Foley catheter vs oral misoprostol for induction of labor: individual participant data meta-analysis.

OBJECTIVE: To compare the effectiveness and safety of Foley catheter and oral misoprostol for induction of labor (IOL). METHODS: The Cochrane Review on Mechanical Methods for Induction of Labour and Ovid MEDLINE, EMBASE via Ovid, Ovid Emcare, CINAHL Plus, ClinicalTrials.gov and Scopus, from inception to April 2019, were searched for randomized controlled trials (RCTs) comparing Foley catheter to oral misoprostol for IOL in viable singleton gestations. Eligible trials for which raw data were obtained were included and individual participant data meta-analysis was performed. Primary outcomes were vaginal birth, a composite of adverse perinatal outcome (including stillbirth, neonatal death, neonatal seizures, admission to the neonatal intensive care unit, severe respiratory compromise or meconium aspiration syndrome) and a composite of adverse maternal outcome (including admission to the intensive care unit, maternal infection, severe postpartum hemorrhage, maternal death or uterine rupture). The quality of the included RCTs was assessed using the Cochrane Risk of Bias 2 tool and the certainty of evidence was evaluated using the GRADE approach. A two-stage random-effects model was used for meta-analysis according to the intention-to-treat principle and interactions between treatment and baseline characteristics were assessed. RESULTS: Of seven eligible trials, four provided individual participant data for a total of 2815 participants undergoing IOL, of whom 1399 were assigned to Foley catheter and 1416 to oral misoprostol. All four trials provided data for each of the primary outcomes in all 2815 women. Compared with those receiving oral misoprostol, Foley catheter recipients had a slightly decreased chance of vaginal birth (risk ratio (RR), 0.95 (95% CI, 0.91-0.99); I2 , 2.0%; moderate-certainty evidence). A trend towards a lower rate of composite adverse perinatal outcome was found in women undergoing IOL using a Foley catheter compared with oral misoprostol (RR, 0.71 (95% CI, 0.48-1.05); I2 , 14.9%; low-certainty evidence). Composite adverse maternal outcome did not differ between the groups (RR, 1.00 (95% CI, 0.97-1.03); I2 , 0%; moderate-certainty evidence). Meta-analyses of effect modifications did not show significant interactions between intervention and parity or gestational age for any of the primary outcomes. CONCLUSIONS: For women undergoing IOL, Foley catheter is less effective than oral misoprostol, as it was associated with fewer vaginal births. However, while we found no significant difference in maternal safety, Foley catheter induction may reduce adverse perinatal outcomes. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Species richness and adaptation of the invasive cattle tick, Rhipicephalus microplus (Acari: Ixodidae) on camps grazed by sheep in the Eastern Cape Province, South Africa.

The seasonal dynamics and distribution of ticks play a pivotal role in the epidemiology of tick-borne diseases. The objective of this study was to establish the seasonal abundance and species richness of questing ixodid ticks on Amathole Montane Grassland camps grazed by sheep. Ticks questing for hosts were collected monthly for a period of three years by dragging flannel strips attached to a wooden spar over the vegetation. At each occasion, six replicate drag-samples were made in camps grazed by sheep. Of the questing ticks (n = 14 891) collected from the vegetation, the most abundant larvae were those of Rhipicephalus microplus (95.04%) followed by Rhipicephalus appendiculatus (2.32%), Rhipicephalus evertsi (1.56%), Rhipicephalus decoloratus (1.03%), Rhipicephalus simus (0.03) and Amblyomma hebraeum (0.02%). Comparing the two Rhipicephalus (Boophilus) spp., R. microplus (98.9%) outcompete the indigenous tick, R. decoloratus (1.1%). The R. microplus larvae were significantly higher (P < 0.05) in 2015 (2.11±0.108), 2016 (2.02 ± 0.076) and 2017 (1.94±0.075) during spring than any other season. There were no significant differences (P ˃ 0.05) from R. appendiculatus questing ticks collected in autumn (0.27±0.007; 0.30±0.052) and spring (0.33±0.007; 0.20±0.052) for 2015 and 2016, respectively. The study showed that the cattle tick, R. microplus adapted very well on host species, in this case sheep, and encroached to areas that were too cold for its adaptation.

Endoscopic localization of colorectal cancer: study of its accuracy and possible error factors.

INTRODUCTION: accurate preoperative localization of colorectal cancer (CRC) is very important, with a wide range of published error rates. AIMS: to determine accuracy of endoscopic localization of CRC in comparison with preoperative computed tomography (CT). To analyse variables that could be associated with a wrong endoscopic localization. PATIENTS AND METHODS: endoscopic and CT localization of a series of CRC without previous surgery were reviewed. We studied the concordance between endoscopic and radiologic localization against operative findings comparing accuracy of endoscopy and CT. We analysed the frequency of wrong endoscopic diagnoses with regard to a series of patient, endoscopy and tumor variables. RESULTS: two hundred thirty seven CRC in 223 patients were studied. Concordance with surgical localization was: colonoscopy = 0.87 and CT = 0.69. Endoscopic localization accuracy was:91.1%; CT: 76.2%: p = 0.00001; OR = 3.22 (1.82-5.72). Obstructive cancer presented a higher rate of wrong localization: 18 vs. 5.7% in non-obstructive tumors (p = 0.0034; OR = 3.65 (1.35-9.96). Endoscopic localization mistakes varied depending on tumor location, being more frequent in descending colon: 36.3%, p = 0.014; OR = 6.23 (1.38-26.87) and cecum: 23.1%, p = 0.007; OR = 3.92 (1.20-12.43). CONCLUSIONS: endoscopic accuracy for CRC localization was very high and significantly better than CT accuracy. Obstructive tumor and those located in the descending colon or cecum wereassociated with a significant increase of the error risk of CRC endoscopic localization.

Expression and purification of Z protein from Junín virus.

Arenaviridae comprises 23 recognized virus species with a bipartite ssRNA genome and an ambisense coding strategy. The virions are enveloped and include nonequimolar amounts of each genomic RNA species, designated L and S, coding for four ORFs (N, GPC, L, and Z). The arenavirus Junín (JUNV) is the etiological agent of Argentine Hemorrhagic Fever, an acute disease with high mortality rate. It has been proposed that Z is the functional counterpart of the matrix proteins found in other negative-stranded enveloped RNA viruses. Here we report the optimized expression of a synthetic gene of Z protein, using three expression systems (two bacterial and a baculoviral one). One of these recombinant proteins was used to generate antibodies. A bioinformatic analysis was made where Z was subdivided into three domains. The data presented contributes methodologies for Z recombinant production and provides the basis for the development of new experiments to test its function.

Epidermal growth factor receptor ligands in murine models for erythropoietic protoporphyria: potential novel players in the progression of liver injury.

Activation of the epidermal growth factor receptor (EGFR) plays an important role in liver regeneration and resistance to acute injury. However its chronic activation participates in the progression of liver disease, including fibrogenesis and malignant transformation. Hepatobiliary disease represents a constant feature in the clinically relevant Fechm1pas/Fechm1pas genetic model of erythropoietic protoporphyria (EPP). Similarly, chronic administration of griseofulvin to mice induces pathological changes similar to those found in patients with EPP-associated liver injury. We investigated the hepatic expression of the EGFR and its seven most relevant ligands in Fechm1pas/Fechm1pas mice bred in three different backgrounds, and in griseofulvin-induced protoporphyria. We observed that the expression of amphiregulin, betacellulin and epiregulin was significantly increased in young EPP mice when compared to aged-matched controls in all genetic backgrounds. The expression of these ligands was also tested in older (11 months) BALB/cJ EPP mice, and it was found to remain induced, while that of the EGFR was downregulated. Griseofulvin feeding also increased the expression of amphiregulin, betacellulin and epiregulin. Interestingly, protoporphyrin accumulation in cultured hepatic AML-12 cells readily elicited the expression of these three EGFR ligands. Our findings suggest that protoporphyrin could directly induce the hepatic expression of EGFR ligands, and that their chronic upregulation might participate in the pathogenesis of EPP-associated liver disease.

Resistance of class C fly ash belite cement to simulated sodium sulphate radioactive liquid waste attack.

The resistance of class C fly ash belite cement (FABC-2-W) to concentrated sodium sulphate salts associated with low level wastes (LLW) and medium level wastes (MLW) is discussed. This study was carried out according to the Koch and Steinegger methodology by testing the flexural strength of mortars immersed in simulated radioactive liquid waste rich in sulphate (48,000 ppm) and demineralised water (used as a reference), at 20 degrees C and 40 degrees C over a period of 180 days. The reaction mechanisms of sulphate ion with the mortar was carried out through a microstructure study, which included the use of Scanning electron microscopy (SEM), porosity and pore-size distribution and X-ray diffraction (XRD). The results showed that the FABC mortar was stable against simulated sulphate radioactive liquid waste (SSRLW) attack at the two chosen temperatures. The enhancement of mechanical properties was a result of the formation of non-expansive ettringite inside the pores and an alkaline activation of the hydraulic activity of cement promoted by the ingress of sulphate. Accordingly, the microstructure was strongly refined.

Durability of class C fly ash belite cement in simulated sodium chloride radioactive liquid waste: influence of temperature.

This work is a continuation of a previous durability study of class C fly ash belite cement (FABC-2-W) in simulated radioactive liquid waste (SRLW) that is very rich in sulphate salts. The same experimental methodology was applied in the present case, but with a SRLW rich in sodium chloride. The study was carried out by testing the flexural strength of mortars immersed in simulated radioactive liquid waste that was rich in chloride (0.5M), and demineralised water as a reference, at 20 and 40 degrees C over a period of 180 days. The reaction mechanism of chloride ions with the mortar was evaluated by scanning electron microscopy (SEM), porosity and pore-size distribution, and X-ray diffraction (XRD). The results showed that the FABC mortar was stable against simulated chloride radioactive liquid waste (SCRLW) attack at the two chosen temperatures. The enhancement of mechanical properties was a result of the formation of non-expansive Friedel's salt inside the pores; accordingly, the microstructure was refined.

Efficiency of fly ash belite cement and zeolite matrices for immobilizing cesium.

The efficiency of innovative matrices for immobilizing cesium is presented in this work. The matrix formulation included the use of fly ash belite cement (FABC-2-W) and gismondine-type Na-P1 zeolite, both of which are synthesized from fly ash of coal combustion. The efficiency for immobilizing cesium is evaluated from the leaching test ANSI/ANS 16.1-1986 at the temperature of 40 degrees C, from which the apparent diffusion coefficient of cesium is obtained. Matrices with 100% of FABC-2-W are used as a reference. The integrity of matrices is evaluated by porosity and pore-size distribution from mercury intrusion porosimetry, X-ray diffraction and nitrogen adsorption analyses. Both matrices can be classified as good solidify systems for cesium, specially the FABC-2-W/zeolite matrix in which the replacement of 50% of belite cement by the gismondine-type Na-P1 zeolite caused a decrease of two orders of magnitude of cesium mean Effective Diffusion Coefficient (D(e)) (2.8e-09 cm(2)/s versus 2.2e-07 cm(2)/s, for FABC-2-W/zeolite and FABC-2-W matrices, respectively).

An analysis of the effectiveness of Spanish primary health care teams.

One of the main objectives of the managers of public health systems in most developed countries is the modernisation of public services through managerial reforms as a way of resolving the traditional inefficiency of this sector. The objective of this article is to observe how the introduction of one tool traditionally used in the private sector, the organisation of work through teams, can contribute to improved performance in public health services. The study was conducted in the primary health care teams of Navarre, an autonomous region of Spain, where a new model of primary health care, based on teamwork was implanted. We analyse the relationship between team characteristics, team members' individual features and team performance from a stakeholder approach. We can conclude that teams are a form of organisational design useful for improving performance in primary health care because insofar as they function properly, they achieve greater degrees of job satisfaction for the employees, greater perceived quality by the users and greater efficiency for the Administration.

Oxytocin induction of labor: a comparison of 20- and 60-min dose increment levels.

OBJECTIVES: To compare the efficacy and complications of oxytocin dose increments at 20- and 60-min intervals for induction of labor in women with low parity. METHODS: One hundred women of low parity requiring induction of labor were randomly allocated to 20- and 60-min oxytocin dose increments, 50 patients in each group. The basal oxytocin dose was 1 milliunit/min and doubling of the oxytocin dose was done at intervals of 20 and 60 min. RESULTS: The group with 60-min increments had a decreased incidence of uterine hyperstimulation, cesarean section and operative vaginal delivery. The induction-delivery interval was similar in both groups. CONCLUSION: The oxytocin infusion regimen with increments at 60-min intervals is safer than and equally effective as 20-min incremental intervals.

Antinociceptive activity of Polygonum hydropiper.

The hexane, ethylacetate and methanol extracts of Polygonum hydropiper whole plant administered to mice at doses of 250 and 500 mg/kg, showed a significant activity on acetic acid-induced writhing. Within the tested extracts, the ethylacetate one showed the most significant activity.

Efficiency of a blast furnace slag cement for immobilizing simulated borate radioactive liquid waste.

The efficiency of a blast furnace slag cement (Spanish CEM III/B) for immobilizing simulated radioactive borate liquid waste [containing H3BO3, NaCl, Na2SO4 and Na(OH)] has been evaluated by means of a leaching attack in de-mineralized water at the temperature of 40 degrees C over 180 days. The leaching was carried out according to the ANSI/ANS-16.1-1986 test. Moreover, changes of the matrix microstructure were characterized through porosity and pore-size distribution analysis carried out by mercury intrusion porosimetry (MIP), X-ray diffraction (XRD) and thermal analysis (TG). The results were compared with those obtained from a calcium aluminate cement matrix, previously published.

Role of aluminous component of fly ash on the durability of Portland cement-fly ash pastes in marine environment.

The durability, of mixtures of two kinds of Spanish fly ashes from coal combustion (ASTM class F) with 0, 15 and 35% replacement of Portland cement by fly ash, in a simulated marine environment (Na(2)SO(4)+NaCl solution of equivalent concentration to that of sea water: 0.03 and 0.45 M for sulphate and chloride, respectively), has been studied for a period of 90 days. The resistance of the different mixtures to the attack was evaluated by means of the Koch-Steinegger test. The results showed that all the mixtures were resistant, in spite of the great amount of Al(2)O(3) content of the fly ash. The diffusion of SO(4)(2-), Na+ and Cl- ions through the pore solution activated the pozzolanic reactivity of the fly ashes causing the corresponding microstructure changes, which were characterized by X-ray diffraction (XRD), mercury intrusion porosimetry (MIP) and scanning electron microscopy (SEM). As a result, the flexural strength of the mixtures increased, principally for the fly ash of a lower particle size and 35% of addition.

Spanish LLW and MLW disposal: durability of cemented materials in (Na, K)Cl simulated radioactive liquid waste.

The microstructural stability or durability of a specific backfilling pozzolanic-cement mortar, which is employed in Spain, in concrete containers for the storage of low level liquid wastes (LLW) and medium level liquid wastes (MLW), has been studied by means of the Koch-Steinegger test at the temperatures of 20 and 40 degrees C during a period of 365 days. Mortar samples were immersed in salt solutions of 3.46 M NaCl and 3.46 M KCl to simulate the salinity of some radioactive liquid waste matrices. The resistance of the mortar to the saline solution attack is evaluated by the development of the relative flexural strength. The changes of the microstructure were followed by mercury intrusion porosimetry (MIP), scanning electron microscopy (SEM) and X-ray diffraction (XRD). Pore solution was extracted and analyzed at different periods of time to know the possible diffusion of sodium, chloride and potassium inside the microstructure.

[Validation of the Short Cognitive Battery (B2C). Value in screening for Alzheimer's disease and depressive disorders in psychiatric practice]. / Validation de la batterie cognitive courte (B2C). Intérêt pour le dépistage précoce de la maladie d'Alzheimer et des troubles dépressifs en pratique psychiatrique.

UNLABELLED: Alzheimer's disease (AD) is a major healthcare challenge due to the increasing longevity of the population. Clinically prominent neuropsychological and neurological impairments, together with behavioral disorders characterize Alzheimer's disease (AD). In the past, behavioural and emotional disturbances received less attention than cognitive symptoms in studies of dementia. The association between cognitive and behavioural symptoms is complicated by the fact that such association could also occur with different patterns during depressive episode without dementia. Because Alzheimer's disease (AD) tends to be under diagnosed, there is an increasing need for accurate neuropsychological screening tools that are easy to administer by psychiatrists. The aim of the present study was to validate, in French, a sensitive and specific screening battery (B2C) designed to improve the discrimination between patients with AD, patients with depression, and healthy elderly subjects. POPULATION AND METHOD: The B2C was administered to 123 ambulatory subjects (mean age 76.4 2.3 years): divided in three groups of subjects. AD subjects were included (n=49) with a Mini-Mental Status Examination (MMSE) score of between 18 and 26, and a confirmed diagnosis (DSM IV) of mild to moderate AD. Subjects were not included if they were receiving treatment with an acetylcholinesterase inhibitor. The depressive group comprised elderly subjects (n=27) with at least two DSM IV criteria for a major depressive episode including the depressive mood criterion and a score of more than 17 on the Montgomery-Asberg Depression Rating Scale (MADRS). The healthy control group (n=47) comprised age-matched subjects with no neurological or psychiatric pathology. The B2C consists of four individual tasks derived from classical neuropsychological tests. Tasks were presented in the following order: temporal orientation test (knowledge of month, date, year, day of the week and time of day), 5 word test (task is originally derived from the Enhanced Cued Recall test), clock drawing test (In this widely used test, the subject had to draw a clock with all the numbers and then draw the clock hands at twenty minutes to four), and the semantic verbal fluency test (the subject was asked to generate as many words as possible from a given category in a fixed time period of 60 seconds). During the pre-study investigator meeting, the test procedure was adapted to ensure uniformity of practice in all centres. The B2C was administered one week to one month after the study inclusion date by a psychologist blinded to the patient groups and who had not participated in the subject's inclusion. Multivariate analysis was performed using a forced model of all four tests. Due to the nature of the dependent variable (AD vs controls and depressive vs control), the chosen discrimination model was a binary logistical regression model. Explanatory variables were limited to the variables of the test battery, and the dependent variable was the subject's status (AD, depressive or control). RESULTS: The mean results for each test are presented in Table II. The time taken to perform the tests was significantly higher (p=0.0001) for the AD group (11.2 minutes) when compared with both the control (7.6 minutes) and depressive group (8.2 minutes). In each of the four subtests, the AD subjects were significantly more impaired than the two other groups. Multivariate analysis was performed using a forced model of all four tests which provided correct classification of a high percentage of subjects (88.5%). The analysis followed a normal distribution and demonstrated that the AD patients were significantly impaired in all four tests of the B2C compared with controls. Depressive, elderly subjects were only impaired in verbal fluency. Multivariate analysis showed that, compared with controls, patients with mild AD were significantly impaired for all four tests. Response operating characteristics (ROC) analysis of the B2C showed: 93.8% sensitivity and 85% specificity for discriminating AD from control patients (table III), and 63% sensitivity and 96% specificity for discriminating AD from depressive patients (table IV). DISCUSSION: The main objective of this study was to demonstrate that the Short Cognitive Evaluation Battery developed in the French language is able to discriminate between patients suffering from AD and healthy elderly subjects. The results clearly demonstrate that AD patients were significantly impaired in all four tests of the B2C compared with the control group. The present study also supports the use of the screening battery for discriminating between AD and depressive subjects. The SCEB was less discriminatory for AD versus depressive patients than for AD versus controls. This could be due to the limited size of the depressive group. The verbal fluency test was the most sensitive for discriminating between AD and depression but this was at the expense of specificity. Other brief screening tests have already been developed in English speaking countries, In French language, the B2C appears to be a highly sensitive and specific tool for discriminating between patients with mild AD and healthy elderly individuals. Furthermore, in combination with clinical evaluation, the B2C could improve the specificity of the difficult discrimination between mild AD and depression. The next step of the validation process will include concurrent validity study and inclusion of a higher number of subjects with depressive symptoms.

[Severe lower gastrointestinal bleeding in a 25-year-old patient]. / Hemorragia digestiva baja grave en joven de 25 años.

Lower gastrointestinal bleeding refers to blood loss originating from a site distal to the ligament of Treitz. The aetiology varies depending on the age of patients. Excluding benign anorectal pathology in children and young people, Meckel's diverticulum, juvenile polyps and inflammatory bowel disease are the main causes. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, being present in about 2% of the general population. Most Meckel's diverticulum are asymptomatic and are diagnosed incidentally. The risk of complications is 4-6%, with bleeding as one of them.

Effect of temperature on the durability of class C fly ash belite cement in simulated radioactive liquid waste: synergy of chloride and sulphate ions.

The durability of class C fly ash belite cement (FABC-2-W) in simulated radioactive liquid waste (SRLW) rich in a mixed sodium chloride and sulphate solution is presented here. The effect of the temperature and potential synergic effect of chloride and sulfate ions are discussed. This study has been carried out according to the Koch-Steinegger test, at the temperature of 20 degrees C and 40 degrees C during a period of 180 days. The durability has been evaluated by the changes of the flexural strength of mortar, fabricated with this cement, immersed in a simulated radioactive liquid waste rich in sulfate (0.5M), chloride (0.5M) and sodium (1.5M) ions--catalogued like severely aggressive for the traditional Portland cement--and demineralised water, which was used as reference. The reaction mechanism of sulphate, chloride and sodium ions with the mortar was evaluated by scanning electron microscopy (SEM), porosity and pore-size distribution, and X-ray diffraction (XRD). The results showed that the chloride binding and formation of Friedel's salt was inhibited by the presence of sulphate. Sulphate ion reacts preferentially with the calcium aluminate hydrates forming non-expansive ettringite which precipitated inside the pores; the microstructure was refined and the mechanical properties enhanced. This process was faster and more marked at 40 degrees C.

Belite cement clinker from coal fly ash of high Ca content. Optimization of synthesis parameters.

The optimization of parameters of synthesis of belite cement clinker from coal fly ash of high Ca content is presented in this paper. The synthesis process is based on the hydrothermal-calcination-route of the fly ash without extra additions. The hydrothermal treatment was carried out in demineralized water and a 1 M NaOH solution for 4 h at the temperatures of 100 degrees C, 150 degrees C, and 200 degrees C. The precursors obtained during the hydrothermal treatmentwere heated at temperatures of 700 degrees C, 800 degrees C, 900 degrees C, and 1000 degrees C. The changes of fly ash composition after the different treatments were characterized by X-ray diffraction (XRD), FT infrared (FTIR) spectroscopy, surface area (BET-N2), and thermal analyses. From the results obtained we concluded that the optimum temperature of the hydrothermal treatment was 200 degrees C, and the optimum temperature for obtaining the belite cement clinker was 800 degrees C.