Management of premature rupture of membranes before 25 weeks

OBJECTIVES: The aim of our study was to define the benefits and risks related to expectant management in the midtrimester rupture of membranes and to assess the prognostic factors in order to give objective informations to parents facing these obstetrical situations. STUDY DESIGN: We conducted a retrospective study. The study population included 49 patients with premature rupture of membranes at 16-23 weeks' gestation during the period January 1998-June 2003. The main criterion for judgement was neonate survival. Statistical analysis included chi2-test for the qualitative variables and Student's test for the quantitative variables. The threshold for significance was 5%. RESULTS: Twenty couples out of 49 chose medical termination of pregnancy. Among the 29 other pregnancies, the mean latency period was 2.1 weeks. The mean gestational age at delivery was 23.2 weeks. Nineteen patients were delivered after 22 weeks. The main prognostic factors were the initial amniotic fluid index (2.9 cm versus 0.8 cm) (p=0.042) and gestational age at delivery (26.7 weeks versus 22.6 weeks) (p<0.001). About 2% of the pregnancies were complicated by maternal infection. Eighty-three percent of the survivors had neonatal respiratory distress syndrome. 41.2% of them presented sepsis. We observed no cases of severe intraventricular haemorrhage. The number of infants born after 24 weeks of gestation and still alive at 1 week was 12, representing 24% of pregnancies and 63% of the infants born after 24 weeks. CONCLUSION: Expectant management can be widely suggested to patients. However, termination of pregnancy is acceptable, in cases with a poor prognosis including anamnios and premature rupture of membranes before 21 weeks.     

High incidence of chromosomal abnormalities in oocyte donors

Oocyte donors are chosen among phenotypically normal and fertile women who are not expected to carry any chromosomal abnormality. A high incidence of balanced structural chromosomal rearrangements has been found within oocyte donors. This result raises the question of a possible bias in their recruitment with respect to their familial background and/or personal reproductive history.     

Quantification of the Hardened Cement Paste Content in Fine Recycled Concrete Aggregates by Means of Salicylic Acid Dissolution

Adherent hardened cement paste attached to recycled concrete aggregates (RCA) generally presents a higher porosity than natural aggregates, which induces a lower porosity in the properties of RCA. The characterization of the adherent hardened cement paste content (HCPC) in the fine RCA would promote better applications of RCA in concrete, but the determination of HCPC in fine RCA is not well established. A simple method based on salicylic acid dissolution was specifically developed to quantify the HCPC in RCA, especially for RCA containing limestone aggregates. The results demonstrated that the soluble fraction in salicylic acid (SFSA) was equal to the HCPC for white cement and slightly lower for grey Portland cement, which was also confirmed by a theoretical approach using modelling the hydration of cement paste with the chemical equations and the stoichiometric ratios. The physical and mechanical properties of RCA (e.g., water absorption) were strongly correlated to the SFSA. For industrial RCA, SFSA did not give the exact value of HCPC, but it was sufficient to correlate HCPC with the other properties of RCA. The water absorption could be estimated with good accuracy for very fine RCA (laboratory-manufactured RCA or industrial RCA) by extrapolating the relationship between water absorption and HCPC, which is very important for concrete formulation.     

Does Tweeting Improve Citations? One-Year Results From the TSSMN Prospective Randomized Trial

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Predictors of cognitive improvement after reality orientation in Alzheimer's disease

BACKGROUND: there is increasing evidence to support the efficacy of reality orientation in cognitive deficits in patients with Alzheimer's disease. The clinical characteristics of patients who respond to reality orientation are poorly understood; this knowledge could be important, given that the provision of reality orientation therapy is labour-intensive and may provoke emotional distress. AIM: to evaluate retrospectively which demographic and clinical characteristics of Alzheimer's patients predict cognitive outcomes. METHOD: we analysed 38 mild-to-moderately demented outpatients who regularly attended a one-month formal reality orientation programme. The mini mental state examination score changes from baseline-and immediately after-reality orientation were correlated with demographic and pre-treatment clinical characteristics by a linear regression analysis. RESULTS: short-term responsiveness to reality orientation was significantly predicted by a lower level of cognitive functioning (as measured by the mini mental state examination) at baseline and by the absence of euphoria, accounting together for 57.6% of variance. CONCLUSION: a lower mini mental state examination and the absence of euphoric behaviour in patients with mild-to-moderate Alzheimer's disease may predict a good cognitive outcome of reality orientation therapy.