Trial of labour after caesarean (TOLAC) is associated with increased risk for instrumental delivery.

We compared the rates of instrumental delivery in a cohort of nulliparous women at term (n = 19,416), to primiparous women who attempted labour after prior caesarean (TOLAC) (n = 1747). The rate of instrumental deliveries was higher in the TOLAC group compared to nulliparous gravidas (17.3 vs. 15% respectively, p = 0.001). The difference was more prominent for women who eventually had successful vaginal delivery (TOLAC: 23.9% vs. CONTROLS: 17.1%, p < 0.0001 respectively). Based on our results, previous caesarean whether urgent or elective was associated with an increased risk of instrumental delivery in the subsequent pregnancy.

Behavioral abnormalities in female mice following administration of aluminum adjuvants and the human papillomavirus (HPV) vaccine Gardasil.

Vaccine adjuvants and vaccines may induce autoimmune and inflammatory manifestations in susceptible individuals. To date most human vaccine trials utilize aluminum (Al) adjuvants as placebos despite much evidence showing that Al in vaccine-relevant exposures can be toxic to humans and animals. We sought to evaluate the effects of Al adjuvant and the HPV vaccine Gardasil versus the true placebo on behavioral and inflammatory parameters in female mice. Six-week-old C57BL/6 female mice were injected with either, Gardasil, Gardasil + pertussis toxin (Pt), Al hydroxide, or, vehicle control in amounts equivalent to human exposure. At 7.5 months of age, Gardasil and Al-injected mice spent significantly more time floating in the forced swimming test (FST) in comparison with vehicle-injected mice (Al, p = 0.009; Gardasil, p = 0.025; Gardasil + Pt, p = 0.005). The increase in floating time was already highly significant at 4.5 months of age for the Gardasil and Gardasil + Pt group (p ≤ 0.0001). No significant differences were observed in the number of stairs climbed in the staircase test which measures locomotor activity. These results indicate that differences observed in the FST were unlikely due to locomotor dysfunction, but rather due to depression. Moreover, anti-HPV antibodies from the sera of Gardasil and Gardasil + Pt-injected mice showed cross-reactivity with the mouse brain protein extract. Immunohistochemistry analysis revealed microglial activation in the CA1 area of the hippocampus of Gardasil-injected mice. It appears that Gardasil via its Al adjuvant and HPV antigens has the ability to trigger neuroinflammation and autoimmune reactions, further leading to behavioral changes.

WITHDRAWN: Behavioral abnormalities in young female mice following administration of aluminum adjuvants and the human papillomavirus (HPV) vaccine Gardasil.

This article has been withdrawn at the request of the Editor-in-Chief due to serious concerns regarding the scientific soundness of the article. Review by the Editor-in-Chief and evaluation by outside experts, confirmed that the methodology is seriously flawed, and the claims that the article makes are unjustified. As an international peer-reviewed journal we believe it is our duty to withdraw the article from further circulation, and to notify the community of this issue. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Sperm preservation by electroejaculation in adolescent cancer patients.

BACKGROUND: The increasing prevalence of cancer survivors who are infertile due to gonadal failure highlights the importance of fertility preservation prior to gonadotoxic treatments. Adolescent cancer patients may not be mature enough to produce sperm by masturbation, leading to the use of alternative methods for obtaining sperm for cryopreservation. The aim of the current study was to evaluate the safety and efficacy of electroejaculation (EEJ) for cryopreservation among adolescent cancer patients. PROCEDURE: This retrospective cohort study included 45 adolescent (12-18 years old) cancer patients who underwent EEJ during 2002-2012 in an academic tertiary referral fertility center. Sperm cryopreservation, ejaculate parameters, and procedure complications were evaluated. RESULTS: EEJ was performed without documented complications. Sperm was successfully obtained in 30 (66.7%) patients. Retrieval failures included ejaculates without sperm in 8 patients (17.8%) and no ejaculate in 7 patients (15.5%). Cryopreserved ejaculates were characterized by severe asthenospermia, normal sperm concentration, and low volume. Retrieved sperm group was further divided to 19 motile sperm ejaculates with significantly higher volume, sperm concentration, and total count compared to 10 non-motile sperm patients. CONCLUSIONS: EEJ is a safe and feasible procedure for cryopreservation in adolescent cancer patients who are unable to masturbate. The wide diversity of EEJ outcome and ejaculate parameters may represent a continuum of pubertal changes in that population.

[Spontaneous rupture of a splenic artery aneurysm during the early puerperium].

A 35-year-old otherwise healthy woman was found unconscious on the floor of her room in the delivery ward 3 days after giving birth by a cesarean section. Following primary evaluation and resuscitation, a relaparotomy for assumed internal bleeding was performed, and active bleeding from a splenic artery aneurysm was discovered. The following case report reminds us yet again that the puerperium is a highly unique period in a woman's life during which submerged pathologies surface, and therefore, poses a great challenge to the caring physician. In this article, the authors report the sequence of events leading from the patient's admittance to the cesarean section to her subsequent relaparotomy. A brief review is presented on the literature related to splenic artery aneurysm rupture during pregnancy and the puerperium.

Elevated cardiac troponins: the ultimate marker for myocardial necrosis, but not without a differential diagnosis.

Cardiac troponins are released from myocytes following myocardial damage and loss of membrane integrity. Their significance when diagnosing acute myocardial infarction is immense, e.g., their high sensitivity and specificity for myocardial tissue, the prognostic information they bear, and their role in risk stratification and therapeutic decisions. However, one cannot fully and blindly rely on cTn testing in diagnosing acute MI since many other conditions are associated with elevation of troponin. A review of the literature demonstrates a myriad of such examples including non-thrombotic cardiac injury, systemic diseases and laboratory interferences. Failure to acknowledge the differential diagnosis of elevated troponin may lead to over-diagnosis of MI and, accordingly, misdiagnosis of the real cause. It is of utmost importance that all physicians who measure troponin recognize the possibility of falsely diagnosing Ml and are familiar with the main alternative causes for cardiac troponin elevation.