Low dose vaginal misoprostol vs vaginal dinoprostone insert for induction of labor beyond 41st week: a randomized trial

Introduction: The aim of this study was to compare the efficacy and safety of a low‐dose protocol of vaginal misoprostol and vaginal dinoprostone insert for induction of labor in women with post‐term pregnancies. Material and methods: We designed a prospective, randomized, open‐labeled trial with evaluators blinded to the end‐point, including women of at least 41 weeks of gestational age with uncomplicated singleton pregnancies and a Bishop score <6. They were randomized into dinoprostone or misoprostol groups in a 1:1 ratio. Baseline maternal data and perinatal outcomes were recorded for statistical analysis. Successful vaginal delivery within 24 hours was the primary outcome variable. A P value <0.05 was considered statistically significant. This study was registered in ClinicalTrials.gov (number NTC03744364). Results: We included 198 women for analysis (99 women in each group). Vaginal birth rate within 24 hours did not differ between groups (49.5% vs 42.4%; P = 0.412). When the Bishop score was <4, dinoprostone insert showed a higher probability of vaginal delivery within 12 hours (17.8% vs 4%; P = 0.012). In the dinoprostone group, removal of the insert was more likely to be due to an adverse event (5.1% vs 14.1%; P = 0.051) and an abnormal fetal heart rate pattern during active labor (44.4% vs 58.6%; P = 0.047). Both groups were similar in neonatal outcomes including Apgar score, umbilical cord pH and neonatal intensive care unit admission. Conclusions: Low‐dose vaginal misoprostol and vaginal dinoprostone insert seem to be equally effective and safe for induction of labor in pregnant women with a gestational age beyond 41 weeks

Moving constraints as stabilizing controls in classical mechanics

The paper analyzes a Lagrangian system which is controlled by directly assigning some of the coordinates as functions of time, by means of frictionless constraints. In a natural system of coordinates, the equations of motions contain terms which are linear or quadratic w.r.t.time derivatives of the control functions. After reviewing the basic equations, we explain the significance of the quadratic terms, related to geodesics orthogonal to a given foliation. We then study the problem of stabilization of the system to a given point, by means of oscillating controls. This problem is first reduced to the weak stability for a related convex-valued differential inclusion, then studied by Lyapunov functions methods. In the last sections, we illustrate the results by means of various mechanical examples.Comment: 52 pages, 4 figure

Dynamic Vortex Phases and Pinning in Superconductors with Twin Boundaries

We investigate the pinning and driven dynamics of vortices interacting with twin boundaries using large scale molecular dynamics simulations on samples with near one million pinning sites. For low applied driving forces, the vortex lattice orients itself parallel to the twin boundary and we observe the creation of a flux gradient and vortex free region near the edges of the twin boundary. For increasing drive, we find evidence for several distinct dynamical flow phases which we characterize by the density of defects in the vortex lattice, the microscopic vortex flow patterns, and orientation of the vortex lattice. We show that these different dynamical phases can be directly related to microscopically measurable voltage - current V(I) curves and voltage noise. By conducting a series of simulations for various twin boundary parameters we derive several vortex dynamic phase diagrams.Comment: 5 figures, to appear in Phys. Rev.

Impact of sugarcane trash on fertilizer requirements for São Paulo, Brazil

The area under mechanized sugarcane (Saccharum spp.) harvesting is expanding in Brazil, increasing the return of trash to the soil. The main questions regarding this management are: (i) after adopting unburned mechanical harvesting, how long will it take to observe decreases in fertilizer requirements, (ii) what will be the magnitude of this decrease and, (iii) the impact in the short run of removing trash for energy purposes in the nutrient cycling? This study aimed to build an N prediction model for long term assessment of the contribution of sugarcane crop residues to sugarcane nutrition and to evaluate the cycling of other nutrients derived from crop residues. Keeping crop residues over the soil will increase soil N stock and N recovery by sugarcane, reaching equilibrium after 40 years with recovery of approximately 40 kg ha-1 year-1 of N. Removing trash for energy production will decrease the potential reduction in N fertilizer requirement. Of the total nutrients in the trash, 75 % of the K2O (81 kg ha-1 year-1) and 50 % of the N (31 kg ha-1 year-1) are in the tops, indicating the importance of maintaining tops in the soil to sustain soil fertility. Because the input data employed in the simulations are representative of the conditions in Southeast Brazil, these results might not be definitive for situations not represented in the experiments used in the study, but the model produced is useful to forecast changes that occur in the soil under different trash management

ANTIMICROBIAL ACTIVITY OF THE FIBER PRODUCED BY “POCHOTE” CEIBA AESCULIFOLIA SUBSP. PARVIFOLIA

Background: The cotton-like fiber from the fruit of Pochote (Ceiba aesculifolia subsp. parvifolia) can be applied to wounds for healing purposes. As microorganisms can infect wounds and hamper the wound healing process, the aim of this study was to determine the antimicrobial activity and chemical composition of the methanolic extract of Pochote fiber. Materials and Methods: The methanolic extract was tested against bacteria and fungi. For bacteria, the Kirby-Baüer disc diffusion and broth dilution methods were employed to determine the MIC and MBC. In addition, bactericidal kinetic curves were generated. The antifungal activity was determined by the radial diffusion method. The antioxidant activity, total phenolic content, and the flavonoid content were determined. Bioassay guided fractionation was also performed. Results: The methanolic extract showed activity against Enterococcus faecalis, Staphylococcus aureus and Vibrio cholerae (cc). The tested V. cholerae strains were the most sensitive strains, and exhibited a clear CFU size reduction from the bactericidal kinetic curves. The methanolic extract had activity against T. mentagrophytes and R. lilacina . The antioxidant activity (SC50= 36.42 μg/mL) was related to the total phenolic (74.4 mg eAG/g) and flavonoid content (21.982 mg (eQ)/g). The bioassay guided fractionation results suggested that the antimicrobial properties of the extract may act through synergism because the total extract had higher activity against bacteria compared to the collected fractions. Conclusion: This study scientifically validates the application of the fruit fiber from Pochote as a part of a traditional medicine approach to alleviate infections caused by bacteria and fungi

Thyroid Function Within the Reference Range and the Risk of Stroke: An Individual Participant Data Analysis.

The currently applied reference ranges for thyroid function are under debate. Despite evidence that thyroid function within the reference range is related with several cardiovascular disorders, its association with the risk of stroke has not been evaluated previously. We identified studies through a systematic literature search and the Thyroid Studies Collaboration, a collaboration of prospective cohort studies. Studies measuring baseline TSH, free T4, and stroke outcomes were included, and we collected individual participant data from each study, including thyroid function measurements and incident all stroke (combined fatal and nonfatal) and fatal stroke. The applied reference range for TSH levels was between 0.45 and 4.49 mIU/L. We collected individual participant data on 43 598 adults with TSH within the reference range from 17 cohorts, with a median follow-up of 11.6 years (interquartile range 5.1-13.9), including 449 908 person-years. Age- and sex-adjusted pooled hazard ratio for TSH was 0.78 (95% confidence interval [CI] 0.65-0.95 across the reference range of TSH) for all stroke and 0.83 (95% CI 0.62-1.09) for fatal stroke. For the free T4 analyses, the hazard ratio was 1.08 (95% CI 0.99-1.15 per SD increase) for all stroke and 1.10 (95% CI 1.04-1.19) for fatal stroke. This was independent of cardiovascular risk factors including systolic blood pressure, total cholesterol, smoking, and prevalent diabetes. Higher levels of TSH within the reference range may decrease the risk of stroke, highlighting the need for further research focusing on the clinical consequences associated with differences within the reference range of thyroid function

Drug-gene interactions of antihypertensive medications and risk of incident cardiovascular disease: A pharmacogenomics study from the CHARGE consortium

Background Hypertension is a major risk factor for a spectrum of cardiovascular diseases (CVD), including myocardial infarction, sudden death, and stroke. In the US, over 65 million people have high blood pressure and a large proportion of these individuals are prescribed antihypertensive medications. Although large long-term clinical trials conducted in the last several decades have identified a number of effective antihypertensive treatments that reduce the risk of future clinical complications, responses to therapy and protection from cardiovascular events vary among individuals. Methods Using a genome-wide association study among 21,267 participants with pharmaceutically treated hypertension, we explored the hypothesis that genetic variants might influence or modify the effectiveness of common antihypertensive therapies on the risk ofmajor cardiovascular outcomes. The classes of drug treatments included angiotensin-converting enzyme inhibitors, beta-blockers, calcium channel blockers, and diuretics. In the setting of the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, each study performed array-based genome-wide genotyping, imputed to HapMap Phase II reference panels, and used additive genetic models in proportional hazards or logistic regressionmodels to evaluate drug-gene interactions for each of four therapeutic drug classes. We used meta-analysis to combine study-specific interaction estimates for approximately 2 million single nucleotide polymorphisms (SNPs) in a discovery analysis among 15,375 European Ancestry participants (3,527 CVD cases) with targeted follow-up in a case-only study of 1,751 European Ancestry GenHAT participants as well as among 4,141 African-Americans (1,267 CVD cases). Results Although drug-SNP interactions were biologically plausible, exposures and outcomes were well measured, and power was sufficient to detect modest interactions, we did not identify any statistically significant interactions from the four antihypertensive therapy meta-analyses (Pinteraction > 5.0×10-8). Similarly, findings were null for meta-analyses restricted to 66 SNPs with significant main effects on coronary artery disease or blood pressure from large published genom

Discovery of Genetic Variation on Chromosome 5q22 Associated with Mortality in Heart Failure

Failure of the human heart to maintain sufficient output of blood for the demands of the body, heart failure, is a common condition with high mortality even with modern therapeutic alternatives. To identify molecular determinant

Genome-Wide Association Study for Incident Myocardial Infarction and Coronary Heart Disease in Prospective Cohort Studies: The CHARGE Consortium

Background Data are limited on genome-wide association studies (GWAS) for incident coronary heart disease (CHD). Moreover, it is not known whether genetic variants identified to date also associate with risk of CHD in a prospective setting. Methods We performed a two-stageGWAS analysis of incident myocardial infarction (MI) and CHD in a total of 64,297 individuals (including 3898MI cases, 5465 CHD cases). SNPs that passed an arbitrary threshold of 5×10-6 in Stage I were taken to Stage II for further discovery. Furthermore, in an analysis of prognosis, we studied whether known SNPs from former GWAS were associated with totalmortality in individuals who experienced MI during follow-up. Results In Stage I 15 loci passed the threshold of 5×10-6; 8 loci for MI and 8 loci for CHD, for which one locus overlapped and none were reported in previous GWAS meta-analyses. We took 60 SNPs representing these 15 loci to Stage II of discovery. Four SNPs near QKI showed nominally significant association with MI (p-value<8.8×10-3) and three exceeded the genome-wide significance threshold when Stage I and Stage II results were combined (top SNP rs6941513: p = 6.2×10-9). Despite excellent power, the 9p21 locus SNP (rs1333049) was only modestly associated with MI (HR = 1.09, p-value = 0.02) and marginally with CHD (HR = 1.06, p-value = 0.08). Among an inception cohort of those who experienced MI during follow-up, the risk allele of rs1333049 was associated with a decreased risk of subsequent mortality (HR = 0.90, p-value = 3.2×10-3). Conclusions QKI represents a novel locus that may serve as a predictor of incident CHD in prospective studies. The association of the 9p21 locus both with increased risk of first myocardial infarction and longer survival after MI highlights the importance of study design in investigating genetic determinants of complex disorders