Introduction
Obesity is an increasing public health concern worldwide and can lead to more complications in pregnancy and childbirth. Women with obesity more often require induction of labor for ...various indications. The aim of this study is to assess which method of induction of labor is safest and most effective in women with obesity.
Material and methods
This is a secondary analysis of two randomized controlled trials about induction of labor. Women with a term singleton pregnancy in cephalic presentation, an unfavorable cervix, intact membranes and without a previous cesarean section were randomly allocated to cervical priming with a Foley catheter or vaginal prostaglandin‐E2‐gel (PROBAAT‐I) or a Foley catheter or oral misoprostol (PROBAAT‐II). The inclusion and exclusion criteria for the studies were identical. Induction methods were compared in women with obesity (body mass index ≥30.0). Main outcomes were cesarean section and postpartum hemorrhage (blood loss >1000 mL).
Results
A total of 2664 women, were included in the trials, 517 of whom were obese: 254 women with obesity received a Foley catheter, 176 oral misoprostol and 87 prostaglandin E2 (PGE2). A cesarean section was performed in 29.1% of women allocated to Foley vs 22.2% in the misoprostol and 23.0% in the PGE2 groups. Comparisons between groups revealed no statistically significant differences: the relative risk RR was 1.31 (95% confidence interval CI 0.94–1.84) in the Foley vs misoprostol group and 1.27 (95% CI 0.83–1.95) in the Foley vs PGE2 group. The rates of postpartum hemorrhage were comparable (10.6%, 11.4% and 6.9%, respectively; P = 0.512). In women with obesity, more often a switch to another method occurred in the Foley group, (20.1% vs 6.3% in misoprostol vs 1.1% in the PGE2 group; P < 0.001). The risk of a failed Foley placement was higher in women with obesity than in women without obesity (8.3% vs 3.2%; adjusted odds ratio 3.12, 95% CI 1.65–5.90).
Conclusions
In women with obesity we found a nonsignificant trend towards an increased rate of cesarean sections in the group induced with a Foley catheter compared to oral misoprostol; however, the study lacked power for this subgroup analysis. The finding of a higher risk of failed placement of a Foley catheter in women with obesity can be used in shared decision making.
In women with obesity, induction of labor with a Foley catheter is slightly less favorable compared with oral misoprostol or prostaglandin gel in regards to method failure. There was no significant difference in mode of delivery, although an increase in cesarean section rate with the use of a Foley catheter cannot be ruled out.
The avascular nature of cartilage makes it a unique tissue
, but whether and how the absence of nutrient supply regulates chondrogenesis remain unknown. Here we show that obstruction of vascular ...invasion during bone healing favours chondrogenic over osteogenic differentiation of skeletal progenitor cells. Unexpectedly, this process is driven by a decreased availability of extracellular lipids. When lipids are scarce, skeletal progenitors activate forkhead box O (FOXO) transcription factors, which bind to the Sox9 promoter and increase its expression. Besides initiating chondrogenesis, SOX9 acts as a regulator of cellular metabolism by suppressing oxidation of fatty acids, and thus adapts the cells to an avascular life. Our results define lipid scarcity as an important determinant of chondrogenic commitment, reveal a role for FOXO transcription factors during lipid starvation, and identify SOX9 as a critical metabolic mediator. These data highlight the importance of the nutritional microenvironment in the specification of skeletal cell fate.
A likelihood-based method for measuring weak gravitational lensing shear in deep galaxy surveys is described and applied to the Canada-France-Hawaii Telescope (CFHT) Lensing Survey (CFHTLenS). ...CFHTLenS comprises 154 deg2 of multi-colour optical data from the CFHT Legacy Survey, with lensing measurements being made in the i
′ band to a depth i′AB < 24.7, for galaxies with signal-to-noise ratio νSN 10. The method is based on the lensfit algorithm described in earlier papers, but here we describe a full analysis pipeline that takes into account the properties of real surveys. The method creates pixel-based models of the varying point spread function (PSF) in individual image exposures. It fits PSF-convolved two-component (disc plus bulge) models to measure the ellipticity of each galaxy, with Bayesian marginalization over model nuisance parameters of galaxy position, size, brightness and bulge fraction. The method allows optimal joint measurement of multiple, dithered image exposures, taking into account imaging distortion and the alignment of the multiple measurements. We discuss the effects of noise bias on the likelihood distribution of galaxy ellipticity. Two sets of image simulations that mirror the observed properties of CFHTLenS have been created to establish the method's accuracy and to derive an empirical correction for the effects of noise bias.
•A foley catheter for induction of labor is probably safer for small-for-gestational age babies compared to oral misoprostol.•The mode of birth is probably equal between induction methods in SGA ...pregnancies.•No valid judgements could be made between a Foley catheter and PGE2 in this study.
To evaluate the safety aspects of different induction methods in pregnancies with small-for-gestational-age neonates.
This was a secondary analysis of two previously reported multicenter, randomized controlled trials conducted in the Netherlands. In the original trials, women were randomized to either a 30 cc Foley catheter, vaginal prostaglandin E2 (PROBAAT-1) or oral misoprostol (PROBAAT-2). A total of 425 patients with a term, singleton pregnancy in cephalic presentation with an indication for labor induction and a small-for-gestational-age neonate were included in this secondary analysis. Our primary outcome was a composed adverse neonatal outcome of Apgar score < 7 after 5 min and/or a pH in the umbilical artery < 7.05 and/or NICU admission. Secondary outcomes were mode of birth, operative birth for fetal distress and pH < 7.10 in the umbilical artery. For these outcome measures, multivariate as well as bivariate analyses were performed.
An adverse neonatal outcome occurred in 4.7 % (10/214) induction with a Foley catheter, versus 12.8 % (19/149) after misoprostol (RR 0.36; 95 % CI 0.17–0.76) and 4.7 % (3/64) after Prostaglandin E2 (RR 0.98; 95 %CI 0.28–3.51).
For individual components of the composed outcome of adverse events, a difference was found between a Foley catheter and misoprostol for Apgar score < 7 at 5 min (0.5 % versus 3.4; RR 0.14; 95 %CI 0.02–1.16) and NICU admission (1.9 % versus 6.1 %; RR 0.31; 0.10–0.97). No differences were found for mode of birth.
For women who gave birth to a small-for-gestational-age neonate, a Foley catheter is probably a safer induction method compared to oral misoprostol.
Abstract Lung transplantation (LTx) is the last treatment for patients suffering from end-stage lung diseases. Survival post-LTx is hampered by the development of the bronchiolitis obliterans ...syndrome (BOS) and diagnosis is often late. Given the urgent clinical need to recognize BOS patients at an early stage, we analyzed circulating miRNAs to identify possible stratification markers for BOS development post-transplantation. Therefore, pro-fibrotic (miR-21, miR-155), anti-fibrotic (miR-29a) and fibrosis-unrelated (miR-103, miR-191) miRNAs were analyzed in serum of end-stage lung disease patients and during LTx follow-up. Significant elevated levels of serum miRNAs were observed for all investigated miRNAs in both chronic obstructive pulmonary disease and interstitial lung disease patients compared to healthy controls. The same miRNAs were also significantly increased in the serum of BOS + vs. BOS − patients. Most importantly, miR-21, miR-29a, miR-103, and miR-191 levels were significantly higher in BOS + patients prior to clinical BOS diagnosis. We demonstrated that a selected group of miRNAs investigated is elevated in end-stage lung disease and BOS + patients, prior to clinical BOS diagnosis. Even if further research is expedient on the prognostic value of circulating miRNAs in BOS and lung conditions in general, these results strongly suggest that circulating miRNAs could be used as potential biomarkers for BOS development.
Aims. We aim to calculate the kinetic, magnetic, thermal, and total energy densities and the flux of energy in axisymmetric sausage modes. The resulting equations should contain as few parameters as ...possible to facilitate applicability for different observations. Methods. The background equilibrium is a one-dimensional cylindrical flux tube model with a piecewise constant radial density profile. This enables us to use linearised magnetohydrodynamic equations to calculate the energy densities and the flux of energy for axisymmetric sausage modes. Results. The equations used to calculate the energy densities and the flux of energy in axisymmetric sausage modes depend on the radius of the flux tube, the equilibrium sound and Alfvén speeds, the density of the plasma, the period and phase speed of the wave, and the radial or longitudinal components of the Lagrangian displacement at the flux tube boundary. Approximate relations for limiting cases of propagating slow and fast sausage modes are also obtained. We also obtained the dispersive first-order correction term to the phase speed for both the fundamental slow body mode under coronal conditions and the slow surface mode under photospheric conditions.
We present the first direct measurement of the galaxy-matter bispectrum as a function of galaxy luminosity, stellar mass and type of spectral energy distribution (SED). Our analysis uses a ...galaxy-galaxy-galaxy lensing technique (G3L), on angular scales between 9 arcsec and 50 arcmin, to quantify (i) the excess surface mass density around galaxy pairs (excess mass hereafter) and (ii) the excess shear-shear correlations around single galaxies, both of which yield a measure of two types of galaxy-matter bispectra. We apply our method to the state-of-the-art Canada-France-Hawaii Telescope Lensing Survey (CFHTLenS), spanning 154 square degrees. This survey allows us to detect a significant change of the bispectra with lens properties. Measurements for lens populations with distinct redshift distributions become comparable by a newly devised normalization technique. That will also aid future comparisons to other surveys or simulations. A significant dependence of the normalized G3L statistics on luminosity within −23 ≤ M
r
≤ −18 and stellar mass within 5 × 109 M ≤ M
* ≤ 2 × 1011 M is found (h = 0.73). Both bispectra exhibit a stronger signal for more luminous lenses or those with higher stellar mass (up to a factor of 2-3). This is accompanied by a steeper equilateral bispectrum for more luminous or higher stellar mass lenses for the excess mass. Importantly, we find the excess mass to be very sensitive to galaxy type as recently predicted with semi-analytic galaxy models: luminous (M
r
< −21) late-type galaxies show no detectable signal, while all excess mass detected for luminous galaxies seems to be associated with early-type galaxies. We also present the first observational constraints on third-order stochastic galaxy biasing parameters.
This paper is the outcome of a community initiative to identify major unsolved scientific problems in hydrology motivated by a need for stronger harmonisation of research efforts. The procedure ...involved a public consultation through online media, followed by two workshops through which a large number of potential science questions were collated, prioritised, and synthesised. In spite of the diversity of the participants (230 scientists in total), the process revealed much about community priorities and the state of our science: a preference for continuity in research questions rather than radical departures or redirections from past and current work. Questions remain focused on the process-based understanding of hydrological variability and causality at all space and time scales. Increased attention to environmental change drives a new emphasis on understanding how change propagates across interfaces within the hydrological system and across disciplinary boundaries. In particular, the expansion of the human footprint raises a new set of questions related to human interactions with nature and water cycle feedbacks in the context of complex water management problems. We hope that this reflection and synthesis of the 23 unsolved problems in hydrology will help guide research efforts for some years to come.
Thirteen common susceptibility loci have been reproducibly associated with cutaneous malignant melanoma (CMM). We report the results of an international 2-stage meta-analysis of CMM genome-wide ...association studies (GWAS). This meta-analysis combines 11 GWAS (5 previously unpublished) and a further three stage 2 data sets, totaling 15,990 CMM cases and 26,409 controls. Five loci not previously associated with CMM risk reached genome-wide significance (P < 5 × 10(-8)), as did 2 previously reported but unreplicated loci and all 13 established loci. Newly associated SNPs fall within putative melanocyte regulatory elements, and bioinformatic and expression quantitative trait locus (eQTL) data highlight candidate genes in the associated regions, including one involved in telomere biology.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SBMB, UILJ, UKNU, UL, UM, UPUK
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