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

Influence of the Month on the Chemical Composition of Mediterranean Italian Buffalo Milk

It is known that the chemical composition of milk is influenced by several factors and the length of lactation plays a prominent role. In Italy, where the reproductive activity of the herd is aimed at the demand for milk from the market, the chemical composition is influenced not only by the adoption or otherwise by the out-breeding-mating-strategy (OBMS) but also by the severity which characterise these techniques (the length of the interruption of sexual promiscuity). The productions and the chemical composition of the milk of 23 farms (average 9000 buffaloes a year) were processed from 2011 to August 2016. The milk was daily conferred and analysed. We evaluated the milk production (kg), the percentage of fat, protein, lactose, dairy yield calculated with the equation of Altiero (1989), the values of the titratable acidity (°SH) and of pH. For each parameter, the monthly values of each farm were divided by the respective annual average and were expressed as an index (monthly values/annual average) in order to homogenize the graphical representations

Bump start needed: linking guidelines, policy and practice in promoting physical activity during and beyond pregnancy

First paragraph: There is compelling evidence that regular physical activity (PA) during pregnancy benefits both mother and baby.1 2 Notably, physical and psychological benefits are evident in the literature, such as marked reductions in the development of gestational diabetes and hypertensive disorders, alongside improvements in depressive symptoms and cardiorespiratory fitness.1 2 The evidence base has been reflected by recent policy initiatives, for example, in 2017 (relaunched in 2019), the UK‘s chief medical officers (CMOs) published PA guidelines for pregnant women, which made substantial strides in unifying and translating the evidence into recommendations.1 The CMO guidelines are aimed at supporting health professionals to provide consistent, evidence-based PA messages to women throughout pregnancy.1 Recently, the Chartered Institute for the Management of Sport and Physical Activity have updated their professional standards for working with antenatal and postnatal clients to align with these CMO guidelines.3 However, not all women have access to professionals with this level of expertise and training, potentially limiting the impact of the CMO guidelines

Optimization of graphene-based materials outperforming host epoxy matrices

The degree of graphite exfoliation and edge-carboxylated layers can be controlled and balanced to design lightweight materials characterized by both low electrical percolation thresholds (EPT) and improved mechanical properties. So far, this challenging task has been undoubtedly very hard to achieve. The results presented in this paper highlight the effect of exfoliation degree and the role of edge-carboxylated graphite layers to give self-assembled structures embedded in the polymeric matrix. Graphene layers inside the matrix may serve as building blocks of complex systems that could outperform the host matrix. Improvements in electrical percolation and mechanical performance have been obtained by a synergic effect due to finely balancing the degree of exfoliation and the chemistry of graphene edges which favors the interfacial interaction between polymer and carbon layers. In particular, for epoxy-based resins including two partially exfoliated graphite samples, differing essentially in the content of carboxylated groups, the percolation threshold reduces from 3 wt% down to 0.3 wt%, as the carboxylated group content increases up to 10 wt%. Edge-carboxylated nanosheets also increase the nanofiller/epoxy matrix interaction, determining a relevant reinforcement in the elastic modulus

Dynamic origin of chirality transfer between chiral surface and achiral ligand in Au38 clusters

The transfer of chirality between nanomolecules is at the core of several applications in chiral technology such as sensing and catalysis. However, the origin of this phenomenon and how exactly nanoscale objects transfer chirality to molecules in their vicinity remain largely obscure. Here, we show that the transfer of chirality for the intrinsically chiral gold cluster Au38(SR)24 is site dependent; that is, it differs depending on the ligand-binding sites. This is closely related to the dynamic nature of the ligands on the cluster surface. Using a combination of NMR techniques and molecular dynamics simulations, we could assign the four symmetry- unique ligands on the cluster. The study reveals largely different conformational dynamics of the bound ligands, explaining the diverse diastereotopicities observed for the CH2 protons of the ligands. Although chirality is a structural property, our study reveals the importance of dynamics for the transfer of chirality