A large familial cluster and sporadic cases of frontal fibrosing alopecia in Brazil reinforce known human leucocyte antigen (HLA) associations and indicate new HLA susceptibility haplotypes.

BACKGROUND: Frontal fibrosing alopecia (FFA) is a lymphocytic scarring alopecia whose worldwide incidence is rising. Environmental triggers combined with genetic predisposition represent one of the current hypotheses in FFA aetiology. Familial clusters are opportunities to investigate the genetic basis of diseases. OBJECTIVES: Assess human leucocyte antigen (HLA) genetic variability in a Brazilian sample of a large familial cluster (six sisters and one daughter) with FFA, unnafected familiar members and sporadic cases of FFA. METHODS: We addressed the HLA-A, HLA-B, HLA-C, HLA-G and HLA-E genetic variability in this family and in seven sporadic FFA cases, comparing allele frequencies with those reported for the São Paulo State from Brazil. RESULTS: Two susceptibility haplotypes, C*17:01:01:02/B*42:01:01:01 and C*07:02:01:03/B*07:02:01:01, were identified among familial cases and also in sporadic cases. The first haplotype is rare among Brazilians, and it was not previously reported as being associated with FFA. Both alleles were found in some different unaffected familiars, what emphasizes the role of environmental triggers in disease development. HLA-A, HLA-G and HLA-E genes were not associated to familiar nor FFA sporadic cases. CONCLUSION: The identification of susceptibility haplotypes in FFA reinforces the genetic predisposition to the disease.

Cleaning cassava genotypes infected with cassava frogskin disease via in vitro shoot tip culture.

This study aimed to develop a methodology for eliminating cassava frogskin disease (CFSD) from in vitro shoot tip culture by associating thermotherapy and tetracycline. Cuttings from different accessions (BGM0232, BGM0315, BGM0464, BGM584, BGM0841, and BGM1342), infected with CFSD according to visual inspection of the disease symptoms, were used for cleaning. To verify the absence of other diseases, the plants were indexed for Cassava common mosaic virus - CsCMV (by ELISA) and Cassava vein mosaic virus - CsVMV (by polymerase chain reaction, PCR), proving that the accessions were free of these viruses, except for BGM0315 and BGM0464, which were infected with CsVMV. Subsequently, the cuttings were submitted to different tetracycline concentrations for 3 min, and then subjected to thermotherapy under different temperatures (35°, 38°, 40°, 45°, and 55°C). Shoots of 2 cm were harvested, and their surfaces were sterilized in a laminar flow chamber. Subsequently, the shoot tips of different sizes were removed (0.2, 0.4, 0.5, and 1.0 mm) for inoculation in a culture medium with tetracycline at the same concentrations in which the cuttings were dipped. After 60 days of cultivation, the explants were transferred to a multiplication medium without antibiotics. Thirty days after the transfer, the viability of the regenerated plants was evaluated, which were then acclimatized for 70 days in a greenhouse and transferred to the field. After 7 months, a visual analysis of the symptomatic roots and a PCR analysis were held to prove the elimination of CFSD and CsVMV from the accessions infected with these viruses (BGM0315 and BGM0464), respectively. Most of the treatments resulted in 100% cleaning of CFSD-infected plants. From accessions that were also infected with CsVMV, only 2% of the plants remained infected, also demonstrating the cleaning efficiency of this protocol for this disease.

A wearable, highly stable, strain and bending sensor based on high aspect ratio graphite nanobelts.

A simple and scalable method was developed for the fabrication of wearable strain and bending sensors, based on high aspect ratio (length/thickness ∼10(3)) graphite nanobelt thin films deposited by a modified Langmuir-Blodgett technique onto flexible polymer substrates. The sensing mechanism is based on the changes in contact resistance between individual nanobelts upon substrate deformation. Very high sensor response stability for more than 5000 strain-release cycles and a device power consumption as low as 1 nW were achieved. The device maximum stretchability is limited by the metal electrodes and the polymer substrate; the maximum strain that could be applied to the polymer used in this work was 40%. Bending tests carried out for various radii of curvature demonstrated distinct sensor responses for positive and negative curvatures. The graphite nanobelt thin flexible films were successfully tested for acoustic vibration and heartbeat sensing.

Sperm abnormalities induced by pre-pubertal exposure to cyclophosphamide are effectively mitigated by Moringa oleifera leaf extract.

Moringa oleifera L. is a medicinal plant with potential antioxidant property. This study was aimed at investigating the chemoprotective effect of Moringa oleifera leaf extract (MOE) on cyclophosphamide (CP)-induced testicular toxicity. Two-week-old male Swiss albino mice were intraperitoneally injected with phosphate-buffered saline, 50 mg kg(-1) of CP and 25 mg kg(-1) of MOE. In combination treatment, mice were injected with 25 mg kg(-1) of MOE 24 h prior to CP injection, 24 h prior and post-CP injection and 24 h post-CP injection for 5 consecutive days (10 mg kg(-1) ). Six weeks later, mice were sacrificed to assess epididymal sperm parameters. MOE alone did not have any significant effect on sperm parameters. However, acute injection of CP resulted in significant decline in motility (P < 0.001), increase in head abnormality (P < 0.01) and DNA damage (P < 0.05). Combining MOE with CP increased the sperm density, motility and reduced head defect and DNA damage, irrespective of the schedule and dosage of MOE. Administration of MOE prior to CP significantly elevated the level of superoxide dismutase and catalase with concomitant decrease in lipid peroxidation in the testicular tissue. In conclusion, MOE may have potential benefit in reducing the loss of male gonadal function following chemotherapy.

Genetic fidelity and variability of micropropagated cassava plants (Manihot esculenta Crantz) evaluated using ISSR markers.

Molecular markers are efficient for assessing the genetic fidelity of various species of plants after in vitro culture. In this study, we evaluated the genetic fidelity and variability of micropropagated cassava plants (Manihot esculenta Crantz) using inter-simple sequence repeat markers. Twenty-two cassava accessions from the Embrapa Cassava & Fruits Germplasm Bank were used. For each accession, DNA was extracted from a plant maintained in the field and from 3 plants grown in vitro. For DNA amplification, 27 inter-simple sequence repeat primers were used, of which 24 generated 175 bands; 100 of those bands were polymorphic and were used to study genetic variability among accessions of cassava plants maintained in the field. Based on the genetic distance matrix calculated using the arithmetic complement of the Jaccard's index, genotypes were clustered using the unweighted pair group method using arithmetic averages. The number of bands per primer was 2-13, with an average of 7.3. For most micropropagated accessions, the fidelity study showed no genetic variation between plants of the same accessions maintained in the field and those maintained in vitro, confirming the high genetic fidelity of the micropropagated plants. However, genetic variability was observed among different accessions grown in the field, and clustering based on the dissimilarity matrix revealed 7 groups. Inter-simple sequence repeat markers were efficient for detecting the genetic homogeneity of cassava plants derived from meristem culture, demonstrating the reliability of this propagation system.

Morphological study of rat skin flaps treated with subcutaneous dimethyl sulfoxide combined with hyperbaric oxygen therapy.

This study investigated the effects of hyperbaric oxygen therapy (HBOT) and dimethyl sulfoxide (DMSO) in tissue necrosis, genotoxicity, and cell apoptosis. Random skin flaps were made in 50 male Wistar rats, randomly divided into the following groups. Control group (CT), wherein a rectangular skin section (2 x 8 cm) was dissected from the dorsal muscle layer, preserving the cranial vessels, lifted, and refixed to the bed; distilled water (DW) group, in which DW was injected into the distal half of the skin flap; DMSO group, wherein 5% DMSO was injected; HBOT group, comprising animals treated only with HBOT; and HBOT + DMSO group, comprising animals treated with 100% oxygen at 2.5 atmospheres absolute for 1 h, 2 h after the experiment, daily for 10 consecutive days. A skinflap specimen investigated by microscopy. The percentage of necrosis was not significantly different between groups. The cell viability index was significantly different between groups (P < 0.001): 87.40% (CT), 86.20% (DW), 84.60% (DMSO), 86.60% (DMSO + HBO), and 91% (HBO) (P < 0.001), as was the cell apoptosis index of 12.60 (CT), 12.00 (DW), 15.40 (DMSO), 9.00 (HBO), and 12.00 (DMSO + HBO) (P < 0.001). The genotoxicity test revealed the percentage of cells with DNA damage to be 22.80 (CT), 22.60 (DW), 26.00 (DMSO), 8.80 (DMSO + HBO), and 7.20 (HBO) (P < 0.001). Although the necrotic area was not different between groups, there was a significant reduction in the cellular DNA damage and apoptosis index in the HBOT group.

Morphology of the superior gluteal nerve: a study in adult human cadavers.

The superior gluteal nerve (SGN) arises from the sacral plexus and enters the gluteal region above the piriformis where it divides into superior and an inferior branches. Former ends in the gluteus medius and occasionally gluteus minimus whereas latter supplies gluteus medius and minimus and ends in tensor fascia latae. Variations, relations, branching pattern and length of the SGN were reported in earlier studies. The present study was conducted to establish preliminary data on the length and branching pattern of the SGN and its relations with the neighbouring bony landmarks. Twenty two lower extremities were examined in 22 male and 13 female formalin fixed cadavers. Tip of the greater trochanter was determined as the point of reference. Statistical analysis was done using student's T test. Present study will help orthopedicians performing total hip replacement through lateral and transgluteal approaches (Tab. 3, Fig. 4, Ref. 19).

Characterization of the normal fetal circulatory system of the ductus venosus using sound complexity parameters.

The aim of this study was to characterize the normality of the fetal circulatory system through the time between ventricular systoles of the ductus venosus in the three gestational trimesters in healthy fetuses using nonlinear methods of the complexity of the signal. A prospective cohort study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) from December 2019 to May 2020. Pregnant women between 11 and 14 weeks, with intrauterine pregnancy and healthy fetus were included. Patients with multiple gestation, positive screening for congenital malformation, including heart disease, and under 18 years of age were excluded. Doppler velocimetry ultrasonography of the ductus venosus was performed between the 11th and 14th weeks, 20th and 24th weeks, and 28th and 32nd weeks of gestation, and then the sound signal was extracted and segmented from the videos. To compare the means between the gestational trimesters of the approximate entropy (ApEn) and Lempel-Ziv complexity (CLZ) of the time between ventricular systoles, the Friedman test was used, with a significance level of 5%. No statistically significant difference was found between the 1st, 2nd, and 3rd trimesters regarding the mean ApEn (P=0.281) and CLZ (P=0.595) of the time between ventricular systoles of the ductus venosus. Ductus venosus systolic time was not sensitive to differentiate fetal cardiovascular dynamics between gestational trimesters. This study pioneered the characterization of cardiovascular normality by nonlinear parameters of the fetal ductus venosus in all three trimesters.

Opiliofauna (ARACHNIDA: OPILIONES) of the Atlantic Forest in the state of Paraná, Brazil.

Opiliones are arachnids that provide different services in terrestrial ecosystems, especially in tropical forests, which justifies inventory studies to better understand the occurrence and distribution of these arthropods in Brazil, since little is known about the harvestmen fauna in Conservation Units such as in the state of Paraná. In this context, the objective of the present study was to survey the harvestmen fauna at the Iguaçu National Park (PARNA) and in the Bela Vista Biological Refuge (BVBR), from September 2021 to May 2022, using a sampling effort of 40 hours in the BVBR, and 66 hours at the PARNA Iguaçu. Ten species/morphospecies were recorded, highlighting a new occurrence for Brazil, the species Opisthoplatus vegetus. The present study reduces the information gap about Opiliones in the state, which reaffirms the importance of Conservation Units for the protection of the biota in the state of Paraná.

Dealing with initial inconclusive serological results for chronic Chagas disease in clinical practice.

Most guidelines for Chagas disease recommend the performance of two serological tests in order to detect it. However, inconclusive results may arise from this strategy. The aim was to describe whether serological follow-up together with the patient's clinical characteristics could clarify the outcome of patients with initial inconclusive test results. In this retrospective case series, all results of Chagas disease serological tests and outpatient visits recorded from 2004 to 2008 were screened for inclusion. The inclusion criterion was clinical suspicion of chronic Chagas disease and the exclusion criteria were previous diagnosis of Chagas disease, suspicion of acute Chagas disease, and serological tests with no corresponding medical evaluation. A total of 1,732 patients were analyzed. Chronic Chagas disease prevalence was 21.1%. After the initial set of serological tests, 2.9% of patients had inconclusive test results. Most of these patients had definite diagnosis after clinical follow-up and the repetition of serological tests in a new blood sample. Loss to follow-up while partaking in the diagnostic investigation reached 17.7%. The prevalence of initial inconclusive serological tests for chronic Chagas disease is low. Clinical evaluations and follow-up clarify the definite diagnosis. Noncompliance to follow-up is a frequent problem. Strategies to reduce inconclusive results and noncompliance are discussed.

Effect of cyclophosphamide exposure on the migration of primordial germ cells in rat fetuses.

OBJECTIVES OF THE STUDY: Effect of a single dose of cyclophosphamide on migration of the primordial germ cells (PGC), when they are about to reach gonadal ridge was investigated histochemically by staining for alkaline phosphatase. This may throw some light on the fate of gonadal ridge when exposed to the drug itself or its breakdown products such as acrolein, which is present as an environmental pollutant. MATERIALS AND METHODS: Twelve pregnant Charles foster rats were divided in to control and treatment groups and kept in separate cages. In the experimental group, Cyclophosphamide 20 mg/kg/body weight was injected intraperitoneally on day 12 of gestation. Transverse sections of fetuses collected on day 16 of gestation were stained for alkaline phosphatase activity. Outcome of the study was analysed by scanning the photomicrographs and represented by photomicrographs. RESULTS: An unique finding in experimental group in the gonadal ridge consisted of homogeneously distributed pale staining cells. The gonadal ridge-mesonephros junction showed a single big cluster of the PGC. Under higher magnification, the PGC could be identified by oval or circular shape with well-defined cell membranes and very distinct dark brown staining. There were no signs of degeneration or disintegration of these cells. CONCLUSIONS: Cyclophosphamide exposure led to failure of PGC to spread inwards from the gonadal ridge-mesonephros junction giving rise to a situation so far not reported in literature. The presented phenomenon will result in improper development of the gonads leading to infertility in an affected individual in future generation (Fig. 4, Ref. 18).

Analysis of the arterial anatomical variations of thyroid gland: anatomic guide for surgical neck dissection.

PURPOSE: Aim of this study was to establish preliminary data on the variations of arterial supply of thyroid gland in Karnataka population. METHODS: The anterior triangles in the neck of formalin fixed cadavers were dissected. The length, branching pattern, number and length of branches of superior thyroid artery (STA) were noted. We measured the length of inferior thyroid artery (ITA) from its point of emergence from thyrocervical trunk (TCT) to lower pole of thyroid gland. The length of the external carotid artery (ECA), TCT from the point of its emergence to the point of its branching was noted. We noted the number of branches from ITA and TCT. Presence of any additional artery supplying the thyroid gland was searched for. Difference in the length of STA and ITA between the two sexes and sides were noted. Statistical analysis was done by Student's t-test. RESULTS: In our study the maximum length of STA was 5.34cm and that of ITA was 5.07cm and there were no statistically significant side-to-side differences in level of bifurcation. CONCLUSIONS: Observations of the present study on the course and branching pattern of arteries around thyroid gland will help in easier approach during thyroid surgeries and interventional techniques (Tab. 1, Fig. 3, Ref. 38).

Morphometry and magnetic resonance imaging of anterior cruciate ligament and measurement of secondary signs of anterior cruciate ligament tear.

UNLABELLED: Injuries or over-stretching of the anterior cruciate ligament (ACL) may lead to its malfunctioning. ACL tear, partial or complete, canto the result of contact or non-contact injuries. To conduct morphometry of ACL, twenty six knees (14 right and 12 left) were examined in 21 male and 5 female formalin fixed cadavers. Measurement of tibial foot print of ACL, distance of its anterior edge from the anterior margin of tibia, length and width of ACL were determined with the help of digital caliper. Indirect signs of ACL tear (sagittal ACL-tibial angle, coronal ACL - tibial angle, Blumensaat line - ACL angle and angle of inclination of the intercondylar roof) complement the magnetic resonance imaging (MRI) diagnosis of ACL injury. We also studied the consequences of meniscal and posterior cruciate ligament injuries on above mentioned angles. In addition 84 MRI images of knees of patients aged between 18 - 74 years were evaluated for diagnosis of any disruption in the morphology of ACL. In our study, mean length of the tibial foot print of ACL was 18.34 ± 3.49 mm, mean width of tibial foot print was 15.26 ± 2.01, mean distance from the anterior edge of tibia to anterior margin of attachment of ACL was 13.11 ± 2.34, length and width of ACL were 32.5 ± 4.33 mm and 9.38 ± 1.58 mm, respectively. The present study will be useful for enhancing the knowledge of anatomy of ACL and may act as a valuable guide for radiologists in evaluating the injury to knee involving ACL, menisci and PCL (Tab. 5, Fig. 9, Ref. 17). KEYWORDS: anterior cruciate ligament, magnetic resonance imaging, posterior cruciate ligament, meniscus, tibia, tear, injury.

Ovarian development in Wistar rat treated prenatally with single dose diisobutyl phthalate.

Phthalates are a class of industrial compounds with an array of toxicological properties used in day to day life. Diisobutyl phthalate on (DIBP) is used as an additive to keep the plastics soft or flexible (plasticizer) in nitrocellulose plastic, nail polish, explosives, lacquer manufacturing etc. Although DIBP exposure in humans is generally low, people in adhesive industries and pharmaceutical industries are exposed to higher levels. The aim of this study was to determine the effect of single dose of DIBP on developing ovary of Wistar rat. One hundred and eight adult pregnant Wistar rats were divided into control and experimental groups. Rats in experimental group were given DIBP on day 10, 12 and 14 of gestation at 0.375, 0.75 and 1.25 ml/kg body weight dose intraperitoneally in a single dose. Sections of ovaries collected on day 21 of gestation were stained with hematoxylin and eosin and examined and Masson's trichrome histologically. Sections belonging to the control group showed the presence of oocytes in clusters separated by thin fibrous septa. Degeneration oocytes, empty follicles surrounded by follicular cells without gonocytes in the center were observed in ovarian stroma. Blood vessels in the ovarian stroma were prominent and congested. Around a bunch of follicles total architectural disarray was observed although on special staining fibrosis was not evident. As pregnant women are constantly exposed, effect of DIBP on ovary of a developing fetus would denote the long term consequence in future generations (Fig. 5, Ref. 39).

Variations in the course and microanatomical study of the lateral femoral cutaneous nerve and its clinical importance.

The lateral femoral cutaneous nerve (LFCN), a branch from the lumbar plexus, may come to the clinician's or surgeon's attention. We studied this nerve to determine its location and its relationship with neighboring structures around the anterior superior iliac spine (ASIS) and the inguinal ligament (IL). Additionally, cross-sectional microanatomy of the LFCN at the IL was studied. The LFCN was dissected in 47 lower limbs from formalin-fixed cadavers. The distances from the ASIS to the point where the LFCN crossed the IL and the lateral border of the sartorius were measured. The distance between the ASIS and the point it pierced the deep fascia was also measured. Twelve nerve specimens at the IL were collected for histological sectioning and were stained with hematoxylin and eosin. On examination of the cross-sectional area, the nonfascicular area was wider than the fascicular area because of an increased amount of thick collagen fibers. This study may be of help to clinicians managing meralgia paresthetica and may also assist in defining a safe area for surgical intervention on the anterolateral aspect of the thigh.

Distribution of sympathetic fiber areas of radial nerve in the forearm: an immunohistochemical study in cadavers.

PURPOSE: Secondary to peripheral nerve injuries, involvement of sympathetic fibers complications such as complex regional pain syndrome (CRPS) have been reported. There are limited studies on the sympathetic fibers and their distribution in the upper limb nerves. There are no reports available in the distribution of the sympathetic fibers/areas of radial nerve in the forearm. The aim of the present study was an attempt to find the distribution of sympathetic fibers in the radial nerve just above cubital fossa (RN), superficial branch of radial nerve at cubital fossa (SBRN-1) and above wrist (SBRN-2). METHODS: We have studied on 19 fresh human cadaveric RN, SBRN-1, and SBRN-2 samples. Frozen sections of these nerves were processed by immunohistochemical (tyrosine hydroxylase) method for sympathetic fibers. RESULTS: The sympathetic fibers area (Asym) was found to be more in RN when compared to SBRN-1 and SBRN-2. The comparison of the sympathetic index (SI = sympathetic fibers area/total fascicular area of the nerve) between RN and SBRN-1 (p < 0.001), RN and SBRN-2 (p < 0.001), and SBRN-1 and SBRN-2 (p = 0.016) were statistically significant. The sympathetic index (SI) for SBRN-1 was more when compared to RN and SBRN-2. CONCLUSIONS: Sympathetic fibers area (Asym) was found to be more in RN when compared to SBRN-1 and SBRN-2. The sympathetic ratio (SI) and percentage of sympathetic fibers area (Asym %) was more in SBRN-1 when compared to RN and SBRN-2. These results of the study might help to explain sympathetic system-related diseases in the area of distribution of RN and SBRN.

5HT expression in the stomach and duodenum of the Rhesus Monkey (Macaca mulatta).

This study aims to provide a histological description of different regions of the gastric and duodenal mucosa in Rhesus monkey, as well as to analyze the distribution and the relative frequency of 5-HT. The cardia region mucosa consists of simple columnar epithelium PAS + and AB + and the 5-HT cells were observed at the base of the gland (QA [5-HT cells]/mm²) = 8.72 ±â€¯4.98). The body region, has a smaller number of glands. The 5-HT cells were found predominant in the base of the gastric glands. QA= 6.96 ±â€¯3.81. When compared to body region, the stomach fundus has smaller gastric pits. The 5-HT cells are found at the base of the glands near the main cells. QA = 5.29 ±â€¯2.09. The pylorus region was found to have deep pits and well-developed gastric glands. The 5-HT cells are scarce, at the base of the pyloric gland. QA = 1.18 ±â€¯1.36. The duodenum presented goblet cells strong PAS + and AB +. 5-HT cells were found both in the lining epithelium and in the intestinal glands. QA = 8.16 ±â€¯2.59.

Effects of high- and moderate-intensity exercise on central hemodynamic and oxygen uptake recovery kinetics in CHF-COPD overlap.

The oxygen uptake (V˙O2) kinetics during onset of and recovery from exercise have been shown to provide valuable parameters regarding functional capacity of both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients. To investigate the influence of comorbidity of COPD in patients with CHF with reduced ejection fraction on recovery from submaximal exercise, 9 CHF-COPD male patients and 10 age-, gender-, and left ventricle ejection fraction (LVEF)-matched CHF patients underwent constant-load exercise tests (CLET) at moderate and high loads. The V˙O2, heart rate (HR), and cardiac output (CO) recovery kinetics were determined for the monoexponential relationship between these variables and time. Within-group analysis showed that the recovery time constant of HR (P<0.05, d=1.19 for CHF and 0.85 for CHF-COPD) and CO (P<0.05, d=1.68 for CHF and 0.69 for CHF-COPD) and the mean response time (MRT) of CO (P<0.05, d=1.84 for CHF and 0.73 for CHF-COPD) were slower when moderate and high loads were compared. CHF-COPD patients showed smaller amplitude of CO recovery kinetics (P<0.05) for both moderate (d=2.15) and high (d=1.07) CLET. Although the recovery time constant and MRT means were greater in CHF-COPD, CHF and CHF-COPD groups were not differently affected by load (P>0.05 in group vs load analysis). The ventilatory efficiency was related to MRT of V˙O2 during high CLET (r=0.71). Our results suggested that the combination of CHF and COPD may further impair the recovery kinetics compared to CHF alone.

Doppler velocimetry of the uterine, umbilical and fetal middle cerebral arteries in pregnant women undergoing tocolysis with oral nifedipine.

OBJECTIVES: To evaluate Doppler velocimetry (resistance index (RI) and peak systolic velocity (PSV)) in the maternal-fetal circulation before and 5 and 24 h after tocolysis with oral nifedipine. METHODS: This was a prospective, observational, analytic cohort study performed in 47 pregnant women undergoing nifedipine tocolysis, each subject acting as her own control. Doppler assessment of uterine, umbilical and fetal middle cerebral (MCA) arteries was performed before and 5 and 24 h after an initial 20-mg sublingual dose, which was repeated twice at 20-min intervals if contractions failed to diminish. The maintenance dose consisted of 20 mg orally every 6 h for 24 h up to a total of 100-120 mg nifedipine. We analyzed whether there was a time effect and compared values at the different time-points. RESULTS: The MCA-RI had decreased significantly after 24 h of tocolysis (0 h = 0.85; 5 h = 0.85; 24 h = 0.81; P = 0.001), with no differences in uterine or umbilical arteries or in the MCA to umbilical artery ratio. The MCA-PSV had reduced significantly after 5 h (0 h = 41.5 cm/s; 5 h = 34.7 cm/s; P = 0.001), returning close to baseline levels between 5 and 24 h. The PSV increased significantly between 5 and 24 h in the right uterine artery (5 h = 55.1 cm/s; 24 h = 65.0 cm/s; P = 0.037) and in the umbilical artery (5 h = 28.4 cm/s; 24 h = 33.1 cm/s; P = 0.038). CONCLUSIONS: Nifedipine tocolysis is associated with a reduction in RI in the MCA but not in the uterine or umbilical arteries, a reduction in PSV in the MCA after 5 h but returning to baseline within 24 h, and an increase in PSV between 5 and 24 h in the umbilical and right uterine arteries.

Comparison of sublingual versus vaginal misoprostol for the induction of labour: a systematic review.

BACKGROUND: The induction of full-term labour in women with a live fetus remains a major challenge in modern obstetrics. OBJECTIVES: To determine, using the best level of evidence available, the efficacy and safety of sublingual administration of misoprostol compared with vaginal misoprostol in the third trimester of pregnancy for the induction of labour, according to initial doses, in women with a live, full-term fetus and an unripe cervix. SEARCH STRATEGY: Pubmed/Medline, Lilacs and Scielo databases were consulted, as well as clinical trials registered in the Cochrane Register from January 1996 to February 2008, using the keywords 'misoprostol', 'labour, obstetric', 'delivery, obstetric', 'induced labour' and 'parturition' with the search limits of 'clinical trials' and 'randomised clinical trials'. SELECTION CRITERIA: This review contains randomised clinical trials in which the sublingual and vaginal routes of administration of misoprostol were compared. Participants were pregnant women with an indication for induction of labour and a live fetus more than 37 weeks of gestational age. DATA COLLECTION AND ANALYSIS: The primary analysis compared sublingual and vaginal routes of administration of misoprostol. Secondary analyses compared different routes and initial doses of misoprostol. Statistical analysis included odds ratios and their respective 95% CI. To evaluate the heterogeneity of the studies, the I-squared test was used, studies being considered heterogeneous when I 2 was greater than 50%. MAIN RESULTS: Five good quality clinical trials involving a total of 740 women were eligible, and all were included. No statistically significant difference was found between the sublingual and the vaginal misoprostol groups with respect to the rate of vaginal delivery not achieved within 24 hours (OR 1.27, 95% CI 0.87-1.84), uterine hyperstimulation syndrome (OR 1.20, 95% CI 0.61-2.33) or caesarean section (OR 1.33, 95% CI 0.96-1.85). An increased risk of uterine tachysystole was found in the sublingual misoprostol group (OR 1.70, 95% CI 1.02-2.83). When the studies were grouped according to the initial dose of misoprostol, no significant difference was found between sublingual or vaginal groups. AUTHOR'S CONCLUSIONS: The sublingual route of administration is as effective as the vaginal route in inducing labour in full-term pregnancies with live fetuses. However, the safety, adverse effects, optimal dose and perinatal outcome related to this route of administration remain to be established, and it cannot be recommended for routine use in obstetric practice.