Tachysystole and risk of cesarean section after labor induction using misoprostol: a cohort study

Le déclenchement artificiel du travail est une pratique obstétricale courante, concernant 20 % des patientes dans le pays occidentaux. Le Misoprostol, un analogue synthétique de la prostaglandine E1, est un agent de déclenchement couramment utilisé en Suisse. Cependant, cet agent induit plus fréquemment que les autres des hypercinésies utérines. Il est craint qu’une fréquence trop élevée de contractions pendant le déclenchement du travail induise une diminution de la perfusion placentaire, une majoration des acidoses fœtales ainsi qu’une augmentation du taux de césarienne. Peu d’études sur le sujet ont été réalisé avec des résultats divergents. De plus, il n’a pas été démontré une augmentation du taux de césarienne ou une élévation de la morbidité néonatale lorsque le Misoprostol est comparé aux autres moyens de déclenchement dans la littérature. L’objectif de notre étude est d’évaluer si la présence d’une hypercinésie lors du déclenchement du travail est associée à une augmentation du taux de césarienne ainsi que des issues maternelles et néonatales défavorables. Nous avons réalisé une étude de cohorte rétrospective au sein de la maternité du Centre Hospitalier Universitaire Vaudois, incluant 446 patientes à plus 37 semaines d'aménorrhées admises pour un déclenchement du travail par Misoprostol entre Mai 2016 et Mai 2017. Les données démographiques, obstétricales et néonatales ont été recueillies par consultation des dossiers médicaux informatisés des patientes. Chaque cardiotocogramme a été analysé et classé selon les recommandations de l’ACOG tant d’un point de vue du rythme cardiaque que des contractions. L’hypercinésie a été définie comme un nombre supérieur à 6 contractions par 10 minutes. Au total 140 patientes (31.4%) ont présenté une hypercinésie. La durée moyenne de l’hypercinésie était de 2 heures et 12 minutes. Nous n’avons pas trouvé d’association entre la présence d’une hypercinésie et le taux de césarienne. La présence d’un rythme cardiaque fœtale suspect était plus fréquent chez les patientes ayant une hypercinésie, toutefois cela n’était pas associé à des issues néonatales défavorables. Les issues maternelles étaient similaires entre les patientes présentant une hypercinésie versus celles qui n’en n’avaient pas. La définition actuelle de l’hypercinésie repose sur un seuil de contraction que la patiente expérimente sur 10 minutes. Une définition reposant uniquement sur la fréquence des contractions n’est pas suffisante pour évaluer l’impact d’une activité utérine excessive et n’est donc pas un prédicteur d’issues maternelles ou néonatales défavorables comme démontré dans notre étude. A ce jour, il n’existe pas de moyen d’investigation permettant de caractériser de manière fiable l’activité contractile utérine. Contrairement à l’étude de l’analyse du rythme cardiaque fœtale, que peu d’auteurs se sont intéressés à l’analyse des contractions et leurs associations aux issues néonatales et maternelles. Il nous semble indispensable de porter notre attention sur la caractérisation de l’activité utérine en salle d’accouchement et d’y développer de nouveaux outils permettant de mesurer la force utérine contractile et le tonus utérin de base afin d’y améliorer la sécurité des mères ainsi que des nouveau-nés. -- Objectives: To investigate if tachysystole was associated with an increased risk of cesarean section or unfavorable maternal or neonatal outcomes following induction of labor by misoprostol vaginal inserts. Study design: We conducted a retrospective cohort study of 446 women over 37 weeks of gestation admitted for labor induction by misoprostol vaginal inserts between May 2016 and May 2017. Fetal heart rate and uterine activity tracings were assessed for tachysystole, defined as 2: 6 contractions per 10 min, averaged over a 30-minute window. Univariate analysis was performed by using t-test and Chi-square, comparing demographics, pregnancy characteristics, intrapartum monitoring, mode of delivery, neonatal outcomes (Apgar score < 7 at 5 min, umbilical cord artery pH < 7.10, neonatal intensive care unit admission) and maternal outcomes, with regard to the presence of tachysystole. The association between tachysystole and cesarean section was evaluated after adjusting for potential confounders by a modified Poisson regression model, expressed as an adjusted risk ratio and 95 % confidence intervals. Results: A total of 140 women (31.4 %) presented with tachysystole. The median duration of tachysystole was 2 h 12 min. The rate of cesarean section was 25.0 % (N = 35) among patients with tachysystole and 19.6 % (N = 60) for those without tachysystole. Presence of tachysystole during induction of labor with misoprostol vaginal inserts was not associated with cesarean section (adjusted risk ratio,1.0; 95 % confidence interval, 0.7–1.4). Neonatal and maternal outcomes were similar between mothers who did and did not experience tachysystole. Conclusions: This study illustrates that tachysystole is not associated with an increased risk of cesarean section after induction of labor by misoprostol vaginal inserts. The impact of excessive uterine activity on the fetal wellbeing defined by the frequency of uterine contraction alone is probably insufficient. Further research on the development of accurate measures of uterine contractility is necessary to better understand its effect on fetal well-being

The role of AP-2 alpha in predicting response to chemotherapy in breast cancer patients

Breast cancer is the most frequent cancer occurring in women in Europe1. In Switzerland, the incidence in 2009 was 32,9% and it was the primary cause of cancer related death in women, with a mortality rate of 19.2%2. The management of this cancer depends on clinical data, morphology of the tumour and its molecular profile3, 4. Five different subclasses have been described using molecular profiling: luminal A, luminal B, normal-like tumour, HER2+ and basal like4, 5. Luminal A is less aggressive than HER2+5. However, it was noticed that some patients had far worse outcomes than predicted when based on molecular criteria5. It is thought that breast cancer arises through a series of molecular alterations at the cellular level, resulting in the evasion of growth-inhibiting signals, evasion of apoptosis and spread of breast epithelial cells4. The human transcription factor and tumour suppressor activator-protein 2 (AP-2) was found to have a central role in the development of breast cancer6,7. Decrease of intracellular AP-2 is associated with more aggressive cancer types6,7. It is possible to study AP-2 levels via new method called protein-binding microarray (PBM)7. DNA-binding protein, as AP-2, is put in contact with double stranded DNA sequences fixed on a microarray8. This technique allowed the detection of protein binding on specific DNA sequences8. This method has been demonstrated to be reliable and highly sensitive7. In an initial study done at the University of Lausanne, it was demonstrated that AP-2 binding on DNA could have a better predictive value than classic molecular diagnosis and may redistribute the subtype classification. Now, there is a need to repeat this trial with more breast cancer specimens and a more robust microarray. My primary objective is to select 100 appropriate specimens from the pathology institute to repeat the trial. Specimens would be of the different subtype and also from tissue next to the tumour. For comparison we will also use tissue from reduction mammoplasties, as a healthy control. These specimens are obtained after either mastectomy or tumorectomy for the pathological tissue and after mammary reduction for the healthy control. All tissues samples were flash frozen and preserved at -80 C° to protect the cell proteins. Specimens and documentations will be rendered anonymously before processing by the lab. Secondly, the specimens will be used in the PBM microarray. The result will be analysed in conjunction with clinical history and follow-up of the patient. In conclusion, the use of PBM technique with the AP-2 protein is promising in order to improve the diagnosis of breast cancer. Using this technique we expected to better describe and understand breast cancer and the action of the tumour itself. This might lead to better prognosis of the disease and even lead to new treatment development

Design and evaluation of two geocast protocols for vehicular ad-hoc networks

Vehicular ad-hoc networks (VANETs) offer a large number of new potential applications. One of the envisioned applications is of course Internet access, which can be provided with the help of some roadside basestations. Many of the applications benefit from multi-hop relaying of information, thus requiring a routing protocol. Characteristics unique to VANETs (such as high mobility and the need for geographical addressing) make many conventional ad hoc routing protocols unsuitable. In this paper we design and evaluate two different, so called, geocast protocols for VANETs. One protocol is designed for fast communication across a large area. The purpose of the other protocol is to provide a routing service for a future reliable transport protocol (enabling Internet applications). We evaluate the performance of the protocols using realistic network and traffic models

A Millimeter-Wave Software-Defined Radio for Wireless Experimentation

In this study, we propose a low-cost and portable millimeter-wave software-defined radio (SDR) for wireless experimentation in the 60 GHz band. The proposed SDR uses Xilinx RFSoC2x2 and Sivers EVK06002 homodyne transceiver and provides a TCP/IP-based interface for companion computer (CC)-based baseband signal processing. To address the large difference between the processing speed of the CC and the sample rate of analog-to-digital converters, we propose a method, called waveform-triggered reception (WTR), where a hard-coded block detects a special trigger waveform to acquire a pre-determined number of IQ samples upon the detection. We also introduce a buffer mechanism to support discontinuous transmissions. By utilizing the WTR along with discontinuous transmissions, we conduct a beam sweeping experiment, where we evaluate 4096 beam pairs rapidly without compromising the flexibility of the CC-based processing. We also generate a dataset that allows one to calculate physical layer parameters such as signal-to-noise ratio and channel frequency response for a given pair of transmit and receive beam indices.Comment: Accepted for presentation at IEEE INFOCOM CNERT: Computer and Networking Experimental Research using Testbeds Workshop 2023, 6 figures, corresponding GitHub page: https://github.com/alphansahin/mmWaveSD

Kriging-Based 3-D Spectrum Awareness for Radio Dynamic Zones Using Aerial Spectrum Sensors

Radio dynamic zones (RDZs) are geographical areas within which dedicated spectrum resources are monitored and controlled to enable the development and testing of new spectrum technologies. Real-time spectrum awareness within an RDZ is critical for preventing interference with nearby incumbent users of the spectrum. In this paper, we consider a 3D RDZ scenario and propose to use unmanned aerial vehicles (UAVs) equipped with spectrum sensors to create and maintain a 3D radio map of received signal power from different sources within the RDZ. In particular, we introduce a 3D Kriging interpolation technique that uses realistic 3D correlation models of the signal power extracted from extensive measurements carried out at the NSF AERPAW platform. Using C-Band signal measurements by a UAV at altitudes between 30 m-110 m, we first develop realistic propagation models on air-to-ground path loss, shadowing, spatial correlation, and semi-variogram, while taking into account the knowledge of antenna radiation patterns and ground reflection. Subsequently, we generate a 3D radio map of a signal source within the RDZ using the Kriging interpolation and evaluate its sensitivity to the number of measurements used and their spatial distribution. Our results show that the proposed 3D Kriging interpolation technique provides significantly better radio maps when compared with an approach that assumes perfect knowledge of path loss