Induction of labour versus expectant monitoring in women with pregnancy induced hypertension or mild preeclampsia at term: the HYPITAT trial

Contains fulltext : 53183.pdf ( ) (Open Access)BACKGROUND: Hypertensive disorders, i.e. pregnancy induced hypertension and preeclampsia, complicate 10 to 15% of all pregnancies at term and are a major cause of maternal and perinatal morbidity and mortality. The only causal treatment is delivery. In case of preterm pregnancies conservative management is advocated if the risks for mother and child remain acceptable. In contrast, there is no consensus on how to manage mild hypertensive disease in pregnancies at term. Induction of labour might prevent maternal and neonatal complications at the expense of increased instrumental vaginal delivery rates and caesarean section rates. METHODS/DESIGN: Women with a pregnancy complicated by pregnancy induced hypertension or mild preeclampsia at a gestational age between 36+0 and 41+0 weeks will be asked to participate in a multi-centre randomised controlled trial. Women will be randomised to either induction of labour or expectant management for spontaneous delivery. The primary outcome of this study is severe maternal morbidity, which can be complicated by maternal mortality in rare cases. Secondary outcome measures are neonatal mortality and morbidity, caesarean and vaginal instrumental delivery rates, maternal quality of life and costs. Analysis will be by intention to treat. In total, 720 pregnant women have to be randomised to show a reduction in severe maternal complications of hypertensive disease from 12 to 6%. DISCUSSION: This trial will provide evidence as to whether or not induction of labour in women with pregnancy induced hypertension or mild preeclampsia (nearly) at term is an effective treatment to prevent severe maternal complications. TRIAL REGISTRATION: The protocol is registered in the clinical trial register number ISRCTN08132825

Environmental Factors Controlling Soil Organic Carbon Stocks in Two Contrasting Mediterranean Climatic Areas of Southern Spain

Managing soil carbon requires accurate estimates of soil organic carbon (SOC) stocks and its dynamics, at scales able to capture the influence of local factors on the carbon pool. This paper develops a spatially explicit methodology to quantify SOC stocks in two contrasting regions of Southern Spain: Sierra Norte de Sevilla (SN) and Cabo de Gata (CG). Also, it examines the relationship between SOC stocks and local environmental factors. Results showed that mean SOC stocks were 4·3 kg m−2 in SN and 3·0 kg m−2 in CG. Differences in SOC in both sites were not significant, suggesting that factors other than climate have a greater influence on SOC stocks. A correlation matrix revealed that SOC has the highest positive correlation with clay content and soil depth. Based on the land use, the largest SOC stocks were found in grassland soils (4·4 kg m−2 in CG and 5·0 kg m−2 in SN) and extensive crops (3·0 kg m−2 in CG and 5·0 kg m−2 in SN), and the smallest under shrubs (2·8 kg m−2 in CG and 3·2 kg m−2 in SN) and forests soils (4·2 kg m−2 in SN). This SOC distribution is explained by the greatest soil depth under agricultural land uses, a common situation across the Mediterranean, where the deepest soils have been cultivated and natural vegetation mostly remains along the marginal sites. Accordingly, strategies to manage SOC stocks in southern Spain will have to acknowledge its high pedodiversity and long history of land use, refusing the adoption of standard global strategies

A Preliminary Gene Map for the Van der Woude Syndrome Critical Region Derived from 900 kb of Genomic Sequence at 1q32–q41

Van der Woude syndrome (VWS) is a common form of syndromic cleft lip and palate and accounts for ∼2% of all cleft lip and palate cases. Distinguishing characteristics include cleft lip with or without cleft palate, isolated cleft palate, bilateral lip pits, hypodontia, normal intelligence, and an autosomal-dominant mode of transmission with a high degree of penetrance. Previously, the VWS locus was mapped to a 1.6-cM region in 1q32–q41 between D1S491 and D1S205, and a 4.4-Mb contig of YAC clones of this region was constructed. In the current investigation, gene-based and anonymous STSs were developed from the existing physical map and were then used to construct a contig of sequence-ready bacterial clones across the entire VWS critical region. All STSs and BAC clones were shared with the Sanger Centre, which developed a contig of PAC clones over the same region. A subset of 11 clones from both contigs was selected for high-throughput sequence analysis across the ∼1.1-Mb region; all but two of these clones have been sequenced completely. Over 900 kb of genomic sequence, including the 350-kb VWS critical region, were analyzed and revealed novel polymorphisms, including an 8-kb deletion/insertion, and revealed 4 known genes, 11 novel genes, 9 putative genes, and 3 psuedogenes. The positional candidates LAMB3, G0S2, HIRF6, and HSD11 were excluded as the VWS gene by mutation analysis. A preliminary gene map for the VWS critical region is as follows: CEN-VWS33-VWS34-D1S491-VWS1-VWS19-LAMB3G0S2-VWS26-VWS25-HSD11-ADORA2BP-VWS17-VWS14-HIRF6-VWS2-VWS18-D1S205-VWS23-VWS20-VWS30-VWS31-VWS35-VWS37VWS38-HIPP-RNASEH1P-VWS40-VWS42-VWS41-TEL. The data provided here will help lead to the identification of the VWS gene, and this study provides a model for how laboratories that have a regional interest in the human genome can contribute to the sequencing efforts of the entire human genome