The evolution of organic material on Asteroid 162173 Ryugu and its delivery to Earth.

The recent return of samples from asteroid 162173 Ryugu provides a first insight into early Solar System prebiotic evolution from known planetary bodies. Ryugu's samples are CI chondrite-like, rich in water and organic material, and primarily composed of phyllosilicate. This phyllosilicate surrounds micron to submicron macromolecular organic particles known as insoluble organic matter. Using advanced microscopy techniques on Hayabusa-2 samples, we find that aqueous alteration on Ryugu produced organic particles richer in aromatics compared to less altered carbonaceous chondrites. This challenges the view that aromatic-rich organic matter formed pre-accretion. Additionally, widespread diffuse organic material occurs in phyllosilicate more aliphatic-, carboxylic-rich, and aromatic-poor than the discrete organic particles, likely preserving the soluble organic material. Some organic particles evolved to encapsulate phyllosilicate, indicating that aqueous alteration on Ryugu led to the containment of soluble organic matter within these particles. Earth therefore has been, and continues to be, delivered micron-sized polymeric organic objects containing biologically relevant molecules.

New estrogen-free oral hormonal contraceptive (Estrogene free ill-EFP).

Methods of hormonal contraception are an important tool in the implementation of family planning. Although the primary design of hormonal contraceptives was based on a combination of estrogenic and progestogenic components, the most important component of hormonal contraceptives is the progestin molecule responsible for the anti-gonadotropic effect leading to ovulation inhibition, increased cervical mucus viscosity and endometrial desynchronization. The combination of progestins with estrogens has improved the bleeding profile, but it has increased the risk of cardiovascular complications, particularly deep venous thrombosis and pulmonary embolism, in patients at specific risk. The development of purely progestogenic contraceptives is being conducted to eliminate these cardiovascular risks. A new hormonal contraceptive based on oral drospirenone alone at a daily dose of 4 mg administered in a 24-active tablet + 4 days hormone-free interval shows contraceptive efficacy and bleeding profile consistent with combined hormonal contraceptives and high safety profile as the risk of deep vein thrombosis and pulmonary embolism does not increase according to recent clinical studies. It appears to be a very effective alternative to combination products suitable for a wide range of users.

A model for predicting unscheduled caesarean section in nulliparae.

OBJECTIVE: The objective of the study is to analyze the predictors of unplanned cesarean section in nulliparae. DESIGN: Prospective cohort study. SETTING: Institute for the Care of Mother and Child in Prague. METHODS: This study consisted of nulliparae giving birth between the 37th and 42nd weeks of singleton low-risk pregnancy, with the fetus in vertex position and without primary indication for CS. Selected prenatal and intranatal factors were analyzed in relation to acute CS due to a failure to progress in labor and/or fetal distress. Using logistic regression analysis (LR1-3) and the classification tree method (chi-square automatic interaction detector 1-2), five prediction models were tested. RESULTS: Of 3,728 nulliparae, 908 (24.4%) had an acute CS. All logistic regression models were comparable (receiver operating characteristic (ROC) 0.837-0.0881) and identified the occiput posterior position (OPP) of the fetus, maternal age, and epidural analgesia as the most influential risk factors. Spontaneous onset of labor, oxytocin administration, and maternal body height decreased are likely indicated for acute CS. The ability to predict a vaginal delivery was 95.7-96.3% and CS was 58.5-61.8%. The classification tree method (ROC 0.860-0.861) identified similar risk factors such as the OPP, peridural analgesia, and spontaneous onset of labor. The prediction abilities were similar at 94.5-96.4% for vaginal delivery and 64.6-59.0% for CS. CONCLUSION: OPP of the fetus was the strongest risk factor for the unsuccessful trial of vaginal labor.

[Myo-inositol in the treatment of polycystic ovary syndrome]. / Myoinositol v terapii syndromu polycystických ovarií

OBJECTIVE: Presentation of a comprehensive body of knowledge on the role of insulin sensitizer myo-inositol in the treatment of polycystic ovary syndrome (PCOS). DESIGN: Review article. SETTING: Institute for the Care of Mother and Child, Prague. METHOD: An overview of publishing data. RESULTS AND CONCLUSION: Polycystic ovary syndrome is the most common cause of ovarian dysfunction and anovulatory infertility in women. The insulin resistance occurs very frequently as a part of PCOS. This paper reviews the literature documenting the effectiveness of insulin sensitizer myo-inositol in the treatment of ovarian dysfunction, symptoms of hyperandrogenism and wide complex of symptoms of metabolic syndrome. Six randomized controlled trials provides evidence of a positive effect of myo-inositol to normalize ovarian function, improve laboratory and clinical manifestations of hyperandrogenism and insulin resistance. The myo-inositol treatment has been demonstrated as a safe method of PCOS management.

[The safety of home birth and evidence-based medicine]. / Bezpecnost domácích porodu a medicína zalozená na dukazech.

OBJECTIVE: To review the available scientific evidence of perinatal outcome of planned home births and their reflection in the Czech Republic. DESIGN: Review article. SETTING: Institute for the Care of Mother and Child, Prague - Podolí. METHOD: An overview of recently published data. RESULTS: Results of studies that evaluate the safety of planned home births are inconsistent and burdened by methodological limitations (selection bias, the absence of randomized trials, insufficient sample size and the lack of a control group). Evidence of argument that home birth is as safe as hospital birth, are insufficient. Consensual acceptance of home birth is conditioned by the exclusion of individual risk of complications, presence of qualified personnel and availability of emergency transfer to hospital. CONCLUSION: Study of the safety of planned home births are methodologically limited and their results are inconsistent. Currently, there is no professional, organizational and legal framework for the management of planned home births in the Czech Republic.

[Characteristics and prognosis of malignant disease of the breast in women of very low age]. / Vlastnosti a prognóza zhoubného onemocnení prsu u zen velmi nízkého veku.

OBJECTIVE: This study aims to describe characteristics of malignant diseases of the breast in women of very low age (thus with breast cancer diagnosed before 35th year of age) and compare those characteristics with the phenotype of "average" breast cancer in Czech female population. METHODS: 98 women diagnosed with breast cancer before the age of 35 and treated between 2001 and 2010 in private medical center Medicon Praha s.r.o, were enrolled to this retrospective study. The control group of 100 women was constituted by random choice from patients older than 35 years at the time of diagnosis treated in the same time period. RESULTS: Size of the tumors at presentation were similar in both study groups. Tumors in younger group exhibited higher proliferative activity, higher grade and lower count of estrogen receptors. On the contrary, in the group of older women was significantly higher percentage of lobular type of cancer and also the proportion of in situ carcinomas. The number of multifocal tumors, positivity of HER-2/neu and progesterone receptors were all without statistically significant difference. In younger women neoadjuvant chemotherapy has been used more frequently. Prognosis of the disease did not differ in both groups. CONCLUSION: Tumors diagnosed in women younger than 35 years can be considered more aggressive. However, using adequate treatment makes the prognosis comparable in both age groups.

[Contraceptive methods used by women in the period before and after giving birth]. / Praxe v pouzívání kontracepcních metod u zen v období pred porodem a po porodu.

GOAL OF THE STUDY: To provide information on the knowledge and practices involving the use of the contraceptive methods employed by women of a fertile age, especially in the period of lactation. DESIGN: A cross-section, descriptive study. SETTING: Institute for the Care of Mother and Child, Prague; Department of Gynaecology and Obstetrics at the Institute of Postgraduate Education in Healthcare, Prague; Cegedim Strategic Data CZ s.r.o., Prague. METHODOLOGY: The method involved a written questionnaire in a structured form. The investigation was undertaken in two phases; the first round took place directly after giving birth, while the second took place 6 months after giving birth. The group consisted of 4535 women who gave birth at the Institute for the Care of Mother and Child in the period between 15. 11. 2006 - 15. 11. 2007. RESULTS: 2540 women (56.0%) answered the questions in the first round; 85% of them were in the 26-35 age group, 44.3% were secondary school graduates and 36.7% were university graduates. 61.3% were first-time mothers, 32.3% were second-time mothers and 5.4% were third-time mothers. Contraception used before current gravidity: (n=2540) oral hormonal contraception 59.7%, a condom 11.1%, intrauterine contraception 1.0% and 20.6% of the women used no contraceptive method. The users of oral hormonal contraception (n=1517) were most frequently prescribed (12.8% of the women) a preparation containing 20 microg ethinylestradiol and 150 eLg desogestrel (Mercilon). The contraception used during the course of lactation after a birth in the group of mothers of more than one child (n=982): oral hormonal contraception 19.6%, a condom 17.1%, intrauterine contraception 1.3%, no contraceptive method 54.5%. Breastfeeding users of oral hormonal contraception (n=192) were most frequently prescribed (20.3% of women) a preparation containing 500 microg lynestrenol (Exluton) and a preparation containing 75 microg desogestrel (Cerazette) (16.1% of women). The contraceptive methods planned by women after birth (n=2540): oral hormonal contraceptive 36.5%, a condom 18.8%, intrauterine contraception 18.8%, no method 20.1%. 1440 women (56.7%) answered the questions in the second round; 83.5% of them were in the 26-35 age group, 45.0% were secondary school graduates and 37.0% were university graduates. 64.4% were first-time mothers, 30.6% were second time mothers and 4.2% were third-time mothers. 74.6% of women were still breastfeeding 6 months after giving birth. Contraception used by breastfeeding women (n=1074): oral hormone contraception 27.6%, a condom 21.8%, an intrauterine system with levonorgestrel 2.8%, intrauterine contraception 2.4%, no method 39.5%. Contraception used by non-breastfeeding women (n=366): oral hormonal contraception 42.1%, a condom 15.0%, an intrauterine system with levonorgestrel 2.7%, intrauterine contraception 2.7%, no method 31.4%. In both groups of women, the users of oral hormonal contraception were most frequently prescribed a preparation containing 75 pg desogestrel (Cerazette); this accounted for 99.3% of the breastfeeding women and 18.8% of those not breastfeeding. 40.0% of breastfeeding and 48.4% of non-breastfeeding women are planning to use hormonal contraception in the coming period. The self-evaluation of the knowledge of contraception methods (n=2540): 61.6% of women evaluated their knowledge as good, but 77.6% of women did not know a suitable hormonal contraceptive for the period of lactation. According to 80.7% of the women, their main source of expert information in the area of family planning is their gynaecologist. CONCLUSION: The prevalence of breastfeeding women 6 months after giving birth is high in the monitored group. Oral hormonal contraceptives are the most frequently used contraceptive method in general, including during the lactation period when women prefer a preparation containing 75 microg desogestrel regardless of whether or not they are breastfeeding. The women's knowledge of suitable methods of contraception during the period of lactation is unsatisfactory and represents a challenge for healthcare providers to improve the amount of information available to women in this area

[Caesarean section--indication or choice?]. / Císarský rez--indikace, nebo volba?

Currently, caesarean section is the most commonly indicated procedure. The proportion of caesarean deliveries continues to rise. And the spectrum of surgical indications has dramatically broadened. This contemplation is focused on the general outcome of surgical indications. The procedure is indicated on the basis of scientific evidence only in a limited manner, more often it is indicated on the basis of empiric results and significant subjective motivation of the participants - the indicating physician and pregnant patient. There is insufficient proof to conclusively demonstrate an increased or decreased risk of elective caesarean section as compared to a trial of labor. Thus making it ethical and professionally acceptable to perform a caesarean section based on the wish of a competent and well-informed pregnant woman.

[Cesarean scar ectopic pregnancy]. / Ektopická gravidita v jizve po císarském rezu.

OBJECTIVE: To present our clinical experience with cases of ectopic implantation in the uterine scar of a prior cesarean section and to analyse current articles with this topic. The authors experienced two cases of cesarean scar pregnancy with different clinical management and outcome. DESIGN: Review article, case report. SETTING: Institute for the Care of Mother and Child, Prague, Institute for Postgraduate Medical Education, Prague. RESULTS: We experienced two cases of cesarean scar pregnancy during the year 2006. Missed abortion in the 12th week of pregnancy was diagnosed in the first patient. During instrumental evacuation of the uterine cavity in the district hospital severe bleeding occured. After transfer to our department abdominal hysterectomy was performed. In the second case early ultrasonographic diagnosis of ectopic nidation was completed. Hysteroscopic evaluation of gestational sac with subsequent instrumental evacuation with ultrasonographic assistance was performed as a fertility saving operation. Subsequent systemic application of methotrexate was indicated after surgery. CONCLUSION: Cesarean scar pregnancy occurs in 1/800 - 1/2216 normal pregnancies. Early sonographic diagnosis enables surgical or medicamentous treatment preserving the fertility of the patient. Late or absent diagnosis of pathological implantation can cause severe uterine bleeding. Treatment options preserving fertility can not be used and hysterectomy is then the only life saving procedure.

[Pregnancy after laparoscopic myomectomy--long-term follow up]. / Tehotenství po laparoskopické myomektomii--dlouhodobé sledování.

OBJECTIVE: Analysis of pregnancy related complications in infertile patient after laparoscopic myometomy (LM). DESIGN: Retrospective analytic study. SETTING: Institute for the Care of Mother and Child, Prague; Institute for Postgraduate Medical Education, Prague. METHODS: The study group were infertile patients referred to our department with the finding of uterine fibroid(s). In all patients LM was the method of choice. Thorough information and results from all infertile patient after LM were assessed and analysed with 18 months follow-up after surgery. RESULTS: The aim of our study was to evaluate pregnancy rate and the possible risks during pregnancy and delivery following LM. We analysed 69 patients after LM. Mean size of a fibroid was 3.3 cm and the number of removed fibroids in one patient was 1.8. The conception rate after LM was 56.5%. We didn't observe any increased incidence of fetomaternal morbidity or severe pregnancy and labour related complications. There was no uterine rupture after LM in our group. The cesarean section was rate 44.8%. CONCLUSIONS: The impact of fiborids on infertility is still controversial. LM in infertile patient is one of the most common surgical procedure. The appropriate surgical management of uterine scar is mandatory. This operation must be performed by skilled reproductive surgeon. Thorough information to the patient before and after LM is necessary. The pregnancy following LM is at high risk with increased caesarean section rate.

[Informed consent in gynecology and obstetrics]. / Informovaný souhlas v gynekologii a porodnictví.

OBJECTIVE: A systematic review of recent available literature on the topic of informed consent, evaluation of the terminus a quo and the creation of theoretical basis for execution of the process of informed consent in clinical practice with attention to specific aspects in gynecology and obstetrics. TYPE OF STUDY: Review of literature. SETTING: Mother and Child Care Institute Prague, Chair of Gynecology and Obstetrics, IPVZ, Prague. METHODS: Review of publications on the given topic and implementation of general principles of medical ethics in the area of gynecology and obstetrics. RESULTS: The branch of gynecology and obstetrics brings about various controversial clinical situations, which arise from specific features of the branch. The informed consent is an integral part of the diagnostic-therapeutic process and precondition of the correct (lege artis) procedure. The adequate agreement with the therapy should be informed, free and competent. It prevents ethical crisis in conditions of an ethical conflict. The paper defines the content and structure of the informed consent and draws attention to its technical prerequisites so as to fulfill the truthfulness and legal validity. CONCLUSION: The informed consent is an important part of communication between the physician and the patient. The physician provides a complex, qualified, truthful and complete information. A competent patient accepts this kind of information and decides, based on full understanding, when and in what form, undergoes the recommended procedure or refuses it.

[Pregnancy complications after intrauterine hysteroscopic surgery]. / Tehotenské komplikace po intrauterinní hysteroskopické chirurgii.

OBJECTIVE: To evaluate our clinical experience of cases of pregnancy after transcervical septum resection and endometrial ablation. There are several case reports in the literature showing increase fetomaternal morbidity after intrauterine surgery. DESIGN: Analytic retrospective study. SETTING: Mother and Child Care Institute, Prague, Institute for Postgraduate Medical Education, Prague. RESULTS: There were three cases of severe complications during pregnancy after intrauterine surgery. We experienced one case of uterine rupture after transcervical septum resection in the second stage of labour. The other two cases were pregnancies after endometrial ablation and septum resection complicated with severe bleeding in the second trimester. CONCLUSION: Pregnancies after some types of intrauterine surgery (septum resection, endometrial ablation) are at high risk. They can lead to increased fetomaternal morbidity. We recommend intensive prenatal care with immediate surgical intervention when complications occur.