Comparison of outpatient with inpatient mifepristone usage for cervical ripening: A randomised controlled trial.

Purpose: The efficacy and safety of using mifepristone for the preinduction/induction of labour (IOL) as the only method or in combination with others has been confirmed in observational and randomised trials. However, there are currently no studies comparing the efficacy and safety of using mifepristone for the preinduction of labour on an inpatient and outpatient basis. Objective: To evaluate whether the outpatient use of mifepristone for cervical ripening before IOL at term is as efficient and safe as in inpatients. Study design: This open-label, prospective, two-arm, non-inferiority randomised controlled trial (ISRCTN26164110) with a 1:1 allocation ratio was conducted in a single tertiary referral hospital. Overall, 322 pregnant women (gestational age: 39-41 weeks; Bishop score < 6, intact membranes, no contraindications for vaginal delivery, and no contraindications for IOL) were included and randomised:162 to the outpatient group and 160 to the inpatient group for cervical ripening with mifepristone. Analyses were performed based on the intention-to-treat principle. Results: In 16 % and 17 % of the cases, labour began spontaneously within 24-36 h after taking mifepristone tablets. The additional use of prostaglandin E2 or a balloon for cervical ripening occurred equally often in the compared groups. Oxytocin was used more frequently to induce labour in the inpatient group (P = 0.035). There was no difference in the length of the interval from the onset of cervical ripening to the onset of labour between the groups (38.6 vs. 38.8 h, P = 0.900). The failed induction rate was 1.85 % vs. 0.63 % (P = 0.346).Regional analgesia (P = 0.011) and abnormal foetal heart rate patterns (P = 0.027) were more common in the inpatient group. In the outpatient mifepristone preinduction group, the average time interval from hospitalisation to discharge was 25 h shorter (P < 0.001). No statistically significant differences were observed between the groups in terms of the rates of adverse side effects or perinatal outcomes. Conclusion: Outpatient cervical ripening with mifepristone reduced the hospital stay duration compared to inpatient ripening, with no difference in efficacy in terms of improvement in the Bishop score, frequency of additional induction method usage, interval from start of preinduction to onset of labour, and labour duration.No differences in the delivery methods, failure rates, or perinatal outcomes were observed. The frequency of adverse effects was low and not related to the setting of the preinduction site. Cervical ripening with mifepristone can be performed on an outpatient basis, because it is as effective and safe as inpatient ripening.

Content of Free Fetal DNA in Maternal Blood and Expression of DNA Recognition Receptors ZBP-1 in Placental Tissue in Preeclampsia and Preterm Labor.

We evaluated the content of cell-free fetal DNA in maternal blood and expression of ZBP-1 receptors in the placental tissue of women with uncomplicated pregnancy, preeclampsia, and preterm labor. The study included 16 women with preeclampsia (early and late-onset preeclampsia, 8 cases each), 16 women with preterm labor, and 21 women with uncomplicated pregnancy. The concentration of cell-free fetal DNA was measured by PCR by detecting hypermethylated region of the RASSF1A gene. Immunohistochemistry was performed on paraffin-embedded sections of the placenta samples using primary polyclonal antibodies to ZBP-1. Significant increase in the level of cell-free fetal DNA was found in women with preeclampsia (both early and late-onset form) in comparison with uncomplicated pregnancy. The concentration of cell-free fetal DNA in preterm labor group did not differ from the control group; however, it was significantly lower than in early-onset preeclampsia, but not late preeclampsia. Immunohistochemical study showed higher expression of ZBP-1 in the villus syncytiotrophoblast in early-onset preeclampsia in comparison with that in preterm labor group (p=0.006). Fragments of damaged placental cells, predominantly trophoblast, enter maternal circulation and are the source of cell-free fetal DNA and a potential ligand for ZBP-1, which leads to further cell damage and the formation of a vicious circle. The increase in the content of cell-free fetal DNA in maternal blood and ZBP-1 expression in the syncytiotrophoblast in preeclampsia are interrelated processes reflecting impaired morphofunctional state of the placenta.

[Endoprosthetic repair of the abdominal aorta in patients with infrarenal aneurysm and unfavourable anatomy of its proximal neck].

Analysed herein are immediate and remote results of endoprosthetic repair of the abdominal aorta in patients with unfavourable anatomy of its proximal neck. Group I (Study Group) was composed of 31 patients with unfavourable anatomy of the proximal neck, the control group (Group II) comprised a total of 52 patients with no unfavourable anatomical factors. The criteria of assessment were as follows: technical success, adequate position of the endograft, frequency of the development of various endoleaks, duration of the operation and hospital stay, lethality in the remote period, and necessity of secondary interventions. Technical success of endoprosthetic repair was achieved in 100% of patients in the both groups. An adequate position by the proximal end of the coated portion of the endograft was observed in 27 (87.1%) patients of Group I and in 51 (98.1%) patients of the control group (p=0.08). Secondary postdilatation of the endograft's body in the proximal neck was statistically more often performed in the study group of patients. The duration of the operation and hospital stay in the compared groups had no statistically significant differences. In the remote period, patients with unfavourable morphology of the proximal neck were found to develop type I-A endoleaks into the cavity of the aneurysm. By other evaluated criteria such as the total survival rate, secondary interventions, graft migration, type I-B, II and V endoleaks no statistically significant differences were revealed. It was concluded that endoprosthetic repair of the abdominal aorta in patients with unfavourable anatomy of the proximal neck of the aneurysm is associated with admissible immediate, short- and long-term outcomes. Longer follow up is required in order to more adequately asses the reliability of the obtained findings.

[Hemodynamic changes in myopia of different degrees].

A total of 78 patients (143 eyes) with low, medium and high degree myopia were assessed. Apart from standard ophthalmological tests, flowmetry and duplex ultrasound of ocular vessels were performed in all cases to evaluate volumetric and velocity parameters of ocular blood flow in relation to the length of anterior-posterior axis and the degree of myopia. It is found that both parameters of regional blood flow progressively decrease as the anterior-posterior axis increases.

[Age dependence of metabolic syndrome association with obesity types among women].

The study included 335 women aged 21 to 74 years. Results showed that age appears to be associated with progressive accumulation of fat tissue and magnitude of the waist-to-hip circumference ratio, which are mostly expressed in the second period of middle age. Ratio of gynoid and android species frequency among women with overweight and obesity in the first and second period of middle age groups and elderly age was 2.7:1; 1.3:1 and 0.2:1, respectively. Occurrence of metabolic syndrome in this age groups of women with gynoid species was 16.3; 18.9 and 30.0%; but with android species 62.5; 47.9 and 83.0%, respectively. Our results allow to state that women with gynoid species have the lowest risk of metabolic syndrome even in elderly age.

[Anatomic and functional ocular characteristics and myopia development].

Literature data dealing with the main anatomic and physiological factors influencing myopia development are reviewed. They are as follows: activity of accomodation structures, haemo- and hidrodynamic changes, rigidity of fibrous tunic. A complex of different examination methods is essential for appropriate management of myopic patients because the degree of influence is variable for every factor and is still completely unknown.

[Comparative study of different CAD/CAM-system for making frameworks of nonremovable dentures].

The comparative study was carried out on different CAD/САМ-systems of precision of reproduction of components surface, precision scanning cavities and abatments. Measured value of the regional gap of the frames was made from these systems.

[Delayed medical consequences of the Chernobyl accident in Armenia. Assessment of life quality and accelerated biological aging of accident liquidators].

In this paper, some final results of 25-year investigations carried out in Scientific Centre for Radiation Medicine and Burns MH RA (SCRMB) on the Armenian cohort of the Chernobyl accident consequences liquidators are shown. These results show that health conditions of the liquidators became worse during the whole observation period. A considerable development of both pathological states atypical of radiation damages and diseases, which may be considered as radiation-induced ones, was determined. Rise of the sickness rate of almost all organism systems, first of all, nervous, cardiovascular, respiratory and digestive ones, was observed. In 70% of liquidators the main disease was primarily detected after working on CNPP. In the intervening years, the average number of diagnoses per 1 liquidator increased from 1.5 in 1987 to 7-8 in the recent time. In addition to the detected diseases, particular functional shifts in neuropsychological and vegetative status of the liquidators were observed. The overwhelming majority of them have increased tonicity of the sympathetic vegetative nervous system, asthenic and depressive syndromes occurring in the form of weakness, somnolence, mood instability, mental capacity decrease, and memory defects. In the paper, the results of investigations aimed at clarification of changes in biological aging processes of the liquidators and assessment of their "life quality" features in terms of physical, psychical and social welfare are considered. Biological aged-related passportization in a definite part of liquidators elucidated an accelerated aging rate. The studies were performed with the help of SF-36 inquirer and indicated that health status aggravation of the liquidators also affected their life satisfaction. The "life quality" indices of the liquidators significantly concede the overall average standards by both physical health and psychical and social welfare scales.

[Genetic polymorphism of Microbotryum violaceum s. I. isolates collected from different plant species on the territory of Russia].

The present-day studies in the field of systematics and phylogeny of microorganisms, fungi, in particular, are characterized by a wide use of new approaches and methods of molecular biology. The use of a diversity of genetic markers permits a distinct differentiation of closely related species into individual evolutionary independent lines. It is shown in this work that all Microbotryum violaceum s. l. isolates studied by us are divided into five evolutionary groups according to the host plant.

[On the occasion of the 20th anniversary of the accident on the Chernobyl NPP: medical consequences in Armenia].

The aim of this work is the analysis of the indices of the health and of the structure of the sicknesses of the inhabitants of Armenia who took part in the liquidation of the consequences of the Chernobyl accident. Also it is the determination of possible dependence of the frequency of diseases for the most widespread classes of sicknesses on the received dose of the irradiation, according to the data of the clinical examination and dispensarysation; and also it is the revelation of the role of other factors influenced on the health indexes.

[Liver regenerative potential of the lake frog Rana ridibunda after partial hepatectomy].

A histomorphological study of the regenerating liver of Rana ridibunda, within 2 months after partial hepatectomy, shows that regenerative processes on the wound surface are slowly proceeding. Processes of reticular fiber reconstruction occurred in the composition of the basal membrane of liver sinusoids. A cytophotometric study shows that glandular cells in R. ridibunda liver are commonly tetraploid. The post-traumatic regeneration of the liver after partial hepatectomy involves activation of DNA synthesis in hepatocytes, leading to increase in their ploidy. Within the 1st month of regeneration, the mitotic index of hepatocytes substantially increased. Regeneration of glandular parenchyma of the liver is accompanied by a quantitative increase in binucleate hepatocytes, which is most highly expressed within 5-20 days after partial hepatectomy.

[Connection of ethidium bromide with single-stranded DNA]. / Sviazyvanie bromida étidiia s odnotsepochechnoi DNK.

The interaction of ethidium bromide with single-stranded synthetic and natural polynucleotides at high temperatures (t = 70 degrees C) and low pH values (pH 3.0) was studied. The isotherms of adsorption of ethidium bromide on single-stranded DNA were obtained. Two modes of binding of single-stranded DNA, strong and weak, were revealed. The values of the corresponding constants of interaction of this ligand and the number of bases per one binding site were determined.

Proton-coupled electron transfer in Fe-superoxide dismutase and Mn-superoxide dismutase.

Fe-containing superoxide dismutase (FeSOD) and MnSOD are widely assumed to employ the same catalytic mechanism. However this has not been completely tested. In 1985, Bull and Fee showed that FeSOD took up a proton upon reduction [J. Am. Chem. Soc. 107 (1985) 3295]. We now demonstrate that MnSOD incorporates the same crucial coupling between electron transfer and proton transfer. The redox-coupled H(+) acceptor has been presumed to be the coordinated solvent molecule, in both FeSOD and MnSOD, however this is very difficult to test experimentally. We have now examined the most plausible alternative: that Tyr34 accepts a proton upon SOD reduction. We report specific incorporation of 13C in the C(zeta) positions of Tyr residues, assignment of the C(zeta) signal of Tyr34 in each of oxidized FeSOD and MnSOD, and direct NMR observations showing that in both cases, Tyr34 is in the neutral protonated state. Thus Tyr34 cannot accept a proton upon SOD reduction, and coordinated solvent is concluded to be the redox-coupled H(+) acceptor instead, in both FeSOD and MnSOD. We have also confirmed by direct 13C observation that the pK of 8.5 of reduced FeSOD corresponds to deprotonation of Tyr34. This work thus provides experimental proof of important commonalities between the detailed mechanisms of FeSOD and MnSOD.

[Restorative operations in colostomy patients with short stump of the rectum]. / Vosstanovitel'nye operatsii u kolostomirovannykh bol'nykh s korotkoi kul'tei priamoi kishki.

An analysis of restorative operations on 113 patients with a story of obstructive resection of the colon after Gartman has shown that of special technical difficulty were operations on patients with a short (less than 10 cm) stump of the rectum. In 26 patients an apparatus stitch "to the pitch" with the help of suturing apparatuses AKA-2 and AKA-4 of the firm "Ethicon" was used. In 9 patients a combined hand sewing was used. In the patients in whom the continuity of the colon was restored with the help of a mechanical suture "to the pitch" or by the hand combined sewing there were no incompetent anastomoses. Results of the operations were followed-up during the period from 6 months to 3 years. In 2 patients (5.4%) stricture of the anastomosis was diagnosed following its formation with the help of the apparatus AKA-4.