Consecutive Delivery Research Articles

Duration of labor in consecutive deliveries: a retrospective data analysis

PurposeLabor is shorter in multiparous women. However, there are no individualized data on differences in duration of labor for consecutive deliveries in the same parturient.MethodsWe conducted a retrospective data analysis from 2004 to 2021 at the University Hospital of Zurich and included all women with 2 or more vaginal deliveries of a singleton child in cephalic position, between 22 and 42 weeks of gestation. Descriptive statistics were performed with SPSS version 25.0 (IBM, SPSS Inc., USA). The primary endpoint was the ratio between durations of labor stages in consecutive deliveries of the same parturient.ResultsA total of 3344 women with 7066 births (2601 first [P0], 2987 s [P1], 1176 third [P2], and 302 fourth [P3]) were included. The ratio of duration of the active first stage of labor between P1 and P0 was 0.49 (95% CI 0.47–0.51, p < 0.001) meaning that the active first stage of labor was 51% shorter. The second stage of labor with a ratio of 0.26 (95% CI 0.24–0.27, p < 0.001) was 74% shorter in P1 compared to P0. Higher birthweight of the first child led to an even greater decrease in duration of the second stage of labor in P1 compared to P0 (p = 0.003). Neuraxial anesthesia was an independent risk factor for a longer duration of labor, irrespective of parity (p < 0.001). Birthweight and HC of the neonates did not significantly differ between the children born by the same women. However, higher birthweight in of the first child significantly augmented the rate of second stage of labor between P0 and P1 (p = 0.003).DiscussionUp to the third delivery, duration of labor decreased with each consecutive delivery of the same parturient. An individualized assessment of the expected duration of labor in multiparous women should be encouraged.

Cesarean section in the second stage of labor is associated with early-term and late preterm birth in subsequent pregnancies

Objectives The objectives of this study were to determine in a population-based cohort study the association between cesarean section (CS) during the second stage of labor and the risk for preterm birth and/or cervical insufficiency in the subsequent pregnancy; to identify maternal and neonatal risk factors for long-term complications following CS due to prolonged second stage of labor. Methods We conducted a retrospective population-based cohort study including women who had at least one consecutive delivery following a CS at our institution from 1991 to 2018, provided that the first delivery was at term. We divided the study cohort into two groups: (1) women who delivered by CS due to failure to progress during the first stage of labor (n = 1068); and (2) those who delivered by CS due to arrest of descent at the second stage of labor (n = 603). Results Of the 120,147 women who met the inclusion criteria, 78,407 had a subsequent delivery during the study period. Women of group 1 were significantly older than those of group 2 (p = .018), and had a higher rate of assisted reproductive technology [61 (5.7%) vs. 18 (3.1%), p < .022,]. Additionally, their hospitalization period was significantly longer (p < .001). The rate of preterm birth in the subsequent delivery was higher among women who had a CS due to arrest of descent than those who had a CS due to arrest in dilatation [43 (7.3%) vs 49 (4.6%), p < .026]. This was confirmed after adjusting for confounding factors In a multivariable regression analysis (OR 1.78, 95% CI 1.14–2.76, p value = .011) A Cox regression analysis implying gestational age at delivery at the time factor identifies CS due to arrest of descent as a risk factor for subsequent preterm birth (Hazard ratio 1.19 95% CI 1.07–1.31). Conclusion CS due to arrest of descent is an independent risk factor for subsequent preterm birth. The exact mechanisms contributing to this association are yet to be determined. Synopsis Cesarean section during the second stage of labor is an independent risk factor for late preterm birth in the subsequent pregnancy when compared to cesarean section in the first stage of labor.

Patch Pumps: Periodic Insulin Delivery Patterns.

Recent in vitro experiments with patch pumps (PP) Omnipod (OP), Omnipod DASH (OP-D), A6 TouchCare (A6), and Accu-Chek Solo (ACS) have observed periodic fluctuations in the delivered amount of insulin during basal rate and consecutive bolus delivery in some PP, calling for a more systematic characterization of these periodic delivery patterns. Here, it was found that during basal rate delivery of 1 U/h, some devices of OP, OP-D, and A6 showed deviations of up to ±30% from target delivery that consistently repeated every 5 hours, whereas ACS showed no clear periodicity with considerably lower deviations. Similar results were found during consecutive bolus delivery of 1 U, where deviations repeated consistently every five boluses in some devices of OP, OP-D, and A6. However, there was a large variability in the periodic delivery patterns between individual devices of the same PP model. Examining their pumping techniques indicated a connection between the insulin delivery mechanism and observed delivery patterns of the PP. However, the clinical impact of such patterns is unclear.

Characteristics of pregnancy with gestational diabetes mellitus and the consecutive pregnancy as predictors for future diabetes mellitus type 2

AimTo explore possible obstetrical history-related, modifiable risk factors of future type 2 diabetes mellitus (T2DM), with focus on characteristics of the index gestational diabetes mellitus (GDM) pregnancy and the consecutive pregnancy. MethodsThis retrospective, population-based, cohort study included 788 women with GDM, who had consecutive deliveries at Emek Medical Center during 1991–2012. Women with pre-existing diabetes were excluded. Factors associated with T2DM development were examined using stepwise multiple Cox regression model. ResultsOverall 178 women developed T2DM (23%). Multivariable analysis demonstrated that the most significant independent risk factors for T2DM development were birth weight ≥ 4000 g (HRadj1.7 95% CI [1.001–2.8]), fasting oral glucose tolerance test value (OGTT, HRadj1.03 95% CI [1.01–1.04], 1-hour post-OGTT glucose value (HRadj1.01 95% CI [1.006–1.02]), earlier gestational week in which GDM was diagnosed (HRadj 0.96 95% CI [0.93–0.99]), higher parity (HRadj 1.15 95% CI [1.06–1.25] and GDM recurrence in the consecutive delivery (HRadj2.4 95% CI [1.6–3.7]). Kaplan Meier survival curve of the time from the consecutive pregnancy until T2DM development showed a statistically significant effect of GDM recurrence and the risk for T2DM. Body mass index (BMI) gain between pregnancies and inter-pregnancy interval were not independent risk factors for T2DM. ConclusionsObstetric characteristics of women with GDM and particularly GDM recurrence are associated with increased risk for T2DM. Strategies to prevent those factors and especially GDM recurrence might reduce the risk of future T2DM.

Analysis of risk factors for gestational diabetes mellitus in elderly multipara women in the next pregnancy

Objective: To investigate the risk factors for gestational diabetes mellitus (GDM) in elderly multipara women in the next pregnancy. Methods: A total of 219 elderly multipara women with 2 consecutive delivery records in Tianjin Binhai New Area Tanggu Obstetrics and Gynecology Hospital from January 2018 to May 2019 were included. Among them, 141 had normal glucose tolerance (NGT) and 78 of them had GDM. The clinical data of the previous and current pregnancy were collected to analyze the risk factors of GDM in elderly multipara women. Results: The average ages of 219 elderly women in previous pregnancy and this pregnancy were (31.9±2.2) and (36.7±1.5) years old, and the prevalence of GDM was 35.62% (78 cases). Compared to NGT group, GDM patients had higher fasting blood glucose(previous (5.51±1.43) vs (4.63±0.62) mmol/L; current (5.26±0.63) vs (4.59±0.30) mmol/L, 1 h blood glucose(previous (11.74±2.36) vs (9.50±1.82) mmol/L; current (11.03±2.03) vs (9.51±1.14) mmol/L) in 75 g oral glucose tolerance test (OGTT) in both previous and current pregnancy. The rates of cesarean section, in both previous and current pregnancy were higher in GDM group (previous 34.6% vs 4.3%; current 52.6% vs 22.0%). Furthermore, prenatal weight and body mass index (BMI) of the previous pregnancy, pre-pregnancy weight and BMI, and prenatal BMI of this pregnancy were also higher in GDM group, and the differences were all statistically significant (all P<0.05). Logistic multivariate regression analysis indicated cesarean section history (OR=10.80, 95%CI: (4.09-28.54)), GDM history of previous pregnancy (OR=10.64, 95%CI: (4.02-28.20)), 75 g OGTT fasting blood glucose≥ 4.86 mmol/L (OR=2.70, 95%CI: (1.27-5.70)), 1 h blood glucose after glucose administration ≥ 8.45 mmol/L (OR=1.78, 95%CI: (1.37-2.31)) were risk factors for GDM in elderly multipara women of this pregnancy. Conclusion: The risk of GDM in elderly multipara women with a history of cesarean section and GDM increases significantly. Results of OGTT in previous pregnancy also has predictive value.

A Synthetic Chrono Genetic Therapy Gene for Consecutive Drug Delivery

Chronotherapy, the delivery of therapeutic interventions personalized to patient's circadian rhythms, has shown enhanced therapeutic efficacy and reduced side effects. Patients exhibit diurnal changes in cytokines in rheumatoid arthritis that lead to inflammatory flares and enhanced disease severity in the early morning. There has been important work showing the administration of anti-inflammatory treatments in the early morning, immediately before the inflammatory flare, in reducing symptoms of RA. Using synthetic biology, we developed chronotherapy-based gene chromogenic therapies that produce our prescribed transgene downstream of the core circadian clock component, Per2. We transduced these lentiviral chromogenic therapies into murine-induced pluripotent stem cells and developed tissue-engineered cartilage as our model system for timed drug delivery. Our anti-inflammatory chromogenic could produce interleukin-1 receptor antagonist (IL-1Ra) in an oscillatory manner tracking with circadian rhythms in vitro. Additionally, the tissue-engineered pellets could entrain host circadian rhythms when implanted into mice and produce different levels of IL-1Ra in the serum at other times of the day. The chromogenic synthetic gene provides a novel cell therapy driving by the circadian clock for controlled biologic delivery at prescribed times of the day.

Consecutive and Selective Double Methylene Insertion of Lithium Carbenoids to Isothiocyanates: A Direct Assembly of Four‐Membered Sulfur‐Containing Cycles

AbstractA formal CH2−CH2homologation conducted with C1 carbenoids on a carbon electrophile for the obtainment of a four‐membered cycle is reported. The logic proposes the consecutive delivery of two single nucleophilic CH2units to an isothiocyanate—as competent electrophilic partner—resulting in the assembling of a rare imino‐thietane cluster. The single synthetic operation procedure documents genuine chemocontrol, as indicated by the tolerance to various reactive elements decorating the starting materials. Significantly, the double homologation protocol is accomplished directly on a carbon electrophile, thus not requiring the installation of heteroatom‐centered manifolds (e.g. boron).

Consecutive and Selective Double Methylene Insertion of Lithium Carbenoids to Isothiocyanates: A Direct Assembly of Four-Membered Sulfur-Containing Cycles.

A formal CH2−CH2 homologation conducted with C1 carbenoids on a carbon electrophile for the obtainment of a four‐membered cycle is reported. The logic proposes the consecutive delivery of two single nucleophilic CH2 units to an isothiocyanate—as competent electrophilic partner—resulting in the assembling of a rare imino‐thietane cluster. The single synthetic operation procedure documents genuine chemocontrol, as indicated by the tolerance to various reactive elements decorating the starting materials. Significantly, the double homologation protocol is accomplished directly on a carbon electrophile, thus not requiring the installation of heteroatom‐centered manifolds (e.g. boron).

Development of a three-layer consecutive gene delivery system for enhanced bone regeneration

This study developed a three-layer consecutive gene delivery system (T-CGDS) for timely gene delivery into human mesenchymal stem cells (hMSCs). The timing of transcription factor expression is important to effectively induce bone differentiation. Therefore, a three-layered nanocomposite was fabricated using differently sized gold nanoparticles to promote bone regeneration and osteogenic differentiation. The core layer comprised 80 nm gold nanoparticles coupled with ATF4 pDNA. Following coating with heparin-conjugated Pluronic F-127 (HP-F127), 50 nm gold nanoparticles coupled with SP7 pDNA were added to fabricate a bi-layer system. After further coating with HP-F127, 20 nm gold nanoparticles combined with RUNX2 pDNA were added. Consequently, a T-CGDS measuring 350–450 nm was fabricated. Genes were released for more than 8 days, while the size of the T-CGDS decreased over time. When the T-CGDS was applied to hMSCs, the gene in the outer layer (RUNX2) was expressed first, followed by those in the middle (SP7) and core (ATF4) layers. The T-CGDS effectively induced bone differentiation and regeneration in vitro and in vivo. Timely delivery of the ATF4 gene to stem cells via the T-CGDS can greatly assist osteogenic differentiation involved in bone regeneration.

Failure of placental detachment in accreta placentation is associated with excessive fibrinoid deposition at the utero-placental interface

The main histopathologic diagnostic criteria for the diagnosis of placenta accreta for more than 80 years has been the finding of a direct attachment of the villous tissue to the superficial myometrium or adjacent to myometrial fibers without interposing decidua. There have been very few detailed histopathologic studies in pregnancies complicated by placenta accreta spectrum disorders and our understanding of the pathophysiology of the condition remains limited. To prospectively evaluate the microscopic changes used in grading and to identify changes that might explain the abnormal placental tissue attachment. A total of 40 consecutive cesarean delivery hysterectomy specimens for placenta previa accreta at 32 to 37 weeks of gestation with at least 1 histologic slide showing deeply implanted villi were analyzed. Prenatal ultrasound examination included placental location, myometrial thickness, subplacental vascularity and lacunae. Macroscopic changes of the lower segment were recorded during surgery and areas of abnormal placental adherence were sampled for histology. In addition, 7 hysterectomy specimens with placenta in-situ from the Boyd Collection at 20.5 to 32.5 weeks were used as controls. All 40 patients had a history of at least 2 previous cesarean deliveries and presented with a mainly anterior placenta previa. Of note, 37 (92.5%) cases presented with increased subplacental vascularity, 31 (77.5%) cases with myometrial thinning and all with lacunae. Furthermore, 20 (50%) cases presented with subplacental hypervascularity, lacunae score of >3, and lacunae feeder vessels. Intraoperative findings included anterior lower segment wall increased vascularization in 36 (90.0%) cases and extended area of dehiscence in 18 (45.0%) cases. Immediate gross examination of hysterectomy specimens showed an abnormally attached areas involving up to 30% of the basal plate, starting at <2 cm from the dehiscence area in all cases. Histologic examination found deeply implanted villi in 86 (53.8%) samples with only 17 (10.6%) samples presenting with villous tissue reaching at least half the uterine wall thickness. There were no villi crossing the entire thickness of the uterine wall. There was microscopic evidence of myometrial scarification in all cases. Dense fibrinoid deposits, 0.5 to 2 mm thick, were found at the utero-placental interface in 119 (74.4%) of the 160 samples between the anchoring villi and the underlying uterine wall at the accreta areas and around all deeply implanted villi. In the control group, the Nitabuch stria and basal plate became discontinuous with advancing gestation and there was no evidence of fibrinoid deposition at these sites. Samples from accreta areas at delivery present with a thick fibrinoid deposition at the utero-placental interface on microscopic examination independently of deeply implanted villous tissue in the sample. These changes are associated with distortion of the Nitabuch membrane and might explain the loss of parts of the physiological site of detachment of the placenta from the uterine wall in placenta accreta spectrum. These findings indicate that accreta placentation is more than direct attachment of the villous tissue to the superficial myometrium and support the concept that accreta villous tissue is not truly invasive.

Development of energy-efficient model in long term evolution (LTE) network using optimum network engineering tools

The concept of the heterogeneous network was introduced to meet the demands of the mobile network’s traffic flow capacity and data rate. It consists of dissimilar networks with diverse wireless access technologies. By convention, a Mobile Subscriber (MS) may travel and attain the vertical handover by a single criterion vertical handover decision, but, conversely, this may cause ineffective handover, unbalanced system load, and service disruption. This Thesis proposed an enhanced vertical handover optimization using multi-attribute parameters in the heterogeneous network environment consisting of 2G, 3G, Long Term Evolution-Advanced (LTE-A in 4G), and Passive Optical Network (PON). The results for vertical handover such as signal strength, service quality, handover delay, monetary price, user mobility pattern, bandwidth availability and security are linked with this project. These Key Performance Indicators (KPIs) conform with the ITU index to assess the quality of the service of mobile networks (QoS). Examples include network coverage, the integrity of service, retainability of service, availability of network and accessibility of networks. The work only includes 2g, 3g and 4g. It also expands to coverage and capacity, but, for consecutive vertical delivery services request because of time constraints, it does not cover the execution of the Algorithm.

Effect of a stepwise opioid-sparing analgesic protocol on in-hospital oxycodone use and discharge prescription after cesarean delivery

IntroductionOpioid exposure during hospitalization for cesarean delivery increases the risk of new persistent opioid use. We studied the effectiveness of stepwise multimodal opioid-sparing analgesia in reducing oxycodone use during cesarean...

Hepatitis C Seroprevalence Among Consecutive Labor and Delivery Admissions in Two New York City Hospitals.

BackgroundRates of hepatitis C virus (HCV) among women of childbearing age have increased as a result of the opioid epidemic, especially in the nonurban white population. Recently updated US Preventative Services Task Force and Centers for Disease Control and Prevention guidance have recommended universal HCV screening during pregnancy, but obstetrics societies have not yet endorsed this recommendation. We evaluated the seroprevalence of HCV among pregnant women in an inner-city population, compared rates with other sexually transmitted infections (STIs) screened for during pregnancy, and evaluated factors associated with HCV positivity.MethodsWe performed a prospective seroprevalence study of consecutive labor and delivery admissions (both antepartum complications and delivery admissions) by testing serum samples for HCV antibody over 9 months at 2 major hospital settings in New York City.ResultsFifty-six of 7373 (0.75%; 95% confidence interval [CI], 0.57–0.98) patients screened positive for HCV, with 28 of 4013 (0.70%; 95% CI, 0.46%–1.01%) and 28 of 3413 (0.82%; 95% CI, 0.55%–1.18%) at each hospital. Forty-one percent of HCV-positive patients had any reported HCV risk factors. Hepatitis C virus-positive patients were less likely to have private insurance and more likely to have a history of cannabis, cocaine, and injection drug use (P < .001). The HCV rates were higher among antepartum admissions compared with delivery admissions and higher than that of hepatitis B virus (0.65%; 95% CI, 0.48–0.86), human immunodeficiency virus (0.27%; 95% CI, 0.16–0.42), and syphilis (0.16%; 95% CI, 0.08–0.28).ConclusionsWe found a higher than expected HCV seroprevalence among pregnant women and higher than most other STIs routinely screened for in pregnancy. Most patients had no risk factors. These findings support universal screening for hepatitis C during pregnancy.

Wildlife and Bait Density Monitoring to Describe the Effectiveness of a Rabies Vaccination Program in Foxes.

Fox rabies has been eliminated from vast areas of West and Central Europe, but cases still occur in the Balkans. Oral vaccination is an effective method for reducing the incidence of the disease in wildlife, but it requires monitoring if bait density is adequate for the density of the wildlife reservoir. We developed a methodology to evaluate the effectiveness of aerial vaccination campaigns conducted in Montenegro during autumn 2011 and spring 2012. The effectiveness of the vaccination campaign was assessed by (i) estimating the density of baits, (ii) estimating the distribution of the red fox, (iii) identifying critical areas of insufficient bait density by combining both variables. Although the two vaccination campaigns resulted in 45% and 47% of the country’s total area not reaching recommended density of 20 baits/km2, the consecutive delivery of both campaigns reduced these “gaps” to 6%. By combining bait and reservoir density data, we were able to show that bait density was lower than fox density in only 5% of Montenegro’s territory. The methodology described can be used for real-time evaluation of aerial vaccine delivery campaigns, to identify areas with insufficient bait densities.

Rendezvous: Opportunistic Data Delivery to Mobile Users by UAVs Through Target Trajectory Prediction

Reliable and timely delivery of data to mobile targets is a challenging problem in mobile ad-hoc networks, because of the opportunistic and unpredictable nature of the problem. Finding a complete series of mobile-to-mobile contacts and forwarding data toward targets within a designated deadline is even more difficult. We leverage unmanned aerial vehicles (UAVs) as message ferries to travel over highly probable rendezvous points for over-the-air delivery to target users. We propose Rendezvous , an opportunistic yet disciplined data delivery scheme based on trajectory prediction of users and UAV path planning. During the offline learning phase, we identify both temporal and spatial regularities of mobile users from real-world trajectories using sequence-wise clustering, and construct a compact yet well-summarized cluster signature that enables efficient search. In the data delivery phase, given recent movement history of users, UAVs perform their own distributed path planning collaboratively over time. Each UAV finds a chronological sequence of future visiting points where it can make consecutive data delivery efforts to users to overcome the uncertainty in mobility and ensure timely delivery. Real-world trace-driven simulation experiments demonstrate that Rendezvous achieves reliable and punctual data delivery using only few UAVs compared with existing algorithms.

Traffic Aware Beamformer Design for Flexible TDD-Based Integrated Access and Backhaul

Integrated access and backhaul (IAB) network consists of base station (BS), relay nodes (RNs), and user-equipments (UEs), where BS and RNs exchange UE data via wireless in-band backhaul while sharing the same frequency-time resources with access links. In this paper, a flexible time-division-duplex (TDD)-based IAB network is considered where RNs and BS are assigned to distinct uplink (UL) or downlink (DL) transmission modes to mitigate conventional half-duplex (HD) loss at RNs. An iterative beamformer design is proposed to manage the resulting cross-channel interference and to allocate wireless backhaul and access resources jointly over two consecutive data delivery intervals required for communications between the BS and UEs through HD RNs. Dynamic traffic behavior is handled via weighted queue minimization objective, and user-specific UL/DL queues are also introduced at RNs to guarantee reliable end-to-end data delivery. Bi-directional forward-backward training via spatially precoded over-the-air pilot signaling is employed to allow decentralized beamformer design across all the nodes. A novel user allocation method is proposed to assign UEs to BS or RNs based only on long-term channel statistics and some practical IAB limitations. The numerical examples illustrate the superior system performance of the considered flexible IAB in comparison to the conventional HD relaying system.

The recurrence risk of group B Streptococcus in consecutive deliveries

Background: Group B streptococcus (GBS) is a significant cause of neonatal morbidity and mortality. GBS maternal colonization status was found to be transient, intermittent, or chronic and screening during each subsequent pregnancy was advised. Recent studies showed that GBS colonization rate was higher among women with history of GBS positive in prior pregnancy.Objective: To establish the cumulative risk of group B streptococcus (GBS) colonization in consecutive subsequent term deliveries as referred to the first delivery GBS colonization status.Study design: A retrospective cohort study, based on a validated computerized database at a tertiary single center between the years 2005–2016. Pregnant women preform vaginal-rectal culture at 35–37 weeks of gestation. We analyzed records of term primiparas women that had records of up to three additional term consecutive deliveries and GBS colonization status.Results: 8641 primiparas met inclusion criteria; 3972 (46.0%), 993 (11.5%), and 243 (2.8%) had second, third, and fourth consecutive deliveries with recorded GBS status respectively. The overall colonization rate for primiparas was 28.4%. The cumulative rates and cumulative risks of repeated GBS positive colonization at the second, third and fourth term consecutive deliveries were 62.0%, 6.93 (95% CI 5.96–8.06), 68.0%, 5.05 (95% CI, 3.67–6.93), and 66.1%, 2.96 (95% CI, 1.54–5.68), respectively. Notably, after a negative GBS colonization in the first, second, and third repeated deliveries, the rate and cumulative risk of GBS positive in each consecutive delivery was significantly lower: 18.2%, 0.14, (95% CI 0.12–0.17), 19.4%, 0.21 (95% CI 0.15–0.28), and 21%, 0.26 (95% CI 0.13–0.51) for the second, third, and fourth consecutive deliveries, respectively.Conclusion: GBS colonization status at the time of first pregnancy is a milestone for the colonization risk in subsequent term deliveries. This risk evaluation may influence the decision-making process for future screening and intrapartum antibiotic prophylaxis for term consecutive deliveries.

Drug-free macromolecular therapeutics exhibit amplified apoptosis in G2/M phase arrested cells

Drug-free macromolecular therapeutics (DFMT) have been recently developed to treat non-Hodgkin lymphoma (NHL). It is a consecutive delivery of two nanoconjugates: (1) bispecific engager that pretargets surface CD20, and (2) multivalent effector polymer that hybridises with CD20-bound engagers. Without the need of low molecular weight drug, the hybridisation of morpholino oligonucleotide containing DFMT at NHL cell surface triggers CD20 crosslinking and subsequent apoptosis. We have previously determined various factors that affect the efficacy of DFMT regarding the synthetic structures. Here, we show that DFMT-mediated apoptosis is also influenced by the state of cells. Compared with other cell cycle states, cells arrested at G2/M phase exhibit enhanced CD20 expression, and have more sustainable CD20 binding by DFMT, resulting in a higher degree of DFMT-mediated CD20 crosslinking. Moreover, the anti-apoptotic Bcl-2 protein was phosphorylated in G2/M phase, thereby increasing the cell susceptibility to DFMT. As a result, DFMT mediated augmented apoptosis in G2/M phase cells. When DFMT was combined with a polymer-docetaxel conjugate that triggered G2/M blockage, a combinatorial apoptotic effect was achieved to induce programmed cell death. Our findings suggest the co-delivery of DFMT and G2/M inhibiting drug combinations may present a therapeutic advantage in NHL treatment.

Air Pollution and Preterm Birth: Do Air Pollution Changes over Time Influence Risk in Consecutive Pregnancies among Low-Risk Nulliparous Women?

Both air pollution, generally decreasing in the U.S., and having a prior preterm birth (PTB) are risk factors for subsequent pregnancy PTB. To investigate whether air pollution exposures would have a potential differential effect on PTB risk in the first and second pregnancy among low-risk women, we estimated exposures based on modified Community Multiscale Air Quality models linked to the NICHD Consecutive Pregnancy Study. Electronic medical records for consecutive delivery admissions were available for 27,137 nulliparous women with singleton births in 20 Utah-based hospitals between 2002-10. We categorized whole pregnancy exposures based on percentiles as high (&amp;gt;75), moderate (25-75) and low (&amp;lt;25). Modified Poisson regression with generalized estimating equations estimated PTB risk in the second pregnancy associated with persistent high and moderate exposure, and increasing or decreasing exposure, compared to persistent low exposure. Analyses were adjusted for prior PTB, interpregnancy interval and other demographic and clinical characteristics. Pollution levels generally decreased over time, reducing the number of women with high second pregnancy exposure. Second pregnancy PTB risk was increased when exposure increased for sulfur dioxide (34%), ozone (80%), nitrogen dioxides (NO2; 38%), and carbon monoxide (CO; 33%) versus stayed consistently low. Similar trends were observed for consistently high versus consistently low exposure. We also observed significant interaction by prior PTB status. Women with no prior PTB had significantly higher risk associated with increasing levels of several pollutants as compared to women with prior PTB, including NO2 (increase of 63% vs. decrease of 7%, p-interaction&amp;#61;0.004) and CO (increase of 57% vs. no change, p-interaction&amp;#61;0.031). These findings suggest area-level changes in air pollution exposure have important consequences in repeated pregnancies even among low risk women at moderate levels of exposure in the U.S.

Labor induction in indicated moderate to late preterm birth

Introduction: The primary objective of this study was to evaluate the success of labor induction for indicated moderate and late preterm birth. As secondary objectives, the mode of delivery was assessed.Material and methods: This is an observational study conducted in a tertiary care unit between 2013 and 2015. All patients who underwent labor induction for indicated preterm birth between 32+0 and 36+6 weeks of gestation (as premature rupture of membranes, preeclampsia, intrauterine growth restriction, fetomaternal alloimmunization, or intrahepatic cholestasis) were included. The main outcome was the success of labor induction defined by repeated uterine contractions associated with cervical dilation >3 cm. The secondary outcomes were mode of delivery and neonatal outcomes.Results: Among 824 women who gave birth during the study period, 105 (12.7%) underwent induction of labor for indicated preterm birth. Labor induction was successful in 90.5% of cases (95/105), and 72.4% of the women (76/105) delivered vaginally. The success rate did not differ significantly in cases of moderate (32+0 to 33+6 weeks), compared with late (34+0 to 36+6 weeks) preterm birth (87.5 versus 90.7%, p = .56). The vaginal delivery rate was significantly lower in moderate compared to late preterm birth (37.5 versus 75.3%, p = .03).Conclusion: The success of labor induction and consecutive vaginal delivery were high in case of moderate and late preterm birth. Labor induction can be considered as an effective option for medical indications.