[Factors associated with cesarean delivery of the second twin after vaginal delivery of the first twin: A case-control study]

OBJECTIVES

To identify risk factors for cesarean section of the second twin after vaginal delivery of the first twin.

METHODS

Case-control study conducted between 2004 and 2018 in a tertiary center, CHU Toulouse. Cases were women with twin pregnancy who had vaginal delivery of the first twin and emergency cesarean of the second twin. Controls were women with twin pregnancy who delivered both twins vaginally. Deliveries before 24 weeks of gestation, birth weight of less than 500 grams, fetal death in utero, terminations of pregnancy and delayed delivery were excluded. The association between potential risk factors and cesarean delivery of the second twin was analyzed using multivariable logistic regression.

RESULTS

Twenty-four patients who had vaginal delivery of the first twin and emergency cesarean of the second twin and 48 patients who delivered both twins vaginally were included. Neonatal morbidity was increased in the group of women who had an emergency cesarean of the second twin. In multivariable analysis, overweight (OR=10.5 [95% CI: 1.78-62.03] for women with body mass index above 25 compared to women with body mass index below 25), weight gain during pregnancy (OR=1.27 [95% CI: 1.01-1.48] for each kilogram) and preterm labor (OR=4,43 [IC 95%:1,10-17,80]) were associated with significantly increased risk of cesarean section of the second twin.

CONCLUSION

Overweight and weight gain during pregnancy are associated with increased risk for cesarean section of the second twin.

Offering women a choice in induction of labour: a prospective cohort study

PURPOSE

To evaluate women's choice in the method of labour induction between oral misoprostol, PGE2 pessary and the Foley catheter. To compare women's satisfaction according to their choice and to identify factors associated with patient satisfaction.

METHODS

We conducted a comparative, prospective cohort study of 520 women who chose their preferred method for labour induction, in a French tertiary hospital, from July 2019 to October 2020. Before and after the delivery, they were asked to argue their choice and to evaluate their satisfaction through the use of questionnaires. The primary outcome was global level of satisfaction.

RESULTS

Of the 520 women included, 67.5% of women chose oral misoprostol compared to 21% PGE2 pessary and 11.5% Foley catheter. Regarding global satisfaction, we found no significant difference between the three groups: 78.4%, 68.8% and 71.2% (p = 0.107) for, respectively, oral misoprostol, PGE2 pessary and Foley catheter. Factors that seem to improve women's satisfaction were nulliparity (aOR = 2.03, 95% CI [1.19-3.53]), delivery within 24 h after the start of induction (aOR = 3.46, 95% CI [2.02-6.14]) and adequate information (aOR = 4.21, 95% CI [1.869.64]). Factors associated with lower satisfaction rates were postpartum haemorrhage (aOR = 0.51, 95% CI [0.30-0.88]) and caesarean section (aOR = 0.31, 95% CI [0.17-0.54]).

CONCLUSION

Women satisfaction rates were not different between the three methods, when chosen by the patients themselves. These finding should encourage caregivers to promote shared decision making when possible.

TRIAL REGISTRATION

The protocol was approved by the French ethics committee for research in obstetrics and gynaecology (CEROG, reference number 2019-OBS-0602) on 1st June 2019.

Tumour and pelvic lymph node metabolic activity on FDG-PET/CT to stratify patients for para-aortic surgical staging in locally advanced cervical cancer

PURPOSE

The aim of our study was to comprehensively evaluate the most valuable metabolic parameters of cervical tumours and pelvic lymph nodes (PLN) by FDG-PET/CT to predict para-aortic lymph node (PALN) metastasis and stratify patients for surgical staging.

METHODS

The study included patients with locally advanced cervical cancer, negative PALN uptake on preoperative FDG-PET/CT, and para-aortic lymphadenectomy. Two senior nuclear medicine physicians expert in gynaecologic oncology reviewed all PET/CT exams, and extracted tumour SUVmax, MTV, and TLG, as well as PLN. Prognostic parameters of PALN involvement were identified using ROC curves and logistic regression analysis.

RESULTS

One hundred and twenty-five consecutive locally advanced cervical cancer patients were included. The FDG-PET/CT false-negative rate was, respectively, 27.7% (13/47) and 5.1% (4/78) in patients with and without FDG-PET/CT PLN uptake. The AUC of cervical tumour size, SUVmax, MTV, and TLG was, respectively, 0.75 (0.62-0.87), 0.59 (0.44-0.76), 0.75 (0.60-0.90), and 0.71 (0.56-0.86). The AUC of PLN size, SUVmax, SUVmean, PLN SUVmax/Tumour SUVmax ratio, MTV, and TLG was, respectively, 0.57 (0.37-0.78), 0.82 (0.68-0.95), 0.77 (0.61-0.94), 0.85 (0.72-0.98), 0.69 (0.51-0.87), and 0.74 (0.57-0.91). The metabolic parameter showing the best trade-off between sensitivity and specificity to predict PALN involvement was the ratio between PLN and tumour SUVmax.

CONCLUSION

The risk of PALN metastasis in FDG-PET/CT negative PLN patients is very low, so para-aortic lymphadenectomy does not seem justified. In patients with preoperative PLN uptake on FDG-PET/CT, surgical staging led to treatment modification in more than 25% of cases and should therefore be performed. Patients with more than one positive PLN and high PLN metabolic activity are at high risk of para-aortic extension and recurrence. Further prospective evaluation is required to consider intensified treatment modalities without prior PALN dissection.

Nonperturbative Functional Renormalization-Group Approach to the Sine-Gordon Model and the Lukyanov-Zamolodchikov Conjecture

We study the quantum sine-Gordon model within a nonperturbative functional renormalization-group approach (FRG). This approach is benchmarked by comparing our findings for the soliton and lightest breather (soliton-antisoliton bound state) masses to exact results. We then examine the validity of the Lukyanov-Zamolodchikov conjecture for the expectation value ⟨e^{(i/2)nβφ}⟩ of the exponential fields in the massive phase (n is integer and 2π/β denotes the periodicity of the potential in the sine-Gordon model). We find that the minimum of the relative and absolute disagreements between the FRG results and the conjecture is smaller than 0.01.

Biomarkers predict enhanced clinical outcomes with afatinib versus methotrexate in patients with second-line recurrent and/or metastatic head and neck cancer

Background

In the phase III LUX-Head & Neck 1 (LUX-H&N1) trial, second-line afatinib significantly improved progression-free survival (PFS) versus methotrexate in patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). Here, we evaluated association of prespecified biomarkers with efficacy outcomes in LUX-H&N1.

Patients and methods

Randomized patients with R/M HNSCC and progression following ≥2 cycles of platinum therapy received afatinib (40 mg/day) or methotrexate (40 mg/m2/week). Tumor/serum samples were collected at study entry for patients who volunteered for inclusion in biomarker analyses. Tumor biomarkers, including p16 (prespecified subgroup; all tumor subsites), EGFR, HER2, HER3, c-MET and PTEN, were assessed using tissue microarray cores and slides; serum protein was evaluated using the VeriStrat® test. Biomarkers were correlated with efficacy outcomes.

Results

Of 483 randomized patients, 326 (67%) were included in the biomarker analyses; baseline characteristics were consistent with the overall study population. Median PFS favored afatinib over methotrexate in patients with p16-negative [2.7 versus 1.6 months; HR 0.70 (95% CI 0.50-0.97)], EGFR-amplified [2.8 versus 1.5 months; HR 0.53 (0.33-0.85)], HER3-low [2.8 versus 1.8 months; HR 0.57 (0.37-0.88)], and PTEN-high [1.6 versus 1.4 months; HR 0.55 (0.29-1.05)] tumors. Afatinib also improved PFS in combined subsets of patients with p16-negative and EGFR-amplified tumors [2.7 versus 1.5 months; HR 0.47 (0.28-0.80)], and patients with p16-negative tumors who were EGFR therapy-naïve [4.0 versus 2.4 months; HR 0.55 (0.31-0.98)]. PFS was improved in afatinib-treated patients who were VeriStrat 'Good' versus 'Poor' [2.7 versus 1.5 months; HR 0.71 (0.49-0.94)], but no treatment interaction was observed. Afatinib improved tumor response versus methotrexate in all subsets analyzed except for those with p16-positive disease (n = 35).

Conclusions

Subgroups of HNSCC patients who may achieve increased benefit from afatinib were identified based on prespecified tumor biomarkers (p16-negative, EGFR-amplified, HER3-low, PTEN-high). Future studies are warranted to validate these findings.

Clinical trial registration

NCT01345682.

Quantum criticality at the superconductor-insulator transition revealed by specific heat measurements

The superconductor–insulator transition (SIT) is considered an excellent example of a quantum phase transition that is driven by quantum fluctuations at zero temperature. The quantum critical point is characterized by a diverging correlation length and a vanishing energy scale. Low-energy fluctuations near quantum criticality may be experimentally detected by specific heat, c_p, measurements. Here we use a unique highly sensitive experiment to measure c_p of two-dimensional granular Pb films through the SIT. The specific heat shows the usual jump at the mean field superconducting transition temperature marking the onset of Cooper pairs formation. As the film thickness is tuned towards the SIT, is relatively unchanged, while the magnitude of the jump and low-temperature specific heat increase significantly. This behaviour is taken as the thermodynamic fingerprint of quantum criticality in the vicinity of a quantum phase transition.

To detect thermodynamic signatures of quantum fluctuations for quantum phase transitions is challenging. Here, Poran et al. report a significant increase in the specific heat when the thickness of granular Pb films approaches a superconductor-insulator transition.

Reexamination of the nonperturbative renormalization-group approach to the Kosterlitz-Thouless transition

We reexamine the two-dimensional linear O(2) model (φ4 theory) in the framework of the nonperturbative renormalization-group. From the flow equations obtained in the derivative expansion to second order and with optimization of the infrared regulator, we find a transition between a high-temperature (disordered) phase and a low-temperature phase displaying a line of fixed points and algebraic order. We obtain a picture in agreement with the standard theory of the Kosterlitz-Thouless (KT) transition and reproduce the universal features of the transition. In particular, we find the anomalous dimension η(T(KT))≃0.24 and the stiffness jump ρ(s)(T(KT)(-))≃0.64 at the transition temperature T(KT), in very good agreement with the exact results η(T(KT))=1/4 and ρ(s)(T(KT)(-))=2/π, as well as an essential singularity of the correlation length in the high-temperature phase as T→T(KT).

Thermodynamics in the vicinity of a relativistic quantum critical point in 2+1 dimensions

We study the thermodynamics of the relativistic quantum O(N) model in two space dimensions. In the vicinity of the zero-temperature quantum critical point (QCP), the pressure can be written in the scaling form P(T)=P(0)+N(T(3)/c(2))F(N)(Δ/T), where c is the velocity of the excitations at the QCP and |Δ| a characteristic zero-temperature energy scale. Using both a large-N approach to leading order and the nonperturbative renormalization group, we compute the universal scaling function F(N). For small values of N (N</~10) we find that F(N)(x) is nonmonotonic in the quantum critical regime (|x|</~1) with a maximum near x=0. The large-N approach-if properly interpreted-is a good approximation both in the renormalized classical (x</~-1) and quantum disordered (x>/~1) regimes, but fails to describe the nonmonotonic behavior of F(N) in the quantum critical regime. We discuss the renormalization-group flows in the various regimes near the QCP and make the connection with the quantum nonlinear sigma model in the renormalized classical regime. We compute the Berezinskii-Kosterlitz-Thouless transition temperature in the quantum O(2) model and find that in the vicinity of the QCP the universal ratio T(BKT)/ρ(s)(0) is very close to π/2, implying that the stiffness ρ(s)(T(BKT)(-)) at the transition is only slightly reduced with respect to the zero-temperature stiffness ρ(s)(0). Finally, we briefly discuss the experimental determination of the universal function F(2) from the pressure of a Bose gas in an optical lattice near the superfluid-Mott-insulator transition.

Tumor oxygenation and radiosensitization by pentoxifylline and a perflubron emulsion carbogen breathing

Oxygen tension measurements were made in three tumors: (i) the murine FSaII fibrosarcoma, (ii) the rat 9L gliosarcoma and (iii) the rat 13672 mammary adenocarcinoma using a pO2 histograph. Tumor oxygenation measurements were made while the animals breathed air or breathed carbogen (95% oxygen/5% carbon dioxide). Pentoxifylline or a perflubron emulsion was administered to the animals and tumor oxygen measurements were repeated under both breathing conditions. Both pentoxifylline and the perflubron emulsion improved the oxygenation of the FSaII fibrosarcoma under air breathing conditions but did not alter the oxygen profiles of either rat tumor compared with air breathing alone. Carbogen breathing increased the oxygenation of all tumors. Pentoxifylline administration did not change the oxygen profiles of the tumors under carbogen breathing conditions but administration of the perflubron emulsion increased the oxygenation of all three tumors under carbogen breathing conditions compared with carbogen breathing alone. Co-administration of pentoxifylline and the perflubron emulsion enhanced the radiation response of the Lewis lung tumor to daily fractionated radiation under air breathing conditions with a dose modifying factor of 1.65 and under carbogen breathing conditions with a dose modifying factor of 2.25. Over a range of perflubron emulsion doses, pentoxifylline increased the growth delay of the Lewis lung tumor in a constant manner. These results indicate that pentoxifylline and the perflubron emulsion have the largest impact on the oxygenation of more hypoxic tumors and that administration of the perflubron emulsion/carbogen breathing is the most effective means of increasing tumor oxygenation and radiation response.

Decreased tumor oxygenation after cyclophosphamide, reoxygenation and therapeutic enhancement with a perflubron emulsion carbogen breathing

Oxygen profiles of the rat mammary 13672 carcinoma were determined using a pO2 histograph prior to treatment and 24 h and 48 h after i.p. administration of a single dose of cyclophosphamide (300 mg/kg). The tumors were severely hypoxic at 24 h post the administration of cyclophosphamide. There was little increase in oxygenation of the tumors at 48 h post therapy compared with 24 h post therapy indicating that reoxygenation after cyclophosphamide was occurring very slowly in this tumor. Carbogen breathing improved the oxygenation of the tumors under each of the conditions studied. Administration of the perflubron emulsion (8 ml/kg) produced little or no change in the oxygenation of the tumors under normal air breathing conditions. However, the addition of carbogen breathing to administration of the perflubron emulsion increased the oxygenation of the tumors to levels equal to or greater than carbogen breathing at the mean/median pO2's. Perhaps most significantly, administration of the perflubron emulsion with carbogen breathing increased the oxygenation of the most hypoxic regions of the tumors but carbogen breathing alone did not. The growth delay of the Lewis lung carcinoma increased with increasing dose.of the perflubron emulsion along with cyclophosphamide (3 x 150 mg/kg) and carbogen breathing (6 h). This combination treatment was most effective when the cyclophosphamide was prepared in the perflubron emulsion. The number of lung metastases decreased in a manner parallel with increased efficacy of the treatment toward the primary tumor.

Infrared behavior in systems with a broken continuous symmetry: classical O(N) model versus interacting bosons

In systems with a spontaneously broken continuous symmetry, the perturbative loop expansion is plagued by infrared divergences due to the coupling between transverse and longitudinal fluctuations. As a result, the longitudinal susceptibility diverges and the self-energy becomes singular at low energy. We study the crossover from the high-energy Gaussian regime, where perturbation theory remains valid, to the low-energy Goldstone regime characterized by a diverging longitudinal susceptibility. We consider both the classical linear O (N) model and interacting bosons at zero temperature, using a variety of techniques: perturbation theory, hydrodynamic approach (i.e., for bosons, Popov's theory), large-N limit, and nonperturbative renormalization group. We emphasize the essential role of the Ginzburg momentum scale p{G}, below which the perturbative approach breaks down. Even though the action of (nonrelativistic) bosons includes a first-order time derivative term, we find remarkable similarities in the weak-coupling limit between the classical O(N) model and interacting bosons at zero temperature.

From local to critical fluctuations in lattice models: a nonperturbative renormalization-group approach

We propose an implementation of the nonperturbative renormalization group (NPRG) which applies to lattice models. Contrary to the usual NPRG approach where the initial condition of the RG flow is the mean-field solution, the lattice NPRG uses the (local) limit of decoupled sites as the (initial) reference system. In the long-distance limit, it is equivalent to the usual NPRG formulation and therefore yields identical results for the critical properties. We discuss both a lattice field theory defined on a d-dimensional hypercubic lattice and classical spin models. The simplest approximation, the local potential approximation, is sufficient to obtain the critical temperature and the magnetization of the three-dimensional Ising, XY, and Heisenberg models to an accuracy on the order of 1%. We show how the local potential approximation can be improved to include a nonzero anomalous dimension η and discuss the Berezinskii-Kosterlitz-Thouless transition of the two-dimensional XY model on a square lattice.

Unified picture of superfluidity: from Bogoliubov's approximation to Popov's hydrodynamic theory

Using a nonperturbative renormalization-group technique, we compute the momentum and frequency dependence of the anomalous self-energy and the one-particle spectral function of two-dimensional interacting bosons at zero temperature. Below a characteristic momentum scale k_{G}, where the Bogoliubov approximation breaks down, the anomalous self-energy develops a square-root singularity and the Goldstone mode of the superfluid phase (Bogoliubov sound mode) coexists with a continuum of excitations, in agreement with the predictions of Popov's hydrodynamic theory. Thus our results provide a unified picture of superfluidity in interacting boson systems and connect Bogoliubov's theory (valid for momenta larger than k_{G}) to Popov's hydrodynamic approach.

A hybrid electroabsorption modulator device for generation of high spectral-efficiency optical modulation formats

We report a novel hybrid integrated optic device consisting of AlGaInAs/InP electroabsorption modulators and a four-arm silica-on-silicon planar lightwave circuit optical interferometer. The device is designed for generation of high spectral efficiency optical modulation formats. We demonstrate generation of 21.4 Gb/s quadrature phase shift keyed optical signals with electrical data drives of 2V(pp) amplitudes, achieving a bit error rate of 10(-9) with the required optical signal to noise ratio of ~18 dB in a 0.1 nm resolution bandwidth.

Triplet superconducting pairing and density-wave instabilities in organic conductors

Using a renormalization group approach, we determine the phase diagram of an extended quasi-one-dimensional electron gas model that includes interchain hopping, nesting deviations, and both intrachain and interchain repulsive interactions. We find a close proximity of spin-density- and charge-density-wave phases and singlet d-wave and triplet f-wave superconducting phases. There is a striking correspondence between our results and recent puzzling experimental findings in the Bechgaard salts, including the coexistence of spin-density-wave and charge-density-wave phases and the possibility of a triplet pairing in the superconducting phase.

Plasmin converts factor X from coagulation zymogen to fibrinolysis cofactor

Known anticoagulant pathways have been shown to exclusively inhibit blood coagulation cofactors and enzymes. In the current work, we first investigated the possibility of a novel anticoagulant mechanism that functions at the level of zymogen inactivation. Utilizing both clotting and chromogenic assays, the fibrinolysis protease plasmin was found to irreversibly inhibit the pivotal function of factor X (FX) in coagulation. This was due to cleavage at several sites, the location of which were altered by association of FX with procoagulant phospholipid (proPL). The final products were approximately 28 and approximately 47 kDa for proPL-bound and unbound FX, respectively, which did not have analogues when activated FX (FXa) was cleaved instead. We next investigated whether the FX derivatives could interact with the plasmin precursor plasminogen, and we found that plasmin exposed a binding site only on proPL-bound FX. The highest apparent affinity was for the 28-kDa fragment, which was identified as the light subunit disulfide linked to a small fragment of the heavy subunit (Met-296 to approximately Lys-330). After cleavage by plasmin, proPL-bound FX furthermore was observed to accelerate plasmin generation by tissue plasminogen activator. Thus, a feedback mechanism localized by proPL is suggested in which plasmin simultaneously inhibits FX clotting function and converts proPL-bound FX into a fibrinolysis cofactor. These data also provide the first evidence for an anticoagulant mechanism aimed directly at the zymogen FX.

Schizophrenia: revisited

Schizophrenia is a devastating illness for the affected individuals and their families. Health care providers and researchers are also challenged by the clinical heterogeneity of this disorder. The goal of the present paper is to offer an updated overview of the aetiology, definition, clinical manifestations and pharmacological and psychosocial treatments of schizophrenia. Finally, some future directions for psychiatric nursing will be suggested in light of the existing knowledge of schizophrenia.

Cyclooxygenase inhibitors - invitro and invivo effects on antitumor alkylating-agents in the emt-6 murine mammary-carcinoma

The nonsteroidal antiinflammatory drugs that inhibit cyclooxygenase block the formation of prostanoids in vivo. These agents may be useful as modulators of cytotoxic anticancer therapies. EMT-6 mouse mammary carcinoma cells growing in culture were exposed for 1 h or 24 h to eleven different nonsteroidal antiinflammatory agents or acetaminophen. None of these drugs was very cytotoxic. A concentration of 50muM of the nonsteroidal antiinflammatory drugs or acetaminophen was chosen for modulator combination studies with the antitumor alkylating agents CDDP, L-PAM, BCNU and 4-HC in cell culture. Several of the modulators protected the EMT-6 cells from the cytotoxicity of the antitumor alkylating agents; however, diflunisal, sulindac, indomethacin, acetaminophen and in some cases ibuprofen and tolmetin were positive modulators of the antitumor alkylating agents under the cell culture conditions tested. EMT-6 tumor cell survival studies and bone marrow CFU-GM survival studies were carried out with seven of the modulators and various doses of cyclophosphamide. Tolmetin, ibuprofen, sulindac, piroxicam and diflunisal in combination with cyclophosphamide produced increased tumor cell killing compared with cyclophosphamide alone without marked changes in toxicity to the bone marrow derived CFU-GM. In EMT-6 tumor growth delay experiments, none of the six modulators tested affected the growth of the tumors; however, tolmetin, ibuprofen, diflunisal and sulindac increased the tumor growth delay obtained with standard dose-schedules of cyclophosphamide or CDDP. When minocycline, a collagenase inhibitor, was added to treatment regimens including diflunisal or sulindac and either cyclophosphamide, CDDP or L-PAM further increases in tumor growth delay were obtained especially when L-PAM was the cytotoxic therapeutic agent. The number of lung metastases and the percentage lung metastases with diameters >3 mm were reduced by treatment with the modulator combinations alone and further reduced with the addition of the antitumor alkylating agents. These results indicate that agents which inhibit signaling pathways among tumor cells and between tumor cells and normal cells can be useful additions to cytotoxic therapies.

Purification and identification of multiple forms of dynorphin in human placenta

Immunoreactive dynorphin (ir-Dyn) and opiate-like peptides (OLP) were measured in acid (HC1) extracts of human placenta by the use of an antibody to synthetic Dyn-(1-13) and of the displacement of [3H]-naloxone binding to rat brain homogenates, respectively. The placenta contained 57.6 pmoles per g of ir-Dyn and 134.4 pmoles per g of naloxone binding equivalents. After passage of the extract through cartridges of Sep Pak C18, half of the OLP was eluted with ir-Dyn at 35% acetonitrile (ACN), the rest being eluted at 60% ACN. Both fractions obtained from Sep Pak were chromatographed separately on Sephadex G-50, the OLP of the 35% ACN fraction coeluting with the ir-Dyn speak and that of the 60% ACN fraction being eluted at the same volume as synthetic beta-endorphin. Conversely, the fraction of OLP coeluting with synthetic leucine-enkephalin (Leu-Enk) in these two chromatographies was minimal. The Dyn-immunoreactive material was further purified by high pressure liquid chromatography on reverse phase micro-Bondapak C18 columns to give three distinct peaks corresponding to synthetic Dyn-(1-11), Dyn-(1-13) and Dyn-(1-12), respectively. Our results indicate that the human placenta contains several forms of ir-Dyn which account for about half of its endogenous OLP.