Preeclampsia presents a major health impact to the maternal-fetal dyad and poses a maternal mortality risk estimated to be 5-15% worldwide, with diagnosis rates for this disorder substantially increasing. This disorder continues to pose a substantial economic burden, with costs estimated at 2.18 billion dollars within the first year postpartum. Despite the dramatic annual impact of preeclampsia, the pathophysiology of this disorder remains poorly understood. Low-dose aspirin (LDA) is the sole primary therapy for the prevention of preeclampsia. The mechanism of action of LDA on the cyclooxygenase isoform, COX-1, and its limited interaction with COX-2 help explain its treatment approach and shortcomings. Important questions remain regarding LDA therapy with respect to its efficacy, optimal timing of initiation, and dosing regimens required to achieve maximal therapeutic benefit. In this review, we explore the pathophysiology of preeclampsia, with attention to the cyclooxygenase pathway as a means of refining understanding of aspirin's mechanism of action, informing potential dosing strategies, and discussing alternative therapies and future directions for preeclampsia treatment.

Intra-abdominal hemorrhage is an extremely rare complication of endoscopic retrograde cholangiopancreatography (ERCP). We report a case of intra-abdominal bleeding that occurred after ERCP for choledocholithiasis with cholangitis in a patient with a cascade stomach. A man in his 70s underwent ERCP for severe acute cholangitis due to a common bile duct stone. The procedure was initially attempted using a TJF-260 V duodenoscope (Olympus); however, insertion into the duodenum was difficult because of the stomach cascade. The scope was changed to a JF-260 V (Olympus), and duodenal access was successfully achieved using a large-diameter sliding tube (ST-CB1; Olympus), followed by biliary stent placement. No sphincterotomy or other invasive procedure was performed. Two hours after the procedure, the patient developed severe epigastric pain, hypotension, and progressive anemia. Contrast-enhanced computed tomography (CT) revealed a large hematoma centered on the gastrosplenic ligament, indicating an intra-abdominal hemorrhage that was likely caused by a traction injury resulting from scope manipulation. No evidence of contrast extravasation was found, and conservative management was performed. The patient's condition improved with blood transfusion and discontinuation of aspirin, and follow-up CT demonstrated resolution of the hematoma. Inserting a scope can be challenging owing to anatomical deformities such as a cascade stomach, and excessive torque or traction may result in vascular injury. Careful insertion using a sliding tube and positional adjustment are essential, with awareness that intra-abdominal hemorrhage, although rare, can be a serious complication.

Fabrication of remote-controlled ion and molecule delivery devices with sub-nanomolar accuracy possesses enormous potential for application in futuristic areas like bio-sensing, molecular machines, energy storage/harvesting, separation, and purification. Here, we combined the excellent photothermal characteristics of oxidised multiwalled carbon nanotubes (o-CNT) with atomically thin 2D sheets of V2O5 (VO) to fabricate fluidic devices capable of discharging ions and molecules with sub-nanomolar accuracy. Remarkably, the delivery of ionic/molecular pulses can be remotely modulated through irradiation with IR light. The heterostructured fluidic membrane (HFM), fabricated as a bilayer membrane with distinctive regions of o-CNT and VO, can continuously deliver K[+] ions at the rate of ∼0.58 nmol min[-1]. The ionic flow rate can be further tuned by modulating the thickness and composition of the HFM. Moreover, triangular HFM can discharge ions in nanomolar pluses (∼1.85 to 6.92 nmol per pulse) when remotely triggered through light of different intensities. Likewise, the intermixed fluidic membrane (IFM), fabricated through vacuum filtration of the homogeneous mixtures of the VO and o-CNT, can discharge biologically relevant molecules like tryptophan (Trp) and aspirin at a rate as low as 0.1 nmol min[-1], which can be further modulated with light and heat.