Injection Of Potassium Chloride Research Articles

Cesarean Ectopic Scar Revision

Video Objective To present a laparoscopic approach to secondary surgical management of cesarean scar pregnancy through removal of retained products of conception and scar revision. Setting We present the case of a 29-year-old G4P3 at 6w5d by LMP referred to a tertiary care facility for cesarean scar ectopic pregnancy. Ultrasound revealed a fetal pole with cardiac motion located at the site of patient's previous cesarean section scar, with bHCG 112,000. Interventions The patient underwent primary medical management with intra-sac and intra-placental administration of methotrexate, followed by intra-embryonic potassium chloride injection to achieve cessation of fetal cardiac motion. bHCG down-trended precipitously, but was persistently positive three months following treatment. Repeat imaging was obtained, which demonstrated retained products of conception (POCs) at the cesarean scar measuring 4.7cm. Given patient's desire for future fertility, she underwent laparoscopic removal of POCs and scar revision. We emphasize the following features of secondary surgical management: temporary bilateral uterine artery ligation, lysis of adhesions between the bladder and lower uterine segment, injection of dilute vasopressin adjacent to defect, enucleation of POCs, and two-layer closure of the myometrial defect. Conclusion There is limited large-scale data or clinical consensus surrounding optimal management for cesarean scar pregnancies. For patients who desire future fertility, little is known about recurrence and subsequent pregnancy outcomes. We present a safe and effective option for secondary surgical management of retained products of conception, which allows for repair of the defect and restoration of normal uterine anatomy.

2363 Laparoscopic Management of Heterotopic Cornual Pregnancy - Tips & Tricks

Video Objective To provide practical tips and tricks on laparoscopic management of a heterotopic cornual pregnancy. Setting This video presents a 38-year-old nulliparous female patient who received bilateral salpingectomy and then underwent in vitro fertilization. Heterotopic pregnancy was found at 8 weeks of gestation. We arranged fetal reduction by ultrasound-guided potassium chloride injection. Two weeks after the procedure, severe lower abdominal pain developed. Due to massive hemoperitoneum with suspected left cornual rupture, she was admitted for laparoscopic intervention. Interventions Laparoscopic surgery was arranged. Left cornual pregnancy with necrosis and oozing were seen upon entry into the abdominal cavity. Estimated internal bleeding was about 3000 ml. Laparoscopic management was carried out in five steps: identification of the cornual protruding mass; control of bleeding via a loop ligation; incision of the cornus precisely with complete removal of the ectopic gestational tissue; closure of the defect of the cornus; and hemostasis using Floseal matrix. Conclusion The surgery was done smoothly and the patient recovered well with ongoing pregnancy. However, the patient underwent termination of pregnancy at 23 weeks of gestation due to fetal hydrocephalus.

Rat Model of Ménière’s Attack: Intratympanic Injection of Potassium Chloride Produces Direction-Changing Spontaneous Nystagmus and Hearing Fluctuations

The major symptoms of Ménière’s disease are episodic vertigo, fluctuating hearing loss, and tinnitus. Direction-changing spontaneous nystagmus is a characteristic vestibular finding in Ménière’s disease. In the acute stage, spontaneous nystagmus beating to the affected side (irritative nystagmus) is often observed, while paralytic nystagmus beating to the healthy side is found in the chronic stage. This direction-changing nystagmus can be reproduced in guinea pigs by increasing the potassium ion concentration in the perilymph. The objectives of the present study were to examine the effects of increasing the potassium ion concentration of the rat perilymph on hearing and nystagmus. Under isoflurane anesthesia, 22 rats received intratympanic injection of different concentrations of potassium chloride (KCl) solution or distilled water: groups 1, 2, 3, and 4 received saturated (3.4 M) KCl solution, 2 M KCl, 1 M KCl, and distilled water, respectively. The nystagmus direction and number per 15 s were monitored for 150 min. In the other 8 rats, hearing was monitored 30 min and 20 h after intratympanic injection of 2 M KCl (group 5) or distilled water (group 6) using the auditory brainstem responses. Rats in groups 1 and 2 showed spontaneous irritative nystagmus beating to the affected ear followed by paralytic nystagmus beating to the contralateral side. In group 3, irritative nystagmus occurred but paralytic nystagmus was rarely observed. Rats in group 4 showed no nystagmus. Rats in group 5 showed significant hearing impairment 30 min after KCl injection that recovered 20 h later. Control animals in group 6 showed no significant changes in hearing. The reversible hearing impairment with direction-changing spontaneous nystagmus induced by potassium injection into the tympanic cavity in rats was quite similar to that observed in acute Ménière’s attacks. This rat model could be used for basic research investigating the pathophysiological mechanisms underlying Ménière’s attacks.

Non-surgical management and obstetric outcomes of heterotopic interstitial pregnancies

Objective: To assess the effectiveness and safety of non-surgical management for six heterotopic interstitial pregnancies.Material and methods: We retrospectively analyzed the data of six women diagnosed with heterotopic interstitial pregnancies who underwent non-surgical treatment at the CHA Bundang Medical Center between January 2007 and December 2017. Three heterotopic interstitial pregnancies were treated with sono-guided potassium chloride (KCl) injections. Two cases were managed expectantly. One heterotopic quadruplet pregnancy with twin, left interstitial, and tubal pregnancy was treated by sono-guided KCl injection and laparoscopic left salpingectomy. Complications and outcomes were measured.Results: Three cases were treated with sono-guided KCl injection and the intrauterine pregnancy continued to term. Intrauterine pregnancies were vaginally delivered without complications. One case that was treated expectantly was delivered at full term, while the other case resulted in spontaneous abortion. Quadruplet heterotopic pregnancy was successfully managed with sono-guided KCl injection and laparoscopic salpingectomy. Intrauterine twin pregnancy was successfully delivered by elective cesarean section at 37 + 0 weeks of gestation with healthy babies. Conclusions: KCl injection under ultrasonographic guidance could be a safer and more effective treatment option than surgical treatment in hemodynamically stable patients with fetal cardiac activity in interstitial pregnancy. Expectant management could be an option for patients with no fetal cardiac activity.

Early first-trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory?

Early first-trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory?

Improving the safety of high-concentration potassium chloride injection

ObjectivesSerious adverse effects, including arrhythmia and cardiac arrest, result from rapid intravenous high concentration of potassium chloride (KCl). We aimed to eliminate prescription of undiluted KCl and encourage dilution of...

Protective effect of carbon monoxide releasing molecules 2 on post-resuscitation myocardial dysfunction in rats

Objective: To investigate the protective effect of carbon monoxide releasing molecule 2 (CORM-2) on post-resuscitation myocardial dysfunction in rats. Methods: Forty male SD rats which were healthy were randomly divided into 5 groups: sham operated group(sham group), cardiopulmonary resuscitation(PCR) group, DMSO group, inactivated CORM-2(iCORM-2) group and CORM-2 group (n=8 each). Established the model of post-cardiac arrest myocardial dysfunction by intravenous potassium chloride (4 ℃) injection combined with asphyxiation for 4 minutes and then followed by artificial chest compression for 3 minutes. Sham group: rats were instrumented with catheter without inducing cardiac arrest and resuscitation, and intraperitoneal injection of 0.9% normal saline (4 ml/kg) was performed 12 hours before catheterization. CPR group: rats were instrumented with catheters and underwent CPR, and intraperitoneal injection of 0.9% normal saline (4 ml/kg) was performed 12 hours before surgery.CORM-2 group: rats were instrumented with catheters and underwent CPR, intraperitoneally injected the prepared CORM-2 solution (4 mg/kg) at 12 hours before surgery. DMSO group: rats were instrumented with catheters and underwent CPR, intraperitoneally injected the prepared DMSO solution (4 ml/kg) at 12 hours before surgery. iCORM-2 group: rats were instrumented with catheters and underwent CPR, iCORM-2 solution (4 mg/kg) was intraperitoneally injected at 12 hours before surgery. Hemodynamic data (MAP, +dp/dtmax, -dp/dt) were continuously monitored and recorded for 4 hours after resuscitation (or catheterization) in each group. Myocardial tissue specimen and blood samples were taken after resuscitation (or catheterization). The myocardial ultrastructure was observed by transmission electron microscope. Lactate dehydrogenase (LDH) activity was measured by lactate-pyruvate method. Serum creatine kinase isoenzyme (CK-MB) concentration was measured by ELISA. Western blot was used to detect the levels of Caspase-3, Caspase-9 and Cyt-C protein in myocardial tissue. Results: MAP, +dp/dtmax and -dp/dt at 0.5, 1, 2, 3 and 4 hours post resuscitation were significantly lower than those immediately after catheterization in CRP, DMSO, iCORM-2 groups (all P<0.05). MAP at 0.5, 1, 2, 3, and 4 hours post resuscitation were significantly lower in CRP, DMSO and iCORM-2 groups than those at respective time points in sham group (all P<0.05), while MAP was similar between CORM-2 group and Sham group at these time points (all P>0.05). +dp/dtmax and -dp/dt values at 0.5, 1, 2, 3, and 4 hours post resuscitation were lower than those at respective time points in sham group and significance was found at 0.5, 1 and 2 hours post resuscitation (both P<0.05), while +dp/dtmax and -dp/dt values were similar between CORM-2 group and sham group at various time points (all P>0.05). Myocardial ultrastructure, especially mitochondrial structural integrity was better preserved in the CORM-2 group than those in the other resuscitation groups at 4 hours after resuscitation. Serum LDH activity and CK-MB concentration were significantly elevated at 4 hours after resuscitation in the CPR group, DMSO group and iCORM-2 group than those in sham group (all P<0.01); CK-MB concentration was also higher in CORM-2 group than that in sham group,and LDH level was similar between CORM-2 group and sham group (P>0.05). Serum LDH activity and CK-MB concentrations were significantly lower in the CORM-2 group than those in the other resuscitation groups (all P<0.01). The myocardial expressions of Caspase-3, Caspase-9 and Cyt-C at 4 hours after resuscitation were significantly higher in the CPR group, DMSO group and iCORM-2 group than those in sham group; the myocardial expressions of Caspase-3 and Caspase-9 were significantly higher in CORM-2 group than those in sham group (both P<0.05), while Cyt-C expression was similar between CORM-2 group and sham group. The expressions of the above 3 proteins were significantly lower in the CORM-2 group than those in the other resuscitation groups (all P<0.05). Conclusions: CORM-2 can effectively alleviate post-resuscitation myocardial injury in rats with cardiopulmonary resuscitation and improve cardiac function. Protecting myocardial mitochondria and inhibiting mitochondrial apoptosis pathway may serve as the protective mechanisms in this model.

Direct Methotrexate Injection into the Gestational Sac for Nontubal Ectopic Pregnancy: A Review of Efficacy and Outcomes from a Single Institution

To evaluate the efficacy of nontubal ectopic pregnancy (NTEP) management with direct methotrexate (MTX) injection into the gestational sac. A retrospective chart review. A tertiary academic and teaching hospital. All cases of confirmed NTEP were retrospectively identified from 2012 to 2017. Ultrasound-guided direct injection of MTX into the fetal pole and surrounding gestational sac and a single dose of systemic MTX with or without fetal intracardiac injection of potassium chloride. Treatment failure, complications from treatment, operating time, and days to negative serum human chorionic gonadotropin (hCG) after treatment were measured. Fourteen women (age 34 ± 5.2 years) with NTEP underwent direct MTX injection (cesarean scar, n = 4; interstitial, n = 6; cervical, n = 4). The mean estimated gestational age was 49 ± 11, CI (43, 56 days). One patient required laparoscopic intervention with a failure rate of 1 of 14 (a double interstitial, heterotopic pregnancy). There were no other major complications. The time in the operating room was similar for all NTEP types. The average time to negative serum hCG was not different for cesarean scar (84.5 ± 36 days), cervical pregnancies (70.5 ± 19 days), or interstitial pregnancies (45.3 ± 38 days, p = .15). Direct MTX injection into the gestational sac for NTEP treatment is safe and effective. The failure rate of 7% is considerably lower than what was previously reported for a failure of systemic MTX in similar cases (25%). Resolution of serum hCG after treatment can be quite prolonged even in uncomplicated cases.

Laparoscopic ovariectomy in dogs in late gestation

BackgroundSurgical sterilization of stray dogs is the most widely used technique to control stray dog population. Although ovariectomy is an effective technique for elective sterilization of female dogs, most stray dog population control programs generally utilize ovariohysterectomy for spaying female dogs. In the context of stray dog sterilization, laparoscopic ovariectomy has been utilized and reported to be cost-effective compared to programs utilizing open surgical approaches. However, when pregnant stray dogs are encountered either conventional ovariohysterectomy is performed or surgery is deferred altogether. It is reported that ovariectomy at any stage during canine pregnancy results in fetal resorption or abortion, however, clinical outcomes following laparoscopic ovariectomy in dogs in late gestation have not been previously reported. The purpose of this study was to investigate the outcome of laparoscopic ovariectomy with intra-gestational sac injection (IGSI) of potassium chloride (KCl) in dogs in late gestation.ResultsEight client owned dogs in the gestational age range of 40–50 days underwent laparoscopic ovariectomy with IGSI of KCl. Laparoscopic ovariectomy resulted in decreased serum progesterone from 11.6 ± 2.6 ng/ml on day 0 to 1.3 ± 0.4 ng/ml 24 h’ post-surgery. IGSI of KCl did not result in immediate fetal death and fetal death temporally closely followed the drop in serum progesterone noted 24 h post-ovariectomy. Viscous brown vulvar discharge preceded fetal expulsion by 12 h and all the fetuses were dead when expelled. Uterine evacuation was documented within 45 ± 20 h (1–3.5 days) in all dogs without any clinically significant complications.ConclusionLaparoscopic ovariectomy enables elective termination of pregnancy and simultaneous neutering of dogs in late gestation and has potential applications in high volume stray dog sterilization programs which utilize laparoscopy. Utility of IGSI of KCl in this regard is unclear.

Severe skin extravasation injury following intravenous injection of potassium chloride.

Severe skin extravasation injury following intravenous injection of potassium chloride.

DISCORDANT ANOMALIES IN MONOZYGOTIC TWINS

Monozygotic twins, as a rule, have the same genotype and phenotype. Cases, where disturbances develop in only one of two twins are very rare. Such cases are called discordant anomalies. The purpose of the work is to systematize the data on the causes of discordant anomalies, their phenotypic manifestations and methods of managing pregnancy in the case of discordant anomalies, search for articles on this topic in the PubMed database and analyze the found literature. Data analysis showed following factors to be able to serve as causes of discordant anomalies: mutations occurred both before and after the separation of the blastomeres; inactivation of one of the X chromosomes in women; variations in the number of copies of genes; different embryo attachment to the placenta; epigenetic factors. Most often there are discordant anomalies of the central nervous system, the cardiovascular system, and defects of the abdominal wall. There are less common chromosomal abnormalities - Down syndrome, Patau syndrome, Klinefelter syndrome. Isolated cases are cystic hygroma and autism spectrum disorders. The average gestational age at which discordant anomalies are detected is 17 weeks in monochorial twins, and 21 weeks in bichorial twins. Malformations of one of the fetuses increase the risk of the miscarriage or premature birth. When detecting twins, discordant for a large anomaly, selective reduction of embryos is appropriate. For bichorial twins, an intracardiac injection of potassium chloride is used. In monochorial twins, umbilical cord coagulation is used, because often monochorial fetuses have vascular anastomoses, and the cardiotoxic agent can enter into a healthy fetus. Discordant anomalies are rare, poorly understood pathology. Anomalies can affect any organ system, often there are multiple malformations. Large anomalies can be an indication for the selective reduction of the fetus.

Alteration of Metabosensitive Afferent Response With Aging: Exercised versus Non-exercised Rats

This study was designed to evaluate the effect of aging on the activity of metabosensitive afferent fibers (thin muscle afferents from group III and IV) and to determine if physical activity performed at old age may influence the afferent discharge. Afferents from tibialis anterior and soleus muscles were recorded on non-exercised rats aged of 3, 6, 12, and 20 months and on animals aged of 12 and 20 months performing a daily incremental treadmill exercise protocol during the last 8 weeks preceding the recordings. Metabosensitive afferent fibers were activated with potassium chloride (KCl) and lactic acid (LA) injections into the blood stream or by muscle electrically-induced fatigue (EIF). Results indicated that aging is associated to a decrease in the magnitude of the responses to chemical injections and EIF. Unfortunately, physical activity did not allow restoring the metabosensitive afferents responses. These results indicate an alteration of the thin afferent fibers with aging and should be taken into account regarding the management of muscle fatigue and potential alterations of exercise pressor reflex (EPR) occurring with aging.

Cesarean Scar Pregnancy, Incidence, and Recurrence: Five-Year Experience at a Single Tertiary Care Referral Center.

To describe the treatment and subsequent pregnancy outcomes in patients with cesarean scar pregnancies at a single institution over 5 years. This is a case series of all cesarean scar pregnancies diagnosed from May 2013 to March 2018 at Yale-New Haven Hospital. Data were collected on each patient using electronic medical record review and included patient demographics; medical, surgical, and obstetric history; pregnancy characteristics; treatment modalities used; response to therapy; complications; and subsequent pregnancy outcomes. Thirty cases of cesarean scar pregnancies were diagnosed in 26 patients, including one recurrence in one patient and three recurrences in another. Forty-six percent of cesarean scar pregnancies were in Hispanic women. The median number of prior cesarean deliveries was two. Mean gestational age at the time of diagnosis was 46 days (SD±10). Fetal cardiac activity was detected in 18 cases. Three patients initially were erroneously diagnosed with a viable intrauterine pregnancy and failed medical termination. Others opted for termination through systemic methotrexate alone (n=4), systemic and local methotrexate (n=12), systemic and local methotrexate with potassium chloride injected into the gestational sac (n=3), potassium chloride injection with laparotomy and wedge resection (n=1), methotrexate with bilateral uterine artery embolization (n=2), or intrauterine balloon (n=4). Five patients who underwent expectant management or methotrexate therapy had retained products of conception and required hysteroscopy and curettage. One patient opted for hysterectomy after failed curettage. After complete resolution of cesarean scar pregnancies, there were 10 subsequent spontaneous conceptions in eight patients, including four recurrent cesarean scar pregnancies, four term pregnancies, and one spontaneous abortion. One viable normally located pregnancy is ongoing. There is a wide array of treatment modalities available for cesarean scar pregnancies. Women with a cesarean scar pregnancy are at risk for its recurrence in the future, although normal pregnancy after a cesarean scar pregnancy is also possible. Safe outcomes depend on timely diagnosis and multidisciplinary care by skilled clinicians.

Application of positron emission tomography in detection of myocardial glucose metabolism in rabbit cardiac arrest models

To investigate the changes of myocardial glucose metabolism in rabbit cardiac arrest models and the effect of hydrogen intervention by 18F-fluroro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) imaging. Methods: Fifteen male New Zealand white rabbits were randomly divided into a hydrogen group (n=6), a control group (n=6) and a sham group (n=3). Cardiac arrest (CA) was induced by intravenous injection of potassium chloride. Conventional cardiopulmonary resuscitation (CPR) was initiated after five-minutes CA. The hydrogen group and the control group were mechanically ventilated into mixed gas with 4% hydrogen+96% oxygen and pure oxygen, respectively, for 30 minutes after CPR. Rats in the sham group was performed the same surgical procedure and was injected adrenaline and potassium chloride but did not induce CA. The vital signs at basic state and 30 min after return of spontaneous circulation (ROSC) were recorded in each group. The parameters of CPR were recorded in two CA groups. Myocardial glucose metabolism was assessed by positron emission tomography (PET) at basic state, 2 h and 24 h after ROSC. The maximum standardized uptake value (SUVmax) of 18F-FDG was measured. Results: There were no significant differences in the basal body weight and vital signs among the three groups. There was no significant difference in the blood glucose level before PET examination. The 18F-FDG SUVmax in the sham group at three time points was not significantly changed. In the hydrogen group and the control group, the 18F-FDG SUVmax at 2 h after ROSC were significantly higher than the basic level (1.89±0.47 vs 3.47±1.24 and 1.90±0.36 vs 4.26±0.80, respectively). Compared with the control group, the 18F-FDG SUVmax in the hydrogen group was lower at the point at 2 h after ROSC. The 18F-FDG SUVmax in the 2 CA group were down to the basic level at 24 h after ROSC (hydrogen group 2.02±0.64, control group 2.07±0.61). Conclusion: Myocardial glucose metabolism in CA rabbits was increased significantly after ROSC, and hydrogen intervention can reduce the degree of glucose metabolism.

OP16.02: Comparison of the clinical outcomes of non‐surgical and surgical treatment of cornual pregnancies

To compare the clinical efficacy and safety of ultrasound-guided intragestational sac injection of methotrexate (MTX) or potassium chloride (KCL) and cornual resection in the management of cornual pregnancies. Between January 2007 and December 2017, we retrospectively reviewed 237 women diagnosed with cornual pregnancy at Bundang CHA university hospital. Of these, we only enrolled 31 cases that were seen embryo heart beat activity at the time diagnosis. The 12 cases were treated with local injection of MTX or KCL under US-guided intragestational sac and 19 cases were treated with corneal resection. The two groups were compared with the procedure-related and subsequent obstetrical outcomes. The serial beta-human gonadotropin (β-hCG) measurements and the clinical outcomes compared between the two groups. in the two groups, the mean initial β-hCG level at the time diagnosis was 26411.60±9719.63 mIU/mL in the local MTX treatment group and 18908.71±2855.75 mIU/mL in the corneal resection treatment group (P = 0.605). Compared with those in the corneal resection group, the local MTX treatment group had the shorter the length of hospital day (2.40±0.54 vs 3.43±0.37, P=0.018) and the mean procedure time (21.64±7.18 vs 60.53±5.16, P<0.01). Changes in hemoglobin (Hb) level after procedure was the lower extent for Hg decrease in the local MTX treatment group (1.59±0.16 vs 2.54 ± 0.29, P=0.012). There was one case in the subsequent pregnant uterine corneal rupture in the previous corneal resection group. Non-surgical treatment is a more effective method for the corneal pregnancies than corneal resection and is associated with better clinical outcomes. Also it is a better and safer approach for the treatment of cornual pregnancies who desire to become pregnant in the future. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Triggers of spawning and oocyte maturation in the commercial sea cucumber Cucumaria frondosa

The present study investigated methods to trigger spawning and artificially induce oocyte maturation in the commercial cold-water suspension-feeding sea cucumber Cucumaria frondosa. Spawning occurred after exposure to live phytoplankton, commercial phytoplankton paste, and conspecific sperm. Live phytoplankton at 1 × 105 cells ml−1 induced the highest proportion of females to spawn (mean of 56%); promoted the greatest oocyte release (mean of 19,200 oocytes female−1), best quality of eggs and highest survival of embryos (65%; 20 d post fertilization). More concentrated live phytoplankton (1 × 106 cells ml−1) triggered 43% of the females to release ~16,100 oocytes female−1 and survival rates 20 d post fertilization were lower (50%). Both phytoplankton paste treatments (1 × 105 and 1 × 106 cells ml−1) yielded intermediate results in terms of percent spawning females (26%), abundance of oocytes released (11,000 and 7300 oocytes female−1, respectively), quality of eggs, and survival of embryos (44 and 50%, respectively). Sperm from conspecific (2 and 10 × 106 spermatozoa ml−1) induced the lowest proportion of females to spawn (16%) with release of 3000 and 1700 oocytes female−1, respectively; furthermore, all embryos died within 10 d post fertilization. Results for males were slightly different: spawning was more frequent (63%) in the sperm treatment at 2 × 106 spermatozoa ml−1 followed by live phytoplankton at 1 × 106 and 1 × 105 cells ml−1 (43%), and phytoplankton paste at 1 × 105 cells ml−1 (46%); the lowest spawning success was observed for phytoplankton paste at 1 × 106 cells ml−1 and conspecific sperm at 10 × 106 spermatozoa ml−1 (26%). Thermal shock, desiccation, potassium chloride (injection or bath), and serotonin (injection) did not induce spawning in C. frondosa. When oocytes isolated from mature ovaries were exposed to three different concentrations of 1-Methyladenine (1-MA), Dithiothreitol (DTT), 2,3-Dimercapto-1-propanol (BAL), and L-cysteine (L-cyst), DTT at 10−1 M induced the highest proportion of oocytes (48%) to shed follicle cells (i.e. ovulate); whereas other treatments induced only 2–6% of ovulation, similar to the control (seawater). All oocytes that shed follicle cells remained unfertilizable. Overall, live phytoplankton emerged as the most suitable spawning trigger for C. frondosa, a Dendrochirotida that produces maternally-provisioned oocytes. In the context of expanding sea cucumber aquaculture, this finding provides a tool to maximize the availability of gametes in this cold-water species, with possible applicability to similar commercial dendrochitotids.

Post-Mortem Magnetic Resonance Imaging Appearances of Feticide in Perinatal Deaths

Objective: The aim of this study was to characterise the imaging features seen in fetuses having undergone feticide by intracardiac potassium chloride injection compared to those of non-terminated fetuses at post-mortem magnetic resonance imaging (PMMRI). Methods: A case-control study was performed comparing PMMRI findings between two groups of patients – those having undergone feticide were matched to a control group of miscarried/stillborn fetuses. The groups were matched according to gestational age, weight, and time since death. Two independent readers reviewed the PMMRI for thoracic, abdominal, and musculoskeletal imaging features. The Fishers exact test was conducted for differences between the patient groups. Results: Twenty-six cases of feticide (mean gestation 25 weeks [20–36]) and 75 non-terminated fetuses (mean gestation 26.7 weeks [19–36]) were compared. There was a higher proportion of feticide cases demonstrating pneumothorax (23.1 vs. 1.3%, p = 0.001), haemothorax (42.3 vs. 4%, p = 0.001), pneumopericardium (30.8 vs. 5.3%, p = 0.002), and haemopericardium (34.6 vs. 0%, p = 0.0001). Intracardiac gas and intra-abdominal findings were higher in the feticide group, but the differences were not statistically significant. Conclusion: Characteristic PMMRI features of feticide can help improve reporter confidence in differentiating iatrogenic from physiological/pathological processes.

Outcomes of dilation and evacuation with and without feticide by intra-cardiac potassium chloride injection: a service evaluation

ObjectiveTo compare procedure duration, complications, and acceptability of dilation and evacuation (D&E) with and without feticide by intra-cardiac potassium chloride (KCL) injection. Study designWe evaluated outcomes with D&E at 18–24 weeks of gestation in the 6 months before and 6 months after removing feticide with KCL from the guidelines of a national British abortion provider. We extracted demographic and procedure-related data from medical records and electronic databases. We surveyed women undergoing D&E in both time periods about acceptability and side effects. ResultsWe analyzed 291 cases with and 257 cases without KCL. Unadjusted mean procedure duration was shorter with KCL than without (12.7 vs. 16.1 min, respectively, p<.001). After adjustment for age, parity, Cesarean deliveries, gestational age, body mass index, surgeon, and number or duration of osmotic dilators used, KCL remained associated with a 3.5 min (95% CI 2.4–4.6) reduction in D&E duration. Uterine atony was more common with KCL than without (3% vs. 0%, respectively, p=.004), despite more frequent administration of prophylactic utero-tonics to women who received KCL (82% KCL vs. 73% no-KCL, p=.001). Women who had KCL reported more pain in the period between feticide and dilator placement and the evacuation than women who had not received feticide (49% vs. 25%, respectively, p<.001). Most women in both groups found their procedure very acceptable or acceptable (79% KCL vs. 87% no-KCL, p=.2). ConclusionsFeticide with intra-cardiac KCL reduced D&E procedure duration, but was associated with more pain and uterine atony. Treatment acceptability was high with and without feticide.Implications.Inducing fetal demise before dilation and evacuation with intra-cardiac potassium chloride may result in shorter operative times but does not appear to improve safety or acceptability. Level I evidence remains needed to support the use of feticide before surgical abortion.

Analysis of Dendritic Spine Density in Hippocampus Following CA/CPR

INTRODUCTIONCardiac arrest (CA) occurs when the electrical system of the heart malfunctions. Patients do not receive enough blood to the brain and experience global cerebral ischemia, causing neuronal damage and affecting memory. The hippocampus is the main area of the brain dealing with learning and memory, and the dendrites and the spines of the CA1 neuron have been shown to undergo plasticity during learning and memory. Previous work has demonstrated that global cerebral ischemia causes persistent deficits in CA1 synaptic plasticity, but it is not known whether these deficits are associated with morphological changes. Acute dendritic plasticity (occurring within two to three days) after cardiac arrest/cardiopulmonary resuscitation (CA/CPR) have been shown previously. However, little is known regarding dendritic spine morphology at chronic time periods after CA/CPR.GOALThis present study investigated the plasticity of the CA1 neurons and their dendrites and spines in mice after CA/CPR.METHODSAdult male mice were given CA by intravenous injection of potassium chloride, and resuscitation was initiated eight minutes after arrest with chest compressions and ventilation. Mice were allowed to survive for one, seven, or 30 days after CA/CPR after which brains were collected. Whole brains were stained with Golgi‐cox staining technique, and sagittal sections were prepared for microscopy. High magnification images were taken on a bright field microscope using QCapture software and analyzed using ImageJ. The dendrites and their spines were observed in the CA1 region, and spine density, soma length, soma width, and soma area were calculated. Spines were also assigned a morphological classification (one to four) that ranges from immature to mature spines.RESULTSOur data shows that there is a significant reduction in spine densities at each of the time points after CA, compared to the sham. Furthermore, spine classification shows that CA caused a shift towards more immature spine morphology at 24 hours and 7 days after CA/CPR but shifted towards more mature spine morphology at 30 days after CA/CPR.CONCLUSIONThese data demonstrate that there is morphological plasticity and changes in dendritic spine anatomy at chronic time periods after CA/CPR. These changes likely correlate with synaptic plasticity impairments in the hippocampus.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

How to Treat Cesarean Scar Pregnancy: A Difficult and Rare Case

Background: Cesarean scar ectopic pregnancy is a rare type of ectopic pregnancy. Due to high morbidity and mortality associated with delayed diagnosis of this condition, a high index of suspicion is important, as well as a thorough transvaginal ultrasound. There is still no consensus on the best treatment of these cases. The choice for conservative options, including medical therapy with methotrexate and transvaginal evacuation, avoids mutilating surgeries, such as hysterectomy, which can compromise women's fertility. Case: A 32-year-old patient with a cesarean scar pregnancy with a 7 weeks live embryo. Results: The patient was treated with transvaginal evacuation and a single dose of intramuscular methotrexate, after an initial attempt with medical treatment, consisting of a local injection of potassium chloride into the sac, proved to be technically impossible. Conclusions: Due to the low incidence of cesarean scar pregnancies and the nonexistence of consensus regarding their treatment, this case report can improve understanding of these pregnancies, which could lead to the establishment of new guidelines. (J GYNECOL SURG 34:99)