How Effective Is Cervical Ripening Using the Controlled-Release Dinoprostone Vaginal Delivery System for Primiparas with Unruptured Membranes?

Background: Labor induction has a low success rate, especially in primiparas with unruptured membranes. Previous studies focused on pregnant women with unruptured membranes, but none specifically targeted primiparas. Aims: To compare the effectiveness of a controlled-release dinoprostone vaginal delivery system for cervical dilatation (PROPESS) with that of mechanical dilation for labor induction in primiparous women with unruptured membranes. Materials and Methods: We retrospectively analyzed the data of 90 primiparas with unruptured membranes (41 and 49 in the PROPESS and mechanical dilation groups, respectively). The primary outcome was the cesarean section (CS) rate. The secondary outcomes were the prevalence of vaginal delivery within 12 or 24 h after the initial insertion, oxytocin usage rate, chorioamnionitis, additional use of mechanical dilation in the PROPESS group, and neonatal outcomes. Results: The CS rate was significantly lower in the PROPESS group than in the mechanical dilation group (p = 0.02). A total of 13 patients (31.7%) delivered within 24 h with PROPESS alone, indicating a significantly higher rate of delivery within 24 h in the PROPESS group (p = 0.02). Fewer patients required additional oxytocin in the PROPESS group than in the mechanical dilation group (p = 0.001). However, 14 (34%) patients in the PROPESS group required additional mechanical cervical dilation, resulting in a longer time to delivery than mechanical dilation. Conclusions: PROPESS significantly reduced CS rates and increased delivery rates 24 h after the initial insertion in primiparas with unruptured membranes compared to mechanical dilatation. However, failure to respond to PROPESS resulted in an overall longer delivery time than that of the conventional mechanical dilation group;therefore, identifying predictors of response to PROPESS is necessary.

Unruptured pregnancy in a noncommunicating rudimentary horn at37 weeks with a live fetus:a case report

We report an extremely rare case of an unmptured non-communicating rudimentary horn full-term pregnancy. A woman who had a uterine malformation was misdiagnosed as uterus didelphys and gave birth to a live, healthy fetus. The correct diagnosis was not made until cesarean section at 37 4/7 weeks. The case suggests that women who are pregnant in a rudimentary horn could obtain a full-term delivery and give birth to a live and healthy baby.

Impact of Luteinized Unruptured Follicles on Endometrial Receptivity

This study examined the impact of luteinized unruptured follicle （LUF） on endometrial receptivity. The menstrual cycle of 17 LUF patients （LUF group） and 13 ovulatory women （control group） was monitored by measuring LH level in urine and by ultrasonic examination. An endometrial biopsy at the sixth to tenth day after LH surge was taken in all the patients. The expressions of endometrial ER, PR and integrin ανβ3 were immunohistochemically determined. At the same time, the serum levels of E2 and P were detected by chemiluminescence. The results exhibited that （1） The mean serum P level in LUF group （7.32±2.56 ng/mL） was significantly lower than that in control group （11.17±3.17 ng/mL） （P0.01）. But there was no significant difference in the mean serum E2 levels between LUF group （179.35±81.60 pg/mL） and the control group （198.58±75.23 pg/mL） （P0.05）; （2） The mean expression intensities of ER, PR in endometrium of LUF group （183.86±2.43, 167.94±3.04） were significantly higher than those in control group （109.35±6.31, 105.98±4.07） （P0.01）; （3） The mean expression intensities of integrin ανβ3 in endomtrium of LUF patients （114.90±11.38） were significantly lower than those in control group （191.34±1.82） （P0.01）; （4） The change profile of integrin ανβ3 expression in the endometrium of LUF patients was in positive relation with serum P level （r=0.77, P0.01）, but bore no significant relationship with serum E2 level （r=0.01, P0.05）. It was concluded that the depression of serum P levels in LUF patients was closely related to the failure of the down-regulation of ER and PR, and the low expressions of integrin ανβ3 also suggested that the delayed implantation and the impaired endometrial receptivity had impact on embryonic implantation.

Posterior reversible encephalopathy syndrome following uneventful clipping of an unruptured intracranial aneurysm:A case report

BACKGROUND Posterior reversible encephalopathy syndrome(PRES)is characterized mainly by occipital and parietal lobe involvement,which can be reversible within a few days.Herein,we report a rare case of PRES that developed after craniotomy for an unruptured intracranial aneurysm(UIA).CASE SUMMARY A 59-year-old man underwent clipping surgery for the treatment of UIA arising from the left middle cerebral artery.Clipping surgery was performed uneventfully,and he regained consciousness quickly immediately after the surgery.At the 4th hour after surgery,he developed a disorder of consciousness and aphasia.Magnetic resonance imaging revealed cortical and subcortical T2/FLAIR hyperintensities in the parietal,occipital,and frontal lobes ipsilaterally,without restricted diffusion,consistent with unilateral PRES.With conservative treatment,his symptoms and radiological findings almost completely disappeared within weeks.In our case,the important causative factor of PRES was suspected to be a sudden increase in cerebral perfusion pressure associated with temporary M1 occlusion.CONCLUSION Our unique case highlights that,to our knowledge,this is the second report of PRES developing after craniotomy for the treatment of UIA.Surgeons must keep PRES in mind as one of the causes of perioperative neurological abnormality following clipping of an UIA.

Developing a Scale for Measuring Uncertainty in Patients with Unruptured Intracranial Aneurysms Undergoing Endovascular Coiling

A measure called the Uncertainty in Unruptured Intracranial Aneurysm Patients Undergoing Endovascular Coiling Scale (UUIACS) was developed and its validity and reliability were examined. The 49 questions that comprised the original draft of the UUIACS were created based on interview data. Based on data from 172 participants, exploratory and confirmatory factor analyses were conducted. As a result of exploratory factor analysis, the UUIACS e retained 17 items and extracted four factors (“Lack of decision-making cues”, “Lack of information and complexity of information interpretation”, “The ambiguous nature of the disease”, and “The unpredictable living with UIA”). All of the UUIACS items showed adequate internal consistency. Between the UUIAC scale and the Universal Uncertainty in Illness Scale (UUIS), the Health Locus of Control (HLC) scale, and the SF-36v2&reg (Japanese version), positive correlations were found between the UUIACS and UUIS, and the HLC scale at a 1% significance level indicating concurrent validity. According to confirmatory factor analysis, the UUIACS had an acceptable goodness of fit. Given these findings, the UUIACS was judged to have satisfied the criteria for use in a clinical setting, although further investigation was required.

Using the modified Delphi method to research the influencing factors of longterm health-related quality of life in patients with unruptured intracranial aneurysms after endovascular treatment

Background:The purpose of this study was to use the modified Delphi method to identify the influencing factors of health-related quality of life(HRQoL)in patients with unruptured intracranial aneurysms(UIAs)after endovascular treatment.Methods:A modified Delphi method to obtain expert consensus on the content of potential influencing factors of HRQoL in patients with UIAs treated by endovascular intervention was employed.The research team consists of three neuroradiologists and one epidemiologist from Xuanwu Hospital of Capital Medical University.They randomly selected 21 well-known experts in cerebrovascular disease diagnosis and treatment as participating experts.The importance of the indicator is based on the 5-Likert scale.The standard deviation(SD),coefficient of variation(CV),mean(x),and minimum and maximum scores of each indicator were calculated.The consistency was described by Kendall coefficient of concordance with a p value<0.05 indicating that the expert consistency was high.Result:Twenty-one and 18 questionnaires were responded in 2 rounds,with effective response rates of 85.7%and 100.0%,respectively.The average authoritative coefficient(Cr)of all 21 experts was 0.88,familiarity with the indicators(Cs)was 0.82,and the judgment basis of the indicators(Ca)was 0.94.Eventually,the x values of arterial puncture hematoma,hyperlipidemia,gender,marital status,and hospitalization for other diseases were lower than 3.5;CV for marital status and gender was higher than 0.35.The Kendall coefficient of concordance in the first round was 0.19(p<0.001),and the second round was 0.15(p<0.001).Conclusion:In this study,the factors affecting the recovery of HRQoL after endovascular treatment in patients with UIAs were analyzed by the modified Delphi method,which provided a valuable evidence for the clinical management and daily life guidance for UIAs patients.

UNRUPTURED ANEURYSM OF THE LEFT CORONARY SINUS OF VALSALVA ASSOCIATED WITH ANEURYSM OF THE INTERVENTRICULAR SEPTUM

Aneurysms of the coronary sinus of Valsalva are commonly seen in the oriental people.Their clinical courses and prognosis depend on the location,size and propensity to rupture.They often occur in the right coronary sinus and tend to rupture to the

Expert Consensus on Assessment of Rupture Factors in Unruptured Intracranial Aneurysms

Intracranial aneurysms have a high prevalence in the population and are associated with high rates of disability and mortality after rupture.It is essential to assess the rupture risk of unruptured intracranial aneurysms by selecting appropriate morphological parameters.However,there is still a need for consistent evidence-based medicine to provide a clinical reference.Therefore,the expert group has jointly written this consensus based on literature review and clinical experience,aiming to provide a standardized reference for predicting the development of intracranial aneurysms and evaluating their rupture risk factors.

Clinical Observations on Electroacupuncture-induced Ovulation in Patients with Luteinized Unruptured Follicle Syndrome

Objective： To investigate the curative effect of electroacupuncture on luteinized unruptured follicle syndrome（LUFS） and its mechanism, Methods： Sixty LUFS patients were randomly allocated to treatment （electroacupuncture） group and control （hCG） group. The follicular condition and ovarian arterial flow under color Doppler ultrasonogaphy and a change in reproductive endocrine level were observed in the patients before and after treatments. The ovulation rates and pregnancy rates were compared between the two groups, and the mechanism was investigated. Results： Both ovulation rate and pregnancy rate were significantly higher in the treatment group than in the control group （P〈0.01）. There was a significant difference in the improvement in ovarian arterial flow between the treatment and control groups （P〈0.01）. The improvement in endocrine level was significantly more marked in the treatment group than in the control group（P〈0.01）. Conclusion： Electroacupuncture has a good effect on luteinized unrupture follicle syndrome. Its mechanism may be related to the improvement in ovarian arterial blood supply and the regulation of endocrine level.

Differences and Correlations of Morphological and Hemodynamic Parameters between Anterior Circulation Bifurcation and Side-wall Aneurysms

Objective:The objective of this research was to explore the difference and correlation of the morphological and hemodynamic features between sidewall and bifurcation aneurysms in anterior circulation arteries,utilizing computational fluid dynamics as a tool for analysis.Methods:In line with the designated inclusion criteria,this study covered 160 aneurysms identified in 131 patients who received treatment at Union Hospital of Tongji Medical College,Huazhong University of Science and Technology,China,from January 2021 to September 2022.Utilizing follow-up digital subtraction angiography(DSA)data,these cases were classified into two distinct groups:the sidewall aneurysm group and the bifurcation aneurysm group.Morphological and hemodynamic parameters in the immediate preoperative period were meticulously calculated and examined in both groups using a three-dimensional DSA reconstruction model.Results:No significant differences were found in the morphological or hemodynamic parameters of bifurcation aneurysms at varied locations within the anterior circulation.However,pronounced differences were identified between sidewall and bifurcation aneurysms in terms of morphological parameters such as the diameter of the parent vessel(Dvessel),inflow angle(θF),and size ratio(SR),as well as the hemodynamic parameter of inflow concentration index(ICI)(P<0.001).Notably,only the SR exhibited a significant correlation with multiple hemodynamic parameters(P<0.001),while the ICI was closely related to several morphological parameters(R>0.5,P<0.001).Conclusions:The significant differences in certain morphological and hemodynamic parameters between sidewall and bifurcation aneurysms emphasize the importance to contemplate variances in threshold values for these parameters when evaluating the risk of rupture in anterior circulation aneurysms.Whether it is a bifurcation or sidewall aneurysm,these disparities should be considered.The morphological parameter SR has the potential to be a valuable clinical tool for promptly distinguishing the distinct rupture risks associated with sidewall and bifurcation aneurysms.

9.1 cm abdominal aortic aneurysm in a 69-year-old male patient

We are presenting a case of one of the largest unruptured abdominal aortic aneurysm ever reported. Presented here is a rare case of a 69-year-old active smoker male with history of hypertension and incidental diagnosis of abdominal aortic aneurysm of 6.2 cm in 2003, who refused surgical intervention at the time of diagnosis with continued smoking habit and was managed medically. Patient was subsequently admitted in 2012 to the hospital due to unresponsiveness secondary to hypoglycemia along with diagnosis of massive symptomatic pulmonary embolism and nonST elevation myocardial infarction. With the further inpatient workup along with known history of abdominal aortic aneurysm, subsequent computed tomography scan of abdomen pelvis revealed increased in size of infrarenal abdominal aortic aneurysm to 9.1 cm of without any signs of rupture. Patient was unable to undergo any surgical intervention this time because of his medical instability and was eventually passed away under hospice care.

FIBRINOLYTIC ACTIVITY OF PERITONEAL FLUID AND LUF IN INFERTILE WOMEN WITH ENDOMETRIOSIS

The fibrinoiytic activity of peritoneal fluid (PF) and the incidence of luteinized unruptured follicle syndrome (LUFS) in 36 infertile women with endometriosis and 27 without endometriosis were studied The results showed that tissue plasminapen activity was significantly diminsihed during the early luteal phase in patients with endometriosis (P<0.05), but no significant difference between these two groups during the late follicular phase, and reduction of t -PA activity was associated with the incidence of LUF. It is postulated that decreare in t-PA activity due to LUF maybe resposible for infertility.

Quantum Mechanical Approach for Rutherford Scattering and Nuclear Scattering with Born Approximation

Rutherford classical scattering theory, as its quantum mechanical analogue, is modified for scattering cross-section and the impact parameter by using quantum mechanical momentum, (de Broglie hypothesis), energy relationship for matter oscillator (Einstein’s oscillator) and quantum mechanical wave vectors, and , respectively. It is observed that the quantum mechanical scattering cross-section and the impact parameter depended on inverse square law of quantum action (Planck’s constant). Born approximation is revisited for quantum mechanical scattering. Using Bessel and Neumann asymptotic functions and response of nuclear surface potential barrier, born approximations were modified. The coulombic fields inside the nucleus of the atom are studied for reflection and transmission with corresponding wave vectors, phase shifts and eigenfunctions Bulk quantum mechanical tunneling and reflection scattering, both for ruptured and unruptured nucleus of the atom, are deciphered with corresponding wave vectors, phase shifts and eigenfunction. Similar calculation ware accomplished for quantum surface tunneling and reflection scattering with corresponding wave vectors, phase shifts and eigenfunctions. Such diverse quantum mechanical scattering cross-section with corresponding wave vectors for tunneling and reflection, phase shifts and eigenfunctions will pave a new dimension to understanding the behavior of exchange fields in the nucleus of the atom with insides layers both ruptured and unruptured. Phase shifts, δl for each of the energy profile (partial) will be different and indeed their corresponding wave vectors for exchange energy eigenvalues.