Placenta Accreta Spectrum (PAS) disorders, including placenta accreta, increta, and percreta, are serious obstetric conditions characterized by abnormal placental adherence to the uterine wall. With increasing incidence, PAS poses significant risks, primarily through massive hemorrhage during or after delivery, often necessitating hysterectomy. Key risk factors include prior cesarean sections, uterine surgery, and placenta previa diagnosis. In this review, we will examine the pathophysiology of PAS, with a focus on the mechanisms underlying abnormal trophoblast invasion and defective decidualization. We will highlight the role of uterine scarring, extracellular matrix remodeling, dysregulated signaling pathways, and immune and vascular alterations in disrupting the maternal-fetal interface, ultimately predisposing to morbid placentation and delivery complications. We will also discuss the life-threatening complications of PAS, such as shock and multi-organ failure, which require urgent multidisciplinary intensive care, as well as the optimization of management through preoperative planning and intraoperative blood loss control to reduce maternal morbidity and mortality.

Targeted protein degradation has been widely adopted as a new approach to eliminate both established and previously recalcitrant therapeutic targets. Here we report the development of small molecule degraders of the envelope (E) protein of dengue virus. We developed two classes of bivalent E-degraders, linking two previously reported E-binding small molecules, GNF-2 and CVM-2-12-2, to a glutarimide-based recruiter of the CRL4 ^CRBN ligase to effect proteosome-mediated degradation of the E protein. ZXH-2-107 (based on GNF-2) is an E degrader with ABL inhibition while ZXH-8-004 (based on CVM-2-12-2) is a selective and potent E-degrader. These two compounds provide proof-of-concept that difficult-to-drug targets such as a viral envelope protein can be effectively eliminated using a bivalent degrader and provide starting points for the future development of a new class antiviral drugs.

Careful perioperative pain management is crucial for good patient outcomes after surgery, as poorly controlled pain interferes with the ability of patients to recover to normal baseline function and increases postoperative morbidity and mortality. Although opioids have been the mainstay for treating postoperative pain, there has been a shift in favor of a multimodal analgesic approach, including regional anesthesia, as a way to circumvent opioid-related adverse events (e.g. nausea and vomiting, respiratory depression, sedation). In this chapter, we present an update on several recently developed regional anesthetic techniques, local anesthetic medications, as well as nerve block adjuncts with the potential to improve pain management in the perioperative setting. With more future studies, these novel methods may be incorporated into postsurgical recovery protocols and provide the opportunity to improve patient outcomes.

Purpose: Tendon- or ligament-to-bone repair remains a surgical challenge. While bone tunnel fixation is a common surgical technique whereby soft tissue is expected to heal against a bone tunnel interface, contemporary methods have yet to recapitulate biomechanical similarity to the native enthesis. In this study, we aim to demonstrate that inside-out longitudinal tendon inversion may improve bone tunnel healing with the hypothesis that inversion removes the gliding epitenon surface from the healing interface thereby improving tunnel interface healing. Methods: 40 male Sprague-Dawley rats underwent either native tendon tenodesis (control group) or tendon inversion tenodesis (experimental group). Interface tissue was harvested 8 weeks post-operatively. Biomechanical testing was performed to assess tensile strength and modes of failure. Histology was performed to assess tissue architecture, and immunohistochemistry was used confirmed abrogation of epitendinous lubricin from interface tissue. Results: Neither surgical intervention led to discernible adverse effects on animal health. Maximum tensile strength increased after tendon inversion compared to control surgery. The extracellular matrix protein lubricin was reduced with tendon inversion, and specimens with tendon inversion had greater healing scores and collagen fibril alignment at the healing interface. Conclusions: Tendon inversion improves bone tunnel healing in rats. Clinical Relevance: Our findings suggest that longitudinal tendon inversion, or inverse tubularization, in a rat biceps tenodesis model improves tendon-to-bone healing in part due to disruption of the epitendinous surface at the bone healing interface. This work provides molecular insight into future improvements for tendon-to-bone repair surgical techniques.