The influence of MRI-based pelvimetric measurements in mother's choice of delivery in fetal breech position.

INTRODUCTION: At term, about 3-4% of all singleton pregnancies present as breech. MRI-based pelvimetry is a valuable tool to support selection of adequate candidates for a trial-of-labor in women expecting term breech babies. Shared decision-making is playing an increasingly important role in obstetrics. Since the divergent existing knowledge of breech term delivery needs to be discussed with the pregnant woman, we examined the influence of MRI results on the shared decision-making process in women with term breech presentation. METHODS: Between 08/2021 and 12/2022, anamnestic and clinical parameters were collected from singleton pregnancies expecting term breech babies resulting in birth at the Hanover Medical School. After information, written consent and inclusion, clinical parameters, the course of birth and the maternal and fetal outcome were collected retrospectively. 32 women participated in a postpartum questionnaire study on inquiry. The subsequent acquisition of information and the arguments in the decision-making process were determined. In addition, the sense of security and self-determination was asked both before and during birth. RESULTS: 50% of the respondents had not decided for a mode of delivery before having MRI pelvimetry. After imaging and information, about the own pelvic dimensions and predictors for a successful vaginal birth, 80% of this subgroup decided to give birth vaginally. Over 40% of the collective descripted that they made a decision based on the result of MRI pelvimetry. None of the women felt to be insecure after having talked about the MRI results. The elective cesarean section group and the group of those who delivered vaginally were approximately equally highly satisfied with their feeling of self-determination of the birth mode. Overall, the study population had a very positive birth experience. The group of women who had delivered by elective cesarean showed a wider range in their assessment and appeared to perceive the experience more negative than the group of women who had a vaginal birth or emergency cesarean. Fetal and maternal outcomes did not differ between the groups. DISCUSSION: MRT pelvimetry measurements can be used as a predictor for a successful vaginal breech delivery. The additional information obtained from the MRI measurements can be used in the shared decision-making process to decide more easily on the mode of delivery while improving women's awareness and safety. A balanced education on rare and frequently adverse events of vaginal delivery and cesarean section and patient expectations about labor processes must be taken into account.

Combination of oral zinc gluconate and topical triclosan: An anti-inflammatory treatment modality for initial hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is often a therapeutic challenge with relapses and chronicity which can severely impact patients' quality of life. OBJECTIVE: To evaluate the efficacy of anti-inflammatory oral zinc gluconate, 90mg/day, combined with topical triclosan, 2% twice daily. METHODS: We retrospectively evaluated the medical records of HS patients in our HS Center of the Department of Dermatology, Venereology, and Allergology, Ruhr-University Bochum, regarding change of disease severity and quality of life. Secondary outcome measures were the number of nodules and fistulas, the number of boils or flair-ups, and the intensity of pain. RESULTS: Sixty-six patients in Hurley stage I and II were included. After 3 months of combination therapy, the modified HS Score and the Dermatology Life Quality Index improved significantly (p<0.0001 and p=0.0386, respectively). The number of inflammatory nodules, new boils or flare-ups, and erythema scores decreased significantly. Fistula count and the visual analogue scale score showed no significant difference. Side-effects (mostly abdominal pain and nausea) were reported by 12 (22.2%) patients. CONCLUSION: The combination therapy of zinc gluconate and topical triclosan can be considered as an anti-inflammatory treatment for HS patients in Hurley stage I and initial Hurley stage II.

Identification of hepatic molecular mechanisms of action of alpha-tocopherol using global gene expression profile analysis in rats.

The recent discovery that vitamin E (VE) regulates gene activity at the transcriptional level indicates that VE may exert part of its biological effects by mechanisms which may be independent of its well-recognised antioxidant function. The objective of this study was the identification of hepatic vitamin E-sensitive genes and examination of the effects of VE on their corresponding biological endpoints. Two groups of male rats were randomly assigned to either a VE-sufficient diet or to a control diet deficient in VE for 290 days. High-density oligonucleotide microarrays comprising over 7000 genes were used to assess the transcriptional response of the liver. Differential gene expression was monitored over a period of 9 months, at four different time-points, and rats were individually profiled. This experimental strategy identified several VE-sensitive genes, which were chronically altered by dietary VE. VE supplementation down-regulated scavenger receptor CD36, coagulation factor IX and 5-alpha-steroid reductase type 1 mRNA levels while hepatic gamma glutamyl-cysteinyl synthetase was significantly up-regulated. Measurement of the corresponding biological endpoints such as activated partial thromboplastin time, plasma dihydrotestosterone and hepatic glutathione substantiated the gene chip data which indicated that dietary VE plays an important role in a range of metabolic processes within the liver.