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Cesarean delivery is currently not recommended before 23 weeks' gestation unless for maternal indications, even in the setting of malpresentation. These recommendations are based on a lack of evidence of improved neonatal outcomes and survival following cesarean delivery and the maternal risks associated with cesarean delivery at this early gestational age. However, as neonatal resuscitative measures and obstetrical interventions improve, studies evaluating the potential neonatal benefit of periviable cesarean delivery have reported inconsistent findings.

This study aimed to compare the survival rates at 1 year of life among resuscitated infants delivered by cesarean delivery with those delivered vaginally at 22 and 23 weeks of gestation.

We conducted a population-based cohort study of all resuscitated livebirths delivered between 22 0/7 and 23 6/7 weeks of gestational age in the United States between 2007 and 2013. The primary outcome was the rate of infant survival at 1 year of life for different routed relative risk, 1.7; 95% confidence interval, 1.1-2.7) was associated with cesarean delivery at 22 to 23 weeks of gestation.

Cesarean delivery is associated with increased survival at 1 year of life among resuscitated, periviable infants born between 22 0/7 and 23 6/7 weeks of gestation, especially in the setting of nonvertex presentation. However, cesarean delivery is associated with increased maternal morbidity.

Cesarean delivery is associated with increased survival at 1 year of life among resuscitated, periviable infants born between 22 0/7 and 23 6/7 weeks of gestation, especially in the setting of nonvertex presentation. However, cesarean delivery is associated with increased maternal morbidity.

The coronavirus disease 2019 pandemic necessitated an abrupt transition to exclusive virtual interviewing for maternal-fetal medicine fellowship programs.

This study aimed to assess the maternal-fetal medicine fellowship program directors' approaches to exclusive virtual interviews and to obtain program director feedback on the virtual interview experience to guide future interview cycles.

A novel cross-sectional online survey was distributed through the Society for Maternal-Fetal Medicine to program directors after the completion of the interview season, but before the results of the National Resident Matching Program on October 14, 2020. Survey data were collected anonymously and managed using secure Research Electronic Data Capture electronic data capture tools.

Overall 71 of 89 program directors (80%) responded. All respondents completed their 2020 interviews 100% virtually. Nearly half of program directors (33 of 68, 49%) interviewed more candidates in 2020 than in 2019. Of those who interviewed he experience for program directors and candidates.

The virtual interview experience was better than expected for most program directors. However, most program directors felt less able to present their programs and assess the candidates on a virtual platform compared with previous in-person experiences. Despite this, most program directors are interested in at least a component of virtual interviewing in future years. Future efforts are needed to refine the virtual interview process to optimize the experience for program directors and candidates.

Insufficient and imprecise information during pregnancy can lead to an overestimation of maternal and fetal risk associated to various exposures during gestation.

This study aimed to assess whether expert obstetrical counseling in cases of maternal infections at risk of vertical transmission could impact maternal perception of risk and the tendency to terminate pregnancy.

This is a monocentric prospective observational study of 185 consecutive pregnant women with confirmed diagnosis of infectious diseases at risk of vertical transmission during the first or second trimester of pregnancy. Patients were divided into 2 different groups, according to the type infectious disease infections at high risk of fetal damages and infections at low risk. Every woman included in the study underwent medical counseling with a physician with experience of vertically transmitted infections. Moreover, each woman involved in the study was offered a detailed second trimester ultrasound scan. Maternal concern for their pregnothers, and, on the other hand, can lead to feasible results, reducing a woman's disposition to termination of pregnancy.

Our results confirm the importance of a comprehensive and sufficient expert medical counseling that, on one hand, can reduce maternal risk perception, improving quality of life for mothers, and, on the other hand, can lead to feasible results, reducing a woman's disposition to termination of pregnancy.

This open-label, phase 1-2 study evaluated the safety and efficacy of rovalpituzumab tesirine (Rova-T), an antibody-drug conjugate targeting DLL3, plus immune checkpoint inhibitors nivolumab plus or minus ipilimumab in previously treated extensive-stage SCLC (ES SCLC).

Patients with histologically or cytologically confirmed, previously treated (two or more lines of therapy) ES SCLC were enrolled into two cohorts. Cohort 1 received 0.3 mg/kg Rova-T (once every 6 wk for two cycles) plus 360 mg nivolumab (two 3-wk cycles beginning on week 4). Cohort 2 received the same dosage of Rova-T as cohort 1 plus 1 mg/kg nivolumab (four 3-wk cycles) and 1 mg/kg ipilimumab (beginning week 4). Both cohorts received 480 mg nivolumab every 4 weeks starting at week 10. Key objectives were to evaluate safety and tolerability and efficacy (per Response Evaluation Criteria in Solid Tumors version 1.1). The response-related results are based on centrally read data.

A total of 42 patients received therapy cohort 1, n= 30; cohoand administration schedules evaluated.

Liver transplantation (LT) offers an effective alternative treatment for unresectable hepatocellular carcinoma (HCC). Despite its growing acceptance and longer life expectancy rates, survival data in older patients are conflicting and consensus guidelines are lacking in terms of a cut-off age range for operations.

We explored our prospectively maintained institutional database to identify patients diagnosed with HCC between January 1, 2002 and December 31, 2019. Long-term oncologic outcomes were analyzed in patients undergoing LT or hepatic resection, with patient age considered as the primary variable.

In total, 1,629 patients with HCC were identified, of whom 700 were considered for curative operations (LT, n= 538; resection, n= 162). Patients older than 65 years were less likely to be considered for LT (p < 0.01), although there were no age-related differences in the de-listing rate among age groups (p= 0.90). Older patients had overall survival (OS) outcomes comparable with younger patients after LT (3-year OS 85.5% vs 84%; 5-year OS 73.9% vs 77%; p= 0.26). Long-term survival was lower in the group who underwent resection, however, older patients still demonstrated equivalent OS outcomes (3-year OS 59% vs 64.8%; 5-year OS 44.8% vs 49%; p= 0.13). There were no differences in the development of local or distant metastatic disease between groups.

Although older candidates were less likely to be considered for LT in the management of HCC, judicious matching can lead to OS data comparable with their younger counterparts. Previous age misconceptions need to be challenged without the concern of worse long-term oncologic outcomes after surgery.

Although older candidates were less likely to be considered for LT in the management of HCC, judicious matching can lead to OS data comparable with their younger counterparts. Previous age misconceptions need to be challenged without the concern of worse long-term oncologic outcomes after surgery.P-wave terminal force (PTF) is accepted as an electrocardiographic criteria to assess left atrial abnormalities in humans. In this study, the applicability of PTF in dogs with myxomatous mitral valve disease (MMVD) was evaluated, and compared its ability to identify left atrial dilatation with 4 other P-wave derived parameters. Seventy-four dogs with echocardiographically diagnosed MMVD were recruited for this prospective cross-sectional study. Also, 47 healthy dogs were included to serve as controls. All dogs underwent physical, electrocardiographic and standard echocardiographic examinations prior to enrollment. Electrocardiographic measurements were obtained from simultaneous recordings at three different locations for precordial lead V1. PTF was defined as the deflection following the second half of the P-wave, and was best documented at the first and third right intercostal spaces. In those locations, the P-wave was negative and P-wave terminal force was recognized as a positive undulation in baseline following P-wave. P-wave terminal force and P-wave duration measured from recordings obtained at either the first or third right intercostal spaces had poor to weak correlations (P less then .05) with echocardiographic surrogates of cardiac remodeling and congestion. In dogs with MMVD, only P-wave duration and P-wave area distinguished normal and dilated left atria (P less then .05). this website In conclusion, PTF had positive polarity and was best recorded when precordial lead V1 electrode was placed at the most cranial right intercostal locations. PTF failed to reliably identify left atrial enlargement in dogs with MMVD.

Military leaders must understand how modern military equipment loads affect trade-offs between movement speed and physiological strain to optimize pacing strategies.

To evaluate the effects of load carried in a recently developed military backpack on the walking speed and cardiometabolic responses of dismounted warfighters.

Fifteen soldiers (1 woman, 14 men; age, 22±2 years; height, 173±7cm; body mass (BM), 73±10kg) completed incremental walking tests with four external load conditions (0, 22, 44, or 66% BM) using the US Army's newest backpack the Modular Lightweight Load-Carrying Equipment 4000 (MOLLE 4000). Oxygen uptake (V̇O

) and heart rate (HR) were evaluated relative to maximal values (V̇O

and HR

respectively). Testing ceased when participants completed the highest tested speed (1.97ms

), exceeded a respiratory exchange ratio (RER) of 1.00, or reached volitional exhaustion.

Peak speed significantly decreased (p<0.03) with successively heavier loads (0% BM, 1.95±0.06ms

 ; 22% BM, 1.87±0.10ms

 ; 44% BM, 1.69±0.13ms

 ; 66% BM, 1.48±0.13ms

). Peak V̇O

was significantly lower (p<0.01) with 0% BM (47±5% V̇O

) than each load (22% BM, 58±8% V̇O

 ; 44% BM, 63±10% V̇O

 ; 66% BM, 61±11% V̇O

). Peak HR was significantly lower (p<0.01) with 0% BM (71±5% HR

) versus each load (22% BM, 83±6% HR

 ; 44% BM, 87±6% HR

 ; 66% BM, 88±6% HR

).

Overburdened warfighters suffer severe impairments in walking speed even when carrying recently developed military load carriage equipment. Our results suggest that the relative work intensity of heavy load carriage may be better described when expressed relative to HR

versus V̇O

.

Overburdened warfighters suffer severe impairments in walking speed even when carrying recently developed military load carriage equipment. Our results suggest that the relative work intensity of heavy load carriage may be better described when expressed relative to HRmax versus V̇O2max.