Cervical cerclage for preterm birth prevention in twin gestation with short cervix: a retrospective cohort study.

OBJECTIVE: To determine if cervical cerclage reduces the rate of spontaneous early preterm birth in cases of dichorionic-diamniotic (DCDA) twin gestation with an ultrasound-detected short cervix. METHODS: This was a retrospective cohort study of 40 consecutive DCDA twin gestations at Saint Peter's University Hospital from November 2006 to November 2014 in which cervical cerclage was performed for an ultrasound-determined cervical length of 1-24 mm at 16-24 weeks' gestation. The cases were matched with 40 controls without cerclage for cervical length and gestational age at cervical assessment. The primary outcome measure was spontaneous birth < 32 weeks. RESULTS: There was no difference between the two groups in maternal age, body mass index (BMI), cigarette smoking, use of in-vitro fertilization (IVF), parity and prior spontaneous preterm birth. There were more Caucasian women among the controls compared with cases. In the cases, compared with controls, spontaneous delivery < 32 weeks was significantly less frequent (20.0% vs 50.0%; relative risk, 0.40 (95% CI, 0.20-0.80)). In the prediction of spontaneous delivery < 32 weeks, logistic regression analysis demonstrated that the risk was reduced with the insertion of cervical cerclage (odds ratio, 0.22 (95% CI, 0.058-0.835); P = 0.026), corrected for maternal age, BMI, racial origin, cigarette smoking, IVF, parity and previous preterm birth. CONCLUSION: In DCDA twin gestation with a short cervix, treatment with cervical cerclage may reduce the rate of early preterm birth. The findings suggest the need for adequate randomized controlled trials on cerclage in twin gestations with a short cervix. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Use of watershed factors to predict consumer surfactant risk, water quality, and habitat quality in the upper Trinity River, Texas.

Surfactants are high production volume chemicals that are used in a wide assortment of "down-the-drain" consumer products. Wastewater treatment plants (WWTPs) generally remove 85 to more than 99% of all surfactants from influents, but residual concentrations are discharged into receiving waters via wastewater treatment plant effluents. The Trinity River that flows through the Dallas-Fort Worth metropolitan area, Texas, is an ideal study site for surfactants due to the high ratio of wastewater treatment plant effluent to river flow (>95%) during late summer months, providing an interesting scenario for surfactant loading into the environment. The objective of this project was to determine whether surfactant concentrations, expressed as toxic units, in-stream water quality, and aquatic habitat in the upper Trinity River could be predicted based on easily accessible watershed characteristics. Surface water and pore water samples were collected in late summer 2005 at 11 sites on the Trinity River in and around the Dallas-Fort Worth metropolitan area. Effluents of 4 major waste water treatment plants that discharge effluents into the Trinity River were also sampled. General chemistries and individual surfactant concentrations were determined, and total surfactant toxic units were calculated. GIS models of geospatial, anthropogenic factors (e.g., population density) and natural factors (e.g., soil organic matter) were collected and analyzed according to subwatersheds. Multiple regression analyses using the stepwise maximum R(2) improvement method were performed to develop prediction models of surfactant risk, water quality, and aquatic habitat (dependent variables) using the geospatial parameters (independent variables) that characterized the upper Trinity River watershed. We show that GIS modeling has the potential to be a reliable and inexpensive method of predicting water and habitat quality in the upper Trinity River watershed and perhaps other highly urbanized watersheds in semi-arid regions.

Role of alpha7-nicotinic acetylcholine receptor in human non-small cell lung cancer proliferation.

OBJECTIVES: Lung cancer is the most common cause of cancer death in the world. Cigarette smoking represents the major risk factor. Nicotine, an active component of cigarettes, can induce cell proliferation, angiogenesis and apoptosis resistance. All these events are mediated through the nicotinic acetylcholine receptor (nAChR) expressed on lung cancer cells. We speculate that new insights into the pathophysiological roles of nAChR may lead to new therapeutic avenues to reduce non-small cell lung cancer (NSCLC) tumour growth. MATERIALS AND METHODS: Human samples of NSCLC, cell lines and mouse models were utilized in Western blotting, reverse transcriptase polymerase chain reaction and apoptosis studies. RESULTS: Human NSCLC tissues expressed alpha7-nAChR. This expression was higher in smoking patients with squamous carcinomas than those with adenocarcinomas and in male smoking patients than in females. All the data support the hypothesis that major expression of alpha7-nAChR is related to major activation of the Rb-Raf-1/phospho-ERK/phospho-p90RSK pathway. alpha7-nAChR antagonists, via mitochondria associated apoptosis, inhibited proliferation of human NSCLC primary and established cells. Nicotine stimulates tumour growth in a murine model, A549 cells orthotopically grafted. The effects of nicotine were associated with increases in phospho-ERK in tumours. Proliferation effects of nicotine could be blocked by inhibition of alpha7-nAChR by the high affinity ligand alpha-cobratoxin. CONCLUSION: These results showed that alpha7-nAChR plays an important role in NSCLC cell growth and tumour progression as well as in cell death.

[Fast track in abdominal aortic surgery]. / Fast track in chirurgia dellaorta addominale.

BACKGROUND: The aim of this work is to evaluate the efficacy of a new perioperative approach to improve the outcome and to reduce hospitalisation after abdominal aortic surgery. EXPERIMENTAL DESIGN: observational study on patients operated from October 1996 to October 1997 (Group 1996), and from November 1997 to November 1998 (group 1998). CENTRE: Anaesthesiology Department of Regional Hospital. PATIENTS: historical group: 56 patients surgically treated with abdominal aortic bypass in 1996. CASE CONTROL GROUP: 58 patients surgically treated with abdominal aortic bypass in 1998. INTERVENTION: group 1996: maintenance of anaesthesia with forane and fentanyl; postoperative infusion of mepivacaine 1% through lumbar epidural catheter. GROUP 1998: preoperative anaesthesia through thoracic (T 4) epidural catheter with infusion of bupivacaine 0.5%; maintenance of anaesthesia with propofol, fentanyl and infusion of bupivacaine 0.125%; postoperative infusion of bupivacaine 0.125%, early rehabilitation care (early removal of nasogastric tube and urinary catheter, early deambulation, feeding and physiotherapy). EVALUATION: analgesia efficacy, day of deambulation, day of removal of the urinary catheter and the nasogastric tube, day of bowel canalization, day of discharge, major complications. RESULTS: In group 1998 analgesia was better. Furthermore a significant improvement consisted in the earlier removal of the nasogastric tube and the urinary catheter, earlier return of the gastrointestinal function and earlier deambulation. The length of stay is significantly reduced. In group 1998 we have less complications. CONCLUSIONS: Total intra-venous anaesthesia associated with a thoracic epidural anaesthesia, connected with early rehabilitation may improve the outcome and reduce the length of stay in patients submitted to abdominal aortic surgery.

[Peridural anesthesia versus subarachnoid anesthesia in cesarean section. Prospective clinical study]. / Anestesia peridurale versus anestesia subaracnoidea nel parto cesareo. Studio clinico prospettico.

OBJECTIVE: To compare technical and clinical differences between epidural and spinal anesthesia for cesarean section. STUDY DESIGN: Randomized prospective trial. PATIENTS AND METHODS: 64 pregnant women at term scheduled for elective cesarean section. Two groups were randomized: A) PD Group (n = 32): continuous epidural anesthesia by administration of bupivacaine 0.5% plus epinephrine 1/400,000 via an epidural catheter. Epidural morphine 3 mg was administered at the end of surgery. B) SP Group (n = 32): "single shot" spinal anesthesia by intrathecal administration of hyperbaric 1% bupivacaine 1-1.4 ml plus morphine 0.2 mg. The pin prick block level reached T2-T6 at incision time. DATA COLLECTION: 1) Time from the beginning of anesthesia to surgical incision. 2) Hypotension episodes. 3) Ephedrine consumption. 4) Intraoperative discomfort at delivery, traction and uterine manipulation, peritoneal toilette. 5) Nausea and vomiting. 6) Apgar score. 7) Postoperative headache. RESULTS: Women in the SP group had more hypotensive episodes (81% vs 53%: p < 0.05) and more ephedrine consumption with a large individual variability (29.12 mg +/- 20.4 vs 12.83 +/- 13.8: p < 0.01) when compared to PD group, without any difference in the Apgar score. The SP group required less time consumption (10.5 min. +/- 6.7 vs 35.9 min. +/- 17.3: p < 0.01) and had less intraoperative discomfort with less analgesic and/or sedative drugs consumption (9.7% vs 29%: p < 0.05) and less vomiting (3% vs 22.5%: p < 0.05). No postoperative headache was noticed in both groups. CONCLUSIONS: With the described pharmacological and technical approach, spinal anesthesia is more suitable than continuous epidural technique for cesarean section, unless contraindicated.