Predictors of successful vaginal birth after a caesarean in women with a previous single caesarean delivery.

OBJECTIVE: The aim of our study was to present our case series of the trial of labor after a caesarean (TOLAC) and determine significant predictors for a successful vaginal birth after a caesarean (VBAC). PATIENTS AND METHODS: Women with previous single caesarean deliveries who underwent TOLAC between January 2016-December 2019 were included in the study (n = 474). All files were analyzed in terms of demographic characteristics, obstetric history, history of index pregnancy and medical characteristics of previous caesarean delivery. For each current pregnancy, we recorded time from the previous delivery, the BISHOP and TOLAC scores at admission, induction of labor, gestational age at delivery, estimated fetal weight, intrapartum characteristics, mode of delivery and intra-operative findings. RESULTS: Among 474 women who had a previous caesarean delivery and gave consent for TOLAC, 216 resulted in a successful vaginal delivery, whereas 258 underwent repeat caesarean delivery. One hundred and seventy-nine women gave up trial of vaginal delivery during labor. The success rate of VBAC after exclusion of caesarean cases due to maternal requests was 73.2%. The induction rate was significantly higher in cases with successful VBAC (40% vs. 29.1%). The risk of uterine rupture was 0.42% in cases with labor induction. ROC analysis showed significant predictive values of the TOLAC score, body mass index (BMI), the number of previous VBACs and the number of previous vaginal deliveries, birth weight and the BISHOP score at admission. CONCLUSIONS: Our data showed us that major determinants for successful VBAC following labor are the BISHOP score at admission, number of previous vaginal deliveries, body mass index, birth weight and the TOLAC score calculated at admission.

Modeling the effects of climatic and land use changes on phytoplankton and water quality of the largest Turkish freshwater lake: Lake Beysehir.

Climate change and intense land use practices are the main threats to ecosystem structure and services of Mediterranean lakes. Therefore, it is essential to predict the future changes and develop mitigation measures to combat such pressures. In this study, Lake Beysehir, the largest freshwater lake in the Mediterranean basin, was selected to study the impacts of climate change and various land use scenarios on the ecosystem dynamics of Mediterranean freshwater ecosystems and the services that they provide. For this purpose, we linked catchment model outputs to the two different processed-based lake models: PCLake and GLM-AED, and tested the scenarios of five General Circulation Models, two Representation Concentration Pathways and three different land use scenarios, which enable us to consider the various sources of uncertainty. Climate change and land use scenarios generally predicted strong future decreases in hydraulic and nutrient loads from the catchment to the lake. These changes in loads translated into alterations in water level as well as minor changes in chlorophyll a (Chl-a) concentrations. We also observed an increased abundance of cyanobacteria in both lake models. Total phosphorus, temperature and hydraulic loading were found to be the most important variables determining cyanobacteria biomass. As the future scenarios revealed only minor changes in Chl-a due to the significant decrease in nutrient loads, our results highlight that reduced nutrient loading in a warming world may play a crucial role in offsetting the effects of temperature on phytoplankton growth. However, our results also showed increased abundance of cyanobacteria in the future may threaten ecosystem integrity and may limit drinking water ecosystem services. In addition, extended periods of decreased hydraulic loads from the catchment and increased evaporation may lead to water level reductions and may diminish the ecosystem services of the lake as a water supply for irrigation and drinking water.

The convention and the consequences of the 8th European Donor Day in Istanbul, Turkey.

The 8th European Donor Day took place in Istanbul, Turkey, on October 14, 2006. It was jointly sponsored by the Council of Europe and the Local Health Care Directorate of Istanbul. International problems of transplantation and organ donation were discussed in the public arena by professionals in five round tables. As a result, the importance of working together internationally to promote organ donation was strongly emphasized, and the immediate positive consequences of this kind of collaboration in Istanbul were discussed.

Protein kinase C activity and hexamethylenebisacetamide-induced erythroleukemia cell differentiation.

Hexamethylenebisacetamide (HMBA) is a potent inducer of murine erythroleukemia (MEL) cell differentiation. The mechanism of action of HMBA is not known. In this study we provide evidence that protein kinase C has a role in inducer-mediated MEL cell differentiation: (i) HMBA induces the formation of a soluble, proteolytically activated form of protein kinase C that is catalytically active in the absence of Ca2+ and phospholipid; (ii) the protease inhibitor leupeptin blocks formation of this activated form of the kinase and inhibits HMBA-induced MEL cell hemoglobin accumulation; (iii) phorbol 12-myristate 13-acetate (PMA) inhibits HMBA-induced MEL differentiation and causes depletion of total protein kinase C activity; (iv) MEL cells depleted in protein kinase C activity by culture with PMA are resistant to induction by HMBA; (v) upon removal of PMA, restoration of MEL cell sensitivity to HMBA is correlated with reaccumulation of protein kinase C activity; and (vi) MEL cells grown to density arrest are both depleted of protein kinase C activity and resistant to HMBA. Together, these results suggest that HMBA-mediated MEL cell differentiation involves a protein kinase C-related mechanism and the proteolytically activated form of the kinase, which does not require Ca2+ or phospholipid for its catalytic activity.

Lymphocyte recognition of lymph node high endothelium. VI. Evidence of distinct structures mediating binding to high endothelial cells of lymph nodes and Peyer's patches.

Lymphocytes migrate from blood into lymph nodes (LN) and Peyer's patches (PP) of rats specifically at segments of venules lined by high endothelium (HEV). We previously identified and isolated a lymphocyte surface component termed high endothelial binding factor (HEBF) that appears to be involved in lymphocyte adhesion to high endothelial cells of LN. HEBF has also been isolated from thoracic duct lymph and is antigenically related to the cell surface component. Soluble HEBF derived from detergent lysates of thoracic duct lymphocytes (TDL) or directly from lymph has affinity for HEVLN in vitro, and is able to block sites where lymphocytes would normally attach. In the present study, lymphocyte binding sites of HEVLN and HEVPP were investigated through the use of lymph-derived HEBF and rabbit antibody to this factor. The results show that treatment of rat TDL with anti-HEBF Fab did not block binding to HEVPP, even though adhesion to HEVLN was reduced by 80% or more. Similarly, HEBF isolated by anti-HEBF F(ab')2 affinity chromatography blocked lymphocyte binding sites of HEVLN but not HEVPP. This material is therefore designated HEBFLN, and antibody to it is designated anti-HEBFLN Ig. Fractionation of thoracic duct lymph revealed that it contained an antigenically distinct component, HEBFPP, which blocked lymphocyte binding to HEVPP but not to HEVLN. Lymph components precipitating between 40 and 60% (NH4)2SO4 saturation contained both factors, which were separated from the bulk of lymph proteins by DEAE-Sepharose chromatography and then from each other by fractionation on the anti-HEBFLN F(ab')2-Sepharose column. The unbound fraction from this column contained HEBFPP, which was then partially purified by CM-Sepharose filtration. HEBFPP appeared to be a glycoprotein because it was destroyed by trypsin, bound to lentil lectin, and was eluted with alpha-methyl-mannoside. Together, the results demonstrate the existence of two antigenically distinct species of HEBF, and imply that lymphocyte binding sites of HEVLN and HEVPP are structurally different. We interpret the results to mean that distinct high endothelial adhesion molecules on lymphocytes mediate their entry into LN and PP.