Puerperal uterine inversion: report of nine cases.

Acute puerperal inversion of the uterus is considered to be rare. In one institution there were nine cases during an 11-year period, a rate of one for every 2176 vaginal deliveries. Analysis of these cases failed to identify any contributing factors occurring during the first or second stage of labour. Six cases were directly attributable to failure to administer an oxytocic preparation or, particularly, failure to await uterine contraction before attempting to expel the placenta by fundal pressure or cord traction. Although active management of the third stage of labour may reduce the incidence of postpartum hemorrhage, incomplete application of its principles is extremely hazardous. Immediate uterine replacement was efficacious in seven cases, but the inadvisability of removing the placenta prior to replacement was demonstrated.     

The Missing Medians: Exclusion of Ordinal Data from Meta-Analyses

Background

Meta-analyses are considered the gold standard of evidence-based health care, and are used to guide clinical decisions and health policy. A major limitation of current meta-analysis techniques is their inability to pool ordinal data. Our objectives were to determine the extent of this problem in the context of neurological rating scales and to provide a solution.

Methods

Using an existing database of clinical trials of oral neuroprotective therapies, we identified the 6 most commonly used clinical rating scales and recorded how data from these scales were reported and analysed. We then identified systematic reviews of studies that used these scales (via the Cochrane database) and recorded the meta-analytic techniques used. Finally, we identified a statistical technique for calculating a common language effect size measure for ordinal data.

Results

We identified 103 studies, with 128 instances of the 6 clinical scales being reported. The majority– 80%–reported means alone for central tendency, with only 13% reporting medians. In analysis, 40% of studies used parametric statistics alone, 34% of studies employed non-parametric analysis, and 26% did not include or specify analysis. Of the 60 systematic reviews identified that included meta-analysis, 88% used mean difference and 22% employed difference in proportions; none included rank-based analysis. We propose the use of a rank-based generalised odds ratio (WMW GenOR) as an assumption-free effect size measure that is easy to compute and can be readily combined in meta-analysis.

Conclusion

There is wide scope for improvement in the reporting and analysis of ordinal data in the literature. We hope that adoption of the WMW GenOR will have the dual effect of improving the reporting of data in individual studies while also increasing the inclusivity (and therefore validity) of meta-analyses.     

Progression of Osteosarcoma from a Non-Metastatic to a Metastatic Phenotype Is Causally Associated with Activation of an Autocrine and Paracrine uPA Axis

Pulmonary metastasis is the major untreatable complication of osteosarcoma (OS) resulting in 10–20% long-term survival. The factors and pathways regulating these processes remain unclear, yet their identification is crucial in order to find new therapeutic targets. In this study we used a multi-omics approach to identify molecules in metastatic and non-metastatic OS cells that may contribute to OS metastasis, followed by validation in vitro and in vivo. We found elevated levels of the urokinase plasminogen activator (uPA) and of the uPA receptor (uPAR) exclusively in metastatic OS cells. uPA was secreted in soluble form and as part of the protein cargo of OS-secreted extracellular vesicles, including exosomes. In addition, in the tumour microenvironment, uPA was expressed and secreted by bone marrow cells (BMC), and OS- and BMC-derived uPA significantly and specifically stimulated migration of metastatic OS cells via uPA-dependent signaling pathways. Silencing of uPAR in metastatic OS cells abrogated the migratory response to uPA in vitro and decreased metastasis in vivo. Finally, a novel small-molecule inhibitor of uPA significantly (P = 0.0004) inhibited metastasis in an orthotopic mouse model of OS. Thus, we show for the first time that malignant conversion of OS cells to a metastatic phenotype is defined by activation of the uPA/uPAR axis in both an autocrine and paracrine fashion. Furthermore, metastasis is driven by changes in OS cells as well as in the microenvironment. Finally, our data show that pharmacological inhibition of the uPA/uPAR axis with a novel small-molecule inhibitor can prevent the emergence of metastatic foci.     

Brachyceran Diptera (Insecta) in Cretaceous ambers, Part IV, Significant New Orthorrhaphous Taxa

Thirteen species of basal Brachycera (11 described as new) are reported, belonging to nine families and three infraorders. They are preserved in amber from the Early Cretaceous (Neocomian) of Lebanon, Albian of northern Spain, upper Albian to lower Cenomanian of northern Myanmar, and Late Cretaceous of New Jersey USA (Turonian) and Alberta, Canada (Campanian). Taxa are as follows, with significance as noted: In Stratiomyomorpha: Stratiomyidae (Cretaceogaster pygmaeus Teskey [2 new specimens in Canadian amber], Lysistrata emerita Grimaldi & Arillo, gen. et sp. n. [stem-group species of the family in Spanish amber]), and Xylomyidae (Cretoxyla azari Grimaldi & Cumming, gen. et sp. n. [in Lebanese amber], and an undescribed species from Spain). In Tabanomorpha: Tabanidae (Cratotabanus newjerseyensis Grimaldi, sp. n., in New Jersey amber). In Muscomorpha: Acroceridae (Schlingeromyia minuta Grimaldi & Hauser, gen. et sp. n. and Burmacyrtus rusmithi Grimaldi & Hauser gen. etsp. n., in Burmese amber, the only definitive species of the family from the Cretaceous); Mythicomyiidae (Microburmyia analvena Grimaldi & Cumming gen. et sp. n. and Microburmyia veanalvena Grimaldi & Cumming, sp. n., stem-group species of the family, both in Burmese amber); Apsilocephalidae or near (therevoid family-group) (Kumaromyia burmitica Grimaldi & Hauser, gen. et sp. n. [in Burmese amber]); Apystomyiidae (Hilarimorphites burmanica Grimaldi & Cumming, sp. n. [in Burmese amber], whose closest relatives are from the Late Jurassic of Kazachstan, the Late Cretaceous of New Jersey, and Recent of California). Lastly, two species belonging to families incertae sedis, both in Burmese amber: Tethepomyiidae (Tethepomyia zigrasi Grimaldi & Arillo sp. n., the aculeate oviscapt of which indicates this family was probably parasitoidal and related to Eremochaetidae); and unplaced to family is Myanmyia asteiformia Grimaldi, gen. et sp. n., a minute fly with highly reduced venation. These new taxa significantly expand the Mesozoic fossil record of rare and phylogenetically significant taxa of lower Brachycera.     

Malaria Risk Factors in North West Tanzania: The Effect of Spraying,Nets and Wealth

Malaria prevalence remains high in many African countries despite massive scaling-up of insecticide treated nets (ITN) and indoor residual spraying (IRS). This paper evaluates the protective effect of pyrethroid IRS and ITNs in relation to risk factors for malaria based on a study conducted in North-West Tanzania, where IRS has been conducted since 2007 and universal coverage of ITNs has been carried out recently. In 2011 community-based cross-sectional surveys were conducted in the two main malaria transmission periods that occur after the short and long rainy seasons. These included 5,152 and 4,325 children aged 0.5–14 years, respectively. Data on IRS and ITN coverage, household demographics and socio-economic status were collected using an adapted version of the Malaria Indicator Survey. Children were screened for malaria by rapid diagnostic test. In the second survey, haemoglobin density was measured and filter paper blood spots were collected to determine age-specific sero-prevalence in each community surveyed. Plasmodium falciparum infection prevalence in children 0.5–14 years old was 9.3% (95%CI:5.9–14.5) and 22.8% (95%CI:17.3–29.4) in the two surveys. Risk factors for infection after the short rains included households not being sprayed (OR = 0.39; 95%CI:0.20–0.75); low community net ownership (OR = 0.45; 95%CI:0.21–0.95); and low community SES (least poor vs. poorest tertile: OR = 0.13, 95%CI:0.05–0.34). Risk factors after the long rains included household poverty (per quintile increase: OR = 0.89; 95%CI:0.82–0.97) and community poverty (least poor vs. poorest tertile: OR = 0.26, 95%CI:0.15–0.44); household IRS or high community ITN ownership were not protective. Despite high IRS coverage and equitable LLIN distribution, poverty was an important risk factor for malaria suggesting it could be beneficial to target additional malaria control activities to poor households and communities. High malaria prevalence in some clusters and the limited protection given by pyrethroid IRS and LLINs suggest that it may be necessary to enhance established vector control activities and consider additional interventions.     

Genotypic variation in aluminum resistance, cellular aluminum fractions, callose and pectin formation and organic acid accumulation in roots of Populus hybrids

Soil acidity and aluminum (Al) toxicity are major factors limiting crop yield and forest productivity worldwide. Hybrid poplar (Populus spp.) was used as a model to assess genotypic variation in Al resistance and physiological stress responses to Al in a woody tree species. Eight hybrid crosses of P. trichocarpa, P. deltoides and P. nigra were exposed to Al in solution culture. Resistance to Al varied by genotype and hybrid cross, with P. trichocarpa × P. deltoides crosses being most resistant, P. trichocarpa × P. nigra being intermediate and P. deltoides × P. nigra being most sensitive to Al. Total root Al accumulation was not a good indicator of Al resistance/sensitivity. However, the partitioning of Al into apoplastic and symplastic fractions indicated that differences in sensitivity among genotypes were associated with Al uptake into the symplasm. Aluminum treatment increased callose and pectin concentrations of root tips in all genotypes, but more prominently in Al sensitive genotypes/hybrids. In Al sensitive genotypes, higher levels of symplastic Al accumulation correlated with elevated concentrations of citrate, malate, succinate or formate in root tips, whereas organic acid accumulation was not as pronounced in Al resistant genotypes. These findings suggest that exclusion of Al from the symplast is associated with Al resistance. Further screening of Al tolerant poplar genotypes could yield successful candidates to be utilized for sustainable reforestation/reclamation and carbon sequestration projects where soil acidity may limit tree growth.     

The influence of calcium decline and climate change on the cladocerans within low calcium, circumneutral lakes of the Experimental Lakes Area

Calcium (Ca) concentrations of many softwater lakes on the Canadian Shield have been in decline for decades as a response primarily to regional acid deposition and repeated cycles of forest harvesting. These Ca declines are of ecological interest, as many lakes have fallen to Ca levels detrimental to the fitness of ecologically important Ca-rich cladoceran taxa such as Daphnia pulex. However, distinguishing the impacts of reduced Ca from acidification (i.e., decreasing pH) on Ca-demanding fauna has proven difficult due to strong correlations between pH and Ca in softwater lakes. Here, we examine cladoceran sedimentary assemblages from low Ca lakes (mean present-day Ca < 2.0 mg l^?1) in the Experimental Lakes Area (ELA) of Ontario, Canada, where Ca concentrations have declined since the 1980s, despite being closed to forestry and remote from (i.e., not downwind of) major sources of acid deposition. Differences between present-day and pre-industrial cladoceran assemblages were greatest among planktonic taxa, including Bosmina spp. and Holopedium glacialis. However, daphniid remains were present in only three of the ten study lakes with minimal directional trends. Overall, in these ELA lakes, daphniid abundance was low historically, and impacts possibly attributable to Ca declines have been obscured by the effects of regional climate warming.