Recent advances in the induction of labor

The rate of labor induction is steadily increasing and, in industrialized countries, approximately one out of four pregnant women has their labor induced. Induction of labor should be considered when the benefits of prompt vaginal delivery outweigh the maternal and/or fetal risks of waiting for the spontaneous onset of labor. However, this procedure is not free of risks, which include an increase in operative vaginal or caesarean delivery and excessive uterine activity with risk of fetal heart rate abnormalities. A search for "Induction of Labor" retrieves more than 18,000 citations from 1844 to the present day. The aim of this review is to summarize the controversies concerning the indications, the methods, and the tools for evaluating the success of the procedure, with an emphasis on the scientific evidence behind each

Growth Kinetics in a Phase Field Model with Continuous Symmetry

We discuss the static and kinetic properties of a Ginzburg-Landau spherically symmetric $O(N)$ model recently introduced (Phys. Rev. Lett. {\bf 75}, 2176, (1995)) in order to generalize the so called Phase field model of Langer. The Hamiltonian contains two $O(N)$ invariant fields $\phi$ and $U$ bilinearly coupled. The order parameter field $\phi$ evolves according to a non conserved dynamics, whereas the diffusive field $U$ follows a conserved dynamics. In the limit $N \to \infty$ we obtain an exact solution, which displays an interesting kinetic behavior characterized by three different growth regimes. In the early regime the system displays normal scaling and the average domain size grows as $t^{1/2}$, in the intermediate regime one observes a finite wavevector instability, which is related to the Mullins-Sekerka instability; finally, in the late stage the structure function has a multiscaling behavior, while the domain size grows as $t^{1/4}$.Comment: 9 pages RevTeX, 9 figures included, files packed with uufiles to appear on Phy. Rev.

Lactacidemia in intrauterine growth restricted (IUGR) pregnancies : relationship to clinical severity, oxygenation and placental weight

The aim of the study was to evaluate the impact of clinical severity and placental weight upon fetal lactacidemia in intrauterine growth restricted (IUGR) pregnancies. Seventy pregnancies complicated by IUGR were compared with 70 normal (appropriate for gestational age, AGA) pregnancies at the time of elective cesarean section. IUGR pregnancies were divided according to clinical severity in three groups: Group 1 had normal fetal heart rate (FHR) and normal pulsatility index of the umbilical artery (PI); Group 2 had normal FHR and abnormal PI; and Group 3 had abnormal FHR and PI. No cases with severe lactacidemia had placental weights >or=250 g. Forty-four fetuses had placental weight or=250 g exhibited an F/P ratio significantly lower than that in AGA fetuses suggesting that IUGR may be due to a reduction of placental function per gram of tissue

Use of sieving as a valuable technology to produce enriched buckwheat flours: A preliminary study

Fractionation processes based on physical separation are a good strategy to produce enriched cereal flours. Therefore, the aim of this work is to evaluate the suitability of sieving of buckwheat flours to produce protein and phenolic (especially rutin) enriched fractions. Because of that, dehulled whole buckwheat flour (GSTQ) was sieved obtaining fractions with a particle size of 215 \uf06dm, 160 \uf06dm, 85 \uf06dm, and 45 \uf06dm (GS215, GS160, GS85, and GS45). For that purpose, the determination of protein, ash, and total starch content and free and bound phenolic compounds was carried out. The highest content of total phenolic compounds was obtained in GS215 (3118.84 mg kg-1 d.w.), followed by GS160 (2499.11 mg kg-1 d.w.), GS85 (989.46 mg kg-1 d.w.), GSTQ (983.15 mg kg-1 d.w.), and GS45 (481.31 mg kg-1 d.w.). Therefore, the phenolic content decreased with the particle size decrease from 215 \uf06dm to 45 \uf06dm. Besides, there were no significant differences between the total phenolic content in GS85 and GSTQ. The fraction with 215 \uf06dm reported the highest protein and mineral salt content and presented rutin amounts four times higher than GSTQ

Effect of a collector bag for measurement of postpartum blood loss after vaginal delivery: cluster randomised trial in 13 European countries

Objective To evaluate the effectiveness of the systematic use of a transparent plastic collector bag to measure postpartum blood loss after vaginal delivery in reducing the incidence of severe postpartum haemorrhage

Evolution of supermassive black holes

Supermassive black holes (SMBHs) are nowadays believed to reside in most local galaxies, and the available data show an empirical correlation between bulge luminosity - or stellar velocity dispersion - and black hole mass, suggesting a single mechanism for assembling black holes and forming spheroids in galaxy halos. The evidence is therefore in favour of a co-evolution between galaxies, black holes and quasars. In cold dark matter cosmogonies, small-mass subgalactic systems form first to merge later into larger and larger structures. In this paradigm galaxy halos experience multiple mergers during their lifetime. If every galaxy with a bulge hosts a SMBH in its center, and a local galaxy has been made up by multiple mergers, then a black hole binary is a natural evolutionary stage. The evolution of the supermassive black hole population clearly has to be investigated taking into account both the cosmological framework and the dynamical evolution of SMBHs and their hosts. The seeds of SMBHs have to be looked for in the early Universe, as very luminous quasars are detected up to redshift higher than z=6. These black holes evolve then in a hierarchical fashion, following the merger hierarchy of their host halos. Accretion of gas, traced by quasar activity, plays a fundamental role in determining the two parameters defining a black hole: mass and spin. A particularly intriguing epoch is the initial phase of SMBH growth. It is very challenging to meet the observational constraints at z=6 if BHs are not fed at very high rates in their infancy.Comment: Extended version of the invited paper to appear in the Proceedings of the Conference "Relativistic Astrophysics and Cosmology - Einstein's Legacy

Percutaneous High Frequency Microwave Ablation of Uterine Fibroids : Systematic Review

Uterine fibroids are the most common benign pelvic tumor of the female genital tract and tend to increase with age; they cause menorrhagia, dysmenorrhea, pelvic pressure symptoms, back pain, and subfertility. Currently, the management is based mainly on medical or surgical approaches. The nonsurgical and minimally invasive therapies are emerging approaches that to the state of the art include uterine artery embolization (UAE), image-guided thermal ablation techniques like magnetic resonance-guided focused ultrasound surgery (MRgFUS) or radiofrequency ablation (RF), and percutaneous microwave ablation (PMWA). The purpose of the present review is to describe feasibility results and safety of PMWA according to largest studies available in current literature. Moreover technical aspects of the procedure were analyzed providing important data on large scale about potential efficacy of PMWA in clinical setting. However larger studies with international registries and randomized, prospective trials are still needed to better demonstrate the expanding benefits of PMWA in the management of uterine fibroids.Uterine fibroids are the most common benign pelvic tumor of the female genital tract and tend to increase with age; they cause menorrhagia, dysmenorrhea, pelvic pressure symptoms, back pain, and subfertility. Currently, the management is based mainly on medical or surgical approaches. The nonsurgical and minimally invasive therapies are emerging approaches that to the state of the art include uterine artery embolization (UAE), image-guided thermal ablation techniques like magnetic resonance-guided focused ultrasound surgery (MRgFUS) or radiofrequency ablation (RF), and percutaneous microwave ablation (PMWA). The purpose of the present review is to describe feasibility results and safety of PMWA according to largest studies available in current literature. Moreover technical aspects of the procedure were analyzed providing important data on large scale about potential efficacy of PMWA in clinical setting. However larger studies with international registries and randomized, prospective trials are still needed to better demonstrate the expanding benefits of PMWA in the management of uterine fibroids

Mini-invasive approach to preneoplastic and neoplastic endometrial lesions. Comparative study among histological, cytological and immunohistochemical diagnosis

Objective: To compare the accuracy of cytology plus immunoistochemistry vs histology in the preoperative diagnosis of endometrial malignancy. Methods: We prospectively analyzed 142 women with a proliferative endometrial lesion undergoing operative hysteroscopy (ISC): at the time of ISC, the fluid used for saline contrast sonohysterography (SCSH) was collected for cytological analysis and compared to histology. In 9 women a markers board (Notch-1+ER-\u3b1+PR-\u3b2) expression was analyzed semiquantitatively in term of presence and intensity, on both glandular and stromal samples. Results: Table 1 shows the comparison between cytological and histological diagnosis. ISC histological results Benign Lesions n=134 Malignant Lesions n=8 Endometrial Polyps n=124 Hypertrophy n=3 Typical hyperplasia n=7 Atypical hyperplasia n=4 Cancer n=4 CTM - 0 0 0 0 0 CTM + 0 0 0 0 3 SCSH cytological results Atypia - 116 3 6 1 0 Atypia + 2 0 0 3 3 Inadequate (5%) 5 (4 cervical cells) (1 scant sample) 0 1 (1 cervical cells) 0 1 (hypocellulated) Cytological sampling was inadequate in 7 cases (5%). The K value between cytology and histology was 98.4% for benign and 85.7% for malignant lesions. Notch-1 revealed a changing expression pattern: absent in benign lesions, focal and marked in atypical hyperplasia and widespread and marked in cancers. Moreover Notch-1 expression was mild and focal in originally cyto-hystologycal benign lesions which turned into atypical hyperplasia during follow up. In cancer cases, ER-\u3b1 and PR-\u3b2 were widespread and markedly expressed either in the glandular or stromal layer. Conclusions: Cytological analysis could be used as a screening test, at least for women at high surgical risk. Notch-1+ER-\u3b1+PR-\u3b2 expression could be predictive for the risk of endometrial malignancy even at an earlier stadium than hyperplasia and could be used to identify the glandular or stromal origin of cancer thus helping in identifying women at increased risk of malignancy

Fetal and maternal non-glucose carbohydrates and polyols concentrations in normal human pregnancies at term

The objective of the present investigation was to determine fetal and maternal plasma concentrations of nonglucose carbohydrates and polyols in normal human pregnancies at term. Uncomplicated human pregnancies (n = 50) were studied at > or =37 wk gestation. Blood samples were obtained from umbilical artery, umbilical vein, and maternal peripheral blood at the time of elective cesarean section. Plasma concentrations of inositol, glycerol, erythritol, sorbitol, and mannose were determined by HPLC analysis. Differences between umbilical venous, umbilical arterial, and maternal concentration were tested by the two-tailed t test for paired samples. Correlations between umbilical and maternal concentration and between umbilical venoarterial concentration difference and umbilical arterial concentration were assessed by Pearson's correlation and multiple regression analysis. All newborns were appropriate for gestational age, and oxygenation and acid-base balance were within the normal range for all fetuses studied. For most of the polyols (inositol, sorbitol, and erythritol), the fetal concentration was significantly higher than the maternal concentration. The umbilical venoarterial concentration difference for inositol was -10.5 +/- 3.6 microM, for glycerol was 10 +/- 1.7 microM, for sorbitol was 3.8 +/- 0.5 microM (p < 0.001), and for mannose was 7.6 +/- 0.7 microM. There was a significant correlation between maternal concentration and umbilical venous concentration of mannose (UV(MAN) = 15.38 + 0.69 M(MAN); R(2) = 0.46; p < 0.001). These results indicate that in normal human pregnancies at term, inositol is produced by the fetus, sorbitol is produced by the placenta, and there is a significant umbilical uptake of mannose from the maternal circulation

Transplacental Supply of Mannose and Inositol in Uncomplicated Pregnancies Using Stable Isotopes

OBJECTIVE: The aim of this study was to determine relative contributions of transplacental flux vs. fetal production for inositol and mannose in normal term pregnancies. STUDY DESIGN: Seven term uncomplicated pregnancies undergoing cesarean section were infused with (13)C- and (2)H-labeled isotopes of glucose, inositol, and mannose until a steady state was achieved. Maternal and fetal concentrations of labeled and unlabeled glucose, mannose, and inositol were measured using gas chromatography/mass spectroscopy. The fetomaternal molar percentage excess ratio was calculated for each glucose, mannose, and inositol. RESULTS: The fetomaternal molar percentage excess ratio of mannose in the fetal artery (F(artery)/M) was 0.99 [97.5% confidence interval (CI), 0.91-1.07] and in the fetal vein (F(vein)/M), 1.02 (97.5% CI, 0.95-1.10). Both were not significantly different from 1.0, consistent with transplacental supply. The fetomaternal ratios for glucose were similar to mannose (fetal artery, 0.95; 97.5% CI, 0.84-1.15; and fetal vein, 0.96; 97.5% CI, 0.85-1.07). The fetomaternal ratio for inositol was significantly less than 1.0 (fetal artery, 0.08; 97.5% CI, 0.05-0.12; fetal vein, 0.12; 97.5% CI, 0.06-0.18), indicating little transplacental flux and significant fetal production. CONCLUSION: In normal term pregnancies, fetal mannose and glucose concentrations are dependent upon maternal transplacental supply. Fetal inositol is not dependent upon transplacental supply