Offering women a choice in induction of labour: a prospective cohort study.

PURPOSE: To evaluate women's choice in the method of labour induction between oral misoprostol, PGE2 pessary and the Foley catheter. To compare women's satisfaction according to their choice and to identify factors associated with patient satisfaction. METHODS: We conducted a comparative, prospective cohort study of 520 women who chose their preferred method for labour induction, in a French tertiary hospital, from July 2019 to October 2020. Before and after the delivery, they were asked to argue their choice and to evaluate their satisfaction through the use of questionnaires. The primary outcome was global level of satisfaction. RESULTS: Of the 520 women included, 67.5% of women chose oral misoprostol compared to 21% PGE2 pessary and 11.5% Foley catheter. Regarding global satisfaction, we found no significant difference between the three groups: 78.4%, 68.8% and 71.2% (p = 0.107) for, respectively, oral misoprostol, PGE2 pessary and Foley catheter. Factors that seem to improve women's satisfaction were nulliparity (aOR = 2.03, 95% CI [1.19-3.53]), delivery within 24 h after the start of induction (aOR = 3.46, 95% CI [2.02-6.14]) and adequate information (aOR = 4.21, 95% CI [1.869.64]). Factors associated with lower satisfaction rates were postpartum haemorrhage (aOR = 0.51, 95% CI [0.30-0.88]) and caesarean section (aOR = 0.31, 95% CI [0.17-0.54]). CONCLUSION: Women satisfaction rates were not different between the three methods, when chosen by the patients themselves. These finding should encourage caregivers to promote shared decision making when possible. TRIAL REGISTRATION: The protocol was approved by the French ethics committee for research in obstetrics and gynaecology (CEROG, reference number 2019-OBS-0602) on 1st June 2019.

[Factors associated with cesarean delivery of the second twin after vaginal delivery of the first twin: A case-control study]. / Facteurs de risque de césarienne sur deuxième jumeau après accouchement voie basse du premier jumeau : étude cas-témoins.

OBJECTIVES: To identify risk factors for cesarean section of the second twin after vaginal delivery of the first twin. METHODS: Case-control study conducted between 2004 and 2018 in a tertiary center, CHU Toulouse. Cases were women with twin pregnancy who had vaginal delivery of the first twin and emergency cesarean of the second twin. Controls were women with twin pregnancy who delivered both twins vaginally. Deliveries before 24 weeks of gestation, birth weight of less than 500 grams, fetal death in utero, terminations of pregnancy and delayed delivery were excluded. The association between potential risk factors and cesarean delivery of the second twin was analyzed using multivariable logistic regression. RESULTS: Twenty-four patients who had vaginal delivery of the first twin and emergency cesarean of the second twin and 48 patients who delivered both twins vaginally were included. Neonatal morbidity was increased in the group of women who had an emergency cesarean of the second twin. In multivariable analysis, overweight (OR=10.5 [95% CI: 1.78-62.03] for women with body mass index above 25 compared to women with body mass index below 25), weight gain during pregnancy (OR=1.27 [95% CI: 1.01-1.48] for each kilogram) and preterm labor (OR=4,43 [IC 95%:1,10-17,80]) were associated with significantly increased risk of cesarean section of the second twin. CONCLUSION: Overweight and weight gain during pregnancy are associated with increased risk for cesarean section of the second twin.

Tumour and pelvic lymph node metabolic activity on FDG-PET/CT to stratify patients for para-aortic surgical staging in locally advanced cervical cancer.

PURPOSE: The aim of our study was to comprehensively evaluate the most valuable metabolic parameters of cervical tumours and pelvic lymph nodes (PLN) by FDG-PET/CT to predict para-aortic lymph node (PALN) metastasis and stratify patients for surgical staging. METHODS: The study included patients with locally advanced cervical cancer, negative PALN uptake on preoperative FDG-PET/CT, and para-aortic lymphadenectomy. Two senior nuclear medicine physicians expert in gynaecologic oncology reviewed all PET/CT exams, and extracted tumour SUVmax, MTV, and TLG, as well as PLN. Prognostic parameters of PALN involvement were identified using ROC curves and logistic regression analysis. RESULTS: One hundred and twenty-five consecutive locally advanced cervical cancer patients were included. The FDG-PET/CT false-negative rate was, respectively, 27.7% (13/47) and 5.1% (4/78) in patients with and without FDG-PET/CT PLN uptake. The AUC of cervical tumour size, SUVmax, MTV, and TLG was, respectively, 0.75 (0.62-0.87), 0.59 (0.44-0.76), 0.75 (0.60-0.90), and 0.71 (0.56-0.86). The AUC of PLN size, SUVmax, SUVmean, PLN SUVmax/Tumour SUVmax ratio, MTV, and TLG was, respectively, 0.57 (0.37-0.78), 0.82 (0.68-0.95), 0.77 (0.61-0.94), 0.85 (0.72-0.98), 0.69 (0.51-0.87), and 0.74 (0.57-0.91). The metabolic parameter showing the best trade-off between sensitivity and specificity to predict PALN involvement was the ratio between PLN and tumour SUVmax. CONCLUSION: The risk of PALN metastasis in FDG-PET/CT negative PLN patients is very low, so para-aortic lymphadenectomy does not seem justified. In patients with preoperative PLN uptake on FDG-PET/CT, surgical staging led to treatment modification in more than 25% of cases and should therefore be performed. Patients with more than one positive PLN and high PLN metabolic activity are at high risk of para-aortic extension and recurrence. Further prospective evaluation is required to consider intensified treatment modalities without prior PALN dissection.

Nonperturbative Functional Renormalization-Group Approach to the Sine-Gordon Model and the Lukyanov-Zamolodchikov Conjecture.

We study the quantum sine-Gordon model within a nonperturbative functional renormalization-group approach (FRG). This approach is benchmarked by comparing our findings for the soliton and lightest breather (soliton-antisoliton bound state) masses to exact results. We then examine the validity of the Lukyanov-Zamolodchikov conjecture for the expectation value ⟨e^{(i/2)nßφ}⟩ of the exponential fields in the massive phase (n is integer and 2π/ß denotes the periodicity of the potential in the sine-Gordon model). We find that the minimum of the relative and absolute disagreements between the FRG results and the conjecture is smaller than 0.01.

Biomarkers predict enhanced clinical outcomes with afatinib versus methotrexate in patients with second-line recurrent and/or metastatic head and neck cancer.

BACKGROUND: In the phase III LUX-Head & Neck 1 (LUX-H&N1) trial, second-line afatinib significantly improved progression-free survival (PFS) versus methotrexate in patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). Here, we evaluated association of prespecified biomarkers with efficacy outcomes in LUX-H&N1. PATIENTS AND METHODS: Randomized patients with R/M HNSCC and progression following ≥2 cycles of platinum therapy received afatinib (40 mg/day) or methotrexate (40 mg/m2/week). Tumor/serum samples were collected at study entry for patients who volunteered for inclusion in biomarker analyses. Tumor biomarkers, including p16 (prespecified subgroup; all tumor subsites), EGFR, HER2, HER3, c-MET and PTEN, were assessed using tissue microarray cores and slides; serum protein was evaluated using the VeriStrat® test. Biomarkers were correlated with efficacy outcomes. RESULTS: Of 483 randomized patients, 326 (67%) were included in the biomarker analyses; baseline characteristics were consistent with the overall study population. Median PFS favored afatinib over methotrexate in patients with p16-negative [2.7 versus 1.6 months; HR 0.70 (95% CI 0.50-0.97)], EGFR-amplified [2.8 versus 1.5 months; HR 0.53 (0.33-0.85)], HER3-low [2.8 versus 1.8 months; HR 0.57 (0.37-0.88)], and PTEN-high [1.6 versus 1.4 months; HR 0.55 (0.29-1.05)] tumors. Afatinib also improved PFS in combined subsets of patients with p16-negative and EGFR-amplified tumors [2.7 versus 1.5 months; HR 0.47 (0.28-0.80)], and patients with p16-negative tumors who were EGFR therapy-naïve [4.0 versus 2.4 months; HR 0.55 (0.31-0.98)]. PFS was improved in afatinib-treated patients who were VeriStrat 'Good' versus 'Poor' [2.7 versus 1.5 months; HR 0.71 (0.49-0.94)], but no treatment interaction was observed. Afatinib improved tumor response versus methotrexate in all subsets analyzed except for those with p16-positive disease (n = 35). CONCLUSIONS: Subgroups of HNSCC patients who may achieve increased benefit from afatinib were identified based on prespecified tumor biomarkers (p16-negative, EGFR-amplified, HER3-low, PTEN-high). Future studies are warranted to validate these findings. CLINICAL TRIAL REGISTRATION: NCT01345682.

Quantum criticality at the superconductor-insulator transition revealed by specific heat measurements.

The superconductor-insulator transition (SIT) is considered an excellent example of a quantum phase transition that is driven by quantum fluctuations at zero temperature. The quantum critical point is characterized by a diverging correlation length and a vanishing energy scale. Low-energy fluctuations near quantum criticality may be experimentally detected by specific heat, cp, measurements. Here we use a unique highly sensitive experiment to measure cp of two-dimensional granular Pb films through the SIT. The specific heat shows the usual jump at the mean field superconducting transition temperature marking the onset of Cooper pairs formation. As the film thickness is tuned towards the SIT, is relatively unchanged, while the magnitude of the jump and low-temperature specific heat increase significantly. This behaviour is taken as the thermodynamic fingerprint of quantum criticality in the vicinity of a quantum phase transition.

Reexamination of the nonperturbative renormalization-group approach to the Kosterlitz-Thouless transition.

We reexamine the two-dimensional linear O(2) model (φ4 theory) in the framework of the nonperturbative renormalization-group. From the flow equations obtained in the derivative expansion to second order and with optimization of the infrared regulator, we find a transition between a high-temperature (disordered) phase and a low-temperature phase displaying a line of fixed points and algebraic order. We obtain a picture in agreement with the standard theory of the Kosterlitz-Thouless (KT) transition and reproduce the universal features of the transition. In particular, we find the anomalous dimension η(T(KT))≃0.24 and the stiffness jump ρ(s)(T(KT)(-))≃0.64 at the transition temperature T(KT), in very good agreement with the exact results η(T(KT))=1/4 and ρ(s)(T(KT)(-))=2/π, as well as an essential singularity of the correlation length in the high-temperature phase as T→T(KT).

Thermodynamics in the vicinity of a relativistic quantum critical point in 2+1 dimensions.

We study the thermodynamics of the relativistic quantum O(N) model in two space dimensions. In the vicinity of the zero-temperature quantum critical point (QCP), the pressure can be written in the scaling form P(T)=P(0)+N(T(3)/c(2))F(N)(Δ/T), where c is the velocity of the excitations at the QCP and |Δ| a characteristic zero-temperature energy scale. Using both a large-N approach to leading order and the nonperturbative renormalization group, we compute the universal scaling function F(N). For small values of N (N/~1) regimes, but fails to describe the nonmonotonic behavior of F(N) in the quantum critical regime. We discuss the renormalization-group flows in the various regimes near the QCP and make the connection with the quantum nonlinear sigma model in the renormalized classical regime. We compute the Berezinskii-Kosterlitz-Thouless transition temperature in the quantum O(2) model and find that in the vicinity of the QCP the universal ratio T(BKT)/ρ(s)(0) is very close to π/2, implying that the stiffness ρ(s)(T(BKT)(-)) at the transition is only slightly reduced with respect to the zero-temperature stiffness ρ(s)(0). Finally, we briefly discuss the experimental determination of the universal function F(2) from the pressure of a Bose gas in an optical lattice near the superfluid-Mott-insulator transition.

Infrared behavior in systems with a broken continuous symmetry: classical O(N) model versus interacting bosons.

In systems with a spontaneously broken continuous symmetry, the perturbative loop expansion is plagued by infrared divergences due to the coupling between transverse and longitudinal fluctuations. As a result, the longitudinal susceptibility diverges and the self-energy becomes singular at low energy. We study the crossover from the high-energy Gaussian regime, where perturbation theory remains valid, to the low-energy Goldstone regime characterized by a diverging longitudinal susceptibility. We consider both the classical linear O (N) model and interacting bosons at zero temperature, using a variety of techniques: perturbation theory, hydrodynamic approach (i.e., for bosons, Popov's theory), large-N limit, and nonperturbative renormalization group. We emphasize the essential role of the Ginzburg momentum scale p{G}, below which the perturbative approach breaks down. Even though the action of (nonrelativistic) bosons includes a first-order time derivative term, we find remarkable similarities in the weak-coupling limit between the classical O(N) model and interacting bosons at zero temperature.

From local to critical fluctuations in lattice models: a nonperturbative renormalization-group approach.

We propose an implementation of the nonperturbative renormalization group (NPRG) which applies to lattice models. Contrary to the usual NPRG approach where the initial condition of the RG flow is the mean-field solution, the lattice NPRG uses the (local) limit of decoupled sites as the (initial) reference system. In the long-distance limit, it is equivalent to the usual NPRG formulation and therefore yields identical results for the critical properties. We discuss both a lattice field theory defined on a d-dimensional hypercubic lattice and classical spin models. The simplest approximation, the local potential approximation, is sufficient to obtain the critical temperature and the magnetization of the three-dimensional Ising, XY, and Heisenberg models to an accuracy on the order of 1%. We show how the local potential approximation can be improved to include a nonzero anomalous dimension η and discuss the Berezinskii-Kosterlitz-Thouless transition of the two-dimensional XY model on a square lattice.

Unified picture of superfluidity: from Bogoliubov's approximation to Popov's hydrodynamic theory.

Using a nonperturbative renormalization-group technique, we compute the momentum and frequency dependence of the anomalous self-energy and the one-particle spectral function of two-dimensional interacting bosons at zero temperature. Below a characteristic momentum scale k_{G}, where the Bogoliubov approximation breaks down, the anomalous self-energy develops a square-root singularity and the Goldstone mode of the superfluid phase (Bogoliubov sound mode) coexists with a continuum of excitations, in agreement with the predictions of Popov's hydrodynamic theory. Thus our results provide a unified picture of superfluidity in interacting boson systems and connect Bogoliubov's theory (valid for momenta larger than k_{G}) to Popov's hydrodynamic approach.

A hybrid electroabsorption modulator device for generation of high spectral-efficiency optical modulation formats.

We report a novel hybrid integrated optic device consisting of AlGaInAs/InP electroabsorption modulators and a four-arm silica-on-silicon planar lightwave circuit optical interferometer. The device is designed for generation of high spectral efficiency optical modulation formats. We demonstrate generation of 21.4 Gb/s quadrature phase shift keyed optical signals with electrical data drives of 2V(pp) amplitudes, achieving a bit error rate of 10(-9) with the required optical signal to noise ratio of ~18 dB in a 0.1 nm resolution bandwidth.

Triplet superconducting pairing and density-wave instabilities in organic conductors.

Using a renormalization group approach, we determine the phase diagram of an extended quasi-one-dimensional electron gas model that includes interchain hopping, nesting deviations, and both intrachain and interchain repulsive interactions. We find a close proximity of spin-density- and charge-density-wave phases and singlet d-wave and triplet f-wave superconducting phases. There is a striking correspondence between our results and recent puzzling experimental findings in the Bechgaard salts, including the coexistence of spin-density-wave and charge-density-wave phases and the possibility of a triplet pairing in the superconducting phase.

Plasmin converts factor X from coagulation zymogen to fibrinolysis cofactor.

Known anticoagulant pathways have been shown to exclusively inhibit blood coagulation cofactors and enzymes. In the current work, we first investigated the possibility of a novel anticoagulant mechanism that functions at the level of zymogen inactivation. Utilizing both clotting and chromogenic assays, the fibrinolysis protease plasmin was found to irreversibly inhibit the pivotal function of factor X (FX) in coagulation. This was due to cleavage at several sites, the location of which were altered by association of FX with procoagulant phospholipid (proPL). The final products were approximately 28 and approximately 47 kDa for proPL-bound and unbound FX, respectively, which did not have analogues when activated FX (FXa) was cleaved instead. We next investigated whether the FX derivatives could interact with the plasmin precursor plasminogen, and we found that plasmin exposed a binding site only on proPL-bound FX. The highest apparent affinity was for the 28-kDa fragment, which was identified as the light subunit disulfide linked to a small fragment of the heavy subunit (Met-296 to approximately Lys-330). After cleavage by plasmin, proPL-bound FX furthermore was observed to accelerate plasmin generation by tissue plasminogen activator. Thus, a feedback mechanism localized by proPL is suggested in which plasmin simultaneously inhibits FX clotting function and converts proPL-bound FX into a fibrinolysis cofactor. These data also provide the first evidence for an anticoagulant mechanism aimed directly at the zymogen FX.

Schizophrenia: revisited.

Schizophrenia is a devastating illness for the affected individuals and their families. Health care providers and researchers are also challenged by the clinical heterogeneity of this disorder. The goal of the present paper is to offer an updated overview of the aetiology, definition, clinical manifestations and pharmacological and psychosocial treatments of schizophrenia. Finally, some future directions for psychiatric nursing will be suggested in light of the existing knowledge of schizophrenia.

Restoration of tumor oxygenation after cytotoxic therapy by a perflubron emulsion/carbogen breathing.

PURPOSE: Hypoxic cells are presumed to be an obstacle to successful cancer treatment because these cells are protected from the cytotoxic effects of radiotherapy and certain anti-cancer drugs. The current study was conducted to determine the effect of cytotoxic therapy on tumor oxygenation and the effect of administration of a perfluorochemical emulsion/carbogen breathing treatment on tumor oxygenation after cytotoxic therapy. MATERIALS AND METHODS: Female Fisher 344 rats bearing 13762 mammary carcinoma cells implanted subcutaneously in a hindlimb were treated with standard therapeutic single doses of anti-tumor treatments of several types, including alkylating agents (cisplatin, melphalan, cyclophosphamide); natural products (doxorubicin, paclitaxel, etoposide); antimetabolites (fluorouracil); hypoxic cell-selective agents (mitomycin, SR-4233); and fractionated irradiation (3 Gy/day for 5 days). The oxygen levels in the tumors were measured with an Eppendorf PO2 histograph before the treatment and 24 hours after treatment under air breathing and carbogen breathing conditions, and after administration of a perflubron emulsion under air breathing and carrbogen breathing conditions. Fifty to 60 points were measured per tumor, and 8 to 10 tumors made up each group. RESULTS: The tumors were more hypoxic after treatment with every anticancer treatment. The percentage of PO2 readings < or = 5 mmHg in the untreated tumors was 49% and ranged from 85% (radiotherapy) to 59% (etoposide) in the treated tumors. Administration of the perflubron emulsion (8 mL/kg) and carbogen breathing (95% O2/5% CO2) increased the oxygenation of the tumors such that the percentage of PO2 readings < or = 5 mmHg was 32% in the untreated control tumors and ranged from 27% (radiotherapy) to 56% (doxorubicin) in the treated tumors. There was a direct correlation between the level of tumor cell killing and the increased oxygenation observed in the tumor. CONCLUSION: Tumors may be more hypoxic after an effective dose of a cytotoxic therapy, and administration of a perflubron emulsion/carbogen mixture can increase the tumor oxygen content when hypoxia is the result of cytotoxic therapy. Hypoxia produced by therapy may be regarded as a mechanism of resistance that leads to diminished tumor cell killing with subsequent doses of drugs or radiation. The restoration of tumor oxygenation by the perflubron emulsion/carbogen breathing may provide a clinically relevant means of overcoming at least in part hypoxia-related resistance.

Influence of an anti-angiogenic treatment on 9L gliosarcoma: oxygenation and response to cytotoxic therapy.

Tissue oxygen tensions were measured in subcutaneously growing rat 9L gliosarcoma under normal air and carbogen breathing conditions prior to and after i.v. administration of a perflubron emulsion. When these animals were treated with the anti-angiogenic agents TNP-470 and minocycline for 5 days prior to oxygen measurement, tumor hypoxia was decreased compared with untreated tumors. Hypoxia, defined as the percent of pO2 readings < or = 5 mm Hg, was decreased from 71% in untreated air-breathing controls to 34% in animals treated with the anti-angiogenic agents, the perflubron emulsion and carbogen breathing. These effects were manifest in the increased response of the tumor to single-dose (10, 20 and 30 Gy) radiation therapy. Twenty-four hours after treatment with BCNU oxygenation of the tumors was not altered; however, 24 hr after administration of adriamycin oxygenation of the tumors was increased such that hypoxia in adriamycin-treated tumors in animals receiving the perflubron emulsion and carbogen was reduced to 21%. Tumor growth delay in the s.c. tumors was increased by the addition of treatment with the anti-angiogenic agents from day 4 through day 18 post-tumor cell implantation along with BCNU or adriamycin on days 7-11. Administration of the perflubron emulsion and carbogen breathing resulted in increased tumor growth delay with the chemotherapeutic agents alone and in combination with the anti-angiogenic agents. Life span in animals bearing intracranially implanted 9L gliosarcoma progressively increased with administration of the anti-angiogenic agents and then the anti-angiogenic agents and perflubron emulsion/carbogen compared to treatment with BCNU or adriamycin.