Delivery Success Rate Research Articles

Morbidity associated with the use of Foley balloon for cervical ripening in women with prior cesarean delivery

Objective We evaluated the morbidity of Foley balloon for cervical ripening in comparison to oxytocin alone in women with a prior cesarean delivery. Study design A four-hospital retrospective review of all women with viable singleton pregnancies and history of a single prior cesarean delivery presenting for cervical ripening between 1994 and 2015. Exposure groups were either Foley balloon or oxytocin, at the treating physician’s discretion. The primary outcome was defined as maternal morbidity, evaluated by a composite that included hemorrhage, and/or uterine infection, and/or uterine rupture. We defined two secondary outcomes: neonatal morbidity, and vaginal delivery rate. Neonatal morbidity was evaluated by a composite that included five-minute APGAR score <7 and/or NICU admission. We adjusted results for potential confounding variables, including hospital site, maternal age and race, initial cervical dilation, and gestational age at delivery. Results We identified 688 patients who received ripening, 276 by Foley balloon and 412 by oxytocin. There was no significant difference in the primary outcome of maternal morbidity between groups: 38 (13.8%) in the Foley balloon group and 79 (19.2%) in the oxytocin group (aOR 1.43; 95% CI, 0.90–2.27). There was no significant difference in the secondary outcome of neonatal morbidity: 31 (11.3%) in the Foley balloon group and 51 (12.4%) in the oxytocin group (aOR 1.02; 95% CI, 0.57–1.80). The rate of vaginal delivery was significantly less in the Foley balloon group compared to the oxytocin group: 56.2% vs 64.1%, p = .037. Conclusion When cervical ripening with either Foley balloon or oxytocin was utilized at the physician’s discretion in women with prior cesarean, there was no identified difference in maternal and neonatal morbidity, but the rate of successful vaginal delivery was lower.

Successful vaginal birth after cesarean in the second delivery is not associated with the stage of labor of the primary unplanned cesarean delivery

BackgroundCandidates for trial of labor after cesarean must be carefully screened to maximize success and minimize morbidity. Demographic and obstetric characteristics affecting success rates must be delineated. ObjectiveWe examined whether the labor stage of the primary delivery in which a woman underwent an unplanned cesarean delivery would affect the likelihood that she could achieve a subsequent vaginal birth. Study designElectronic medical records-based study of 676 parturients. Trial of labor rates and outcomes were compared between women whose primary cesarean delivery was performed in the first vs. the second stage of labor. SettingHadassah Medical Center, Israel PopulationWomen in their second pregnancies, with singleton fetuses, who underwent unplanned cesarean delivery in their first pregnancy and elected trial of labor in the second delivery. The main outcome measures were maternal and neonatal complications and vaginal birth rates in first vs. second stage of labor groups. ResultsIn our population, 76 % of women attempt trial of labor after cesarean. Rates of successful vaginal delivery did not differ significantly between those who underwent primary cesarean in the first vs. second stage of labor: 67.4 % vs. 70.2 %, p = 0.483, respectively. Among women whose primary UCD was in the second stage, only 18.2 % (35/192) required a UCD in the second stage in the subsequent delivery, while 58.9 % (113/192) underwent UCD in the first stage in both deliveries. ConclusionLabor stage of the primary unplanned cesarean delivery, should not dissuade women from a trial of labor after cesarean in their second delivery.

PPtaxi: Non-Stop Package Delivery via Multi-Hop Ridesharing

City-wide package delivery becomes popular due to the dramatic rise of online shopping. It places a tremendous burden on the traditional logistics industry, which relies on dedicated couriers and is labor-intensive. Leveraging the ridesharing systems is a promising alternative, yet existing solutions are limited to one-hop ridesharing or need consignment warehouses as relays. In this paper, we propose a new package delivery scheme which takes advantage of multi-hop ridesharing and is entirely consignment free. Specifically, a package is assigned to a taxi which is guided to deliver the package all along to its destination while transporting successive passengers. We tackle it with a two-phase solution, named \textbf{PPtaxi}. In the first phase, we use the Multivariate Gauss distribution and Bayesian inference to predict the passenger orders. In the second phase, both the computation efficiency and solution effectiveness are considered to plan package delivery routes. We evaluate \textbf{PPtaxi} with a real-world dataset from an online taxi-taking platform and compare it with multiple benchmarks. The results show that the successful delivery rate of packages with our solution can reach $95\%$ on average during the daytime, and is at most $46.9\%$ higher than those of the benchmarks.

Sealing of Coronary Perforations With a Second-Generation Covered Stent Graft - Results From the PAST-PERF Registry

BackgroundThe PAST-PERF registry was initiated to collect data on the PK Papyrus covered stent, a second-generation device for the treatment of coronary artery perforations with enhanced mechanical properties, but with limited available data. MethodsPatients treated for coronary artery perforations with the PK Papyrus stent at 14 international centers were retrospectively identified. The primary effectiveness outcome was successful sealing of the perforation. The primary safety outcome was a composite of all-cause mortality, definite or probable stent thrombosis, myocardial infarction and target lesion revascularization. ResultsAmong the 94 included patients, 72.3% (68/94) had Ellis type III and cavity spilling perforations. Complete sealing was achieved in 93.6% (n = 88), and no sealing could be achieved in 3.2% (n = 3, including one patient with a geographical miss and one patient in whom the device could not be implanted). Pericardiocentesis was required in 25.0% (n = 23), emergency cardiac surgery was needed in 7.6% (n = 7), acute stent thrombosis was observed in 1.1% (n = 1), and in-hospital mortality occurred in 11.7% (n = 11). The median follow-up duration was 283 (IQR:40;670) days. At 6 and 12 months, the incidence of the primary safety endpoint was 26.6% [95%CI:18.6;37.1] and 32.0% [95%CI:22.8;43.4], mortality 15.0% [95%CI:9.0;24.6] and 19.0% [95%CI:11.3;30.0], and target lesion revascularization 5.5% [95%CI:2.0;14.6] and 7.7% [95%CI:3.1;18.2]. Two definite stent thrombosis occurred, one during the procedure and one on post-procedure day 233. ConclusionsThe registry demonstrates favorably high rates of successful stent delivery and sealing of coronary perforations using a second-generation covered stent with low target lesion revascularization and stent thrombosis rates. Annotated table of contentThe PAST-PERF registry demonstrates favorably high rates of successful stent delivery and sealing of coronary perforations using a second-generation covered stent with low target lesion revascularization and stent thrombosis rates. Specifically, complete sealing was achieved in 93.6% of patients (n = 88/94), and no sealing could be achieved in 3.2% (n = 3, including one patient with a geographical miss and one patient in whom the device could not be implanted). The 12-month mortality was 19.0% [95%CI:11.3;30.0], the rate of target lesion revascularization was 7.7% [95%CI:3.1;18.2], and two definite stent thromboses occurred (one during procedure and one on post-procedure day 233).

A study of LoRaWAN protocol performance for IoT applications in smart agriculture

The use of Internet of Things (IoT) is becoming increasingly common in agribusiness to increase food production capacity for the expanding global population. Recently, low-power wide-area networks (LPWANs) have been used in the development of IoT applications that require low power consumption and low data transmission rates. LoRaWAN is considered the most suitable communication network for LPWANs for IoT applications in smart agriculture. In this paper, we present an in-depth study of the performance of the LoRaWAN communication network in the context of an IoT application for a pilot farm. We consider several scenarios and analyze simulation results by using Network Simulator 3. We then propose a mathematical model that precisely predicts the successful packet delivery rate for this type of network considering the number of nodes and the transmission interval duration. Finally, we validate the results of our model by comparing them with other simulation results under different scenarios.

Vaginal Delivery After External Cephalic Version in Patients With a Previous Cesarean Delivery: A Systematic Review and Meta-analysis.

To estimate the rate of vaginal delivery after successful external cephalic version for breech presentation in women with compared with without a previous cesarean birth. We searched MEDLINE, Scopus, EMBASE, CINAHL, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials for studies comparing the mode of delivery after successful external cephalic version in women with and without a previous cesarean birth. Two reviewers independently identified studies, extracted data, and evaluated study quality. The rate of vaginal delivery after successful external cephalic version in women with and without a previous cesarean birth was compared, and odds ratios (ORs) with 95% CIs were estimated. Six cohort studies and two case-control studies, reporting on 14,515 women were identified. The median point prevalence of a successful external cephalic version was 74% (interquartile range 63-81%) in women with a previous cesarean birth compared with 69% (interquartile range 64-83%) in women without a previous cesarean birth. The overall success rate of external cephalic version in women with a previous cesarean birth was similar compared with women without a previous cesarean birth (pooled OR 0.84, 95% CI 0.61-1.15). The median point prevalence of a vaginal delivery was 75% (interquartile range 61-84%) in women with a previous cesarean birth compared with 92% (interquartile range 85-95%) in women without a previous cesarean birth after a successful external cephalic version. The overall success rate of a vaginal delivery in women with a previous cesarean birth was less compared with women without a previous cesarean birth (pooled OR 0.26, 95% CI 0.14-0.50). A planned subgroup analysis on studies that included only multiparous women in the control group (parity one or greater) noted the overall success rate of external cephalic version in women with a previous cesarean birth 76% (853/1,123) was lower compared with multiparous women without a previous cesarean birth 84% (9,911/11,855) (pooled OR 0.70, 95% CI 0.54-0.89, I 37%). The overall success rate of a vaginal delivery in women with a previous cesarean birth 83% (666/806) was less compared with women without a previous cesarean birth 97% (9,449/9,746) (pooled OR 0.21, 95% CI 0.12-0.39, I 73%). Women with previous cesarean birth have similar rates of successful external cephalic version when compared with women without a cesarean birth. Although the rate of vaginal delivery is lower, the majority of patients have a successful vaginal birth after cesarean. PROSPERO, CRD42020160145.

Neonatal and Maternal Outcomes in Spontaneously-Conceived Twin PregnanciesAccording to Mode of Delivery.

Appropriate intrapartum conduct in a twin delivery remains a challenging aspect of obstetric practice. The objective of this study was to compare neonatal and maternal outcomes in twin pregnancies according to mode of delivery. This is a single centre retrospective cohort study of all consecutive spontaneously-conceived twin deliver-ies (≥ 24 weeks, estimated fetal weight ≥ 500 grams) over a nine-year period between 01/01/2007 - 31/12/2016 at a tertiary-level centre. Neonatal outcomes included survival, APGAR score, prematurity-associated pathology (PAP), admission to the neonatal intensive care unit (NICU) and length of stay (LOS). Maternal outcomes included postpartum complications and LOS. Statistical analysis comprised Chi-square test with subsequent p-value and odds-ratio with 95% confidence interval. Statistical significance was set at p<0.05. A total of 173 consecutive women with spontaneously-conceived twin deliveries were enrolled in this study, 129 (74.6%) women delivered by caesarean section (CS). The success rate of vaginal delivery (VD) was 93.6% (44/47). A strong statistical correlation was identified between CS and NICU admission; 53.2% vs. 1.5% (p=0.0001). Neonatal LOS in the NICU was significantly longer in the CS group. Prematurity-associated pathology (PAP) was noted in 75 pairs of twins (75/173); 61 pairs were delivered by CS, bearing strong statistical significance (p<0.0001). Postpartum complications occurred in 14.7% of CS compared to 13.6% of VDs. Neonates delivered by CS had a higher rate of PAP, NICU admission, lower birth weight and longer LOS. This study showed that VD is safe, especially when the first twin is in cephalic presentation.

Outcomes After Coronary Orbital Atherectomy at Centers Without On-Site Surgical Backup: Diabetics Versus Non-Diabetics and Impact of Access Site

Background/purposeThere is limited data available on atherectomy usage in hospitals or centers without on-site surgical backup. The purpose of this retrospective analysis was to gain further knowledge by analyzing the in-hospital and 30-day outcomes of complex PCI patients (including diabetics) treated with coronary orbital atherectomy (OA) at centers without on-site surgical back-up. Methods/materialsAll comers treated with OA at two centers without on-site surgical backup were included. Baseline, procedure, and outcome data were compared in diabetic and non-diabetic patients. The impact of transfemoral (TFA) versus transradial (TRA) vascular access was also assessed. ResultsOf the 221 patients treated with OA, 43% were diabetics. The diabetes and no-diabetes groups had similar baseline demographic and lesion characteristics, except for the higher rate of chronic kidney disease seen in the diabetics. Overall, there was a high freedom from major adverse cardiac events (MACE; in-hospital: 99.5%; 30-day: 98.6%), as well as a high success in stent delivery (99.5%) and procedural success (97.3%). The rate of angiographic complications was low in both the diabetes and no-diabetes groups (3.1% vs. 1.6%, p = 0.450). TFA and TRA were used in 36% and 64% of the patients, respectively—resulting in low angiographic complications in both groups (3.8% vs. 1.4%, p = 0.263). ConclusionsDespite the complexity of patient co-morbidities and the presence of heavily calcified lesions, the results indicate that coronary OA can be used safely and effectively without on-site surgical back-up. OA treatment resulted in a high rate of successful stent delivery and procedural success, as well as low rates of angiographic complications and MACE, in diabetic and non-diabetic patients, regardless of access site. Table of contents summaryThere is limited data available on atherectomy usage in centers without on-site surgical backup. The purpose of this retrospective analysis was to gain further knowledge by analyzing the outcomes of complex PCI patients (including diabetics) treated with coronary orbital atherectomy (OA) at centers without on-site surgical back-up. The impact of transfemoral (TFA) versus transradial (TRA) vascular access was also assessed. Despite the complexity of patient co-morbidities and the presence of heavily calcified lesions, the results indicate that coronary OA can be used safely and effectively without on-site surgical back-up. OA treatment resulted in a high rate of successful stent delivery and procedural success, as well as low rates of angiographic complications and major adverse cardiac events, in diabetic and non-diabetic patients, regardless of access site (TFA or TRA).

Optimal Exploitation of On-Street Parked Vehicles as Roadside Gateways for Social IoV—A Case of Kigali City

Vehicular Ad Hoc Network (VANET) is a subclass of Mobile Ad Hoc Network that mainly consists of moving and/or stationary vehicles, connected through wireless protocols such as IEEE 802.11p and wireless access in vehicular environments (WAVE). With the evolution of the Internet of Things (IoT), ordinary VANET has turned to the Internet of Vehicles (IoV), with additional social aspects, a novel extension themed SIoV has become common in urban areas. However vehicular wireless communication paradigms exhibit short radio communication. This problem has always been approached by supplementing moving vehicles with stationary Road Side Infrastructures, commonly known as roadside units (RSUs). The penetration of such RSUs on the global market is very low; furthermore, their procurement, deployment, and maintenance costs are prohibitively very high. All mentioned challenges have discouraged the widespread deployment of roadside infrastructure especially within large urban scenarios. With this research, we leverage on-street parked vehicles to allow them to exist as temporal gateways in the case study area. A novel modeling technique is introduced to enable a specific Percentage of parked vehicles to take up the role of roadside gateways for a certain percentage of their parking time. A mobile application is implemented that manages parking duration of the vehicle, based on the arrival, and departure time frames. Two more existing strategies were discussed (road-intersection RSUs deployment approach and Inter-vehicle scheme) to validate our proposed method through comparative studies. To evaluate the network performance evaluation, we compare two performance metrics, that is, Packets success delivery rate, and overall packets throughput under numerous vehicle densities. Using parked vehicles as temporal roadside gateways has demonstrated better results in comparison to intersection based RSUs deployment approach, and free vehicle to vehicle communication approach.

Impact of clinical practice guidelines for vacuum-assisted delivery on maternal and neonatal outcomes in Japan: A single-center observational study.

Practice guidelines for vacuum-assisted delivery in Japan were revised in 2014 to improve clinical safety. We aimed to determine the success rates of vacuum delivery before and after the release of the revised guidelines. This retrospective observational study included singleton deliveries at term gestation. Success rate of vacuum delivery, duration of extraction, number of tractions and maternal and neonatal injuries were compared between 2011-2014 and 2015-2019. Vacuum extraction was attempted in 249 (15%) of 1657 deliveries. Duration of extraction was shorter in 2015-2019 (median, 3.0 min; interquartile range [IQR], 1.0-5.8 min) than in 2011-2014 (median, 4.0 min; IQR, 2.0-6.5 min; P = 0.0045). No significant differences were seen in success of vacuum extraction (98%), prolonged (>20 min) duration of extraction (1.5%) and repeated (>5 pulls) tractions (3.1%) in vacuum deliveries during 2011-2014, compared to success of vacuum extraction (94%), prolonged duration of extraction (1.6%) and repeated tractions (1.1%) in those during 2015-2019. Likewise, no significant differences were identified in maternal or neonatal injuries. Successful vacuum-assisted deliveries and shortened duration of extraction were still confirmed after guideline revision. However, because of consistent safe practice with vacuum delivery from before the revision, improvements in maternal and neonatal injuries were not observed.

Energy Efficient Location Error Resilient Connectivity in Wireless Sensor Networks

Geographic routing for realistic conditions is often permeated with localization errors resulting in poor performance and high energy consumption. We propose a simple yet novel geographic routing method to accomplish routing in the presence of location and channel errors. In this algorithm, it is proposed that next hop node is selected based on the combined probability of distance, estimated location error and estimated channel access probability associated with neighbor nodes. The metrics observed for performance were the successful packet delivery rate and the energy consumed. Our algorithms performance is better compared to greedy forwarding techniques of algorithms such as Greedy routing scheme (GRS) and geographic random forwarding (GeRaF). Simulations show the throughput for our algorithm is better compared to others along with reducing the energy wasted on lost packets.

Efficient vehicular content delivery

Nowadays, most of the traffic in vehicular networks is relevant to content, so the content-to-requester method could be an ideal solution for vehicular content delivery. However, due to the features of vehicular networks such as high mobility, the content-to-requester paradigm might cause the frequent content delivery failures and increase the content delivery cost. Inspired by the idea that the address-based mechanism can support mobility and reduce content delivery costs, we are motivated to take advantage of the address-based mechanism to achieve the content-to-requester paradigm. Based on this motivation, we propose a vehicular content delivery scheme with mobility support (VCDM). In VCDM, the receiver and provider handovers are achieved so that a receiver can correctly receive the requested content from a provider via one successful content delivery process. Moreover, a location-based address is proposed so that a requester can acquire the content from the nearest provider in a unicast way. Finally, VCDM is analyzed and evaluated, and the data show that VCDM effectively improves the content delivery success rate and reduces the content delivery cost and latency.

Cache-Enabled HetNets With Limited Backhaul: A Stochastic Geometry Model

With the rapid explosion of data volume from mobile networks, edge caching has received significant attentions as an efficient approach to boost content delivery efficiency by bringing contents near users. In this article, cache-enabled heterogeneous networks (HetNets) considering the limited backhaul is analyzed with the aid of the stochastic geometry approach. A hybrid caching policy, in which the most popular contents are cached in the macro BSs tier with the deterministic caching strategy and the less popular contents are cached in the helpers tier with the probabilistic caching strategy, is proposed. Correspondingly, the content-centric association strategy is designed based on the comprehensive state of the access link, the cache and the backhaul link. Under the hybrid caching policy, new analytical results for successful content delivery probability, average successful delivery rate and energy efficiency are derived in the general scenario, the interference-limited scenario and the mean load scenario. The simulation results show that the proposed caching policy outperforms the most popular caching policy in HetNets with the limited backhaul. The performance gain is dramatically improved when the content popularity is less skewed, the cache capacity is sufficient and the helper density is relatively large. Furthermore, it is confirmed that there exists an optimal helper density to maximize the energy efficiency of the cache-enabled HetNets.

Guidewire-assisted over-the-scope clip delivery method into the distal intestine: a case series

Background The Over-the-scope clip (OTSC) has been recently introduced for multiple purposes, including refractory bleeding, perforation, fistula, and anastomotic dehiscence of the gastrointestinal tract. However, no easy access techniques for delivering OTSCs to distant sites have been described. Therefore, we have developed a simple and safe guidewire-assisted OTSC delivery (GOD) method for use on the distal intestine. This study aimed to investigate the technical feasibility and safety of the method. Material and methods Between June 2018 and April 2019, all eight patients who underwent the GOD method were retrospectively examined. The primary outcome was the successful rate of OTSC delivery to the lesion without complications. The secondary outcomes were GOD procedure time, total procedure time, technical and clinical OTSC success rates, and GOD- and OTSC-associated complications. Results The rate of successful OTSC delivery was 100%. The median procedure time of GOD was 21 min (range 8–29). The median total procedure time was 38.5 min (range 26–41). The technical and clinical success rates of OTSC were 100% and 75% (6/8), respectively. No GOD- or OTSC-associated complications occurred. Conclusions The GOD method is a feasible and safe technique for delivering OTSC toward the small and proximal large intestine.

A Priority-Based Cross-Layer Design for Future VANETs Through Full-Duplex Technology

Among all requirements for vehicle-to-everything (V2X) communications, successful delivery of packets with small delay is of the highest significance. Especially, the delivery of a message before a potential accident (i.e. emergency message) should be guaranteed. In this work, we propose a novel cross-layer design to enhance the delivery of emergency messages so that accidents can be further avoided. Particularly, in the PHY layer, imperfect full-duplex (FD) simultaneous transmitting and sensing is analysed and dynamic thresholds for determining the channel status before and during transmissions are mathematically formulated. Then a novel FD MAC protocol, named priority-based multiple access (PBMA), based on prioritised messaging between different vehicles is proposed. Average collision probability, collision duration, waiting time as well as successful delivery rate of the system are formulated too. The delivery performance of emergency messages is also mathematically derived. In addition, comparisons have been made among three different mechanisms. Benchmark is the DSRC standard which uses half-duplex (HD) technology with enhanced distributed channel access (EDCA) protocol. We also compare our proposed protocol with FD EDCA. Simulations have verified the accuracy of our analysis. They have also illustrated the delivery of emergency messages has been enhanced by deploying our proposed design.

A comparison of fetomaternal outcome in PCEA using fentanyl, clonidine and dexmedetomidine as adjuvants with Ropivacaine in painless labor: a prospective, double blinded randomized study

Background: Patient controlled epidural analgesia has been associated with marked maternal satisfaction. Combination of local anesthetics with various adjuvants have been tried to ensure optimum analgesia with no or negligible fetomaternal side effects. Aim: To compare fentanyl, clonidine or dexmedetomidine as adjuvants with ropivacaine for labor epidural analgesia (LEA) using a PCEA pump with the objective to assess fetomaternal outcome in terms of analgesic effect, success rate of vaginal delivery, complications, neonatal APGAR score and maternal satisfaction. Materials and methods: Sixty full term laboring women received 10 ml 0.2% ropivacaine followed by continuous infusion of 0.1% ropivacaine with 2 μg/ml of either dexmedetomidine, fentanyl or clonidine respectively in Groups A, B, and C at 6 ml/hr. demand bolus setting was 2 ml with a lock out interval of 15 minutes. At full cervical dilatation another 10 ml bolus of respective solution were given. Parturients were monitored at 0, 10, 20, 30 min after giving 1st epidural bolus dose and then at 30 min interval for ongoing labor for pain relief (VAS), motor blockade (Bromage score), progress of labor (duration of 1st stage and 2nd stage), mode of delivery, fetal APGAR score (at 1 min and 5 min), vitals (HR, NIBP, RR, SpO2), overall patient satisfaction and complications. The statistical analysis was done both qualitatively (Fisher-exact test/Chi-square test) and quantitatively (one-way analysis of variance test with post-hoc intergroup comparisons using Bonferroni’s correction). Results: Onset of pain relief was earlier in fentanyl group, however after 1 h all three groups showed comparable pain relief (P&gt;0.05). There was a significant reduction in HR in group C and B compared to group A (P&lt;0.001) and MAP in group C compared to groups A and B. The motor- blocking potency was slightly higher in dexmedetomidine group, however no significant motor weakness observed in any parturient. Mean demand bolus need was more in group C compared to A and B (P&lt;0.001). There was no significant difference in mode of delivery (either SVD or cesarean) in between the groups. There was not a single case of fetal distress and most of the parturients showed satisfactory response to PCEA. Conclusion: All three study drugs produced equipotent analgesia in combination with ropivacaine 0.1%. There was absolute pain relief without significant motor blockade or any increase in instrumentation/cesarean deliveries or any adverse fetal outcomes.

Analysis of scoring system of twin pregnancy vaginal delivery

Objective: To Analyze the prenatal factors and forecast the success rate of vaginal delivery of twin pregnancy. Methods: Totally, 114 cases of twin pregnant women who were under the systematic antenatal care and had deliveries in Beijing Obstetrics and Gynecology Hospital from January 2017 to March 2019 were collected. The inclusive criteria were uncomplicated twin pregnancy with head downward position of the first fetus, not monochorioallantoic twin twins, and the willingness for vaginal delivery. Two groups were classified based on their successful vaginal delivery. 96 cases in vaginal delivery group (study group) and 18 cases in the comparison groupwhich were transferred to Caesarean sections during trial delivery. The evaluated prenatal factors included: (1) Fetal factors: the chorionicity of the twin pregnancy, position of the second fetus, fetal weights and the weight difference of two fetuses. (2) Maternal factors:the maternal age, delivery gestational age, parity, body mass index (BMI), reasonability of weight gain during pregnancy, pregnancy complications, such as gestational diabetes mellitus (GDM), hypertensive disorder of pregnancy, and the application of assisted reproductive technology. (3) The technical title of the delivery doctor, modes of labour (spontaneous labor or induced labour and its mode) and the application of labor analgesia, etc. Single-factor logistic analysis and multiple-factor logistic regression were used to do statistical analysis and nomograms were plotted, finally receiver operating characteristic (ROC) curves and standard curves were formed for internal verifications and Youden index were utilized to determine the cut-off values. Results: Five variables:maternal age,complicated GDM, reasonability of weight gain during pregnancy, parity, and the weight of the second fetus is less than the firsthad obvious influence on the success rate of vaginal delivery in twin pregnancy. After quantifying the influence weight, the influence of each factor was as follows:the age of the mother <35 years old: 64; no GDM: 100, no insulin application in GDM: 47, and application of insulin: 0; reasonability of weight gain during pregnancy: 82; parity≥2: 58; and the weight of the second fetus was less than the first: 57. The ROC curve was plotted and the area under the curve (AUC) is 0.856 1, which were able to forecast the success rates well, the maximum value of the Youden index was 0.564 7 and the corresponding score was 168. Conclusions: maternal age, reasonability of weight gain during pregnancy, the complication of GDM, parity, and the weight of the second fetus less than the first are the influential prenatal factors on vaginal delivery of twin pregnancy. After assigning the influence weight of each influencing factor, when the total score reaches 168 the success rate of vaginal delivery is significantly improved.

PK Papyrus coronary stent system: the ultrathin struts polyurethane-covered stent.

In the emergency setting of a coronary vessel perforation, the knowledge of materials needed to fix it and the intrinsic quality of the device used is mandatory for the interventional cardiologist. The PK Papyrus covered stent (Biotronik AG) is an ultrathin strut (60μm) balloon-expandable stent covered on the abluminal surface with an electrospun polyurethane matrix. It is intended to facilitate device delivery and effectively treat coronary artery perforations.In published studies, rates of successful device delivery and perforation sealing were above 90%, respectively, and most events were usually resolved with a single stent. In this review we focused on the main technical characteristics as well on the published evidence that compare its performance with other coronary covered stent.

Predicting labor induction success by cervical funneling in uncomplicated pregnancies.

AimPredictive accuracy of cervical funneling for successful vaginal delivery prior to labor induction was compared to that of conventional methods such as Bishop score and cervical length.MethodsProspective observational study was conducted on nulliparous women at 38 gestational weeks or more with intact membranes who delivered vaginally following labor induction. Transvaginal ultrasound was performed prior to labor induction to evaluate the cervix, to determine the cervical length and to check for the presence of funneling. Following pelvic examinations, the Bishop score was calculated. Predictive accuracy of the three different methods, namely cervical funneling, cervical length and Bishop, were compared.ResultsA total of 235 nulliparous women with intact membranes were recruited. Of these, 194 women (82.6%) had successful vaginal deliveries following induction. Cervical funneling was observed in 105 women (44.7%). The rate of successful vaginal delivery was significantly higher in women with cervical funneling than in those without funneling (90.5% vs 76.2%, P < 0.004). Multivariable analysis showed that cervical funneling, similar to traditional measures such as the Bishop score and cervical length, was an independent predictor of successful vaginal delivery following labor induction (odds ratio = 2.95; 95% confidence interval: 1.38–6.47; P = 0.007).ConclusionsSimilar to the conventional methods of cervical evaluation, such as the Bishop score and cervical length, cervical funneling may serve as a useful and valid predictor of successful vaginal deliveries prior to labor induction.

Energy efficient network path reconfiguration for industrial field data

Energy efficiency and reliability are vital design requirements of recent industrial networking solutions. Increased energy consumption, poor data access rates and unpredictable end-to-end data access latencies are catastrophic when transferring high volumes of critical industrial data in strict temporal deadlines. These requirements might become impossible to meet later on, due to node failures, or excessive degradation of the performance of wireless links. In this paper, we focus on maintaining the network functionality required by the industrial, best effort, low-latency applications after such events, by sacrificing latency guarantees to improve energy consumption and reliability. We avoid continuously recomputing the network configuration centrally, by designing an energy efficient, local and distributed path reconfiguration method. Specifically, given the operational parameters required by the applications, our method locally reconfigures the data distribution paths, when a network node fails. Additionally, our method also regulates the return to an operational state of nodes that have been offline in the past. We compare the performance of our method through simulations to the performance of other state of the art protocols and we demonstrate performance gains in terms of energy consumption, data delivery success rate, and in some cases, end-to-end data access latency. We conclude by providing some emerging key insights which can lead to further performance improvements.