Vacuum Extraction Research Articles

Temporal trends and regional variations in operative vaginal deliveries in Japan: A national representative cohort study.

To analyze temporal trends and regional variations in operative vaginal delivery (OVD) in Japan. Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan from 2014 to 2021, we identified the numbers of vacuum and forceps deliveries. We analyzed annual totals and proportions of OVDs and calculated the mean age of women undergoing these deliveries. We also predicted trends in OVD for the next 20 years and compared geographical differences in the proportions of forceps deliveries among OVDs. During the observation period, out of 7 368 814 total births, 8.4% were through OVD, including 7.6% by vacuum and 0.8% by forceps. Both delivery methods showed an increasing trend from 2014 to 2021: vacuum deliveries rose from 7.0% to 8.7%, and forceps deliveries increased from 0.6% to 1.0%. Notably, the proportion of forceps deliveries in OVD increased from 8.1% to 10.5%. The mean age was higher for forceps deliveries than vacuum deliveries. According to our predictions, vacuum deliveries may continue to increase, but forceps deliveries may stabilize. The proportion of forceps deliveries among OVDs ranged from 0% to 38% across Japanese prefectures. This study shows an increase in the use of OVD in Japan from 2014 to 2021. There are large regional differences in the choice between vacuum and forceps deliveries. These findings can help us understand the practice of OVD in Japan.

Assessing physicochemical characteristics of a shear-thinning polysaccharide mucilage extracted from marshmallow root (Althaea officinalis L.) by an ohmic heating system

Althaea officinalis L. root mucilage holds promise for food industries due to its functional properties. Despite various extraction techniques, ohmic systems remain underexplored for mucilage extraction. This study aimed to compare the efficacy of mucilage extraction using ohmic systems with maceration and investigate their physicochemical properties. The mucilage extraction was carried out utilizing maceration (M), ohmic-assisted extraction (OAE), and ohmic-assisted vacuum extraction (OAVE). Various parameters were evaluated, such as densities and specific energy consumption. The mucilage obtained by OAE had the highest yield (8.9 %). The highest solubility corresponded to the mucilage obtained by the OAE system (85.18 % at 65 °C). OAVE mucilage had 76.16 % swelling and 82.5 g water/g dry sample binding capacity, while OAE mucilage had 19.6 g water/g dry sample binding capacity. The OAVE mucilage oil absorption (12.3 g oil/g dry sample) was almost twice that of the OAE system. Rheological analysis characterized them as a pseudoplastic behavior. DSC thermogram of mucilage samples exhibited a singular endothermic peak (92.05 to 108.3 °C). FTIR analysis highlighted that the primary constituents of mucilage samples predominantly consisted of polysaccharides. This study concluded that ohmic-assisted extraction was the most efficient method for obtaining mucilage. Further research could explore the potential applications of this mucilage.

How the Mode of Delivery Is Influenced by Patient's Opinions and Risk-Informed Consent in Women with a History of Caesarean Section? Is Vaginal Delivery a Real Option after Caesarean Section?

Background/Objectives: In recent years, there has been a noticeable increase in the rates of caesarean section (CS), being one of the most commonly performed surgical procedures. For the following pregnancy, the previous CS represents the backbone of the risks and complications, such as uterine scar formation, uterine rupture, massive bleeding, and serious negative outcomes for both the mother and child. Our study followed patients with a history of CS from the birth planning prenatal check-up to delivery. Methods: We reviewed the records of 125 pregnant women with previous CS who presented in the third trimester for a prenatal check-up and completed our questionnaire from March 2021 to April 2022 in the Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Germany. Results: Before the prenatal check-up, 74 patients (59.2%) preferred vaginal delivery (VD), while 51 (40.8%) preferred CS. After discussing birth planning with the obstetrician, 72 women (57.6%) decided upon VD, while 53 (42.4%) preferred CS. Ultimately, 78 (62.4%) of women gave birth through CS (either planned or by medical necessity) and 47 (37.6%) gave birth vaginally (either natural or per vacuum extraction). Conclusions: VD for patients with CS in their medical history is a real option. The patient must be well informed about the risks and benefits of the medical situation and should be empowered and supported on their chosen mode of delivery, which should be respected.

Reverse takotsubo induced cardiogenic shock in the peripartum period: A case report and literature review.

Reverse takotsubo cardiomyopathy is a rare variant of a rare disease characterized by basal ballooning and dysfunction of the left ventricle. While it can render patients profoundly unwell and reliant on intensivist care, it is a transient phenomenon, with the worst symptoms subsiding after 2-3 days. At term, a young woman spontaneously entered labor prior to a planned repeat cesarean section. After experiencing physical and psychological distress during labor and a vacuum extraction, she developed cardiogenic shock from reverse takotsubo cardiomyopathy, quickly diagnosed with transthoracic echocardiogram. She required 2 days of intensive care support and made an excellent recovery. This very rare condition should be considered in systemically unwell women in the peripartum as it can be quickly diagnosed, providing patients with the best appropriate care.

Obstetric anal sphincter injuries during instrumental vaginal delivery: An observational study based on 18-years of real-world data.

To determine the prevalence and secular trends of obstetric anal sphincter injuries (OASIS) in vacuum and forceps deliveries in Norway, both with and without episiotomy. Population-based real-world data collected during 2001-2018. Medical Birth Registry Norway. Nulliparous women with singleton foetuses in a cephalic presentation delivered by either vacuum or forceps (n = 70 783). Logistic regression analyses were applied to the OASIS prevalence in six 3-year time periods. Both crude odds ratios and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were determined. OASIS prevalence. The OASIS prevalence in vacuum and forceps deliveries decreased from 14.8% during 2001-2003 to 5.2% during 2016-2018. The overall reduction between the first and last 3-year time period was 61% (aOR = 0.39, 95% CIs = 0.35-0.43). The only exception to this decreasing trend in OASIS was found in forceps deliveries performed without an episiotomy. The OASIS prevalence was approximately twofold higher in forceps compared to vacuum deliveries (aOR = 1.92, 95% CIs = 1.79-2.05). Performing either a mediolateral or lateral episiotomy was associated with a 45% decrease in the prevalence of OASIS relative to no episiotomy (aOR = 0.55, 95% CIs = 0.52-0.58). Opting for vacuum rather than forceps delivery in conjunction with a mediolateral or lateral episiotomy could significantly lower the OASIS prevalence in nulliparous women.

The state of female reproductive health in a city with a large petrochemical complex

Introduction. The demographic situation in the country is characterized by a natural decline in the population, which determines the special importance of the protection of motherhood and childhood. The system of obstetrics largely affects the health status of the population and the future generation. Therefore, the study of the state of obstetrics has a high social significance and is relevant. Purpose of the study. To assess the state of female reproductive health of the population living in a city with a large petrochemical complex. Materials and methods. An analysis of primary digital data characterizing the intensive and extensive indicators of the state of obstetric care in the city of Salavat for 2020 was performed. According to the report of the Ministry of Health of the Republic of Bashkortostan “The state of health of the population and the activities of medical institutions of the Republic of Bashkortostan in 2020” a comparative analysis was carried out. Results. An analysis of the state of obstetric care in the city of Salavat showed that women began to give birth less, they interrupted one third of the onset of pregnancies with abortions. The number of abortions per 1,000 women of childbearing age is 1.5 times higher than in the republic. Over the years, the number of abortions is growing against the background of their decline in the republic. Women who wish to give birth in the vast majority come under the supervision of an antenatal clinic until the 12-week gestation period. The results of the course of pregnancy, childbirth, and the postpartum period, the absence of maternal mortality indicate to a high level of obstetric care. However, he draws attention to the fact that 45.6±1.5% of deliveries and the postpartum period proceeded against the background of complications, among which the most significant were anemia, premature rupture of the amniotic membrane, and violations of labour activity. Every third woman in labour underwent a caesarean section, every fifth - vacuum extraction. The health indicators of the fetus and newborn in the trend in years are improving and more favourable than in the republic as a whole, but 58.9±1.3% of neonates were born sick and fell ill. Mainly in the form of asphyxia during childbirth (18.6±1.2%) and infectious diseases (39.5±4.4%). Preterm infants get sick 2 times more often than full-term ones and the main reason is asphyxia during delivery and respiratory disorders over the perinatal period. Limitations. The analysis of the primary digital values of obstetric care indicators of the forms of federal statistical observation and accounting of medical institutions in Salavat for 2020 was carried out. Conclusion. More favourable health indicators of pregnant women, mothers, fetuses in Salavat in comparison with republican and all-Russian ones indicate to the high-quality, qualified obstetric care. The higher incidence of respiratory diseases in infants during the first year of life living in a city of large petrochemistry determines the need for special in-depth studies.

The δ18O contrast between bulk goethite and water extracted from it does not reliably reveal goethite growth temperature

Goethite (α-FeOOH) contains two structurally-distinct oxygen sites that can potentially be independently interrogated for isotopic composition by analyzing bulk goethite δ18O (δ18Obulk) and the δ18O of water extracted from it (δ18Oextracted). The isotopic contrast between these two components may form the basis of a paleothermometer (Miller et al., 2020). We sought to better understand the behavior of goethite undergoing vacuum dehydroxylation, the key step in this potential paleothermometric technique. A refined method for making these measurements applied to a suite of natural and synthetic goethites revealed that δ18Oextracted is extremely sensitive to extraction temperature and to details of the vacuum environment in which the goethite is dehydroxylated. This sensitivity likely arises from the fundamental mechanism by which evolved water is removed from goethite in vacuum, via nm-wide pores penetrating nascent hematite surrounding dehydroxylating goethite. These pores may provide favorable conditions for back reaction that scrambles the oxygen isotopic composition, and also for kinetic mass fractionation. The character of these pores is known to vary with goethite composition, crystallinity, and extraction temperature. We identified additional sample-specific factors that affect δ18Oextracted. For example, some synthetic goethites undergo dehydroxylation at surprisingly low temperature (<90 °C) in vacuum, under conditions usually used to remove nonstoichiometric water. In addition, some of the synthetic goethites have spectroscopic characteristics suggesting a range of OH bonding environments that complicate the idea that goethite has just two structurally (and potentially isotopically) distinct oxygen sites. Instead, in fine grained or poorly crystalline goethite there may be a continuum of physisorbed water, chemisorbed water, and stoichiometric water that is simultaneously released during vacuum extraction. After investigating a wide range of extraction conditions, we determined that rapid heating to 255 ± 5 °C is optimal for achieving high degrees of water extraction with the least apparent back reaction. When applied to synthetic goethites grown between 5 °C and 70 °C, we found no compelling correlation between synthesis temperature and the contrast between δ18Obulk and δ18Oextracted. Analyses of two natural samples, known to have grown at ∼5 °C and ∼ 25 °C, revealed no significant difference in measured isotopic contrast. Together these observations suggest that goethite has no resolvable formation temperature information encoded in the bulk and extracted water oxygen isotope ratios as interrogated by the method we explored. If there is temperature-dependent isotopic contrast between the two oxygen sites in goethite, the use of the dehydroxylation method appears unable to reliably reveal it.

Trauma-informed support after a complicated childbirth – An early intervention to reduce symptoms of post-traumatic stress, fear of childbirth and mental illness

ObjectiveWomen who experience obstetric interventions and complications during childbirth have an increased risk of developing postnatal post-traumatic stress and mental illness. This study aimed to test the effect of a trauma-informed support programme based on psychological first aid (PFA) to reduce the mothers' symptoms of stress, fear of childbirth (FOC), anxiety and depression after a complicated childbirth. MethodsThe study population consisted of women ≥ 18 years old who had undergone a complicated childbirth (i.e. acute or emergency caesarean section, vacuum extraction, child in need of neonatal care, manual placenta removal, obstetric anal sphincter injury, shoulder dystocia or major haemorrhage (>1000 ml)). A total of 101 women participated in the study, of whom 43 received the intervention. Demographic questions and three self-assessment instruments measuring stress symptoms, FOC, anxiety and depression were answered one to three months after birth. ResultsThe women in the intervention group scored significantly lower on the stress symptom scale, with a halved median score compared to the control group. There was no significant difference between the groups regarding FOC, depression and anxiety. ConclusionOur results indicate that this PFA-based support programme might reduce post-traumatic stress symptoms in women who have gone through a complicated childbirth. With further studies in a larger population, this support programme has the potential to contribute to improved maternal care optimizing postnatal mental health.

Programmed Intermittent Epidural Bolus Reduces Workloads in Labor Analgesia: A Single Center's Experience.

Background and Objectives: Labor epidural analgesia can be maintained through programmed intermittent epidural bolus (PIEB), continuous epidural infusion (CEI), or patient-controlled epidural analgesia (PCEA). Our department changed from CEI+PCEA to PIEB+PCEA as the maintenance method. The higher hourly dose setting in the current regimen brought to our concern that side effects would increase with proportional staff workloads. This study aimed to investigate the validity of our proposal that PIEB+PCEA may function as a feasible tool in reducing the amount of work in the obstetrics anesthesia units. Materials and methods: This 2-year retrospective review included parturients with vaginal deliveries under epidural analgesia. We compared the staff burden before and after the switch from CEI (6 mL/h, PCEA 6 mL lockout 15 min, group A) to PIEB (8 mL/h, PCEA 8 mL lockout 10 min, group B). The primary outcome was the difference of proportion of parturients requiring unscheduled visits between groups. Side effects and labor and neonatal outcomes were compared. Results: Of the 694 parturients analyzed, the proportion of those requiring unscheduled visits were significantly reduced in group B (20.8% vs. 27.7%, chi-square test, p = 0.033). The multivariate logistic regression showed that PIEB was associated with fewer unscheduled visits than CEI (OR = 0.53, 95% CI [0.36-0.80], p < 0.01). Group B exhibited a significantly lower incidence of asymmetric blockade, as well as motor blockade. In nulliparous subjects, obstetric anal sphincter injury occurred less frequently when PIEB+PCEA was used. Significantly more multiparous women experienced vacuum extraction delivery in group B than in group A, and they had a longer second stage of labor. Conclusions: The PIEB+PCEA protocol in our study reduced workloads in labor epidural analgesia as compared to CEI+PCEA, despite that a higher dose of analgesics was administered. Future studies are warranted to investigate the effect of manipulating the PIEB settings on the labor outcomes.

Interpregnancy interval after vacuum delivery and subsequent perinatal outcomes.

To evaluate whether a short interpregnancy interval (IPI) after vacuum extraction (VE), poses similar perinatal risks in a subsequent pregnancy. This was a retrospective, single-center cohort study between 2011 and 2021. Nulliparous women with term, singleton VE deliveries and with known pregnancy outcomes in their subsequent pregnancy were eligible for inclusion in the study. Each woman was allocated into one of two groups based on the IPI, <18 months and between 18 and 60 months. The primary outcome was the risk of spontaneous preterm birth (PTB) <37 weeks in the consecutive birth. We included 1094 pregnancies: 212 (19.4%) with IPI <18 months and 882 (80.6%) with IPI between 18 and 60 months following the previous VE delivery. The VE characteristics were comparable between the groups. Young maternal age was a risk factor for a short IPI (28.0 ± 4.8 vs 30.3 ± 4 years, P < 0.01). Spontaneous PTB <37 weeks was significantly higher in the IPI <18 months group with 18-60 months (7.1% vs 2.6%, P = 0.002). Polynomial regression analysis also confirmed a significantly increased risk of preterm birth <37 weeks (P < 0.01). Short IPI <18 months was also associated with an increase in the risk of low birthweight <2500 g (6.1% vs 2.8%, P = 0.02) and admission to the neonatal intensive care unit (6.1% vs 2.6%, P = 0.013). The incidence of recurrent VE, albeit significant (2.3% vs 4.9%, P = 0.049), was low in both groups. No differences were noted in any of the other secondary outcomes. Short IPI (<18 months) following term VE delivery is associated with higher neonatal risks, particularly PTB, in the subsequent pregnancy. These findings are particularly important when counseling women planning an optimal IPI.

Prediction of spontaneous vaginal delivery in the prolonged second stage using the delta angle of progression

It is clinically challenging to determine when to intervene in the prolonged second stage. Although individualized prediction of spontaneous vaginal delivery is crucial to avoid maternal and neonatal complications associated with operative deliveries, the approach has not been fully established. We aimed to evaluate the predictability of spontaneous vaginal delivery using the difference in angle of progression between pushing and rest, delta angle of progression, to establish a novel method to predict spontaneous vaginal delivery during the prolonged second stage in nulliparous women with epidural anesthesia. We retrospectively analyzed deliveries of nulliparous women with epidural anesthesia between September 2018 and October 2023. Women were included if their delta angle of progression during the second stage was available. Operative deliveries were defined as the cases that required forceps, vacuum, and cesarean deliveries due to labor arrest. Women requiring operative deliveries due to fetal and maternal concerns, or women with fetal occiput posterior presentation were excluded. The second stage was stratified into the prolonged second stage, the period after 3 hours in the second stage, and the normal second stage, the period from the beginning until the third hour of the second stage. The association of the delta angle of the progression measured during each stage with spontaneous vaginal delivery and operative deliveries was investigated. Furthermore, the predictability of spontaneous vaginal delivery was evaluated by combining the delta and rest angle of progression. A total of 129 women were eligible for analysis. The delta angle of progression measured during the prolonged second stage and normal second stage were significantly larger in women who achieved spontaneous vaginal delivery compared to operative deliveries (p<.001 and p<.05, respectively). During the prolonged second stage, a cutoff of 18.8 derived from the receiver operative characteristic curves in the context of the delta angle of progression predicted the possibility of spontaneous vaginal delivery (sensitivity, 81.8%; specificity, 60.0%; AUC, 0.76). Combining the rest angle of progression (>140) and delta angle of progression (>18.8) also provided quantitative prediction of spontaneous vaginal delivery (sensitivity, 86.7%; specificity, 70.0%; AUC, 0.80). The delta angle of progression alone or in combination with the rest angle of progression can be used to predict spontaneous vaginal delivery in the second stage in nulliparous women with epidural anesthesia. Quantitative analysis of the effect of pushing using the delta angle of progression provides an objective guide to assist with an assessment of labor dystocia in the prolonged second stage on an individualized basis, which may optimize labor management in the prolonged second stage by reducing neonatal and maternal complications related to unnecessary operative deliveries and prolonged second stage of labor.

Join point trends of instrumental vaginal deliveries and cesarean sections at the Lagos University Teaching Hospital, Lagos, Nigeria (2002-2017).

To determine the trends of instrumental vaginal delivery (IVD) and cesarean section (CS) at the Lagos University Teaching Hospital (LUTH), Nigeria, over 16 years, from 2002 to 2017. A retrospective cross-sectional study. The case records of all women who had IVD and CS during the study period were reviewed. The trends in the IVD and CS rates were evaluated using join point regression modeling. The average annual percent change (AAPC) and annual percent change (APC) with associated 95% confidence interval of segmental trends were calculated. The overall IVD rate was 1.36%. Vacuum delivery rate was higher than forceps (0.79% vs 0.57%). The CS rate was 44.9 per 100 deliveries; the rate increased by about 3.7% per annum. CS rates were 7.1-89.9 times the IVD rates within the study period. The number of IVDs performed in the hospital declined by about 83.02%, from 53 cases in 2002 to nine cases in 2017. Forceps delivery declined at a faster rate than vacuum delivery between 2002 and 2017 (AAPC for forceps: -12.6% [-17.5 to -7.5], P < 0.001 vs AAPC for vacuum: -6.2% [-14.3 to 2.7], P = 0.200). The commonest indication for IVD was prolonged second stage of labor (47/162, 29.01%) and shortening of the second stage of labor for maternal conditions (47/162, 29.01%). IVD rates are low and declining at LUTH. There is need to train accoucheurs on the safe use of IVDs to potentially reduce the CS rate.

2- Acetyl-1-pyrroline originated from Maillard reaction is the key odorant of cooked Lipu taro

Lipu taro is one of the most famous varieties of taro in China with strong aroma. In this study, vacuum simultaneous steam distillation and extraction and gas chromatography-mass spectrometry were applied to extract and analyze the volatile components, combined with gas chromatography-olfactometry, aroma extraction dilution analysis, odor activity value, aroma recombination and omission experiments to determine the key aroma-active compounds in cooked Lipu taro. Results revealed that 18 odorants, such as 2-acetyl-1-pyrroline (2-AP), (E,E)-2,4-decadienal, methional, nonanal, 1-octen-3-one, etc., were identified as the key aroma-active compounds, and they could recombine the taro aroma at detected concentration. Among these key odorants, 2-AP exhibited the most significant roles in cooked Lipu taro. 2-AP was confirmed to be originated from Maillard reaction, as the addition of Maillard reaction precursors (L-proline and D-glucose) could increase its content significantly. This result offers a practical method of enhancing the characteristic aroma of cooked taro.

Neonatal complications and risk factors associated with assisted vaginal delivery

To investigate neonatal injuries, morbidities and risk factors related to vaginal deliveries. This retrospective, descriptive study identified 3500 patients who underwent vaginal delivery between 2020 and 2022. Demographic data, neonatal injuries, complications arising from vaginal delivery and pertinent risk factors were documented. Neonatal injuries and morbidities were prevalent in cases of assisted vacuum delivery, gestational diabetes mellitus class A2 (GDMA2) and pre-eclampsia with severe features. Caput succedaneum and petechiae were observed in 291/3500 cases (8.31%) and 108/3500 cases (3.09%), respectively. Caput succedaneum was associated with multiparity (adjusted odds ratio [AOR] 0.36, 95% confidence interval [CI] 0.22–0.57, P < 0.001) and assisted vacuum delivery (AOR 5.18, 95% CI 2.60–10.3, P < 0.001). Cephalohaematoma was linked to GDMA2 (AOR 11.3, 95% CI 2.96–43.2, P < 0.001) and assisted vacuum delivery (AOR 16.5, 95% CI 6.71–40.5, P < 0.001). Scalp lacerations correlated with assisted vacuum and forceps deliveries (AOR 6.94, 95% CI 1.85–26.1, P < 0.004; and AOR 10.5, 95% CI 1.08–102.2, P < 0.042, respectively). Neonatal morbidities were associated with preterm delivery (AOR 3.49, 95% CI 1.39–8.72, P = 0.008), night-time delivery (AOR 1.32, 95% CI 1.07–1.63, P = 0.009) and low birth weight (AOR 7.52, 95% CI 3.79–14.9, P < 0.001). Neonatal injuries and morbidities were common in assisted vacuum delivery, maternal GDMA2, pre-eclampsia with severe features, preterm delivery and low birth weight. Cephalohaematoma and scalp lacerations were prevalent in assisted vaginal deliveries. Most morbidities occurred at night.Clinical trial registration: Thai Clinical Trials Registry 20220126004.

Circumscribed Thinning of the Calvaria - A Long-Term Sequela After Vacuum Extraction Delivery

Abstract Background Vacuum extraction deliveries are associated with a number of complications like injuries to the skin, subperiosteal, subgaleal and intracranial hemorrhages. Even skull fractures have been described, but data on persistent changes in the bone structure of the skull like thinning of the calvaria is lacking in the literature. Aims We describe a previously unreported long-term sequela of vacuum extraction delivery. Methods We present a series of 8 children, who were referred because of an irregularity of the cranial surface without other symptoms. The investigations revealed a circumscribed thinning of the calvaria in all 8 cases. Detailed history and the specific clinical findings were crucial in the assessment. Various imaging techniques were used to visualize the lesions and rule out some differential diagnoses. Results All children had undergone a vacuum-assisted delivery. All irregularities of the cranial surface were discovered incidentally. Clinical examination revealed a round (6) or linear (1) channel-shaped indentation of the calvaria in 7 cases. The shape and size of the annular thinning of the calvaria matched devices commonly used in vacuum extraction very well. In one patient, a localized protrusion of the calvaria was investigated, but an indentation more posteriorly was detected in the CT scan. CT scan was performed in 6 patients, in 2, parents refused this examination. In the follow-up, no progression or symptoms was observed in any of the patients. Conclusion Such long-term sequelae after vacuum-assisted delivery have not been reported yet and the underlying mechanism is unclear. In children who present with irregularities of the cranium, an accurate history, including the mode of birth, and detailed clinical examination should be performed. Knowledge about the presented pathology may help to avoid extensive investigations, particularly CT scan. The publication of further cases could help to propagate the circumscribed thinning of the calvaria after vacuum extraction as a distinctive clinical entity.

Enhancing in situ remediation of clayey soils contaminated with total petroleum hydrocarbons by combining pneumatic fracturing, plasma blasting, and vacuum extraction: A comprehensive field investigation

Oxidant injection technology is widely used in soil remediation; however, subsurface conditions, including soil properties and permeability, significantly influence its effectiveness. In this study, the potential of the combination of pneumatic fracturing, plasma discharge, and vacuum extraction (PPV) in enhancing soil permeability and remediating field-scale silt/clayey soils contaminated by total petroleum hydrocarbon (TPH) was studied. Improved soil permeability was assessed by measuring the chlorine and H2O2 concentrations in soil samples, and the remediation efficiency of PPV was evaluated by analyzing the TPH concentrations in the soil samples. The initial highest TPH concentration was 6922 mg kg−1; after a 42-day operation period, the TPH levels decreased to 541 mg kg−1. The economic assessment of PPV revealed it to be cost-effective, with a total operating cost of US$ 3077 for remediating 265 m³ of contaminated soil, equating to US$ 11.6 per ton of soil. Since PPV requires a short operational period, is inexpensive, and is suitable for purifying low-permeability soil, it is a promising and economically advantageous approach for soil purification. Overall, PPV demonstrated the ability to enhance oxidizing agent transfer by increasing soil permeability, suggesting its potential for efficient and targeted soil remediation.

Adverse maternal outcomes and associated factors among mothers of advanced age delivering at a tertiary hospital, southwestern Uganda: a cross-sectional study

BackgroundMothers of advanced age, defined as pregnant women aged ≥ 35 years at the time of giving birth, are traditionally known to be associated with increased risks of adverse maternal outcomes. We determined the prevalence of adverse maternal outcomes and associated factors among mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH), in Southwestern Uganda.MethodsWe conducted a cross-sectional study at the Maternity Ward of KRRH from April to September 2023. We consecutively enrolled pregnant women aged ≥ 35 years during their immediate post-delivery period and before discharge. We obtained data on their socio-demographic, obstetric, medical characteristics and their maternal outcomes using interviewer-administered questionnaires. We defined adverse maternal outcome as any complication sustained by the mother that was related to pregnancy, delivery and immediate post-partum events (obstructed labour, antepartum haemorrhage, mode of delivery [cesarean or vacuum extraction], postpartum haemorrhage, hypertensive disorders of pregnancy, preterm or postdate pregnancy, anemia, premature rupture of membranes, multiple pregnancy, and maternal death). A participant was considered to have an adverse outcome if they experienced any one of these complications. We identified factors associated with adverse outcomes using modified Poisson regression.ResultsOut of 417 participants, most were aged 35–37 years (n = 206; 49.4%), and had parity ≥ 5 (65.5%). The prevalence of adverse maternal outcomes was 37.6% (n = 157, 95%CI: 33.1–42.4%). Common adverse maternal outcomes included caesarian delivery (23%), and obstructed labour (14.4%). Other complications included anemia in pregnancy (4.5%), chorioamnionitis (4.1%), preterm prelabour rupture of membranes (3.9%), and chronic hypertension and preeclampsia (both 2.4%). Factors associated with adverse maternal outcomes were precipitate labour (adjusted prevalence ratio [aPR] = 1.95, 95%CI: 1.44–2.65), prolonged labour, lasting > 12 h (aPR = 2.86, 95%CI: 1.48–3.16), and chronic hypertension (aPR = 2.01, 95%CI: 1.34–3.9).ConclusionApproximately two-fifth of the advanced-aged mothers surveyed had adverse outcomes. Mothers with prolonged labour, precipitate labour and chronic hypertension were more likely to experience adverse outcomes. We recommend implementation of targeted interventions, emphasizing proper management of labor as well as close monitoring of hypertensive mothers, and those with precipitate or prolonged labor, to mitigate risks of adverse outcomes within this study population.

Factors Associated with Obstetric Anal Sphincter Injury During Vacuum-Assisted Vaginal Delivery.

Obstetric anal sphincter injury (OASI) is a major complication associated with vacuum-assisted vaginal delivery (VAVD). The aim of this study was to evaluate risk factors related to vacuum extraction that are associated with OASI. This was a case-control study performed at a tertiary university teaching hospital. Included were patients aged 18-45years who had a singleton pregnancy resulting in a live, term, VAVD. The study group consisted of women diagnosed with OASI following vacuum extraction. The control group included women following VAVD without OASI. Matching at a ratio of 1:2 was performed. Groups were compared regarding demographic, obstetric. and labor-related parameters, specifically focusing on variables related to the vacuum procedure itself. One hundred and ten patients within the study group and 212 within the control group were included in the final analysis. Patients in the OASI group were more likely to undergo induction of labor, use of oxytocin during labor, increased second stage of labor, higher likelihood of the operator being a resident, increased number of pulls, procedure lasting under 10min, occipito-posterior head position at vacuum initiation, episiotomy, increased neonatal head circumference, and birthweight. Multivariate logistic regression analysis revealed that increased week of gestation (OR 1.67, 95% CI 1.25-2.22, p < 0.001), unsupervised resident performing the procedure (OR 4.63, 95% CI 2.17-9.90), p < 0.001), indication of VAVD being fetal distress (OR 2.72, 95% CI 1.04-7.10, p = 0.041), and length of procedure under 10min (OR 4.75, 95% CI 1.53-14.68, p = 0.007) were associated with OASI. Increased maternal age was associated with lower risk of OASI (OR 0.9, 95% CI 0.84-0.98, p = 0.012). When performing VAVD, increased week of gestation, unsupervised resident performing the procedure, fetal distress as vacuum indication, and vacuum procedure under 10min were associated with OASI. In contrast, increased maternal age was shown to be a protective factor.

Biocompatibility of Nb2C MXene film for ophthalmic implants

The Nb2C MXene film was prepared by tetrafluoroboric acid (HBF4) and hydrofluoric acid (HF) etching and vacuum extraction. The surface structure, properties, and composition of Nb2C MXene were characterized by scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS), and other methods. The biocompatibility of Nb2C MXene film was evaluated by in vivo and in vitro experiments. The results show the layered, micro–nano surface structure of Nb2C MXene with abundant hydroxyl groups (—OH) on the surface. Compared with the control group, the proliferation rate of conjunctival fibroblasts cultured with 1 mg/mL Nb2C MXene is 72.15% (p<0.05). The cytotoxicity of Nb2C MXene is Grade 0 (p>0.05), and the hemolysis rate is 0.38% (<5%). The oxidative stress and inflammatory responses in rabbit ocular tissues are inhibited by Nb2C MXene film, which promotes wound healing without inducing fibrosis, and its micro–nano structure promotes cell adhesion and proliferation, demonstrating good biocompatibility.

Validation of vacuum extraction protocol for larval sampling of spotted-wing drosophila in blueberries

For spotted-wing drosophila, Drosophila suzukii Matsumura, the standard larval sampling protocol from the fruits involves immersing the fruits in hot water, salt, or sugar solution followed by enumerating the larvae that exit from the fruit. In this study, using the fruit samples collected from commercial blueberry farms, we validated the efficacy of a novel D. suzukii larval sampling technique, the vacuum extraction protocol. The larval extraction efficacy of the vacuum extraction method was compared with the salt extraction method using paired fruit samples collected from three different fields for four consecutive weeks. Overall, larval counts detected through the vacuum extraction were significantly higher than those detected through salt extraction in two out of three blueberry fields. Additionally, among the five blueberry fruit sample volumes tested (118, 177, 237, 355, and 473 mL), we identified 355 mL (12 fl. oz.) as the optimum fruit sample volume for vacuum extraction that maximized sampling precision for unit sampling cost. Since D. suzukii larvae exited from fruits after vacuum extraction remain alive and active, a delay in separating the larvae from the sample with coffee filter extraction may result in larval movement back into the fruit flesh. However, compared with immediate processing, delaying coffee filter extraction up to 60 minutes after vacuum incubating the fruit samples at -98 kPa for 60 minutes did not significantly reduce the larval count. Overall, the results of validation trials indicate that vacuum extraction is a promising sampling method for growers to detect D. suzukii larval infestation in blueberries.