Diabetes mellitus: an independent predictor of duration of prostaglandin labor induction.

OBJECTIVE: The objective of this study is to analyze the association of diabetes mellitus with progress and outcomes of prostaglandin (PG) labor induction using a retrievable vaginal insert. STUDY DESIGN: This is a secondary analysis of data collected during the Misoprostol Vaginal Insert Trial (Miso-Obs-004), a multicenter, double-blind, randomized controlled trial of women undergoing induction of labor with PGs. The duration, characteristics and outcomes of labor were compared in women with and without diabetes. Multivariable regression analysis was performed on all outcomes of interest, adjusting for differences in baseline characteristics. RESULTS: There were 122 women with diabetes within the sample of 1275 women who delivered during their first admission. The time to reach active labor was significantly prolonged among women with diabetes compared with those without (22.0±13.0 vs 18.5±11.1, P=0.008) as was the time to delivery (30.2±15.0 vs 26.0±12.6, P=0.004). Fewer women with diabetes delivered within 36 h (adjusted odds ratio: 0.41, 95% confidence interval: 0.26 to 0.66, P=0.0003) and 48 h (adjusted odds ratio: 0.36, 95% confidence interval: 0.19 to 0.71, P=0.004). These relationships were significant after a multivariate regression analysis of baseline characteristics that adjusted for age, race, parity, body mass index, baseline modified Bishop Score, gestational age at induction and treatment group allocation. CONCLUSION: After PG labor induction, women with diabetes took longer to reach active labor and to deliver. We emphasize that this result comes from a secondary analysis and needs confirmation with additional studies.

Phylogenetic insights into the pace and pattern of plant genome size evolution.

It has long been known that organismal complexity is poorly correlated with genome size and that tremendous variation in DNA content exists within many groups of organisms. This diversity has generated considerable interest in: (1) the identity and relative impact of sequences responsible for genome size variation, and (2) the suite of internal mechanisms and external evolutionary forces that collectively are responsible for the observed diversity. Genome size in any given taxon reflects the net effects of multiple mechanisms of DNA expansion and contraction, which by virtue of their complexity and temporal juxtaposition, may be challenging to tease apart into their constituent contributions. Here we review our current understanding of genome size variation in plants and the spectrum of mechanisms thought to be responsible for this variation. We present a synopsis of the insights into the mechanisms and pace of genome size change that are uniquely facilitated by a phylogenetic perspective, particularly among closely related species. We also highlight recent studies in diverse angiosperm groups where comparative genomic approaches have yielded general insights into the myriad mechanisms responsible for much of the observed genome size variation, most prominently the contribution of transposable elements (TEs). Finally, we draw attention to the possibility of divergence in the relative importance of different mechanisms of genome size evolution during cladogenesis.

Gianturco coil embolization of vein of Galen aneurysms: technical aspects.

Galenic A-V fistulas typically result in hydrocephalus and increased cerebral venous pressure, with symptoms of progressive seizure activity, chronic cardiac failure and failure to thrive. Surgery and arterial embolization have been only partially successful in reducing flow through these shunts. The authors present technical details of a procedure for embolizing such lesions via a transtorcular venous approach. Early results in 15 patients are reported: Twelve patients appear to have had significant symptomatic improvement; two have died of persistent heart failure, and one died of a subdural hematoma associated with ventriculostomy.

Directional needle for antegrade guide wire placement with vertical arterial puncture.

A directional needle with a closed pencil-point tip and a distal side hole was developed to permit antegrade guide wire placement by way of a 90 degrees puncture angle. It has been used in over 25 patients without technical difficulties or complications. It has been very effective for catheterization of the superficial femoral artery for angioplasty, diagnostic studies, and chemotherapy infusion, providing easy antegrade access in patients in whom the traditional antegrade approach may be difficult.