Therapy-induced senescent cancer cells exhibit complement activation and increased complement regulatory protein expression

Therapy-induced senescence (TIS) is a primary response to chemotherapy, contributing to untoward treatment outcomes such as evasion of immunosurveillance. Despite the established role of the complement system in the immune response to cancer, the role of complement in mediating the immune response against senescent tumor cells remains poorly understood. To explore this relationship, we exposed lung adenocarcinoma (A549), breast adenocarcinoma (MCF7) and pancreatic carcinoma (Panc-1) cell lines to sublethal doses of either etoposide or doxorubicin to trigger TIS. Identification of TIS was based on morphological changes, upregulation of the senescence-associated β-galactosidase, p21Cip1 induction and lamin B1 downregulation. Using immunofluorescence microscopy, quantitative PCR, ELISA of conditioned media and in silico analysis, we investigated complement activation, complement protein expression, C3 levels in the conditioned media of senescent cells and secreted complement proteins as part of the senescence-associated secretory phenotype (SASP), respectively. In cell lines undergoing TIS, complement-related changes included (i) activation of the terminal pathway, evidenced by the deposition of C5b-9 on senescent cells; (ii) an increase in the expression of CD59 and complement factor H and (iii) in A549 cells, an elevation in the expression of C3 with its secretion into the medium. In addition, increased C3 expression was observed in breast cancer samples expressing TIS hallmarks following exposure to neoadjuvant chemotherapy. In conclusion, TIS led to the activation of complement, upregulation of complement regulatory proteins and increased C3 expression. Complement appears to play a role in shaping the cancer microenvironment upon senescence induction.

Cisplatin Provokes Peripheral Nociception and Neuronal Features of Therapy-Induced Senescence and Calcium Dysregulation in Rats

Therapy-Induced Senescence (TIS) is a form of senescence that is typically described in malignant cells in response to the exposure of cancer chemotherapy or radiation but can also be precipitated in non-malignant cells. TIS has been shown to contribute to the development of several cancer therapy-related adverse effects; however, evidence on its role in mediating chemotherapy-induced neurotoxicity, such as Chemotherapy-induced Peripheral Neuropathy (CIPN), is limited. We here show that cisplatin treatment over two cycles (cumulative dose of 23 mg/kg) provoked mechanical allodynia and thermal hyperalgesia in Sprague-Dawley rats. Isolation of dorsal root ganglia (DRG) from the cisplatin-treated rats demonstrated robust SA-β-gal upregulation at both day 8 (after the first cycle) and day 18 (after the second cycle), decreased lmnb1 expression, increased expression of cdkn1a and cdkn2a, and of several factors of the Senescence-associated Secretory Phenotype (SASP) (Il6, Il1b, and mmp9). Moreover, single-cell calcium imaging of cultured DRGs revealed a significant increase in terms of the magnitude of KCl-evoked calcium responses in cisplatin-treated rats compared to vehicle-treated rats. No significant change was observed in terms of the magnitude of capsaicin-evoked calcium responses in cisplatin-treated rats compared to vehicle-treated rats but with decreased area under the curve of the responses in cisplatin-treated rats. Further evidence to support the contribution of TIS to therapy adverse effects is required but should encourage the use of senescence-modulating agents (senotherapeutics) as novel palliative approaches to mitigate chemotherapy-induced neurotoxicity.

NOXA expression is downregulated in human breast cancer undergoing incomplete pathological response and senescence after neoadjuvant chemotherapy

Neoadjuvant chemotherapy (NAC) is a frequently utilized approach to treat locally advanced breast cancer, but, unfortunately, a subset of tumors fails to undergo complete pathological response. Apoptosis and therapy-induced senescence (TIS) are both cell stress mechanisms but their exact role in mediating the pathological response to NAC is not fully elucidated. We investigated the change in expression of PAMIP1, the gene encoding for the pro-apoptotic protein, NOXA, following NAC in two breast cancer gene datasets, and the change in NOXA protein expression in response to NAC in 55 matched patient samples (pre- and post-NAC). PAMIP1 expression significantly declined in post-NAC in the two sets, and in our cohort, 75% of the samples exhibited a downregulation in NOXA post-NAC. Matched samples that showed a decline in NOXA post-NAC were examined for TIS based on a signature of downregulated expression of Lamin-B1 and Ki-67 and increased p16INK4a, and the majority exhibited a decrease in Lamin B1 (66%) and Ki-67 (80%), and increased p16INK4a (49%). Since our cohort consisted of patients that did not develop complete pathological response, such findings have clinical implications on the role of TIS and NOXA downregulation in mediating suboptimal responses to the currently established NAC.

Catalytic pyrolysis of waste polypropylene using low-cost natural catalysts

The objective of this research is to produce oil from the catalytic pyrolysis of waste polypropylene (WPP) using a low-cost natural catalyst. Three natural catalysts were examined, i.e. Kaolin, Hematite, and white sand. Different catalyst-to-plastic ratios were examined, i.e. 1:1, 1:2, 1:4, 1:6, and 1:8. The utilized catalysts were elementally analyzed using the XRF analysis and the surface area was analyzed by the BET multi-point method. The WPP thermal degradation behavior was investigated by the thermogravimetric analysis (TGA), then the generated liquid oil was analyzed using the gas chromatography-mass spectrometry (GC-MS) and the differential scanning calorimetry (DSC). Thermal cracking without a catalyst produced a yield of 70 wt% of liquid oil, and the maximum oil yield in case of using Hematite and white sand as a catalysts were 70 wt% and 68 wt%, respectively. However, the ratio of 1:2 of the Kaolin to the WPP produced the highest oil yield of 80.75 wt%, and the ratio of 1:8 of the white sand to the WPP produced the highest gas yield, i.e. 44 wt%. Using Kaolin in the catalytic pyrolysis of WPP produced oil with the lowest percentage of heavy oils, i.e. 25.98%, and the highest percentage of light oils, which is 25.37%, when compared to other catalysts such as Hematite and white sand. Kaolin has the lowest cost of oil production compared to Hematite and white sand, which is 0.28 $/kg of oil. Kaolin is an economical catalyst that improves the quality, as well as the quantity of the produced oil in comparison to Hematite, white sand and the non-catalytic case.

Biophotonic sensor for swift detection of malignant brain tissues by using nanocomposite YBa2Cu3O7/dielectric material as a 1D defective photonic crystal

In the present research work we have theoretically examined the biosensing capabilities of proposed one dimensional defective photonic crystal for swift detection of malignant brain tissues. The transfer matrix formulation and MATLAB computational tool have been used to examine the transmission properties of proposed structure. The identical buffer layers of nanocomposite superconducting material have been used either side of cavity region to enhance the interaction between incident light and different brain tissue samples poured into the cavity region. All the investigations have been carried out under normal incidence to suppress the experimental liabilities involved. We have investigated the biosensing performance of the proposed design by changing the values of two internal parameters (1) the cavity layer thickness (d₄) and (2) volume fraction (η) of nanocomposite buffer layers one by one to get the optimum biosensing performance from the structure. It has been found that the sensitivity of the proposed design becomes 1.42607 μm/RIU when the cavity region of thickness 15dd is loaded with lymphoma brain tissue. This value of sensitivity can be further increased to 2.66136 μm/RIU with η = 0.8. The findings of this work are very beneficial for designing of various bio-sensing structures composed of nanocomposite materials of diversified biomedical applications.

A three-marker signature identifies senescence in human breast cancer exposed to neoadjuvant chemotherapy

PURPOSE

Despite the beneficial effects of chemotherapy, therapy-induced senescence (TIS) manifests itself as an undesirable byproduct. Preclinical evidence suggests that tumor cells undergoing TIS can re-emerge as more aggressive divergents and contribute to recurrence, and thus, senolytics were proposed as adjuvant treatment to eliminate senescent tumor cells. However, the identification of TIS in clinical samples is essential for the optimal use of senolytics in cancer therapy. In this study, we aimed to detect and quantify TIS using matched breast cancer samples collected pre- and post-exposure to neoadjuvant chemotherapy (NAC).

METHODS

Detection of TIS was based on the change in gene and protein expression levels of three senescence-associated markers (downregulation of Lamin B1 and Ki-67 and upregulation of p16^INK4a).

RESULTS

Our analysis revealed that 23 of 72 (31%) of tumors had a shift in the protein expression of the three markers after exposure to NAC suggestive of TIS. Gene expression sets of two independent NAC-treated breast cancer samples showed consistent changes in the expression levels of LMNB1, MKI67 and CDKN2A.

CONCLUSIONS

Collectively, our study shows a more individualized approach to measure TIS hallmarks in matched breast cancer samples and provides an estimation of the extent of TIS in breast cancer clinically. Results from this work should be complemented with more comprehensive identification approaches of TIS in clinical samples in order to adopt a more careful implementation of senolytics in cancer treatment.

Experimental and computational chemical studies on the corrosion inhibition of new pyrimidinone derivatives for copper in nitric acid

Inhibition of copper corrosion by some pyrimidinone derivatives, namely; (E)-N-(3-((1,3-dimethyl-2,4,6-trioxohexahydropyrimidin-5-yl)diazenyl)-2,5-diethoxyphenyl)benzamide (MA-975) and(E)-6-(4-((4-chlorophenyl)diazenyl)-3-methyl-5-oxo-4,5-dihydro-1H-pyrazol-1-yl)-1,3 dimethylpyrimidine-2,4(1H,3H)-dione (MA-978C) in 1.0 M nitric acid (HNO₃) was studied using weight loss (WL), electrochemical impedance spectroscopy (EIS), and potentiodynamic polarization (PP) measurements. The efficiency of inhibition increases as the concentration of inhibitor increases, and it also increases as the temperature increases. With the addition of the examined inhibitors, significant corrosion protection was obtained, and (MA-975) showed a very promising % IE (89.59%) at 21 × 10⁻⁶ M using the (WL) method. The polarization data revealed that these compounds act as mixed-type compounds and are adsorbed on the copper surface following Langmuir adsorption isotherm forming a protective thin film protecting the metal in the corrosive media. Scanning electron microscopy (SEM) and Energy Dispersive X-ray were used to examine the surface morphology of copper samples. Quantum calculations and Monte Carlo simulation techniques were applied with informative yields and the results matched the experimental findings.

Aptamers Chemistry: Chemical Modifications and Conjugation Strategies

Soon after they were first described in 1990, aptamers were largely recognized as a new class of biological ligands that can rival antibodies in various analytical, diagnostic, and therapeutic applications. Aptamers are short single-stranded RNA or DNA oligonucleotides capable of folding into complex 3D structures, enabling them to bind to a large variety of targets ranging from small ions to an entire organism. Their high binding specificity and affinity make them comparable to antibodies, but they are superior regarding a longer shelf life, simple production and chemical modification, in addition to low toxicity and immunogenicity. In the past three decades, aptamers have been used in a plethora of therapeutics and drug delivery systems that involve innovative delivery mechanisms and carrying various types of drug cargos. However, the successful translation of aptamer research from bench to bedside has been challenged by several limitations that slow down the realization of promising aptamer applications as therapeutics at the clinical level. The main limitations include the susceptibility to degradation by nucleases, fast renal clearance, low thermal stability, and the limited functional group diversity. The solution to overcome such limitations lies in the chemistry of aptamers. The current review will focus on the recent arts of aptamer chemistry that have been evolved to refine the pharmacological properties of aptamers. Moreover, this review will analyze the advantages and disadvantages of such chemical modifications and how they impact the pharmacological properties of aptamers. Finally, this review will summarize the conjugation strategies of aptamers to nanocarriers for developing targeted drug delivery systems.

Mechanically exfoliated In2Se3 as a saturable absorber for mode-locking a thulium-doped fluoride fiber laser operating in S-band

The rise of 2D materials since the discovery of graphene has been exponential. Their mechanical, electrical and optical properties are exceptional, similar to their 3D counterparts. In this paper, an α-In₂Se₃ crystal is mechanically exfoliated and transferred directly onto a fiber ferrule to serve as a saturable absorber (SA). A thulium-doped fluoride fiber is used as a gain medium to generate mode-locked pulses together with the In₂Se₃-based SA. The SA has a modulation depth of 14.6% and a saturation intensity of 0.4  kW/cm². The passively generated mode-locked pulses have a repetition rate of 6.93 MHz and a pulse width of 5.79 ps. The mode-locked pulses also have a signal-to-noise ratio of 65.4 dB and a time-bandwidth product of 0.36. The pulse energy and peak power are 0.179 nJ and 27.2 W, respectively.

Integrated analysis of SNP, CNV and gene expression data in genetic association studies

Integrative approaches that combine multiple forms of data can more accurately capture pathway associations and so provide a comprehensive understanding of the molecular mechanisms that cause complex diseases. Association analyses based on single nucleotide polymorphism (SNP) genotypes, copy number variant (CNV) genotypes, and gene expression profiles are the 3 most common paradigms used for gene set/pathway enrichment analyses. Many work has been done to leverage information from 2 types of data from these 3 paradigms. However, to the best of our knowledge, there is no work done before to integrate the 3 paradigms all together. In this article, we present an integrated analysis that combine SNP, CNV, and gene expression data to generate a single gene list. We present different methods to compare this gene list with the other 3 possible lists that result from the combinations of the following pairs of data: SNP genotype with gene expression, CNV genotype with gene expression, and SNP genotype with CNV genotype. The comparison is done using 3 different cancer datasets and 2 different methods of comparison. Our results show that integrating SNP, CNV, and gene expression data give better association results than integrating any pair of 3 data.

Tunable Q-switched fiber laser using zinc oxide nanoparticles as a saturable absorber

Nanomaterials have ignited new interest due to their distinctive electronic, mechanical, and optical properties. Zinc oxide nanostructures are fabricated into thin film and then inserted between two fiber ferrules to act as a saturable absorber (SA). The modulation depth and insertion loss of the SA are 5% and 3.5 dB, respectively. When the ZnO-SA is incorporated into the laser cavity, a stable Q-switched pulse tunable from 1536 to 1586 nm (50 nm range) with pulse energy up to 46 nJ was observed. Our result suggests that ZnO is a promising broadband SA to generate passively Q-switched fiber lasers.

Passively Q-switched erbium-doped fiber laser at C-band region based on WS₂ saturable absorber

We demonstrate a Q-switched erbium-doped fiber laser using tungsten disulfide (WS₂) as a saturable absorber. The WS₂ is deposited onto fiber ferrules using a drop-casting method. Passive Q-switched pulses operating in the C-band region with a central wavelength of 1560.7 nm are successfully generated by a tunable pulse repetition rate ranging from 27.2 to 84.8 kHz when pump power is increased from 40 to 220 mW. At the same time, the pulse width decreases from a maximum value of 3.84 μs to a minimum value of 1.44 μs. The signal-to-noise ratio gives a stable value of 43.7 dB. The modulation depth and saturation intensity are measured to be 0.99% and 36.2  MW/cm², respectively.

Bacterial and fungal endophthalmitis in upper Egypt: related species and risk factors

OBJECTIVE

To study risk factors, contributing factors of bacterial and fungal endophthalmitis in Upper Egypt, test the isolated species sensitive to some therapeutic agents, and to investigate the air-borne bacteria and fungi in opthalmology operating rooms.

METHODS

Thirty one cases of endophthalmitis were clinically diagnosed and microbiologically studied. Indoor air-borne bacteria and fungi inside four air-conditioned operating rooms in the Ophthalmology Department at Assiut University Hospitals were also investigated. The isolated microbes from endophthalmitis cases were tested for their ability to produce some extracellular enzymes including protease, lipase, urease, phosphatase and catalase. Also the ability of 5 fungal isolates from endophthalmitis origin to produce mycotoxins and their sensitivity to some therapeutic agents were studied.

RESULTS

Results showed that bacteria and fungi were responsihle for infection in 10 and 6 cases of endophthalmitis, respectively and only 2 cases produced a mixture of bacteria and fungi. Trauma was the most prevalent risk factor of endophthalmitis where 58.1% of the 31 cases were due to trauma. In ophthalmology operating rooms, different bacterial and fungal species were isolated. 8 bacterial and 5 fungal isolates showed their ability to produce enzymes while only 3 fungal isolates were able to produce mycotoxins. Terbinafine showed the highest effect against most isolates in vitro.

CONCLUSIONS

The ability of bacterial and fungal isolates to produce extracellular enzymes and mycotoxins may be aid in the invasion and destruction of eye tissues. Microbial contamination of operating rooms with air-borne bacteria and fungi in the present work may be a source of postoperative endophthalmitis.

Mode-locked thulium bismuth codoped fiber laser using graphene saturable absorber in ring cavity: reply

Jung and Lee have made comments [Appl. Opt.53, 553-554 (2014)] on "Mode-locked thulium bismuth codoped fiber laser using Graphene saturable absorber in ring cavity" [Appl. Opt.52, 1226-1229 (2013)]. The answer for the comment is provided in this report.

Mode-locked thulium-bismuth codoped fiber laser using graphene saturable absorber in ring cavity

We demonstrate mode locking of a thulium-bismuth codoped fiber laser (TBFL) operating at 1901.6 nm, using a graphene-based saturable absorber (SA). In this work, a single layer graphene is mechanically exfoliated using the scotch tape method and directly transferred onto the surface of a fiber pigtail to fabricate the SA. The obtained Raman spectrum characteristic indicates that the graphene on the core surface has a single layer. At 1552 nm pump power of 869 mW, the mode-locked TBFL self starts to generate an optical pulse train with a repetition rate of 16.7 MHz and pulse width of 0.37 ps. This is a simple, low-cost, stable, and convenient laser oscillator for applications where eye-safe and low-photon-energy light sources are required, such as sensing and biomedical diagnostics.

In vitro metabolism of an orally active O-methyl amidoxime prodrug for the treatment of CNS trypanosomiasis

A new aza-analogue of furamidine, 6-[5-(4-amidinophenyl)-furan-2-yl]nicotinamidine (DB820), has potent in vitro antitrypanosomal activity; however, it suffers from poor oral activity because of its positively charged amidine groups. The dimethoxyamidine prodrug of DB820, N-methoxy-6-{5-[4-(N-methoxyamidino)phenyl]-furan-2-yl}-nicotinamidine (DB844), has potent oral activity in mouse models of both early-stage and CNS African trypanosomiasis. Metabolism of DB844 in human liver microsomes (HLM) was investigated using liquid chromatography-mass spectrometry (LC-MS/MS). The metabolism of DB844 in HLM was NADPH-dependent and resulted in the production of eight metabolites over a 90?min incubation. O-Demethylation and N-dehydroxylation reactions resulted in the metabolic conversion of DB844 to its active DB820 metabolite. Chromatographic conditions used for LC-MS analysis allowed for the separation and identification of all metabolites including positional isomers. Demethylation of either the phenyl or pyridine side of DB844 (DB844 m/z 366.2) resulted in the production of two metabolites (M1A, M1B), each with a molecular ion of m/z of 352.3 and MS(2) fragments of 288.1, 305.2, 321.2 and 335.2. However, the intensities of the MS(2) fragments were different among the two isomeric metabolites, and comparison to an authentic standard allowed for the structural determination of each metabolite. The isomeric metabolites M2A and M2B, resulting from amidoxime reductions of M1A and M1B, were also chromatographically separated and had distinguishable MS(2) profiles that allowed for their structural assignments when compared to an authentic standard. The di-amidoxime product resulting from O-demethylation of either side of DB844 was also identified as an abundant metabolite during microsomal incubations. The active antitrypanosomal metabolite, DB820, was the last metabolite to be formed and thus provides evidence that DB844 may effectively be metabolized to its active metabolite in vivo.

Synthesis, characterization and antifungal activities of some benzenesulphonylamino acid derivatives

Condensation of benzenesulphonyl chloride (1) with a series of amino acids afforded benzenesulphonylamino acids (2a-d). Esterification of the derivatives (2a-d) in methanol gave the corresponding benzensulphonylamino acid methylesters (3a-d), which condensed with o-aminophenol and o-phenylene diamine to give the benzoxazoles (4a-d) and benximidazoles (5a-d) respectively. Hydrazinolysis of the methyl esters (3a-d) afforded the hydrazide derivatives (6a-d). The 1,2-diazeridine derivatives (7a-d) can be prepared by the reaction of hydrazides (6a-d) with alpha-chloroacetylchloide. Schiff's bases (10a-d) were achieved by the condensation of p-chlorobenzaldehyde with the hydrazides (6a-d). Condensation of Schiff's bases (10a-d) with p-chlorophenyldiazonium chloride afforded the formazan derviatives (11a-d). The hydrazides (6a-d) were reacted with acetylethylacetate to give 3-methyl-2-pyrazoline-2-one derivatives (8a-d), which condensed with p-chlorobenzaldehyde to give 4-arylidino-3-methyl-2-pyrazoline-2-one derivatives (9a-d). All derivatives (2-11) were tested against: A. flavus, A. parasiticus, A. alutaceus and F. moniliforme. Some of the derivatives showed promising results against the tested fungi.

Formalin dab for haemorrhagic radiation proctitis

BACKGROUND

Haemorrhagic radiation proctitis frequently presents as a problem in management. We analysed the technique of formalin dab in its management.

PATIENTS AND METHODS

Twenty patients presenting with haemorrhagic radiation proctitis and treated with formalin dab were prospectively analysed.

RESULTS

Twelve patients ceased to bleed following one session of formnalin dab. Six patients needed more than one session to effect haemostasis. Two of three patients with torrential bleeding failed to respond to formalin dab and required surgical excision of the rectum.

CONCLUSION

Formalin dab is a simple, effective and safe treatment modality in the management of chronic haemorrhagic radiation proctitis, and hence should be considered as the initial treatment modality for such a condition.

Deterioration and spoilage of peanuts and desiccated coconuts from two sub-Saharan tropical East African countries due to the associated mycobiota and their degradative enzymes

A broad variety of fungi (84 species belonging to 36 genera) were identified with more taxa infesting peanut seed samples from two tropical countries (29 genera and 61 species) compared to those found in desiccated coconuts (20 genera and 55 species) on both DRBC and DG18 media. This may be due to the higher moisture levels in peanuts (5.07-7.97%) compared with coconuts (1.5-4.17%). More taxa and propagules were recovered on DG18 in both cases. The dominant fungi from both substrates on both isolation media were Aspergillus and Penicillium, with other fungi from only one substrate/medium. The aflatoxigenic species (A. flavus) dominated Kenyan samples more so than Ugandan samples on both substrates. However only 71.5% and 87.5% of the peanut kernels, on DRBC and DG18, respectively, were found to be infested with fungi. The aflatoxigenic species (A. flavus/parasiticus) were found in 75% of the samples, however only 15.75% and 13% of the kernels analyzed were infested. The most frequently isolated species from peanuts were A. niger followed by A. flavus and M. phaseolina. E. repens, E. amstelodami, E. rubrum and E. chevalieri dominated peanut seeds on DG18, and R. stolonifer, A. parasiticus, F. solani, L. theobromae and P. chrysogenum on DRBC. The mean count of fungal propagules in coconut samples were approximately 0.7 x 10(3) and 0.8 x 10(3) on DRBC and DG18, respectively, with a high proportion of those propagules recorded for the aflatoxigenic species (about 0. 17 x 10(3) and 0.25 x 10(3) colonies/g). The mycobiota of desiccated coconut was dominated by A. niger, A. flavus and P. chrysogenum. Also A. ochraceus, P. waksmanii, Paecilomyces variotii, P. islandicum and R. mucilaginosa were more frequent on DRBC, while, species of Cladosporium. Chrysosporium and Eurotium were more frequent on DG18. Enzyme indices (or the activities) for each specific strain, when determined after 5 and 8 days of incubation, proved to be similar. A recommendation is given. The proteolytic and lipolytic potentialities of the most commonly encountered species from both peanuts and coconuts were studied. The most interesting observation is that most of the positive isolates, in both commodities had high enzymic activity compared to those reported earlier for isolates of the same species. Such capabilities suggest that these commodities are expected to deteriorate, since climatic conditions in tropical areas favour fungal proliferation. Emphasis on the proper harvesting, drying, handling, transportation and/or storage; and also education of the populace, especially those are dealing with these foods, should be taken into consideration by the relevant authorities. The contaminated foods constitute a health hazard for human consumption.

Failed vaginal birth after a cesarean section: how risky is it? I. Maternal morbidity

OBJECTIVE

Our purpose was to determine the maternal risks associated with failed attempt at vaginal birth after cesarean compared with elective repeat cesarean delivery or successful vaginal birth after cesarean.

STUDY DESIGN

From 1989 to 1998 all patients attempting vaginal birth after cesarean and all patients undergoing repeat cesarean deliveries were reviewed. Data were extracted from a computerized obstetric database and from medical charts. The following three groups were defined: women who had successful vaginal birth after cesarean, women who had failed vaginal birth after cesarean, and women who underwent elective repeat cesarean. Criteria for the elective repeat cesarean group included no more than two previous low transverse or vertical incisions, fetus in cephalic or breech presentation, no previous uterine surgery, no active herpes, and adequate pelvis. Predictor variables included age, parity, type and number of previous incisions, reasons for repeat cesarean delivery, gestational age, and infant weight. Outcome variables included uterine rupture or dehiscence, hemorrhage >1000 mL, hemorrhage >2000 mL, need for transfusion, chorioamnionitis, endometritis, and length of hospital stay. The Student t test and the chi(2) test were used to compare categoric variables and means; maternal complications and factors associated with successful vaginal birth after cesarean were analyzed with multivariate logistic regression, allowing odds ratios, adjusted odds ratios, 95% confidence intervals, and P values to be calculated.

RESULTS

A total of 29,255 patients were delivered during the study period, with 2450 having previously had cesarean delivery. Repeat cesarean deliveries were performed in 1461 women (5.0%), and 989 successful vaginal births after cesarean delivery occurred (3.4%). Charts were reviewed for 97.6% of all women who underwent repeat cesarean delivery and for 93% of all women who had vaginal birth after cesarean. Vaginal birth after cesarean was attempted by 1344 patients or 75% of all appropriate candidates. Vaginal birth after cesarean was successful in 921 women (69%) and unsuccessful in 424 women. Four hundred fifty-one patients undergoing cesarean delivery were deemed appropriate for vaginal birth after cesarean. Multiple gestations were excluded from analysis. Final groups included 431 repeat cesarean deliveries and 1324 attempted vaginal births after cesarean; in the latter group 908 were successful and 416 failed. The overall rate of uterine disruption was 1.1% of all women attempting labor; the rate of true rupture was 0.8%; and the rate of hysterectomy was 0.5%. Blood loss was lower (odds ratio, 0.5%; 95% confidence interval, 0.3-0.9) and chorioamnionitis was higher (odds ratio, 3.8%; 95% confidence interval, 2.3-6.4) in women who attempted vaginal births after cesarean. Compared with women who had successful vaginal births after cesarean, women who experienced failed vaginal births after cesarean had a rate of uterine rupture that was 8.9% (95% confidence interval, 1.9-42) higher, a rate of transfusion that was 3.9% (95% confidence interval, 1.1-13.3) higher, a rate of chorioamnionitis that was 1.5% (95% confidence interval, 1.1-2.1) higher, and a rate of endometritis that was 6.4% (95% confidence interval, 4.1-9.8) higher.

CONCLUSION

Patients who experience failed vaginal birth after cesarean have higher risks of uterine disruption and infectious morbidity compared with patients who have successful vaginal birth after cesarean or elective repeat cesarean delivery. Because actual numbers of morbid events are small, caution should be exercised in interpreting results and counseling patients. More accurate prediction for safe, successful vaginal birth after cesarean delivery is needed.

Preliminary surveys of outdoor and indoor aeromycobiota in Uganda

This investigation was conducted during the period of March through June 1998 to trap, enumerate and identify the different airborne fungi in a variety of microhabitats of outdoor and indoor environments in different localities of Uganda. The settle plate method was used and Czapek-Dox agar was the isolation medium. A total of 47 genera and 61 species in addition to some other unidentified airborne fungi were trapped from all exposures at outdoor (39 genera and 52 species) and indoor (35 and 49) environments. The total fungal catches of outdoor airspora obtained from all exposures (and even in most individual exposures) were more than twice (5222 colonies) of that of the indoor ones (4361) when the exposure periods are taken into consideration. It is worth mentioning that the most highly polluted sites were either parks, forests or river banks for outdoor exposures, or teaching laboratory, library, laterines or bathrooms for indoor exposures. The most prevalent fungi from both outdoor and indoor microhabitats being species of Mycosphaerella, Yeasts, Penicillium, Fusarium, Aspergillus, Cochliobolus and Alternaria. However, several others were trapped frequently from either outdoor or indoor environments. On the other hand, several others were trapped only, but not frequently (in low or rare instances) from either outdoor or indoor microhabitats. The implications of these airborne spores are also discussed.

Evaluation of the mycological status of luncheon meat with special reference to aflatoxigenic moulds and aflatoxin residues

The luncheon meat samples analyzed, which were produced locally by the two main luncheon meat producing companies in Egypt were relatively highly contaminated either by moulds and yeasts in general, aflatoxigenic species and aflatoxin residues in particular. The most frequently encountered fungi from the samples were yeasts, Aspergillus niger, A. flavus, Penicillium chrysogenum, Rhizopus stolonifer, Mucor circinelloides. Less common were Cladosporium sphaerospermum, Alternaria alternata, Mycosphaerella tassiana, P. aurantiogriseum and P. oxalicum. The most important aflatoxigenic species, A. flavus, was isolated frequently. It was 10% of the total fungal isolates from both samples of the two companies. Seven luncheon meat samples out of 50 analyzed were positive for aflatoxin B1 or B1 and G1, while all samples were negative for aflatoxins B2, G2, M1 and M2. Aflatoxin B1 was detected only in 4 and 3 samples out of 25 analyzed from each of company A and B, respectively. The highest detectable level, 11.1 ppb, was recorded in a sample from company B and the least, 0.5 ppb, in a sample from company A. Aflatoxin G1, at concentration of 3.2 ppb, was detected in only one sample of the aflatoxin B1--contaminated 3 samples of company B: this sample also had the highest level of aflatoxin B1. Some luncheon meat samples had higher numbers of aflatoxigenic A. flavus than others, however these samples were negative for aflatoxins. The hazardous potential of such contamination will be discussed.

The use of colchicine in treatment of experimental toxoplasmosis

Colchicine was given in 2 doses (3 and 15 micrograms/mouse) at the time of infection or 48 hours late. It proved effective in both doses, but better results were obtained with early treatment. The mortality rates were 30% & 30%, and Toxoplasma carriers among the surviving mice was 28.6% and 42.9% with high and low doses respectively. When the treatment was given 48 hours after infection, the mortality rates were 50% and 60%, Toxoplasma carriers were 40% and 50% with high and low doses respectively.

Comparison of vaginal and cesarean section delivery for fetuses in breech presentation

OBJECTIVES

Our purpose was to evaluate the perinatal mortality and morbidity of deliveries with fetuses presenting by the breech comparing outcomes of two groups according to mode of delivery: vaginal and cesarean section.

RESULTS

Of 756 fetuses studied, 271 were delivered vaginally and 485 by cesarean section. In infants weighing > or = 1500 grams, "further corrected" mortality and morbidity rates were low and similar for both delivery routes: one neonatal death (NNM) in each. Among very low birth weight (VLBW) infants (< 1500 grams) the "further corrected" mortality rate was higher in the vaginal group: 57.4%, and 18.0% in abdominal deliveries (odds ratio [OR] = 6.1, 95% CI: 3.1 to 12.1). Likewise, rate of depression at five minutes were higher in the vaginal group (p < 0.001). However, the average fetal weight among the vaginal deliveries VLBW (787 grams) was 250 grams less than in the cesarean section group (1040 grams). After adjustment for fetal weight, gestational age, and other prognostic variables the odds ratio for neonatal death was no longer statistically significant (adjusted OR = 2.1, 95% CI: 0.9 to 5.2, p = 0.105). Comparison of planned vaginal delivery with elective cesarean section yielded smaller differences (adjusted OR for neonatal death = 1.3, 95% CI: 0.6 to 2.9, p = 0.525).

CONCLUSION

The poor perinatal outcomes of breech delivered infants are due primarily to VLBW, congenital malformations, and premature labor. Although abdominal delivery had a lower NNM rate than vaginal delivery, the difference was not significant after adjustment for confounding factors. The results confirm the findings of a previously analyzed similar series delivered at our institution between 1980 and 1987. They suggest that, with appropriate technique, abdominal delivery is not mandatory in breech presentation.

Microbial populations, ammonification and nitrification in soil treated with urea and inorganic salts

Soil fertilization with urea at rates of 0.2 and 0.5 mg N/g soil was toxic for total counts of bacteria and fungi except with cellulolytic fungi where growth was promoted by addition of urea after 90-d incubation. Also, the population numbers of both bacteria and fungi were significantly decreased when soil was amended with CaCl2 and K2SO4 applied at two levels (50 and 100 mumol/g soil). Some alleviation of the toxic effect of either urea or the inorganic salts was observed when they were applied in combination. Fungal species composition was found to be affected in the treated soil. The most tolerant fungi were Alternaria alternata, Aspergillus flavus, A. fumigatus, A. niger, A. terreus, Eurotium amstelodami, E. chevalieri, Nectria haematococca, Paecilomyces variotii and Stachybotrys chartarum. Other species of fungi were either sensitive to all treatments or sensitive to some and tolerant to others. Ammonium nitrogen was found to be more accumulated in soil treated with urea mixed with inorganic salts compared with soil treated only with urea whereas NO3(-)-N (and NO2(-)-N) was decreased. The overall effect of the addition of inorganic salts on total mineralized nitrogen, however was promotive. Soil pH was increased in urea-treated soil but was depressed by application of CaCl2 or K2SO4 to values lower than that of untreated soil. The results may be of agronomical interest in overcoming problems encountered with urea application as N fertilizer.

Massive bleeding from colonic diverticular disease with NSAID use

Non-steriodal anti-inflammatory drugs (NSAID) are not only associated with bleeding in the stomach and duodenum, but can also complicate pre-existing diverticular disease of the colon. Here, a 58 year-old male with severe per rectal bleeding is presented and the role of NSAID as a causative factor of his problem is discussed.

Spectroscopic studies of 9-hydroxyellipticine binding to DNA

The binding of 9-hydroxyellipticine to calf thymus DNA, poly[d(A-T)]2, and poly[d(G-C)]2 has been studied in detail by means of CD, linear dichroism, resonance light scattering, and molecular dynamics. The transition moment polarizations of 9-hydroxyellipticine were determined in polyvinyl alcohol stretched film. Spectroscopic solution studies of the DNA/drug complex are combined with theoretical CD calculations using the final 50 ps of a series of molecular dynamics simulations as input. The spectroscopic data shows 9-hydroxyellipticine to adopt two main binding modes, one intercalative and the other a stacked binding mode involving the formation of drug oligomers in the DNA major groove. Analysis of the intercalated binding mode in poly[d(A-T)]2 suggests the 9-hydroxyellipticine hydroxyl group lies in the minor groove and hydrogen bonds to water with the pyridine ring protruding into the major groove. The stacked binding mode was examined using resonance light scattering and it was concluded that the drug was forming small oligomer stacks rather than extended aggregates. Reduced linear dichroism measurements suggested a binding geometry that precluded a minor groove binding mode where the plane of the drug makes a 45 degrees angle with the plane of the bases. Thus it was concluded that the drug stacks in the major groove. No obvious differences in the mode of binding of 9-hydroxyellipticine were observed between different DNA sequences; however, the stacked binding mode appeared to be more favorable for calf thymus DNA and poly[d(G-C)]2 than for poly[d(A-T)]2, an observation that could be explained by the slightly greater steric hindrance of the poly[d(A-T)]2 major groove. A strong concentration dependence was observed for the two binding modes where intercalation is favored at very low drug load, with stacking interactions becoming more prominent as the drug concentration is increased. Even at DNA: drug mixing ratios of 70:1 the stacked binding mode was still important for GC-rich DNAs.

1,3-Dimethylpyrimidoheterocycles as antibacterial agents

1,3-Dimethylbarbituric acid was used as a versatile precursor for the preparation of annelated pyranopyrimidines 2 and 3a-c besides pyrrolopyrimidine 12. The isolated pyrazolopyrimidines 8a-c and 10 and fused pyrazolopyrimidines 14a-d were also synthesized. In addition the new obtained pyrimidoheterocycles were subjected to bacterial testings.

Based on biochemical and physiological behavior, where is Aspergillus egyptiacus better placed?

Physiological and biochemical properties were tested in 45 isolates of Aspergillus egyptiacus (16 isolates), Emericella nidulans (16) and Aspergillus versicolor (13). The three fungal species exhibited common and similar features. The big similarity between A. egyptiacus and E. nidulans was greater than between A. egyptiacus and A. versicolor. It included the inability to produce base either from sodium citrate or lactic acid media, growth at 45 degrees C (thermophilicity), and production of very similar pigmentations on Aspergillus flavus and parasiticus agar. A. egyptiacus is therefore better placed in the Aspergillus nidulans-Emericella assemblage.

CA-125 in peritoneal fluid from patients with nonmalignant gynecologic disorders

To assess the diagnostic value of measuring CA-125 levels in peritoneal fluid from women with nonmalignant gynecologic disorders, we determined CA-125 levels in peritoneal fluid and in serum collected simultaneously from 46 women undergoing gynecologic surgery. Patients with benign ovarian disease, non-ovarian gynecologic pathology and severe endometriosis had, on average, higher CA-125 levels in peritoneal fluid than did patients with a normal pelvis and those with mild endometriosis. There was no obvious correlation between peritoneal fluid and serum levels of CA-125. Our data show that (1) measurement of serum CA-125 levels is not useful for distinguishing between different benign gynecologic disorders, and (2) levels of CA-125 in peritoneal fluid in benign gynecologic disorders are comparable to the reported lower range of levels observed in women with intraperitoneal malignancies.

Mycoflora inhabiting water closet environments

Sixty-six fungal species in addition to two species varieties belonging to 31 genera were isolated during the current study from water closet (WC) sewage samples (39 species and two varieties in 20 genera) and WC air (53 species and two varieties in 25 genera). There were more fungi in the WC air than in sewage. The most prevalent fungi in WC sewage and air were members of the genera Aspergillus, Cladosporium and Penicillium. Acremonium, Alternaria, Emericella, Mycosphaerella and Pleospora were dominant only in WC air. Some species of these genera are considered to be true or opportunistic pathogens. The pollution level due to the bacterial flora either in the air or in the sewage of WCs was relatively higher than that of the fungal flora. Testing the capability to produce urease, nearly all fungal isolates (65 out of 67) and bacteria tested (35 out of 36) proved to be good urease producers.

Significance of positive cervical cultures for Chlamydia trachomatis in patients with preterm premature rupture of membranes

We tested the hypothesis that in patients with preterm premature rupture of membranes the presence of Chlamydia trachomatis in the cervix shortens the latent period (time from rupture of membranes to delivery) and increases the incidence of chorioamnionitis and early endometritis. A total of 178 conservatively managed patients with PROM between 22 and 35 weeks' gestation had cervical cultures for chlamydia, group B Streptococcus (GBS) and Neisseria gonorrhoeae performed at the time of rupture. Patients with GBS and gonorrhea were treated at the time the culture results were available and excluded from analysis. The remaining patients were divided into group 1: 26 patients (14.6%) positive for only chlamydia (and not treated until discharge from the hospital); group 2: 120 patients (67.4%) negative for all three organisms. The two groups did not differ in cesarean rate, duration of conservative management, hospital stay, or birthweight. Furthermore, the rates of chorioamnionitis (30.8% group 1; 38.3% group 2) or early endometritis (11.5% group 1; 20.8% group 2) were similar. We conclude that in patients with preterm premature rupture of membranes, the presence of chlamydia in the cervix appears to neither decrease the latent period nor increase the incidence of chorioamnionitis and early endometritis.

Use of the drop volume of amniotic fluid in predicting fetal lung maturity. Clinical experience

Respiratory distress syndrome (RDS), resulting from inadequate amounts of alveolar surfactant, is a leading cause of neonatal mortality. This study analyzed the drop volume for predicting the risk of neonatal RDS by evaluating the surface tension of amniotic fluid. The drop-volume method quantifies the surface tension of amniotic fluid using the fact that the volume of a falling drop of liquid is proportional to the quantity of surface-active substances (surfactant) in the solution. Distilled water is used as a reference solution. The test is simple to perform and requires only two minutes and 2 mL of amniotic fluid. Amniotic fluid was obtained by amniocentesis from 120 pregnancies, ranging from 24 to 42 weeks of gestation, within four days of delivery. Specimens contaminated with meconium or hemolyzed blood or from patients with clinical chorioamnionitis were not used. The lecithin:sphingomyelin ratio and phosphatidylglycerol tests were also determined for 54 of the study cases. A mature drop-volume test result was associated with a healthy infant with no RDS 95% of the time (negative predictive value). Fifty-two percent of the healthy infants in the study were predicted by an arbitrary unit of time (S) value of less than or equal to 85.0 (specificity). Thirteen of the 16 infants who developed RDS (81%) were predicted by an S value of greater than or equal to 85.1 (sensitivity). Of those infants with an S value of greater than or equal to 85.1, 21% developed RDS (positive predictive value).

The effect of filtration of amniotic fluid on the growth of Chlamydia trachomatis and Escherichia coli

There is increasing concern about Chlamydia trachomatis infection during pregnancy, because of reports of increased maternal, fetal, and neonatal risks. Amniotic fluid is known to possess antibacterial activity and has recently been shown to inhibit formation of chlamydial inclusions in McCoy cell culture. To further characterize the anti-chlamydial factor, we investigated the effect of filtering the fluid (0.45 microns pores) prior to incubation. Amniotic fluid was obtained from 12 women at term gestation, either by amniocentesis, or at cesarean section, Chlamydial inclusion formation was studied in McCoy cell cultures, and Escherichia coli growth was studied by a plate-count method. Filtered amniotic fluid had significantly less inhibitory activity against chlamydial inclusion formation than nonfiltered fluid did. Both filtered and nonfiltered amniotic fluid were equally effective in inhibiting E. coli colony growth. These data suggest that the chlamydial inhibitor in amniotic fluid does not pass through 0.45 microns pores and is larger than the bacterial inhibitor that was reported to be a peptide of low molecular weight.

Keratinophilic and other fungi isolated from combine harvester wheat and sorghum dusts and from the atmosphere of winnow sites in Egypt

Three methods were used for the isolation of fungi in the present investigation: the dilution-plate method, hair-baiting technique with horse hairs and the "exposed plate" method. Sabouraud's glucose agar at 28 degrees C was also used as isolation medium. 102 species and 2 species varieties belonging to 36 genera were collected from combine harvester wheat and sorghum dusts and from the atmosphere of hay or winnow sites. Chrysosporium was represented by 6 species: C. asperatum, C. indicum, C. keratinophilum, C. merdarium, C. pannorum and C. tropicum. Several filamentous fungi tolerating high levels of cycloheximide and other moulds were frequently encountered in the two types of dusts and in the two atmospheres, such as members of Acremonium, Alternaria, Aspergillus, Cladosporium, Emericella, Eupenicillium, Fusarium, Paecilomyces, Penicillium, Piedraia, Rhizopus, Scopulariopsis and others.

Cardiac echinococcosis: the diagnostic value of computed tomography scanning

The diagnosis of cardiac hydatid disease is a difficult one. Conventional and specific cardiac investigations are not pathognomonic of this disease. In this report, the diagnostic value of computed tomography (CT) scanning was prospectively investigated in seven patients. In five patients, the diagnosis was confirmed surgically. The CT-information obtained correlated accurately to the operative findings. In all the patients, CT-densities of the lesions were measured and were found to coincide with values of mean CT-densities of hydatid cysts elsewhere in the body. The capability of measuring tissue densities is unique to CT-scanning and have been emphasized in this report.

Selective effect of cefoxitin prophylaxis on post-cesarean-section microbial flora

A double-blind study was done to test the efficacy of cefoxitin in the prevention of post-cesarean-section infection. The antibiotic was given in three 2-g doses; the initial dose was given immediately after the cord was clamped, and subsequent doses were given four and eight hours later. Cefoxitin prophylaxis significantly reduced morbidity serious enough to require therapeutic antibiotics or to prolong the hospital stay and led to an overall reduction in the anaerobic microbial flora of the endocervix. However, the antibiotic was selective for the overgrowth of enterococci, which were present in nearly half the postoperative cultures of patients who had received the drug. Enterococcal sepsis occurred in one patient, and three other patients had significant bacteriuria and/or urinary tract infections from enterococci. No cefoxitin-resistant strains of Enterobacteriaceae, among species normally sensitive to the drug, were isolated from the stool samples after prophylaxis. The risk of enterococcal colonization and superinfection must be weighted against the benefits of reduction of the infection risk when deciding upon routine antibiotic prophylaxis for cesarean section.

Unique anomalies in cephalothoracopagus janiceps conjoined twins with implications for multiple mechanisms in the abnormal embryogenesis

The anatomic features of female conjoined twins with the Janiceps type of cephalothoracopagus are described. Abnormalities included bilateral clefts of the alveolar arches, shared rudimentary mandible, high, arched clavicles, multiple rib deformities, single shared foregut and small intestine, absent large intestines, omphalocele, multicystic kidneys, hypoplastic lungs, interconnected aortas and neck vessels, single ovary with elongated uterus in each twin, displaced labia, abnormal segmentation of the vertebrae, spinal dysraphism, diastasis of the symphysis pubis, malrotated lower extremity, bilateral posterior dislocation of the hips, and club feet. There were two hearts with internal anomalies. Both spinal cords had a myelocele in the lumbar region. The abnormalities noted in previous reports of conjoined twins of this type are reviewed and compared. We propose that factors associated with conjoining, dysgenetic (developmental) defects, and deformations resulting from crowding in utero all may have been important in the abnormal development in this case.

Fungal flora associated with combine harvester wheat and sorghum dusts from Egypt

107 species and 8 species varieties belonging to 44 genera were collected from combine harvester wheat and sorghum dusts (35 genera and 91 species + 4 varieties) and from the atmosphere of their hay sites (26 genera and 69 species + 4 varieties) on glucose- and cellulose-Czapek's Dox agar at 28 degrees C and 45 degrees C. The mycoflora of wheat and sorghum dusts were basically similar on the two types of media and the most common fungi were: Alternaria alternata, Aspergillus flavus, A. fumigatus, A. niger, A. ochraceus, A. sydowii, A. terreus, Cochliobolus spicifer, Emericella nidulans, Fusarium moniliforme, Penicillium chrysogenum, P. duclauxii, P. funiculosum and P. oxalicum. Truly thermophilic species were frequently encountered from the two substrates: Chaetomium thermophilum, Humicola grisea var. thermoidae, H. insolens, Malbranchea pulchella var., sulphurea, Rhizomucor pusillus, Sporotrichum thermophilum, Talaromyces thermophilus, Thermoascus thermophilus and Thermomyces lanuginosus. The airborne fungi in the two atmospheres were basically similar and the most prevalent species were members of Alternaria (1 species), Aspergillus (18 species + 2 varieties), Chaetomium (2 species), Cochliobolus(3 species), Emericella (3 species + 2 varieties), Fusarium (3 species), Mucor (1 species), Penicillium (14 species) and Stachybotrys (1 species).

Fetal urinary tract obstruction and trisomy 18 mosaicism. A case report

Routine ultrasound examination has led increasingly to antepartum detection of fetal anomalies. Management decisions remain difficult, however, because information on the presence of other anomalies is frequently unobtainable. A case of fetal urinary tract obstruction, although apparently an isolated defect, proved to be associated with a lethal chromosome abnormality, trisomy 18 mosaicism.

A comparison of cefonicid and cefoxitin for preventing infections after vaginal hysterectomy

One hundred women who underwent vaginal hysterectomy were randomly and prospectively divided into two study groups, one to receive a single, 1-g preoperative dose of cefonicid and the other to receive 2 g of cefoxitin preoperatively and postoperatively for a total of four doses. There were no differences between the two groups in the rates of febrile morbidity, urinary tract infection, serious infection, noninfectious morbidity or duration of hospitalization. Both cefonicid and cefoxitin were equally effective in preventing postoperative infectious morbidity and demonstrated little difference in side effects. The single-dose regimen of cefonicid provides the advantages of decreased cost and prolonged therapeutic tissue levels when compared to cefoxitin. Perioperative antimicrobial prophylaxis with this single-dose cephalosporin provides a cost-effective regimen that is both safe and prophylactically effective.

N-nitrosoephedrine and N-nitrosopseudoephedrine: their dissolution, absorption, blood clearance and elimination studies

Dissolution and absorption rates (in vitro); clearance from blood and elimination rates of N-nitrosoephedrine (NEP) and N-nitrosopseudophedrine (NPEP) in mice were determined. The two isomers obeyed first-order kinetics and from the slope of the regression line, the rate constant for each study was obtained. These constants were 0.023, 0.038 min-1 (dissolution); 0.192, 0.225 h-1 (stomach absorption); 2.898, 1.980 h-1 (intestinal absorption); 0.33, 0.55 h-1 (blood clearance) and 0.373, 0.393 h-1 (elimination from whole animal) of NEP and NPEP, respectively, and were tested by Student's t-test. Significant differences in the dissolution, absorption and blood clearance rates of NPEP from those of NEP have been observed (P less than 0.05-0.01). These differences are expected to exert their influence on the metabolic rates and the carcinogenic and/or spectral properties of NEP and NPEP, in a related pattern.

Use of C-reactive protein to predict the outcome of medical management of tuboovarian abscesses

Medical management of tuboovarian abscesses (TOAs) has been shown to be successful. However, the ability to predict which patients with TOA would respond to antibiotic therapy could shorten the hospital stay and decrease treatment costs. C-reactive protein (CRP), an acute-phase-reactant protein with a short half-life, was investigated as a possible predictor of response by TOA patients to medical therapy. Twenty-two patients with TOAs were admitted prospectively into this study, which included daily quantitative determinations of CRP. The patients had either resolution of the mass and symptoms (responders), increased evidence of systemic sepsis and acute peritonitis requiring surgery (failures) or continuation of the tender adnexal mass without evidence of peritoneal irritation (persisters). Twelve patients classified as responders showed a continued daily decrease in quantitative CRP levels of at least 20% per day below the previous day's value until the return to normal levels. The five failures showed a progressive rise in CRP levels as well as evidence of systemic sepsis. Persisters showed an initial decrease in the CRP level followed by a leveling off of the value to a decrease of less than 20% per day. The rate at which daily CRP determinations decline may be a useful predictor of the response to antibiotic therapy.

Surgical approaches to pelvic infections in women

Pelvic abscess is a complication of gynecologic disease or obstetric surgery. Tuboovarian complex is differentiated from abscesses because of the absence of a true abscess wall; treatment of a tuboovarian complex is conservative. The diagnosis of tuboovarian complex is made by history, pelvic examination and ultrasonography. Tuboovarian abscesses (TOAs) are sequelae of surgical procedures. Both conventional and novel surgical techniques can be used to manage them. Pelvic thrombophlebitis and ovarian vein thrombosis are late complications of pelvic infections that may be associated with significant morbidity and mortality.

Role of Chlamydia trachomatis in postpartum endometritis

To investigate the role of Chlamydia trachomatis in puerperal endometritis, 72 patients with endometritis following vaginal or cesarean section delivery were studied. Blood, urine and endometrial cultures for aerobic and anaerobic bacteria and for C trachomatis were performed for all patients. C trachomatis was isolated in 25% of patients with endometritis. Patients with post-vaginal-delivery endometritis and a positive C trachomatis culture had a later onset of infection as well as a favorable clinical response to treatment despite persistence of C trachomatis in their endometrial cultures at the end of therapy. Cephalosporins failed to eradicate C trachomatis from endometrial cultures after five days of intravenous therapy.

Ureteral stent placement for recurrent hydronephrosis in pregnancy. A case report

Conservative management of recurrent hydronephrosis in pregnancy is an alternative to surgical intervention and placement of a ureteral stent during the second trimester.

On the local optimality of the fuzzy isodata clustering algorithm

The convergence of the fuzzy ISODATA clustering algorithm was proved by Bezdek [3]. Two sets of conditions were derived and it was conjectured that they are necessary and sufficient for a local minimum point. In this paper, we address this conjecture and explore the properties of the underlying optimization problem. The notions of reduced objective function and improving and feasible directions are used to examine this conjecture. Finally, based on the derived properties of the problem, a new stopping criterion for the fuzzy ISODATA algorithm is proposed.