Third Of Stage Research Articles

Misoprostol and oxytocin versus oxytocin alone in the active management of the third stage of labour: a randomised, double-blind, placebo-controlled trial

We investigated whether the use of misoprostol plus oxytocin in the active management of the third of stage of labour (AMTSL) would reduce the rate of primary postpartum haemorrhage (PPH) compared with intramuscular oxytocin alone. This was a multicentre, double-blind, placebo-controlled, randomised trial where 1036 pregnant women, in addition to intramuscular oxytocin (10 IU) in the third stage of labour, randomly received either 400 µg sublingual misoprostol (519 women) or a placebo (517 women). The primary outcome measure was the mean blood loss (MBL) within 1 h of delivery. The trial was registered with ClinicalTrials.gov (NCT02424201). The MBL in the oxytocin plus misoprostol group was 229.73 ± 108.12 compared to 274.58 ± 121.09 in the oxytocin plus placebo group (t = 6.289, p < .001). Twenty-eight (5.4%) women in the misoprostol group had a blood loss ≥500 ml versus 39 (7.5%) women in the placebo group (risk-ratio [RR] − 0·72, 95%CI 0.45–1.14; p = .1616). The combination of misoprostol with oxytocin in the AMTSL reduces MBL post-delivery but is not superior to oxytocin alone in the reduction of the rate of PPH. IMPACT STATEMENT What is already known on this subject? The routine use of 10IU of intramuscular oxytocin in the active management of the third stage of labour reduces the rates of postpartum haemorrhage. What do the results of this study add? The addition of 400ug of sublingual misoprostol to the routine use of 10IU of intramuscular oxytocin in the active management of the third stage of labour reduces mean blood loss when compared with intramuscular oxytocin alone, but is not better in reducing the rates of postpartum haemorrhage. What are the implications of these findings for clinical practice and/or further research? Routine use of misoprostol as adjuncts to the active management of the third stage of labour does not reduce the rate of PPH.

Stage I ovarian carcinoma: different clinical pathologic patterns

To analyze clinicopathologic patterns of early ovarian carcinoma. Retrospective chart and histopathology review. Mount Sinai School of Medicine, New York and the Centre Jean Perrin, Clermont Ferrand, France. Seventy-six consecutive cases of Fédération Internationale de Gynécologie et d'Obstétrique stage I ovarian carcinoma. Surgical staging. Symptomatology, pathology, and histology analysis. Twenty-two cases (29%) were serous papillary carcinomas and 54 were nonserous carcinomas (71%) (40 endometrioid, 10 clear cell, and 4 mixed endometrioid and clear cell carcinomas). Ninety-eight percent of ovarian endometriosis, 95% of endometrial carcinomas, and 83% of endometrial polyps and hyperplasias were associated with nonserous carcinomas. Most patients with serous papillary carcinoma presented with asymptomatic pelvic masses; patients with nonserous carcinomas presented with pelvic pain or abnormal vaginal bleeding with or without pelvic mass. Over two thirds of stage I ovarian carcinomas were nonserous, and were diagnosed because of associated symptoms: pelvic pain with endometriosis and/or adnexal masses, or vaginal bleeding from endometrial pathology. Serous papillary carcinomas were often asymptomatic and diagnosed during follow-up evaluations in breast cancer patients. Stage I ovarian carcinoma has different clinical and pathologic patterns than advanced ovarian carcinoma. The risk of ovarian and endometrial malignancy should be taken into consideration during evaluation of patients with endometriosis and breast cancer histories.

Diffusion of He atoms in fullerite [formula omitted

In situ X-ray powder diffraction has been utilized to study the He diffusion kinetics in C 60 by monitoring the time dependence of the structure characteristics (lattice parameter, reflection intensities and widths). Based on the time variations of the structure characteristics the intercalation is shown to occur in two stages: octahedral voids are filled during the faster stage 1, while during the much slower stage 2 tetrahedral voids are filled. To make experimental intensities consistent with the estimates made, we came to the conclusion that during the first third of stage 1 at least part of octahedral voids accommodate two helium atoms rather than one. The room-temperature diffusion coefficient (about 7 × 10 - 14 cm 2 / s ) of He over octahedral voids of C 60 has been evaluated from the time dependence of the lattice parameter. Analysis of the degassing kinetics gives diffusion coefficients very close to those obtained from intercalation measurements. The characteristic time constant of the tetrahedral filling is an order of magnitude longer than for octahedral filling, which indicates that the respective effective diffusivity is four orders of magnitude slower compared to infusion into octahedral voids. Thermodynamics of intercalation of He into C 60 at room temperature has been constructed to show that the entropy factor is the main thermodynamic force in the case discussed. These consideration leads also to the conclusion that the internal pressure due to the kinetic energy of He atoms in octahedral voids is large enough to expand the C 60 lattice to the extent observed in experiment.

Stage I non-seminomatous germ-cell tumours of the testis: identification of a subgroup of patients with a very low risk of relapse

There is no consensus about a reproducible prognostic model capable of distinguishing between clinical stage I non-seminomatous germ cell tumour (NSGCT) carrying a high and low risk of relapse. The aim of this study was to assess the prognostic value of histological parameters in patients with stage I NSGCT undergoing surveillance after orchiectomy. We retrospectively evaluated tumour specimens from 88 consecutive stage I NSGCT patients undergoing surveillance in our institution between 1984 and 1996. 24 patients relapsed (27%). Multivariate analysis singled out vessel invasion (VI) (relative risk (RR)=3.8; 95% confidence interval (CI) 1.4–10.4) and the presence of mature teratoma (RR= 0.2; 95% CI 0.1–0.6) as independently correlated with relapse-free survival (RFS). Patients can be classified accordingly into three prognostic groups with a low (27 patients with mature teratoma but without VI), intermediate (34 patients with both VI and mature teratoma or with neither VI or mature teratoma) and a high risk (23 patients with VI, but without mature teratoma) of relapse. Relapse rates in these three groups were 0%, 29% (95% CI: 23–35%) and 61% (95% CI: 55–67%), respectively. This prognostic index, based on two standard pathological parameters, identified a subgroup with a very low risk of relapse that represents approximately one third of stage I patients. Patients who belong to this subgroup should be managed by surveillance only, instead of retroperitoneal lymph node dissection (RPLND) or adjuvant chemotherapy.

Type X collagen synthesis by cultured chondrocytes derived from the permanent cartilaginous region of chick embryo sternum

In the developing chick embryo sternum, type X collagen is synthesized by chondrocytes from the cephalic region (presumptive mineralization zone) but not by chondrocytes from the caudal region (permanent cartilaginous zone) (Gibson et al., 1984, J. Cell Biol. 99, 208–216). To distinguish between two possibilities, the presence of a nonpermissive microenvironment in the permanent cartilage or the intrinsic inability of caudal chondrocytes to become hypertrophic, type X-producing cells, we have isolated chondrocytes from the caudal third of stage 44 chick embryo sterna and grown them in suspension on agarose-coated dishes. We have found that in these conditions chondrocytes from the caudal zone differentiate to hypertrophic chondrocytes and synthesize large amount of type X collagen, as revealed by the electrophoretic pattern of labeled proteins made in vitro and by slot blot analysis of mRNAs with specific cDNA probes.

Age‐ and region‐dependent redistribution of con A binding sites on chick wing‐bud mesoderm cells

AbstractThe distribution of concanavalin A (con A) binding sites on chick wing‐bud mesoderm cells from two different developmental stages and from different regions of the same embyronic limbs was examined. Fluorescein isothiocyanate (FITC)‐labeled con A binding sites on mesoderm cells from whole stage 19–20 and the distal third of stage 25 limbs redistributed from a random array over the cell surface to form clusters or caps of binding sites. In contrast, a significantly smaller percentage of developmentally “older” mesoderm cells from the proximal third of stage 25 limbs underwent redistribution of bound con A from its normal random arrangement. In order to further examine the basis for the decrease in con A redistribution in the stage 25 proximal cells, this segment was subdivided into a core (presumptive chondrogenic) and peripheral (presumptive myogenic) region. The results of con A redistribution studies utilizing these two cell populations indicate that a significantly smaller percentage of the core cells are capable of forming clusters or caps. Likewise, in agglutination studies, core cells proved significantly less susceptible to con A‐induced agglutination. These findings indicates that the differences in agglutination and con A redistribution, seen when comparing the proximal cells with the other cell populations, is attributable to a subpopulation of the proximal cells, specifically, those located in the chondrogenic core region. Since the proximal core and peripheral cells are of the same developmental age, these findings suggest that developmental age is not solely responsible for the differences reported here. Thus, prospective phenotype appears also to be involved in the decreased agglutination and a con A redistribution of the chondrogenic core cells.

Region-Dependent Capacity for Limb Chondrogenesis: Patterns of Chondrogenesis in Cultures from Different Regions of the Developing Chick Wing

The in vitro chondrogenic patterns expressed by mesoderm cells obtained from the proximal, middle, and distal thirds of stage 25 chick embryo wing buds were studied. Region-dependent differences were observed in the patterns of Toluidine Blue-staining extracellular matrix produced. These differences were subsequently shown to be highly reproducible. Chondrogenesis in cultures containing cells from the proximal third of the limb is restricted primarily to the center of the dish and takes the form of small nodules by day 4. These nodules coalesce into a large colony by day 6. In cultures containing similar numbers of cells from the distal third of the limb, aggregates of cells surrounded by metachromatic extracellular matrix materials are detectable somewhat earlier than in those containing cells from the proximal region. A centrally located concentration of matrix material is found in these distal cell cultures, however, a large number of nodules are also scattered throughout the monolayer. The difference between the chondrogenic patterns seen in the proximal and distal cell cultures becomes more pronounced by day 6 of culture. This is due primarily to the absence of demonstrable cartilaginous matrix in the peripheral areas of the proximal cell cultures. Cultures composed of cells derived from the middle third of stage 25 wings exhibit patterns of Chondrogenesis intermediate in appearance between those containing cells from the other two regions. It is unlikely that these readily repeatable differences in chondrogenic patterns can be explained solely by convection currents in the media caused by the seeding and handling of the cultures prior to attachment of the cells. The different chondrogenic patterns might therefore be suggestive of region-dependent differences in the cell surface characteristics of limb mesoderm cells.