Prediction of labor outcome using serial transperineal ultrasound in the first stage of labor

Objective: The objective of this study is to evaluate the feasibility of predicting labor outcome using serial transperineal ultrasound (TPU) in the early active phase of labor.

Methods: This is a single center prospective observational study in a tertiary obstetrics unit in Hong Kong. Nulliparous women carrying singleton pregnancy at the onset of active phase of labor were recruited. Serial 3D volumes by TPU were acquired and then repeated after 1 and 2?h, which were subsequently analyzed for fetal head symphyseal distance (HSD), angle of progression (AoP), and fetal head progression distance (PD). The women were classified into two groups, according to whether they had vaginal delivery or cesarean section (CS) for reasons other than non-progressive labor (Group A) or CS for non-progressive labor (Group B). The TPU parameters were then compared between the groups.

Results: Group A consisted of 74 (60.0%) women with vaginal delivery, 27 (21.8%) with instrumental delivery and 3 (2.4%) CS for reasons other than non-progressive labor, while Group B consisted of 20 (16.1%) women who had a CS for non-progressive labor. Group B had a significant slower hourly progression rate of AoP, HSD, and PD at 1-h and 2-h from the initial assessment, compared with Group A. Multivariate logistic regression analysis demonstrated that PD progression at 2-h and the use of oxytocin were significant independent predictors for CS for non-progressive labor.

Conclusion: It is feasible to predict CS for non-progressive labor in the early active phase of labor by a slower rate of fetal head descent determined by TPU.     

Plasma Epstein-Barr virus DNA as a biomarker for nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is common in southern China and Southeast Asia. Epstein-Barr virus (EBV) infection is an important etiology for NPC, and EBV genome can be detected in almost all tumor ti...     

Psoriasis and non‐alcoholic fatty liver disease

Several recent studies have found an increased prevalence of non‐alcoholic fatty liver disease within psoriasis patients. The exact pathophysiological mechanisms behind these observations are unclear, but are likely related to the high prevalence of obesity and metabolic syndrome within this patient population. Chronic inflammation, mediated by either proinflammatory adipokines or skin‐derived cytokines, may contribute to fatty liver disease development by increasing insulin resistance which in turn promotes hepatic lipid accumulation. These same adipokines in addition to hepatic cytokines may act on the skin to influence psoriasis disease severity.     

Assessment of smear layer removal protocols in curved root canals

This study sought to assess if the final rinse protocol interferes with the smear layer removal in the apical area of curved canals. Sixty‐four extracted human mandibular molars with curved mesial roots were instrumented with rotary files and divided into six experimental groups for final rinse: 1EDTA (syringe irrigation with 1 mL of 17% ethylenediaminetetraacetic acid (EDTA) ), 5EDTA (syringe irrigation with 5 mL of 17% EDTA), 1EDTA‐P (syringe irrigation with 1 mL of 17% EDTA + pumping with gutta‐percha point), 5EDTA‐P (syringe irrigation with 5 mL of 17% EDTA + pumping with gutta‐percha point), 1EDTA‐EA (syringe irrigation with 1 mL of 17% EDTA + EndoActivator) and 5EDTA‐EA (syringe irrigation with 5 mL of 17% EDTA + EndoActivator). Final rinsing was carried out over 3 min. The specimens were split lengthwise and observed under a scanning electron microscope using a score criterion. Comparison among the groups showed statistically significant difference only between the 5EDTA‐EA group and the other groups (Kruskal–Wallis and Dunn's post‐hoc tests, P < 0.05). The combination of 5 mL of 17% EDTA and 3 mL of 2.5% sodium hypochlorite (NaOCl) with the EndoActivator removed smear layer from the apical area of curved root canals more effectively than the other protocols used.     

Comparison of the verification performance and radiation dose between ExacTrac x-ray system and On-Board Imager—A phantom study

Recently, On-Board Imager (OBI) and ExacTrac x-ray 6 degree-of-freedom system (ExacTrac) are increasingly used verification systems in local radiotherapy centers. This study aimed to compare the differences between these two systems in terms of verification accuracy, organ doses, and verification time for head-and-neck (H&N) and pelvic cases. Rando anthropomorphic phantoms of H&N and pelvic regions were positioned with known set-up deviations from the reference position in the linear accelerator. x-Ray verification images were then acquired using both systems. Verification accuracy was evaluated based on the residual positioning error (δD) after image registration. Thermoluminescence dose meters (TLD-100s) were placed in specific locations of the phantoms for the measurement of imaging doses at the organs of interest. Besides, the verification time was also recorded for comparison. Most average detection errors for both systems were within 1?mm. The detection error of ExacTrac was significantly larger than OBI in the H&N region in all directions (p?<?0.05), but was significantly lower in the pelvis (p?<?0.05). The mean imaging doses to all organs of interest from ExacTrac were significantly lower than OBI (p?<?0.05). The mean verification time for ExacTrac was about 10 seconds, which was significantly shorter than the 100 seconds in OBI (p?<?0.001). Both verification systems achieved satisfactory performance in the H&N and pelvic regions despite ExacTrac being better in terms of verification time and organ dose. The verification accuracy of Exactrac was better in pelvic region than the H&N region when compared with OBI.     

Increased expression of tumor-associated antigens in pediatric and adult ependymomas: implication for vaccine therapy

Despite surgery and radiotherapy, as many as 50 % of children with ependymomas will suffer from tumor recurrences that will ultimately lead to death. Our group’s initial peptide-based glioma vaccine targeting EphA2, IL-13Rα2, and Survivin, which are overexpressed in pediatric gliomas, has shown promise in its initial phase of testing. We therefore investigated whether EphA2, IL-13Rα2, Survivin, and, additionally, Wilms’ Tumor 1 (WT1), are overexpressed in pediatric ependymomas to determine if a similar immunotherapy approach could be applicable. Immunohistochemistry was performed using antibodies specific for EphA2, IL-13Rα2, Survivin, and WT1 on paraffin-embedded specimens from 19 pediatric and 13 adult ependymomas. Normal brain and ependyma were used for background staining controls. Negative staining was defined as no staining or staining equaling the background intensity in normal brain tissues. In the 19 pediatric cases, 18 (95 %) demonstrated positive staining for EphA2, 16 (84 %) for IL-13Rα2, 18 (95 %) for Survivin, and only 7 (37 %) for WT1. Only 3 of 19 cases were positive for two or fewer tumor-associated antigens (TAAs); 16 of 19 cases were positive for three or more TAAs. In the 13 adult cases, all 13 demonstrated positive staining for EphA2, IL-13Rα2, and Survivin. Only 2 of 13 cases (15 %) demonstrated positive staining for WT1. All adult specimens were positive for three or more TAAs. Some ependymomas showed patchy variability in intensity. Pediatric and adult ependymomas frequently express EphA2, IL-13Rα2, and Survivin. This provides the basis for the utilization of an established multiple peptide vaccine for ependymoma in a clinical trial setting.     

Asymptomatic bacteriuria in pregnancy in Port Harcourt

ObjectiveTo determine the prevalence of asymptomatic bacteriuria in pregnancy, to consider the antimicrobial sensitivity patterns of involved uropathogens, to elucidate the safety profiles of antibacterial agents, and to evaluate the role of urinalysis in screening for asymptomatic bacteriuria.MethodsAbout 760 apparently healthy pregnant subjects attending the Antenatal Clinic of the University of Port Harcourt Teaching Hospital were randomly selected for this study. Urinalysis and microscopy, culture, and sensitivity tests were carried out on clean-catch midstream urine samples obtained from subjects. Biochemical reagent strips were used for urinalysis while the standard wire loop and agar diffusion technique were respectively employed for culture and susceptibility testing.ResultsA total of 111 samples yielded moderate or severe growth on culture after 48 hours comprising 35, 31, 27, and 18 isolates of Staphylococcus spp., Proteus spp., Klebsiella spp., and Escherichia spp, respectivehy. Urinalysis results were positive for the presence of nitrate reductase and leucocyte esterase activity in 17 urine samples of these 111 samples. The isolates showed a general sensitivity to the fluorinated quinolones and to Nitrofurantoin.ConclusionsThe prevalence of asymptomatic bacteriuria is 14.6%, with the predominant organism being Staphylococcus spp. Drugs used for treatment should have excellent fetal safety profiles, and a rapid screening test with a high negative predictive value for asymptomatic bacteriuria would be ideal.