Objectives
To estimate the incidence and risk of complications associated with a fetal scalp electrode and to determine whether its application in the setting of operative vaginal delivery was ...associated with increased neonatal morbidity.
Design
Retrospective cohort study.
Setting
Twelve clinical centers with 19 hospitals across nine American Congress of Obstetricians and Gynecologists US districts.
Population
Women in the USA.
Methods
We evaluated 171 698 women with singleton deliveries ≥ 23 weeks of gestation in a secondary analysis of the Consortium on Safe Labor study between 2002 and 2008, after excluding conditions that precluded fetal scalp electrode application such as prelabour caesarean delivery. Secondary analysis limited to operative vaginal deliveries ≥ 34 weeks of gestation was also performed.
Main outcome measures
Incidences and adjusted odds ratios with 95% confidence intervals of neonatal complications were calculated, controlling for maternal characteristics, delivery mode and pregnancy complications.
Results
Fetal scalp electrode was used in 37 492 (22%) of deliveries. In non‐operative vaginal delivery, fetal scalp electrode was associated with increased risk of injury to scalp due to birth trauma (1.2% versus 0.9%; adjusted odds ratios 1.62; 95% confidence intervals 1.41–1.86) and cephalohaematoma (1.0% versus 0.9%; adjusted odds ratios 1.57; 95% confidence intervals 1.36–1.83). Neonatal complications were not significantly different comparing fetal scalp electrode with vacuum‐assisted vaginal delivery and vacuum‐assisted vaginal delivery alone or comparing fetal scalp electrode with forceps‐assisted vaginal delivery and forceps‐assisted vaginal delivery alone.
Conclusions
We found increased neonatal morbidity with fetal scalp electrode though the absolute risk was very low. It is possible that these findings reflect an underlying indication for its use. Our findings support the use of fetal scalp electrodes when clinically indicated.
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Neonatal risks associated with fetal scalp electrode use were low (injury to scalp 1.2% and cephalohaematoma 1.0%).
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Neonatal risks associated with fetal scalp electrode use were low (injury to scalp 1.2% and cephalohaematoma 1.0%).
ObjectiveTo investigate the contributions of adenosine triphosphate (ATP) and adenosine diphosphate (ADP) to the increase in skeletal muscle blood flow (MBF) observed following manual acupuncture ...(MA) stimulation in rats.MethodsMale Sprague-Dawley rats were used as experimental animals (300–370 g, n=40). MA was applied to the right tibialis anterior muscle (TA) for 1 min using a stainless steel acupuncture needle. In eight rats, high-performance liquid chromatography with the microdialysis technique was used to measure local extracellular concentrations of ATP, ADP, adenosine monophosphate (AMP), and adenosine in the TA. In the remaining 32 rats, fluorescent microspheres (15 µm in diameter) were used to measure MBF in the TA following pre-treatment with either the P2 receptor antagonist suramin (100 mg/kg intra-arterially) or saline (control) (n=16 each). Rats receiving MA (Suramin+MA and Saline+MA groups, n=8 each) were compared with untreated rats (Suramin and Saline groups, n=8).ResultsMA significantly increased the local extracellular concentration of ATP, ADP, and adenosine (p<0.05, before MA vs 30 min after MA). In addition, MA significantly increased MBF in rats pre-treated with saline or suramin (p<0.01, Saline vs Saline+MA; p<0.05, Suramin vs Suramin+MA, respectively). However, suramin significantly suppressed this MA-induced increase in MBF (p<0.05, Saline+MA vs Suramin+MA).ConclusionsThese results suggest that both ATP and ADP partially contribute to the MA-induced increase in MBF via P2 receptors. However, further studies are needed to clarify the contributions of other vasodilators.
The mass transfer zone (MTZ) method using the linear driving force (LDF) approximation is the most common and frequently used technique for the analysis of adsorption kinetics from a fixed‐bed ...breakthrough curve and for adsorptive process design. However, the adsorption kinetics obtained by the MTZ method includes approximations and estimation errors. This report describes a new analytical method for determining the intraparticle diffusivity (DS) and the fluid‐film mass transfer coefficient (kF) from an experimental breakthrough curve without using the LDF approximation and empirical correlations for estimating kF . The proposed method has the advantage of less trial and error on the curve‐fitting process and helps better determine DS and kF . The estimation procedure of the Biot number that represents the ratio of DS to kF is the key of this method. The values of DS and kF for the adsorption of phenols onto activated carbon were determined from experimental breakthrough curves using the new analytical method. The results indicate that the method presented in this study yields reliable values.
The mass transfer zone method for the analysis of adsorption kinetics from a fixed‐bed breakthrough curve includes approxima‐tions and estimation errors. A new analytical procedure for determining intraparticle diffusivity and the fluid‐film mass transfer coefficient from an experimental breakthrough curve is described. The proposed method has the advantage of less trial and error and yields reliable results.
To report five cases of gonococcal keratoconjunctivitis with severe corneal involvement treated with therapeutic keratoplasty.
Retrospective case series.
Five consecutive cases of gonococcal ...keratoconjunctivitis treated with keratoplasty for corneal perforation, with a mean age of 21.2 years, were analysed by patient's history, surgical approaches, and clinical outcomes, corrected visual acuity at initial visit and last follow-up.
All adult cases were originally diagnosed as epidemic keratoconjunctivitis by elsewhere, and corneal perforation occurred with a mean duration of 11 days after development of conjunctivitis. While laboratory tests revealed Neisseria gonorrhoeae in all five cases, three patients showed resistance to ofloxacin. Intensive medical treatment using penicillins and/or cephems was initiated. Two patients had peripheral corneal perforations, one had a paracentral perforation, and another, a large corneal perforation with stromal melting. One case had a central microcorneal perforation. In all cases, the anterior chamber was flat. Corneal perforations were treated with lamellar or penetrating keratoplasty using cryopreserved or fresh corneal grafts. All grafts remained clear during the mean follow-up period of 34.9 months. Final best-corrected visual acuity ranged from 20/60 to 20/16.
Severe gonococcal keratoconjunctivitis can benefit from intensive surgical and medical intervention resulting in satisfactory visual rehabilitation.
AML1-MTG8 generated by t(8;21) contributes to leukemic transformation, but additional events are required for full leukemogenesis. We examined whether mutations in the receptor tyrosine kinase (RTK) ...pathway could be the genetic events that cause acute myeloblastic leukemia (AML) harboring t(8;21). Mutations in the second tyrosine kinase domain, juxtamembrane (JM) domain and exon 8 of the C-KIT gene were observed in 10, one and three of 37 AML patients with t(8;21), respectively. Three patients showed an internal tandem duplication in the JM domain of the FLT3 gene. One patient had a mutation in the K-Ras gene at codon 12. As the occurrence of these mutations was mutually exclusive, a total of 18 (49%) patients showed mutations in the RTK pathway. These results suggest that activating mutations in the RTK pathway play a role in part as an additional event leading to the development of t(8;21) AML. The 6-year cumulative incidence of relapse in patients with RTK pathway mutations was 79.8%, compared with 13.5% in patients lacking such mutations (P=0.0029). Furthermore, the 6-year relapse-free survival in patients with mutations was 18% compared to 60% in those without mutations (P=0.0340), indicating that RTK mutations are associated with the clinical outcome in t(8;21) AML.
Fibrosis and excessive extracellular matrix production are characteristic features of lacrimal gland chronic GVHD (cGVHD). Tranilast (n-3,4-anthoranilic acid), used for fibrotic skin disease, ...inhibits transforming growth factor-beta-induced matrix production. We conducted a non-randomized study comparing 8 patients (five men, three women; median age, 47 years) given topical tranilast with 10 patients (three men, seven women; median age, 37 years) receiving therapy with topical artificial tears, sodium hyaluronate and vitamin A for mild ocular cGVHD. The tranilast group instilled topical tranilast and artificial tears q.i.d., beginning the day of dry eye diagnosis. The ocular surface and tear dynamics of each patient were evaluated before hematopoietic stem cell transplant, at the onset of dry eye and after 3 months of treatment. At 3 months, the scores of the Rose Bengal test and Schirmer test with nasal stimulation had significantly improved in the tranilast group compared with that in the control group (P<0.05). Furthermore, although five control patients (50%) developed severe dry eye within the treatment period, only one tranilast-treated patient (12.5%) did; the rest still had mild dry eye (P<0.05). These results suggest the hypothesis that topical tranilast may effectively retard the progression of mild dry eye associated with cGVHD.
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