Lower and extended dosage of misoprostol for cervical ripening in 1st trimester miscarriage (MISO200): A randomized clinical trial.

OBJECTIVE: To compare the efficacy of priming the uterine cervix before Manual Vaccum Aspiration (MVA) using 200 µg or 400 µg of vaginal misoprostol, inserted a mean time of 6 h before MVA in first trimester miscarriage. STUDY DESIGN: Randomized, triple-blind, non-inferiority clinical trial. Patients between 18 and 50 years old, with a diagnosis of miscarriage, were eligible for the study. Patients were allocated to receive either 200 µg or 400 µg of misoprostol before the MVA. The primary outcome was the need to dilate the uterine cervix with mechanical dilators (Hegar dilators). As a secondary outcome, cervical dilatation ≥8 mm before the procedure was considered successful. A difference of <25% was considered as non-inferior. RESULTS: Between December 21, 2016 and October 6, 2019, 269 women were screened. After screening, 105 and 106 women received 200 µg and 400 µg of misoprostol, respectively. Mechanical cervical dilatation was not necessary in 84.8% (95%CI 77% to 90%) and 96.2% (95%CI 91% to 99%), in the 200 µg and 400 µg groups, respectively [difference = 11.5% (95%CI 3.7% to 19.2%). Cervical dilatation of ≥8 mm was 52.4% (95%CI 42.9% to 61.7%) in the 200 µg misoprostol group, while in the 400 µg group was 71.7% (95%CI 62.5% to 79.4%) [difference = 19.3% (95%CI 6.5 to 32.2). CONCLUSION: After a mean time of 6 h, 200 µg of vaginal misoprostol is not inferior to 400 µg of misoprostol for cervical priming before MVA, in first trimester miscarriage. This non-inferiority was not observed when the ≥8 mm criterion was considered.

Using radar plots for performance benchmarking at patient and hospital levels using an Australian orthopaedics dataset.

This study will highlight the diagnostic potential that radar plots display for reporting on performance benchmarking from patient admissions to hospital for surgical procedures. Two drawbacks of radar plots - the presence of missing information and ordering of indicators - are addressed. Ten different orthopaedic surgery procedures were considered in this study. Moreover, twelve outcome indicators were provided for each of the 10 surgeries of interest. These indicators were displayed using a radar plot, which we call a scorecard. At the hospital level, we propose a facile process by which to consolidate our 10 scorecards into one. We addressed the ordering of indicators in our scorecards by considering the national median of the indicators as a benchmark. Furthermore, our the consolidated scorecard facilitates concise visualisation and dissemination of complex data. It also enables the classification of providers into potential low and high performers that warrant further investigation. In conclusion, radar plots provide a clear and effective comparative tool for discerning multiple outcome indicators against the benchmarks of patient admission. A case study between two top and bottom performers on a consolidated scorecard (at hospital level) showed that medical provider charges varied more than other outcome indicators.

Long-latency event-related responses to vowels: N1-P2 decomposition by two-step principal component analysis.

The N1-P2 complex of the auditory event-related potential (ERP) has been used to examine neural activity associated with speech sound perception. Since it is thought to reflect multiple generator processes, its functional significance is difficult to infer. In the present study, a temporospatial principal component analysis (PCA) was used to decompose the N1-P2 response into latent factors underlying covariance patterns in ERP data recorded during passive listening to pairs of successive vowels. In each trial, one of six sounds drawn from an /i/-/e/ vowel continuum was followed either by an identical sound, a different token of the same vowel category, or a token from the other category. Responses were examined as to how they were modulated by within- and across-category vowel differences and by adaptation (repetition suppression) effects. Five PCA factors were identified as corresponding to three well-known N1 subcomponents and two P2 subcomponents. Results added evidence that the N1 peak reflects both generators that are sensitive to spectral information and generators that are not. For later latency ranges, different patterns of sensitivity to vowel quality were found, including category-related effects. Particularly, a subcomponent identified as the Tb wave showed release from adaptation in response to an /i/ followed by an /e/ sound. A P2 subcomponent varied linearly with spectral shape along the vowel continuum, while the other was stronger the closer the vowel was to the category boundary, suggesting separate processing of continuous and category-related information. Thus, the PCA-based decomposition of the N1-P2 complex was functionally meaningful, revealing distinct underlying processes at work during speech sound perception.

Evaluation of cytogenotoxicity, antioxidant and hypoglycemiant activities of isolate compounds from Mansoa hirsuta D.C. (Bignoniaceae).

Mansoa hirsuta (Bignoniaceae) is a native plant from caatinga in Brazilian semiarid. This plant has been locally used as antimicrobial and hypoglycemiant agents, but their action mechanisms and toxicity remain largely unknown. Therefore, we evaluated the composition and antioxidant, cytoprotective and hypoglycemiant effects of raw extract, fractions and compounds from leaves of M. hirsuta. The cytogenotoxic effects of ursolic and oleanolic acids, the main phytotherapic components of this plant, were assessed. The raw extract and fractions presented steroids, saponins, flavonols, flavanonols, flavanones, xanthones, phenols, tannins, anthocyanins, anthocyanidins and flavonoids. The ethyl acetate fraction inhibited efficiently the cascade of lipid peroxidation while the hydroalcoholic fraction was richer in total phenols and more efficient in capturing 2,2-diphenyl-1-picrylhydrazyl (·DPPH) and 2,2'-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS·+) radicals. The isolated fraction of M. hirsuta also inhibited the α-amylase activity. Cytotoxic effects were absent in both raw extract and fractions while ursolic+oleanolic acids were efficient in protecting cells after exposure to hydrogen peroxide. Moreover, this mixture of acid shad no significant interference on the mitotic index and frequency of nuclear and/or chromosomal abnormalities in Allium cepa test. Therefore, M. hirsuta represents a potential source of phytochemicals against inflammatory and oxidative pathologies, including diabetes.

Evaluation of cytogenotoxicity, antioxidant and hypoglycemiant activities of isolate compounds from Mansoa hirsuta D.C. (Bignoniaceae)

ABSTRACT Mansoa hirsuta (Bignoniaceae) is a native plant from caatinga in Brazilian semiarid. This plant has been locally used as antimicrobial and hypoglycemiant agents, but their action mechanisms and toxicity remain largely unknown. Therefore, we evaluated the composition and antioxidant, cytoprotective and hypoglycemiant effects of raw extract, fractions and compounds from leaves of M. hirsuta. The cytogenotoxic effects of ursolic and oleanolic acids, the main phytotherapic components of this plant, were assessed. The raw extract and fractions presented steroids, saponins, flavonols, flavanonols, flavanones, xanthones, phenols, tannins, anthocyanins, anthocyanidins and flavonoids. The ethyl acetate fraction inhibited efficiently the cascade of lipid peroxidation while the hydroalcoholic fraction was richer in total phenols and more efficient in capturing 2,2-diphenyl-1-picrylhydrazyl (·DPPH) and 2,2'-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS·+) radicals. The isolated fraction of M. hirsuta also inhibited the α-amylase activity. Cytotoxic effects were absent in both raw extract and fractions while ursolic+oleanolic acids were efficient in protecting cells after exposure to hydrogen peroxide. Moreover, this mixture of acid shad no significant interference on the mitotic index and frequency of nuclear and/or chromosomal abnormalities in Allium cepa test. Therefore, M. hirsuta represents a potential source of phytochemicals against inflammatory and oxidative pathologies, including diabetes.

N1 response attenuation and the mismatch negativity (MMN) to within- and across-category phonetic contrasts.

According to the neural adaptation model of the mismatch negativity (MMN), the sensitivity of this event-related response to both acoustic and categorical information in speech sounds can be accounted for by assuming that (a) the degree of overlapping between neural representations of two sounds depends on both the acoustic difference between them and whether or not they belong to distinct phonetic categories, and (b) a release from stimulus-specific adaptation causes an enhanced N1 obligatory response to infrequent deviant stimuli. On the basis of this view, we tested in Experiment 1 whether the N1 response to the second sound of a pair (S2 ) would be more attenuated in pairs of identical vowels compared with pairs of different vowels, and in pairs of exemplars of the same vowel category compared with pairs of exemplars of different categories. The psychoacoustic distance between S1 and S2 was the same for all within-category and across-category pairs. While N1 amplitudes decreased markedly from S1 to S2 , responses to S2 were quite similar across pair types, indicating that the attenuation effect in such conditions is not stimulus specific. In Experiment 2, a pronounced MMN was elicited by a deviant vowel sound in an across-category oddball sequence, but not when the exact same deviant vowel was presented in a within-category oddball sequence. This adds evidence that MMN reflects categorical phonetic processing. Taken together, the results suggest that different neural processes underlie the attenuation of the N1 response to S2 and the MMN to vowels.

Compositional Design of Dielectric, Ferroelectric and Piezoelectric Properties of (K, Na)NbO3 and (Ba, Na)(Ti, Nb)O3 Based Ceramics Prepared by Different Sintering Routes.

Lead free piezoelectric materials are being intensively investigated in order to substitute lead based ones, commonly used in many different applications. Among the most promising lead-free materials are those with modified NaNbO3, such as (K, Na)NbO3 (KNN) and (Ba, Na)(Ti, Nb)O3 (BTNN) families. From a ceramic processing point of view, high density single phase KNN and BTNN ceramics are very difficult to sinter due to the volatility of the alkaline elements, the narrow sintering temperature range and the anomalous grain growth. In this work, Spark Plasma Sintering (SPS) and high-energy ball milling (HEBM), following heat treatments (calcining and sintering), in oxidative (O2) atmosphere have been used to prepare single phase highly densified KNN ("pure" and Cu2+ or Li1+ doped), with theoretical densities ρth > 97% and BTNN ceramics (ρth - 90%), respectively. Using BTTN ceramics with a P4mm perovskite-like structure, we showed that by increasing the NaNbO3 content, the ferroelectric properties change from having a relaxor effect to an almost "normal" ferroelectric character, while the tetragonality and grain size increase and the shear piezoelectric coefficients (k15, g15 and d15) improve. For KNN ceramics, the results reveal that the values for remanent polarization as well as for most of the coercive field are quite similar among all compositions. These facts evidenced that Cu2+ may be incorporated into the A and/or B sites of the perovskite structure, having both hardening and softening effects.

Synthesis and Characterization of Cobalt(III), Nickel(II) and Copper(II) Mononuclear Complexes with the Ligand 1,3-bis[(2-aminoethyl)amino]-2-propanol and Their Catalase-Like Activity.

In this work, we present the synthesis and characterization of two new mononuclear complexes with the ligand 1,3-bis[(2-aminoethyl)amino]-2-propanol (HL), [Co(L)(H2O)](ClO4)2 (1), [Ni(HL)](ClO4)2 (2), as well as the known complex [Cu(HL)](ClO4)2 (3) for comparison. Their abilities to catalyze the dismutation of H2O2 and the oxidation of cyclohexane were investigated. The complexes were characterized by X-ray diffraction, elemental analysis, electronic and infrared spectroscopy, cyclic voltammetry, electrospray ionization mass spectrometry (ESI-MS) and conductivity measurements. The X-ray structures showed that the nickel (2) and copper (3) complexes are tetracoordinated, with the metal ion bound to the nitrogen atoms of the ligand. On the other hand, the cobalt complex (1) is hexacoordinated, possessing additional bonds to the alkoxo group of the ligand and to a water molecule. Neither of the complexes was able to catalyze the oxidation of cyclohexane, but all of them exhibited catalase-like activity, following Michaelis-Menten kinetics, which suggest resemblance with the catalase natural enzymes. The catalytic activity followed the order: [Ni(HL)](ClO4)2 (2) > [Cu(HL)](ClO4)2 (3) > [Co(L)(H2O)](ClO4)2 (1). As far as we know, this is the first description of a nickel complex presenting a significant catalase-like activity.

Gleason underestimation is predicted by prostate biopsy core length.

PURPOSE: To evaluate whether core length impacts biopsy accuracy and Gleason score underestimation compared to radical prostatectomy (RP) specimens. METHODS: From 2010 to 2011, 8,928 cores were trans-rectal obtained from 744 consecutive patients (178 RP, 24%), 557 by an experienced performer (>250/year) and 187 (25%) by in-training urology residents. Prospectively analyzed variables were core length, age, prostate volume, free and total prostate-specific antigen (PSA), PSA density and free/total PSA ratio. RESULTS: Mean core length for Gleason upgrading on RP (42.7%, n = 76) was 11.61 (±2.5, median 11.40) compared to 13.52 (±3.2, median 13.70), p < 0.001 for perfect biopsy-RP Gleason agreement (57.3%, n = 102). In multivariate analysis, for each unit of core length increment in millimeter, the Gleason upgrading risk decreased 89.9%, p = 0.049 [odds ratio (OR) 0.10, 95% confidence interval (CI) 0.01-0.99]. Biopsy positivity between experienced (35.5%) and in-training performer (30.1%) was not significantly different (p = 0.20), with comparable mean patient age (65.1 vs. 64.1), prostate volume (52.3 vs. 50.7) and median PSA (5.2 vs. 5.1), respectively. Denoting wider variability in terms of core length, in-training performers obtained significantly larger cores for positive biopsies (11.33 ± 3.42 vs. 10.83 ± 3.68), p = 0.043, compared to experienced performer (11.39 ± 3.36 vs. 11.37 ± 3.64), p = 0.30. In multivariate analysis, PSA density (OR 1.14, 95% CI 1.02-1.28) and age (OR 1.04, 95% CI 1.01-1.07) were significantly associated with biopsy positivity, p = 0.021 and p = 0.011, respectively. CONCLUSION: While core length on trans-rectal biopsy independently affects Gleason upgrading on RP specimens, performer experience has minor impact on Gleason discordance or biopsy positivity due to a sharp learning curve.