Planned induction versus spontaneous delivery among women using prophylactic anticoagulation therapy: a retrospective study.

OBJECTIVES: To examine the outcomes of planned induction of labour versus spontaneous onset of labour among women using prophylactic-dose low-molecular weight heparin (LMWH) therapy. DESIGN: Retrospective cohort study. SETTING: University hospital. POPULATION: Women receiving antepartum prophylactic LMWH therapy undergoing a trial of vaginal delivery. METHODS: Charts from 2018-2019 were reviewed. MAIN OUTCOME MEASURES: Duration of anticoagulation interruption and eligibility to receive neuraxial anaesthesia. RESULTS: Data from 199 women were analysed; 78 (39.2%) were admitted following spontaneous onset of labour and 121 (60.8%) underwent planned induction of labour. Compared to women who underwent planned induction of labour, women who presented with spontaneous onset of labour had a shorter median admission-to-delivery interval (4.7 versus 29.3 hours, P < 0.001). Similarly, intervals from the last LMWH injection to delivery (25.8 versus 48.2 hours, P < 0.001) and to the first postpartum LMWH injection (41.2 versus 63.7 hours, P < 0.001) were shorter. Among those with spontaneous onset of labour, 69 (88.5%) were eligible to receive neuraxial anaesthesia. Rates of postpartum haemorrhage and blood transfusion were similar between the groups. No thrombotic events were encountered in those with spontaneous onset of labour, but four (3.3%) women who delivered following induction of labour developed a postpartum thrombotic event. CONCLUSION: Planned induction of labour was associated with a higher risk of postpartum thrombotic events than was spontaneous onset of labour (4 of 121 [3.3%] versus 0 of 78 [0%]), presumably due to prolonged duration of anticoagulation interruption, although the difference was not statistically significant. Allowing spontaneous onset of labour was associated with comparable rates of bleeding complications, and only a low proportion (9 of 78, 11.5%) were not eligible to receive neuraxial anaesthesia. TWEETABLE ABSTRACT: Planned induction among women using prophylactic LMWH therapy might increase the risk of thromboembolic complications.

History-indicated cervical cerclage in management of twin pregnancy.

OBJECTIVE: Cervical cerclage, when performed in twin gestation, has been reported to be associated with poor outcome. However, the role of first-trimester history-indicated cerclage among women with a twin pregnancy and a history of preterm birth has not been evaluated. The aim of this study was to assess pregnancy outcomes among women with a twin pregnancy who underwent first-trimester history-indicated cervical cerclage compared with outcomes in those managed expectantly. METHODS: This was a retrospective matched case-control study. The study group comprised all women with a twin pregnancy who had undergone first-trimester history-indicated cerclage during the period 2006 to 2017 at Hadassah-Hebrew University Medical Center. A control group of women with a twin pregnancy who were managed expectantly was established by matching age, history of spontaneous preterm birth (20-36 weeks' gestation) and year of delivery. Pregnancy and delivery characteristics and neonatal outcomes were compared between the two groups. RESULTS: Data from 82 women with a twin gestation were analyzed, of whom 41 underwent first-trimester history-indicated cerclage and 41 were matched controls who were managed expectantly. Gestational age at delivery was higher in the cerclage group than in those managed expectantly (median 35 vs 30 weeks; P < 0.0001). Rates of spontaneous preterm birth before 24 weeks (2.4% vs 19.5%; odds ratio (OR), 0.10 (95% CI, 0.01-0.87); P = 0.03), before 28 weeks (12.2% vs 34.1%; OR, 0.27 (95% CI, 0.09-0.84); P = 0.03), before 32 weeks (22.0% vs 56.1%; OR, 0.22 (95% CI, 0.08-0.58); P = 0.003) and before 34 weeks (34.1% vs 82.9%; OR, 0.11 (95% CI, 0.04-0.30); P < 0.0001) were significantly lower in the cerclage group than in the control group. Median birth weight was higher in the cerclage group (2072 g vs 1750 g; P = 0.003), with lower rates of low birth weight (< 2500 g) (65.0% vs 89.4%; P = 0.001) and very low birth weight (< 1500 g) (21.3% vs 37.9%; P = 0.03) than in the group managed expectantly. Rates were also lower in the cerclage group for stillbirth, admission to the neonatal intensive care unit, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, neonatal mortality and composite adverse neonatal outcome. CONCLUSIONS: History-indicated cerclage performed in the first trimester, as compared with expectant management, in women with a twin pregnancy had an overall positive effect on pregnancy and neonatal outcomes. These findings suggest the need for adequate randomized trials on cerclage placement in this subset of women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Photon number measurement using heterodyne method for a detector's quantum efficiency determination based on spontaneous parametric down-conversion.

Active development of quantum informational components such as quantum computers and quantum key distribution systems requires parameter characterization of single photon detectors. A key property of the single photon detectors is detection efficiency. One of the methods of the detection efficiency measurement, as listed in the international standard ETSI, is the reference-free twin-photon-based Klyshko method. The signal-to-noise ratio (SNR) of this method depends on the combination of the pump wavelength, the nonlinear crystal's axis angle, and the type of detector's sensitive element. When the combination is difficult, one has to deal with the low SNR of the detector counts measurement. To gain the high SNR, one has to average the long record complicated with the "random telegraph signal" noise. This type of noise exhibits high spectral density at a zero frequency, where simple averaging works. The heterodyne based method we have proposed is to perform averaging at the higher frequency of the modulation introduced to the standard Klyshko measurement scheme. The method was numerically simulated and experimentally tested. The 14 times improvement in SNR for the proposed method relative to the simple averaging was demonstrated by the numerical simulation and confirmed experimentally.

Exposure to prolonged controllable or uncontrollable stress affects GABAergic function in sub-regions of the hippocampus and the amygdala.

The degree of behavioral control that an individual has over a stressor can critically determine its behavioral and neurochemical outcomes. Exposure to uncontrollable stress was previously shown to have detrimental effects on behavior, whereas exposure to equivalent controllable stress prevented these negative outcomes and even improved later stress coping. As many lines of evidence show, stress exposure can have maladaptive changes on inhibitory circuitry, and these effects were largely shown in the hippocampus and amygdala. In the current study we set out to examine alterations in GABAergic activity following exposure to the prolonged two way shuttle (TWS) avoidance task, focusing on the GABA-related factors glutamate decarboxylase (GAD)65, cholecystokinin (CCK) and neuropeptide Y (NPY). As recent views of the hippocampus assume regional specificity in hippocampal function, we examined different regions in the hippocampus, as well as the basolateral amygdala (BLA). Our findings reveal similar alterations in GAD65 in BLA for both controllable and uncontrollable stress exposure, but differential alterations in GAD65 and NPY in the dorsal dentate gyrus (DG). Synaptic plasticity and inhibitory activity in the dorsal DG was further assessed by applying different stimulation protocols and measuring evoked field potentials in vivo. Our results support a role for the DG in stress processing, emphasizing its sensitivity to the nature of the stressor.

A novel approach to PTSD modeling in rats reveals alternating patterns of limbic activity in different types of stress reaction.

Human reactions to trauma exposure are extremely diverse, with some individuals exhibiting only time-limited distress and others qualifying for posttraumatic stress disorder diagnosis (PTSD). Furthermore, whereas most PTSD patients mainly display fear-based symptoms, a minority of patients display a co-morbid anhedonic phenotype. We employed an individual profiling approach to model these intriguing facets of the psychiatric condition in underwater-trauma exposed rats. Based on long-term assessments of anxiety-like and anhedonic behaviors, our analysis uncovered three separate phenotypes of stress response; an anxious, fear-based (38%), a co-morbid, fear-anhedonic (15%), and an exposed-unaffected group (47%). Immunohistochemical assessments for cellular activation (c-Fos) and activation of inhibition (c-Fos+GAD67) revealed a differential involvement of limbic regions and distinct co-activity patterns for each of these phenotypes, validating the behavioral categorization. In accordance with recent neurocognitive hypotheses for posttraumatic depression, we show that enhanced pretrauma anxiety predicts the progression of posttraumatic anhedonia only in the fear-anhedonic phenotype.

Antithrombin Activity of Erythrocyte Microvesicles.

Coagulation and optical (based on chromogenic substrate) methods were employed to examine antithrombin activity of erythrocytes and erythrocyte-derived microvesicles isolated days 7, 14, 21, and 28 on erythrocyte storage. The erythrocyte-derived microvesicles decelerated fibrin clot formation from fibrinogen in the presence of exogenous thrombin both with and without heparin. Microvesicles reduced optical density of chromogenic substrate. These data suggest that erythrocyte-derived microvesicles display a prominent antithrombin activity, which significantly increases during erythrocyte storage.

[AGGREGATION OF METABOLICALLY DEPLETED HUMAN ERYTHROCYTES].

An aggregation of erythrocytes in autologous plasma after blood storage for 14 days at 4 °C was studied using photometry and light microscopy. The decrease of ATP content, the formation of echinocytes and spheroechinocytes, the decrease of rouleaux form of erythrocyte aggregation were observed during the storage. On the other hand the aggregates of echinocytes were formed in the stored blood. The addition of plasma from the fresh blood didn't restore the normal discocytic shape and aggregation of erythrocytes in the stored blood. The possible mechanisms of erythrocytes and echinocytes aggregation are discussed.

[The influence of erythrocyte-derived microvesicles on aggregation of platelets in burn injury].

Burn Injury is accompanied by a significant homeostasis disorder, including the disorder of primary homeostasis, associated with aggregation of platelets. The role of erythrocyte-derived microvesicles in this process has not undergone thorough research. Microvesicles were isolated from washed erythrocytes after one day of storage by ultracentrifugation at 100000 g. The number of MVs was determined by flow cytometry and was standardized in the samples. Heparin-dependent and heparin-independent antithrombin activity in erythrocyte microvesicles was studied by coagulation method. We studied platelet aggregation induced and not induced by ADP under the conditions of artificial shear flow. It was shown that at the early stage of bum injury the number of erythrocyte-derived microvesicles in blood demonstrated a 4.2-fold ncrease. We determined that microvesicles, derived from the erythrocytes of burn patients displayed a significantly less aggregation activity than the microvesicles from donors. The main reason is a considerably lower antithrombin activity in the erythrocyte microvesicles of bum patients. Thus, we can conclude that the decrease of antiaggregation and antithrombin activity of erythrocyte microvesicles associated with the increase in their concentration in blood contributes to thrombophilia of bum patients. Keywords: erythrocytes, microvesicles, bum injury, platelet aggregation, antithrombin activity

[The role of erythrocyte microvesiculation and hemoglobin glycation in hemorheological disordes during burn injury].

INTRODUCTION: Hemorheological disorders play an important part in pathogenesis of acute period of burn injury. This mechanism remains practically unstudied. Thus, unknown is the role of hemoglobin glycation and erythrocyte microvesiculation in the decrease in erythrocyte deformability after thermal trauma. METHODS: Research was performed on 30 blood samples of burn patients in the acute period and 40 blood samples of healthy donors. The number of erythrocyte-derived microvesicles was determined by flow cytometry and then standardized in the samples; the microvesicles were preliminarily separated by ultracentrifugation at 100,000 g, for 60 minutes. Electrophoretic mobility of erythrocytes was measured in a processing chamber of the optical cuvette under the light microscope. Deformability of erythrocytes was assessed by the level of their extension in the artificial shear flow. RESULTS: It was found that the amount of HbA1c in red blood cells of burn patients demonstrated a 2-fold increase compared to healthy donors. In the experiments in vitro it was proved that deformability of erythrocytes correlates with the level of hemoglobin glycation. Hb glycation leads to the increased rigidity of erythrocytes also by increasing their microvesiculation. The number of microvesicles derived from red blood cells of burn patients demonstrated a 3.47-fold increase compared to healthy donors. An important reason for microvesiculation is the destabilization of lipid complex of erythrocyte membrane, which is accompanied by the increase in the erythrocyte negative charge. It can be concluded that Hb glycation and redistribution of erythrocyte membrane phospholipids are he important reasons for the increase erythrocyte microvesiculation and are accompanied by the decrease in erythrocyte deformability after thermal trauma.

[Lysophosphatidic acid and human erythrocyte aggregation].

The effects of lysophosphatidic acid on the morphology and aggregation of human erythrocytes has been studied. Morphology of erythrocytes and their aggregates were studied by light microscopy. It has been shown that lysophosphatidic acid changes the shape of red blood cells: diskocyte become echinocytes. Aggregation of red blood cells (rouleaux) was significantly reduced in autoplasma. At the same time there is a strong aggregation of echinocytes. This was accompanied by the formation of microvesicles. Adding normal plasma to echinocytes restores shape and aggregation of red blood cells consisting of "rouleaux". A possible mechanism of action of lysophosphatidic acid on erythrocytes is discussed.

[Effect of adenosine on the shape, aggregates morphology and aggregability of ATP-depleted erythrocytes].

The effect of adenosine on the shape, aggregate morphology and aggregability of ATP-depleted erythrocytes was studied. It is shown that the ATP-depletion of erythrocyte leads to the change in their shape: diskocytes transform to echinocytes. It is found that the aggregability of such cells in autoplasma significantly decreased. Incubation of echinocytes with adenosine largely restored discoid shape and erythrocyte aggregability.

[Spectrophotometric method for aminoglycoside concentration measurement in blood plasma].

The aim of the research was to develop a simple, available and rapid spectrophotometric method for measuring aminoglycoside concentration in blood plasma and to evaluate the antibiotic efficacy and susceptibility. The method is based on the ability of aminoglycosides, in particular amikacin, to change the color of Fast Blue B Salt Dye (SIGMA-ALDRICH). An antibiotic at various concentrations and the dye were added to blood plasma. The resulting mixture was filtered to separate the insoluble residue. After that the optical density of the filtrate were measured spectrophotometrically against the control specimen with no antibiotic at the wavelength of 450 nm. It was demonstrated that an increase in the plasma antibiotic concentration led to a directly proportional increase of the antibiotic solution extinction. This is a simple, precise and rapid method.

Wheat germ supplementation has modest effects on gut health markers but improves glucose homeostasis markers in adults classified as overweight: A randomized controlled pilot study.

Wheat germ (WG), a by-product of flour milling, is rich in bioactive substances that may help improve health complications associated with increased adiposity. This study investigated the effects of WG on gut health, metabolic, and inflammatory markers in adults classified as overweight. We hypothesized that WG, because of its many bioactive components, would improve gut health and metabolic, and inflammatory markers in overweight adults. Forty adults (18-45 years old) and with a body mass index between 25 and 30 kg/m2 participated in this single-blinded randomized controlled pilot study. Participants consumed the study supplements containing 30 g of either cornmeal (control, CL) or WG daily for 4 weeks. Primary outcome variables were gut health markers including gut microbiota, gut integrity markers, and fecal short-chain fatty acids, whereas secondary outcome variables included metabolic and inflammatory parameters assessed at baseline and at the end of supplementation. Thirty-nine participants (n = 19 and 20 for CL and WG group, respectively) completed the study. The genus Faecalibacterium was significantly higher in the WG group compared to CL post-supplementation but no significant changes in other gut health markers, short-chain fatty acids, inflammatory markers, and lipid profiles were observed. Compared with baseline, WG improved markers of glucose homeostasis including insulin (P = .02), homeostatic model assessment of insulin resistance (P = .03), glycated hemoglobin (P = .07), and the pro-inflammatory adipokine, resistin (P = .04). However, these parameters after intervention were not different with control. Our findings suggest that WG supplementation have modest effects on gut health but may provide an economical option for individuals to improve glycemic control.

Long-term effects of maternal separation on chronic stress response suppressed by amitriptyline treatment.

Abstract The early-life environment has many long-term effects on mammals. Maternal interaction and early stressful events may affect regulation of the HPA axis during adulthood, leading to differential glucocorticoid secretion in response to stressful situations. These adverse experiences during postnatal development may even sensitize specific neurocircuits to subsequent stressors. Later in life, the overreaction of the HPA axis to stress can constitute a risk factor for metabolic and mental diseases. As tricyclic antidepressants are known to correct glucocorticoid hypersecretion during depression, we treated maternally separated animals with amitriptyline, at a lower dose than habitually used in depression models, to prevent the response to chronic stress during adulthood. Male Wistar rats were separated from the mother for 4.5 h every day for the first 3 weeks of life. From postnatal day 50, animals were subjected to chronic variable stress during 24 d (five types of stressors at different times of day). During the stress, protocol rats were orally administered amitriptyline (5 mg/kg) daily. We observed that maternal separation caused a reduction in plasma ACTH levels (p < 0.05), but evoked hypersecretion of corticosterone (p < 0.05) when it was combined with stress in adulthood. This rise was completely prevented by antidepressant treatment with amitriptyline.

Effects of erythrocyte microvesicles on the coagulation process stages.

We studied the effect of erythrocyte microvesicles on various stages of platelet-free autoplasma coagulation process. The erythrocyte microvesicles not only exhibited procoagulant activity, but also produced a pronounced anticoagulant effect by inhibiting fibrin formation process. The effects of microvesicles isolated from erythrocytes after 24- and 48-hour cell storage on plasma coagulation were different. The hemocoagulation effects of the "light" and "heavy" microvesicles were studied.

[Antioxidative system of the organism and thermo-initiated chemiluminescence method for quantitative evaluation of its state].

Evolutionary stages of the development of an antioxidative system within the human organism are shortly considered and the technique for measurement of blood plasma parameters, which reflect the state of antioxidative homeostasis, based on thermo-initiated chemiluminescence of azo compounds in the presence of luminal, is described. Parameters, suitable for quantitative estimation of the degree of oxidative stress and the efficiency control of causal and adjuvant antioxidative therapy in the course of primary and secondary prevention of civilization illnesses are recommended. A special attention is focused on sports activities as the most accessible and effective way of achieving the specified preventive purposes.

[Study of the relationship between shape and aggregation change in human erythrocytes].

The relationship between shape and spontaneous and fibrinogen-induced aggregation change in human erythrocytes was studied. Spontaneous and fibrinogen-induced erythrocyte aggregation was investigated using a rheoscope designed according to the method of H. Schmid-Schonbein et al. (1973). The erythrocyte shape was studied by means of light microscopy. It was shown that plasma enriched with lysophosphatidic acid and ATP depletion of erythrocytes led to the change of erythrocyte shape: discocytes transformed into echinocytes. It was found that spontaneous aggregation of such cells was considerably decreased. Aggregation of erythrocytes, treated with lysophosphatidic acid, was diminished more markedly. Fibrinogen-induced aggregation of echinocytes, obtained after treatment with lysophosphatidic acid and produced by ATP depletion, was also greatly reduced.

[Status of the water-soluble component of the antioxidant defense system in the conditions of 520-day isolation].

In the 520-d chamber experiment within the international project Mars-500 blood samples of 6 male test-subjects of 28 to 39 years of age were analyzed for water-soluble antioxidants: total bilirubin and uric acid; in addition, total antioxidant capacity of blood plasma was determined. Maximal values of these parameters were associated with the most stressful periods of the experiment, i.e. adaptation to the life in isolation and confinement, simulation of the egress onto Martian surface, and change of the diet. On attainment of the homeostatic equilibrium the parameters stabilized on levels slightly lower relative to baseline (pre-isolation) values. Therefore, dynamics of the water-soluble antioxidants reflected adequately the homeostatic reactions to and compensation by organism of the effects of the 520-day life in isolation and confinement.