Early amniotomy after cervical ripening for induction of labor: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE DATA: Timing of artificial rupture of membranes (ie, amniotomy) in induction of labor is controversial, because it has been associated not only with shorter labors, but also with fetal nonreassuring testing, at times necessitating cesarean delivery. The aim of this systematic review and metaanalysis of randomized trials was to evaluate the effectiveness of early amniotomy vs late amniotomy or spontaneous rupture of membranes after cervical ripening. STUDY: The search was conducted with the use of electronic databases from inception of each database through February 2019. Review of articles included the abstracts of all references that were retrieved from the search. STUDY APPRAISAL AND SYNTHESIS METHODS: Selection criteria included randomized clinical trials that compared early amniotomy vs control (ie, late amniotomy or spontaneous rupture of membranes) after cervical ripening with either Foley catheter or prostaglandins at any dose. The primary outcome was the incidence of cesarean delivery. The summary measures were reported as summary relative risk with 95% of confidence interval with the use of the random effects model of DerSimonian and Laird. RESULTS: Four trials that included 1273 women who underwent cervical ripening with either Foley catheter or prostaglandins and then were assigned randomly to either early amniotomy, late amniotomy, or spontaneous rupture of membranes (control subjects) were included in the review. Women who were assigned randomly to early amniotomy had a similar risk of cesarean delivery (31.1% vs 30.9%; relative risk, 1.05; 95% confidence interval, 0.71-1.56) compared with control subjects and had a shorter interval from induction to delivery of approximately 5 hours (mean difference, -4.95 hours; 95% confidence interval, -8.12 to -1.78). Spontaneous vaginal delivery was also reduced in the early amniotomy group, but only 1 of the included trials reported this outcome (67.5% vs 69.1%; relative risk, 0.78; 95% confidence interval, 0.66-0.93). No between-group differences were reported in the other obstetrics or perinatal outcomes. CONCLUSION: After cervical ripening, routine early amniotomy does not increase the risk of cesarean delivery and reduces the interval from induction to delivery

A Comparison Between Growth Morphology of Eutectic Cells/Dendrites and Single-Phase Cells/Dendrites

Directionally solidified (DS) intermetallic and ceramicbased eutectic alloys with an in-situ composite microstructure microstructure containing finely distributed, long aspect ratio, fiber, or plate reinforcements are being seriously examined for several advanced aero-propulsion applications. In designing these alloys, additional solutes need to be added to the base eutectic composition in order to improve their high temperature strength, and provide for adequate toughness and resistance to environmental degradation. Solute addition, however, promotes instability at the planar liquid-solid interface resulting in the formation of two-phase eutectic “colonies.”[1–4] Because morphology of eutectic colonies is very similar to the single-phase cells and dendrites, the stability analysis of Mullins and Sekerka[5] has been extended to describe their formation.[6,7,8] Onset of their formation shows a good agreement with this approach;[9] however, unlike the single-phase cells and dendrites, there is limited examination of their growth speed dependence of spacing, morphology, and spatial distribution.[4,10–11] The purpose of this study is to compare the growth speed dependence of the morphology, spacing, and spatial distribution of eutectic cells and dendrites with that for the single-phase cells and dendrites

Exploring perinatal asphyxia by metabolomics

Brain damage related to perinatal asphyxia is the second cause of neuro-disability worldwide. Its incidence was estimated in 2010 as 8.5 cases per 1000 live births worldwide, with no further recent improvement even in more industrialized countries. If so, hypoxic-ischemic encephalopathy is still an issue of global health concern. It is thought that a consistent number of cases may be avoided, and its sequelae may be preventable by a prompt and efficient physical and therapeutic treatment. The lack of early, reliable, and specific biomarkers has up to now hampered a more effective use of hypothermia, which represents the only validated therapy for this condition. The urge to unravel the biological modifications underlying perinatal asphyxia and hypoxic-ischemic encephalopathy needs new diagnostic and therapeutic tools. Metabolomics for its own features is a powerful approach that may help for the identification of specific metabolic profiles related to the pathological mechanism and foreseeable outcome. The metabolomic profiles of animal and human infants exposed to perinatal asphyxia or developing hypoxic-ischemic encephalopathy have so far been investigated by means of 1H nuclear magnetic resonance spectroscopy and mass spectrometry coupled with gas or liquid chromatography, leading to the identification of promising metabolomic signatures. In this work, an extensive review of the relevant literature was performed

A Preliminary Investigation of the Cr3Si-Mo Pseudo-Binary Phase Diagram

An investigation was undertaken to study the phase relations in Cr3Si alloyed with Mo varying from 10 to 83.5 wt. % of the material. Specimens were prepared from arc-melted buttons that were subsequently heat treated at 1673 K for 200 h and air quenched to room temperature to structures. Alloys containing more than 20 wt. % MO were primarily two-phase materials of M3Si and M5Si3, where M is (Cr,Mo). Three alloys contained less than 5% of a third phase, which also had the M5Si3 crystal structure. Differential thermal analysis (DTA) was performed on several specimens at temperatures up to 2073 K in order to determine a solidus curve for the M3Si phase. Since only one DTA peak was observed in each alloy, the M5Si3 phase must melt above 2073 K, the maximum temperature examined. A preliminary pseudo-binary phase diagram for (Cr,Mo)3Si and a portion of the 1673 K isothermal section of the Cr-Mo-Si ternary phase diagram are presented

Effects of Microalloying on the Microstructures and Mechanical Properties of Directionally Solidified Ni-33(at.%)Al-31Cr-3Mo Eutectic Alloys Investigated

Despite nickel aluminide (NiAl) alloys' attractive combination of oxidation and thermophysical properties, their development as replacements for superalloy airfoils in gas turbine engines has been largely limited by difficulties in developing alloys with an optimum combination of elevated-temperature creep resistance and room-temperature fracture toughness. Alternatively, research has focused on developing directionally solidified NiAl-based in situ eutectic composites composed of NiAl and (Cr,Mo) phases in order to obtain a desirable combination of properties a systematic investigation was undertaken at the NASA Glenn Research Center to examine the effects of small additions of 11 alloying elements (Co, Cu, Fe, Hf, Mn, Nb, Re, Si, Ta, Ti, and Zr) in amounts varying from 0.25 to 1.0 at.% on the elevated-temperature strength and room-temperature fracture toughness of directionally solidified Ni-33Al-31Cr-3Mo eutectic alloy. The alloys were grown at 12.7 mm/hr, where the unalloyed eutectic base alloy exhibited a planar eutectic microstructure. The different microstructures that formed because of these fifth-element additions are included in the table. The additions of these elements even in small amounts resulted in the formation of cellular microstructures, and in some cases, dendrites and third phases were observed. Most of these elemental additions did not improve either the elevated-temperature strength or the room-temperature fracture toughness over that of the base alloy. However, small improvements in the compression strength were observed between 1200 and 1400 K when 0.5 at.% Hf and 0.25 at.% Ti were added to the base alloy. The results of this study suggest that the microalloying of Ni-33Al-31Cr-3Mo will not significantly improve either its elevatedtemperature strength or its room-temperature fracture toughness. Thus, any improvements in these properties must be acquired by changing the processing conditions

Directionally Solidified NiAl-Based Alloys Studied for Improved Elevated-Temperature Strength and Room-Temperature Fracture Toughness

Efforts are underway to replace superalloys used in the hot sections of gas turbine engines with materials possessing better mechanical and physical properties. Alloys based on the intermetallic NiAl have demonstrated potential; however, they generally suffer from low fracture resistance (toughness) at room temperature and from poor strength at elevated temperatures. Directional solidification of NiAl alloyed with both Cr and Mo has yielded materials with useful toughness and elevated-temperature strength values. The intermetallic alloy NiAl has been proposed as an advanced material to extend the maximum operational temperature of gas turbine engines by several hundred degrees centigrade. This intermetallic alloy displays a lower density (approximately 30-percent less) and a higher thermal conductivity (4 to 8 times greater) than conventional superalloys as well as good high-temperature oxidation resistance. Unfortunately, unalloyed NiAl has poor elevated temperature strength (approximately 50 MPa at 1027 C) and low room-temperature fracture toughness (about 5 MPa). Directionally solidified NiAl eutectic alloys are known to possess a combination of high elevated-temperature strength and good room-temperature fracture toughness. Research has demonstrated that a NiAl matrix containing a uniform distribution of very thin Cr plates alloyed with Mo possessed both increased fracture toughness and elevated-temperature creep strength. Although attractive properties were obtained, these alloys were formed at low growth rates (greater than 19 mm/hr), which are considered to be economically unviable. Hence, an investigation was warranted of the strength and toughness behavior of NiAl-(Cr,Mo) directionally solidified at faster growth rates. If the mechanical properties did not deteriorate with increased growth rates, directional solidification could offer an economical means to produce NiAl-based alloys commercially for gas turbine engines. An investigation at the NASA Glenn Research Center at Lewis Field was undertaken to study the effect of the directional solidification growth rate on the microstructure, room temperature fracture toughness, and strength at 1027 C of a Ni-33Al-31Cr-3Mo eutectic alloy. The directionally solidified rates varied between 7.6 and 508 millimeters per hour Essentially fault-free, alternating (Cr, Mo)/NiAl lamellar plate microstructures (left photograph) were formed during growth at and below 12.7 mm/hr, whereas cellular microstructures (right photograph) with the (Cr, Mo) phase in a radial spokelike pattern were developed at faster growth rates. The compressive strength at 1027 C continuously increased with increasing growth rate and did not indicate a maxima as was reported for directionally solidified Ni-33Al-34Cr. Surprisingly, samples with the lamellar plate microstructure (left photograph) possessed a room-temperature fracture toughness of approximately 12 MPa(sup square root of m), whereas all the alloys with a cellular microstructure had a toughness of about 17 MPa(sup square root of m). These results are significant since they clearly demonstrate that Ni-33Al-31Cr-3Mo can be directionally solidified at much faster growth rates without any observable deterioration in its mechanical properties. Thus, the potential to produce strong, tough NiAl-based eutectics at commercially acceptable growth rates exists. Additional testing and alloy optimization studies are underway

Effect of Exposure on the Mechanical Properties of Gamma MET PX

The effect of a service environment exposure on the mechanical properties of a high Nb content TiAl alloy, Gamma MET PX , was assessed. Gamma MET PX, like other TiAl alloys, experiences a reduction of ductility following high temperature exposure. Exposure in Ar, air, and high-purity oxygen all resulted in a loss of ductility with the ductility reduction increasing with oxygen content in the exposure atmosphere. Embrittling mechanisms, including bulk microstructural changes, moisture induced environmental embrittlement, and near surface effects were investigated. The embrittlement has been shown to be a near-surface effect, most likely due to the diffusion of oxygen into the alloy

Social enrichment reverses the isolation-induced deficits of neuronal plasticity in the hippocampus of male rats

Environmental enrichment is known to improve brain plasticity and protect synaptic function from negative insults. In the present study we used the exposure to social enrichment to ameliorate the negative effect observed in post weaning isolated male rats in which neurotrophic factors, neurogenesis, neuronal dendritic trees and spines were altered markedly in the hippocampus. After the 4 weeks of post-weaning social isolation followed by 4 weeks of reunion, different neuronal growth markers as well as neuronal morphology were evaluated using different experimental approaches. Social enrichment restored the reduction of BDNF, NGF and Arc gene expression in the whole hippocampus of social isolated rats. This effect was paralleled by an increase in density and morphology of dendritic spines, as well as in neuronal tree arborisation in granule cells of the dentate gyrus. These changes were associated with a marked increase in neuronal proliferation and neurogenesis in the same hippocampal subregion that were reduced by social isolation stress. These results further suggest that the exposure to social enrichment, by abolishing the negative effect of social isolation stress on hippocampal plasticity, may improve neuronal resilience with a beneficial effect on cognitive function

Microstructure and Phase Stability of Single Crystal NiAl Alloyed with Hf and Zr

Six near stoichiometric, NiAl single-crystal alloys, with 0.05-1.5 at.% of Hf and Zr additions plus Si impurities, were microstructurally analyzed in the as-cast, homogenized, and aged conditions. Hafnium-rich interdendritic regions, containing the Heusler phase (Ni2AlHf), were found in all the as-cast alloys containing Hf. Homogenization heat treatments partially reduced these interdendritic segregated regions. Transmission electron microscopy (TEM) observations of the as-cast and homogenized microstructures revealed the presence of a high density of fine Hf (or Zr) and Si-rich precipitates. These were identified as G-phase, Nil6X6Si7, or as an orthorhombic NiXSi phase, where X is Hf or Zr. Under these conditions the expected Heusler phase (beta') was almost completely absent. The Si responsible for the formation of the G and NiHfSi phases is the result of molten metal reacting with the Si-containing crucible used during the casting process. Varying the cooling rates after homogenization resulted in the refinement or complete suppression of the G and NiHfSi phases. In some of the alloys studied, long-term aging heat treatments resulted in the formation of Heusler precipitates, which were more stable at the aging temperature and coarsened at the expense of the G-phase. In other alloys, long-term aging resulted in the formation of the NiXSi phase. The stability of the Heusler or NiXSi phases can be traced to the reactive element (Hf or Zr) to silicon ratio. If the ratio is high, then the Heusler phase appears stable after long time aging. If the ratio is low, then the NiHfSi phase appears to be the stable phase

Phase I study on docetaxel and ifosfamide in patients with advanced solid tumours.

Docetaxel and ifosfamide have shown significant activity against a variety of solid tumours. This prompted a phase I trial on the combination of these drugs. This phase I study was performed to assess the feasibility of the combination, to determine the maximum tolerated dose (MTD) and the side effects, and to propose a safe schedule for further phase II studies. A total of 34 patients with a histologically confirmed solid tumour, who were not pretreated with taxanes or ifosfamide and who had received no more than one line of chemotherapy for advanced disease were entered into the study. Treatment consisted of docetaxel given as a 1-h infusion followed by ifosfamide as a 24-h infusion (schedule A), or ifosfamide followed by docetaxel (schedule B) every 3 weeks. Docetaxel doses ranged from 60 to 85 mg m(-2) and ifosfamide doses from 2.5 to 5.0 g m(-2). Granulocytopenia grade 3 and 4 were common (89%), short lasting and ifosfamide dose dependent. Febrile neutropenia and sepsis occurred in 17% and 2% of courses respectively. Non-haematological toxicities were mild to moderate and included alopecia, nausea, vomiting, mucositis, diarrhoea, sensory neuropathy, skin and nail toxicity and oedema. There did not appear to be any pharmacokinetic interaction between docetaxel and ifosfamide. One complete response (CR) (soft tissue sarcoma) and two partial responses (PRs) were documented. A dose of 75 mg m(-2) of docetaxel combined with 5.0 g m(-2) ifosfamide appeared to be manageable. Schedule A was advocated for further treatment