In Vitro Fertilization in a Nulliparous Female Resulting in Placenta Increta and Postpartum Hemorrhage.

A 32-year-old female with unexplained infertility delivered a healthy male infant at 39 weeks 0 days gestational age; the pregnancy was facilitated by in vitro fertilization. Shortly after delivery, she was found to have a morbidly adherent placenta. Attempted removal resulted in postpartum hemorrhage and ultimately hysterectomy after attempting multiple fertility preserving methods to achieve hemostatic control. Pathology results revealed a diagnosis of a 0.1 cm placenta increta (Grade 2 placental villi invasion), the least common diagnosis within the placenta accreta spectrum (PAS). Likely due to the small point of trophoblastic invasion, the diagnosis and outcome were not foreseen. This case highlights the need for additional data collection and development of standardized guidelines for the diagnosis and management of PAS, given a patient's risk factors. Current research may be limited by stigmatization surrounding infertility and reproductive-altering surgeries (e.g. hysterectomy). Additionally, counseling in all stages of pregnancy is critical to achieving the best patient-centered outcomes.

Primary Small Cell Carcinoma of the Bladder.

A 64-year-old Caucasian man with a 20 to 25-pack-year cigarette smoking history presented to his primary care provider with the chief complaint of gross hematuria after experiencing three to four months of urinary frequency and urgency. His workup consisted of laboratory blood work, a renal/bladder ultrasound (US), a CT scan without contrast, cystoscopy with biopsy (with an attempted transurethral resection of bladder tumor), and a PET scan. He was diagnosed with stage T4 small cell carcinoma of the bladder (SCCB) shortly after seeking medical care with metastases to the liver, bone, and lymph nodes. There was no evidence of lung involvement. The patient's primary concerns included difficulty urinating and sustained hematuria. He underwent palliative radiotherapy and placement of bilateral nephrostomy tubes in order to preserve his quality of life. He also received a chemotherapy regimen consisting of cisplatin, etoposide, and atezolizumab. The patient underwent hospice care and died approximately six months after the presentation.

Cell chemotaxis on paper for diagnostics.

Microfluidic chemotaxis platforms have historically been utilized to probe phenomena such as neutrophil migration and are beginning to be developed for diagnostic applications; however, current microfluidic chemotaxis systems require specialized engineering equipment such as syringe pumps and long time frames (hours) to develop a chemokine gradient, and cell chemotaxis typically requires multiple additional hours. The paperfluidic device described in this work is a low-cost, sharp (2 mm wide), quasi-stable (at least 20 min) and rapidly generated (<1 s) chemokine gradient system capable of examining cell migration response over short time frames (20 min) that can be easily assembled. A proof-of-concept experiment on human pan-T cells showed significant (p ≪ 0.01) directed migration to the chemokine gradient over the control condition. This new technique for cell migration studies provides a foundational step in designing microfluidic chemotactic platforms for point-of-care diagnostics.