Peripartum pubic symphysis separation--Current strategies in diagnosis and therapy and presentation of two cases.

BACKGROUND: During spontaneous vaginal delivery, pubic symphyseal widening is normal. Common changes are reversible after complication-free birth. However, cases of peripartum symphysis separation are rare. There is no consensus in the literature on how to treat pregnancy-related pubic symphysis separation. METHODS: This review used a literature-based search (PubMed, 1900-2013) and analysis of 2 own case reports. Studies with conclusions regarding management were particularly considered. RESULTS: Characteristic symptoms, suprapubic pain and tenderness radiating to the posterior pelvic girdle or lower back, may be noted 48 h after delivery. Pain on movement, especially walking or climbing stairs, is often present. Conservative treatments, such as a pelvic brace with physiotherapy and local interventions such as infiltration, are successful in most cases. Symptom reduction within 6 weeks is the most common outcome, but can take up to 6 months in some cases. Surgical intervention is needed in cases of persistent separation. Anterior plate fixation is offered as a well-known and safe procedure. Minimally invasive SI joint screw fixation is required in cases of combined posterior pelvic girdle lesions. SUMMARY: Postpartum symphyseal rupture can be indicated with the rare occurrence of pelvic pain post-delivery, with sciatica or lumbago and decreased mobility. The diagnosis is made on clinical findings, as well as radiographs of the pelvic girdle. Conservative treatment with a pelvic brace is the gold standard in pre- and postpartum cases of symphysis dysfunction.

Performance comparison of neural network training algorithms in modeling of bimodal drug delivery.

The major aim of this study was to model the effect of two causal factors, i.e. coating weight gain and amount of pectin-chitosan in the coating solution on the in vitro release profile of theophylline for bimodal drug delivery. Artificial neural network (ANN) as a multilayer perceptron feedforward network was incorporated for developing a predictive model of the formulations. Five different training algorithms belonging to three classes: gradient descent, quasi-Newton (Levenberg-Marquardt, LM) and genetic algorithm (GA) were used to train ANN containing a single hidden layer of four nodes. The next objective of the current study was to compare the performance of aforementioned algorithms with regard to predicting ability. The ANNs were trained with those algorithms using the available experimental data as the training set. The divergence of the RMSE between the output and target values of test set was monitored and used as a criterion to stop training. Two versions of gradient descent backpropagation algorithms, i.e. incremental backpropagation (IBP) and batch backpropagation (BBP) outperformed the others. No significant differences were found between the predictive abilities of IBP and BBP, although, the convergence speed of BBP is three- to four-fold higher than IBP. Although, both gradient descent backpropagation and LM methodologies gave comparable results for the data modeling, training of ANNs with genetic algorithm was erratic. The precision of predictive ability was measured for each training algorithm and their performances were in the order of: IBP, BBP>LM>QP (quick propagation)>GA. According to BBP-ANN implementation, an increase in coating levels and a decrease in the amount of pectin-chitosan generally retarded the drug release. Moreover, the latter causal factor namely the amount of pectin-chitosan played slightly more dominant role in determination of the dissolution profiles.

Effects of high sugar diets on renal fluid, electrolyte and mineral handling in rats: relationship to blood pressure.

OBJECTIVE: We examined whether sugar-induced systolic blood pressure (SBP) elevations in rats may develop, in part, through a mechanism common to salt-induced hypertension, i.e., renal retention of water and salt. DESIGN: Spontaneously hypertensive rats (SHR) ate four diets: two high (> 50% of calories) and two low (< 12% of calories) in sugar (sucrose). SBP, various urinary parameters, and the renal angiotensin and prostaglandin systems were assessed. RESULTS: SHR consuming diets high in sugar showed significantly decreased urinary volume and excretion of electrolytes, which coincided with increasing SBP. When low sugar diets replaced high sugar diets, SBP and urinary parameters rapidly returned to baseline. SHR received captopril while consuming high sugar diets, and both SBP and urinary parameters assumed baseline values, comparable to ones seen in SHR consuming low sugar diets. A direct angiotensin II receptor antagonist (DuPont 753) did not influence SBP. However, we found decreased PGE2 excretion in SHR consuming excess sugar. CONCLUSIONS: Salt and water retention occur early during sugar-induced hypertension due to reduced renal excretion, consistent with some part in the pathogenesis. The effects of high sugar diets on SBP were not due to angiotensin II inhibition, however, decreased availability of vasodilatory prostaglandins may play a role in the renal events and sugar-induced hypertension in SHR.

Cholinergic stimulation of neuropeptide Y secretion from the isolated perfused rat stomach.

Neuropeptide Y (NPY) is present in both extrinsic sympathetic adrenergic nerve terminals and intrinsic nerves of the gastrointestinal (GI) tract. Based on this localization a number of functions have been attributed to GI NPY including regulation of blood flow, intestinal fluid and electrolyte transport, and motility. There is nothing currently known, however, about the regulation of its secretion from GI nerves. The effect of cholinergic agonists and antagonists on secretion of NPY immunoreactivity (NPY-IR) from the isolated perfused rat stomach was investigated in the present study. Perfusate samples were extracted and concentrated on SepPak cartridges. Basal levels of NPY-IR varied between 98 and 147 fmol/min. Release was stimulated by high potassium concentrations (50 mM) and acetylcholine (ACh; 1 microM). ACh-induced secretion was unaffected by atropine, but inhibited by hexamethonium. Further evidence for a nicotinic component in the regulation of NPY-IR secretion was obtained by the finding of hexamethonium-induced reduction in basal secretion and stimulation of secretion by 1,1-dimethyl-4-phenyl-piperazinium (DMPP). In conclusion, cholinergic agonists and antagonists can modulate gastric NPY-IR secretion, and the cholinergic stimulatory effects are probably mediated via nicotinic receptor stimulation at the level of the intrinsic ganglia.