Predelivery sonographic predictors of obstetric anal sphincter injury among nulliparous women

OBJECTIVE

Data available at admission to delivery of nulliparous has rarely been investigated for prediction of obstetric anal sphincter injury (OASI). The aim of the present study was to study risk factors for OASI in nulliparous based on information available at admission.

METHODS

A retrospective study of all nulliparous women undergoing labor, during March 2011 to January 2021 was performed. We compared women with OASI following delivery to those without by univariate and multivariable regression.

RESULTS

A total of 30 262 deliveries were included and 4181 (13.4%) of those were delivered by an emergent cesarean delivery. OASI followed 453 (1.5%) deliveries. Women in the OASI group were younger 29 ± 4.4 versus 30 ± 4.8, P = 0.001. In a multivariable regression analysis, higher sonographic estimated fetal weight was positively associated with OASI occurrence (aOR, 95% CI: 1.13 [1.00-1.29]). Maternal age was inversely associated with OASI occurrence (adjusted odds ratio [aOR], 95% confidence interval [CI] 0.95 [0.92-0.97]).

CONCLUSION

Sonographic fetal weight estimation is an independent risk factor for OASI occurrence that may be available at admission for delivery among nulliparous women.

Heating of metallic orthodontic devices during anti-aging treatment with vacuum and electromagnetic fields: In vitro study

BACKGROUND

The physical appearance of an individual plays a primary role as it influences the opinion of the viewer. For this reason, orthodontic therapy to improve perceived aesthetics is in high demand among patients. This factor, combined with the increase in the number of non-invasive facial aesthetic treatments, has led to the need to understand potential risk factors in the application of medical devices to the perioral skin in patients with fixed orthodontic appliances. The aim of this study was to evaluate in vitro heating of the orthodontic bracket following electromagnetic fields and negative pressure (V-EMF) used as an anti-aging treatment.

METHODS

Two different types of titanium alloy wires, one made of "beta-Titanium" alloy and the other "Ni-Ti" (DW Lingual Systems GmbH-Bad Essen-Germany) were used. The orthodontic wires and brackets mounted on a resin mouth were covered with porcine muscle tissue, then subjected to anti-aging therapy with a Bi-one LifeTouchTherapy medical device (Expo Italia Srl-Florence-Italy) which generates a combination of vacuum and electromagnetic fields (V-EMF) already adopted for antiaging therapy. During administration of the therapy, the orthodontic brackets and porcine tissue were thermally monitored using a Wavetek Materman TMD90 thermal probe (Willtek Communications GmbH-Germany). In total 20 orthodontic mouths were used, 10 with Beta Titanium wires and 10 with Nickel Titanium wires.

RESULTS

A temperature increase of about 1°C was recorded in each group. The outcome of the present research shows that the absolute temperatures measured on orthodontic appliances, which, despite having a slightly different curve, both show an increase in temperature of 1.1°C at the end of the session, thus falling well within the safety range of 2°C as specified by the standard CENELEC EN 45502-1. Therefore, V-EMF therapy can be considered safe for the entire dental system and for metal prostheses, which tend to heat up at most as much as biological tissue (+0.9°C/1.1°C vs. 1.1°C/1.1°C).

CONCLUSION

In conclusion, anti-aging therapy with V-EMF causes a thermal increase on orthodontic brackets that is not harmful to pulp health.

Trends in vacuum and forceps delivery in teaching hospitals and academic health systems in West Java, Indonesia: A retrospective study

Objectives

Recently, there has been a decline in the use of vacuums and forceps. This is due to complications that occur in the mother and baby as well as the operator's ability to operate the instruments. Concerning Professional Education Standards for Obstetrics and Gynecology Specialists, the minimum skill that must be achieved by vacuum extraction and forceps is a minimum of five cases. This is difficult to achieve with the number of obstetrics and gynecology residents in West Java.

Methods

A retrospective study was conducted using medical records based on the International Classification of Disease 10th Revision from 1 to 28 February 2023 at teaching hospitals and Academic Health System in West Java, namely Hasan Sadikin Hospital, Al-Ihsan Hospital Bandung, and Cikalong Wetan Hospital West Bandung, in the period 1 January 2018 to 31 December 2022. The main outcome was vacuum and forceps extraction with consecutive sampling. The relationship between maternal characteristics such as maternal age, parity, gestational age, and indication for delivery with vaginal operative delivery was descriptive statistics analyzed using IBM SPSS Statistics 26.

Results

Trends indicate that the percentage of vaginal operative deliveries tends to be low, below 5%. Vacuum deliveries decreased from 0.75% in 2018 to 0.68% in 2022, while forceps deliveries decreased from 2.77% to 0.98% over the same period.

Conclusion

This study concludes that there was an insufficiency of vacuum extraction and forceps delivery cases at the teaching hospital and Academic Health System in West Java to achieve a minimum case of vacuum and forceps. Further research studying how educational interventions improve operative delivery skills might be considered.

Operative delivery in the second stage of labor and preterm birth in a subsequent pregnancy: a systematic review and meta-analysis

OBJECTIVE

This study aimed to quantify the association between mode of operative delivery in the second stage of labor (cesarean delivery vs operative vaginal delivery) and spontaneous preterm birth in a subsequent pregnancy.

DATA SOURCES

MEDLINE, Embase, EmCare, CINAHL, the Cochrane Library, Web of Science: Core Collection, and Scopus were searched from database inception to April 1, 2023.

STUDY ELIGIBILITY CRITERIA

All retrospective cohort studies with participants who had a second-stage cesarean delivery (defined as intrapartum cesarean delivery at full cervical dilation) or operative vaginal delivery (including forceps- and/or vacuum-assisted delivery) and that reported the rate of preterm birth (either spontaneous or not specified) in subsequent pregnancy were included.

METHODS

Both a descriptive analysis and a meta-analysis were performed. A meta-analysis was performed for dichotomous data using the Mantel-Haenszel random-effects model and used the odds ratio as an effect measure with 95% confidence intervals. The risk of bias was assessed using Cochrane's 2022 Risk Of Bias In Non-randomized Studies of Exposure tool.

RESULTS

After screening 2671 articles from 7 databases, a total of 18 retrospective cohort studies encompassing 605,138 patients were included. The pooled rates of spontaneous preterm birth in a subsequent pregnancy were 6.9% (12 studies) after second-stage cesarean delivery and 2.6% (8 studies) after operative vaginal delivery. A total of 7 studies encompassing 75,460 patients compared the primary outcome of spontaneous preterm birth after second-stage cesarean delivery vs operative vaginal delivery in an index pregnancy with an odds ratio of 2.01 (95% confidence interval, 1.57-2.58) in favor of operative vaginal delivery. However, most studies did not include important confounding factors, did not address exposure misclassification because of failed operative vaginal delivery, and considered operative vaginal delivery as a homogeneous category with no distinction between forceps- and vacuum-assisted deliveries.

CONCLUSION

Although a synthesis of the existing literature suggests that the risk of spontaneous preterm birth is higher in those with a previous second-stage cesarean delivery than in those with operative vaginal delivery, the risk of bias in these studies is very high. Findings should be interpreted with caution.

The OdonAssist inflatable device for assisted vaginal birth-the ASSIST II study (United Kingdom)

BACKGROUND

Decreasing rates of assisted vaginal birth have been paralleled with increasing rates of cesarean deliveries over the last 40 years. The OdonAssist is a novel device for assisted vaginal birth. Iterative changes to clinical parameters, device design, and technique have been made to improve device efficacy and usability.

OBJECTIVE

This study aimed to determine if the feasibility, safety, and efficacy of the OdonAssist device were sufficient to justify conducting a future randomized controlled trial.

STUDY DESIGN

An open-label nonrandomized study of 104 participants having a clinically indicated assisted vaginal birth using the OdonAssist was undertaken at Southmead Hospital, Bristol, United Kingdom. Data were also collected from participants who consented to participate in the study but for whom trained OdonAssist operators were not available, providing a nested cohort. The primary clinical outcome was the proportion of births successfully expedited with the OdonAssist. Secondary outcomes included clinical, patient-reported, operator-reported, device and health care utilization. Neonatal outcome data were reviewed at day 28, and maternal outcomes were investigated up to day 90. Given that the number of successful OdonAssist births was ≥61 out of 104, the hypothesis of a poor rate of 50% was rejected in favor of a good rate of ≥65%.

RESULTS

Between August 2019 and June 2021, 941 (64%) of the 1471 approached, eligible participants consented to participate. Of these, 104 received the OdonAssist intervention. Birth was assisted in all cephalic vertex fetal positions, at all stations ≥1 cm below the ischial spines (with or without regional analgesia). The OdonAssist was effective in 69 of the 104 (66%) cases, consistent with the hypothesis of a good efficacy rate. There were no serious device-related maternal or neonatal adverse reactions, and there were no serious adverse device effects. Only 4% of neonatal soft tissue bruising in the successful OdonAssist group was considered device-related, as opposed to 20% and 23% in the unsuccessful OdonAssist group and the nested cohort, respectively. Participants reported high birth perception scores. All practitioners found the device use to be straightforward.

CONCLUSION

Recruitment to an interventional study of a new device for assisted vaginal birth is feasible; 64% of eligible participants were willing to participate. The success rate of the OdonAssist was comparable to that of the Kiwi OmniCup when introduced in the same unit in 2002, meeting the threshold for a randomized controlled trial to compare the OdonAssist with current standard practice. There were no disadvantages of study participation in terms of maternal and neonatal outcomes. There were potential advantages of using the OdonAssist, particularly reduced neonatal soft tissue injury. The same application technique is used for all fetal positions, with all operators deeming the device straightforward to use. This study provides important data to inform future study design.

Parturition at term: induction, second and third stages of labor, and optimal management of life-threatening complications-hemorrhage, infection, and uterine rupture

Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information.

Hyper- and Hypopigmentation in a Subject with Fitzpatrick Skin Phototype VI: A New Treatment Option

Background: Laser therapies can cause hyper- and hypopigmentation of the skin. There is little evidence in the literature of effective treatments for these types of problems in Fitzpatrick skin phototypes IV-VI. The main aim of this retrospective study is to evaluate the effects of a new therapy that combines the application of electromagnetic fields and vacuum on a subject with Fitzpatrick skin phototype VI, who presented extensive, laser-induced facial dyschromia. The secondary aim is to test the effectiveness of a free imaging software for assessing skin pigmentation. Methods: The level of improvement after therapy was evaluated, with a 5-point Likert scale, one month after the end of the treatment by the subject and by the doctor who performed the treatment, and by two blinded dermatologists. With the free software, a three-dimensional reconstruction of the treated area and the evaluation of the color distribution were performed. Results: Both the subject and the doctors involved in the study positively evaluated the effects of the treatment. The image analysis highlighted the homogenization of the skin color in the treated area. Conclusions: The combination of electromagnetic fields and vacuum for dyschromia treatments appears promising. The new method of assessing melanin levels resulted particularly efficient.

Evaluation of the Shelf life of Ready-to-Eat Fresh Bamboo Sprouts (Phyllostachys edulis) Packaged in a Modified Atmosphere or Vacuum: A Comparative Study

During the last decades, the consumption of bamboo sprouts (Phyllostacys edulis) has increased because they are considered a "superfood". However, this product is characterized by a short shelf life due to the deterioration in quality parameters. The aim of this study was to investigate the application of two modified atmosphere packaging (MAP) systems (MAP1: 2% O2, 5% CO2, 93% N2 and MAP2: 3% O2, 7% CO2, 90% N2) to fresh-shelled ready-to-eat bamboo sprouts and compare these packaging systems with vacuum packaging during storage for 28 days at 4 °C using heat-sealable polyamide and polyethylene (PA/PE) trays. Several chemical-physical parameters (moisture content, water activity, pH, headspace composition, and firmness) were monitored, as well as CIELab colorimetric parameters and microbial growth. The quantification of selected organic acids was performed via UHPLC. Mathematical kinetic models were applied to study the evolution of total phenol (TPC), flavonoid (TFC), and carotenoid content (TCC) during storage. The evolution of antioxidant potential investigated by ABTS, DPPH, and β-carotene bleaching tests was also assessed. Results showed that at the end of the storage period, significant variations in the colorimetric parameters are detectable between the sprouts apical portion and the basal one, regardless of both applied MAPs. A linear reduction in both DPPH and ABTS radical scavenging activity was evidenced during storage, regardless of the type of packaging applied. In DPPH test samples packaged in MAP after 28 days of storage, they retain good antioxidant activity, whereas in vacuum, this activity is reduced by 50% compared to the initial value (IC50 values from 24.77 to 32.74 μg/mL and from 24.77 to 71.12 μg/mL for MAP2 and vacuum, respectively).

Drying of Tarhana dough by Refractance Window™ technology under vacuum/atmospheric conditions: Characterization of physical and quality parameters

This study aimed to produce dried tarhana using a refractance window drying (RWD) system. The drying process was also carried out under vacuum; the current study is the first in the literature. Using different heating mediums, the maximum temperature can be adjusted to a level above that used in RWD studies. Considering results, process time savings in RWD were over 85% and 75% compared to control groups (oven and hot air dryer), respectively. Tarhana samples dried in RWD were also faster (50%) under vacuum conditions than atmospheric ones. The highest preservation of total phenolic content (TPC) and total antioxidant activity (TAA) was for samples dried by RWD at 110°C under atmospheric conditions. Techno-physical properties were better than the control group. The rheological behavior of tarhana soups was similar to pseudoplastic flow behavior and well defined by the Power law and Herschel-Bulkey models. In conclusion, RWD can be a promising technique for tarhana production.

Intradermal DNA vaccine delivery using vacuum-controlled, needle-free electroporation

Intradermal delivery of DNA vaccines via electroporation (ID-EP) has shown clinical promise, but the use of needle electrodes is typically required to achieve consistent results. Here, delivery of a DNA vaccine targeting the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is achieved using noninvasive intradermal vacuum-EP (ID-VEP), which functions by pulling a small volume of skin tissue into a vacuum chamber containing noninvasive electrodes to perform EP at the injection site. Gene expression and immunogenicity correlated with EP parameters and vacuum chamber geometry in guinea pigs. ID-VEP generated potent humoral and cellular immune responses across multiple studies, while vacuum (without EP) greatly enhanced localized transfection but did not improve immunogenicity. Because EP was performed noninvasively, the only treatment site reaction observed was transient redness, and ID-VEP immune responses were comparable to a clinical needle-based ID-EP device. The ID-VEP delivery procedure is straightforward and highly repeatable, without any dependence on operator technique. This work demonstrates a novel, reliable, and needle-free delivery method for DNA vaccines.

Vacuum and electromagnetic field in synergy for skin rejuvenation: A retrospective study on 217 patients

BACKGROUND

There are many aesthetic treatments aimed at combating aging. In the most common and frequently used ones there are often side effects, albeit minor ones. However, sometimes it is necessary to use medications before or after treatments.

OBJECTIVES

To evaluate the anti-aging efficacy and application safety of a therapy based on the combination of vacuum and electromagnetic fields (EMFs).

METHODS

A retrospective study was conducted to evaluate the aesthetic effects of the treatment on 217 subjects. Before treatment (T0) and after the last session (T1), skin hydration levels, the amount of sebum present and the pH were measured. The presence of discomfort during the sessions and side effects at T1 was verified. At T1, the levels of satisfaction of the patients and of the doctors who performed the treatment were assessed. At 3 and 6 months of follow-up the aesthetic results were re-evaluated.

RESULTS

For all treated subjects, an evident qualitative improvement was observed in the quality of the skin of the neck and face, with an increase in tone and a reduction in wrinkles. The instrumental tests highlighted a normalization of skin hydration, pH, and sebum values. High levels of satisfaction at T0 and good stability of results up to 6 months of follow-up were reported. No discomfort was referred during the treatment sessions, nor any side effects after the entire treatment.

CONCLUSIONS

The treatment that exploits the synergy between vacuum and EMFs is very promising given the effectiveness and safety of the technique.

Thermal Desorption of 2,4,6-Trichloroanisole from Cork

While extensive efforts have been made over the past two decades to understand how cork becomes contaminated by 2,4,6-trichloroanisole (TCA), the nature of its bond to cork remains unclear. A deeper understanding of this interaction is crucial in designing processes to effectively remove TCA from cork stoppers. This study presents an investigation into the thermal desorption of TCA from cork under vacuum conditions. To facilitate detection by a quadrupole mass spectrometer, samples were artificially contaminated with sufficient TCA. A calibration system was developed to determine the absolute rate of TCA released from the cork. Desorption spectra revealed two peaks at 80 °C and 170 °C. Despite the known variability of cork, repeated measurements demonstrated reasonable repeatability. The low-temperature peak decreased with time and after preheating the sample to 50 °C. It is proposed that the high-temperature peak corresponds to TCA bonded to the cork material. Experiments with naturally contaminated cork stoppers revealed a significant reduction in the amount of releasable TCA following a vacuum-heating process. This study provides an insightful discussion on the adsorption of TCA on cork and proposes an estimate for the adsorption energy. Furthermore, it discloses a process capable of removing TCA from natural cork stoppers.

Steerable Ureteroscopic Renal Evacuation (SURE) for Large Renal Stones: A Multi-Institutional Center Study

BACKGROUND

The results of a recent pilot study suggest that steerable ureteroscopic renal evacuation (SURE) is safe and more effective in stone removal than basketing following laser lithotripsy. The objective of this retrospective study was to further assess the safety and efficacy of SURE using the CVAC® Aspiration System (Calyxo, Inc., Pleasanton, CA) in patients with large stone burdens.

MATERIALS AND METHODS

Patients with a baseline stone burden of ≥10 mm who underwent SURE were identified. Subject demographics, secondary procedures, complications, and stone clearance (defined as percent baseline volume reduction) were evaluated. Sub-analyses were performed to explore patients identified as high-risk for percutaneous nephrolithotomy (PCNL) because 1) they were on anticoagulation or antiplatelet therapy at the time of procedure, or 2) they had limited mobility due to neurological conditions.

RESULTS

Identified patients (N=43) had a mean pre-operative stone burden of 29±12 mm and mean stone volume of 3,092±5,002 mm3. Approximately one-half of patients (n=24, 55.8%) had computerized tomography (CT) imaging at follow-up, and of those, eight (33.3%) had no residual stones, 22 (91.7%) had >90% stone clearance, 23 (95.8%) had >80% stone clearance and 24 (100%) had >60% stone clearance. Stone clearance based on baseline stone burden varied between 93.8% and 98.9%. At baseline, 21 patients were anticipated to require staged ureteroscopy; however, only two of those (9.5%) needed secondary procedures. High-risk patients (n=22) were on anticoagulation or antiplatelet therapy (n=12) or had neurologic conditions (n=10). Stone clearance was 97% among patients in the anticoagulated cohort with postoperative CT imaging, and 83% in patients with neurologic conditions. There were no device-related complications and no post-operative admissions.

CONCLUSIONS

The CVAC® Aspiration System is safe and effective for treating large stone burdens, including in high-risk patients, and may decrease the need for PCNL or secondary procedures.

Effect of Vacuum Roasting on Total Selenium Content of Selenium-Enriched Rapeseed, Maillard Reaction Products, Oxidative Stability and Physicochemical Properties of Selenium-Enriched Rapeseed Oil

Selenium-enriched rapeseed (SER) is an emerging oil seed. Roasting is beneficial in improving oil yield and promoting the release of micronutrients into SER oil, but high temperatures and dry air lead to selenium loss and fatty acid degradation in SER. To minimize the selenium loss and improve the SER oil quality, this study investigated the effects of vacuum (VC) roasting (90-170 °C for 30 min) on the SER selenium content, Maillard reaction products, oxidative stability, and physicochemical properties of SER oil, with conventional dry air (DA) roasting as the control. The results showed that the selenium loss in VC-roasted SER meals increased from 7.17 to 19.76% (90-170 °C for 30 min), which was 47.13 to 80.48% of that in DA-roasted SER meals, while no selenium was detected in the SER oils. Compared to DA roasting, VC roasting (90-170 °C for 30 min) reduced lipid oxidation products (LOPs), Maillard reaction products (MRPs), and benzo[a]pyrene contents, and increased carotenoids, unsaturated fatty acid contents, reaching a maximum oil yield of 35.58% at a lower temperature (130 °C for 30 min). Selenium contents exhibited a highly significant negative correlation with MRPs and LOPs (p ≤ 0.005). The VC roasting retarded selenium loss and improved SER oil quality compared to conventional DA roasting.

Association of white blood cell count after operative vaginal delivery with maternal adverse outcome: A retrospective cohort study

BACKGROUND

The white blood cell count is often used to assess the maternal condition after an operative vaginal delivery. However, it remains unknown whether the maternal white blood cell count on the day after delivery is associated with sequential maternal adverse outcomes, especially infectious complications. The aim of this study was to investigate the association between maternal white blood cell count on the day after operative vaginal delivery and sequential maternal adverse events.

METHODS

The study was a retrospective cohort study using the Medical Data Vision claims database containing administrative claims data, discharge abstracts, and laboratory values in Japan. We identified all patients who underwent operative vaginal delivery with data on maternal white blood cell count from December 2011 to November 2020. The main composite outcome was maternal adverse outcomes, comprising additional treatment for maternal injuries, postpartum intravenous antibiotic use, and intensive care unit use during hospitalization. We conducted a restricted cubic spline analysis to investigate the nonlinear association between white blood cell count and the primary outcome.

RESULTS

There were 485 eligible patients including 73 patients with occurrence of the primary outcome. The median (interquartile range) white blood cell count on the day after delivery in all eligible women was 15,170 (12,610-18,300)/mL. In the restricted cubic spline analysis, there was no significant association of white blood cell count with the primary outcome.

CONCLUSION

White blood cell count on the day after operative vaginal delivery was not significantly associated with maternal adverse outcomes during hospitalization.

Shelf Life Prediction of Vacuum-Packaged Grilled Mackerel

The current study aimed to establish the shelf life of vacuum-packaged grilled mackerel stored at 5, -5, and -20°C for 70 days. To this end, physicochemical analyses, which involved determining the pH, volatile basic nitrogen, amino nitrogen, trimethylamine (TMA), and thiobarbituric acid levels; microbiological analyses (aerobic plate count and coliform); and sensory quality determination were performed. Regression analysis on the relationship between physicochemical properties and storage time at various temperatures revealed TMA level was the most suitable parameter (R²=0.9769) for predicting changes in the quality of grilled mackerel during storage, with a quality limit value of 8.74 mg/100 g. The shelf life of vacuum-packaged grilled mackerel according to temperature was 21, 53, 62, and 75 days for 5, -5, -15, and -20°C, respectively, with the use-by date being 23 days at 5°C and 74 days at -5°C. In conclusion, TMA was the most suitable parameter for predicting changes in the quality of grilled mackerel during storage.

Preliminary data on the microbial profile of dry and wet aged bovine meat obtained from different breeds in Sardinia

This study aimed to evaluate the influence of dry and wet aging on microbial profile and physicochemical characteristics of bovine loins obtained from four animals of two different breeds, namely two Friesian cull cows and two Sardo-Bruna bovines. During dry and wet aging aerobic colony count, Enterobacteriaceae, mesophilic lactic acid bacteria, Pseudomonas, molds and yeasts, Salmonella enterica, Listeria monocytogenes and Yersinia enterocolitica, pH and water activity (a_w) were determined in meat samples collected from the internal part of the loins. Moreover, the microbial profile was determined with sponge samples taken from the surface of the meat cuts. Samples obtained from Friesian cows were analyzed starting from the first day of the aging period and after 7, 14, and 21 days. Samples obtained from the Sardo Bruna bovines were also analyzed after 28 and 35 days. Wet aging allowed better control of Pseudomonas spp. during storage that showed statistically lower levels (P>0.05) in wet-aged meats with respect to dry-aged meats during aging and particularly at the end of the period (P>0.01) in both cattle breeds. At the end of the experiment (21 days), aerobic colony count and Pseudomonas in Fresian cows' dry-aged meats showed mean levels >8 log, while lactic acid bacteria mean counts >7 log were detected in wet-aged meats of both cattle breeds. In meats submitted to dry aging, pH was significantly higher (P<0.01) with respect to wet-aged meats at all analysis times and in both cattle breeds. A_w showed a stable trend during both dry and wet aging without significant differences. These preliminary results highlight the critical importance of the strict application of good hygiene practices during all stages of production of these particular cuts of meat intended for aging.

Photopneumatic Technology for the Treatment of Mild-to-moderate Acne Vulgaris-A Review

Acne vulgaris, despite being one of the most common dermatological diseases, remains challenging to treat. Acne lesion location and type, skin tone, genetics, and environmental factors influence mono- or multimodal therapeutic decisions. Combination topical and oral treatments may successfully reduce lesion count; however, these agents take time to work, and side effects are not uncommon. The long-term therapeutic engagement required to treat acne may be too costly or burdensome for many patients, which may impact treatment adherence, which can negatively impact patient outcomes. There is increased interest in noninvasive acne treatments to reduce side effects, provide rapid results, and foster treatment adherence. TheraClearX® X Acne System combines broadband pulsed light and vacuum suction technology. The combination of these two treatment modalities mechanically clears congested follicles and targets endogenous porphyrins produced by Cutibacterium acnes and other acnegenic bacteria. This article describes the proposed mechanism of action, treatment advantages, examples of treatment protocols, and anecdotal results using this combination device in the treatment of acne.

Comparing Different Packaging Conditions on Quality Stability of High-Pressure Treated Serra da Estrela Cheeses during Cold Storage

Serra da Estrela cheese with a Protected Designation of Origin (PDO) is a traditional cheese that is wrapped in paper without vacuum. High-pressure processing (HPP), which requires vacuum packaging of the cheese, has been used for its cold pasteurization to overcome safety issues. In this study, two packaging systems were studied: non-vacuum greaseproof paper wrapping package and vacuum packaging in plastic film. Lactococci, lactobacilli, enterococci, and total mesophiles reached ca. 8 log cfu g^-1 and 4-6 log cfu g^-1 in control (unpasteurized) and HPP-treated cheeses, respectively, with no significant differences between packaging systems. Spoilage microorganisms' viable cell numbers were reduced to <3 log cfu g^-1 (quantification limit) in HPP-treated cheeses, independently of the packaging system. Yeasts and molds reached >5 log cfu g^-1 in non-vacuum paper-wrapped cheeses. A vacuum-packaging system enabled better control of cheese proteolysis, which was revealed to be closer to that of the original control cheese values at the end of the 10-month storage period. In addition, cheese stored under vacuum film packaging became harder than non-vacuum paper-wrapped cheeses at each time point. Overall, conventional non-vacuum paper wrapping is adequate for short storage periods (<3 months), but for long periods vacuum packaging in plastic film is preferable.

Plasma Surface Modification of 3Y-TZP at Low and Atmospheric Pressures with Different Treatment Times

The efficiency of plasma surface modifications depends on the operating conditions. This study investigated the effect of chamber pressure and plasma exposure time on the surface properties of 3Y-TZP with N2/Ar gas. Plate-shaped zirconia specimens were randomly divided into two categories: vacuum plasma and atmospheric plasma. Each group was subdivided into five subgroups according to the treatment time: 1, 5, 10, 15, and 20 min. Following the plasma treatments, we characterized the surface properties, including wettability, chemical composition, crystal structure, surface morphology, and zeta potential. These were analyzed through various techniques, such as contact angle measurement, XPS, XRD, SEM, FIB, CLSM, and electrokinetic measurements. The atmospheric plasma treatments increased zirconia's electron donation (γ-) capacity, while the vacuum plasma treatments decreased γ- parameter with increasing times. The highest concentration of the basic hydroxyl OH(b) groups was identified after a 5 min exposure to atmospheric plasmas. With longer exposure times, the vacuum plasmas induce electrical damage. Both plasma systems increased the zeta potential of 3Y-TZP, showing positive values in a vacuum. In the atmosphere, the zeta potential rapidly increased after 1 min. Atmospheric plasma treatments would be beneficial for the adsorption of oxygen and nitrogen from ambient air and the generation of various active species on the zirconia surface.

Trends in instrument preference for operative vaginal delivery in a tertiary referral center: 2008-2021

OBJECTIVE

To examine temporal trends in operative vaginal deliveries as well as the ratio between vacuum and forceps deliveries over 15 years in a large tertiary hospital.

METHODS

This retrospective study assessed prospectively collected data from 2008 to 2021. Women with greater than 37 weeks of gestation who underwent an operative vaginal delivery were included. The rate and ratio of instrumental deliveries and perineal trauma were recorded.

RESULTS

From 2008 to 2021 there was a total of 109 230 term deliveries, of which 20 151 were an operative vaginal delivery. The rate of operative vaginal delivery as a proportion of all term deliveries decreased from 21.9% (1547 of 7069) in 2008 to 17.1% in 2021 (1428 of 8338, P < 0.001). The ratio between vacuum and forceps-assisted deliveries decreased significantly over the study period, from 7.06 in 2008 to 2.39 in 2021 (P < 0.001). Perineal trauma remained unchanged during the study period.

CONCLUSION

Operative vaginal delivery rates declined over the 15-year study period. While vacuum-assisted vaginal deliveries remain the favored instrument, forceps-assisted deliveries are becoming more prevalent. The cause for this change in practice is unclear but is likely multifactorial.

Effect of Chitosan and Alginate-Based Edible Membranes with Oregano Essential Oil and Olive Oil in the Microbiological, Physicochemical and Organoleptic Characteristics of Mutton

Edible chitosan or alginate coatings and their combinations with oregano essential oil or olive oil, have been examined for their effect on the microbiological, physicochemical and organoleptic characteristics of mutton. The results indicated that these edible coatings can contribute to maintaining good quality characteristics and extending mutton shelf-life. The total mesophilic counts in mutton ranged from 3.48 to 8.00 log¹⁰ CFU/g, the total psychrophilic counts from 4.00 to 9.50 log¹⁰ CFU/g, the B. thermosphacta counts from 2.30 to 7.77 log¹⁰ CFU/g and the lactic acid bacteria counts from 2.00 to 5.85 log¹⁰ CFU/g. Chitosan coatings significantly (p < 0.05) reduced the total mesophilic, the total psychrophilic (1-2 log₁₀ cfu/g), the B. thermosphacta and the lactic acid bacteria counts in mutton. Alginate exhibited a lower L* value and a higher a* value and chroma compared with the control and chitosan lots. No significant differences were observed in the chemical composition of meat pieces among the experimental groups. Oregano oil positively affected the sensory attributes of meat. The most favourable combination, based on the microbiological counts, the organoleptic characteristics and the shelf-life extension of mutton, was that of chitosan with oregano essential oil.

Optimization of Modified Atmosphere Packaging for Sheep's Milk Semi-Hard Cheese Wedges during Refrigerated Storage: Physicochemical and Sensory Properties

Modified atmosphere packaging (MAP) has become a good potential strategy to retain quality throughout the shelf life of perishable foods. The aim of this work was to evaluate different packaging atmospheres on semi-hard protected designation of origin Idiazabal cheese wedges. Six different packaging treatments (air, vacuum, and CO₂/N₂ gas mixtures in the ratio of 20/80, 50/50, 80/20, and 100/0% v/v, respectively) were studied. Changes in gas headspace composition, cheese gross composition, weight loss, pH, acidity, colour, and textural and sensory properties were investigated during 56 days of refrigerated storage at 5 ± 1 °C. MAP was the most effective preserving technique compared to air- and vacuum-packaging treatments. The cheese characteristics with the greatest discriminating weight in the preservation techniques were paste appearance, holes, flavour, a* (redness) and b* (yellowness) colour parameters, and slope to hardness. Air-packaged cheeses, on 35 day, presented a mouldy flavour. Vacuum packaging affected paste appearance (greasy, plastic marks, and non-homogeneous colour) and holes (occluded and unnatural appearance) starting after 14 packaging days. MAP mixtures with CO₂ concentration between 50/50 and 80/20% CO₂/N₂ (v/v) are recommended to ensure sensory quality and stability in the distribution of these raw sheep-milk cheese wedges.

Vacuum-Assisted Block Freeze Concentration Studies in Cheese Whey and Its Potential in Lactose Recovery

Block freeze concentration (BFC) is considered an emerging technology which allows the acquiring of high quality organoleptic products, due to the low temperatures employed. In this study we have outlined how the vacuum-assisted BFC of whey was investigated. The effects of vacuum time, vacuum pressure, and the initial solids concentration in whey were studied. The results obtained show that the three variables significantly affect each of the following parameters analysed: solute yield (Y) and concentration index (CI). The best Y results were obtained at a pressure of 10 kPa, 7.5 °Bx, and 60 min. For CI parameter, the highest values were given at 10 kPa, 7.5 °Bx, and 20 min, respectively. In a second phase, by applying the conditions that provide higher solute yield to three different types of dairy whey, Y values of 70% or higher are reached in a single step, while that the CI of lactose are higher than those of soluble solids. Therefore, it is possible to recover, in a single step, at least 70% of the lactose contained in the initial whey samples. This suggests that vacuum-assisted BFC technology may be an interesting alternative for the recovery of lactose contained in whey.

Trends and Determinants of Operative Vaginal Delivery at Two Academic Hospitals in Johannesburg, South Africa 2005-2019

Operative Vaginal delivery (OVD) can reduce perinatal and maternal morbidity and mortality especially in low resource setting such as South Africa. We evaluated the trends and determinants of OVD rates using join point regression at Charlotte Maxeke Johannesburg (CMJAH) and Chris Hani Baragwaneth (CHBAH) Academic Hospitals from 1 January 2005−31 December 2019 and conducted a comparative study of OVD (n = 179) and normal delivery (n = 179). Over the 15-year study period (2005−2019), 323,617 deliveries and 4391 OVDs were conducted at CHBAH giving an OVD rate of 1.36 per 100 births. In CMJAH, 74,485 deliveries and 1191 OVDs were conducted over an eleven-year period (2009−2019) with OVD rate of 1.60 per 100 births. OVD rate at CHBAH increased from 2005−2014 at 9.1% per annum and declined by 13.6% from 2014−2019, while OVD rates fluctuates at CMJAH. Of the 179 patients who had OVD, majority (n = 166,92.74%) had vacuum. Women who had OVDs were younger than those who vaginal delivery (p-value < 0.001). The prevalence of OVDs was higher among nulliparous women (p-value < 0.001), HIV negative women (p-value = 0.021), underweight (p-value < 0.001) as compared to normal delivery. The OVD rates has dramatically reduced over the study period This study heightens the need to further evaluate barriers to OVD use in our environment

Operative vaginal delivery as an independent risk factor for maternal postpartum infectious morbidity

BACKGROUND

A recent study from the United Kingdom suggested that a single dosage of adjunctive amoxicillin/clavulanic acid with operative vaginal delivery reduces maternal infectious morbidity by 40% (from 19% to 11%). However, 89% of their study population received an episiotomy.

OBJECTIVE

This study aimed to evaluate whether operative vaginal delivery is an independent risk factor for composite maternal postpartum infectious morbidity in a population with a low episiotomy rate.

STUDY DESIGN

This was a retrospective cohort study of patients with viable singleton vaginal deliveries after ≥34 weeks gestation at a single perinatal center (2013-2018). The patients were categorized by the mode of delivery: spontaneous vaginal delivery or operative vaginal delivery (forceps or vacuum-assisted). The primary outcome was a composite of maternal infectious morbidity up to 6 weeks after delivery, defined as (1) endometritis, (2) perineal wound morbidity (infection, breakdown, or dehiscence), or (3) culture-proven urinary tract infection. The patient characteristics and outcomes were compared between the groups using appropriate tests. Multivariable models were used to estimate the association between operative vaginal delivery and study outcomes compared with spontaneous vaginal delivery, with adjustment for selected confounders.

RESULTS

Of 14,647 deliveries meeting the inclusion criteria, 732 (5.0%) were operative vaginal deliveries: 354 (48%) forceps and 378 (52%) vacuums. Overall, 210 (1.4%) patients developed the morbidity composite. Patients having an operative vaginal delivery were more likely to be nulliparous, have labor inductions, develop intrapartum chorioamnionitis, receive an episiotomy, and sustain a third- or fourth-degree laceration. After adjusting for confounding factors, no significant association was observed between operative vaginal delivery and composite morbidity (adjusted odds ratio, 1.4 [0.8-2.4]) or any of its individual components. Administration of postpartum antibiotics and documented fever were also similar between groups. There was also no significant association between instrument (forceps vs vacuum) and the maternal infection composite.

CONCLUSION

In this single-center US cohort, operative vaginal delivery was not an independent risk factor for maternal composite postpartum infectious morbidity.

Vacuum-assisted cortex removal - A novel change to the tradition

In developing countries, manual small-incision cataract surgery (MSICS) has surfaced as the cost-effective alternative to phacoemulsification. The Simcoe irrigation-aspiration cannula was developed nearly 40 years ago and is still the most frequently employed tool for cortex aspiration. Although it stands unsurpassed, here we attempt to introduce an addition to the existing Simcoe cannula to achieve a dynamic and controlled vacuum with the added advantage of less physical strain and an effective volume of aspiration. The vacuum-assisted cortex removal device is based on a simple spring action mechanism, where the relaxation of the spring pushes the plunger up and thereby generates a controlled vacuum.

Angle of progression measured using transperineal ultrasound for prediction of uncomplicated operative vaginal delivery: systematic review and meta-analysis

OBJECTIVE

To determine whether intrapartum transperineal ultrasound measurement of the angle of progression (AoP) during the second stage of labor can predict uncomplicated operative vaginal delivery (OVD) using vacuum or forceps extraction.

METHODS

A systematic search in PubMed, EMBASE, Scopus, Web of Science and Google Scholar was performed from inception to February 2021. Studies assessing the predictive accuracy of AoP, measured using intrapartum transperineal ultrasound, for uncomplicated OVD, defined as successful vaginal delivery within three pulls using forceps or no more than two detachments of the vacuum extractor cup, were included. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Summary receiver-operating-characteristics (ROC) curves, pooled sensitivity and specificity, area under the ROC curve (AUC) and summary likelihood ratios (LRs) were calculated.

RESULTS

Seven studies reporting on a total of 782 patients undergoing OVD were included in this systematic review and meta-analysis. Second-stage AoP measured during maternal rest had a pooled sensitivity of 80% (95% CI, 59-92%) and specificity of 89% (95% CI, 76-95%), with a LR+ of 7.3 (95% CI, 3.1-15.8) for uncomplicated OVD. AoP measured during active pushing had a sensitivity of 91% (95% CI, 85-94%) and specificity of 83% (95% CI, 69-92%), with a LR+ of 5.4 (95% CI, 2.7-10.6) for uncomplicated OVD. The performance of AoP measured at rest was particularly high in nulliparous women, with a sensitivity of 87% (95% CI, 75-94%) and specificity of 90% (95% CI, 82-94%) for uncomplicated OVD.

CONCLUSION

AoP may be a reliable predictor for uncomplicated OVD when measured during the second stage of labor, especially in nulliparous women. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Vacuum-Driven Orientation of Nanostructured Diblock Copolymer Thin Films

This work aims to demonstrate a facile method for the controlled orientation of nanostructures of block copolymer (BCP) thin films. A simple diblock copolymer system, polystyrene-block-polydimethylsiloxane (PS-b-PDMS), is chosen to demonstrate vacuum-driven orientation for solving the notorious low-surface-energy problem of silicon-based BCP nanopatterning. By taking advantage of the pressure dependence of the surface tension of polymeric materials, a neutral air surface for the PS-b-PDMS thin film can be formed under a high vacuum degree (∼10^-4 Pa), allowing the formation of the film-spanning perpendicular cylinders and lamellae upon thermal annealing. In contrast to perpendicular lamellae, a long-range lateral order for forming perpendicular cylinders can be efficiently achieved through the self-alignment mechanism for induced ordering from the top and bottom of the free-standing thin film.

Effect of different packaging methods on the free amino acid profiles of the deep-water rose shrimp (Parapenaeus longirostris) during frozen storage

The composition of free amino acids (FAAs) in seafood products contributes to characterizing their flavor, as well as freshness and quality during storage. Deep-water rose shrimps (Parapenaues longirostris, Lucas, 1846) (DWRS) are being increasingly harvested in the Mediterranean Sea, and the captured specimens are quickly frozen onboard fishing trawlers to preserve freshness and post-harvest quality. Here, we quantified the FAA profiles of DWRS packaged using five methods: (1) 100% N₂; (2) vacuum; (3) 50% N₂ + 50% CO₂; (4) commercial anhydrous sodium sulfite; and (5) air (control). All samples were quickly frozen at -35°C and stored for 12 months at -18°C. Arginine (661 mg/100 g), proline (538 mg/100 g), and glycine (424 mg/100 g) were the most abundant FAAs, whereas the least abundant were tyrosine (67 mg/100 g), histidine (58 mg/100 g), and aspartic acid (34 mg/100 g). FAAs in all samples gradually (and significantly) increased in the first 6 to 8 months of storage, and then significantly decreased. The sodium sulfite treatment (Method 4) kept the initial FAA contents lower than the other treatments, due to the strong antioxidant action of sulfite agents. Interestingly, similar results were obtained for vacuum packaging (Method 2). Thus, combining frozen storage with vacuum packaging represents an alternative approach to chemical additives in shrimp/prawn processing to meet the increasing demand for high-quality seafood products with long shelf-life.

Do doctors preferring forceps encounter more obstetric anal sphincter injuries: A retrospective analysis

BACKGROUND

Obstetric anal sphincter injuries (OASIS) is a hospital-acquired injury and can affect a woman's quality of life with problems such as anal incontinence, perineal pain, dyspareunia, mental health, psychosexual issues, and concerns about future childbirth choices.

AIMS

The aim of this study was to determine whether there is a correlation between a doctor's preference for instruments, their individual OASIS rate and whether factors such as their fully dilated caesarean section rate, rate of double instrumental and seniority, influences their individual rate of OASIS.

MATERIALS AND METHODS

A population-based retrospective cohort study was performed on 1340 term nulliparous women with singleton pregnancies who underwent an instrumental delivery or fully dilated caesarean section. A survey of doctors involved in these deliveries was performed. The risk of OASIS was analysed for maternal age, ethnicity, birth position, level of training and doctor's instrument preference using a generalised linear mixed model. Doctors' instrument preferences were established in two ways: a self-reported survey and data-inferred preference based on the most used instrument per doctor. The OASIS rate for individual doctors was calculated.

RESULTS

The overall risk of OASIS is higher for forceps compared to vacuum deliveries. Doctors with a preference for forceps compared to vacuum, correlated with both a lower OASIS rate and a higher fully dilated caesarean section rate.

CONCLUSIONS

Doctors preferring forceps report a lower OASIS and higher fully dilated caesarean section rate. Doctors preferring vacuum must consider carefully whether forceps should follow if a vacuum fails as OASIS is more likely to occur.

Statistical signature of electrobreakdown in graphene nanojunctions

Controlled electrobreakdown of graphene is important for the fabrication of stable nanometer-size tunnel gaps, large-scale graphene quantum dots, and nanoscale resistive switches, etc. However, owing to the complex thermal, electronic, and electrochemical processes at the nanoscale that dictate the rupture of graphene, it is difficult to generate conclusions from individual devices. We describe here a way to explore the statistical signature of the graphene electrobreakdown process. Such analysis tells us that feedback-controlled electrobreakdown of graphene in the air first shows signs of joule heating-induced cleaning followed by rupturing of the graphene lattice that is manifested by the lowering of its conductance. We show that when the conductance of the graphene becomes smaller than around 0.1 G0, the effective graphene notch width starts to decrease exponentially slower with time. Further, we show how this signature gets modified as we change the environment and or the substrate. Using statistical analysis, we show that the electrobreakdown under a high vacuum could lead to substrate modification and resistive-switching behavior, without the application of any electroforming voltage. This is attributed to the formation of a semiconducting filament that makes a Schottky barrier with the graphene. We also provide here the statistically extracted Schottky barrier threshold voltages for various substrate studies. Such analysis not only gives a better understanding of the electrobreakdown of graphene but also can serve as a tool in the future for single-molecule diagnostics.

DC Surface Flashover Characteristics of Polyimide Containing Polyhedral Oligomeric Silsesquioxane (POSS) in the Main Chains under Vacuum

Polyimide, which is widely used to insulate power equipment operating in a vacuum environment, is prone to insulation failure due to surface flashover. Using POSS to modify it is an effective solution. This paper focuses on the study of DC surface flashover characteristics in vacuum of POSS/polyimide composite film, by introducing 1%, 3%, 5% equivalent mole content of POSS into polyimide, and conducting a surface flashover characteristics test in vacuum together with pure polyimide. The physical and chemical properties of the composite films were tested utilizing Fourier transform infrared spectroscopy and ultraviolet–visible spectroscopy. Combined with resistivity, SEM, and other test techniques, the influence mechanism of POSS molecular modification on DC surface flashover characteristics of polyimide films in vacuum was initially revealed. The results showed that after the introduction of POSS, the overall functional group structure of polyimide remained unchanged, the intermolecular charge transfer complexation was inhibited, and the transmittance of the film increased. The thermal conductivity and thermogravimetric temperature of the film are improved to a certain extent, and the mechanical properties are slightly decreased. With the increase of the introduced POSS content, the dielectric strength of the composite film is also enhanced. The surface flashover voltage of the composite film with a POSS content of 5% is 17.5 kV in vacuum, which is 30.5% higher than that of the pure film. Further analysis shows that the introduction of POSS will reduce the resistivity of the composite film, accelerate the dissipation of surface charges, and increase the flashover voltage. In addition, POSS forms a uniformly distributed Si-O-Si cage-like structure through molecular modification. When the surface of the film is damaged, SiOx inorganic flocculent particles are generated, which can not only scatter electrons, but also shallow the depth of trap energy level and accelerate the dissipation rate of surface charge, thus increasing the flashover voltage.

Overview of the MEMS Pirani Sensors

Vacuum equipment has a wide range of applications, and vacuum monitoring in such equipment is necessary in order to meet practical applications. Pirani sensors work by using the effect of air density on the heat conduction of the gas to cause temperature changes in sensitive structures, thus detecting the pressure in the surrounding environment and thus vacuum monitoring. In past decades, MEMS Pirani sensors have received considerable attention and practical applications because of their advances in simple structures, long service life, wide measurement range and high sensitivity. This review systematically summarizes and compares different types of MEMS Pirani sensors. The configuration, material, mechanism, and performance of different types of MEMS Pirani sensors are discussed, including the ones based on thermistors, thermocouples, diodes and surface acoustic wave. Further, the development status of novel Pirani sensors based on functional materials such as nanoporous materials, carbon nanotubes and graphene are investigated, and the possible future development directions for MEMS Pirani sensors are discussed. This review is with the purpose to focus on a generalized knowledge of MEMS Pirani sensors, thus inspiring the investigations on their practical applications.

Development of instant paneer type product from groundnut using microwave dehydration

The present study aimed at the development of a groundnut-based dehydrated paneer type product which could serve as an instant vegan protein source. In the process of preparing groundnut paneer, a ratio of 1:5 of groundnut to water and 2.0% calcium chloride (CaCl₂) solution was used for the preparation of groundnut paneer and the product was evaluated for physicochemical, instrumental color, instrumental textural, and sensory characteristics. The developed paneer cubes (1.5 × 1.5 × 1 cm) were dehydrated using a vacuum-assisted microwave dryer at different microwave powers (200-600 W, 250 mbar vacuum). The minimum bulk density (0.55 g/cc) and maximum rehydration ratio (2.9) were recorded in the sample dehydrated at 600 W. The samples dried at 600 W also showed significantly (p < .05) higher L* values, softer texture and high sensory scores for color, aroma, taste, texture, and overall acceptability after rehydration.

Additional Excision Biopsy in Patients With Atypical Ductal Hyperplasia at Ultrasound-guided Vacuum-assisted Breast Biopsy

BACKGROUND/AIM

We conducted this single-center, retrospective study to identify predictors of upgrading to malignancy and to discuss the necessity of additional excision biopsy in patients who were diagnosed with atypical ductal hyperplasia (ADH) at ultrasound (US)-guided vacuum-assisted breast biopsy (VABB) based on our 18-year, single-center experience.

PATIENTS AND METHODS

The current study was conducted in a total of 12,160 patients who were evaluated at our medical institution during an 18-year period between January of 2003 and December of 2020. We included the patients who were diagnosed with ADH at US-guided VABB using the Mammotome^® (Devicor Medical Products, Inc., Cincinnati, OH, USA). We therefore included a total of 114 patients (n=114) with ADH in the current study.

RESULTS

Of 114 eligible patients, 36 underwent additional excision biopsy and the remaining 78 did not. Of these 36 patients, 15 were found to have an upgrading to malignancy at a rate of upgrading of 41.7%. These include 7 cases (46.6%) of low-grade ductal carcinoma in situ (DCIS), 3 cases (20.0%) of intermediate grade DCIS, 1 case (6.7%) of microinvasive DCIS, 3 cases (20.0%) of multifocal lobular carcinoma in situ, and 1 case (6.7%) of mucinous carcinoma. Finally, only suspicious microcalcification on mammography was a significant predictor of upgrading to malignancy (p=0.023).

CONCLUSION

An additional excision biopsy is recommended to reduce the rate of upgrading to malignancy in patients who were diagnosed with ADH through a US-guided VABB.

Diagnostic assessment of traumatic brain injury by vacuum extraction in newborns: overview on forensic perspectives and proposal of operating procedures

BACKGROUND

Traumatic brain injury (TBI) during birth constitutes one of the most relevant causes of mortality and morbidity in newborns worldwide. Although improvements in obstetrical management and better indications for caesarean section have led to a consistent decrease in the incidence of perinatal mechanical injury, vacuum extraction is still associated with a high complications rate leading to several forensic issues in the evaluation of healthcare professional management.

METHODS

Vacuum-associated lesions may be topographically distinguished as extracranial or intracranial injuries. In order to achieve a correct assessment, diagnostic procedure should include post-mortem computed tomography and magnetic resonance imaging, autopsy examination, brain sampling and histological/immunohistochemical examination.

RESULTS

Post-mortem imaging represents a valid aid to guarantee preliminary evidence and direct subsequent investigations. An appropriate autopsy sampling must include several areas of cortex and underlying white matter; moreover, any visceral hemorrhages or other lesions should be sampled for the histological and immunohistochemical assessment of vitality and timing.

CONCLUSIONS

This study aimed to promote a validated step-by-step procedure to be adopted in order to standardize and to make easier the post-mortem framing and timing of vacuum-associated pediatric brain injuries.

Efficacy and determinants of vacuum bell treatment in preschool children with pectus excavatum

OBJECTIVE

The outcome of vacuum bell (VB) treatment for preschool patients with pectus excavatum (PE) is poorly understood. We aim to investigate the short-term treatment effect of VB with a three-dimensional scanner and assess the clinical and demographic factors that might influence treatment outcomes.

METHODS

We conducted a chart review study to review the records of preschool patients with PE who received VB treatment in a tertiary hospital from January 1, 2021, through January 1, 2022. Demographic data and chest wall deformity assessments were recorded at follow-up, including the anterior chest wall depths and depth ratio (DR). The demographic and clinical factors influencing treatment outcomes were tested using a logistic regression model.

RESULTS

139 patients who accepted vacuum bell treatment were included in the final study analysis, with a mean age of 4.6 years and a BMI of 14.9. Forty-three patients (30.9%) with a depth of less than 3 mm met the termination criteria and showed cosmetic results. The changes in depths (P < 0.001) and DR (P < 0.001) were statistically significant in 55 patients with three or four follow-ups. Multifactor logistic regression analysis showed that initial depth (OR 0.69, 95% CI 0.58-0.84, P < 0.001) and treatment period (OR 1.58, 95% CI 1.23-2.04, P < 0.001) were independent predictors of achieving complete correction.

CONCLUSION

VB is an effective treatment modality in preschool patients in the short-term follow-up, which is influenced by the depth of depression and the duration of treatment. However, further prospective studies are needed to confirm these results.

European guidelines on perinatal care- Peripartum care Episiotomy

OF RECOMMENDATIONS1. Episiotomy should be performed by indication only, and not routinely (Moderate quality evidence +++-; Strong recommendation). Accepted indications for episiotomy are to shorten the second stage of labor when there is suspected fetal hypoxia (Low quality evidence ++-; Weak recommendation); to prevent obstetric anal sphincter injury in vaginal operative deliveries, or when obstetric sphincter injury occurred in previous deliveries (Moderate quality evidence +++-; Strong recommendation)2. Mediolateral or lateral episiotomy technique should be used (Moderate quality evidence +++-; Strong recommendation). Labor ward staff should be offered regular training in correct episiotomy techniques (Moderate quality evidence +++-; Strong recommendation).3. Pain relief needs to be considered before episiotomy is performed, and epidural analgesia may be insufficient. The perineal skin needs to be tested for pain before an episiotomy is performed, even when an epidural is in place. Local anesthetics or pudendal block need to be considered as isolated or additional pain relief methods (Low quality evidence ++-; Strong recommendation).4. After childbirth the perineum should be carefully inspected, and the anal sphincter palpated to identify possible injury (Moderate quality evidence +++-; Strong recommendation). Primary suturing immediately after childbirth should be offered and a continuous suturing technique should be used when repairing an uncomplicated episiotomy (High quality evidence ++++; Strong recommendation).

Optimizing Tip Diameter in Phacoemulsification of Varying Lens Sizes: An in vitro Study

Purpose

We assessed the effect of two lens cube sizes, three tip sizes, and two ultrasound (US) approaches on phacoemulsification efficiency and chatter.

Methods

After porcine lens nuclei were soaked in formalin, we divided them into cubes measuring 2.0 mm or 3.0 mm. We collected efficiency and chatter data for 30-degree bent 19 G, 20 G, and 21 G tips with a continuous torsional US system; and for straight 19 G, 20 G, and 21 G tips with a micropulse longitudinal US system.

Results

The average time needed for removal was always higher for the 3.0 mm lens cube than for the 2.0 mm lens cube. Statistically significant differences were observed between the 19 G and 21 G tips with micropulse longitudinal US using a 2.0 mm cube and a 3.0 mm cube, and with continuous transversal US using a 2.0 mm lens cube and a 3.0 mm cube. We did not observe significant differences between 19 G and 20 G tips with either cube size in either US system. However, we noted identical trends for both cube sizes with both US approaches; 19 G tips performed better than 20 G and 21 G tips.

Conclusion

Regardless of the lens size, 19 G needles were the most efficient, and had both the fewest outliers and the smallest standard deviations.

Enhanced Non-Contact Grip Force and Swirl Stability by a Combined Venturi-Vortex Air Head

A combination of the venturi module and the vortex cup was proposed to solve vortex instability and to enhance grip capacity. Mounting a venturi suction pad inside the vortex cup improved vacuum generation efficiency. When the vortex cup properly maintained the non-contact air gap and generated an equivalent vacuum to achieve a sealing effect around the open gap of the suction pad, the combined head improved grip capacity and stabilized the non-contact environment. Furthermore, the flow patterns around the venturi chamber and the swirl inside the vortex cup were analyzed based on the design elements of each module. In a module that integrated some of the venturi’s features internally, increased air consumption of the vortex cup was required than that of the venturi. However, it supported a wide range of non-contact grips. The coupled model effectively protected the vacuum suction features of the venturi suction pad in all non-contact environments in that range.

Ultrasound vs routine care before instrumental vaginal delivery: A systematic review and meta-analysis

INTRODUCTION

The objective was to report the role of intrapartum ultrasound examination in affecting maternal and perinatal outcome in women undergoing instrumental vaginal delivery.

MATERIAL AND METHODS

MEDLINE, Embase, CINAHL, Google Scholar and ClinicalTrial.gov databases were searched. Inclusion criteria were randomized controlled trials comparing ultrasound assessment of fetal head position vs routine standard care (digital examination) before instrumental vaginal delivery (either vacuum or forceps). The primary outcome was failed instrumental delivery extraction followed by cesarean section. Secondary outcomes were postpartum hemorrhage, 3rd or 4th degree perineal lacerations, episiotomy, prolonged hospital stay, Apgar score<7 at 5 min, umbilical artery pH <7.0 and base excess greater than -12 mEq, admission to neonatal intensive care unit (NICU), shoulder dystocia, birth trauma, a composite score of adverse maternal and neonatal outcome and incorrect diagnosis of fetal head position. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB-2). The quality of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. Head-to-head meta-analyses using a random-effect model were used to analyze the data and results are reported as relative risk with their 95% confidence intervals.

RESULTS

Five studies were included (1463 women). There was no difference in the maternal, pregnancy or labor characteristics between the two groups. An ultrasound assessment prior to instrumental vaginal delivery did not affect the cesarean section rate compared with standard care (p = 0.805). Likewise, the risk of composite adverse maternal outcome (p = 0.428), perineal lacerations (p = 0.800), postpartum hemorrhage (p = 0.303), shoulder dystocia (p = 0.862) and prolonged stay in hospital (p = 0.059) were not different between the two groups. Composite adverse neonatal outcome was not different between the women undergoing and those not undergoing ultrasound assessment prior to instrumental delivery (p = 0.400). Likewise, there was no increased risk with abnormal Apgar score (p = 0.882), umbilical artery pH < 7.2 (p = 0.713), base excess greater than -12 (p = 0.742), admission to NICU (p = 0.879) or birth trauma (p = 0.968). The risk of having an incorrect diagnosis of fetal head position was lower when ultrasound was performed before instrumental delivery, with a relative risk of 0.16 (95% confidence interval 0.1-0.3; I² :77%, p < 0.001).

CONCLUSIONS

Although ultrasound examination was associated with a lower rate of incorrect diagnoses of fetal head position and station, this did not translate to any improvement of maternal or neonatal outcomes.

Trends in Operative Delivery in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A 5 years' Retrospective Review

Background

Operative vaginal delivery refers to the use of measures to accomplish vaginal delivery through the use of instruments, mainly obstetric forceps and vacuum cups. In developed countries, the rate of cesarean section is increasing for fear of vaginal delivery complications, including instrumental delivery. This study was done to explore trends of operative vaginal deliveries and their characteristics.

Methods

A cross-sectional, facility-based retrospective study was conducted over a period of five years July 1, 2011, to June 30, 2016, using data collected from the labor ward logbook, patient charts. Data were coded, entered, using SPSS version 20 statistical software. Descriptive statistical analysis was used to describe and analyze the data into graphs and tables.

Results

The rates of operative vaginal delivery and cesarean section over the five-year study period were 11.9% and 30.4%, respectively. The trend in the operative vaginal delivery rate declined from 15.8% in July 2011 to 9.9% in June 2016, while it shows a noticeable rise in cesarean section rate 25.4% to 33.8%. The trend in the use of vacuum has shown a sharp decrease from 58% in the 1st year to 10.5% in the fifth year of the study period. There is a rise in the use of forceps from 42% of all operative vaginal delivery in the first year to 89.5% in the fifth year.

Conclusion

This study shows that the rate of operative vaginal delivery has declined. The use of vacuum-assisted delivery has especially decreased compared to that of forceps-assisted delivery.

Resident and program director confidence in resident preparedness for operative vaginal deliveries in Obstetrics and Gynecology Training Programs in the United States

BACKGROUND

Operative vaginal delivery is used to expedite a safe vaginal delivery in the second stage of labor and is considered an essential part of residency training in obstetrics and gynecology.

OBJECTIVE

To assess the self-reported readiness of obstetrics and gynecology residents in the United States to perform vacuum-assisted vaginal delivery and forceps-assisted vaginal delivery compared with the perceptions of program directors.

STUDY DESIGN

The Council on Resident Education in Obstetrics and Gynecology surveyed the residents in all US training programs about their readiness to perform forceps-assisted and vacuum-assisted deliveries. The program directors were simultaneously surveyed about the readiness of their cohort to perform operative deliveries with and without attending oversight. The primary outcome of the survey was the residents' self-reported confidence in their ability to autonomously and independently perform operative deliveries.

RESULTS

Α total of 5084 out of 5514 (92.9%) resident physicians and 241 out of the 292 (83%) residency program directors completed the survey. Eighty-seven percent (95% confidence interval, 84.9-88.9) of the graduating residents reported feeling that they could autonomously perform a vacuum-assisted vaginal delivery, compared with 49.5% (95% confidence interval, 46.6-52.4) for forceps-assisted vaginal delivery (P<.01). Similarly, whereas 95.9% (95% confidence interval, 94.6-97.0) of the residents felt that they could confidently perform an emergency vacuum-assisted vaginal delivery, only 42.3% (95% confidence interval, 39.4-45.2) felt confident performing an emergency forceps-assisted vaginal delivery (P<.01). The residency program directors significantly overestimated their residents' confidence in independently performing an emergency forceps-assisted vaginal delivery or vacuum-assisted vaginal delivery than the residents themselves (54% [95% confidence interval, 47.1-60.5] vs 24% [95% confidence interval, 22.5-24.9] and 98.6% [95% confidence interval, 97.0-100] vs 71.9 [95% confidence interval, 70.6-73.2] respectively P<.01). Trainees in military-based residency programs and those interested in pursuing a career as generalists or maternal-fetal medicine specialists reported significantly higher preparedness to perform a forceps-assisted vaginal delivery.

CONCLUSION

Graduating obstetrics and gynecology residents report feeling less prepared to independently perform a forceps-assisted vaginal delivery than a vacuum-assisted vaginal delivery. The program directors had more confidence in the ability of their residents to perform an operative vaginal delivery than the residents themselves.

Optimization of γ-Aminobutyric Acid (GABA) Accumulation in Germinating Adzuki Beans (Vigna angularis) by Vacuum Treatment and Monosodium Glutamate, and the Molecular Mechanisms

This study aimed to investigate the optimal hypoxic and monosodium glutamate (MSG) stress conditions for the enrichment of γ-Aminobutyric acid (GABA) in germinating adzuki beans and to reveal the potential underlying molecular mechanisms of GABA accumulation. Using single-factor experiments and response surface model, we investigated the effects of germination time, germination temperature, vacuum time, and MSG concentration on GABA contents, and further explored the activity and gene expression of glutamate decarboxylase (GAD) and polyamine oxidase (PAO) critical rate restriction enzymes during GABA synthesis. The optimal soaking temperature, soaking time, and pH conditions were 35°C, 16 h, and 5, respectively. Furthermore, the optimal germination conditions for optimal GABA enrichment were 48 h, 1.99 mg/ml MSG concentration, germination temperature of 31.49°C, and vacuum time of 15.83 h. Under such conditions, the predicted GABA concentration was 443.57 ± 7.18 mg/100 g, with no significant difference between the predicted and experimental data. The vacuum + MSG (FZM) treatment has a maximum contribution rate of GABA to 38.29%, which significantly increase GABA content, and the increase was associated with increased GAD and PAO activity. In addition, MSG in combination with vacuum treatment could significantly induce VaGAD4 and VaGAD6 genes in 2 days germination of adzuki beans. According to the results of the present study, vacuum + MSG treatment is an effective approach to enhancing GABA accumulation in germinating adzuki beans, which could be employed in enhancing the functional quality of germinating adzuki beans.

Investigation on Design Theory and Performance Analysis of Vacuum Capacitive Micromachined Ultrasonic Transducer

The capacitive micromachined ultrasonic transducer (CMUT), as a new acoustic-electric conversion element, has a promising application prospect. In this paper, the structure of the vacuum capacitive micromachined ultrasonic transducer is presented, and its performance-influencing factors are investigated. Firstly, the influencing factors of the performance parameters of the vacuum CMUT are analyzed theoretically based on the circular plate model and flat plate capacitance model, and the design principles of the structural parameters of the CMUT cell are proposed. Then, the finite element simulation software COMSOL Multiphysics is used to construct CMUT cell models with different membrane materials, membrane shapes, membrane radius thicknesses, and cavity heights for simulation verification. The results show that both the membrane parameters and the cavity heights affect the performance parameters of the Vacuum CMUT. In order to improve the efficiency of the CMUT, materials with low bending stiffness should be selected, and the filling factor of the membrane should be increased. In order to achieve high-transmission sound pressure, a smaller radius thickness and a larger cavity height should be selected. To achieve high reception sensitivity, a larger membrane radius thickness and a smaller cavity height should be selected. In order to obtain high fractional bandwidth, a larger membrane radius thickness should be selected. The results of this paper provide a basis for the design of Vacuum CMUT cell structure.

Process characterization and optimization of cold brew coffee: effect of pressure, temperature, time and solvent volume on yield, caffeine and phenol content

BACKGROUND

Cold brew coffee, based on cold extraction, is rapidly attracting consumers' preference worldwide. Low total solids yield and long extraction times (up to 24 h) are the main drawbacks of this process. Five different treatments were investigated: the traditional cold extraction method, freezing, lyophilization of coffee beans, use of chaotropic salt and reduced pressure extraction. The latter was optimized by applying a Box-Behnken design. Pressure, vacuum cycles, duration of each cycle and mass of ground coffee to water ratio were the optimization parameters. Yield, caffeine and phenol concentration were the response variables.

RESULTS

Caffeine concentration and yield were significantly affected by vacuum cycles and by the combination of vacuum cycles and duration of each cycle. Validation of the derived quadratic models for each response variable was performed. Optimum values for highest extraction yield (22%) and phenol concentration as well as mass transfer coefficients of phenol and caffeine were also determined.

CONCLUSIONS

Extraction under reduced pressure might be the best treatment for the acceleration of cold brew coffee extraction. © 2021 Society of Chemical Industry.

The Assessment of Changes in the Fatty Acid Profile and Dietary Indicators Depending on the Storage Conditions of Goose Meat

The deterioration of food quality due to lipid oxidation is a serious problem in the food sector. Oxidation reactions adversely affect the physicochemical properties of food, worsening its quality. Lipid oxidation products are formed during the production, processing, and storage of food products. In the human diet, the sources of lipid oxidation products are all fat-containing products, including goose meat with a high content of polyunsaturated fatty acids. This study aims at comparing the fatty acid profile of goose breast muscle lipids depending on the storage conditions: type of atmosphere, temperature, and storage time. Three-way variance analysis was used to evaluate changes in the fatty acids profile occurring in goose meat. The health aspect of fatty acid oxidation of goose meat is also discussed. In general, the fatty acid composition changed significantly during storage in the meat packed in the high-oxygen modified atmosphere at different temperatures (1 °C and 4 °C). Higher temperature led to a higher degree of lipid oxidation and nutrient loss. During the storage of samples in vacuum, no changes in the fatty acid content and dietary indices were found, regardless of the storage temperature, which indicates that the anaerobic atmosphere ensured the oxidative stability of goose meat during 11 days of refrigerated storage.

Ultrasound vs routine care before instrumental vaginal delivery: A systematic review and meta-analysis

INTRODUCTION

The objective was to report the role of intrapartum ultrasound examination in affecting maternal and perinatal outcome in women undergoing instrumental vaginal delivery.

MATERIAL AND METHODS

MEDLINE, Embase, CINAHL, Google Scholar and ClinicalTrial.gov databases were searched. Inclusion criteria were randomized controlled trials comparing ultrasound assessment of fetal head position vs routine standard care (digital examination) before instrumental vaginal delivery (either vacuum or forceps). The primary outcome was failed instrumental delivery extraction followed by cesarean section. Secondary outcomes were postpartum hemorrhage, 3rd or 4th degree perineal lacerations, episiotomy, prolonged hospital stay, Apgar score<7 at 5 min, umbilical artery pH <7.0 and base excess greater than -12 mEq, admission to neonatal intensive care unit (NICU), shoulder dystocia, birth trauma, a composite score of adverse maternal and neonatal outcome and incorrect diagnosis of fetal head position. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB-2). The quality of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. Head-to-head meta-analyses using a random-effect model were used to analyze the data and results are reported as relative risk with their 95% confidence intervals.

RESULTS

Five studies were included (1463 women). There was no difference in the maternal, pregnancy or labor characteristics between the two groups. An ultrasound assessment prior to instrumental vaginal delivery did not affect the cesarean section rate compared with standard care (p = 0.805). Likewise, the risk of composite adverse maternal outcome (p = 0.428), perineal lacerations (p = 0.800), postpartum hemorrhage (p = 0.303), shoulder dystocia (p = 0.862) and prolonged stay in hospital (p = 0.059) were not different between the two groups. Composite adverse neonatal outcome was not different between the women undergoing and those not undergoing ultrasound assessment prior to instrumental delivery (p = 0.400). Likewise, there was no increased risk with abnormal Apgar score (p = 0.882), umbilical artery pH < 7.2 (p = 0.713), base excess greater than -12 (p = 0.742), admission to NICU (p = 0.879) or birth trauma (p = 0.968). The risk of having an incorrect diagnosis of fetal head position was lower when ultrasound was performed before instrumental delivery, with a relative risk of 0.16 (95% confidence interval 0.1-0.3; I² :77%, p < 0.001).

CONCLUSIONS

Although ultrasound examination was associated with a lower rate of incorrect diagnoses of fetal head position and station, this did not translate to any improvement of maternal or neonatal outcomes.