Diagnosis of potential umbilical cord compromise, namely, true knots of the umbilical cord and nuchal cords has been enabled with increasing accuracy with current enhanced prenatal sonography. Often an incidental finding at delivery, the incidence of true knots of the umbilical cord has been estimated at between 0.04% and 3% of deliveries. This condition has been reported to account for a 4 to 10-fold increase of stillbirth and perinatal morbidity of 11% of cases. Nuchal cords, commonly observed at the delivery of uncompromised, non-hypoxic non-acidotic newborns occur more frequently with single nuchal cords noted in between 20% and 35% of all deliveries at term. Multiple nuchal cords are considerably less frequent, with decreasing frequencies inverse to the number of nuchal cord loops. While clearly single (and likely double) nuchal cords are almost uniformly associated with favorable neonatal outcomes, emerging data suggest that cases of ≥3 loops of nuchal cords are more likely to be associated with an increased risk of adverse perinatal outcome (either stillbirth or compromised neonatal condition at delivery). We define cases of a true knot of the umbilical cord, cases of ≥3 loops of nuchal cords, any combination of a true knot and nuchal cord, or any umbilical cord entanglement (nuchal or true knot) in the presence of a single umbilical artery, in singleton gestations as complex umbilical cord entanglement. Two concurrent developments, the increase in accuracy of prenatal sonographic diagnosis of complex umbilical cord entanglement and recent data confirming fatal compromise of the umbilical circulation in approximately 20% of cases of stillbirth, suggest that establishing governing body guidelines for reporting of potential umbilical cord compromise, and recommendation of consideration for early-term delivery of select cases, may be warranted. This commentary will address current perspectives of prenatal diagnosis and clinical management challenges of complex umbilical cord entanglement.
ImportanceStudies have sought to evaluate factors that have perpetuated disparities in health care, including urogynecologic care. However, there remains a lack of understanding of barriers to care specific to racial/ethnic minority populations.ObjectivesWe aimed to report identified barriers to urogynecologic care (eg, care for symptoms/diagnoses of urinary incontinence [UI], accidental bowel leakage [ABL], and pelvic organ prolapse [POP]) for underrepresented racial and ethnic minority (URM) women in the United States.Study DesignWe conducted a systematic search for studies through 5 electronic bibliographic databases. Inclusion criteria for eligible studies included the following: (1) studies reporting barriers to care for those with urogynecologic symptoms/diagnoses, (2) publication date year 2000 or later. Exclusion criteria included study cohorts with children, exclusively non-U.S. populations, cohorts without URM participants, and studies without qualitative research methodology. Study methodology, characteristics, as well as barriers and facilitators to urogynecologic care were captured using a thematic synthesis approach.ResultsThere were 360 studies identified. Twelve studies met criteria: 6 had study populations with UI, 3 with POP, 2 on UI and/or POP, and 1 on ABL. There were 7 focus group studies (total 44 groups, n = 330), 4 interview studies (total 160 interviews, n = 160), and 1 had both (10 interviews, 6 groups, n = 39). Most studies reported on patient-associated barriers (n = 10/12) and physician/provider-associated barriers (n = 10/12), whereas only half reported system-associated barriers (n = 6/12).ConclusionIdentified barriers to urogynecologic care for URM populations were examined. Findings likely do not fully reflect barriers to urogynecologic care for URM populations. Comprehensive evaluation of social determinants of health and systemic racism within studies is needed to understand the unique barriers present for racially/ethnically diverse populations.
Introduction: In the US, breast cancer is the second leading cause of cancer deaths in women. Estrogen receptor positive [ER(+)] breast cancers represent 70-75% of human breast cancers. Selective estrogen receptor modulators such as tamoxifen, have a well-established role in preventing ER (+) breast cancer. However, these agents have limitations due to development of tamoxifen resistance. It is now well accepted that non-steroidal anti-inflammatory drugs (NSAIDs) reduce the risk of and mortality from colon cancer and constitute the prototypical colon cancer chemopreventive agents. Recent exhaustive meta-analysis also provides evidence that NSAID also reduce the risk for ER(+) breast cancer. However, regular NSAID use may lead to life threatening side effects. To overcome these limitations, we developed NOSH-aspirin, a nitric oxide-, and hydrogen sulfide-releasing hybrid that is very potent yet devoid of any cyto-toxicity. Here we report on the effects of NOSH-aspirin alone or in combination with 5-fluorouracil (5-FU) on treatment of established tumors in a xenograft model of human ER(+) breast cancer. Methods: NOSH-aspirin was synthesized and purified by us. Cell line: breast MCF-7 (ER+), Xenografts: Female athymic nude mice (N=25) were implanted s.c. in the right flank with MCF-7 cells (2 x 106), when the tumor volumes reached ∼100 mm3, the animals were randomly divided into 5 groups (N=5/gp) and treated with NOSH-aspirin (po,50 and 100 mg/kg body wt/day), 5-FU (ip, 10 mg/kg x 2/week), high dose NOSH-aspirin+5-FU as above, or vehicle (po). Tumor volume and animal weight were recorded every 3 days. After 3 weeks of treatment, mice were sacrificed, tumors excised, weighed, and fixed in 10% buffered formalin for IHC studies. We also weighed the livers and the kidneys. Results: NOSH-aspirin dose-dependently reduced tumor volume as a function of time. 5-FU also significantly reduced tumor volume, however, there was a synergistic effect in the combination group. Tumor mass at sacrifice in each group was, vehicle (2.35±0.22g), NOSH-aspirin 50 mg/kg (0.80±0.28g, 66% reduction, P<0.01), NOSH-aspirin 100 mg/kg (0.17±0.08g, 93% reduction, P<0.001), 5-FU (0.065±0.024g, 97% reduction, P<0.001), high dose NOSH-aspirin+5-FU (0.018±0.007g 99% reduction P<0.001). The tumor regression was significantly more in the combination group compared to NOSH-aspirin or 5-FU alone. NOSH-aspirin had no effect on the weight of the mice whether alone or in combination with 5-FU, there were no overt signs of toxicity. There was a 10% reduction in the weight of animals in the 5-FU group; however, this difference was not significant. There were no differences in liver or kidney masses amongst the groups. Conclusions: NOSH-aspirin has potent anti-cancer properties and demonstrates synergistic properties with 5-FU. It merits further evaluation as a chemotherapeutic agent. Citation Format: Sarin A. Soyemi, Mitali Chattopadhyay, Khosrow Kashfi. NOSH-aspirin alone or in combination with 5-fluorouracil induces tumor regression in a xenograft model of estrogen receptor positive breast cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2513. doi:10.1158/1538-7445.AM2014-2513
Marked first‐trimester nonimmue hydrops fetalis and 45,X with neonatal survival.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.