Cesarean section scar measurements in non-pregnant women using three-dimensional ultrasound: a repeatability study.

OBJECTIVE: To evaluate intra- and inter-observer agreement in measurements of the cesarean scar niche and the residual myometrial thickness (RMT) using 3-dimensional (3D) transvaginal ultrasonography. STUDY DESIGN: Fifty-eight uterine 3D volumes from women with deep cesarean scar niches were evaluated. 3D volumes were obtained six to fifteen months after a primary cesarean section. Evaluation of the 3D volume was performed in a standardized multiplanar view. Two observers independently obtained RMT, cesarean scar niche depth (D), length (L), width (W), and myometrium adjacent to the scar (M). Differences within and between observers were expressed in mm and were evaluated according to the Bland-Altman method including the calculation of limits of agreement (LOAs). RESULTS: The intra-observer LOAs in mm were as follows: RMT: -3.7 to 4.0; D: -2.2 to 2.6; L: -3.6 to 4.2; W: -4.0 to 3.7; and M: -3.4 to 4.5. The inter-observer LOAs in mm were as follows: RMT: -3.2 to 4.1; D: -3.3 to 2.2; L: -3.4 to 4.2; W: -3.2 to 4.1; and M: -4.1 to 3.2. CONCLUSIONS: In non-pregnant women, we found rather wide limits of agreement measuring the cesarean section scar niche and myometrium using 3D volumes. Whether 3D transvaginal ultrasonography provides clinical advantages compared to 2D TVU needs clarification.

Ultrasound evaluation of Cesarean scar after single- and double-layer uterotomy closure: a cohort study.

OBJECTIVES: To compare residual myometrial thickness (RMT) and size of the Cesarean scar defect after single- and double-layer uterotomy closure following first elective Cesarean section. METHODS: A retrospective cohort study was conducted in 149 women at least 6 months after an uncomplicated, elective Cesarean delivery. Two-dimensional transvaginal ultrasonographic measures of RMT, scar defect depth, width and length and myometrial thickness adjacent to the scar were compared in 68 women with single-layer and 81 women with double-layer closure delivered before and after, respectively, a change in the surgical procedure. Outcomes between the two groups were compared. RESULTS: Median RMT was 5.8 (interquartile range (IQR), 4.1-7.8) mm in women with double-layer closure vs 4.6 (IQR, 3.4-6.5) mm in those with single-layer closure (P = 0.04). Scar defect length was greater in women with single-layer closure (median, 6.8 (IQR, 4.4-8.5) mm) than in those with double-layer closure (median, 5.6 (IQR, 3.9-6.8) mm) (P = 0.01). Measurements of defect depth and width, and the proportion of scars with RMT < 2.3 mm were similar in the two groups. CONCLUSIONS: RMT was greater and defect length, but not defect depth and width, was smaller following double-layer compared with single-layer closure, which may indicate some limited benefit of double-layer closure following first elective Cesarean section.

Accuracy of telemedical home blood pressure measurement in the diagnosis of hypertension.

This study was conducted to compare the accuracy of clinic blood pressure (CBP) and telemedical home blood pressure (HBP) measurement in the diagnosis of hypertension in primary care. The study subjects were 411 patients with average CBP > or =140 mmHg systolic or > or =90 mmHg diastolic, who performed telemedical HBP measurement (5 days, four times daily) and ambulatory blood pressure (ABP) monitoring in random order. Main outcome measure was the agreement of CBP and HBP with daytime ABP. CBP was much higher than daytime ABP and average HBP (P<0.001) with no difference between the latter two. The correlation between CBP and ABP was weak (systolic: r=0.499, diastolic: r=0.543), whereas strong correlations existed between HBP and ABP (systolic: r=0.847, diastolic: r=0.812). A progressive improvement in the strength of the linear regression between average HBP of single days and ABP was obtained from day 1 to day 4, with no further benefit obtained on the fifth day. The HBP readings taken at noon and in the afternoon showed significantly stronger correlations with ABP than the blood pressures measured in the morning and in the evening. In conclusion, the accuracy of telemedical HBP measurement was substantially better than that of CBP in the diagnosis of hypertension in primary care. HBP most accurately reflected ABP on the fourth day of monitoring, and the readings at noon and in the afternoon seemed to be most accurate.

Surface damage formation during ion-beam thinning of samples for transmission electron microscopy.

All techniques employed in the preparation of samples for transmission electron microscopy (TEM) introduce or include artifacts that can degrade the images of the materials being studied. One significant cause of this image degradation is surface amorphization. The damaged top and bottom surface layers of TEM samples can obscure subtle detail, particularly at high magnification. Of the techniques typically used for TEM sample preparation of semiconducting materials, cleaving produces samples with the least surface amorphization, followed by low-angle ion milling, conventional ion milling, and focused ion beam (FIB) preparation. In this work, we present direct measurements of surface damage on silicon produced during TEM sample preparation utilizing these techniques. The thinnest damaged layer formed on a silicon surface was measured as 1.5 nm thick, while an optimized FIB sample preparation process results in the formation of a 22 nm thick damaged layer. Lattice images are obtainable from all samples.

Myeloid-related protein (MRP)-8 from cervico-vaginal secretions activates HIV replication.

OBJECTIVES: To identify a substance found in female genital tract secretions that enhances HIV expression in infected cells. DESIGN: Cervico-vaginal lavages (CVL), collected in sterile normal saline, were fractionated and tested for HIV-inducing activity using HIV-infected monocytes. METHODS: To purify the component(s) of CVL that enhance HIV production, Mono-Q ion exchange chromatography followed by Superose-12 molecular sieve analysis, and SDS--PAGE were performed. The purified protein was identified by amino acid sequence analysis. RESULTS: SDS--PAGE of bioactive fractions showed a 14 kDa polypeptide band. Amino acid sequence analysis of selected peptides from the 14 kDa band showed 100% homology with the myeloid-related protein (MRP)-8, an inflammatory protein found in mucosal secretions. Western blot analysis revealed that bioactive CVL contained more immunoreactive MRP-8 than samples without bioactivity. The HIV-inducing activity of MRP-8 was further confirmed by showing that human recombinant MRP-8 increased HIV expression by up to 40-fold. CONCLUSIONS: MRP-8 in cervico-vaginal secretions stimulates HIV production. Strategies aimed at blocking MRP-8 activity in the genital tract could reduce risk of sexual as well as maternal--infant transmission of HIV.

Palliative care in Denmark.

The palliative effort in Denmark has increased during recent years. Many initiatives to improve conditions for patients who need supportive and palliative care have been introduced. All hospitals offer symptom control and "open admission". The Social Security Authority has passed an act giving relatives the opportunity to nurse a patient who wishes to die at home without losing their income. Three hospices have been established, all on a non-statutory basis. This article describes the different initiatives and future plans.

Influence of material properties on TEM specimen preparation of thin films.

Several factors must be taken into account when deciding which specimen preparation technique(s) to use. These factors include the amount of material available, ease of preparing this material due to its properties and familiarity, location and size of the region of interest, amount of information sought, facilities accessible, and time available by the researcher to devote to the preparation of the specimen. The more popular specimen preparations for thin films, namely, electropolishing, cleaving, crushing, mechanical thinning followed by ion milling, and ultramicrotomy are discussed and the more unusual techniques such as extraction/replication, photochemical etching, lithography and reactive ion etching (RIE), chemically assisted ion beam etching (CAIBE), and precision polishing-based techniques are described. Their advantages and disadvantages in the context of the above factors are discussed. Suggestions for increasing one's success rate in preparing specimens are given. The role of transmission electron microscopy (TEM) analysis is considered since it rarely stands in isolation from other physical analytical techniques, nor is it often used as a quick diagnostic tool. Conservation of material by the minimization of the amount of material used (or destroyed) by TEM specimen preparation, and conservation of one's time by performing TEM analysis only on "worthy" samples should be given maximum consideration.