Long-term exposure to air pollution linked to VTE, finds study

A large study found that greater exposure to long-term air pollution was linked with increased risks for blood clots that can occur in deep veins, which, if untreated, can block blood flow and cause serious complications, even death.

These findings came from a longitudinal study funded by the National Institutes of Health (NIH) that included 6,651 U.S. adults who were followed for an average of 17 years between 2000 and 2018. Participants lived in or near one of six major metropolitan areas: New York, Baltimore, Chicago, Los Angeles, Minneapolis, and Winston-Salem, North Carolina.

Throughout the study, 248 adults, 3.7% of the study sample, developed blood clots in deep veins that required hospital care. The likelihood of this outcome was linked to anywhere from a 39% to a more than two-fold increased risk based on long-term exposure to three different types of air pollutants.

Blood clots in deep veins, collectively known as venous thromboembolism (VTE), include deep vein thrombosis, which occurs when a blood clot forms in a deep vein of the legs, arms, or an internal organ, and pulmonary embolism, which occurs when a blood clot breaks off from a deep vein and travels to the lungs.

Exposure to air pollution, which can set the stage for inflammation and contribute to blood clotting, has long been associated with cardiovascular and respiratory diseases. While previous research has also suggested a link to VTE, this is the largest, most comprehensive U.S. study to report that association with three different types of air pollutants.

This included exposure to tiny air pollution particles equal to or less than 2.5 micrometers, which can be inhaled from a variety of sources, including smoke from coal-burning power plants, forest fires, and motor vehicle exhaust. Participants with greater overall exposure to this type of air pollution had a 39% increased associated risk for VTE compared to people exposed to lower levels. People with increased exposure to oxides of nitrogen and nitrogen dioxide, pollutants most often found from vehicle exhaust, had a respective 121% to 174% increased risk.

To reach these findings, the researchers analyzed the relationship between patients hospitalized for VTE and levels of air pollution collected through extensive biweekly community-level monitoring-including samples taken from the homes of participants. They then compared those with the highest exposure levels — the top 75% — to those with the lowest exposure-the bottom 25%. They also conducted multiple analyses to control for variables associated with VTE, such as age, exposure to tobacco, and underlying respiratory and other health conditions.

VTE affects up to 900,000 Americans each year. Many cases occur after surgery, but other factors, including age, long periods of inactivity, heart disease, pregnancy, and genetics, can increase risks.

Reference:

Pamela L Lutsey, Jeffrey R Misialek, Michael T Young, Jesse David Berman, Claire Leiser, Zachary C Pope, Mary Cushman, Aaron R. Folsom, Joel D Kaufman, Air pollution is associated with increased risk of venous thromboembolism: the Multi-Ethnic Study of Atherosclerosis, Blood, https://doi.org/10.1182/blood.2024026399.

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Silver diamine fluoride faster and less invasive alternative to ART for treatment of caries lesions: Study

Silver diamine fluoride faster and less invasive alternative to ART for treatment of caries lesions suggests a study published in the Clinical Oral Investigations.

A study was done to compare the efficacy of silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) in arresting caries lesions. Variables such as treatment time, adverse effects/parental aesthetic perception, anxiety and patients’ behavior were also evaluated. Children (3.53 ± 1.03 years) with dentin caries lesions on the occlusal surface of primary molars were randomized into test (SDF) and control (ART) groups. To determine the presence of caries, dmf-t and ICDAS indexes were used. Caries lesions were also classified according to activity (active or inactive). The time required to perform treatments was recorded and the children’s anxiety was assessed by a Facial Image Scale. The adverse events/aesthetic perception were registered by the operator and caregivers. The Frankl Behavioral Scale assessed patients’ behavior. The chi-square/Fisher’s exact and Mann-Whitney tests were used to compare the groups. Results: Of the 118 participants who received treatment (SDF, n = 59; ART, n = 59), after 12-month follow-up, 91.5% (43/47) of caries lesions in the SDF and 90.2% (46/51) in the ART group were arrested (p = 1.000). After 24 months, 72% (18/25) were arrested in the SDF group and 95.2% (20/21) in the ART. The treatment times were 6.08 ± 1.72 and 13.58 ± 4.83, for SDF and ART, respectively (p < 0.001). No statistically significant difference of adverse effects, aesthetic perception, anxiety, and patients’ behavior were found between the groups. SDF was similar to ART in arresting caries lesion but required less time for treatment. The anxiety, adverse effects/aesthetic perception and patients’ behavior were also similar between the groups. The use of SDF may be a faster and less invasive alternative for the treatment of caries lesions.

Reference:

Rodrigues, G.F., Vollú, A.L., Vargas, T.R. et al. Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment in arresting dentin caries lesions in preschoolers: a randomized clinical trial. Clin Oral Invest 29, 3 (2025). https://doi.org/10.1007/s00784-024-06081-8

Keywords:

Silver, diamine, fluoride, faster, less, invasive, alternative, ART, treatment, caries, lesions, study , Clinical Oral Investigations, Rodrigues, G.F., Vollú, A.L., Vargas, T.R, Dental caries, Child, preschool, Cariostatic agents, Silver diamine fluoride, Glass ionomer cements, Dental atraumatic restorative treatment

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Endoscopic full-thickness plication may reduce PPI usage and total reflux episodes in GERD patients, finds study

A recent meta-analysis published in the JGH Open Journal of Gastroenterology and Hepatology Foundation revealed that endoscopic full-thickness plication (EFTP) was effective in the treatment of gastroesophageal reflux disease (GERD), especially for patients unresponsive to conventional therapy.

GERD which is commonly managed with proton pump inhibitors (PPIs) is diagnosed in approximately 20% of adults in the United States. However, these medications are linked to potential long-term side effects, prompting the need for alternative solutions. The meta-analysis compared EFTP with a sham procedure as a treatment for refractory GERD. EFTP is a minimally invasive endoscopic technique designed to enhance the functionality of the gastroesophageal junction, addressing one of the root causes of GERD.

This research adhered to Cochrane guidelines and PRISMA standards in their systematic review. The study involved a total of 2144 screened articles, of which 3 high-quality randomized controlled trials (RCTs) with 272 patients met the inclusion criteria. Of these, 136 patients underwent EFTP, and the other 136 received sham procedures.

The analysis revealed strong evidence supporting the efficacy of EFTP. The patients who underwent EFTP demonstrated a significant reduction in dependency on PPIs when compared to the sham group. The relative risk (RR) was calculated at 0.51, with a 95% confidence interval (CI) of 0.35–0.73 (p < 0.01). This indicates a nearly 50% decrease in medication use.

EFTP led to over 50% improvement in GERD-Health-Related Quality of Life (GERD-HRQL) scores at the 3-month mark (RR 15.81; 95% CI 1.40–178.71; p = 0.03) which highlighted the effectiveness in reducing symptoms.

The DeMeester score which measures acid exposure in the esophagus, showed no significant difference between the EFTP and sham groups (mean difference 12.57; 95% CI −35.12 to 9.98; p = 0.27). While esophageal pH time showed no difference, EFTP significantly decreased the total number of reflux episodes, suggesting better control of GERD symptoms.

Overall, this study supports EFTP as a promising minimally invasive treatment for GERD, offering significant symptom relief and reduced reliance on PPIs. However, the need for further studies comparing EFTP with other advanced techniques to establish the most effective treatment approach is imperative.

Source:

Shahzil, M., Chaudhary, A. J., Qureshi, A. A., Hasan, F., Faisal, M. S., Sohail, A., Khaqan, M. A., Jamali, T., Khan, M. Z., Alsheik, E., & Zuchelli, T. (2024). Endoscopic Full‐Thickness Plication for the Treatment of Gastroesophageal Reflux Disease: A Systematic Review and Meta‐Analysis of Randomized Sham Controlled Trials. In JGH Open (Vol. 8, Issue 11). Wiley. https://doi.org/10.1002/jgh3.70056

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Paracetamol use not as safe as perceived among older people, according to new study

New research, led by experts at the University of Nottingham, has found that repeated doses of paracetamol in people aged 65 and over, can lead to an increased risk of gastrointestinal, cardiovascular and renal complications.

The new study, which is published in Arthritis Care and Research, shows that care must be taken when repeated doses are required for chronic painful conditions such as osteoarthritis in older people.

The study was led by Professor Weiya Zhang, from the NIHR Biomedical Research Centre in the School of Medicine at the University of Nottingham.

Professor Zhang said: “Due to its perceived safety, paracetamol has long been recommended as the first line drug treatment for osteoarthritis by many treatment guidelines, especially in older people who are at higher risk of drug-related complications.”

The study analysed data from the Clinical Practice Research Datalink-Gold. Participants were aged 65 and over with an average age of 75, and had been registered with a UK GP practice for at least a year between 1998 and 2018.

Researchers looked at the health records of 180,483 people who had been prescribed paracetamol repeatedly (≥2 prescriptions within six months) during the study. Their health outcomes were then compared to 402,478 people of the same age who had never been prescribed paracetamol repeatedly.

The findings showed that prolonged paracetamol use was associated with an increased risk of peptic ulcers, heart failure, hypertension and chronic kidney disease.

Professor Zhang adds: “Whilst further research is now needed to confirm our findings, given its minimal pain-relief effect, the use of paracetamol as a first line pain killer for long-term conditions such as osteoarthritis in older people needs to be carefully considered.”

Reference:

Jaspreet Kaur, Incidence of side effects associated with acetaminophen in people aged 65 years or more: a prospective cohort study using data from the Clinical Practice Research Datalink, Arthritis Care & Research, https://doi.org/10.1002/acr.25471.

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Vitamin D and bisphosphonates combo improve BMD in patients with postmenopausal osteoporosis: Study

A new study published in the Frontiers in Pharmacology found that combining vitamin D with bisphosphonates led to positive effects on bone mineral density (BMD) in postmenopausal osteoporosis patients. One of the most prevalent illnesses among the elderly is osteoporosis, which affects nearly 30% of postmenopausal women worldwide and has a prevalence of 18.3%.

As of now, there is disagreement about whether vitamin D (VitD) and bisphosphonates work better together than they do alone to treat postmenopausal osteoporosis. Thereby, to integrate the current information and further explore whether the combination use of vitamin D and bisphosphonates is preferable to monotherapy in treating osteoporosis in postmenopausal women, Yang Y and colleagues set out to perform a meta-analysis of recent pertinent studies.

To find randomized controlled trials (RCTs) comparing the effects of vitamin D or bisphosphonates alone versus their combination therapy in the treatment of postmenopausal osteoporosis, this research conducted a thorough search of EMBASE, PubMed, the Cochrane Library, and Web of Science through February 1, 2024.

The standardized mean difference (SMD) and 95% confidence intervals (CI) were used to represent the changes in mean values and percentage changes for bone resorption indicators, bone formation markers, bone mineral density, and bone mineral metabolism markers. The I[2] test was used to quantitatively characterize heterogeneity. Sensitivity analysis for data with notable heterogeneity were then conducted. The kind of monotherapy employed was the basis for subgroup analysis, and possible publication bias was evaluated.

In comparison to the monotherapy group, the analysis showed that the combination of vitamin D and bisphosphonates had a more noticeable effect on raising serum levels of alkaline phosphatase (ALP), 25-hydroxyvitamin D (25-OH-VD), and calcium (sCa), while lowering levels of serum C-terminal telopeptide of type I collagen (sCTX), bone-specific alkaline phosphatase (sBALP), and urinary N-telopeptide of type I collagen (UriNTX).

However, in terms of raising osteocalcin levels, the combination of vitamin D and bisphosphonates did not provide a discernible benefit over monotherapy. The percentage increases in parathyroid hormone (PTH) and the mean changes in osteocalcin, UriNTX, and sCa were not statistically significant (p > 0.05). Overall, this meta-analysis indicates that the combined therapy of vitamin D and bisphosphonates has a greater positive impact on indicators related to bone calcium metabolism and bone mineral density than monotherapy.

Source:

Yang, Y., Yang, M., Su, X., & Xie, F. (2024). Efficacy of combination therapy of vitamin D and bisphosphonates in the treatment of postmenopausal osteoporosis: a systematic review and meta-analysis. In Frontiers in Pharmacology (Vol. 15). Frontiers Media SA. https://doi.org/10.3389/fphar.2024.1422062

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Olive, grape, garlic, rosemary and saffron have preventive properties against CVD, reveals research

Cardiovascular problems are the leading cause of disease and mortality worldwide. Plant extracts, rich in bioactive compounds, have contributed significantly to the development of drugs, as they offer therapeutic potential for several of these diseases. However, their use is limited by possible side effects, drug-drug interactions and the lack of scientific evidence from quality preclinical and clinical studies.

During the 2023/24 academic year, biologist Mateu Anguera Tejedor made an important contribution in this field with his final year Biology degree project at the UAB, tutored by the then postdoctoral researcher at the Institut de Neurociències of the UAB (INc-UAB) and current lecturer at the Faculty of Pharmacy and Food Sciences of the University of Barcelona, René Delgado.

The study, recently published as a scientific article in the journal Food Bioscience, provides an overview of the mechanisms of action and the preclinical and clinical evidence, as well as the adverse effects of essential bioactive compounds derived from a group of selected Mediterranean plants which form part of the Mediterranean diet.

Among the species analysed, six representative plants and their major active components are reported: garlic (Allium sativum, with diallyl trisulfide, allicin and S-allyl [cysteine]), hawthorn shrub (Crataegus monogyna, with quercetin, apigenin and chlorogenic acid), saffron (Crocus sativus, with crocin and safranal), olive (Olea europaea, with oleic acid, oleuropein, hydroxytyrosol and oleacein), rosemary (Salvia rosmarinus, with rosmarinic acid and carnosic acid) and grapevine (Vitis vinifera, with resveratrol). The review focused on the most important pharmacological mechanisms, including their antioxidant, anti-inflammatory and vasodilatory actions, as well as their regulation of lipid metabolism, which may be relevant for conditions such as atherosclerosis and hypertension. The results show that these active components are promising in the potential treatment of atherosclerosis and could reduce the risk of heat attacks and strokes.

In addition to summarising the current scientific evidence, the study provides a reference guide for future research by identifying potential knowledge gaps and offering timely recommendations for designing preclinical and clinical studies in this area. Key areas for future exploration include the long-term safety of these compounds, the evaluation of their synergistic effects when consumed as part of a Mediterranean diet, and the need to establish standardised protocols in controlled clinical settings. By broadening the scientific basis of these traditional remedies, this review may help pave the way for their use as active pharmaceutical ingredients in the development of future phytomedicines.

Combined ingestion could alter the efficacy of individual extracts

The research team believes that the use of these natural extracts is promising, but their combined ingestion could influence therapeutic outcomes due to the “matrix effect”, which implies that dietary components can alter the efficacy of each extract, either enhancing or diminishing their individual benefits. Understanding this interaction is essential to optimise the therapeutic application of these plant extracts in a dietary context. It is important to recognise that there is often a lack of robust evidence of the impact of natural extracts in humans, and therefore researchers caution that “the label of ‘natural’ does not guarantee safety, and this emphasises the need to prioritise pharmacokinetic, toxicological and clinical studies to evaluate their efficacy, safety and efficiency in comparison with existing drugs”.

Reference:

Mateu Anguera-Tejedor, Gabino Garrido, Bárbara B. Garrido-Suárez, Alejandro Ardiles-Rivera, Àngel Bistué-Rovira, Francesc Jiménez-Altayó, René Delgado-Hernández, Exploring the therapeutic potential of bioactive compounds from selected plant extracts of Mediterranean diet constituents for cardiovascular diseases: A review of mechanisms of action, clinical evidence, and adverse effects, Food Bioscience, https://doi.org/10.1016/j.fbio.2024.105487

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Prenatal 2D Ultrasound reveals significant adrenal gland adaptation in patients with Fetal growth restriction: Study

Fetal growth restriction (FGR) is defined as a pathological
in utero growth disorder primarily caused by factors related to the fetus, the
mother, or the placenta. Neonatal mortality rates are higher in FGR compared to
cases in which there is normal growth. Additionally, FGR is associated with
increased risks of both short- and long-term neonatal morbidities, such as
intraventricular hemorrhage, infections, respiratory distress, delayed brain
development, impaired endocrine function, and cardiovascular disease.

The principal cause of placenta-related FGR is insufficient
remodeling of the uterine spiral arteries that supply the placenta. The
maintenance of blood supply to vital organs such as the brain, myocardium, and
adrenal glands requires redistribution of fetal circulation, primarily through
the hypothalamus-pituitary-adrenal axis (HPA). Glucocorticoid (GC) hormones,
particularly cortisol, are crucial in managing stress responses during fetal
development and in regulating the growth and maturation of fetal tissues and
organs.

The fetal adrenal glands, appearing early at 28–30 days post
fertilization, are among the largest organs when the fetus is near term. The
fetal adrenal cortex undergoes rapid growth during the prenatal period and
divides into three zones: the fetal zone (FZ), the definitive zone (DZ), and
the transitional zone (TZ). The fetal adrenal medulla, however, is not recognizable
until delivery. The FZ is responsible for the synthesis of
dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S),
which are crucial for facilitating placental estrogen production. Meanwhile,
the DZ and TZ, also known as the “neocortex,” are involved in the production of
cortisol and aldosterone during pregnancy.

The fetal adrenal glands comprise a highly vascularized
organ, which receives blood from several primary arteries: the superior adrenal
artery (SAA), middle adrenal artery (MAA), and inferior adrenal artery (IAA),
which originate from the inferior phrenic artery, abdominal aorta, and renal
artery, respectively. The superior and inferior portions of the DZ are
primarily supplied by the SAA and IAA, respectively, while the FZ is predominantly
supplied by the MAA.

Theoretically, chronic fetal hypoxia and stress could
trigger the activation of the HPA axis, potentially affecting both the adrenal
vessels and the adrenal glands. Therefore, a study was carried out to compare
the differences in Doppler indices of the adrenal artery and adrenal gland
sizes between fetuses with growth restriction and those with normal growth.

This study aimed at comparing the Doppler indices of the
adrenal artery and the adrenal gland sizes between FGR and those with normal
growth. A multicenter, cross-sectional study was conducted from February to
December 2023. Authors compared 34 FGR to 34 with normal growth in terms of
inferior adrenal artery (IAA) Doppler indices and adrenal gland volumes.

The IAA peak systolic velocity (PSV) in the FGR group was
14.9±2.9 cm/s compared to 13.5±2.0 cm/s in the normal group, with a mean difference
of 1.4 cm/s (p value = 0.017). There were no significant differences between
groups in terms of IAA pulsatility index (PI), resistance index (RI), or
systolic/diastolic (S/D), with p values of 0.438, 0.441, and 0.658,
respectively. The volumes of the corrected whole adrenal gland and the corrected
neocortex were significantly larger in the FGR group, with p values of 0.031
and 0.020, respectively.

The Doppler study of the IAA in fetuses with growth
restriction revealed a significant increase in PSV, while no changes were
observed in the PI, RI, and S/D compared to those with normal growth.
Additionally, both the corrected WAG volume and the corrected neocortex volume
were significantly enlarged in FGR.

Both increased IAA PSV and enlarged volumes of the corrected
WAG and neocortex were found in fetuses with FGR, suggesting significant
adrenal gland adaptation in response to chronic intrauterine stress.

Source: Suphawan et al; Wiley Journal of Pregnancy Volume
2024, Article ID 9968509, 10 pages https://doi.org/10.1155/2024/9968509

Both increased inferior adrenal artery peak systolic velocity and enlarged volumes of the corrected whole adrenal gland volume and neocortex were found in fetuses with

  suggesting significant adrenal gland adaptation in response to chronic intrauterine stress.

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Robotic Thymectomy Matches VATS in Long-Term Outcomes, Excels in Perioperative Results: Study

Researchers have found that robotic-assisted thoracoscopic surgery (RATS) thymectomy delivers outstanding perioperative outcomes with equivalent long-term oncological outcomes when compared to video-assisted thoracoscopic surgery (VATS) in treating thymic epithelial tumors. A recent study was conducted by Long-Fei and colleagues which was published in the journal BMC Surgery.

The study involved an analysis of data from 180 patients who underwent thymectomy through RATS or VATS between July 2016 and December 2019. Of these, 85 patients were operated on by RATS, and 95 patients were operated on by VATS. To allow for balanced comparisons, the analysis was done with a 1:1 propensity score-matched approach. The analysis was focused on perioperative factors, including operation time, blood loss, and conversion rates to open surgery, and long-term oncological outcomes, such as 5-year progression-free survival and tumor-related survival rates.

Key Results

Perioperative Outcomes:

  • Operation Time: The median operation time was significantly shorter in the RATS group, 100 minutes, compared to the VATS group, 120 minutes (p = 0.039).

  • Blood Loss: The patients in the RATS group had less blood loss with a median of 40.00 ml compared to the VATS group, 50.00 ml (p= 0.011).

  • Conversion Rates: Conversion to open surgery was remarkably less in the RATS group with only 2 patients (3.03%) compared with 10 patients (15.15%) in the VATS group (p= 0.030).

Late Oncological Outcomes :

Progression-Free Survival

  • The 5-year progression-free survival rate was found out to be 87.70% in the RATS group which is equal to the overall percentage of the VATS group.

  • Tumor-Related Survival: The 5-year tumor-related survival rate for the RATS group was 92.31%, without any statistical significance when compared with the VATS group.

RATS thymectomy resulted in excellent perioperative outcomes and long-term oncologic results compared with VATS. Based on these data, RATS can be considered as an effective and efficient alternative to VATS for thymic epithelial tumor treatment. Due to the possibility of combining the perioperative advantages with reliable long-term results, RATS will have an important position in the surgical treatment of thymic malignancies.

Reference:

Zhu, L.-F., Zhang, L.-M., Zuo, C.-J., Jiang, B., & Cheng, N. (2024). Long‐term outcomes of robot versus video-assisted thymectomy for thymic epithelial tumors: a propensity matched analysis. BMC Surgery, 24(1). https://doi.org/10.1186/s12893-024-02661-3

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Untangling Enigma of Cesarean Scar Pregnancies: Study Unravels Optimal Treatment Approach

Cesarean scar pregnancy (CSP), a unique type of ectopic pregnancy, poses difficulties in effective treatment. It is classified into three subtypes based on where the placenta embeds and the thickness of the uterine scar, but the best treatment options for these subtypes have not been thoroughly explored. Recent research paper by Ma et al. explores the challenges in managing Cesarean scar pregnancy (CSP) and categorizes it into three subtypes based on placental implantation location and myometrium thickness at the uterine scar. The study investigates the cases of 130 patients diagnosed with CSP who underwent various treatment approaches, including ultrasound-guided dilation and curettage (D&C), hysteroscopic surgery alone or in combination with laparoscopic surgery (HCoLC), or uterine artery embolization (UAE) followed by curettage. The paper highlights the lack of research on the most effective treatment modalities for these CSP subtypes.

Treatment Outcomes

The results from the study conducted between January 2017 and December 2021 show varying success rates and outcomes for different CSP subtypes based on the treatment modality chosen. The study indicates that Type I CSP patients had higher success rates with D&C, while Type II CSP required more complex interventions with longer surgical durations and higher hospitalization costs. Type III CSP cases underwent simultaneous hysteroscopic and laparoscopic interventions with a 100% success rate in their initial treatment. HCoLC showed higher success rates and shorter hospital stays compared to D&C and UAE groups.

Surgical Intervention Strategies

Moreover, the paper emphasizes the importance of accurate classification of CSP and measurement of gestational sac size in determining the most appropriate surgical intervention strategy. Patients with Type I and Type II CSP often achieve higher success rates with direct surgical procedures. For larger gestational sacs or Type II CSP, hysteroscopy either alone or in combination with laparoscopy is recommended. The study concludes that timely diagnosis, intervention, and treatment initiation are crucial for managing CSP, and additional research is needed to establish more efficacious and secure treatment strategies for patients with CSP.

Study Limitations and Conclusion

Overall, the research highlights the significance of classifying CSP in clinical diagnosis and treatment but acknowledges limitations, including its retrospective design, small sample size, and the need for further research on the impact of CSP on fertility and recurrent ectopic pregnancy risk. The study underscores the complexity of managing CSP and the importance of personalized treatment strategies for better patient outcomes.

Key Points

1. The research paper by Ma et al. categorizes Cesarean scar pregnancy (CSP) into three subtypes based on placental implantation location and myometrium thickness at the uterine scar. The study included 130 patients with CSP who underwent treatment approaches such as ultrasound-guided dilation and curettage (D&C), hysteroscopic surgery alone or combined with laparoscopic surgery (HCoLC), or uterine artery embolization (UAE) followed by curettage.

2. Treatment outcomes varied for different CSP subtypes with different success rates and outcomes depending on the selected treatment modality. Type I CSP patients had higher success rates with D&C, while Type II CSP required more complex interventions with longer surgical durations and higher hospitalization costs. Type III CSP cases had a 100% success rate with simultaneous hysteroscopic and laparoscopic interventions, showing higher success rates and shorter hospital stays compared to D&C and UAE groups.

3. Accurate classification of CSP and measurement of gestational sac size are crucial in determining the most appropriate surgical intervention strategy. Surgical procedures were found to be more successful for Type I and Type II CSP, while hysteroscopy alone or in combination with laparoscopy was recommended for larger gestational sacs or Type II CSP. Timely diagnosis and treatment initiation were emphasized as crucial for managing CSP effectively.

4. The study acknowledges limitations such as its retrospective design, small sample size, and the need for further research on the impact of CSP on fertility and recurrent ectopic pregnancy risk. The complexity of managing CSP and the importance of personalized treatment strategies for improved patient outcomes were underscored.

5. The paper highlights the lack of research on effective treatment modalities for CSP subtypes and emphasizes the importance of establishing more efficacious and secure treatment strategies for patients with CSP through additional research.

6. Overall, the research by Ma et al. underscores the significance of classifying CSP in clinical diagnosis and treatment, pointing out the need for more comprehensive studies to address the challenges in managing CSP and to enhance patient outcomes in the future.

Reference –

Ma, R., Chen, S., Xu, W. et al. Surgical treatment of cesarean scar pregnancy based on the three-category system: a retrospective analysis. BMC Pregnancy Childbirth 24, 687 (2024). https://doi.org/10.1186/s12884-024-06887-0

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Combined models using maternal biophysical factors, ultrasound and biochemical markers may predict stillbirths accurately: Study

Stillbirth presents a substantial global health issue with an estimated annual occurrence of 2.6 million cases, predominantly affecting low- and middle-income nations. The primary causes of stillbirth differ between high-income and low- to middle-income countries, with factors like fetal growth restriction, placental insufficiency, and congenital anomalies more prevalent in the former, while maternal infections, hypertensive disorders, and obstetric complications are more common in the latter. Recent study aimed to evaluate the accuracy of combined models using maternal biophysical factors, ultrasound, and biochemical markers to predict stillbirths. The researchers conducted a retrospective cohort study of 1,643 pregnant women who underwent first-trimester pre-eclampsia screening at 11-13 weeks of gestation. The study found that there were 13 (0.79%) cases of stillbirth. The combination of maternal factors (including chronic hypertension and previous pregnancy with pre-eclampsia), mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and placental growth factor (PlGF) significantly contributed to the prediction of stillbirth. This combined model was a good predictor for all (including controls) types of stillbirth, with an area under the receiver-operating-characteristics curve (AUC) of 0.879 and a sensitivity of 99.3% and specificity of 38.5%.

Accuracy in Prediction

The model was especially accurate in predicting placental dysfunction-related stillbirths, with an AUC of 0.984, sensitivity of 98.5%, and specificity of 85.7%. However, the model had lower predictive accuracy for non-placental dysfunction-related stillbirths, with an AUC of 0.780.

Research Conclusion

The researchers concluded that screening at 11-13 weeks’ gestation by combining maternal factors, MAP, UtA-PI, and PlGF can predict a high proportion of stillbirths, particularly those related to placental dysfunction. The model has good accuracy and could be used in clinical practice to allow early intervention strategies to prevent stillbirth.

Key Points

1. The study aimed to evaluate the accuracy of combined models using maternal biophysical factors, ultrasound, and biochemical markers to predict stillbirths.

2. The study found that the combination of maternal factors (including chronic hypertension and previous pregnancy with pre-eclampsia), mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and placental growth factor (PlGF) significantly contributed to the prediction of stillbirth.

3. The combined model was a good predictor for all types of stillbirth, with an area under the receiver-operating-characteristics curve (AUC) of 0.879 and a sensitivity of 99.3% and specificity of 38.5%.

4. The model was especially accurate in predicting placental dysfunction-related stillbirths, with an AUC of 0.984, sensitivity of 98.5%, and specificity of 85.7%.

5. The model had lower predictive accuracy for non-placental dysfunction-related stillbirths, with an AUC of 0.780.

6. The researchers concluded that screening at 11-13 weeks’ gestation by combining maternal factors, MAP, UtA-PI, and PlGF can predict a high proportion of stillbirths, particularly those related to placental dysfunction, and the model has good accuracy that could be used in clinical practice to allow early intervention strategies to prevent stillbirth.

Reference –

Adly Nanda Al-Fattah et al. (2024). A Prediction Model For Stillbirth Based On First Trimester Pre-Eclampsia Combined Screening.. *International Journal Of Gynaecology And Obstetrics: The Official Organ Of The International Federation Of Gynaecology And Obstetrics*. https://doi.org/10.1002/ijgo.15755.

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