Retained products of conception (RPOC) are a partial retention of placental tissue after dilation and curettage (D&C) procedures or vaginal deliveries. Ultrasound scan reports sometimes mention the presence of increased endometrial / sub‐endometrial vascularity in the context of retained products of conception. This raises the possibility of serious intra‐operative haemorrhage because of the possibility of arterio‐venous malformation. The aim of this article is to discuss the diagnosis and management options of retained products of conception (RPOC) with increased vascularity where simple dilatation and curettage may lead to life threatening haemorrhage and endanger the life of the patient and to enlighten the importance of evaluation of vascularity in all cases of RPOC prior to dilatation and curettage in order to avoid the dreaded complication of massive haemorrhage.
G-banded karyotyping is the conventional cytogenetic technique used in analysis of products of conception (POC), which could detect chromosomal aneuploidies, structural abnormalities, duplications or deletions (>5- 10Mb), polyploidies and mosaicism. However, it has several limitations such as low resolution, high rates of culture fail- ure and long reporting time . Then some rapid tech- niques for genetic testing of chromosomal aneuploidies have emerged including quantitative fluorescent PCR (QF-PCR), fluorescence in situ hybridization (FISH),
The term retained products of conception (RPOC) refers to intrauterine tissue that devel- ops after conception and persists after medical and surgical pregnancy termination, miscar- riage, and vaginal or cesarean delivery. This intrauterine tissue is often of placental origin . RPOC is one of the most common causes of postpartum bleeding, but the clinical presenta- tion can be also characterized by pain or fever. The incidence of RPOC seems to related on the gestational age of the pregnancy, most fre- quently after second-trimester delivery or ter- mination of pregnancy. RPOC are estimated approximately 1% of term pregnancies . The main risk factors are failure to progress during delivery, placenta accreta, and instrument delivery. The diagnosis presents a major clini- cal challenge. The association between clinical features and ultrasonographic characteristic is essential for diagnosis; however color Doppler US increases the positive predictive value for
Retained products of conception (RPOC) consist of intra- uterine tissue that develops after conception and persists after miscarriage, termination of pregnancy, delivery or caesarean section . The occurrence of RPOC is not rare; however, the prevalence varies widely (from 0.5 to as much as 19%) depending on pregnancy duration, preg- nancy outcome and the successive management . There is no consensus in literature on the type of tissue RPOC comprise. Some authors describe RPOC as non-villous trophoblastic tissue, chorionic villi or foetal membranes, and they state that decidua alone does not fall within the
From January 2011 to December 2016, a total of 1294 POC samples were investigated. CMA analysis was per- formed on all POC samples including chorionic villi samples (CVSs) from women who had spontaneous mis- carriages or tissue (muscle) of the fetus with congenital anomalies. Each sample was rinsed in normal saline solution three times. Then 10 mg of each tissue were submitted to genomic DNA extraction. Fifteen CVSs and one tissue samples were found having partial tri- somy for one chromosome and partial monosomy for the other chromosome. Parental studies using karyotyp- ing and/or FISH technologies were performed on all the cases. The information of these cases was summarized in Table 1, and Case 1 and 2 were described in detail as follows:
other relevant information were collected and submitted for histopathological examination. Results: Incomplete miscarriage was the commonest type of miscarriage and constituted 65.3% of the studied group and surgical evacuation was the most common method of termination. The histopathology reports confirmed the pregnancy in all patients and revealed retained product of normal pregnancy in 315 (86.6%) cases, partial mole in 15 (4%) patients, complete hydatidiform mole in one (0.2%) case, decidual reaction in 21 (5.6%) cases and no product of conception in 13 (3.4%) cases .
In 2009, the Department of Obstetrics and Gynecology at our institution introduced outpatient MVA under local anaesthesia as an alternative to EVA with intraven- ous anaesthesia performed in the operating room for the treatment of spontaneous abortion, induced abortion, in- complete abortion, and retained products of conception. To assess the impact of this policy change, a conveni- ence sample of women who chose surgical management of spontaneous abortion, induced abortion, incomplete abortion, and retained products of conception were sur- veyed after their procedure. Not all outpatient offices of- fered MVA. Women underwent MVA or EVA based on the location of their diagnosis. Women seen in the in- patient triage area and in outpatient offices that had MVA available underwent MVA procedures. Women di- agnosed in outpatient offices without MVA available had EVA in the operating room. Our institution does not
After local Ethical Committee approval and with appropriate informed consent, placental tissue identified by its macroscopic appearance, was dissected from products of conception obtained from women undergoing elective surgical termination of pregnancy (TOP) at 8-10 weeks (early TOP; n = 8; gestational age 8.8 ± 0.9 weeks [Mean ± S.D.]) and 12-14 weeks’ gestational age (mid TOP; n = 11; gestational age 12.7 ± 1.0 weeks). Placental samples were also taken at delivery in the third trimester from 11 women with normotensive pregnancy (39.1 ± 1.4 weeks) and 10 women with PE (37.6 ± 2.6 weeks) who underwent Caesarean section prior to labour. We compared these observations with angiotensin receptor data previously obtained in these samples using identical methodology .
While contact with products of conception has been shown to be a risk factor for brucellosis transmission in other places, closeness of households in livestock keeping communities and the social background have not been documented as important risk factors for brucellosis transmission. The current study indicates that health education on ways to prevent brucellosis transmission through contact while assisting animal delivery should be given a priority in Arusha and Manyara regions. Though it may be difficult for each and every farmer to acquire and use protective gloves while assisting animal parturition because of affordability and availability issues, other simple and cheap material such as plastic bags that are easily available in the rural settings could be used to prevent direct contact with the products of conception from livestock that have been shown to have high concentrations of Brucella. Other items that can be used include papers and clothes that could be disposed off after a single use. The study also indicates the importance of increasing awareness even to those who don’t keep livestock on the potential of acquiring brucellosis from their neighbours’ livestock through contact with infected products of conception.
A reverse transcription nested PCR (RT-PCR) assay for the detection of rubella virus RNA using primers from the E1 open reading frame was established. This assay was found to be sensitive (detecting approximately two synthetic RNA copies and RNA extracted from 0.1 50% tissue culture infective dose of rubella virus) and specific; five wild-type rubella strains and four vaccine strains were detected, and no nonspecific amplification of 16 other RNA viruses or RNAs from seven cell types occurred. Rubella virus RNA was detected in 12 pharyngeal swabs from patients with serologically confirmed rubella; these RT-PCR results were in complete agreement with virus isolation. Analysis of products of conception obtained after confirmed primary maternal rubella infection by RT-PCR gave 92% agreement (12 of 13 samples) with virus isolation. No false-positive results were obtained. The potential use of this assay for prenatal diagnosis of congenital rubella infection and for investigating aspects of the pathogenesis of chronic disease is discussed.
perfect freedom of their thought. Another conception came rather later, when the small city-states with exclusive rights of citizenship had been merged In a larger wholej the conception of the universal fellowship between man and man founded upon a universal and eternal principle. Greece realized soon after the Persian war that she had a mission to the world, that Hellenism stood for the higher life of man as against barbarism, for Arete, or Excellence, as against the mere effortless average. First came the crude patriotism which regarded every Greek
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V2X . To fulfill these service requirements, more challeng- ing performance indicators such as 1ms transmission delay, 100x higher data rate, 1000x more connections need to be provided compared to current 4G networks. Though these requirements are not necessarily to be met at the same time, any one of them may initiate the revisit of the mobile networks. A novel radio access framework has been evolved from traditional cell centric access to user centric access based on hyper-cell abstraction. A hyper-cell is formed with one or many transmission and reception points (TRPs). A TRP can be a macro eNB, a pico eNB, an RRU or any other kind of light node. Hyper-cell concept decouples UE from physical cell site and simplifies heterogeneous node deployment . A hyper- cell based user-centric no-cell (UCNC) network architecture is shown in Fig. 1 where centralized data processing and hierarchical control logical is applied. UCNC can enable large scale coordination of many TRPs for consistent user expe- rience provisioning across network. Many new technologies and terminologies have been derived in UCNC framework, for instance, multiple TRPs assisted network synchronization, a new Energy Conserved Operation (ECO) state and UE tracking in ECO, grant-free based UL access both in RRC Connected and ECO state, coordinated UL/DL transmission, to list a few. Proof of concept (PoC) has been conducted to verify the feasibility and effectiveness of the newly proposed technolo- gies. This paper presents an overview of phase I prototype of UCNC with the focus on UL grant-free transmission for massive connectivity support.
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The world crisis actualized the problem of brittleness of the society and the vulnerability of a human being. The Government intervention through the strengthening of the regulation of the enterprises and the markets are considered by many experts as a method of indirect solution of the above men- tioned problem. However, the eﬀ ective management must be based on the knowledge of features and unique characteristics of each economic entity. Universal in its essence the system of government does not ﬁ t to it. Therefore, we speak about the creation of the direct control concept of the environment of the human life – “an Enterprise as a Microcivilization”. Its core is the Culturological paradigma and the Civilizational approach. The structure of the concept includes such models: the Contextual model of civilizational entities, the Complex model of a human, the Growth and the development model of microcivilization, the Model of civilizational entity “human – community – society”, and the applied Method of identifying microcivilization, the Assessment of values and the civilized Pro- ﬁ le of microcivilization’s citizen. The conception of “an Enterprise as a Microcivilization” was tested on a group of the Ukrainian food industry enterprises. From the set of 162 enterprises was allocated 9 pretenders for the status of microcivilization. Three of them - identiﬁ ed as a microcivilization. In one of them have been started the formation of the Institute of Cultural Leadership.
These results for female ageing raise the question of whether reproductive ageing during the time period of attempted conception should be incorporated more generally into computa- tional modelling of time to pregnancy in different populations. It should be noted first that the computations required to incorporate reproductive decline after each cycle of non-conception in example 5 required orders of magnitude more computational time than examples 1 to 4. A more fundamental difficulty is that the model of ageing used in example 5 is based on a specific population model , with assumptions about both individual ageing and variation within the population; the question of exactly how to tailor the model to fit other populations then arises. There is also the question of how accurately the population-based model captures individual female reproductive ageing. However, the results we report in Table 12 indicate that, at least for the specific assumptions of model 5, the effect of ignoring reproductive decline during the period of attempted conception is modest, adding up to two cycles to the computed number of non-conception cycles before a subfertility metric is reached. It is likely that the magnitude of this effect will be similar for other models making any reasonable assumptions about reproductive ageing in individ- uals and within populations. This raises the possibility of introducing a simple correction for ageing into any clinical application of the methods described here.
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Symmetry is, in general, an important feature of unity, and thus of physical comprehensibility. In requiring of a fundamental physical theory that it satisfies a symmetry principle (such as Lorentz invariance) or a global or local gauge symmetry, we are, in effect, demanding that the theory accords with a more or less specific conception of unity and physical comprehensibility.
parenthood via Donor Conception (DC) are associated with psychological distress. Research however, has strongly biased towards the experiences of women. Few studies have investigated either how men make sense of becoming a recipient father, or the psychological impact of lifting donor anonymity. This qualitative study drew upon information gathered from semi- structured interviews with eight recipient fathers. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Three super-ordinate themes were identified. ‘The me that couldn’t be and who I have become’, depicted the complex and recursive nature of the psychological challenges of both infertility and DC. It portrayed the difficult road from infertility to becoming a parent, resulting in a reconstruction of the meaning of ‘fatherhood’. ‘The safety of silence; the triumph of talk’, described how men felt both isolated and silenced regarding infertility and DC. The reparative value of talking to non-judgemental others was highlighted. All the men believed it was important to disclose the children’s DC origins to them, despite the feared repercussions. ‘The strangers in my family’, illustrated the ways in which professionals, the donor, and the child itself, could all be experienced as intruders into the men’s lives and minds. The lifting of donor anonymity seemed to place additional burdens on recipient fathers. Initial bonding seemed particularly difficult with sons, but strengthened over time. These findings are considered in relation to the literature and
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Abstract--A scrutinizes of patient during the crucial situation plays a vital role in every house. Point-of-care (POC) patient monitoring refers to near patient testing, usually outside the central hospital or primary care facility. Sometimes, poc testing is performed by a hospital employee by regular visits to the patient's home to monitor vital parameters or the state of a patient in the recovery process of rehabilitation. Remote patient monitoring is an alternative to regular home check-ups of patients with certain special medical conditions or the elderly who are unable to regularly visit a healthcare facility. Here we used wireless technologies to reduce the number of home visits which are now only required when special attention is needed.
meaningful imagery…. A symbol comes into being whenever we give a fact, a number, a word, a sign, a plant, a picture, a building—in a word, a thing—a deeper meaning than it possesses simply as is; when we give these things and their forms a greater value and meaning than would ordinarily be theirs; when we give the purely external thing a deeper intellectual or moral significance and thus make it an image for mental or spiritual events that could otherwise never have been expressed.” 3 The Freemasons believe that only the “most important should be invested with the rank of symbol. … In the symbol, the concept itself enters the corporeal world and becomes, itself, immediately visible.” 4 If I followed the Freemasons in this perspective, I needed symbols to create art about conception, creation, and birth.
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Nursing workload for glucose control per day was determined by the number of POC measurements or measurements from the sensor, which were entered in the computerized glucose regulation protocol and the amount of calibrations of the CGM sensor (in the inter- vention group only). A time-in-motion design was used to estimate the time that it took to execute targeted glucose control and insulin treatment per group. The following subtasks were observed: (1) POC measurement (this included the initiation, blood sampling, blood testing and processing), (2) sensor placement, (3) sensor calibra- tion and (4) time needed to determine a CGM value and entering the value in the decision support module. The tenfold-recorded elapsed times per subtask were averaged and then multiplied by the 24-hour blood sample average collected from the clinical trial.
The temperature dependence of organic carbon production (e.g., primary production, released from permafrost and soil erosion) and consumption (e.g., mineralization, respiration and methane emission) increases the influence of tempera- ture on aquatic ecosystems and reflects the importance of temperature in the carbon cycle (Gudasz et al., 2010; Pad- field et al., 2015; Yvon-Durocher et al., 2011a, b, 2012, 2014, 2015a, b; Zona et al., 2016). POC and PON levels show a high positive correlation with temperature in the Northern Hemisphere with the relationships PON = 0.142 · T + 0.260 (R 2 = 0.74) and POC = 0.788 · T + 3.340 (R 2 = 0.74). How- ever, the effect of temperature on POC and PON levels in the Southern Hemisphere is not very significant, with cor- relation coefficients (r) of − 0.11 and − 0.08, respectively. The influence of temperature on POC and PON levels at a global scale is not homogeneous (Fig. 10a, b). The increased sensitivity of POC and PON to temperature in the Northern Hemisphere may be caused by relatively large amounts of nutrients and a large land area when compared to the South- ern Hemisphere. POC / PON showed a high negative corre- lation with temperature in the Northern Hemisphere, with the relationship POC / PON = 11.88 · T −0.190 (R 2 = 0.81) (not including samples with subzero temperature). Phyto- plankton and microzooplankton growing at low tempera- tures (subzero) may regulate POC / PON, keeping the value low (Crawford et al., 2015; Talmy et al., 2016), and nitro- gen (NO − 3 and NH + 4 ) uptake and light may also play a role (Yun et al., 2012). The impact of temperature on POC / PON in the Southern Hemisphere (r = − 0.31) is relatively low when compared to the Northern Hemisphere (Fig. 10c). This may indicate that the mineralization of organic carbon occurs at a much higher rate than organic nitrogen with increas- ing temperature, or that terrestrial organic carbon, which has a high POC / PON ratio, is more efficiently kept than phytoplankton- and microzooplankton-derived organic car- bon, which has a low POC / PON ratio, with increasing tem- perature (Sharma, et al., 2015; Porcal et al., 2015; Crawford et al., 2015; Talmy et al., 2016).
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