Correlation of uterine artery Doppler flow velocimetry and β-human chorionic gonadotropin levels during postmolar evacuation surveillance: A pilot study in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Background@#During postmolar evacuation surveillance, beta-human chorionic gonadotropin (β-hCG) regression levels can predict invasive disease while Doppler ultrasound can assess in vivo tumor neovascularization and quantify uterine blood supply. As an ancillary tool to β-hCG monitoring, ultrasound can detect the early presence of viable trophoblastic tissues and identify patients at risk of developing postmolar gestational trophoblastic Neoplasia (PMGTN). @*Objective@#The objective of this study was to correlate uterine artery Doppler ultrasound with β-hCG levels during pre- and postmolar evacuation surveillance among patients with complete mole.@*Materials and Methods@#A cohort of patients with sonographic diagnosis of complete hydatidiform mole and managed with suction curettage in the same institution were prospectively followed up after evacuation. The pre- and postmolar evacuation surveillance period was at days 1, 7, 14, 21, 28, and 35. Monitoring of serum β-hCG levels was based on the standard regression curve. For Doppler ultrasound parameters, monitoring of the systolic/diastolic (S/D) ratio, pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) was based on its relationship with its serum β-hCG levels. The ultrasound images generated were archived and reviewed by the authors. Descriptive and inferential statistics were utilized to analyze median differences. For the correlation of uterine artery Doppler flow parameters, analysis for the test of difference used Pearson correlation and multiple linear regression analysis for the odds ratio.@*Results@#Sixteen of the 23 enrolled patients completed the protocol (16 of 23, 69.50%). A majority had spontaneous remission (13; 81%) while 3 cases (19%) presented increasing and plateauing β-hCG levels. The pre- and post evacuation median β-hCG levels showed a significant decrease (P = 0.001). As post evacuation β-hCG levels decreased, PSV also decreased (r = 0.478, P = 0.061) while Doppler parameters, RI, PI, and S/D ratio increased. However, when post evacuation β-hCG levels rose or plateaued, Doppler parameters decreased. These changes had statistical correlation (all P < 0.05). Moreover, the magnitude of the relationship for β-hCG and Doppler parameters was moderate and ranged from 0.524 to 0.581. Among the Doppler parameters, the S/D ratio and RI of the right uterine artery strongly predicted a rise in β-hCG levels. The odds ratio of predicting increased β-hCG levels and risk of gestational trophoblastic neoplasia by the right S/D ratio were − 2683.67 (confidence interval [CI] = −271.692–5095.655; P = 0.034) and by the right RI − 66,193.34 (CI = −161,818.107–29,431.433; P = 0.046). Notably, Doppler parameter changes appeared early at day 14 up to day 35 and before the appearance of abnormal β-hCG regression patterns.@*Conclusion@#There is a strong correlation between uterine artery Doppler flow changes and β-hCG levels during postmolar evacuation surveillance. The inverse relationship of the S/D ratio, PI and RI, and β-hCG regression patterns confirms spontaneous remission of the disease. For patients with abnormal β-hCG patterns, this relationship is altered. The Doppler changes become erratic, unpredictable, and significantly decreased. These changes were detected as early as 2 weeks post evacuation. Thus, the use of ultrasound as an adjunct to β-hCG post evacuation surveillance can predict abnormal β-hCG regression patterns and identify patients at risk of developing postmolar gestational trophoblastic neoplasia (PMGTN).

Total ureteral avulsion caused by uterine evacuation: a case report / 中华泌尿外科杂志

Currently, the total ureteral avulsion are mainly secondary to ureteroscopy, and it is rarely caused by uterine evacuation clinically. This paper reported a case of total ureter avulsion after uterine evacuation, treating by ileal replacement for ureter under general anesthesia, and the surgical outcome was good. Uterine evacuation is a routine, less risky procedure, but it also can lead to serious complications such as total ureteral avulsion or bladder rupture. For potential high-risk patients with uterine evacuation, preventive measures such as accurate localization under B-ultrasound guidance or pre-operative ureteral stents indwelling are useful to avoid the occurrence of such serious complications. If total ureteral avulsion occurs, ileal replacement for ureter is a viable and effective treatment.

Influence of radiation protection on layout of fuel reprocessing plant and countermeasures / 中国辐射卫生

@#Radiation protection is an important requirement in the design of spent nuclear fuel reprocessing plant. The design of all main process plants should consider the impact of radiation on staff and environment, while radiation protection is not required in the design of general industrial and civil buildings. This difference puts forward higher requirements for the architectural design of spent nuclear fuel reprocessing plant. From the perspective of architectural design, this paper analyzed the differences between spent nuclear fuel reprocessing plant and ordinary plant, as well as the compatibility of radiation protection requirements and current architectural design specifications. We proposed corresponding countermeasures based on our engineering experience, and summarized important design principles related to radiation protection requirements, which can be used as a reference by architectural designers in designing spent nuclear fuel reprocessing plants.

Estudo da fisiologia anorretal pré e pós terapia neoadjuvante para câncer de reto por manometria anorretal e escore de Jorge-Wexner / Study of anorectal physiology pre and pos neoadjuvant therapy for rectal cancer by anorectal manometry and jorge-wexner score

ABSTRACT Background: The treatment of distal rectal cancer may be accompanied by evacuation disorders of multifactorial etiology. Neoadjuvant chemoradiotherapy (NCRT) is part of the standard treatment for patients with locally advanced extraperitoneal rectal cancer. The assessment of anorectal function after long-term NCRT in patients with cancer of the extraperitoneal rectum has been poorly evaluated. Objective: The aim of the present study was to evaluate the effects of NCRT on anorectal function and continence in patients with extraperitoneal rectal cancer. Methods: Rectal adenocarcinoma patients undergoing neoadjuvant therapy were submitted to functional evaluation by anorectal manometry and the degree of fecal incontinence using the Jorge-Wexner score, before and eight weeks after NCRT. The manometric parameters evaluated were mean resting anal pressure (ARp), maximum voluntary contraction anal pressure (MaxSp) and average voluntary contraction anal pressure (ASp). All patients underwent the same NCRT protocol based on the application of fluoropyrimidine (5-FU) at a dosage of 350 mg/m2 associated with folic acid at a dosage of 20 mg/m2, intravenously, in the first and last week of treatment, concomitantly with conformational radiotherapy with a total dose of 50.4Gy, divided into 28 daily fractions of 1.8Gy. For statistical analysis of the quantitative variables with normal distribution, the mean, standard deviation, median and interquartile range were calculated. For comparison of two related samples (before and eight weeks after NCRT), Wilcoxon's non-parametric test was used. Results: Forty-eight patients with rectal cancer were included in the study, with a mean age of 62.8 (39-81) years, 36 (75%) of whom were male. The use of NCRT was associated with a decrease in the values of ARp (55.0 mmHg vs 39.1 mmHg, P<0.05) and ASp (161.9 mmHg vs 141.9 mmHg, P<0.05) without changing MaxSp values (185,5 mmHg vs 173 mmHg, P=0.05). There was no worsening of the incontinence score eight weeks after the use of NCRT (3.0 vs 3.3; P>0.05). Conclusion: NCRT was associated with a reduction in the values of ARp and the ASp. There was no change in MaxSp, as well as in the degree of fecal continence by the Jorge-Wexner score.

RESUMO Contexto: O tratamento do câncer retal distal pode ser acompanhado por distúrbios evacuatórios de etiologia multifatorial. A quimiorradioterapia neoadjuvante faz parte do tratamento padrão para pacientes com câncer retal extraperitoneal localmente avançado. A avaliação da função anorretal após neoadjuvância de longa duração em pacientes com câncer de reto extraperitoneal tem sido pouco estudada. Objetivo: O objetivo do presente estudo foi avaliar os efeitos da neoadjuvância na função anorretal e na incontinência em pacientes com câncer retal extraperitoneal. Métodos: Pacientes com adenocarcinoma de reto candidatos à terapia neoadjuvante foram submetidos a avaliação funcional por manometria anorretal e avaliação do grau de incontinência fecal pelo escore de Jorge-Wexner, pré e oito semanas após a neoadjuvância. Os parâmetros manométricos avaliados foram pressão anal média de repouso, pressão anal de contração voluntária máxima e pressão anal média de contração voluntária. Todos os pacientes foram submetidos ao mesmo protocolo de neoadjuvância baseado na aplicação de fluoropirimidina (5-FU) na dosagem de 350 mg/m2 associada ao ácido fólico na dosagem de 20 mg/m2, por via intravenosa, na primeira e última semana de tratamento, concomitantemente à radioterapia conformacional com dose total de 50,4Gy, dividida em 28 frações diárias de 1,8Gy. Para análise estatística das variáveis quantitativas com distribuição normal, foram calculados a média, desvio padrão, mediana e intervalo interquartil. Para comparação de duas amostras relacionadas (antes e oito semanas após a neoadjuvância, foi utilizado o teste não paramétrico de Wilcoxon. Resultados: Quarenta e oito pacientes com câncer retal foram incluídos no estudo, com média de idade de 62,8 (39-81) anos, sendo 36 (75%) do sexo masculino. O uso de neoadjuvância foi associado à diminuição dos valores de média de pressão de repouso (55,0 mmHg vs 39,1 mmHg, P<0,05) e média de pressão de contração voluntária (161,9 mmHg vs 141,9 mmHg, P<0,05) sem alterar os valores de pressão de contração voluntária máxima ((185,5 mmHg vs 173 mmHg, P=0.05)). Não houve piora do escore de incontinência oito semanas após o uso da quimiorradioterapia neoadjuvante (3,0 vs 3,3; P>0,05). Conclusão: A neoadjuvância associou-se à redução dos valores de média de pressão de repouso e média dos valores contração voluntária. Não houve alteração nos valores de contração voluntária máxima, bem como no grau de continência fecal pelo escore de Jorge-Wexner.

Prevalence and predictors of functional evacuation disorder in patients with chronic constipation

Background: Functional evacuation disorder (FED) is the second most common cause of functional constipation (FC) after constipation-predominant irritable bowel syndrome. However, the data on FED is relatively scanty in our region. Hence, the present study was performed to evaluate the demographics of FED and to find out the predictors of FED in patients with chronic constipation. Methods: A total of 134 patients with chronic constipation diagnosed according to the Rome IV criteria who were referred for high-resolution anorectal manometry (HRAM) were retrospectively enrolled in the present study. All FC patients who underwent HRAM were asked to fill a questionnaire and underwent anorectal manometry and were submitted to the balloon expulsion test (BET). Results: The mean age of patients was 43.09 ± 9.32 years old, with a total of 76 (54%) males. The most common symptom was straining during defecation (87%) followed by incomplete evacuation (86%). The prevalence of FED, diagnosed by HRAM and by the BET was 39%. Patients with FED had a significantly higher percentage of straining and sensation of anorectal blockade compared with those without FED (96 versus 82%; p < 0.01; 81 versus 44%; p < 0.001, respectively). On the multivariate regression analysis, straining > 30 minutes (odds ratio [OR] = 3.63; p = 0.03), maximum squeeze pressure (OR = 1.05; p < 0.001), and balloon volume at maximal sensation (OR = 1.06; p < 0.001) were found to be significant independent predictors of FED. Conclusion: Prolonged straining and sensation of anorectal blockade were significant indicators of FED in patients with chronic constipation. (AU)

OCCURRENCE, MANAGEMENT AND OUTCOME OF MOLAR PREGNANCIES IN TERTIARY CARE CENTRE, GMCH

Molar pregnancies represent a signi?cant burden of disease on the spectrum of gestational trophoblastic disease. The incidence varies widely in different parts of the world. The objective of this study is to determine the occurrence, management, and outcome of molar pregnancies at our institution. During the study period of 1 year, a total of 36 cases were diagnosed with GTD, giving an incidence of 2.6 per 1000 pregnancies, 2.7 per 1000 deliveries and 2.8 per 1000 livebirths in the department of Obstetrics and Gynaecology, GMCH. Vaginal bleeding was the commonest symptoms (66.66%) apart from amenorrhea. Suction evacuation was the primary mode of treatment (91.66%) and only 4 patients (11.11%) underwent hysterectomy. Chemotherapy was administered in 12 patients. During the follow up period, 5 patients (13.88%) were diagnosed with GTN, 4 of them being invasive mole and 1 being choriocarcinoma. Use of routine ?rst trimester ultrasonography has led to early diagnosis and majority of cases are cured by simple surgical intervention. Longer follow up protocol attribute to poor compliance. A multi-centered study is essential in India to determine the true incidence and overall outcome of molar pregnancy that will help in the understanding of the burden of the disease.

Efficacy of neuroendoscopic hematoma removal versus soft channel drainage for chronic subdural hematoma / 中国基层医药

Objective:To investigate the clinical efficacy of neuroendoscopic hematoma removal versus soft channel drainage in the treatment of chronic subdural hematoma (CSDH) and their effects on neurological function and quality of life. Methods:The clinical data of 97 patients with CSDH who received treatment between February 2018 and December 2019 were retrospectively analyzed. These patients were divided into group A ( n = 48, soft channel drainage) and group B ( n = 49, neuroendoscopic hematoma removal) according to different surgical methods. Clinical indicators, neurological function, quality of life, and incidence of complications were compared between groups A and B. Results:Operative time, length of hospital stay, and latency to hematoma disappearance in group B were (31.3 ± 2.18) minutes, (8.16 ± 1.32) days, (7.45 ± 1.49) days, which were significantly shorter than those in group A [(35.15 ± 4.32) minutes, (13.18 ± 1.56) days, (11.32 ± 1.88) days, t = 5.53, 17.12, 11.25, all P < 0.001]. At 3 months after surgery, the score of each dimension of SF-36 in each group was increased. The scores of physiological functioning, bodily pain, mental health, general health perceptions, social role functioning, vitality, role limitations due to emotional health, role limitations due to physical health in group B were (84.94 ± 7.25) points, (84.02 ± 6.29) points, (82.85 ± 8.16) points, (84.36 ± 9.15) points, (83.51 ± 10.39) points, (82.68 ± 8.36) points, (84.93 ± 10.15) points, (86.12 ± 9.13) points, which were significantly higher than those in group A [(62.68 ± 5.47) points, (71.39 ± 7.42) points, (69.51 ± 6.39) points, (72.68 ± 7.36) points, (72.81 ± 8.15) points, (73.12 ± 10.13) points, (77.91 ± 9.52) points, (75.32 ± 7.51) points, t = 19.82, 18.34, 19.75, 16.71, 17.94, 20.57, 18.22, 16.44, all P < 0.001]. At 7 days after surgery, neurotrophic factor, neuron specific enolase, hydrogen sulfide and S100B protein levels in group B were (42.53 ± 6.09) μg/L, (6.52 ± 2.79) μg/L, (203.17 ± 15.03) μmol/L, (0.25 ± 0.05) μg/L, respectively, which were significantly lower than those in group A [(67.38 ± 7.42) μg/L, (9.18 ± 2.27) μg/L, (242.79 ± 14.08) μmol/L, (0.36 ± 0.07) μg/L, t = 17.94, 5.12, 13.33, 8.86, all P < 0.001]. There was no significant difference in the incidence of complications between group B and group A [8.16% (4/49) vs. 18.75% (9/48), χ2 = 2.22, P = 0.136]. Conclusion:Compared with soft channel drainage, neuroendoscopic hematoma removal can better improve clinical indicators, neurological function, and quality of life in patients with CSDH, and is highly safe Neuroendoscopic hematoma removal is of certain clinical application value and innovation.

Strategy and effects of the areo-medical evacuation team in Mali to prevent and control COVID-19 pneumonia epidemic / 上海预防医学

This article summarizes the strategy and effects of preventing and controlling the epidemic in the evacuation support of the aero medical evacuation team of the 7th peacekeeping medical contingent of China to Mali， to actively respond to the coronavirus disease-19 （COVID-19 ）epidemic based on existing medical conditions and further provide scientific evidence for guaranteeing military medical service in public health emergencies.

Plan de evacuación en quirófano / Evacuation plan in the operating room

Todo quirófano debe adecuar el plan de evacuación según sus riesgos más probables y sus posibilidades operativas en forma realista y creativa. En el presente se tomó el incendio como el factor con mayor posibilidad que pueda producir una situación de desastre y/o emergencia. Objetivo: Diseñar, disponer e implementar un Plan de Evacuación que permita hacer frente a una situación peligrosa (un incendio, una inundación, un derrumbe del edificio, etc.) y ayude a que las personas y los bienes sufran el menor daño posible, en el servicio de quirófano del Sanatorio Allende sede Nueva Córdoba, en diciembre del año 2019. Es un proyecto de intervención, que se comenzó en mayo del mismo año y fue planificado para que se ejecute en el año 2020. El plan debe ser responsabilidad de todo el equipo quirúrgico. Conclusión: Contar con un plan de evacuación implica tener un equipo interdisciplinario capacitado permanentemente en condiciones de dar respuestas a amenaza de orden natural o generada por el hombre. Para ello es necesario la formación de brigadas en donde quedarán explícitos los roles y las acciones que cumple cada integrante ante un evento adverso. La seguridad no se improvisa, todos son responsables[AU]

Every operating room must adapt their evacuation plan according to its most probable risks and its operational possibilities in a realistic and creative way. In the following, the fire was taken as the most likely factor that could produce a disaster and/ or emergency situation. Objective: Design, arrange and implement an Evacuation Plan that allows to deal with a dangerous situation (a fire, a flood, a collapsing building, etc.) and help people and property suffer the least possible damage, in the operating room service of the Sanatorio Allende, Nueva Córdoba headquarters, in December of 2019. It is an intervention project, which began in May of the same year and was planned to be executed in 2020. The plan must be the responsibility of the entire surgical team. Conclusion: Having an evacuation plan implies having an interdisciplinary team permanently trained in a position to respond to natural or man-made threats. This requires the formation of brigades where roles and actions that each member must fulfill in case of an adverse event, will be explicit. Security is not improvised, everyone is responsible[AU]

Toda sala de operações deve adaptar seu plano de evacuação de acordo com suas riscos mais prováveis e suas possibilidades operacionais de maneira realista e criativa. A seguir, o incêndio foi considerado o fator mais provável que poderia causar um desastre e / ou situação de emergência. Objetivo: projetar, organizar e implementar um plano de evacuação que permita lidar com uma situação perigosa (incêndio, inundação, prédio em colapso etc.) e ajude pessoas e propriedades a sofrerem o menor dano possível no serviço da sala de operações do hospital. Sanatório Allende, sede de Nueva Córdoba, em dezembro de 2019. Trata-se de um projeto de intervenção, iniciado em maio do mesmo ano e previsto para ser executado em 2020. O plano deve ser de responsabilidade de toda a equipe cirúrgica. Conclusão: Ter um plano de evacuação implica uma equipe interdisciplinar permanentemente treinada em uma posição para responder a ameaças naturais ou provocadas pelo homem. Isso requer a formação de brigadas onde serão explicitados os papéis e ações que cada membro deve cumprir em caso de evento adverso. A segurança não é improvisada, todos são responsáveis[AU]

A case of adrenal cortical carcinoma with inferior vena cava thrombus extending into the right atrium: a two staged procedure

We present a case of adrenal cortical carcinoma (ACC) with tumor thrombus involving the inferior vena cava (IVC) and right atrium in a morbidly obese, middle-aged female. ACC is a rare type of cancer with a poor outcome. Most cases present with metastasis at the time of initial presentation. This patient presented with breathing difficulty and flank pain. With endocrinology evaluation and collaborative effort of multidisciplinary teams, the patient successfully underwent staged procedures of atrial clot evacuation after thoracotomy with cardiopulmonary bypass (CBP) along with inferior vena cava thrombectomy (IVCT) and left radical nephroadrenalectomy. The two staged procedure reduces the mortality when compared with a single staged procedure. The patient underwent atrial clot evacuation, performed by cardiothoracic surgery team under CBP and deployment of IVC filter by interventional radiologist as a first staged procedure. At six months of follow-up, the patient had locoregional disease spread but with good functional status. This case report highlights that even a high-volume disease, with proper planning by an experienced surgical team, can be operated successfully with an acceptable post-surgery quality of life for the patients.

A novel way to deal with challenge and fear of smoke and gas evacuation during minimal invasive surgery in the current era of COVID-19 pandemic: an ingenuity with review of literature

Presently COVID-19 viral transmission is a major concern among surgeons worldwide with the use of minimally invasive surgery due to creation of pneumoperitoneum. Due to this proposed concern, we sought to review the scientific data, evaluate the use of MIS and introduction of a novel concept to deal with surgical smoke and gas to prevent the risk of COVID-19 viral transmission. A review of literature of viral transmission in surgery, especially emphasizing the transmission of the COVID-19 was done. We also reviewed other surgical society guidelines and recommendations regarding surgery during this pandemic. Few studies have been performed on viral transmission during surgery, but to date there is not enough evidence to support use of MIS over open surgery or vice versa. There are societal guidelines and expert consensus on the modification of standard practices to minimize the risk of viral transmission. With every day rise in COVID-19 patients therefore consequent increase in surgeries in suspected or confirmed cases and exposure of operative staff to aerosolized particles during MIS, use of surgical smoke and gas evacuation system becomes essential. Although different available filters, insufflation systems are part of the surgical procedures but their cost and availability may concern a COVID-19 fighting or a developing nation. We introduced a novel, simple, easily available and cost effective technique to prevent and reduce the risk of viral transmission in the current era of COVID-19 pandemic.

The incidence of diabetes among the non-diabetic residents in Kawauchi village, Fukushima, who experienced evacuation after the 2011 Fukushima Daiichi nuclear power plant disaster

OBJECTIVES@#After the Fukushima Daiichi nuclear power plant disaster in 2011, residents of Kawauchi village who experienced evacuation had a high risk of suffering from diabetes and metabolic syndrome compared with non-evacuees. In addition to evacuation, lifestyle characteristics can be important factors influencing the development and prognosis of diabetes or glucose tolerance. The current study aimed to evaluate the effects of evacuation (i.e., lifestyle changes) on the incidence of diabetes among the non-diabetic residents of Kawauchi village.@*METHODS@#Design is retrospective cohort study. Annual health examination data of residents of Kawauchi village and control area (Ono town) in Fukushima prefecture from 2008 to 2017, as available from the Japanese National Health Insurance system. Participants were classified into three groups: "Diabetes (DM)" (FBG ≥ 126 mg/dL or HbA1c ≥ 6.5% or hospital visit for DM or usage of diabetic medication), "Borderline DM" (126 mg/dL > FBG ≥ 110 mg/dL or 6.5% > HbA1c ≥ 6.0%, and without hospital visit, and without diabetic medication), and "Normoglycemic" (FBG < 110 mg/dL and HbA1c < 6.0%, and without hospital visit, and without diabetic medication). New onset of diabetes was evaluated and the events or missing data were occurred at health checkup. For this survival analysis, 339 residents in Kawauchi and 598 residents in Ono were included. Average follow-up periods after 2010 were 3.9 years in Kawauchi village and 3.6 years in Ono town.@*RESULTS@#Compared with the normoglycemic group, incidence of DM was much greater in the borderline DM group, where DM occurred among 38.2% of the group in 2012 and increased to over 60% cumulatively through 2017 in Kawauchi village. DM had a prevalence of 16.3% in 2012, and below 30% in 2017 in borderline DM group of Ono town. Cox proportional hazard regression analysis was applied to non-DM groups at both study sites separately to evaluate the effects of lifestyle changes at each site. While BMI, BMI change, and the lack of regular exercise (HR = 1.29, 1.72, and 5.04, respectively) showed significant associations with the onset of diabetes in Ono town, only BMI and late-night dinner (HR = 1.21 and 4.86, respectively) showed significant associations with diabetes onset in Kawauchi village.@*CONCLUSIONS@#The current results confirmed that diabetes incidence was increased 6 years after the Daiichi nuclear power plant disaster in Kawauchi. We also found changes in lifestyle habits, suggesting that diabetes prevention with promotion of healthy lifestyle behaviors is an urgent priority.

Effects of hypobaric hypoxia on respiratory and motor function in spinal cord injury rats / 解放军医学杂志

Objective To investigate the effect of hypobaric hypoxia on the respiratory function of C5 spinal cord injury rats by simulating the environment of low pressure and low oxygen in air transport. Methods 20 male SD rats were randomly divided into 3 groups: sham operation group (n=4), spinal cord injury group (n=8) and spinal cord injury + low pressure group (n=8). Spinal cord injury model was made by compression method. These rats in the three groups were treated with carotid artery catheterization, and were fed for 24 hours. Spinal cord injury + low pressure group was put into 2500 m low pressure environment for 4 hours. Arterial blood gas, blood routine test, HE staining of the spinal cord and lung tissue were detected to evaluate respiratory function, and BBB score was used to evaluate motor function of rats. Results There was no significant difference between the three groups in pH, oxygen partial pressure, carbon dioxide partial pressure, oxygen saturation, glucose, lactate, alkali surplus, buffer alkali and other indicators (P>0.05). The percentage of reticulocyte in spinal cord injury group was lower than that in sham operation group (2.05%±0.69% vs. 2.88%±0.20%, P=0.034), there was no significant difference between spinal cord injury + low pressure group and other two groups (2.37%±0.59% vs. 2.88%±0.20%, P=0.178; 2.37%±0.59% vs. 2.05%±0.69%, P=0.282). There was no significant difference among the three groups in the leukocyte counts and percentage of neutrophils, lymphocytes, monocytes, erythrocytes, hemoglobin and hematocrit (P>0.05). HE staining showed that there was no obvious bleeding and exudative changes in spinal cord in sham operation group, and the tissue structure was intact. The histological integrity of spinal cord injury group and spinal cord injury + low pressure group was significantly different from that of sham operation group, but there was no significant difference between the two groups. There was no significant difference in bleeding, exudation and edema between the three groups, and the alveolar structure was intact. BBB score showed no significant difference between spinal cord injury group and spinal cord injury + low pressure group (P=0.440). Conclusion The respiratory and motor function of C5 spinal cord injury rats would not be significantly affected by 4 hours of low pressure and hypoxia.

Early Abdominal Closure Achieved through Retroperitoneal Hematoma Evacuation after Endovascular Aneurysm Repair and Open Abdominal Management for a Ruptured Aortic Aneurysm / 日本心臓血管外科学会雑誌

Abdominal compartment syndrome (ACS) is an important postoperative complication of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (rAAA). Open abdominal management (OAM) has been reported to be effective in EVAR ; however, only a limited number of reports are available on when and how to close the abdomen. Here we report a case of early abdominal wall closure achieved through the combined use of retroperitoneal hematoma evacuation after EVAR and OAM for rAAA. The patient was a 79-year-old woman who underwent EVAR for rAAA on an emergency basis. She developed ACS after EVAR and underwent OAM. Four days after surgery, a decrease in intraabdominal pressure was confirmed, and subsequent contrast-enhanced computed tomography revealed the absence of an endoleak ; retroperitoneal hematoma evacuation was performed, during which the abdominal wall was closed. The postoperative course was good, and the patient was discharged. Early closure of the abdomen may be possible by concomitant retroperitoneal hematoma evacuation after EVAR and OAM for rAAA.

Disaster-Preparedness Education and Support in Time of Disaster: Challenges of Foreign Residents Living in Japan Observed from the Responses of Workshop Participants / 国際保健医療

Introduction  In December 2017, a workshop was held for foreign and Japanese residents to learn about the prevention of health problems in the time of disaster.   This paper presents the results of a questionnaire survey conducted at the workshop, focusing on a disaster-preparedness education and support for foreigners living in Japan. Methods  The workshop participants were asked about their knowledge of health problems in the time of disasters and their experiences with health counseling. Results  Data were obtained from 25 of the 48 workshop participants. Almost half of the respondents indicated that they understood the potential mental and physical health problems in the time of disaster. Foreign participants were able to grasp the medical system at the evacuation shelters in Japan, and were able to learn about diseases, especially with regards to being aware of their own health condition. Regarding health maintenance at evacuation shelters, participants indicated their need for physical and mental health support, as well as more information and sharing. Conclusions  Foreign participants emphasized their need for support regarding physical and mental aspects. This was informed by their experiences of living in an evacuation shelter and the workshop lecture, which facilitated a greater understanding of how everyday life would be affected after the disaster. The participants described challenges related to their own health, as well as language challenges in their experiences of health counseling. Since foreigners tend to hesitate when consulting others about language concerns, it is necessary to clarify the workings of support and medical care systems at evacuation shelters. In addition, frequently used medical terms and health guidance contents need to be presented in more than one language to lessen foreign residents’ anxiety during-the disaster.

Evacuación aeromédica de pacientes COVID-19. Reporte de casos / Case reports: Aeromedical evacuation of patients COVID-19

BACKGROUND: The aeromedical evacuation in the Chilean Air Force has had an important development in the last 15 years. The coronavirus disease declared as a global pandemic by the WHO has generated the challenge of transferring highly infectious patients to centers of greater complexity. The objective of this article is to report our experience in the transfer of COVID ­ 19 patients in constant attention and medical monitoring. CLINICAL CASE REPORTS: The aeromedical evacuation of 2 COVID-19 patients was performed from the Hanga Roa Hospital, Rapa Nui, to the National Thorax Institute, Metropolitan Region, in a Lockheed Hercules C-130, which corresponds to a pressurized fixed-wing airplane. The transfer was carried out with the corresponding personal protection elements and in individual isolation capsules with advanced negative pressure life support (ISO ­ POD), in order to reduce the level of contagion to the aero sanitary crew and minimize the impact on the flight material used. DISCUSSION: The transfer was carried out achieving all the objectives set out under a strict security protocol and the two COVID-19 patients were transferred successfully. The negative pressure isolation capsule system was safe and reliable, since no crew member presented symptoms or was infected by COVID -19, and also allowed the transfer of highly contagious patients during an 8-hour flight operation.

INTRODUCCIÓN: La evacuación aeromédica en la Fuerza Aérea de Chile ha tenido un importante desarrollo en los últimos 15 años. La enfermedad por coronavirus declarada como pandemia mundial por la OMS ha generado el desafío de trasladar pacientes altamente infecciosos a centros de mayor complejidad. El objetivo de este artículo es reportar nuestra experiencia en el traslado de pacientes COVID ­ 19 en constante atención y monitorización médica. REPORTE DE CASOS CLÍNICOS: Se realizó la evacuación aeromédica de 2 pacientes COVID ­ 19 desde el Hospital de Hanga Roa, Rapa Nui, hacía el Instituto Nacional del Tórax, Región Metropolitana, en un Lockheed Hércules C-130, que corresponde a un avión de ala fija presurizado. El traslado se realizó con los elementos de protección personal correspondientes y en capsulas de aislamiento individual con soporte vital avanzado a presión negativa (ISO ­ POD), con la finalidad de reducir el nivel de contagio a la tripulación aero sanitaria y minimizar el impacto en el material de vuelo utilizado. DISCUSIÓN: El traslado se desarrolló logrando todos los objetivos planteados bajo un estricto protocolo de seguridad y los dos enfermos COVID-19 fueron trasladados de manera exitosa. El sistema de cápsulas de aislamiento a presión negativa fue seguro y confiable, ya que ningún miembro de la tripulación presento sintomatología o resultó contagiado por COVID -19, y además permitió trasladar pacientes altamente contagiosos durante una operación de vuelo de 8 horas.

Scenario of molar pregnancy in a tertiary care centre in Delhi, India

Background: Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases with incidence varying with geographic region. Aim was to review all molar pregnancies admitted at our institution and to study the incidence, clinical presentation, management, complications and outcome of molar pregnancies.Methods: An observational study was done in department of obstetrics and gynaecology at Dr. BSA Medical College and Hospital among women with molar pregnancy over two years.Results: The incidence of molar pregnancy of the institute was 1.05/1000 deliveries. 21- 25 years age group and nulliparous women constituted 28.1% of patients. Amenorrhea (100.0%) was the commonest presenting complaints followed by abnormal vaginal bleeding (90.62%). Anemia (37%) was the commonest complication followed by acute hemorrhage (31%) and hyperthyroidism (18%). Suction evacuation was done in 96.8% of patients and 87.5% required blood transfusion. Only 6.2% (2/32) of patients had post evacuation chemotherapy. None of the cases developed choriocarcinoma. Limitation of the study was that the incidence of subsequent pregnancies after complete treatment of molar pregnancies was not studied.Conclusions: Early diagnosis of complete molar pregnancy can change the clinical presentation, diagnosis, and treatment of molar pregnancy. There is need for early recognition, timely referral, prompt and proper treatment of this condition. Adequate follow-up of the patients and need for contraception should be reinforced.

Manual vacuum aspiration: a safe and effective surgical management of early pregnancy loss

Background: Manual vacuum aspiration (MVA) is an alternative to the standard sharp uterine curettage, performed under local anaesthetic or sedation in the daycare setting. The objectives of this study were to assess the efficacy and safety of MVA, the pain perception and the factors related to it.Methods: This was a prospective observational study of 58 consecutive patients who had undergone Manual Vacuum Aspiration (MVA) in Early Pregnancy Assessment Clinic, Hospital Kemaman between January and December 2017. Data on the patients’ characteristics and the procedures were analysed.Results: The efficacy of the procedure was 96.5% (56/58) with no major complication recorded. Majority of the patients (91.3%) reported mild to moderate pain with 2/3 of them agreed to undergo MVA in the future and would recommend it to other patients. There was no significant difference in mean pain score between different groups of women (parity, education levels, occupations, previous uterine evacuation) or procedural techniques (analgesia, sedation, cervical block, cervical dilatation, procedure duration, number of aspiration passes).Conclusions: MVA is safe and well accepted procedure for out-patient surgical evacuation of early miscarriages.

Maternal Near Miss Cases in Medical College Ambikapur Running in Tribal Zone of Chhattisgarh: A Retrospective Study

MMR being an important index for evaluation of obstetric care of that area has a little information regarding actions to be taken to negotiate the maternal health issues of that area. Hence more number of cases who were moribund and critical but fortunately escaped death grouped as near miss was being studied to find out the shadowed causes of maternal mortality. Methods: All 312 near miss cases women were evaluated out of total 6040 admissions in obstetric ward of this institute during a period of one year from April 2017 to March 2018 to know the steps to be taken for improvement of maternal health in tribal and low resource newly started medical college. Result: Hypertensive disorders of pregnancy are the main culprit of maternal mortality whereas hemorrhage and its aftereffects are proved to be the most important cause of near miss. Incomplete abortion is the most common cause of hemorrhage and over the counter sell and misuse of Mifegest is found mainly responsible for incomplete abortion. Conclusion: To improve the obstetric care we have to educate the public for proper antenatal checkup. It will help health workers to identify the high risk pregnancies and their timely management. Apart from public awareness program there is necessity of well-equipped government health set ups where the poor tribal and also the other needy ones can report easily with all faith and confidence. Scarcity of skilled staff is also a subject to be noticed.

An analysis of patients evacuated by a civilian physician-staffed helicopter from a military base / Journal of Rural Medicine

Objective: We herein report our analysis of patients evacuated by a physician-staffed helicopter (doctor helicopter; DH) from a Japan Self Defense Force (JSDF) base.Methods: From March 2004 to November 2018, a medical chart review was retrospectively performed for all patients who were transported by a DH from the temporary heliport at the JSDF Fuji base. The subjects were divided into two groups: the Before-2013 group (n=6) and the After-2013 group (n=7).Results: The rate of military-patient involvement and the heart rate of the After-2013 group were greater than those of the-Before 2013 group, and the percutaneous oxygen saturation in the After-2013 group was lower than the Before-2013 group. Furthermore, the Glasgow Coma Scale in the After-2013 group was significantly lower than in the Before-2013 group. The survival rate was not significantly different between the two groups.Conclusion: Patients transported by DHs in the After-2013 group tended to be in more severe conditions than those transported in the Before-2013 group. This might be due to the fact that over time, the fire department, or JSDF, began to appreciate the useful role played by the DH in life-saving management.