Injection Of KCl Research Articles

Characteristics of Patients Undergoing Fetal Potassium Chloride Injection at a Single Center Over Time.

Changes in the U.S. laws, particularly the Dobbs decision in 2022, altered access to abortions. Fetal potassium chloride (KCl) injections can be used for second- and third-trimester abortions. This descriptive study aims to present the characteristics of patients who received KCl injections in a state with protective laws (Colorado), including pre- and post-Dobbs. Patients undergoing KCl injection at our institution between January 2014 and December 2023 were included. Records were reviewed for demographic data, parity, and procedure details. Distance traveled and area deprivation index (ADI) were determined based on residence data. Group differences pre- and post-Dobbs were analyzed using Chi-squared and Mann-Whitney U tests. Subanalyses were performed to compare in-state and out-of-state (OOS) patients. One hundred and nineteen patients were included: 56 pre-Dobbs and 63 post-Dobbs, representing a 6.4-fold increase in volume post-Dobbs. Patients were from 10 states of residence pre-Dobbs and 17 post-Dobbs. Median distance traveled significantly increased post-Dobbs, 29.8 versus 383.9 miles (p = 0.004). The maximum distance traveled was 855 miles pre-Dobbs and 1,201 miles post-Dobbs. ADI did not vary pre- or post-Dobbs. Singleton procedures increased post-Dobbs for all patients. There was no change in gestational duration at the time of procedure across any comparison. Procedure volume and distance traveled increased for both in-state and OOS patients with minimal change in patient characteristics pre- and post-Dobbs. Our data indicate an increased need for these procedures, even in a state with protective laws.

Reproductive conditioning, spawning induction and early development of the estuarine Caribbean clam, Polymesoda arctata (Deshayes, 1854), under hatchery conditions

Polymesoda arctata is a Caribbean estuarine clam commercially important that currently is considered threatened. The reproductive conditioning, spawning and early development were evaluated under laboratory conditions using organisms collected in the lagoon system of Ciénaga Grande de Santa Marta (Colombian Caribbean) between December 2020 and May 2021. Two reproductive conditioning experiments were conducted over 7 weeks, examining the frequency of mature animals in the natural environment (controls) and in the laboratory under two water temperatures (26 and 29 °C) and different salinity regimes (constant at 5 and 15 ppt, increasing from 5 to 15 ppt, and decreasing from 15 to 5 ppt). One spawning experiment was done, comparing the spawning response of adult clams exposed to various stimuli (changes in water temperature and salinity, flow of seawater irradiated with UV light, addition of a high concentration of food and sperm to the water, as well as injections of serotonin and KCl into the foot and/or adductor muscle). Higher frequencies of mature clams were observed after 2 to 5 weeks of reproductive conditioning at a low temperature (26 °C) and under a constant salinity regime (at 5 or 15 ppt). Higher percentages of spawning and post-stimulation survival as well as spawning response speed were observed in specimens injected in the foot with a low concentration of serotonin (0.4 mL at 20 μM). The time of spawning response onset was shorter in males than in females. The fecundity increased with the live weight of the females, showing an average value of 3.4 × 106 oocytes per female. The early development of the estuarine clam from oocyte to juvenile stage was described in detail. The growth rates of larvae and spat were relatively high but their survival values were low, showing the need for additional research on the larval and post-larval rearing.

Does the righting behaviour effectively reflect stress in Arbacia dufresnii Arbacioida: Arbaciidae)?

Introduction: Righting behaviour has been used as a health indicator in response to stressor variables. Using this parameter in aquaculture could help to reduce mortality and improve welfare in the sea urchin Arbacia dufresnii culture.
 Objective: The purpose of this study was to determine the effect of sex, diameter, and three stressor factors on the righting behaviour of the sea urchin A. dufresnii.
 Methods: A total of 300 animals were evaluated for complete righting behaviour (CRB) time, with 100 of them also recording half righting behaviour (HRB) time. Three stressors were applied to the animals: serial repetitions (three successive turnings), temperature (24-hour shock), and spawning induction with KCl injection. A stopwatch was used to record the time, and a precision calliper was used to measure the diameter.
 Results: Righting time was discovered to be diameter dependent but sex independent. The upper temperature limit of 19 °C had a significant effect on righting behaviour compared to 16 °C and 13 °C with CRB times up to 150 seconds. Serial repetitions and spawning had no significant effect. However, based on the recorded times, it can be deduced that spawning had an effect on the health of the animals, with CRB times of up to 150 seconds compared to the control, with lower times.
 Conclusions: Complete righting behaviour appears to be an optimal indicator for evaluating the health and condition of the sea urchin A. dufresnii, but more tests would be performed to confirm the effect of the control treatment on post-spawning stress.

Intracardiac KCl Injection in Cesarean Scar Pregnancy: A Review Article

Embryo implantation in a previous caesarean scar (CS) resulting in a caesarean scar pregnancy (CSP) is another rare but potentially catastrophic complication of a previous caesarean birth. CSP can be detected between days 33 and 94 of pregnancy. Methotrexate and potassium chloride (KCl) are the most common feticidal agents used. intracardiac KCl causes feticide and reduces the uteroplacental blood flow, thereby decreasing the rate of hemorrhage due to placenta previa, caesarian scar pregnancy and in cases of fibroids; it is easy to evacuate the macerated fetus. Intracardiac KCl causes feticide and reduces the uteroplacental blood flow, thereby decreasing the rate of hemorrhage and abortion time before termination of pregnancy (TOP) leading to an easy evacuation of the macerated fetus. In conclusion, feticide with intracardiac KCl is a safe procedure.

Advances in Aquaculture Hatchery Techniques of Sea Urchin Sphaerechinus granularis (Lamarck, 1816) (Echinoidea: Toxopneustidae): Broodstock Conditioning and Spawning Induction.

In response to the growing demand for sea urchin gonads (roe or uni) in Asian and European markets and the concerns regarding the overexploitation of wild populations, this preliminary study addresses the need for cost-effective protocols in echinoculture. The primary focus of this research was to evaluate the gonadosomatic index (GI) in captive-conditioned Sphaerechinus granularis over a five-month period and compare it with that of their wild-caught conspecifics. Additionally, two different spawning induction methods were assessed: potassium chloride (KCl) injection and agitation. Results indicate that captive-conditioned sea urchins exhibit significantly higher GI values when compared to their wild-caught counterparts. Furthermore, it was observed that the agitation method is equally effective as the KCl injection in triggering a positive response, i.e., gamete ejection, while maintaining lower mortality rates among the subjected S. granularis. In conclusion, this preliminary study underscores the pivotal role of broodstock conditioning in supporting the sustainability of sea urchin aquaculture. Moreover, the spawning induction method through agitation emerges as a viable alternative to the traditional intracelomic KCl injection, offering comparable efficacy without compromising the survival of the broodstock. These findings have significant implications for the development of sustainable sea urchin farming practices.

Abstract 197: Establishing a Novel Pulse Wave Velocity-Guided Mouse Model of Cardiac Arrest With Different Durations

Background: Neurological and cardiovascular injuries are the leading causes of death following cardiac arrest (CA). Few rodent models recapitulate these post-resuscitation symptoms. Aims: To develop extended ischemic CA models under Pulse Wave Velocity ( PWV) guidance with consistent post-CA brain injury (PCABI) and coronary dysfunction as potential therapeutic targets and mechanical studies. Methods: Forty-eight mice were randomized into four experimental groups (control, 8-, 12-, and 16-min CA). Potassium chloride (KCL) was intravenously injected, resulting in immediate asystole. Mice were resuscitated with an injection of epinephrine and manual chest compressions. PWV was monitored for the left carotid artery velocity and coronary flow reserve (CFR). Resuscitability, synaptic density in the hippocampal CA1 region, blood-brain barrier (BBB), and neurologic deficit scores (NDS) were also evaluated. Results: The PWV could monitor rapid asystole after KCL injection, improve cardiopulmonary resuscitation (CPR) success rates, and avoid the pre-matured end of resuscitation. Compared to the standard control, mice with 8-min CA had preserved CFR, mild loss of synaptic density (p>0.05), mild hypothermal, and a normal electrocardiogram. They maintained BBB integrity with no significant change to neurologic function. Compared with a 92% CPR success rate in 8 min-CA mice, 12 min-CA mice had 83%, and 16 min-CA mice had 58% resuscitability. Twelve min-CA mice had significantly impaired CFR at 24 hours and high lethality (40%, P<0.05) within the first three days; 16 min-CA mice worsened (33% survival rate, p<0.01). The 24 hrs electron microscope showed that CA-induced synaptic vesicle densities were ischemic time-dependent [350±60 (control) vs. 289±64 (8 min CA) vs. 269±34 (12 min CA) vs. 181±41/field (16 min CA)], consistent with NDS. The cerebrum and hippocampus were the most valuable regions, indicated by Evans blue evaluation at 48 hrs after CA. Conclusions: We established elongated PWV-guided CA models as with successful CPR, post-CA neurological deficits, leaky BBB, loss of synaptic density, coronary endothelial dysfunction, and even death in mice, which closely recapitulated the post-resuscitation symptoms in survived patients after CPR.

Intertwin nuchal translucency difference predicts the chance of co-twin death after fetal reduction in dichorionic triplet pregnancies: a retrospective analysis study

ObjectivesTo compare the clinical outcomes of different multifetal pregnancy reduction (MFPR) programs in dichorionic (DC) triplets, and explore the association between early ultrasound characteristics and co-twin death after potassium chloride (KCl) injection into one monochorionic (MC) twin.MethodsWe retrospectively reviewed the data of DC triplets who underwent MFPR at our center during 2012–2021. Patients were grouped as follows: intracardiac KCl injection into one MC twin (group A), intracardiac KCl injection into both MC twins simultaneously (group B), and reduction of the singleton fetus (group C) and pregnancy outcomes were compared. Logistic regression was used to determine whether ultrasound measurements at 11–13+6 weeks predicted co-twin death and the receiver operator characteristic (ROC) analysis was conducted to assess the predictive performance.ResultsFinally, we enrolled 184 patients. 153 cases were in group A, and 18, 13 cases were in group B and C respectively. Gestational age at the time of MFPR did not differ among the 3 groups (median: 12^frac67 weeks). The survival rate was 89.6%, 88.9%, and 92.3% in group A, B, and C respectively, which was comparable among groups. Preterm birth was more common in group C (10/12, 83.3%). After KCl injection into one MC twin, co-twin death occurred in 86.3% cases (132/153) within 1 day; however, 3 patients had 2 live births each, with normal postnatal development. Intertwin nuchal translucency (NT) difference/discordance significantly predicted co-twin death within 1 day after MFPR, and the areas under the ROC curve were 0.694 and 0.689, respectively.ConclusionsFor MFPR in DC triplet pregnancies, reduction of the MC twins results in less preterm birth, and women with KCl injection into either one or both MC twins had similar outcomes. Large intertwin NT difference/discordance was associated with co-twin death within 1 day after KCl injection into one of the MC twins.

A series of fetal reductions and their outcomes at a tertiary care center in North Karnataka: Fetal reduction series: A boon?

Fetal reduction is a novel method that aims to reduce a higher-order gestation to lower-order pregnancy to reduce both maternal and perinatal adverse outcomes. One of the methods of fetal reduction is by intracardiac injection of KCl under ultrasound guidance. Here, we present a case series of eight women who had undergone fetal reduction. All of them were trichorionic triamniotic triplets at the time of reduction. In seven women, the reduction was done to twin gestation, whereas one reduction was to singleton pregnancy. Out of eight cases, only one carried to full term and underwent vaginal delivery. One case was lost to follow-up and 2 women underwent expulsion. A total of nine live births were reported with 8 babies going to the neonatal intensive care unit for low birth weight and preterm care. Fetal reduction is an important method that needs to be widely practiced and reported to improve maternal and perinatal outcomes in multifetal gestation.

Evaluation of the effectiveness of potassium chloride in the management of out-of hospital cardiac arrest by refractory ventricular fibrillation: Study protocol of the POTACREH study.

Out-of-hospital cardiac arrest (OHCA) has a poor prognosis, with an overall survival rate of about 5% at discharge. Shockable rhythm cardiac arrests (ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT)) have a better prognosis. In case of shockable rhythm, treatment is based on defibrillation, and thereafter, in case of failure of 3 external electric shocks (EES), on direct intravenous administration of 300 mg amiodarone, or lidocaine when amiodarone is unavailable or inefficient. During surgical procedures under extracorporeal circulation, a high potassium cardioplegia solution is administered to interrupt cardiac activity and facilitate surgical procedure. By extension, direct intravenous administration of potassium chloride (KCl) has been shown to convert VF, resulting in return to a hemodynamically efficient organized heart rate within a few minutes. The aim of this study is to provide clinical evidence that direct intravenous injection of KCl, into a patient presenting with OHCA due to refractory VF although 3 EES, should interrupt this VF and then allow rapid restauration of an organized heart rhythm, and thus return of spontaneous circulation (ROSC). A multicenter, prospective, single group, phase 2 study will be conducted on 81 patients presenting with refractory VF. After failure of 3 EES, each patient will receive direct intravenous injection of 20 mmol KCl instead of amiodarone. The primary outcome will be survival rate at hospital admission. Major secondary outcomes will include ROSC and time to ROSC in the prehospital setting, number of VF recidivism after KCl injection, survival rate at hospital discharge with a good neurologic prognostic, and survival rate 3 months after hospital discharge with a good neurologic prognostic. No patient is currently included in the study. Conventional guideline strategy based on antiarrhythmic drug administration, i.e. amiodarone or lidocaine, for OHCA due to shockable rhythm, has not yet demonstrated an increase in survival at hospital admission or at hospital discharge. This may be related to the major cardiodepressant effect of those drugs. ClinicalTrials.gov Identifier: NCT04316611. Registered on March 2020. AP-HP180577 / N° EUDRACT: 2019-002544-24. Funded by the French Health Ministry. https://clinicaltrials.gov/ct2/show/NCT04316611.

Inhibition of γδ T Cells Alleviates Blood-Brain Barrier in Cardiac Arrest and Cardiopulmonary Resuscitation in Mice.

Ischemia/reperfusion (I/R) injury is the leading cause of death following cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). γδT cells are suggested to aggravate blood-brain barrier (BBB) injury in various pathological processes. We herein investigate the effects of γδT cells inhibitor (UC7-13D5) against I/R injury post-CA/CPR. C57BL/6 mice were subjected to CA through injection of KCL (70 μL of 0.5mol/L) and cessation of mechanical ventilation followed by CPR. Flow cytometry was performed to measure the proportion of CD3-positive cells after intraperitoneal injection of 200μg UC7-13D5 at 6h, 24h, and 48h post-resuscitation into mice. Neurological scores and modified neurological severity scores were assessed to examine neurological functions. Brain edema was estimated via brain water content measurements. Immunohistochemistry of caspase-3 and immunofluorescence staining of claudin-1, ZO-1 and CD31 were performed to detect neuronal apoptosis, BBB integrity and angiogenesis. Microvascular morphology in the cortical area was assessed via H&E staining. Oxidative stress was determined by measuring malondialdehyde, myeloperoxidase, xanthine oxidase, superoxide dismutase, and glutathione peroxidase activities. Western blotting was performed to measure the protein levels of Nuclear factor-E2-related factor 2 (Nrf2) and Heme oxygenase-1 (HO-1). UC7-13D5 effectively depleted γδT cells. Inhibition of γδT cells improved neurological deficits and reduced brain edema post-CA/CPR. γδT cells depletion attenuated neuronal apoptosis, BBB disruption and oxidative stress and promoted angiogenesis following CA/CPR. Inhibition of γδT cells facilitated the activation of the Nrf2/HO-1 pathway in CA/CPR-induced mice. Inhibition of γδT cells alleviates neurological deficits and cerebral edema in mice with CA/CPR by inhibiting neuronal apoptosis, BBB disruption and oxidative stress, and promoting angiogenesis via activation of the Nrf2/HO-1 pathway.

Sodium bicarbonate and salbutamol facilitate recovery from hyperkalemia-induced electrocardiogram abnormalities in bullfrog hearts.

Hyperkalemia is a common electrolyte abnormality frequently complicated with chronic kidney disease. By injecting potassium chloride (KCl) solutions intravenously into bullfrogs, we reproduced typical electrocardiogram (ECG) abnormalities of hyperkalemia in the frog hearts, such as the peaked T waves and the widening of QRS complexes. Simultaneous recordings of cardiac action potentials showed morphological changes that synchronized with those of ECG. After 100 mM KCl injection, the widened QRS complexes continued for a while and gradually restored to their baseline widths. However, pre-treatment with sodium bicarbonate or salbutamol, which directly or indirectly stimulates Na+/K+-ATPase activity, significantly facilitated the recovery from the widened QRS duration, indicating the transcellular movement of potassium ions from the extracellular fluid into the intracellular stores.

8557 Laparoscopic Resection of Involuting Cesarean Scar Pregnancy after Failed Multidose Methotrexate and KCl Treatment

<h3>Study Objective</h3> To describe the workup, treatment, and follow up of a cesarean-section scar ectopic pregnancy (CSP) that failed medical management and to demonstrate a laparoscopic resection of a cesarean section scar ectopic pregnancy that has failed medical management. <h3>Design</h3> Surgical video. <h3>Setting</h3> An academic teaching hospital and tertiary care center. <h3>Patients or Participants</h3> 36-year-old G2P2022, with a persistent cesarean scar ectopic pregnancy, who failed medical management with a multi-dose Methotrexate protocol and intrasac KCl injection and presented 3 months later for infertility evaluation. <h3>Interventions</h3> After failing medical management, the patient consented for a laparoscopic resection of CSP with revision of the previous scar. During surgery, the patient was found to have an involuting ectopic pregnancy at the site of the previous scar, which was successfully resected. The uterine incision was repaired in two layers. <h3>Measurements and Main Results</h3> The laparoscopic repair was completed successfully. Pathology showed fibrotic and necrotic chorionic villi with an adjacent decidual reaction consistent with a pregnancy. The patient's beta-hcg trended down to non-pregnant levels and she had a normal postoperative visit with no concerns. <h3>Conclusion</h3> Recommended treatment for CSP includes surgical resection, as medical management alone is unlikely to be successful. Key strategies for laparoscopic excision include use of backfilling the bladder to delineate borders, avoidance of excessive thermal energy, and closure of the defect in multiple layers.

Future Perspectives of Ectopic Pregnancy Treatment-Review of Possible Pharmacological Methods.

Ectopic pregnancy, that is, a blastocyst occurring outside the endometrial cavity of the uterus, affects nearly 2% of pregnancies. The treatment of ectopic pregnancy is surgical or pharmacological. Since surgical management is associated with numerous serious side effects, conservative treatment is sought. The treatment of choice in the majority of cases is based on pharmacotherapy with methotrexate (MTX) in a single- or multi-dose regimen. Although the efficacy of methotrexate reaches between 70 and 90%, its use requires specific conditions regarding both the general condition of the patient and the characteristic features of the ectopic pregnancy. Moreover, MTX can cause severe adverse effects, including stomatitis, hepatotoxicity and myelosuppression. Therefore, clinicians and researchers are still looking for a less toxic, more effective treatment, which could prevent surgeries as a second-choice treatment. Some studies indicate that other substances might constitute a good alternative to methotrexate in the management of ectopic pregnancies. These substances include aromatase inhibitors, especially letrozole. Another promising substance in EP treatment is gefitinib, an inhibitor of EGFR tyrosine domain which, combined with MTX, seems to constitute a more effective alternative in the management of tubal ectopic pregnancies. Other substances for local administration include KCl and absolute ethanol. KCl injections used in combination with MTX may be used when foetal heart function is detected in cervical ectopic pregnancies, as well as in heterotopic pregnancy treatment. Absolute ethanol injections proved successful and safe in caesarean scar pregnancies management. Thus far, little is known about the use of those substances in the treatment of ectopic pregnancies, but already conducted studies seem to be promising.

Inhibition of HSP90 Preserves Blood-Brain Barrier Integrity after Cortical Spreading Depression.

Cortical spreading depression (CSD) is a pathophysiological mechanism underlying headache disorders, including migraine. Blood–brain barrier (BBB) permeability is increased during CSD. Recent papers have suggested that heat shock proteins (HSP) contribute to the integrity of the blood–brain barrier. In this study, the possible role of HSP90 in CSD-associated blood–brain barrier leak at the endothelial cell was investigated using an in vitro model, for the blood–endothelial barrier (BEB), and an in vivo model with an intact BBB. We measured barrier integrity using trans endothelial electric resistance (TEER) across a monolayer of rodent brain endothelial cells (bEnd.3), a sucrose uptake assay, and in situ brain perfusion using female Sprague Dawley rats. CSD was induced by application of 60 mM KCl for 5 min in in vitro experiments or cortical injection of KCl (1 M, 0.5 µL) through a dural cannula in vivo. HSP90 was selectively blocked by 17-AAG. Our data showed that preincubation with 17-AAG (1 µM) prevented the reduction of TEER values caused by the KCl pulse on the monolayer of bEnd.3 cells. The elevated uptake of 14C-sucrose across the same endothelial monolayer induced by the KCl pulse was significantly reduced after preincubation with HSP90 inhibitor. Pre-exposure to 17-AAG significantly mitigated the transient BBB leak after CSD induced by cortical KCl injection as determined by in situ brain perfusion in female rats. Our results demonstrated that inhibition of HSP90 with the selective agent 17-AAG reduced CSD-associated BEB/BBB paracellular leak. Overall, this novel observation supports HSP90 inhibition mitigates KCl-induced BBB permeability and suggests the development of new therapeutic approaches targeting HSP90 in headache disorders.

Inhibition of Γδ T Cells Alleviates Brain Ischemic Injury in Cardiopulmonary-Cerebral Resuscitation Mice

A half-million people in the United States suffer from cardiac arrest (CA) requiring cardiopulmonary resuscitation (CPR). An inflammatory mechanism is associated with neuronal injury in the presence of cerebral ischemia. T lymphocytes are identified as crucial regulators of inflammation. Therefore, we investigated the relationship between CA/CPR-induced ischemia injury and T lymphocytes. C57BL/6 mice were subjected to CA through injection of KCl (30 μL of 0.5 mol/L) and cessation of mechanical ventilation followed by CPR. The survival rate and neurologic deficit scores were assessed. Terminal deoxynucleotidyl transferase dUTP nick end labeling staining was carried out to detect neuronal death. Histologic changes were observed by hematoxylin-eosin staining. The levels of Trgv4, Trgv5 and Trgv7 were quantified by RT-qPCR. Inflammatory responses were identified by measurement of IL-1β, IL-6 and IL-17. Downregulated γδ T cells improved survival and neurologic outcomes and inhibits neuronal apoptosis. γδ T inhibition protected brains from CA/CPR-mediated tissue damage. UC7-13D5 treatment inhibited the levels of γδ T markers. Knockdown of γδ T cells ameliorated neuroinflammation. Inhibition of γδ T cells ameliorates ischemic injury in mice with CA/CPR by attenuating inflammation and neuronal apoptosis.

A case of heterotopic pregnancy with intrauterine and cervical pregnancy coexisting: intrasacular KCl injection, intrauterine pregnancy being preserved, and then massive bleeding at 32 weeks

Background: Heterotopic pregnancy is the condition in which intrauterine and ectopic pregnancy coexist. The conservative management of the ectopic pregnancy, with the intrauterine pregnancy preserved, has been reported. Case(s): Here, we report a very rare case: intrauterine and cervical pregnancy coexist: intrasacular Potassium chloride (KCL) injection successfully terminated cervical pregnancy with intrauterine pregnancy preserved, but later massive bleeding occurred from the cervix. A 39-year-old woman at 7+1 weeks was diagnosed with a heterotopic cervical gestation, with intrauterine and cervical sac, both with live embryos. The ectopic pregnancy was successfully terminated with intrasacular injection of KCl, preserving the intrauterine pregnancy. At 32+4 weeks of gestation the patient started with a profuse bleeding from the cervical sac, causing maternal hypotension (80/45 mmHg) and tachycardia (160 bpm) and a decelerative pattern in the cardiotocographic fetal monitoring, prompting us to perform caesarean section. The cessation of bleeding was achieved using a double balloon intracervical catheter, which was withdrawn 24 hours after its insertion without observing a new bleeding episode. The patient was discharged after 8 days and the newborn after 35 days of life, both in good health. Conclusions: Conservative treatment of a heterotopic gestation is possible, managing to preserve the viability of the intrauterine pregnancy.

Stepwise disassembly of GABAergic synapses during pathogenic excitotoxicity.

SUMMARYGABAergic synaptic inhibition controls neuronal firing, excitability, and synaptic plasticity to regulate neuronal circuits. Following an acute excitotoxic insult, inhibitory synapses are eliminated, reducing synaptic inhibition, elevating circuit excitability, and contributing to the pathophysiology of brain injuries. However, mechanisms that drive inhibitory synapse disassembly and elimination are undefined. We find that inhibitory synapses are disassembled in a sequential manner following excitotoxicity: GABAARs undergo rapid nanoscale rearrangement and are dispersed from the synapse along with presynaptic active zone components, followed by the gradual removal of the gephyrin scaffold, prior to complete elimination of the presynaptic terminal. GABAAR nanoscale reorganization and synaptic declustering depends on calcineurin signaling, whereas disassembly of gephyrin relies on calpain activation, and blockade of both enzymes preserves inhibitory synapses after excitotoxic insult. Thus, inhibitory synapse disassembly occurs rapidly, with nanoscale precision, in a stepwise manner and most likely represents a critical step in the progression of hyperexcitability following excitotoxicity.

Laparoscopic Management of Cesarean Scar Pregnancy

<h3>Study Objective</h3> To present a case and surgical video of a laparoscopic excision of a cesarean scar pregnancy at 12 weeks and review the literature regarding cesarean scar pregnancy management. <h3>Design</h3> Case report and surgical video. <h3>Setting</h3> Tertiary care hospital. <h3>Patients or Participants</h3> One patient. <h3>Interventions</h3> 23 y/o G5P0131 at 7 weeks 1 day with history of obesity and a 31-week low transverse cesarean delivery presented for initial prenatal care to an outside OB. Cesarean scar pregnancy diagnosis was not recognized until patient presented for a nucal translucency to maternal fetal medicine at 11 weeks and 3 days where suspicion for scar pregnancy was raised. Patient was referred to our institution where cesarean scar pregnancy was confirmed at 11 weeks and 6 days and laparoscopic excision was recommended, as it was felt that pregnancy was too large and advanced in gestational age for medical management to be successful. Patient underwent uterine artery embolization and fetal intra-cardiac KCl injection the day prior to procedure to prevent hemorrhage during surgery, then patient underwent laparoscopic excision of cesarean scar pregnancy. <h3>Measurements and Main Results</h3> Laparoscopic excision of cesarean scar pregnancy was completed successfully with no intra or post-operative complications. Surgical techniques are reviewed in the surgical video. Patient had a good surgical recovery. <h3>Conclusion</h3> Laparoscopic excision of a cesarean scar pregnancy can be accomplished successfully with good outcomes when preventative measures to achieve good hemostasis such as pre-operative uterine artery embolization and fetal intra-cardiac KCl injection are used.

Tolerance and osmotic response to food deprivation and salt loading in the herbivorous non-drinking Moroccan Spiny-tailed lizard Uromastyx nigriventris (Sauria: Agamidae)

Abstract Animals inhabiting arid environments use a variety of behavioural and physiological strategies to balance their water and salt budgets. We studied the effects of dehydration and salt loading on osmoregulatory capacities in a large herbivorous desert lizard, the Moroccan Spiny-tailed lizard Uromastyx nigriventris, the family Agamidae. These lizards select plants with a high K+ to Na+ ratio of 15 to 20, and like other herbivorous lizards, effectively eliminate the extra electrolyte load, mainly via a pair of active nasal salt glands, which exude the extra ions from blood. Here we present results of a series of laboratory experiments, which tested a five-week food and water deprivation and the excretory response of nasal salt glands, during a short period of five days, following salt loading by two separated injections of KCl or NaCl at a 5-day interval (4th and 9th days). During food-water deprivation, hypohydrated lizards lost 32% of their initial body mass with a substantial decrease of their Body Condition Index and the tail volume as an index of energy (fat and then potential metabolic water) storage. Plasma osmolality significantly increased by 20%. There were also significantly increased plasma sodium, chloride, and total protein concentrations. On the other hand, there was no significant decrease in the plasma glucose level. Most of the salt loaded lizards secreted far more K+ than Na+ via the nasal glands, even after NaCl loading. The K+/Na+ ratio decreased only after two to three repetitive NaCl injections but insufficient Na+ was eliminated. Two successive KCl injections were successfully eliminated, but daily natural average K+ administration induced progressive hyperkaliemia. These experimental data agreed with previous observations showing variations of plasma Na+ and K+ concentrations in free-living lizards. The nasal gland constitutes the main route of Cl− excretion but the Cl−/(Na+ + K+) ratio may vary according to observations in other herbivorous species.

OP01.04: Non‐surgical treatment of Caesarean scar pregnancy

Case 1 is of a 33-year-old woman with a history of one previous Caesarean section (CS) presented with spotting. Transvaginal sonography showed a 33mm gestation sac, 3mm live fetal pole with heart beat at lower segment of uterus at the location of previous CS scar. The first β-hcG titer of the patient was 58000 IU/L. Her second set of β-hcG increased to 110500 IU/L. Two doses of MTX with 48 hours' interval was prescribed for her. The fetus was reducted with KCL injection with sonography guidance transadominally. The patient was observed for one more week and then discharged with weekly checking of β-hcG titer. At the third week of follow-up, her β-hcG level was under 1000 IU/L. The level of β-HcG became negative after 4 weeks and pregnancy mass in Caesarean scar disappeared after 5 months. Case 2 is of a 34-year-old woman with a history of one previous CS who was presented with spotting. Transvaginal sonography showed an 18x20 mm gestation sac with fetal heart and yolk sac at lower segment of uterus at the location of the previous CS scar. The patient's first set of serum β-hcG titer was 14480IU/L. Two doses of MTX were prescribed for her. In follow up, the repeated transvaginal sonography showed similar findings with fetal heart activity. The patient did not experience any symptom of pain or bleeding at this point and was clinically stable. She was offered the option of Intra sac MTX injection with sonography guidance. In her follow-up after injection, the fetal heart was not detected. She was discharged with weekly checking of β-hcG titer. At the second month of follow-up, her β-hcG level was undetectable. Caesarean scar mass disappeared after 6 months and she became pregnant with normal implantation of pregnancy after 2 years.