cord. The diagnosis of SUA was confirmed on histopathology examination of the placenta and umbilical cord. Monochorionic twins, fetuses with chromosomal abnormalities or concurrent extracardiac anomalies were excluded from the study. A total of 261 fetuses with SUA were identified in the study period and 146 (59%) cases were isolated; no chromosomal or extracardiac abnormalities were present. Complete data were available in 104/146 pregnancies (71.2%). The mean gestational age at diagnosis was 21 weeks. A cardiac anomaly was detected in 19 of these fetuses (13.0%): six hypoplastic left heart syndromes; three coarctations of the aorta; two tetralogies of Fallot; two hypoplastic right heart syndromes; two pulmonary atresia/stenosis; one absent ductus venosus with cardiomegaly; one left isomerism; one right isomerism and one transposition of the great arteries. Fetal growth restriction was present in 9.8% (10) and preterm delivery before 34 weeks occurred in nine cases (8.7%). Our study has shown that isolated SUA is associated with cardiac anomalies, but is not associated with increased frequency of FGR and preterm delivery before 34 weeks. [ABSTRACT FROM AUTHOR]

Background: Dermatological presentations are common in primary care. The digital health space is growing in investment, revenue, and in usership numbers. Doctors utilise mobile health apps for referencing, communicating, and for clinical decision making. Dermabuddy is a secure mobile health app by which information and expertise around skin problems can be shared among a group of medical professionals with the aim of finding the best treatment and management plan., Aim: To assess the utility of the Dermabuddy health app for GPs and associated trainees in the Republic of Ireland., Design & Setting: This is a descriptive cross-sectional study, which involved a survey link distributed by email to GPs with Irish Medical Council membership., Method: GPs were surveyed on their experiences of using the dermatology mobile application, Dermabuddy., Results: In total, 203 members took this questionnaire (13.5% response rate). Ninety-six per cent who responded to the statement, 'The app was easy to use' , agreed it was 'easy' or 'very easy'. Eighty-seven per cent of those who responded to the statement, 'I would use this app again' , agreed they 'definitely would'. Fifty-eight per cent of those who responded to the statement, 'The app is useful for my healthcare practice' , gave it a five-star rating. The content of 36 comments included advice for improvement and positive feedback., Conclusion: The Dermabuddy app was well received by participants in this study. Across all sections of the questionnaire looking at aspects of the app, including ease of use, interface and satisfaction, and usefulness, there was a positive response. Mobile health apps, such as Dermabuddy, may provide alternative solutions to meet the rising challenge of managing patients with dermatological conditions in primary care., (Copyright © 2024, The Authors.)

Background: Steroids, the mainstay of treatment for nephrotic syndrome in children, have multiple adverse effects including growth suppression., Methods: Anthropometric measurements in children < 18 years enrolled in the Nephrotic Syndrome Study Network (NEPTUNE) were collected. The longitudinal association of medication exposure and nephrotic syndrome characteristics with height z-score and growth velocity was determined using adjusted Generalized Estimating Equation regression and linear regression., Results: A total of 318 children (57.2% males) with a baseline age of 7.64 ± 5.04 years were analyzed. The cumulative steroid dose was 216.4 (IQR 61.5, 652.7) mg/kg (N = 233). Overall, height z-scores were not significantly different at the last follow-up compared to baseline (- 0.13 ± 1.21 vs. - 0.23 ± 1.71, p = 0.21). In models adjusted for age, sex, and eGFR, greater cumulative steroid exposure (β - 7.5 × 10 -6 , CI - 1.2 × 10 -5 , - 3 × 10 -6 , p = 0.001) and incident cases of NS (vs. prevalent) (β - 1.1, CI - 2.22, - 0.11, p = 0.03) were significantly associated with lower height z-scores over time. Rituximab exposure was associated with higher height z-scores (β 0.16, CI 0.04, 0.29, p = 0.01) over time., Conclusion: Steroid dose was associated with lower height z-score, while rituximab use was associated with higher height z-score., (© 2024. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)

The COVID-19 era has been a reminder to clinicians around the world of the important role that viral infections play in promoting glomerular disease. Several viral infections including human immunodeficiency virus (HIV), severe acute respiratory syndrome coronavirus 2, Epstein-Barr virus, cytomegalovirus, and parvovirus B19 can cause podocyte injury and present with a collapsing glomerulopathy (CG) variant of focal segmental glomerulosclerosis or minimal change disease. CG associated with COVID-19 has been termed COVID-19-associated nephropathy due to its striking resemblance to HIV-associated nephropathy. Host susceptibility is a major determinant of viral infection-associated CG, and the presence of two APOL1 risk variants explains most of the racial predilection to viral-associated CG observed in individuals of African ancestry. Interactions between APOL1 risk variants, viral genes, and the systemic inflammatory response to viral infection all contribute to kidney injury. This review will summarize our current knowledge of viral infection-associated CG, focusing primarily on the clinical presentation, histological features, mechanisms, and disease course of HIV-associated nephropathy and COVID-19-associated nephropathy., (Copyright © 2023 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: In the current study, longitudinal BP and lipid measurements were examined in a NEPTUNE cohort of children with newly diagnosed nephrotic syndrome (cNEPTUNE). We hypothesized that hypertensive BP and dyslipidemia would persist in children with nephrotic syndrome, regardless of steroid treatment response., Methods: A multi-center longitudinal observational analysis of data obtained from children < 19 years of age with new onset nephrotic syndrome enrolled in the Nephrotic Syndrome Study Network (cNEPTUNE) was conducted. BP and lipid data were examined over time stratified by disease activity and steroid exposure. Generalized estimating equation regressions were used to find determinants of hypertensive BP and dyslipidemia., Results: Among 122 children, the prevalence of hypertensive BP at any visit ranged from 17.4% to 57.4%, while dyslipidemia prevalence ranged from 40.0% to 96.2% over a median of 30 months of follow-up. Hypertensive BP was found in 46.2% (116/251) of study visits during active disease compared with 31.0% (84/271) of visits while in remission. Dyslipidemia was present in 88.2% (120/136) of study visits during active disease and in 66.0% (101/153) while in remission. Neither dyslipidemia nor hypertensive BP were significantly different with/without medication exposure (steroids and/or CNI). In regression analysis, male sex and urine protein:creatinine ratio (UPC) were significant determinants of hypertensive BP over time, while eGFR was found to be a determinant of dyslipidemia over time., Conclusions: Results demonstrate persistent hypertensive BPs and unfavorable lipid profiles in the cNEPTUNE cohort regardless of remission status or concurrent steroid or calcineurin inhibitor treatment., (© 2024. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)

Two variant alleles of the gene apolipoprotein L1 (APOL1), known as risk variants (RVs), are a major contributor to kidney disease burden in those of African descent. The APOL1 protein contributes to innate immunity and may protect against Trypanosoma, HIV, Salmonella, and leishmaniasis. However, the effects of carrying 1 or more RVs contribute to a variety of disease processes starting as early as in utero and can be exacerbated by other factors (or "second hits"). Indeed, these genetic variations interact with environmental exposures, infections, and systemic disease to modify health outcomes across the life span. This review focuses on APOL1-associated diseases through the life-course perspective and discusses how early exposure to second hits can impact long-term outcomes. APOL1-related kidney disease typically presents in adolescents to young adults, and individuals harboring RVs are more likely to progress to kidney failure than are those with kidney disease who lack APOL-1 RVs. Ongoing research is aimed at elucidating the association of APOL1 RV effects with adverse donor and recipient kidney transplant outcomes. Unfortunately, there is currently no established treatment for APOL1-associated nephropathy. Long-term research is needed to evaluate the risk and protective factors associated with APOL1 RVs at different stages of life., (Copyright © 2024 National Kidney Foundation, Inc. All rights reserved.)

The method of salt-assisted vapor-liquid-solid (VLS) growth is introduced to synthesize 1D nanostructures of trichalcogenide van der Waals (vdW) materials, exemplified by niobium trisulfide (NbS 3 ). The method uses a unique catalyst consisting of an alloy of Au and an alkali metal halide (NaCl) to enable rapid and directional growth. High yields of two types of NbS 3 1D nanostructures, nanowires and nanoribbons, each with sub-ten nanometer diameter, tens of micrometers length, and distinct 1D morphology and growth orientation are demonstrated. Strategies to control the location, size, and morphology of growth, and extend the growth method to synthesize other transition metal trichalcogenides, NbSe 3 and TiS 3 , as nanowires are demonstrated. Finally, the role of the Au-NaCl alloy catalyst in guiding VLS synthesis is described and the growth mechanism based on the relationships measured between structure (growth orientation, morphology, and dimensions) and growth conditions (catalyst volume and growth time) is discussed. These results introduce opportunities to expand the library of emerging 1D vdW materials to make use of their unique properties through controlled growth at nanoscale dimensions., (© 2024 The Authors. Advanced Materials published by Wiley‐VCH GmbH.)