Visual biofeedback for shortening second stage of labor: randomized controlled trial.

OBJECTIVE: To determine whether visual biofeedback can be used during labor as an effective tool for shortening the second stage of labor and reducing the need for instrumental delivery. METHODS: This was a single-center randomized controlled trial. Nulliparous women under epidural anesthesia were randomized at the point of full dilation into the biofeedback group (n = 50) or the control group (n = 50). Both groups received coached maternal pushing during four consecutive contractions, while an experienced obstetrician performed transperineal ultrasound. Only women in the biofeedback group observed the ultrasound display screen. Following this intervention, labor was managed routinely by the obstetric team. Angle of progression (AOP) was measured at rest and while pushing, before and during the first and fourth contractions. Second-stage duration and delivery outcomes were compared between groups. RESULTS: Visual biofeedback did not affect the duration of the second stage, which lasted for a median of 2.28 (interquartile range (IQR), 1.25-3.10) h in the biofeedback group vs 2.08 (IQR, 1.58-3.02) h in the control group (P = 0.981). AOP was significantly higher in the biofeedback group compared with the control group, both at rest before the fourth contraction (mean ± SD, 142.6° ± 15.9° vs 136.8° ± 13.1°; P = 0.049) and while pushing during the fourth contraction (mean ± SD, 159.3° ± 19.2° vs 149.4° ± 15.1°; P = 0.005). The increase in AOP was significantly higher in the biofeedback compared with the control group between rest and pushing at the last push (mean ± SD, 16.6° ± 11.0° vs 12.6° ± 8.3°; P = 0.041) and between the first rest and last push (mean ± SD, 24.4° ± 13.6° vs 17.9° ± 11.3°; P = 0.011). The rate of intact perineum was similar between groups (12% vs 8%; P = 0.505). CONCLUSIONS: Visual biofeedback during the second stage of labor may facilitate descent of fetal head during maternal pushing without affecting second-stage duration, possibly due to the short duration of the intervention. Future studies should focus on continuous intervention throughout the second stage of labor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Dental Pathology of the Grey Fox (Urocyon cinereoargenteus).

Museum specimens from 637 grey foxes (Urocyon cinereoargenteus) were examined macroscopically according to predefined criteria. Of the 637 specimens, 569 were included for further examination. The study population included more males (n = 261, 45.9%) than females (n = 196, 34.4%) and animals of unknown sex (n = 112, 19.7%). Additionally, 481 (84.5%) adults, 67 (11.8%) young adults and 21 (3.7%) individuals of unknown age comprised the study population, with juveniles and neonates excluded. The number of teeth present for examination was 23,066 (96.5%) with 624 (2.6%) absent artefactually, 15 (0.06%) absent congenitally and 193 (0.8%) lost ante mortem through acquired tooth loss. No persistent deciduous teeth or temporomandibular joint osteoarthritis were found in any of the specimens. Ten supernumerary teeth from nine (1.6%) specimens were encountered. Teeth with extra roots were found in 61 individuals (10.7%), with 0.4% of all teeth affected. Of the alveoli examined, 1,529 (6.4%) displayed bony changes suggestive of periodontitis, with 276 (48.7%) of individuals affected. Significantly more adults were affected by bony changes associated with stage 3 periodontitis than young adults. All specimens displaying stage 4 periodontitis were adults. Fractures affected 446 (78.4%) of the specimens examined and 3,554 (15.4%) of teeth present. Almost half (n = 10,856, 47.1%) of the teeth available for examination and most specimens (n = 487, 85.6%) displayed some degree of attrition or abrasion. Two individuals (0.4%) exhibited periapical lesions. Traumatic skull injuries affected 56 (9.8%) specimens. Characterizing the dental pathology in the grey fox provides key insight into the ecology of the species and factors contributing to fitness.

[Crohn's disease of small bowel manifested by obstructive carcinoma].

In ulcerative colitis the incidence of adenocarcinoma of the small bowel is higher than in the general population. More than 100 cases of carcinoma of the small bowel have been reported in patients with Crohn's disease of the same segment. However, obstructive carcinoma of the small bowel as the first manifestation of Crohn's disease has seldom been reported. We present such a case in which the first manifestation of otherwise silent Crohn's disease was intestinal obstruction by adenocarcinoma of the same segment.

[Diagnosis and treatment of malignant polyps of the rectum and sigmoid]. / Diagnostika i lechenie malignizirovannykh polipov priamoi i sigmovidnoi kishok.

By means of cytological and histological methods of investigation malignant transformation of rectal and sigmoid polyps was revealed in 6.3% among 127 patients suffering polyps. Electroexcision of tumors resulting in persistent cure is felt to be the method of choice in treatment of such patients.