Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management: A systematic review of randomised controlled trials.

BACKGROUND: A systematic review to determine the efficacy and safety of prostaglandins (PG) and Foley catheter (FC) for cervical priming in the outpatient setting. Various methods are available to achieve cervical ripening prior to induction of labour (IOL). In this systematic review, we will report the literature to date, and investigate the efficacy and safety of using the Foley catheter balloon or prostaglandins for cervical ripening, comparing both methods with each other, and discuss the implications of these findings for midwifery led units. METHODS: English peer-reviewed journals were systematically searched in the databases PubMed, MEDLINE, EMCARE, EMBASE and CINAHL, for studies investigating cervical ripening using the FC or PGs. Additional randomised controlled trials (RCTs) and non-RCTs were identified by a manual search. Search terms included: cervix dilatation effacement, cervix ripening, outpatient, ambulatory care, obstetric patients, pharmacological preparations, and Foley catheter. Only RCTs of FC versus PG or either intervention versus placebo or intervention in the in-patient Vs. outpatient setting were included. 15 RCTs were included. RESULTS: The results of this review show that both FC and PG analogues are equally effective cervical ripening agents. When compared to FC, PGs lead to a reduced requirement for oxytocin augmentation and a shorter intervention to delivery interval. However, PG use is also associated with an increased risk of hyperstimulation, cardiotocographic monitoring abnormalities and negative neonatal outcomes. CONCLUSIONS: FC cervical ripening is an effective method of outpatient cervical priming, which is safe, acceptable, and cost-effective and thus has a potential role in both resource-rich and resource-poor countries. With appropriate dosing, some PG analogues also appear to offer similar outcomes.

The plant ionome revisited by the nutrient balance concept.

Tissue analysis is commonly used in ecology and agronomy to portray plant nutrient signatures. Nutrient concentration data, or ionomes, belongs to the compositional data class, i.e., multivariate data that are proportions of some whole, hence carrying important numerical properties. Statistics computed across raw or ordinary log-transformed nutrient data are intrinsically biased, hence possibly leading to wrong inferences. Our objective was to present a sound and robust approach based on a novel nutrient balance concept to classify plant ionomes. We analyzed leaf N, P, K, Ca, and Mg of two wild and six domesticated fruit species from Canada, Brazil, and New Zealand sampled during reproductive stages. Nutrient concentrations were (1) analyzed without transformation, (2) ordinary log-transformed as commonly but incorrectly applied in practice, (3) additive log-ratio (alr) transformed as surrogate to stoichiometric rules, and (4) converted to isometric log-ratios (ilr) arranged as sound nutrient balance variables. Raw concentration and ordinary log transformation both led to biased multivariate analysis due to redundancy between interacting nutrients. The alr- and ilr-transformed data provided unbiased discriminant analyses of plant ionomes, where wild and domesticated species formed distinct groups and the ionomes of species and cultivars were differentiated without numerical bias. The ilr nutrient balance concept is preferable to alr, because the ilr technique projects the most important interactions between nutrients into a convenient Euclidean space. This novel numerical approach allows rectifying historical biases and supervising phenotypic plasticity in plant nutrition studies.

A practical review of the Glasgow Coma Scale and Score.

Since the Glasgow Coma Scale was introduced in 1974,(1) it has become the most common method of describing a patient's level of consciousness. However, despite its almost universal use, there remain a number of misunderstandings, particularly regarding the appropriate situations in which to use the Glasgow Coma Score rather than the Scale, and also in the correct way to elicit and record the motor responses. This article, aimed at non-neurosurgeons, addresses these problems, and provides a reference for those wishing to learn or teach the Glasgow Coma Scale and Score.

Review of rapid tests available for measuring the quality changes in frying oils and comparison with standard methods.

Repeated use of oils and fats for frying of food brings about many changes in their physical and chemical properties. Due to increasing health concerns, the assessment of the quality of reused oils has received much attention, since such assessment is useful in determining the discarding point of the oils. The official analytical methods used in laboratories for this purpose need skill, time, and a large consumption of solvents. To make the oil testing simpler, several rapid test kits have been developed based on either physical parameters (such as viscosity or dielectric changes) or chemical parameters (such as free fatty acids, oxidized fatty acids, or carbonyl compounds). These test kits usually comprise a portable instrument or colorimetric reaction sticks, capable of providing a direct or indirect measurement of a single parameter. The review presented in this paper evaluates the use of such rapid test kits and highlights the need to develop multi-parameter test kits in order to establish the quality of reused oil and the point at which it should be discarded. The review also encompasses pertinent details on the standard analytical methods, and deterioration of frying oils that occur during and after their use and the associated health consequences.

An unusual case of spontaneous subarachnoid haemorrhage - a ruptured aneurysm of a basilar perforator artery.

A 51-year-old gentleman with no significant past medical history presented with a WFNS grade 1 subarachnoid haemorrhage. Initial angiographic investigations revealed no cause, but repeat tests showed a small basilar perforator aneurysm. Following a failed attempt at endovascular treatment, a craniotomy and excision of the aneurysm was performed. Post-operatively the patient made a good recovery. This case highlights the importance of delayed repeat catheter angiography in selected patients with suspicious initial CT head results.

Vitamin D2 from irradiated mushrooms significantly increases femur bone mineral density in rats.

A method has been optimized for the conversion of ergosterol in mushrooms to vitamin D2, and the vitamin D-enriched mushrooms have been tested for bioavailability of vitamin D2 using a rat model. Femur bone mineral density (BMD) of the experimental group of animals fed with vitamin D2 (1 microg/d) obtained from irradiated mushrooms was significantly increased. Femur BMD of two groups was significantly higher. Femur BMD of the experimental group was significantly elevated compared to initial femur BMD of the study group. Data indicate that vitamin D2 from ultraviolet (UV)-irradiated mushrooms was well absorbed and metabolized in animals.

Single laboratory validation of a method for the determination of Bisphenol A, Bisphenol A diglycidyl ether and its derivatives in canned foods by reversed-phase liquid chromatography.

A method was developed and validated for the simultaneous determination of Bisphenol A (BPA), Bisphenol A diglycidyl ether (BADGE), BADGE-H2O, BADGE-2H2O, BADGE-H2O-HCl, BADGE-HCl, and BADGE-2HCl in canned food using reversed phase high-performance liquid chromatography (HPLC) with fluorescence detection; chromatographic separation of all seven analytes was achieved (Rs > or = 1.08) using HPLC gradient elution technique. Acetonitrile was used to extract the analytes from the food matrix before subjecting the samples to liquid-liquid extraction, solid-phase extraction for further clean-up and preconcentration prior to HPLC analysis. Excellent inter-day precision data (n = 10) and intra-day precision data (n = 5) were obtained on a 200 microg/kg spiked sample. The RSD ranged from 0.20% to 2.96% for the inter-day precision tests, and 0.04% to 2.82% for the intra-day precision tests. Accuracy was measured at three concentration levels: 200, 1000, and 2000 microg/kg; recoveries ranged from 86.07% to 114.06%. The excellent validation data suggests that this method can be applied on canned foods for the determination of migration of BPA, BADGE and its derivatives from can coatings into food.

Functional and structural properties of 2S soy protein in relation to other molecular protein fractions.

The purpose of this investigation is to develop a better understanding of the structure-function relationship of the 2S fraction of soy protein that has not been considered in earnest by the research community. Defatted soy flour was used to extract the three major fractions of the protein (2S, 7S, and 11S). It was found that 2S exhibits better foaming and emulsification properties than the other two molecular fractions. Work was extended to structural properties, which were monitored using spectrophotometry, atomic force microscopy, scanning electron microscopy, small-deformation dynamic oscillation on shear, and large-deformation compression testing. An experimental protocol utilizing glucono-delta-lactone (GDL), GDL with N-ethylmaleimide, or GDL with urea was capable of identifying the nature of molecular interactions responsible for gelation. Surprisingly, it was found that in the initial stages of structure formation, 2S fared better than 7S, with 11S exhibiting the highest rates of aggregation. Given time, however, 7S produced a firmer network with a better water-holding capacity than that of 2S. Non-covalent interactions, as opposed to disulfide bridging, were found to be largely responsible for the changing functionality of the molecular fractions throughout the experimentation from the formation of a vestigial structure to that of a mature gel.

Isolation and structure elucidation of phenolic compounds from longan (Dimocarpus longan Lour.) seed by high-performance liquid chromatography-electrospray ionization mass spectrometry.

High-performance liquid chromatography coupled with electrospray ionization mass spectrometry (HPLC-ESI-MS) analysis revealed the phenolics profile of longan (Dimocarpus longan Lour.) seed. Gallic acid, ellagic acid, monogalloyl-glucose, monogalloyl-diglucose, digalloyl-diglucose, penta- to heptagalloyl-glucose, ellagic acid-pentose conjugate, galloyl-HHDP (Hexahydroxydiphenoyl)-glucopyranose, pentagalloy-HHDP-glucopyranose, procyanidin A-type dimer, procyanidin B2 and quercetin-3-O-rhamnoside were found to be present in longan seed along with a number of, as yet, unknown compounds. The results illustrate the rich array of phenolic compounds in longan seeds which could be utilized as health-beneficial bioactive compounds rather than just discarded as waste.

Bioavailability of vitamin D2 from irradiated mushrooms: an in vivo study.

Vitamin D2 from irradiated edible mushrooms might present a possible dietary source of this vitamin, subject to its bioavailability. Having previously optimized a method for the conversion of ergosterol in mushrooms to vitamin D2, this paper examines the vitamin D-enriched mushrooms (Lentinula edodes) for their bioavailability of the vitamin, using an animal model. Thirty male Wistar rats were fed for 1 week with a diet deficient in vitamin D. After this 1-week period, six rats were randomly selected and killed for analysis of initial bone mineral density, and serum level of 25-hydroxyvitamin D. A group of twelve rats of the test animals received 1 mug of vitamin D2 from irradiated mushrooms for a period of 4 weeks until being killed. The remaining twelve rats were fed un-irradiated mushrooms at the same level to act as controls. At the end of a 4-week period, the mean serum 25-hydroxyvitamin D level of the experimental group was 129.42 (sd 22.00) nmol/l whereas it was only 6.06 (sd 1.09) nmol/l in the control group. Femur bone mineral density of the experimental group of animals was significantly higher (P<0.01) than the control group. In addition, serum Ca concentrations among groups were shown to be significantly higher (P<0.01). It may be concluded from the results that vitamin D2 from UV-irradiated mushrooms is well absorbed and metabolized in this model animal system. Significant increase in femur bone mineralization (P<0.01) was shown in the presence of vitamin D2 from irradiated mushrooms compared with the controls.

Effect of cooking on the loss of persistent organic pollutants from salmon.

Recent studies have raised concern over the presence of high levels of persistent organic pollutants (POPs) in farmed fish relative to wild specimens of the same species, particularly salmon. Although cooking is known to reduce the burden of POPs in fish, the mechanisms of loss/degradation are not clearly understood. This study investigated the loss of POPs, including polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), p,p'-DDT [2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane] and its related metabolites (sum noted as DDTs), and chlordane congeners, from salmon (Salmo salar) steaks when subjected to baking, boiling, frying, or microwave cooking. Ranges in the raw flesh were 25.1-62.9 ng/g wet weight (ww) for PCBs, 2.5-7.6 ng/g ww for PBDEs, 2.4-5.3 ng/g ww for chlordanes, and 17.5-43.8 ng/g ww for DDTs. Analysis of raw steaks from along the fish body revealed a significant variation of POP concentrations along the fish body, with higher concentrations at the head end than the tail, with a peak in the central section. After cooking, levels of POPs decreased in salmon steak with an average loss of 26 +/- 15% relative to the initial POP load in the raw steak. The removal of the skin from the cooked salmon steak resulted in a further average loss of 9 +/- 3%. The loss of POPs did not differ significantly between cooking methods. Losses of POPs were significantly and linearly correlated with the losses of lipid during cooking, suggesting removal of lipids is the critical factor for POPs reduction in cooked fish. Cooking of raw fish contaminated with POPs can therefore be expected to reduce the consumption exposure risk to human health.

Bioaccumulation of DDT pesticide in cultured Asian seabass following dietary exposure.

Bioaccumulation and metabolism of p,p'-DDT was studied in the marine carnivorous fish Lates calcarifer, Asian seabass, in a controlled aquaculture experiment. Over a 42-d period, seabass were fed pellets dosed with p,p'-DDT at environmentally realistic levels. Virtually all p,p'-DDT in pellets bioaccumulated in the fish with an uptake efficiency of 98%. The levels of p,p'-DDT and the metabolites p,p'-DDD and p,p'-DDE were analyzed in muscle, liver, visceral fat, brain, and remaining tissues. Partitioning of p,p'-DDT and its metabolites among the control, low-dose, and high-dose exposed seabass were 14.8% in muscle, 3.5% in liver, 37.1% in visceral fat, 0.11% in brain, and 45.5% in remaining tissues, where partitioning between tissues was a function of tissue lipid content. p,p'-DDT bioaccumulation increased linearly with exposure in visceral fat and muscle tissue. The metabolism of p,p'-DDT, which occurs mainly in the liver, resulted in the degradation of 2.5% of p,p'-DDT into p,p'-DDD. These new findings show that bioaccumulation processes at environmentally realistic ingestion exposure levels (ng/g) differ from previous DDT ingestion studies conducted at unrealistically high DDT levels (microg/g), highlighting the need to revise models on the transfer of persistent organic pollutants in the marine environment and aquaculture systems.