Visual biofeedback for shortening second stage of labor: randomized controlled trial.

OBJECTIVE: To determine whether visual biofeedback can be used during labor as an effective tool for shortening the second stage of labor and reducing the need for instrumental delivery. METHODS: This was a single-center randomized controlled trial. Nulliparous women under epidural anesthesia were randomized at the point of full dilation into the biofeedback group (n = 50) or the control group (n = 50). Both groups received coached maternal pushing during four consecutive contractions, while an experienced obstetrician performed transperineal ultrasound. Only women in the biofeedback group observed the ultrasound display screen. Following this intervention, labor was managed routinely by the obstetric team. Angle of progression (AOP) was measured at rest and while pushing, before and during the first and fourth contractions. Second-stage duration and delivery outcomes were compared between groups. RESULTS: Visual biofeedback did not affect the duration of the second stage, which lasted for a median of 2.28 (interquartile range (IQR), 1.25-3.10) h in the biofeedback group vs 2.08 (IQR, 1.58-3.02) h in the control group (P = 0.981). AOP was significantly higher in the biofeedback group compared with the control group, both at rest before the fourth contraction (mean ± SD, 142.6° ± 15.9° vs 136.8° ± 13.1°; P = 0.049) and while pushing during the fourth contraction (mean ± SD, 159.3° ± 19.2° vs 149.4° ± 15.1°; P = 0.005). The increase in AOP was significantly higher in the biofeedback compared with the control group between rest and pushing at the last push (mean ± SD, 16.6° ± 11.0° vs 12.6° ± 8.3°; P = 0.041) and between the first rest and last push (mean ± SD, 24.4° ± 13.6° vs 17.9° ± 11.3°; P = 0.011). The rate of intact perineum was similar between groups (12% vs 8%; P = 0.505). CONCLUSIONS: Visual biofeedback during the second stage of labor may facilitate descent of fetal head during maternal pushing without affecting second-stage duration, possibly due to the short duration of the intervention. Future studies should focus on continuous intervention throughout the second stage of labor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Retroperitoneal lymph node recurrence of epithelial ovarian cancer: Prognostic factors and treatment outcome.

OBJECTIVE: To evaluate the treatment outcome and survival of patients with epithelial ovarian cancer recurrence isolated to the retroperitoneal lymph nodes compared to intraperitoneal spread. METHODS: A retrospective cohort study including women with recurrence of epithelial ovarian, cancer, who were treated at a single medical center, between 2000 and 2015. Patients were classified into three groups according to the site of recurrence: intraperitoneal only, retroperitoneal lymph nodes only, and both. Response to treatment was assessed by the RECIST criteria. RESULTS: Out of 135 patients in our cohort, 66 were diagnosed with intraperitoneal recurrence, 30 with retroperitoneal lymph node recurrence and 39 with combined site recurrence. The clinical, pathological and surgical characteristics were similar among all groups, besides CA-125 which was significantly lower in the retroperitoneal recurrence group at diagnosis, end of treatment and recurrence. The median follow-up period was 45.8 months. Overall survival (OS) and post relapse survival (PRS) were significantly higher in the retroperitoneal recurrence group vs. the intraperitoneal and combined site recurrence groups. (OS - 93.07, 47.9 and 41.7 months, respectively, p < .001, PRS - 68.57, 29.67 and 19.7 months, respectively, p < .001). On cox's regression analysis, retroperitoneal recurrence was found to be an independent prognostic factor for survival. CONCLUSIONS: The site of recurrence has significant prognostic value regarding PRS and OS. Patients with recurrence limited to the retroperitoneal lymph nodes have a favourable prognosis with median survival longer than 5 years.

Conductance saturation in a series of highly transmitting molecular junctions.

Revealing the mechanisms of electronic transport through metal-molecule interfaces is of central importance for a variety of molecule-based devices. A key method for understanding these mechanisms is based on the study of conductance versus molecule length in molecular junctions. However, previous works focused on transport governed either by coherent tunnelling or hopping, both at low conductance. Here, we study the upper limit of conductance across metal-molecule-metal interfaces. Using highly conducting single-molecule junctions based on oligoacenes with increasing length, we find that the conductance saturates at an upper limit where it is independent of molecule length. With the aid of two prototype systems, in which the molecules are contacted by either Ag or Pt electrodes, we find two different possible origins for conductance saturation. The results are explained by an intuitive model, backed by ab initio calculations. Our findings shed light on the mechanisms that constrain the conductance of metal-molecule interfaces at the high-transmission limit.

Electron-vibration interaction in the presence of a switchable Kondo resonance realized in a molecular junction.

The interaction of individual electrons with vibrations has been extensively studied. However, the nature of electron-vibration interaction in the presence of many-body electron correlations such as a Kondo state has not been fully investigated. Here, we present transport measurements on a Copper-phthalocyanine molecule, suspended between two silver electrodes in a break-junction setup. Our measurements reveal both zero bias and satellite conductance peaks, which are identified as Kondo resonances with a similar Kondo temperature. The relation of the satellite peaks to electron-vibration interaction is corroborated using several independent spectroscopic indications, as well as ab initio calculations. Further analysis reveals that the contribution of vibration-induced inelastic current is significant in the presence of a Kondo resonance.

A framework for identifying factors controlling cyanobacterium Microcystis flos-aquae blooms by coupled CCM-ECCM Bayesian networks.

Cyanobacterial blooms in freshwater sources are a global concern, and gaining insight into their causes is crucial for effective resource management and control. In this study, we present a novel computational framework for the causal analysis of cyanobacterial harmful algal blooms (cyanoHABs) in Lake Kinneret. Our framework integrates Convergent Cross Mapping (CCM) and Extended CCM (ECCM) causal networks with Bayesian Network (BN) models. The constructed CCM-ECCM causal networks and BN models unveil significant interactions among factors influencing cyanoHAB formation. These interactions have been validated by domain experts and supported by evidence from peer-reviewed publications. Our findings suggest that Microcystis flos-aquae levels are influenced not only by community structure but also by ammonium, phosphate, oxygen, and temperature levels in the weeks preceding bloom occurrences. We demonstrated a non-parametric computational framework for causal analysis of a multivariate ecosystem. Our framework offers a more comprehensive understanding of the underlying mechanisms driving M. flos-aquae blooms in Lake Kinneret. It captures complex interactions and provides an explainable prediction model. By considering causal relationships, temporal dynamics, and joint probabilities of environmental factors, the proposed framework enhances our understanding of cyanoHABs in Lake Kinneret.

Assessment of seasonal pattern of idiopathic sudden sensorineural hearing loss: a retrospective cross-sectional study.

BACKGROUND: A seasonal trend of patients with idiopathic sudden sensorineural hearing loss may direct research into possible aetiology. METHODS: This study reviewed data from the medical records of patients who presented from 2004 to 2019 and who were diagnosed with new-onset idiopathic sudden sensorineural hearing loss. Seasonal pattern was assessed using chi-square and Rayleigh tests, and further confirmed by Monte Carlo simulation. RESULTS: The study included 740 patients with a mean age of 48.3 years and a median age of 49 years. There was no statistical evidence for a difference in the distribution of sensorineural hearing loss cases for the four seasons of each year or with the cumulative data. New-onset idiopathic sudden sensorineural hearing loss cases averaged around 11 per month; there was no statistical evidence for a seasonal difference, as determined either by the Rayleigh test or with Monte Carlo simulation. CONCLUSION: There was no evidence to support the claim that idiopathic sudden sensorineural hearing loss incidence displays a seasonal pattern. More research is necessary to explore potential external factors such as climate or infection.

Normalisation of spot urine samples to 24-h collection for assessment of exposure to uranium.

For dose assessment of workers at Nuclear Research Center Negev exposed to natural uranium, spot urine samples are analysed and the results are normalised to 24-h urine excretion based on 'standard' man urine volume of 1.6 l d(-1). In the present work, the urine volume, uranium level and creatinine concentration were determined in two or three 24-h urine collections from 133 male workers (319 samples) and 33 female workers (88 samples). Three volunteers provided urine spot samples from each voiding during a 24-h period and a good correlation was found between the relative level of creatinine and uranium in spot samples collected from the same individual. The results show that normalisation of uranium concentration to creatinine in a spot sample represents the 24-h content of uranium better than normalisation to the standard volume and may be used to reduce the uncertainty of dose assessment based on spot samples.

Metallurgical investigation on fourth century BCE silver jewellery of two hoards from Samaria.

A fourth century BCE silver jewellery collection, which is part of two hoards of Samarian coins (the Samaria and Nablus Hoards), was studied by non-destructive analyses. The collection, which consists of pendants, rings, beads and earrings, had been examined by visual testing, multi-focal microscopy and SEM-EDS analysis. In order to enhance our knowledge of past technologies of silver jewellery production, we developed a metallurgical methodology based on the chemical composition of the joints and bulk. The results show that all artefacts are made of silver containing a small percentage of copper. Higher copper concentrations were measured in the joining regions. Our research indicates that the manufacturing of the jewellery from both hoards involved similar techniques, including casting, cutting, hammering, bending, granulating and joining methods, indicating that the artefacts were made by trained silversmiths. Although the burial date of the Samaria Hoard - 352 BCE - is some 21 years earlier than that of the Nablus Hoard - circa 331 BCE, a noted continuity in the local production technology is apparent in the analysed items. This information provides better understanding of the technological abilities in the late Persian-period province of Samaria and bears implications on the local silver coins produced in the region.

The prothrombin 20209 C-->T mutation in Jewish-Moroccan Caucasians: molecular analysis of gain-of-function of 3' end processing.

BACKGROUND: Mutations of the 3' end mRNA-processing signal of the prothrombin (F2) gene have been reported to cause elevated F2 plasma concentrations, thrombosis, and complications of pregnancy. Whereas the common F2 20210*A mutation is almost exclusively found in Caucasians, the F2 20209*T mutation has been reported in Afro-Americans and Afro-Caribbeans only. PATIENTS AND METHODS: Using LightCycler technology, three unrelated Jewish-Moroccan patients tested for obstetric complications were found to be carriers of the F2 20209*T allele. A detailed molecular analysis was performed to identify the functional impact of this mutation. RESULTS: We report three unrelated women of Jewish-Moroccan origin with a F2 20209*T mutation and fetal loss or infertility. The functional analysis revealed that the F2 20209*T mutation stimulates 3' end processing and up-regulates prothrombin protein expression as assessed by a highly sensitive luminescence-based reporter system. CONCLUSIONS: This is the first report of 20209*T in Caucasians, and functional analysis demonstrates that F2 20209*T falls into a general category of mutations of the F2 gene, which may possibly contribute to thrombophilia and complications of pregnancy by interfering with a tightly balanced architecture of non-canonical F2 3' end formation signals.

Electronic properties of doped molecular thin films measured by Kelvin probe force microscopy.

We report on high-resolution electronic measurements of doped organic thin-film transistors using Kelvin probe force microscopy. Measurements conducted on field effect transistors made of N,NI-diphenyl-N,NI-bis(1-naphthyl)-1,1I-biphenyl-4,4I-diamine p-doped with tetrafluoro-tetracyanoquinodimethane have allowed us to determine the rich structure of the doping-induced density of states. In addition, the doping process changes only slightly the Fermi energy position with respect to the highest occupied molecular orbital level center. The moderate change is explained by two counter-acting effects on the Fermi energy position: the doping-induced additional charge and the broadening of the density of states.

Determination of 234U/238U ratio: comparison of multi-collector ICPMS and ICP-QMS for water, hair and nails samples, and comparison with alpha-spectrometry for water samples.

The (234)U/(238)U ratio in water, hair and nails samples was determined by multi-collector inductively coupled plasma mass spectrometry (MC-ICPMS) and inductively coupled plasma quadrupole mass spectrometry (ICP-QMS) and by alpha-spectrometry for the water samples only. A correlation of 0.99 was found between the two ICPMS methods and of 0.98 with alpha-spectrometry. The range of activity ratios was between 0.9 and 2.6 according to the MC-ICPMS measurements. The reproducibility of both ICPMS techniques was better than 4% for water samples containing 1 mug l(-1) of uranium and a (234)U/(238)U atom ratio of 54.9 x 10(-6). Sample preparation for the ICPMS consisted of dilution of water samples containing >10 microg l(-1) of uranium and measurement time was approximately 1 min, while alpha-spectrometry involved pre-concentration and separation of the uranium and counting times of 1,000 min.

Measurement of the 234U/238U ratio by MC-ICPMS in drinking water, hair, nails, and urine as an indicator of uranium exposure source.

The isotopic ratio (234)U/(238)U in drinking water and in hair, toenail, and urine samples from 45 individuals who consumed 0.2-2775 microg d(-1) of uranium in their drinking water was determined using a multi-collector inductively coupled plasma mass spectrometer (MC-ICPMS). The U/U atom ratio in the water samples varied from 51 x 10(-6) to 252 x 10(-6) whereas in secular equilibrium (i.e., unity activity ratio) the ratio is 54.9 x 10(-6). The correlation of the (234)U/(238)U ratio between hair and nail samples was 0.98, and between hair and nails and urine the ratio was 0.91 and 0.89, respectively. The correlation of the ratio between water and the hair or nails was 0.97 but only 0.72 for water and urine, possibly due to spectral interferences. These results conclusively demonstrated that the uranium found in the bioassays can be traced to the drinking water, thus providing a direct link to the source of exposure. Hair may serve as an excellent indicator of occupational or environmental exposure to uranium and provide information regarding its source. Bioassay of hair is attractive as it is an effective bio-concentrator, samples can be easily stored, the concentration reflects an integrated value, and, finally, the measurement of the (234)U/(238)U isotopic ratio in digested hair samples by MC-ICPMS is feasible and highly informative. Hair bioassay can also be used to assess exposure to depleted uranium long after the subjects have left the area suspected of contamination.

Urine, hair, and nails as indicators for ingestion of uranium in drinking water.

The concentration of uranium in urine, hair, and nails due to continuous exposure through ingestion of drinking water was studied. The study population consisted of 205 individuals living in 134 different households in southern Finland where drinking water is supplied from private drilled wells. The population was selected to include a broad range of uranium daily intake from drinking water (0.03-2,775 microg d). The uranium content in drinking water, urine (overnight collection), hair and nails was determined by ICPMS. Uranium in urine was corrected for the matrix effects by use of thallium as an internal standard and adjusted by creatinine normalization. Hair and toenail samples were rinsed to remove external contamination prior to acid digestion and analysis. The uranium content in all excretion pathways was correlated with the uranium intake, particularly at elevated levels (> or =10 microg d) where drinking water was the major source of exposure to uranium. The median of the individual uranium absorption factors for urine, hair, and toenails were fu=0.003, fh=0.003, and fn=4 x 10, respectively. The association between the different bioassays was examined. The absorption factor, f1, was calculated for the population with an intake above 10 microg d and was below 0.01 for 72% of the study persons (range 0.0002 to 0.070). No statistically significant difference in f1 values was found between women and men. However, the absorption factor was higher among younger (< 60 y) than older (> or =60 y) subjects and among people with a lower exposure (below 100 microg d) than among those that ingest over 100 microg d.

The relative frequency of hereditary thrombotic disorders among 107 patients with thrombophilia in Israel.

Since most patients with thrombophilia in Israel are referred for diagnosis to our center, it was possible to estimate the relative frequency of the hereditary disorders leading to thrombophilia. 107 unrelated patients were evaluated over 4 years. Diagnoses were established in 23 patients (21.5%) while in 84 (78.5%) no abnormality was detected. Antithrombin III deficiency was found in 8 patients (7.5%), dominant protein C deficiency in 6 (5.6%), recessive homozygous protein C deficiency in 1, protein S deficiency in 3 (2.8%) and dysfibrinogenemia in 1. Four additional patients (3.7%) had a lupus anticoagulant. The frequency of deep vein thrombosis and pulmonary embolism was similar in patients with and without a definite diagnosis. Thrombosis of visceral or cerebral vessels and a positive family history were more frequent among patients in whom a definite diagnosis was made. In both groups there was a substantial lag between the time of presentation of the first thrombotic episode and the time of evaluation. Since the number of referred patients with thrombophilia has gradually increased over the period of the study, it is at present impossible to establish the prevalence of the various hereditary disorders leading to thrombophilia in the population.

Use of sunscreen is linked with elevated naevi counts in Israeli school children and adolescents.

Epidemiological evidence indicates that a fair complexion and exposure to solar radiation in early years contribute to the proliferation of naevi and subsequent melanoma risk. To determine whether protection from sunlight is associated with lower naevi counts, we examined the prevalence and risk factors of naevi in a sample of Israeli school pupils. Whole body counts of naevi were recorded in 974 out of 1312 (74.2%) recruited pupils (7 and 12 year olds) from Ramat-Gan and Jerusalem. Host characteristics and habits of sun exposure were obtained using questionnaires. In each age group and geographic area, the mean whole body naevi counts, adjusted for confounders, were higher among males, pupils of European-American descent, and those susceptible to sunburn. The contributions to naevi risk of fair skin colour and frequent recreational sun exposure were higher among 7 year olds. Regular sunscreen use contributed to the naevi risk for both age strata in Ramat-Gan (at age 7, rate ratio [RR] = 1.7, 95% confidence interval [CI] = 1.3-2.2; at age 12, RR = 1.5, 95% CI = 1.1-2.1). Among the younger age group in Ramat-Gan, even seldom compared with no use of sunscreen was associated with higher naevi counts (RR= 1.5, 95% CI = 1.2-2.0). Similar patterns were noted with the pupils from Jerusalem. In conclusion, the elevated naevi count with increased sunscreen use indicates that sunscreens apparently do not modify the genetic predisposition to naevi proliferation. For better protection of children and adolescents, including those who use sunscreens, from the naevogenic effect of solar radiation, they should be encouraged to limit their exposure and wear protective clothing when in the sun.

The outcome of bacterial infection in subjects with benign familial leukopenia (BFL).

Benign familial leukopenia (BFL) is a hereditary phenomenon, encountered in several ethnic groups. Subjects bearing BFL are believed to be affected by bacterial infection in no greater incidence than normal subjects. In our study we investigated a group of subjects with BFL during an acute bacterial infection in comparison to subjects without BFL with the same infection. We found that the subjects with BFL had no absolute leukocytosis during the infection. Nevertheless, they reacted similarly to the other subjects in regard to their temperature and heart rate; however, they were hospitalized for fewer days than subjects without BFL. We conclude that BFL is a benign phenomenon, requiring neither specific treatment as such, nor more aggressive therapy during infection. The benign course of an acute bacterial infection in BFL indicates that perhaps the number of WBC's that are normally recruited during an infection in normal subjects highly exceeds that which is necessary.

[Cutaneous larva migrans].

Larva migrans is a rare cutaneous parasitic infestation, whose incidence in Israel has increased over the past few years. This is mainly due to the growing number of Israelis traveling to the Far East and to Central and South America. We present 4 such cases. The treatment of choice for this parasite is thiabendazole, an imidazole with anthelminthic properties.