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Hysterectomy of the didelphic uterus is extensively documented utilizing the laparoscopic and abdominal surgical approach with very few cases documenting the vaginal approach. This report will discuss the surgical modifications to the vaginal hysterectomy (VH) technique successfully employed in a case of a didelphic uterus. These techniques include staged transection of the uterosacral ligaments for the difficult posterior colpotomy, morcellation for the enlarged size of the uterus, and inversion of the uterus for delivery through the vaginal canal. This case displays the feasibility of the vaginal route for the didelphic uterus and augments the American College of Obstetricians and Gynecologists (ACOG) Committee Opinion No. 701 by expanding the patient pathology that qualifies for benign indications for hysterectomy through the most minimally invasive route.

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A G4P4 woman in her 30s with a type II vesicouterine fistula, as defined by the Jozwik classification system, presented with symptoms of menouria, vaginal menses and urinary incontinence 8 years after caesarean delivery, the time of probable origination of the fistula tract. Transvaginal ultrasound identified a fistula tract communicating between the bladder and uterus, a rare finding that many years remote from caesarean delivery. Traditional surgical technique includes laparoscopic, abdominal and endoscopic methods of repair, sometimes using a transvesical approach. Transvesical repair can be associated with subsequent inpatient hospital stays and prolonged catheterisation. Our technique proposes a transvaginal surgical approach as an outpatient procedure with decreased operating time (40 min), postoperative pain and catheterisation requirement. It is the authors' belief that a transvaginal approach is less invasive and allows for better preservation of the uterus for future pregnancies and vaginal deliveries, as desired by the patient.

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Here, we present a strong test of the hypothesis that sacrificial moral dilemmas are solved using the same value-based decision mechanism that operates on decisions concerning economic goods. To test this hypothesis, we developed Psychological Value Theory. Psychological Value Theory is an expansion and generalization of Cohen and Ahn's (2016) Theory of Subjective Utilitarianism. Psychological Value Theory defines a new theoretical construct termed Psychological Value, measures Psychological Value using a traditional psychophysics paradigm, and predicts preferential choice from those measurements using a value-based computational model. We evaluate the validity of Psychological Value Theory across six experiments. In Experiment 1, we use Psychological Value Theory to estimate the perceived Psychological Value of human lives and economic goods. The data reveal that perceived Psychological Value of lives is highly influenced by individual differences of people but minimally influenced by the number of people in a group. In Experiments 2-5, we demonstrate that when used as input in a value-based computational model, perceived Psychological Values of human lives accurately predict participants' RT and response choices to sacrificial moral dilemmas. In Experiment 6, we replicate these findings for decisions involving economic goods. We cross-validate our results with multiple data sets using multiple methods. We conclude that the same value-based processes underlying economic decisions also underlie choices involving human lives. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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The optimal timing of aortic valve replacement (AVR) remains controversial. Several biomarkers reflect the underlying pathophysiological processes in aortic stenosis (AS) and may be of use as mortality predictors. The aim of this systematic review and meta-analysis is to evaluate the blood biomarkers utilised in AS and assess whether they associate with mortality. PubMed and Embase were searched for studies reporting baseline biomarker level and mortality outcomes in patients with AS. A total of 83 studies met the inclusion criteria and were systematically reviewed. Of these, 21 reporting brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), Troponin and Galectin-3 were meta-analysed. Pooled analysis demonstrated that all-cause mortality was significantly associated with elevated baseline levels of BNP (HR 2.59; 95% CI 1.95-3.44; p < 0.00001), NT-proBNP (HR 1.73; 95% CI 1.45-2.06; p = 0.00001), Troponin (HR 1.65; 95% CI 1.31-2.07; p < 0.0001) and Galectin-3 (HR 1.82; 95% CI 1.27-2.61; p < 0.001) compared to lower baseline biomarker levels. Elevated levels of baseline BNP, NT-proBNP, Troponin and Galectin-3 were associated with increased all-cause mortality in a population of patients with AS. Therefore, a change in biomarker level could be considered to refine optimal timing of intervention. The results of this meta-analysis highlight the importance of biomarkers in risk stratification of AS, regardless of symptom status.

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PURPOSE OF REVIEW: The role of renin-angiotensin-aldosterone system (RAAS) inhibitors, notably angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs), in the COVID-19 pandemic has not been fully evaluated. With an increasing number of COVID-19 cases worldwide, it is imperative to better understand the impact of RAAS inhibitors in hypertensive COVID patients. PubMed, Embase and the pre-print database Medrxiv were searched, and studies with data on patients on ACEi/ARB with COVID-19 were included. Random effects models were used to estimate the pooled mean difference with 95% confidence interval using Open Meta[Analyst] software. RECENT FINDINGS: A total of 28,872 patients were included in this meta-analysis. The use of any RAAS inhibition for any conditions showed a trend to lower risk of death/critical events (OR 0.671, CI 0.435 to 1.034, p = 0.071). Within the hypertensive cohort, however, there was a significant lower association with deaths (OR 0.664, CI 0.458 to 0.964, p = 0.031) or the combination of death/critical outcomes (OR 0.670, CI 0.495 to 0.908, p = 0.010). There was no significant association of critical/death outcomes within ACEi vs non-ACEi (OR 1.008, CI 0.822 to 1.235, p = 0.941) and ARB vs non-ARB (OR 0.946, CI 0.735 to 1.218, p = 0.668). This is the largest meta-analysis including critical events and mortality data on patients prescribed ACEi/ARB and found evidence of beneficial effects of chronic ACEi/ARB use especially in hypertensive cohort with COVID-19. As such, we would strongly encourage patients to continue with RAAS inhibitor pharmacotherapy during the COVID-19 pandemic.

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In experimental contexts, affect-related word lists have been widely applied when examining how cognitive processes interact with emotional processes. These lists, however, present limitations when studying the relation between emotion and cognitive processes such as time and number processing because affective words do not inherently contain time or quantity information. Live events, in contrast, are experienced by an observer and therefore inherently carry affect information. Unfortunately, existing life-event lists and inventories have been largely applied within clinical contexts as diagnostic tools, and therefore are not suitable for many experimental contexts because they do not contain a balanced number of reliably positive, negative, and neutral life events. In Experiment 1, we create a standardized affect-related life-events list with 171 positive, negative, and neutral affect-related life events. In Experiment 2, we show that strength of affect and significance of the event are integral dimensions, suggesting that these two features are difficult to separate perceptually. The implications of these findings and some potential future applications of the created life-events list are discussed.

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OBJECTIVES: (1) To determine a normal range for urinary citrate for term babies. (2) To compare urinary citrate measured in ex preterm babies at term with this normal range. (3) To evaluate whether urinary citrate was related to presence of nephrocalcinosis (NC) and chronic Lung Disease (CLD) in these ex preterm babies. STUDY DESIGN: Urinary citrate was measured in 38 healthy term babies (mean birth weight 3.52 kg, mean gestation 41 weeks) at a mean postnatal age of 3 days (1-5 days) and in 53 ex preterm babies (<32 weeks gestation at birth) at term. These preterm babies were part of a larger study on NC in which two renal ultrasound scans were performed at 1 month and term. RESULTS: The normal range for urinary citrate in term babies was 0.025-2.97 (mean 1.03) mmol/l and citrate/creatinine ratio 0.0011-0.852 (mean 0.27). In the ex-preterm urinary citrate was not significantly different (mean 1.1 vs. 1.03, p=0.7232) but urine citrate/creatinine ratio was significantly higher (mean 1.27 vs. 0.27, p=0.0005). There was no significant difference in urinary citrate or ratios of citrate/creatinine and calcium/citrate in the 11 (20.7%) with NC or in the 17 (32%) babies with CLD. There was no significant relationship found between duration of TPN and urinary citrate measured at term. CONCLUSION: We have determined a normal range for urinary citrate in healthy term babies in the first week of life. The range was very wide. Ex preterm babies had similar values at term and there was no association between urinary citrate and NC or CLD.

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