Trial of labor versus elective cesarean delivery for patients with two prior cesarean sections: a systematic review and meta-analysis

Cesarean section (CS) rates have been on the rise globally, leading to an increasing number of women facing the decision between a Trial of Labor after two Cesarean Sections (TOLAC-2) or opting for an Elective Repeat Cesarean Section (ERCS). This study evaluates and compares safety outcomes of TOLAC and ERCS in women with a history of two previous CS deliveries. PubMed, MEDLINE, EMbase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for studies published until 30 June 2023. Eligible studies were included based on predetermined criteria, and a random-effects model was employed to pool data for maternal and neonatal outcomes. Thirteen studies with a combined sample size of 101,011 women who had two prior CS were included. TOLAC-2 was associated with significantly higher maternal mortality (odds ratio (OR)=1.50, 95% confidence interval (CI)= 1.25–1.81) and higher chance of uterine rupture (OR = 7.15, 95% CI = 3.44–14.87) compared to ERCS. However, no correlation was found for other maternal outcomes, including blood transfusion, hysterectomy, or post-partum hemorrhage. Furthermore, neonatal outcomes, such as Apgar scores, NICU admissions, and neonatal mortality, were comparable in the TOLAC-2 and ERCS groups. Our findings suggest an increased risk of uterine rupture and maternal mortality with TOLAC-2, emphasizing the need for personalized risk assessment and shared decision-making by healthcare professionals. Additional studies are needed to refine our understanding of these outcomes in the context of TOLAC-2.</p

White matter differences between survivors with radiation treatment with or without chemotherapy (RT) and survivors without radiation treatment (NRT).

<p>(A) Significant white matter differences were identified between the RT group and the NRT group in the empirically-identified white matter regions from TBSS. White matter skeleton (color coded in green) is overlaid on a T₁ weighted image. Clusters of significantly lower fractional anisotropy (FA) for the RT survivor group are in orange and red. (B) The plot of statistically significant correlations between intellectual performance and the white matter FA measured from the areas of anterior portion of corpus callosum (green), right middle temporal (red) and right middle frontal (blue) regions. CC = corpus callosum (green), RMF = right middle frontal (blue), RMT = right middle temporal (red). VIQ = verbal intelligence quotient, PIQ = performance intelligence quotient, a.u = arbitrary units.</p

The correlations of IQ and cumulative neurological risk with fractional anisotropy values of specific white matter regions in survivors with radiation treatment with and without chemotherapy (RT) compared to the survivors who did not receive radiation treatment (NRT).

<p>Note: ^a: Correlation coefficient; VIQ = Verbal Intelligence Quotient; PIQ = Performance IQ; NPS = Neurological Predictor Scale; FA = fractional anisotropy; RT = survivors treated with radiation treatment with or without chemotherapy; NRT = survivors who did not receive radiation treatment.</p><p>*: P < 0.05</p><p>**: P < 0.01. CC: corpus callosum; RMF: right middle frontal; RFP: right frontal pole; LIF: left inferior frontal; LMF: left middle frontal; RMT: right middle temporal; RTP: right temporal pole.</p><p>The correlations of IQ and cumulative neurological risk with fractional anisotropy values of specific white matter regions in survivors with radiation treatment with and without chemotherapy (RT) compared to the survivors who did not receive radiation treatment (NRT).</p

White matter differences between survivors treated with radiation therapy with or without chemotherapy and healthy controls.

<p>(A) Significant white matter differences between survivors with radiation treatment with or without chemotherapy (RT) and healthy controls (HC) were found in the empirically-identified white matter regions from TBSS. White matter skeleton (color coded in green) is overlaid on a T₁ weighted image. Clusters of significantly lower fractional anisotropy (FA) for survivor group are in orange and red. (B) The plot of statistically significant correlations between intellectual performance and the white matter FA measured from the areas of left middle frontal (red) and left middle temporal (blue). LMF = left middle frontal (red), LMT = left middle temporal (blue). VIQ = verbal intelligence quotient, PIQ = performance intelligence quotient. a.u. = arbitrary units.</p

Fractional anisotropy (FA) values of white matter regions in all brain tumor survivors were lower compared to those of healthy controls, and correlated with IQ.

<p>Note: ^a: Correlation coefficient; FA = Fractional Anisotropy, VIQ = Verbal Intelligence Quotient; PIQ = Performance Intelligence Quotient.</p><p>*: P < 0.05</p><p>**: P < 0.01.CC: corpus callosum, LSF: left superior frontal; LFP: left frontal pole; LMF: left middle frontal; LFP: left frontal pole; RMF: right middle frontal; RFP: right frontal pole; RFO: right frontal orbital; RIF: right inferior frontal; LST: left superior; LMT: left middle temporal; LIT: left inferior temporal; LPT: left planum temporale; RST: right superior temporal; RMT: right middle temporal; RIT: right inferior temporal; RPT: right planum temporale.</p><p>Fractional anisotropy (FA) values of white matter regions in all brain tumor survivors were lower compared to those of healthy controls, and correlated with IQ.</p

Demographic, treatment history, and intellectual performance of each group.

<p>Note: RT = survivors who received radiation treatment with or without chemotherapy, NRT = survivors who did not receive radiation treatment. Groups were similar across demographic variables.</p><p><b>*</b>: Variables with significant group difference (<i>p</i> < .05).</p><p>^a,b: Different superscripts (e.g., ^a and ^b) signify significant mean differences between groups (χ2, <i>p</i> < .05), whereas matching superscripts illustrate similar means (e.g., ^b and ^b). RT group had significantly more individuals treated with chemotherapy and individuals identified with hormone deficiency. Across most cognitive tasks and indices, the RT group was significantly lower relative to both NRT and HC groups; in contrast, the NRT group was similar to controls. IQ Mean = 100, SD = 15; Subtest T Score Mean = 50, SD = 10.</p><p>Demographic, treatment history, and intellectual performance of each group.</p

Fractional anisotropy (FA) values were lower in specific white matter regions in survivors compared to healthy controls, and correlated with IQ.

<p>Note: a: Correlation coefficient; VIQ = Verbal Intelligence Quotient; PIQ = Performance IQ; FA = fractional anisotropy; RT = survivors treated with radiation treatment with or without chemotherapy; NRT = survivors who did not receive radiation treatment; HC = Healthy Controls.</p><p>*: P < 0.05</p><p>**: P < 0.01. CC: corpus callosum, LSF: left superior frontal; LMF: left middle frontal; LFP: left frontal pole; RSF: right superior frontal; RMF: right middle frontal; RIF: right inferior frontal; LFO: left frontal orbital; LFP: left frontal pole; LIF: left inferior frontal; LST: left superior temporal; LMT: left middle temporal; LIT: left inferior temporal; LPT: left planum temporale; RST: right superior temporal; RMT: right middle temporal; RIT: right inferior temporal; RPT: right planum temporale.</p><p>Fractional anisotropy (FA) values were lower in specific white matter regions in survivors compared to healthy controls, and correlated with IQ.</p

White matter differences between survivors with no radiation treatment and healthy controls.

<p>Significant white matter differences between survivors with no radiation treatment (NRT) and healthy controls (HC) were found in the empirically-identified white matter regions from TBSS. White matter skeleton (color coded in green) is overlaid on a T₁ weighted image. Clusters of significantly lower fractional anisotropy (FA) for survivor group are in orange and red. No statistically significant correlation between intellectual performance and the white matter FA was found in these areas.</p

One-Step Facile Synthesis of Highly Magnetic and Surface Functionalized Iron Oxide Nanorods for Biomarker-Targeted Applications

We report a one-step method for facile and sustainable synthesis of magnetic iron oxide nanorods (or IONRs) with mean lengths ranging from 25 to 50 nm and mean diameters ranging from 5 to 8 nm. The prepared IONRs are highly stable in aqueous media and can be surface functionalized for biomarker-targeted applications. This synthetic strategy involves the reaction of iron­(III) acetylacetonate with polyethyleneimine in the presence of oleylamine and phenyl ether, followed by thermal decomposition. Importantly, the length and diameter as well as the aspect ratio of the prepared IONRs can be controlled by modulating the reaction parameters. We show that the resultant IONRs exhibit stronger magnetic properties compared to those of the widely used spherical iron oxide nanoparticles (IONPs) at the same iron content. The increased magnetic properties are dependent on the aspect ratio, with the magnetic saturation gradually increasing from 10 to 75 emu g^–1 when increasing length of the IONRs, 5 nm in diameter, from 25 to 50 nm. The magnetic resonance imaging (MRI) contrast-enhancing effect, as measured in terms of the transverse relaxivity, <i>r</i>₂, increased from 670.6 to 905.5 mM^–1 s^–1, when increasing the length from 25 to 50 nm. When applied to the immunomagnetic cell separation of the transferrin receptor (TfR)-overexpressed medulloblastoma cells using transferrin (Tf) as the targeting ligand, Tf-conjugated IONRs can capture 92 ± 3% of the targeted cells under a given condition (2.0 × 10⁴ cells/mL, 0.2 mg Fe/mL concentration of magnetic materials, and 2.5 min of incubation time) compared to only 37 ± 2% when using the spherical IONPs, and 14 ± 2% when using commercially available magnetic beads, significantly improving the efficiency of separating the targeted cells

Baseline Characteristics of Patients in the 20 Studies Included.

<p>Baseline Characteristics of Patients in the 20 Studies Included.</p