Beyond Cervical Length: Association between Postcerclage Transvaginal Ultrasound Parameters and Preterm Birth.

OBJECTIVE: To assess the value of transvaginal ultrasound parameters after cerclage placement in estimating the risk of spontaneous preterm birth. STUDY DESIGN: This is a retrospective cohort at a single tertiary care center from 2013 to 2016. Women carrying a singleton, nonanomalous fetus with cerclage in situ and at least one postcerclage transvaginal ultrasound from 160/7 to 256/7 weeks' gestation were included. In addition to abstracting maternal demographic and obstetric characteristics, two study investigators separately reviewed each of the images from the first transvaginal ultrasound after cerclage placement, masked to pregnancy outcomes. We measured the angle between the anterior uterine wall and cervical canal at the internal os and external os, closed canal length above and below the stitch, width of the anterior and posterior cervix at the level of the cerclage, and stitch distance from the cervical canal. The presence of additional ultrasound findings such as sludge and cervical funneling was also noted. The main outcomes were preterm birth < 34 weeks and preterm birth < 37 weeks. Transvaginal ultrasound parameters were compared between women with preterm birth and those without preterm birth using chi-square, Fisher's exact, and Wilcoxon's rank-sum tests, as appropriate. Log binomial regression was used to estimate the relative risk of preterm birth for all significant obstetric and ultrasound characteristics. RESULTS: A total of 102 women met inclusion criteria: 58% had history-indicated, 20% ultrasound-indicated, and 23% exam-indicated cerclages. Of these, 28 (27.5%) women delivered at < 34 weeks' gestation, and 48 (47.0%) women delivered at < 37 weeks' gestation. Preterm birth did not vary by race, maternal age, insurance, smoking, or gestational age of the earliest prior preterm birth (for multiparous women), but women who had preterm birth were more likely to have exam-indicated cerclage. There were several transvaginal ultrasound parameters associated with preterm birth < 34 weeks and preterm birth < 37 weeks. Of these, cervical length below the stitch, stitch distance from the cervical canal, straight cervical canal, funneling to or past the stitch, and presence of sludge had the greatest effect sizes. CONCLUSION: Rates of preterm birth are high postcerclage. In addition to measuring cervical length, utilization of postcerclage transvaginal ultrasound to evaluate the location of the cerclage within the cervix, the curvature of the cervical canal, and the presence of funneling and sludge may help identify women who are at the highest risk for preterm birth.

Transient, Image-Guided Gel-Dissection for Percutaneous Thermal Ablation.

Image-guided tumor ablative therapies are mainstay cancer treatment options but often require intra-procedural protective tissue displacement to reduce the risk of collateral damage to neighboring organs. Standard of care strategies, such as hydrodissection (fluidic injection), are limited by rapid diffusion of fluid and poor retention time, risking injury to adjacent organs, increasing cancer recurrence rates from incomplete tumor ablations, and limiting patient qualification. Herein, a "gel-dissection" technique is developed, leveraging injectable hydrogels for longer-lasting, shapeable, and transient tissue separation to empower clinicans with improved ablation operation windows and greater control. A rheological model is designed to understand and tune gel-dissection parameters. In swine models, gel-dissection achieves 24 times longer-lasting tissue separation dynamics compared to saline, with 40% less injected volume. Gel-dissection achieves anti-dependent dissection between free-floating organs in the peritoneal cavity and clinically significant thermal protection, with the potential to expand minimally invasive therapeutic techniques, especially across locoregional therapies including radiation, cryoablation, endoscopy, and surgery.

Type II Endoleak Nidus Volume on Arterial and Delayed Phases of Initial CT Angiography after Endovascular Abdominal Aortic Aneurysm Repair Predicts Persistent Endoleak and Aneurysm Sac Enlargement.

PURPOSE: To evaluate type II endoleak nidus volume (ENV) in the arterial phase (ENVAP) and delayed phase (ENVDP) of the first postoperative CT angiography (CTA) as a predictor of persistent endoleak and aneurysm sac enlargement at follow-up CTA in patients with endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm. MATERIALS AND METHODS: Ninety-three patients (mean age ± standard deviation, 72 years ± 8; range, 56-88 years) with EVAR and type II endoleak were included in a single-institution retrospective study conducted between March 1, 2005, and December 31, 2018. ENVAP, ENVDP, change of volume (ENVDP-AP), and percentage of ENVAP and ENVDP in aneurysm sac volume (ASV) (ENVAP/ASV%, ENVDP/ASV%, respectively) were measured on first postoperative CTA images. The mean follow-up was 31.6 months ± 26.6 (range, 6-163.8 months). Patients were divided into two groups (group A, spontaneous resolution of endoleak without intervention [n = 29] and group B, persistent endoleak at follow-up CTA [n = 64]) and compared by using the Mann-Whitney U, Wilcoxon signed rank, and Pearson χ2 tests. Receiver operating characteristic (ROC) analysis was used to compare accuracies of parameters at first postoperative CTA. RESULTS: The accuracy of ENVDP (area under the ROC curve [AUC], 0.78) was superior to the accuracy of ENVDP/ASV% (AUC, 0.76), ENVDP-AP (AUC, 0.74), ENVAP (AUC, 0.71), and ENVAP/ASV% (AUC, 0.69) in indicating persistent endoleak. In group B, 46 patients (72%) showed ASV enlargement and 44 patients (69%) underwent endoleak embolization. ENVAP (1.7 cm3 ± 2.9 vs 3.4 cm3 ± 4.2; P = .001), ENVDP (2.9 cm3 ± 3.8 vs 8.0 cm3 ± 9.6; P < .001), ENVDP-AP (1.1 cm3 ± 1.8 vs 4.5 cm3 ± 7.8; P < .001), ENVAP/ASV% (0.9% ± 1.5 vs 1.7% ± 2.2; P = .003), and ENVDP/ASV% (1.6% ± 2.2 vs 3.7% ± 3.6; P < .001) were smaller in group A than in group B. CONCLUSION: ENVDP of the first postoperative CTA is an accurate predictor of persistent endoleak compared with ENVAP, and persistent endoleak is associated with aneurysm sac enlargement, in which earlier intervention is recommended.© RSNA, 2021.

Curriculum Vitae Workshops: Promoting Transparency in Alpha Omega Alpha While Serving Student Needs.

OBJECTIVE: To promote equity in the Alpha Omega Alpha Honor Medical Society (AOA) selection process, clear and timely communication of eligibility criteria is needed. Herein, the authors describe and assess the effectiveness of a novel method for improving transparency in the AOA selection process while also teaching students key professional development skills. METHODS: The authors hosted curriculum vitae (CV) workshops for interested medical students. One part of each session was dedicated to sharing information about AOA and its selection process, while the rest focused on teaching students how to build effective CVs. After the most recent session, students were asked to complete a survey about the effectiveness of the workshop. RESULTS: Between 2019 and 2020, three CV workshops were hosted. Interest in the events was high, with approximately 15 to 30 first- and second-year medical students participating in each. Based on survey results, participants found the workshop helped them gain a better understanding of AOA eligibility and selection (100%, n = 10) and taught them key CV development skills (100%, n = 10). CONCLUSION: These workshops are a novel approach to disseminating AOA eligibility criteria and can be employed by medical schools to promote transparency in the AOA selection process. They also give students the skills to craft CVs that will better prepare them for applying to residency and other academic opportunities. As such medical schools and AOA chapters should consider implementing a similar model at their institutions.