Laparoscopic excision and repair of a cesarean scar pregnancy in a woman with uterine didelphys: a case report.

Cesarean scar pregnancy (CSP) is a rare complication that occurs in less than 1% of ectopic pregnancies, and uterine didelphys is one of the rarest uterine forms. We report a successful laparoscopic excision and repair of CSP in a woman with uterine didelphys and a double vagina. A 34-year-old gravida one, para one woman with a history of low transverse cesarean section presented to our hospital with a suspected CSP. She was confirmed to have uterine didelphys with a double vagina during an infertility examination 7 years earlier. Magnetic resonance imaging showed a 2.5-cm gestational sac-like cystic lesion in the lower segment of the right uterus at the cesarean scar. We decided to perform a laparoscopic approach after informing the patient of the surgical procedure. The lower segment of the previous cesarean site was excised with monopolar diathermy to minimize bleeding. We identified the gestational sac in the lower segment of the right uterus, which was evacuated using spoon forceps. The myometrium and serosa of the uterus were sutured layer-by-layer using synthetic absorbable sutures. No remnant gestational tissue was visible on follow-up ultrasonography one month after the surgery. This laparoscopic approach to CSP in a woman with uterine didelphys is an effective and safe method of treatment. In women with uterine anomalies, it is important to confirm the exact location of the gestational sac by preoperative imaging for successful surgery.

The Safety and Efficacy of an Unflanged 4F Pancreatic Stent in Transpancreatic Precut Sphincterotomy for Patients with Difficult Biliary Cannulation: A Prospective Cohort Study.

Prophylactic pancreatic stenting effectively reduces the rate and severity of post-ERCP pancreatitis (PEP) in the precut technique; however, studies on the optimal type and duration of the stent are still lacking. This prospective study evaluated the incidence and severity of PEP and the rate of spontaneous stent dislodgement in patients undergoing transpancreatic precut sphincterotomy (TPS) accompanied by prophylactic pancreatic stenting with an unflanged plastic stent (4F × 5 cm) for difficult biliary cannulation. A total of 247 patients with naïve papilla were enrolled in this study, and data were collected prospectively. In the final analysis, 170 and 61 patients were included in the standard cannulation technique and TPS groups, respectively. The incidence of PEP in the standard cannulation technique and TPS groups was 3.5% and 1.6% (p = 0.679), respectively. The technical success rate of selective biliary cannulation in the TPS group was 91.8%. The spontaneous dislodgement rate of the prophylactic plastic stent was 98.4%. In conclusion, an unflanged pancreatic stent (4F × 5 cm) placement in TPS for patients with failed standard cannulation technique is a safe and effective measure due to low adverse events and few additional endoscopic procedures for removing the pancreatic duct (PD) stent.

Marginal and internal fit of 3D printed provisional crowns according to build directions.

PURPOSE: This study aimed to fabricate provisional crowns at varying build directions using the digital light processing (DLP)-based 3D printing and evaluate the marginal and internal fit of the provisional crowns using the silicone replica technique (SRT). MATERIALS AND METHODS: The prepared resin tooth was scanned and a single crown was designed using computer-aided design (CAD) software. Provisional crowns were printed using a DLP-based 3D printer at 6 directions (120°, 135°, 150°, 180°, 210°, 225°) with 10 crowns in each direction. In total, sixty crowns were printed. To measure the marginal and internal fit, a silicone replica was fabricated and the thickness of the silicone impression material was measured using a digital microscope. Sixteen reference points were set and divided into the following 4 groups: marginal gap (MG), cervical gap (CG), axial gap (AG), and occlusal gap (OG). The measurements were statistically analyzed using one-way ANOVA and Dunnett T3. RESULTS: MG, CG, and OG were significantly different by build angle groups (P<.05). The MG and CG were significantly larger in the 120° group than in other groups. OG was the smallest in the 150° and 180° and the largest in the 120° and 135° groups. CONCLUSION: The marginal and internal fit of the 3D-printed provisional crowns can vary depending on the build angle and the best fit was achieved with build angles of 150° and 180°.

Understanding global PM2.5 concentrations and their drivers in recent decades (1998-2016).

The threat of fine particulate matter (PM2.5) is increasing globally. Tackling this issue requires an accurate understanding of its trends and drivers. In this study, global risk regions of PM2.5 concentrations during 1998-2016 were spatiotemporally derived. Time series analysis was conducted in the spatial relationship between PM2.5 and three socio-environmental drivers: population, urban ratio, and vegetation greenness that can cause changes in the concentration of PM2.5. "High Risk" areas were widely distributed in India and China. In India and sub-Saharan Africa, the increased overall population was strongly correlated with PM2.5 concentrations. Urban ratio increased in both developed and developing countries. A "decoupling" phenomenon occurred in developed countries, where urban expansion continued while PM2.5 concentrations decreased. Vegetation greenness and PM2.5 were strongly correlated in High Risk zones. Although urban expansion and population growth generally reduce vegetation greenness, developed countries reduced PM2.5 while maintaining greenness, whereas developing countries increased PM2.5 with decreasing greenness significantly in High Risk regions. Ultimately, economic and national growth should occur without increasing PM2.5 concentrations. Recent cases from Europe and the eastern United States demonstrate that this is possible, depending on the development pathway.

Competitive enzyme-linked immunosorbent assay for a selective and sensitive determination of dopamine in the presence of ascorbic acid and uric acid.

Dopamine (DA) is one of the most important catecholamine neurotransmitter molecules in the central nervous system (CNS). An abnormal level of DA in vivo can cause CNS diseases such as Parkinsonism and Schizophrenia. Thus, it is essential to develop an accurate and easy to use method for determining the level of DA in biological fluids such as urine and serum as a tool for clinical diagnostics as well as for pathological research. This work is the first ELISA application to detect DA in the presence of a high concentration of ascorbic acid (AA) and uric acid (UA) which are endogenous in urine. The LOD value of 1.26 x 10(-9) M and dynamic ranges of 3.16 x 10(-3) M to 3.16 x 10(-7) M were observed. It shows a good sensitivity with a broad dynamic range. Also, the competitive ELISA method for DA developed here showed no interference effect due to AA and UA, which are found in urine. The presence of AA and UA caused interference for DA determination by an electrochemical method because UA, AA, and DA have similar oxidation potential. Also, this selective and sensitive ELISA method can be made into an ELISA test kit which can be used to quantify the level of DA with ease and simplicity in clinics and laboratories.