Impaired aortic strain and distensibility by cardiac MRI in children with chronic kidney disease.

Renal disease is associated with increased arterial stiffness. The aim was to investigate the effect of renal disease on regional aortic strain and distensibility in children with chronic kidney disease (CKD) by cardiac magnetic resonance imaging (MRI). The study included 30 children with CKD on hemodialysis, and ten healthy control subjects. Using cardiac MRI, maximal and minimal aortic areas were measured in axial cine steady state free precision images at the ascending aorta, proximal descending, and aorta at diaphragm. Regional strain and distensibility were calculated using previously validated formulas. Second reader aortic areas measurements were used to assess inter-observer agreement. Ascending aorta strain was significantly reduced in patients (38.4 ± 17.4%) compared to the control group (56.1 ± 17%), p-value 0.011. Ascending Aorta distensibility was significantly reduced in patients (9.1 ± 4.4 [× 10-3 mm Hg-1]) compared to the control group (13.9 ± 4.9 [× 10-3 mm Hg-1]), p-value 0.006. Strain and distensibility were reduced in proximal descending aorta and aorta at diaphragm but did not reach statistical significance. Only ascending aorta strain and distensibility had significant correlations with clinical and cardiac MRI parameters. Inter-observer agreement for strain and distensibility was almost perfect or strong in the three aortic regions. Aortic strain and distensibility by cardiac MRI are important imaging biomarkers for initial clinical evaluation and follow up of children with CKD.

Cervical Priming by Vaginal or Oral Misoprostol Before Operative Hysteroscopy: A Double-Blind, Randomized Controlled Trial.

STUDY OBJECTIVE: To evaluate whether misoprostol oral is as effective as vaginal tablets for cervical ripening. DESIGN: Randomized controlled trial involving a parallel, double-blinded study (Canadian Task Force Classification IB). SETTING: Department of Obstetrics and Gynecology, Cairo University Hospital, between January 2014 and January 2016. PATIENTS: Patients undergoing operative hysteroscopy for various indications. INTERVENTIONS: At 12 hours before hysteroscopy, the oral group received a 400-µg misoprostol tablet and 2 vaginal starch tablets. The vaginal group received 400 µg of misoprostol and 2 oral starch tablets. The control group received 2 oral starch and 2 vaginal starch tablets as placebo. Preoperative preparation was the same in all patients. MEASUREMENTS AND MAIN RESULTS: The main outcome measures were width of the endocervical canal, ease of dilatation, time to dilatation, and adverse effects. All subjects eligible for operative hysteroscopy (n = 430) were invited to participate. Twenty subjects refused, and 20 subjects were excluded. The enrolled subjects (n = 390) were randomized to oral misoprostol, vaginal misoprostol, or placebo. The differences in mean width of the endocervical canal between the oral and the control groups (4.79 ± 1.07 mm vs 3.92 ± 0.92 mm), and also between the vaginal and the control groups (4.25 ± 0.71 mm vs 3.92 ± 0.92 mm) were significant (p < .001 for both). Moreover, the difference in mean width of the endocervical canal between the oral and the vaginal groups was significant (4.79 ± 1.07 mm vs 4.25 ± 0.71 mm; p = .009). Cervical entry was easier in the oral and vaginal groups compared with the control group (mean Likert score, 4.25 ± 0.64 vs 4.22 ± 0.74 vs 2.55 ± 0.87; p < .001). In addition, the ease of cervical entry did not differ significantly between the oral and vaginal groups (p = .998). The mean time to dilatation was shorter in the oral group and the vaginal group (compared with the control group (48.98 ± 12.6 seconds vs 46.55 ± 15.32 seconds vs 178.05 ± 74.18 seconds; p < .001), but the difference between the oral and vaginal groups was not significant (p = .987). Adverse effects were comparable between groups (p > .05). CONCLUSION: We found no statistically significant difference in the efficacy of cervical priming between oral misoprostol and vaginal misoprostol.