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

High concordance between trained nurses and gastroenterologists in evaluating recordings of small bowel video capsule endoscopy (VCE)

Background & Aims: The video capsule endoscopy (VCE) is an accurate and validated tool to investigate the entire small bowel mucosa, but VCE recordings interpretation by the gastroenterologist is time-consuming. A pre-reading of VCE recordings by an expert nurse could be accurate and cost saving. We assessed the concordance between nurses and gastroenterologists in detecting lesions on VCE examinations. Methods: This was a prospective study enrolling consecutive patients who had undergone VCE in clinical practice. Two trained nurses and two expert gastroenterologists participated in the study. At VCE pre-reading the nurses selected any abnormalities, saved them as “thumbnails” and classified the detected lesions as a vascular abnormality, ulcerative lesion, polyp, tumor mass, and unclassified lesion. Then, the gastroenterologist evaluated and interpreted the selected lesions and, successively, reviewed the entire video for potential missed lesions. The time for VCE evaluation was recorded. Results: A total of 95 VCE procedures performed on consecutive patients (M/F: 47/48; mean age: 63 ± 12 years, range: 27−86 years) were evaluated. Overall, the nurses detected at least one lesion in 54 (56.8%) patients. There was total agreement between nurses and gastroenterologists, no missing lesions being discovered at a second look of the entire VCE recording by the physician. The pre-reading procedure by nurse allowed a time reduction of medical evaluation from 49 (33-69) to 10 (8-16) minutes (difference:-79.6%). Conclusions: Our data suggest that trained nurses can accurately identify and select relevant lesions in thumbnails that subsequently were faster reviewed by the gastroenterologist for a final diagnosis. This could significantly reduce the cost of VCE procedure

Control of Molecular Packing in Crystal and Electron Communication of Two Ferrocenyl Moieties across Chiral Isomannide or Isosorbide Bridge

Intramolecular electronic communication between electrochemically active groups connected by a bridging moiety can be modified through small changes in the spatial disposition of the redox active moieties and/or by the nature of the central core. In this study, chiral bio-based compounds, namely isomannide and isosorbide, were employed as cheap and easy-to-functionalize chiral scaffolds to bridge two ferrocenyl electroactive moieties. The crystal structures of both bis-ferrocenyl diester complexes were studied and they showed that the chirality of the bridge results in an open or tight helical crystal packing. The electron communication between the two electroactive units in the mixed valent monocations was also investigated using electrochemistry (cyclic voltammetry and differential pulsed voltammetry), and spectroelectrochemistry in the UV-Vis NIR. A computational study through time-dependent DFT was also employed to gain greater insight into the results obtained

Renewable Resources for Enantiodiscrimination: Chiral Solvating Agents for NMR Spectroscopy from Isomannide and Isosorbide

A new family of chiral selectors was synthesized in a single synthetic step with yields up to 84% starting from isomannide and isosorbide. Mono- or disubstituted carbamate derivatives were obtained by reacting the isohexides with electron-donating arylisocyanate (3,5-dimethylphenyl- or 3,5-dimethoxyphenyl-) and electron-withdrawing arylisocyanate (3,5-bis(trifluoromethyl)phenyl-) groups to test opposite electronic effects on enantiodifferentiation. Deeper chiral pockets and derivatives with more acidic protons were obtained by derivatization with 1-naphthylisocyanate and p-toluenesulfonylisocyanate, respectively. All compounds were tested as chiral solvating agents (CSAs) in H-1 NMR experiments with rac-N-3,5-dinitrobenzoylphenylglycine methyl ester in order to determine the influence of different structural features on the enantiodiscrimination capabilities. Some selected compounds were tested with other racemic analytes, still leading to enantiodiscrimination. The enantiodiscrimination conditions were then optimized for the best CSA/analyte couple. Finally, a 2D- and 1D-NMR study was performed employing the best performing CSA with the two enantiomers of the selected analyte, aiming to determine the enantiodiscrimination mechanism, the stoichiometry of interaction, and the complexation constant

Algebraic entropy for algebraic maps

We propose an extension of the concept of algebraic entropy, as introduced by Bellon and Viallet for rational maps, to algebraic maps (or correspondences) of a certain kind. The corresponding entropy is an index of the complexity of the map. The definition inherits the basic properties from the definition of entropy for rational maps. We give an example with positive entropy, as well as two examples taken from the theory of Backlund transformations

Backlund transformations and Hamiltonian flows

In this work we show that, under certain conditions, parametric Backlund transformations (BTs) for a finite dimensional integrable system can be interpreted as solutions to the equations of motion defined by an associated non-autonomous Hamiltonian. The two systems share the same constants of motion. This observation lead to the identification of the Hamiltonian interpolating the iteration of the discrete map defined by the transformations, that indeed will be a linear combination of the integrals appearing in the spectral curve of the Lax matrix. An application to the Toda periodic lattice is given.Comment: 19 pages, 2 figures. to appear in J. Phys.

Multifocal gastrointestinal angiosarcoma: A challenging diagnosis?

Angiosarcoma rarely involves the gastrointestinal tract. Herein, we describe the case of a 68-year-old man with haemoptysis and melena who was eventually diagnosed with multifocal angiosarcoma of the stomach, small bowel, lungs, and thyroid. The peculiarity was that the histological feature of the polypoid lesions removed at endoscopy was initially misinterpreted as benign hyperplastic polyps, whilst their neoplastic nature was clinically suspected only when the videocapsule endoscopy revealed the presence of multiple variable-sized nodules with apical erosion or active bleeding in the small bowel. Based on the very low incidence, diagnosis of angiosarcoma involving the gastrointestinal tract may be misinterpreted by both the endoscopist and pathologist

Variação temporal da biomassa do café arábica arborizado e a pleno sol, através de índices de vegetação.

Abstract. In recent years, several works have been accomplished in order to analyze the spectral response of coffee crop fields cultivated in full sun. However, the number of papers related to the monitoring of shaded coffee systems is reduced although this kind of cultivation is very important from the perspective of climate change and agriculture. In addition, the biomass of coffee systems can store carbon, which is a mitigation action. In this context, this paper presents the assessment of the meteorological variation joined with the biomass increase in three different coffee plantation systems: full sun, shaded coffee associated with legumes (SAF), and shaded coffee with Macadamia trees. We used Landsat-5 images from 2004 to 2010, and the NDVI and SAVI indexes. LAI index measured in the test area during all 2009 year. The results showed that the shaded coffee systems presented the NDVI and SAVI indexes with higher values than those found with the system of planting in full sun what corroborates the idea of greater amount of biomass in this type of planting. All indexes present the seasonal rain variation. One month after a large period of drought the indexes NDVI, SAVI and LAI decrease. The NDVI and SAVI indexes presented high correlation with the measured LAI. The shaded coffee system and the full sun coffee reached high vegetation indexes what indicate a high concentration of biomass. This factor should be considered in the decision making process since is important to take advantage of cultivation systems acting as carbon sinks.SBSR 2011

Analysis of meiotic segregation by triple-color fish on both total and motile sperm fractions in a t(1p;18) river buffalo bull

Chromosomal aberrations are relatively frequent pathologies in both humans and animals. Among them, translocations present a specific meiotic segregation pattern able to give a higher percentage of unbalanced gametes that can induce fertility problems. In this study, the meiotic segregation patterns of 1p, 1q and 18 Bubalus bubalis chromosomes were analyzed in both total sperm fraction and motile sperm fraction of a t(1p;18) carrier and a control bulls by triple-color FISH analysis with a pool of specific BAC probes. The frequencies of each total sperm fraction products in the carrier resulting from alternate, adjacent I, adjacent II and 3:1 segregation were 39%, 20%, 1% and 38%, respectively. On the other hand, the frequencies of each motile sperm fraction products in the carrier resulting from alternate, adjacent I, adjacent II and 3:1 segregation were 93%, 5%, 0% and 2%, respectively. The frequencies of normal sperms in the carrier were 27% and 69% in total sperm fraction and motile sperm fraction, respectively. The frequencies detected in motile sperm fraction were also validated by comparison with bull's progeny. To our knowledge, this is the first report on the meiotic segregation patterns in motile sperm fractions of B. bubalis bull carrying a chromosomal translocation. These data suggest that translocation has a very limited effect on aneuploidy in the gametes, and therefore, on the reproductive abilities of the bull